Wednesday, November 9, 2011

Smoking for Nurses

Ok, so being a nurse, let me first say that I know better. I really do. However, for the last 11 years, I've been a pack a day smoker.

It's been pretty easy to keep it up: at first I had nursing school as an excuse. I told myself that I'll quit right after nursing school. However, right after that I was dealing with my divorce. I'll quit right after my divorce. Now it's a paternity/custody battle with my son. I'll quit right after that. Also, my job is really stressful at times; I'll just smoke when I'm stressed out. I once had a COPD patient go into respiratory distress, desat to about 68%, get put on a full-rebreather, and sent to the ER; the entire incident stressed me out so much I had to take a break and go burn one. Oh, the irony of that situation is epic.

I definitely recognize this behavior as self-justification. For God's sake, I learned about it psychiatric nursing. Anyhow, since no time will be a good time to quit I decided to just dive right in.

Having several failed attempts with patches and gum, I decided to go with a medication. First of all, let me state that I personally am very skeptical about medications and their long term effects on the body, so it has to be a pretty extreme circumstance for me to consider medication for anything. Especially if the medication works on the brain.

My reasons for quitting are pretty much "DUH!" at this point, but I think the real kicker that got me moving is that I'm sick of hacking up copious phlegm every morning and I really noticed that I've been getting winded easily when I exercise.

I decided on Chantix because it seems to have a general consensus (among websites like WebMD; I refuse to pay $30 for the actual research) to have a higher success rate than Zyban. I liked the more attractive pricing of the Zyban, as well as the antidepressive properties (after all, it is just rebranded Wellbutrin). However, I decided to go for broke and get the newer, supposedly more effective drug (ignoring the research that links depression and suicide to its use). So far, I'm about a week in, so I can still smoke.

My experiences thus far has been pretty positive. I've had no disturbances in sleep and I don't believe that I'm feeling any more depressed than normal. Sure being in the middle of a court case, apartment hunting, and having bill collectors call 24/7 for debts from my marriage that my ex has no intention of paying makes you feel pretty rundown, but I don't believe anymore so than normal. I'm certainly not thinking of offing myself either, so worries there either. (By the way... not me in the photo!)

One thing I've noticed is that I don't have the urge to smoke as much. At the end of my first week, which would be tonight, I've noticed about a 75% reduction in the amount of cigarettes I'm smoking. Sometimes I just forget to, even though I can. I'm smoking about 5 a day instead of the normal 20. When I smoke, it doesn't have the same appeal that it used to. The way the action of the medication works is that it supposedly inhabits the receptor cells in the brain that nicotine used to. I immediately think to compare it to narcotics and narcan. It seems to be doing a decent job so far.

We'll see tomorrow when I go smoke-free. Fingers crossed!

Tuesday, November 8, 2011

Angry Nurses

Okay, so I got screamed  at by an incoming nurse during report. I decided to write a little post about this, and maybe I can get some feedback.

First of all, you probably want to know what major offense caused this particular nurse to go ape-shit, banshee-screaming wild on me. In a nutshell, I forgot to put multi-podus boots (MPB) on someone. Normally, I agree that this is a big deal, however, as explained to her, due to the fact that this particular patient's skin issues were known to me, I repositioned this patient hourly, making sure heels were floated on the pillow each time. Skin issues were abundant. This patient had at least 5-6 pressure ulcers, poor nutrition, tube feeder, wound vac, foley, spongy heels... just the works.

As a sidebar, I don't feel this patient is appropriate for a rehabilitation hospital such as ours; our focus is being the bridge between hospital admissions and home. A prerequisite of our facility is that the patient must be able to physically endure three hours of physical, occupational, and/or speech therapy daily. A big focus is on recovering lost ability or learning to live with a disability. A newly appointed marketing team has been sending us incredibly inappropriate patients. One of last week's patient had dementia so bad she couldn't even finish a sentence because she couldn't recall what she was saying midway through.

Back to the issue at hand, in my defense, I simply didn't have a chance to run across the paperwork stating that MPB were ordered until late in the shift. I have 10-12 acutely ill patients nightly and reading every physician order since admission (it didn't appear on the kardex) is simply not feasible. I was the first one to even notice the order and reported it to her. So, I believe I acted to the best of my ability, and while MPB are great, repositioning hourly I feel would be more effective anyhow, especially since the heels were elevated.

Well, this nurse basically turned into a screaming banshee and laid in to me, called me lazy, and embarrassed me in front of a bunch of nurses in the large report room. The one thing I hate about this field is simply working with women sometimes... I feel like I'm cruising on a hormonal highway sometimes; this is something I'm definitely not used to. This particular nurse has had this incredible hulk issue before with others. I don't think it's so much what was said, it was how it was said. I think I had ex-wife post-divorce screaming match flashbacks. Horribly unprofessional, in any case. I did handle the situation well and remained composed... though in the back of my mind I wanted to ask her if perhaps her Paxil prescription ran out.

My point is this: can't we just assume in most cases that our colleagues aren't incompetent or lazy next time someone doesn't have a last bowel movement or other similarly important, yet not immediately crucial, piece of information?

Wednesday, November 2, 2011

Refresher

Okay, so I'm back, my blog has a new name and a new domain!

If you haven't already figured it out, I passed my NCLEX-RN boards! Two clues would have been that number one, I can afford my own domain name now, and two, I haven't really had any time to post.

My divorce with my cheating bitch of an ex-wife is done and over with, now we are just fighting out custody for my son. And get this... three months after the divorce, this dumb ass is married yet again, to the same douchebag who she was with while I busted my ass in nursing school and managed to pay our bills. Oh well, you live and you learn. I'm happier now that I've completed nursing school than I've been in a long time. Get my son out of that weird ass Jerry Springer white trash situation and I'll be doing fantastic.

Nursing school was definitely worth it. Definitely. It was the hardest thing I've ever had to do, but now that's it's done, I've got a really great career. That's a good thing. That's not to say it's not without its downfalls though. It's stressful.

I see a big difference between LPN and RN, even though at first it didn't appear to be a big difference. Speaking about technical skills, it's not very different. However, the big difference comes in with the paperwork. Apparently, there are many... many forms that require an RN signature. There are careplans that need to be done (GAWD I hoped I'd seen the last of those; no such luck). It's just a stressful bitch of a job at times. At least the LPN to RN pay raise was worth the extra schooling.

Hopefully in a month or two I'll have saved up enough into a nice, new apartment. I'm currently rooming with two graduate students who smoke a ton of pot and watch ESPN all day long. It's been a fun ride, but I think I'd rather get a new place with a little more privacy and a little more kid-friendly for my son. Extra privacy for my awesome girlfriend :)

Anyhow there's a little personal update about me. I got a ton of responses regarding my personal issues I made in previous blog posts, so I figured what the hell. I'll be probably posting some stuff that's actually nursing-related in the near future, so keep reading!

New website, same posts, still in the works!

I've been trying to find the time to get this site back up and running! New look, new domain... but I retained all the same posts from the past and will have a bunch more new ones upcoming.