Grrrr...eetings From the Dark Side

As of today, it's two shifts down, five to go. So far I am learning a ton, getting lots of experience at different things, and happy because I feel like critical care is my thing. I love it. I'm going to keep track a few days at a time, as I go.

Day One:

Nurse-Vampire here, fresh off my first all-night preceptorship plus 5 hours of sleep and ready to go at it again in a few more hours.

This week I might only be in the CVICU if they have any patients. There isn't a lot of heart surgery going on right now so they close that unit down and put everyone in the ICU. Last night it was slow and they called off the original preceptor I was scheduled with, so I was put with a different nurse, this young guy who is only a year out of nursing school and has only been on ICU for 2 months. It was a great experience because I realized how busy you stay all night with doing assessments and staying up with measuring urine output and such. And I did get a ton of practice at basic skills, like giving IV meds and learning rationales for doing different things. I got lots of practice with alcohol withdrawal protocol. Roger showed up at the beginning of the shift and told us to e-mail him our learning goals. That was it for him. No more instructors standing over you and making you nervous.

Our two patients were almost med-surg patients, but they did need a lot of attention, so they belonged in the ICU. One was in because she passed out drinking and we were trying to keep up with her before she got to DTs. We kept trying Ativan and it worked a little at first but the longer we progressed into the night, she got more and more restless and she was flashing everyone on the monitor at the nurses station because she kept pulling her clothes off while she was rolling all over the bed.. Finally one of the more experienced nurses suggested that we call the doctor and try to get an order for Haldol. We did, and it worked- she was out for the rest of the shift.

The other patient was a COPDer who had one of those "difficult" personalities. Demanding and you can't please her no matter what. I wonder if you get those at Metro as frequently as you do in Desert Valley. That could be an interesting thing to study. She was a Jekyl and Hyde type, according to the report we got. But the nurse I was with knew how to deal with that, and it turned out okay. She seemed to like men better than women, but she never gave me a problem except for once when I had to do her fingerstick. She was on a BiPap machine all night so she was in there sleeping. It was quiet other than keeping up with the one patient's restlessness.

It was a good intro to the ICU, like a step up from Med Surg bu not overwhelming. The cool thing was that being up there, I felt like YES! This is IT! I liked the environment and I think I'll be happy working ICU. The nurses all help each other and it's a great place to learn and ask questions because you have all these people who have experience and know an amazing amount of stuff. It will be interesting to see how different my other preceptors are in how they do things. I am sure I will learn a ton in 7 shifts.

Friday afternoon before my shift I had an interview with the hospital in Colorado, it was a phone interview. It went well, I felt like I did well answering the questions and it felt relaxed. I was nervous before it because I had one phone interview a long time ago interviewing for an academic job and I remember it being one of the worst experiences ever. But these people were nice and easy to talk with on the phone. They will be making decisions in 2 weeks and I'll see what happens. They have a 6 month orientation for new grads in ICU. I have a job, no matter what, so I'm cool. If they offer it to me, then we'll have to sweat over a decision. And our neighbors who put their house on the market in May sold theirs this week. Next door they are asking quite a bit for their house, more than I thought we'd ask for ours, should be interesting to see how long it takes to sell.

Oh yeah, and I almost forgot, I resigned from my CNA job, finally, today. Gave two weeks notice for on-call, but I am done.

Day two, or last night. Whatever it was.

On day 2 I was with an experienced nurse, and she had two patients. One with an aortic-femoral bypass for peripheral vascular disease, and the other was this kid with diabetes who came in in DKA, and had some psych issues. She took the easy one, the post-op patient, who needed a lot of vascular checks and various medications. I took the hard one, the DKA kid. I got lots of practice with his arterial line, and he needed lots of blood draws from it and was on an insulin drip, so I was busy all the time. I had to adjust the insulin based on his blood glucose readings every hour. I had to hang a lot of IV fluids and potassium, and convince him to take a bed bath, which is not an easy thing to convince an adolescent to do. Greasy, stinky kid, he needed a bath! He was dressed in all black with this thick chain on his long shorts attached that he kept getting his feet tangled up in. I tried to get him to at least take the chain off but he refused. He wore the hospital gown but stayed in those shorts. I gave him all his supplies, filled up the water basin, closed the curtain, and left the room. I was finally successful at 4 am and after he bathed I went in and changed his linens. I talked to his family and I had to stay on top of the lab and pharmacy because of all the changes in his orders. He was sweating a lot and the probe for his pulse oximeter kept sliding off and the monitor was beeping all night. In ICU they have to be monitored, so all I could do was keep replacing the disposable probe cover every hour or so. One thing we did was teach him about managing diabetes and compliance with his medications and insulin. The nurse asked him if he liked girls, and then told him if he didn't control his sugar in a few years down the road he wouldn't be able to have an erection. I thought that was a pretty good way to convince a kid that age how important it is to take care of himself.

It was pretty quiet but I had enough work to do that I didn't get tired until about 4:30 when I finished my charting and suddenly felt like I could rest my head on the desk and crash. They turn on the lights in the ICU around 6 am, so that helped me avoid getting too relaxed.

I only slept 5 hours between my first two shifts. I kept trying to go back to sleep and couldn't so I gave up and went for a short run. It was not too hot but I feel a little more dizzy right now than I have been, so it was hard to relax during the run. I felt like I couldn't concentrate. This has to be fatigue. This morning I ate breakfast, then took the girls for a walk after trying to run and feeling like the girls were going to pull me down and drag me. Soon I will go to bed, as soon as I can't keep my eyes open anymore. I have two days off before shift # 3. I am going to try to sleep and live like a normal person instead of trying to force myself to get on a night schedule.

I don't mind night shift, it's kind of fun and relaxed. I was more tired the second night than the first, but I am not sure right now whether doing this night shift is harder because of the sleep loss or because of the other things it does to your body. Thanks to the cafeteria food e.g. tacos at 1:30 am, and the extensive variety of healthy foods available in the middle of the night, I think I will soon need one of those enemas they have in the supply room. Nothing else seems to be working. Not the salads at home, not the coffee, and not the walks and short runs (now I'm down to about 20 minutes per run).

I shouldn't feel so bad. My classmate who was doing a shift with me on ICU last night was limping. I asked her what happened. Yesterday she was on her way to buy some new scrub pants because she had a nursing school- induced "growth spurt" over this past summer, and she was so exhausted, she fell out of her boyfriend's SUV while getting out of it in the parking lot of the scrubs store, and sprained her ankle. Now she's limping around with a latex glove full of ice tied to her leg and she couldn't call off because we can't miss any preceptorship days, and we're so close to graduation!

I tell you, I don't recommend this accelerated program. BAAAAAD for your health.

Peace, love, two blissful days of sleep, and intact gastrocolic reflexes,

Towanda, ICU RN2B

Trauma, Shock & Awe!

I am sitting down to write this with the most profound state of exhaustion I've ever been in. Even a dysfunctional thyroid approaching myxedemic coma doesn't come close. Fortunately I've been writing little bits in this journal all week so there's not too much to add today. I just got home from school. We had the final exam this morning, then our preceptorship orientation, then a rehearsal for graduation. I am too tired to be elated. I am happy inside but I feel like crying, mostly feeling so mentally exhausted and overwhelmed by everything. I'm okay, it's going to be a few more weeks until I can re-balance my life. And things could also be much worse- I could be one of the half dozen people in my class who are right on the edge of passing with their grades, who were there all day today not knowing. So I consider myself fortunate. We won't find out grades for a little while- they said they'd be posted by 6 pm tonight.

This week has been jam packed with excitement again. How did I start my week? Driving up to the hospital entrance on my last clinical day, turning off of Roosevelt to pull into the parking lot, there was a guy lying on the grass. He was on his side, with his t-shirt soaked with blood over the entire front. Probably a gunshot or stab wound. A cop car was already parked with it's lights on, and I could see an ambulance headed to the corner. The cop was talking to the guy on the grass, looking at his eyes. Looked like everything was under control. Another morning at Metro.

Then our class was waiting to go in the elevators up to the Labor & Delivery floor and one of my classmates told me I had hair on my butt. Hmm. News to me. I didn't know that either. Turns out I had a huge blob of black dog hair all over my white scrub pants all over my butt. Must have picked it up on the front seat of my truck. I asked if anyone had tape and someone did. So I de-haired my butt with tape on the trip up in the elevator. I will be so glad to dispose of these white pants! Only 7 more times, in the preceptorship, and then I can burn them. If I don't split them by then.

Last day of clinicals I was in postpartum. I worked with a great nurse who floats to different areas. She walked and talked fast so I was running all over with her. I did a blood draw and she had a few high risk patients so we were checking on them a lot. I got to speak more Spanish again. The morning went quick. We all felt like slacking and took a long lunch. The instructor let us go to our postconference early because we had presentations. No one was in the mood to give a serious presentation. We were all goofy and laughing at everything. I made up a haiku there:

last day gigglefest in the cafeteria
burn the uniform

When I got home from clinical Dale told me that the hospital in Colorado called and they want to do a phone interview. It's for ICU. I am leaving it up to the universe. We'll see what happens. If we both had good jobs up there, it could happen. But I will talk to them and ask a lot of questions. It can't hurt.

We have our final over trauma and shock and then everything else. I am trying to find time to study and I am so exhausted nothing is going in. I can find all kinds of other things to do that require no concentration. I feel like a truck ran over me. The weird thing is that I've been sleeping fairly consistently 8 hours a night. I still feel completely worn out. I guess going nonstop 7 days a week with a few 14 hour days thrown in there, it will eventually catch up to you. I haven't had one day off all summer except right around July 4th I think I had a couple of days where I only studied for a couple of hours.

I have been worried about my application for my license. I sent it in a week and a half ago and didn't hear anything. You never know with the mail around here. So I checked my checking account to see if the state boards check went through yet. It did. So now all I have to do is graduate. I did everything online that I could because it makes the whole process go quicker. I might be lucky enough to get my authorization to test before we leave on vacation. If we do, I'm going to get it over with.

When I walked out of the house Tuesday morning, I saw that our next door neighbors have a for sale sign that sprouted up in their front yard overnight! EEK! I wonder what they are asking for that house. They bought it last summer for a lot of money. Then they put a ton of work into it.

I interviewed at Metro Tuesday morning. The nurse manager, actually the assistant nurse manager who is in charge of the medical ICU, interviewed me. It went well, it was actually pretty short because she already got half of it done last week. She asked me what my goals were and what I want to accomplish in this job. And I asked her a few questions about how the unit is run and she offered me the job. She seemed happy with the fact that I said I want to learn everything and be able to float to any of the different critical care units eventually. I verbally accepted it. I have to work out the details of money and my start date and all that with the nurse recruiter.

WAAAAAAAAAAHOOOOOOOOOOOOOOOOOOOOOOOOOOOOO! Dale was at the movies on his day off, so I came home and had a howl-fest with the girls before I had to leave for campus to take the HESI.

The HESI is a standardized test that the nursing schools make you take, it's how they compare how they are doing to other nursing schools. And it's a good indicator of how you'll do on boards. It's broken down into categories so you can see which areas you are strong and weak in, and can study for boards accordingly. I kicked butt on the HESI. I think it was the shot of adrenaline in my brain after the morning job offer. I remember I didn't do quite as well on the HESI after Block 2.

I think the universe is trying to tell me something. My pens keep running out of ink this week. I think that is a sign that it's time for school to be over. They are as worn out as I am. I hope I don't run out of ink before 11:30 on Thursday when the final is over.

Wednesday I was so exhausted, and I woke up at 3:42 am. I don't know why. I could not go back to sleep, so I got up, made coffee for Dale, and finally forced myself to study some. I am so over it. I can't force myself. Around 10:30 I got a call from Desert Valley. Surprise, surprise. They finally decided to call me to set up an interview. First they wanted to do a phone interview, which they had to schedule either today or tomorrow. Excuse the f**k out of me. I turned in my first application back in June, and they wait until the day before finals to tell me they have to do it either on my last study day or the day of my final? F**k You, is what I wanted to say. A 15 minute phone interview. Give me a break. So I set that up for the afternoon, even though I was hoping to get a nap in. Then they said they had new grad jobs in telemetry at South, but no information on North ICU as far as new grads. And they had some openings on the trauma neuro floor which is not what I want. So I went with tele. Which is originally where I thought I'd want to work, before I became enlightened. That's the floor where she told me she hired 6 new grads. I wonder if one of them didn't work out. Or was consumed whole by one of the other nurses, more likely. I set up an interview with the manager at telemetry for the hell of it, I like to get practice at these things. I set it up for 3:30 next Tuesday afternoon, which I sort of resented because I was looking at that afternoon as a day when I was thinking I might be able to go down to Metro and take care of business, before my night shift on the CVICU.

As soon as I got off the phone with HR I called Dale at work. I had steam coming out of my ears. I told him about the phone interview- today or tomorrow. It occurred to me that it would be good to do the phone interview to give me a preview of what they might ask me on Friday with the hospital in Colorado. He agreed that it would be worth it to do the phone interview. But I am so pissed at Desert Valley's timing.

I took a 15 minute nap, that was all I could sleep, and then felt better, so I studied and waited for HR to call. They did, and the interview was pretty much your standard interview, but I found it interesting when she asked me at the beginning what my current position was with the hospital. I said CNA. She asked me why I wasn't a nurse extern. I had to stop and think about it for a second. Then I remembered why. So I told her the truth. My boss used externs as aides. They were using externs only as aides on my floor, so I didn't feel like I was going to get any worthwhile experience out of it, so I decided to go on call and not work a regular schedule during the last 2 semesters of school.

I would have worked a little this spring if I was going to move beyond buttwiping. But not with my boss. I didn't tell the HR rep about the buttwiping part, though. I remember I didn't like any of the other med-surg floors at the hospital and I wasn't looking for a lot of hours, so I did a quick search at Banner and that was a weird experience. And I never even bothered to ask my boss about being an extern again. I wouldn't have been able to get the experience that an extern job is supposed to give you. It wasn't worth it. If my boss was on board, she would realize that it would have been a valuable experience for nursing students to work with the nurses and earn from them. But my boss is in the ice age.

The HR rep also told me what Desert Valley was paying new grads, which is a little more than Metro. It's less than 2 dollars an hour difference. And the more I think about it, I have learned several lessons in life already that will guide me to the right decision here. First: The more money I've made in the past, the unhappier I've been. And two: First impressions are important. And three: Trust your gut. I have had nothing but roadblocks with Desert Valley and I don't see myself being happy there. I look back at the experiences I've had and I don't feel that they have all been on board to support nursing students coming through. They make it sound like they are, but they're not. After two years of working and clinicals at Desert Valley, constantly dodging nasty nurses and doctors who are too good to even make eye contact with a lowly CNA or student, and I'm already in the system, so I apply for jobs and hear nothing for months. I was at Metro for two days, felt like I was in a different world and the doctors even talked to me by name, I met the nurse recruiter, applied for a job and talked to the manager all within 24 hours, and a week later I was interviewed and offered a job.

But the nurse recruiter from Metro happened to call and left a voice message during my phone interview with Desert Valley. I called him back. I like that on his voice mail he refers to himself as "YOUR nurse recruiter". He wanted to schedule a time for me to come in and do my new hire paperwork and get my pre-employment physical. I asked him when would be good and he said, How about 3:00 next Tuesday? I said, sure that sounds great. So we set it up. Now I will have to call HR at Desert Valley back tomorrow and tell them I can't make the interview. And by then I'll know if I feel like rescheduling. I don't think so. I might save myself the energy. Maybe instead I'll make a special trip to turn in my 2 weeks notice to my boss then. I think that's going to feel good.

The final was this morning, going into it I needed 69% in order to keep my A. Not too worried. Then we had our preceptorship orientation. I had my schedule changed, which I was not happy about, but it's not that big a deal. I was hoping to get Friday off at least, to get some sleep and regroup before my first night shift. But now I have to start tomorrow (Friday). I have my interview in the afternoon. I hope I have time for a good nap. I have 4 different preceptors in 7 shifts, which I'm not thrilled about, but it will work out. The nice thing is Roger is the faculty member I report to for preceptorship, and he knows everyone over there, and he will keep me steered in the right direction. At least now all my shifts are scheduled. I'll be floating between the two ICUs: med-surg ICU and the CVICU. That's good- plenty of experience. I will be officially done at 7:30 am on August 8th. As of right now. That could change. Nothing is for sure until August 10th, graduation, is over. Unfortunately we do have an assignment and some paperwork I need to complete sometime between tonight and tomorrow at the beginning of my shift. When you think it's over, it's NOT!

Before the final I wrote a haiku on the board, the one that goes: forty coconuts, toasted baked shredded and flaked, marinate in whine. The Coconut was giving the exam and she had never seen it before. She loved it. The final was hard! I went back to over 20 questions and had to think about them. I usually only circle 7 or 8. It was a killer. Harder than the Amazon's exams.

We had a break for lunch and I was not happy about my sudden schedule change but I knew I had to get over it. I went home and called a friend I was going to go out with Friday night. When I think it might be possible to socialize again, DENIED!

The orientation was controlled chaos as usual. I am about ready to strangle the two or three people in class who need to have everything repeated to them. I'm so glad I only have to deal with them one more time- at graduation. But I might end up strangling them during the ceremony. It looked like there were some good places to hide bodies behind the stage. I filled out my info sheet for graduation. I put a haiku on there to read during the ceremony. I hope they'll do it.

Then we had to go over to the performing arts center and rehearse graduation. The Coconut is always running a little late and everyone is so fried. And there are several people who were in tears because they were rehearsing graduation but weren't sure if they passed the class, because we didn't have our exam grades yet. My patience was getting short. I hung out until 4 pm and we were almost done., and I decided I'd had enough, so I slipped out the front door with one of the other students while the Coconut was wrapping things up.

Just checked on the final exam on the online student website. The grades are posted. I got a 97%. Kick ass. Wahoo!

Dale got home a minute ago. He read my mind. He has a six pack of Full Sail. I haven't had any beer all summer. I think it's time.

No this is not the last journal. I'll fill you in on the preceptorship and graduation as I go.

I don't need to dress up in a flightsuit with a codpiece and land on the deck of some aircraft carrier. No photo ops necessary. But I feel like I *can* say:

Peace, love, and MISSION ACCOMPLISHED,

Towanda, ICU RN2B

Breaking the Log Jam: First Interview Scheduled!

I should be sleeping right now. The only thing that's keeping me awake is adrenaline. I am thoroughly exhausted, excited, frustrated, mad, relieved, sad, overjoyed, and whatever other emotion I can possibly have. No I'm not even PMSing.

Today we had our last day of lecture and our last regular exam (on Neuro) before finals. It finally hit me this week, I think it was Tuesday, that I'm going to miss my nursing classmates! At least most of them. The final is next week, along with the HESI and the last day of clinicals. I'll postpone my sad and overjoyed feelings until then. For now I'll focus on all the other feelings.

Things have been extremely frustrating and slow moving on the job search front. Along with the fact that the real estate market is all but dead and interest rates are inching up. Dale and I had a long talk about moving the other day. Right now things are moving at a snail's pace up in Colorado at the hospital where I want to work. They are hiring for right now but not for later this fall yet. There is no word on when they will be starting people to work in the new hospital, or when they will seriously do their hiring. Dale got a good pay raise at work. We are looking at things, financially and practically, and it would be much to our advantage to stay here, even if it's only for a year or two, to get ourselves in a good position to move. Plus the added advantage of going up to Colorado with experience and being able to get a higher paying job then. So barring some unforeseen miracle, like both of us suddenly getting good job ofers for this fall up there, we are going to stay here for now.

That takes a HUGE burden off me. I didn't realize how additionally stressed out I was with the moving and worrying about getting the house ready and where we were going to come up with the money for everything revolving around that, plus going on vacation in August and having to spend half of that time job searching when we want to be on vacation in the mountains, and so on...

We had our neuro exam today and I had little time to study for it yesterday. I procrastinated. I could not get myself to look at the stuff. So I spent pretty much the whole day applying for jobs. I had a doctor's appointment with an ear nose & throat specialist to rule out the dizziness being anything with my inner ear first thing in the morning. It took most of the morning before I got out. That was interesting. I got my hearing checked first. No problem there, I have great hearing. Then the doctor did a neuro check on me and checked my inner ears. No problems there. No fluid. Neurologically I check out perfect, and the fact that I'm still running and it hasn't affected my balance tells him that it's not inner ear and not likely to be neuro. He asked me, have you had your thyroid checked lately or a CBC? And did I have any undue stress in my life? He said thyroid dysfunction can cause this, or anemia, and stress. Stress????!! What stress?

I told him I got all that bloodwork done in June and I never had time to pick up the results from the doctor's office, but they told me everything was within normal limits and my TSH was good. But I never SAW the numbers, normally I would, but it was one more thing to do. I need to go pick up a copy and look at the numbers. With my thyroid they did not check my free T3 which is the thing I've had the most trouble with. I will have to go check the numbers and see what my blood counts were, I doubt it could be iron deficiency since it seems like all I eat is meat these days, compared to what I normally eat. For months my diet has consisted of whatever is least expensive and fastest to cook. But I did have a major change in my diet when I cut out wheat a few months back. Who knows, maybe there's some vitamin deficiency. I need to get my thyroid checked again and get a free T3 drawn. This family practice doctor I saw ordered the labs back in June and I was so stressed out then that I didn't bother to check what she ordered.

Basically this ENT doctor told me other than double checking those labs, he thinks I should wait 6 weeks and see if it doesn't resolve after graduation and a vacation. He said the next step would be an MRI to rule out anything else going on. He said to come back in 6 weeks if it doesn't go away after some rest.

I have to admit I liked that. I am still skeptical. Kind of makes it sound like it's all in my head. Which it is, of course. But this is for real. I feel like I'm still in a boat and today it's bad. Today has been disproportionately stressful too.

Well after all that and finding everything under the sun to do except study for the neuro exam, I did manage to glance at my notes for a total of 15 minutes yesterday. Today we had the neuro exam and I walked out of there feeling awful, like I did the worst on that exam that I've ever done in all of nursing school. I felt like there were so many things I had to guess at, I didn't study enough details. No worries. I managed to get 47 out of 50. Again I am staying consistent with my downward trend- by one point per exam- but I'm still in the A range. I told the Amazon I was neurologically impaired when I gave her my exam.

Lecture afterwards took forever with the drama. The Coconut had to talk with us about our preceptorships and she got a flat tire on the way to school and was late, so we waited around for 2 hours including lunch. Finally she got there and I found out my preceptor is who I thought it was, and I will be in both ICU and CVICU, so I get a bonus of being in both places. I have 5 of my 7 shifts scheduled so far and the Coconut will have to figure out 2 more shifts for me to fit in somewhere. So my life is still up in the air and being turned upside down because I'll be working the 7 pm to 7 am shift! There were a few people who were upset about what they ended up with and one of them stomped out of the room in tears, bawling because Coconut didn't give her what she wanted (she is one of my least favorite classmates and the inspiration for several haiku) After all the drama, the Amazon finished the last lecture on shock and trauma. She got done at 5:20 pm and then they both talked to us about our graduation. As it turns out we voted to have our class president speak, if the dean of nursing okays it and approves her speech. I cannot believe the control issues these nursing faculty have.

Next Thursday is our final exam. The next 7 days are nonstop, jam packed. I feel like I'm going to lose my mind, my head will explode. Finishing all the OB care plans, presentations, assignments, plus reading and studying for the new material plus the final covering everything, plus applying for jobs and interviews. Yes, you read that right. I have an interview! More about that below.

For now I am so looking forward to the peacefulness of the ICU at night. The way I feel right now, somehow it seems like it will be surreal, the late night time world of vampires in the ICU, with no homework and no exams. Calm and patient care. I can't wait, even if I will be a zombie for at least the first shift or two until I adjust.

On the interview front. I have an interview!!!! How did this happen? On Tuesday during our OB clinical day at Metro I was talking with my classmate who got hired there in the cardiac ICU. She introduced me to the nurse recruiter, who gave me his card and told me to apply and call him as soon as I did. That afternoon was slow on postpartum and all I did all day was feed one baby and work on my care plan. So my classmate took me upstairs to check out the ICU. While we were there she introduced me to her new boss. I told him I was interested in cardiac ICU. He said, I don't know if I'm going to be able to hire another new grad right now but let me introduce you to someone. He took me over to the manager of the medical ICU and introduced me, and she *is* hiring. And she needs someone on DAYS. Days as a new grad in ICU is hard to come by. I would love to not have to spend my first year as a nurse-vampire. Maybe I could even get a social life again.

We talked and she took me on a tour around the unit. She introduced me to the educator, the physicians, the other nurses, and told me how they work it- that you'd never be alone and it would be about 6-8 months of being on orientation because you take classes and you work all the different critical care units and learn everything. That means surgical, cardiac, medical, neuro, you name it. They see everything there. While I was there the patients I saw looked like they were probably homeless, they looked pretty bad and worn down. Lots of skinny young men with tattoos. The ICU is all one big unit, no private rooms. One patient after another with side by side beds, curtains in between them.

It's a teaching hospital so you get so many opportunities to learn. It's downtown and is a publically funded hospital and a huge percentage of their patients are uninsured, underserved, non-English speaking. Plus with the patient population there, you see things you'd never see in a private hospital since they get so little primary care. We walked back to the managers office. She asked me if I had any hospital experience. I told her about the CNA job. She asked me if I could work days, and when I could start. I felt like she was practically offering me the job. She told me to apply and set up an interview through the nurse recruiter and that she'd be there next week on Tues and Thurs, and to call her if I didn't hear from them by the end of this week. They are starting a new critical care class in September. I sure could use a paycheck before October.

I went home Tuesday night and put in my online application and sent a resume and letter to the nurse recruiter. Today when I got home there was a message from him to set up an interview. I have an interview Tuesday morning. And to top it off the nurse recruiter not only was a nice guy, he sounds like he's intelligent and knowledgeable about things, and interested in expediting the hiring process. No dim bulbs there.

I have also applied for more jobs in Colorado, for the hell of it, and sent in my applications for the new grad orientation program at Desert Valley and for several jobs there. Yes, this is where I worked as a CNA. Did they call me? No. The HR person emailed me to tell me that they'd be contacting me soon to set up interviews because they now know which units are hiring new grads. HEL-LO-OOO. What are they waiting for!! They are so slow. It's pathetic. There are a lot of people in my class who worked for Desert Valley who are taking jobs other places because the nurse recruiters here are dragging their butts and the other hospitals are offering good orientation programs and taking new grads in all areas, and hiring them quickly. St. Francis and Metro have been much more proactive in hiring new grads. It already sounds like about a quarter of my class have been hired at Metro!

I'd love to work at Desert Valley for the convenience. It's close to home, I could even ride my bike there sometimes. Thirteen miles each way. But I have to weigh other things. Like what were my overall impressions. In Desert Valley I had some horrible clinical experiences at one hospital, the one where I worked. It was better at the other one. I can't say I particularly liked working there either. I liked the nurses on my floor, and I liked the patients who didn't order you around, but once I left my floor it was nurses eating their young, everywhere. When I walked into Metro there was a completely different feeling. Kind of like stepping out of one world and into another. There was no pretense. People are people. There's not an air of superiority, not among the staff, the doctors, the nurses, or the patients. I felt at ease. I also love the idea of being able to speak Spanish again. Of course many of my patients might be unconscious. I'll be talking to them anyway, I talk to all my patients regardless of their level of consciousness. I talk to myself regardless of that too.

My classmates are having similar struggles with applying for jobs. It's hard to turn down a good job offer in an area you like when you're offered it right away instead of being stuck in the application process and waiting to be called for an interview. Everyone I've talked to in my class has been frustrated with them. It's pretty sad because they are the ones who co-sponsored our program with the community college. They sure aren't doing a good job of hiring us. And my boss- the one I won't work for- she still expects me to come back and work for her. As if! As if I would choose to be an overworked butt-wiping floor slave working for a boss who is totally unsupportive of her nursing staff. If I get a good job offer at Metro, and decide to take it, I could be giving her my letter of resignation the next moment. I told her directly that I am looking at cardiac and critical care. She thinks all new grads should start in med surg. She is stuck in the ice age. Needs to retire.

Tonight when I got home I was so exhausted and I feel dizzy and tired, and wound up tight. I need a break so bad. The stress of everything- studying, clinical days, worrying about jobs, the stress of running out of money soon and figuring out how long you can stretch and allow yourself a break, it's getting to everyone. One of my classmates today told me she was having panic attacks with all that's going on. Others say they get diarrhea and upset stomachs before exams. And I've been dizzy since school started this summer. And here I am when I should be asleep I'm awake but in a daze, typing away hoping to purge myself of all these thoughts so I can sleep.

21 days to graduation. ZERO more lectures, two exams to take, and one job to find.

WAAAAAAAHOOOOOOOOOOOOOOOOOOO!!!!!!!!!!!!!!!!!!!!!!!!

I feel better now.

Peace, love, and keep telling me it's all downhill from here,

Towanda, RN2B

Su bebe es fuerte!

Today I was in labor & delivery at Metro. I'd have to say today was one of the best days I've ever had in all of nursing school. Maybe the best clinical day of all? The nurses were great, the patients were great, it was fast-paced, the instructor we had was awesome, and I got to do all kinds of things all day. Before lunch I delivered a baby (along with the nurse, almost all by ourselves except the resident got in there in time to cut the cord and deliver the placenta), spoke almost no english all day except at the nurses' station, did a complete newborn assessment, set up the fetal heart rate and uterine contraction monitors, started 3 IVs, put in a foley and did 3 straight caths, and helped the nurse with an intake and assessment in triage and then watched an ultrasound of a woman who came in at 20 weeks with bleeding. One of my L & D patients was from Guatemala, two were from Mexico and spoke no English, and out of all the maybe dozen patients I worked with all day, only one spoke English at all.

I was surprised how fast the Spanish came back, even though I'm so limited in my grammar. Once I heard the nurse talking with them and I remembered the words I had no problem communicating, because even though I can't speak it all that well I could understand all of their questions and everything the doctors and nurses were saying to the patients. So it was easy to answer questions in my pathetic broken words and get the message across. I am sure being in that environment all the time it gets easy. My teacher kept apologizing for her Spanish but the patients understood her perfectly. I understood her too and it helped me learn fast. By mid-morning I was having no problem answering call lights and getting what they needed, and answering their questions.

The woman who delivered was my first patient of the day. This was her third. She was this little tiny woman from Mexico. Her husband was in the room and helped her push when she delivered. We had the monitor on her for a couple of hours, she was almost completely dilated but it seemed like it took forever for her contractions to get closer together. So we waited. All she got was a little Demerol and Phenergan in her IV, she didn't want an epidural. She hardly made a peep the whole time, a little quiet moaning at the end. We saw the contractions getting close together on the monitor so we went in, got the table set up and got her to start pushing. We stood there and coached her to breathe out slowly and push when she had the contractions, and the nurse ran out and called for a doctor and left me with her momentarily, and ran back in. I think I blinked my eyes for a second and suddenly here was this head, full of black hair, screaming. He came out wailing, and so fast it was a good thing the nurse got back in there in time to catch him! Then the doctor came in after the head came out! She got in there and finished the delivery and I dried the baby off and took him to the warmer. He was a little over 6 pounds and had a great set of lungs and seemed to be healthy in every way. I did all the measurements and vital signs, gave him his vitamin K injection, put the ointment in his eyes, and checked him for cleft palate and everything else, and he looked good all over. He wasn't having any trouble breathing, that's for sure. Pink and screaming!

After we got the baby assessed and warm we gave him to his mom to breast feed. Then I got to start IVs on some of the patients on the floor. The nurses kept coming for me because the other two students I was with were both gone to surgery for C Sections. Then they needed help in triage so I straight cathed 3 different patients there. It was a busy morning. The teacher was cool and laid back. She let us have a long lunch break, and we got to go home early too. We are all so fried, and she understood. Driving home on the freeway is not my favorite part of the day, but I beat the worst of rush hour. Tomorrow I'm in the nursery- I bet I'll be changing diapers all day. And then next Monday I'll be in postpartum, writing my care plan. I'm glad I got to have some fun today!

I thought Metro was great. It is always so nice to get out of Desert Valley and be around people who aren't mostly overprivileged white folks who feel entitled to everything. The nurses were there to help the students learn, and even the doctors were nice and respectful toward us. I wonder what it would be like to work there. The nurses seemed pretty happy but that's the only place I've been at Metro.

There is another big flap right now about graduation. The class officers are arguing with the administration over the plans for our graduation (pinning) ceremony. It's so silly. It's like the administration wants to control every little thing about our graduation. They were going to have a speaker but then the administration came back and said no, we'll have a speaker only if the dean of the nursing school wants us to have one, and they will invite that person.

Anyway there is this big e-mailing thing and a bunch of people are all upset. I think our class president should speak and that's enough. I hate to sit there through a bunch of speeches at graduation. Let's get it over with and party! The class president asked me if I wanted to speak. I can think of things I'd like to say, but I don't feel like getting up there in front of several hundred people. I'd prefer if they'd have the class president do a short speech and get done.

Not only that, but we’re not supposed to call it “graduation”. It’s “pinning”. That’s why all the flap about us wearing caps and gowns as opposed to wearing white scrubs. Our class, we are the high maintenance radicals. They don’t trust us. I don’t understand why you can’t call it graduation, we’re getting associates degrees. Whatf***ing ever. How many more days until they lose their grip on us?

I'm starting to feel like Harriet the spy with my little journal here. My classmates don't know I did this. I've recorded, from my point of view, the entire way through nursing school. This journal is going to come to an end soon, but I'll keep it going at least a little ways into my first job. At least through taking my boards and getting started wherever I end up working.

The neuro exam keeps getting bigger. There is so much stuff on that exam I hope my brain can handle storing it all, or I'll have increased intracranial pressure until after the exam Thursday. I need to make sure I have chocolate.

I'll have to be there again tomorrow morning real early.

Peace, love, empuje y respire lentamente,

Towanda, RN2B

WAHOO! CVICU!

Today was a loooooong day of neuro with the Amazon. It's hot and everyone is anxious because the material is difficult, and the Amazon gave us the option to stay and get more lecture from 3:30 to 5 pm but about half the class opted out. We are all toast! It got kind of crazy in there after a while, the Amazon was talking about Cranial Nerve number 10, the “Vegas” nerve. She said it’s important “because when you have cabana boys you need to make sure your hypoglossal nerve is intact.” It's been a LONG program for the teachers too, obviously, if this is what we're doing after 16 months. I decided to go home early because there are so many stupid questions that I felt like I could spend less time doing it on my own with less annoyance.

Today's haiku:

sitting in chairs
lowers some people's
cerebral perfusion pressure

pneumocephaly
epidemic manifested by dumb questions

The exciting thing that happened today is I found out from the Amazon that I GOT A PRECEPTORSHIP in the CVICU! I am going to be at North, close to home, and I think I might know who my preceptor is. If it's the person I think it is, he's a young guy out of nursing school 3 years, but he is supposed to be good. The only thing that isn't fantastic about this is that it's on nights. I'll be doing the 7 pm to 7 am shift. I am NOT a night person, not at all. But at least the 3 am to 7 am hours won't be so foreign to my body! I figure, when I start out working, it will most likely be at night, especially in an ICU setting as a new grad. Might as well get used to it. I am happy.

Future nursing students should take my advice that graduating from nursing school costs as much as going to nursing school. Between NCLEX, and graduation, and your license, and reviewing for boards, and all the little expenses you don't think of. Like needing clothes to wear to a job interview since all you own are scrubs, and tshirts and shorts for sitting in class, and besides that, you don't fit in any of your regular clothes anymore because you've gained so much weight since you last needed them. Then you have to wait for your license so you can actually start working. Twiddling your thumbs while the state board takes it's time processing your application that costs you lots of money. And lunch. Gets expensive. Especially when your only social outlet is lunchtime with your classmates so you can vent and commiserate. I'd call it a therapy expense. And chocolate. That adds up too. Today I actually went through the entire day without chocolate. I'm wondering if the lack of chocolate in class was related to the lack of attention span.

I made an appointment with an ENT doctor today too, I have been trying to figure out what is going on with my vertigo, and I spent all afternoon yesterday surfing for info on it. I decided to start with an ENT and go from there. The fantastic thing is that I got an appointment for next Wednesday morning, perfect. No wait, and it was a day when I'm able to go. Sometimes it takes months to get into a specialist, like it did with my endocrinologist. It will be interesting. They start with a hearing test, with the audiologist. Here we go again....

Wow. Things are not looking good in the middle east. Plus it looks like we are going to get some expensive gas before long. I won't even get started ranting here. What I do know is that I'm getting nervous about all the stuff coming up, like moving and trying to sell the house and both get jobs and so on. I can't worry about it right now and the next 6 weeks will tell a lot. But I am scared of getting stuck here in Arizona. Things could be much worse of course. I'm needing to focus on getting through the next 2 weeks for now. The economy will crash as much as it wants to. Hopefully we'll still be here with no nuclear war and they'll still need nurses by September.

Well I gotta go put in my obligatory phone call to my congressman, even though I know he disagrees with me on everything and doesn’t work for me. If everyone would call, things would change. It's what I *CAN* do today, right now.

Peace, love, and...
Not only peace, but INSIST ON PEACE.
DEMAND IT.

Towanda, RN2B

Perineal Hematoma Snark-a-Rama

Happy Fourth. It was a happy one, we had no clinical this week. I loved being home, hanging out with Dale and the girls, a couple of hours of studying each day and all that time to relax....NOT. We are getting ready to MOVE! Now I'm facing one more free day and then back to the grind- for a few more weeks. Speaking of flags, one of the dogs jumped on me at one point this weekend and scratched me with her paws, creating an interesting bruise-scratch-bruise pattern that has three sets of alternating red, white (tan) and blue stripes on my leg. Looks kind of like a flag. My younger dog’s birthday is on the 5th and I know she hates having it obscured by a holiday the day before. I'm sure that's the meaning behind this. Gotta go stock up on the doggie ice cream.

The air conditioning went out in the Nursing building last Thursday while we had lecture all day long. The Coconut did the best she could at getting through the lecture but the usual clowns were asking stupid questions. Liz and I wrote notes to each other on a blank notebook sheet, by the end of the day there was a lot of snark in my notebook. When it comes to OB, everybody has to tell their little story about what happened in their delivery or so-and-so's experience. Omigod. Our eyes were rolling. I wondered if I should raise my hand and tell my experience when I had my litter!

It was only 106 outside and there was a light breeze, so it actually felt better outside than in the classroom. I had my frozen water bottles and stuck them down the back of my shirt- I had to be the coolest one in the whole class. The Coconut went into detail about perineal injuries during labor and delivery, and I couldn't help feeling like I was getting a perineal hematoma sitting there. Something about sitting in a chair for 8 hours or longer a day with only a few stretch breaks. I'm amazed that no one has developed a DVT!

I wrote my haikus for graduation and gave them to the class president. Of course she has to get them approved to go in the graduation program by the dean. They are lightweight. "Nice" you could say. Not what I wanted to say deep down but I think I get a valuable message out there. These weren't snarky biting ones like in Block three. I think they'll get approved. I also sent a bunch of pictures I had from Block One of the group and people putting foleys in the mannequins. Lots of naked mannequin pictures, and me stuffing my face in the cafeteria. Exciting stuff.

Friday I applied for an ICU/CCU position at my hospital of choice. It isn't exactly what I wanted, and the hours would suck but it looks like as a new grad I won't have a lot of control over my work hours. I expect that. The cool thing is that they appear to heave 8 hour shifts in the ICU, which is a dream for me. One of the things that has kept me from being so enthusiastic about critical care is the fact that most hospitals have only 12 hours shifts in those. When I saw there were 8s, I decided to go for it. Why not, and after a short while I could have my dream job- day shift, 8 hours x 4 days a week, and only every third weekend. WAHOO! I already know that no nursing shift is ever 8 hours. And no 12 hour shift is ever 12 hours. That's why 8s are so nice.

I will apply for other stuff as it comes up but I might as well get started now.

Coconut also told me she still hasn't heard from the managers on my preceptorship but she put in for CVICU for me and I am keeping my fingers crossed for that. I will take tele if there isn't a slot, but I am hoping for something good. About a quarter of the class still hasn't heard. Coconut is going on vacation and the Amazon will be giving her exam next week.

I have a long weekend and I have 2 Peds care plans to do, plus an assignment and presentation, plus studying for the OB exam next Thursday. Plus there is a huge pile of reading to do for Neuro, the Amazon is back with us next week after the exam. I hope the air conditioning is working by then, or it's going to make hell feel like the north pole. I was in an especially creative but snarky mood last week in class. Perhaps I'm still dizzy because I roll my eyes so much in class. Reading the textbook or looking something up on your own seems to be a novel concept for some. You would think that by the end of school they could look up the correct spelling in the textbook, and not waste class time asking the teacher. Especially when it's on the handout, on the next page. Plenty of haiku came to me on the way home, as a result.

if only mouths could break
like A-C in June classrooms
we'd be so happy

does your tongue have
a hematoma yet
I see you're working on it

ice cube enema
this classroom could make
polar bears migrate to hell

On the 2nd I bought the Sunday paper. Not to read. I don't read that tabloid piece of feces. I use it to wipe my....stick between the cracks of my... wrap my old... for packing material! Over the 4th of July weekend we spent a lot of time on prepping the house to sell. We painted the kitchen, pulled all the remaining fruit off the trees in back, packed boxes, caulked cracks, and got rid of a lot of junk.

But when I was pulling the paper apart because we were about to paint the kitchen and needed to cover the cabinets, and I saw an obituary, for my last patient in telemetry a couple of weeks ago, the liver guy. I knew he was in trouble. He died two days later. I guess that's something nurses must run into a lot- the obituaries of the patients they took care of. All I can do is hope I made his last days on earth a little more comfortable.

I am reading Nursing Against the Odds by Suzanne Gordon. I am about 1/4 way through the book and man is it depressing. So far she's been talking about the history of how nurses came to be subservient to physicians and basically the bottom of the heap of the medical staff as far as respect and having a voice. She gives a lot of examples and I can relate with a lot of things I've witnessed in the hospitals. I've seen a lot of good working relationships between physicians and nurses where I work and there are only a few docs who are jerks. But I understand the OR can be different-the surgeons can be tough. From what I've seen and heard the ICU nurses get more respect. ICU keeps sounding better.

Big OB exam on Thursday. I feel like I have nothing to study. It's kind of scary, I hope I'll do okay. Three more days of lecture! We also have three more exams.

Things should start happening soon, the long July 4th holiday is over and managers should get to the business of hiring and making decisions about preceptors and new grads and so on.

Peace, love, and red white & blue hematomas,

Towanda, RN2B