My first my own patient

This was an exciting day for me in my nursing career. It was my very first my own patient day. On Monday when I had my meeting with the nurse educator on my unit she said that she thought it was time for me to take over the complete care of a patient. I still worked with my preceptor, but I was the primary nurse. Talk about exciting. And it is cool because the timing of this event was perfect. On Monday I was feeling by the end of the day that I was to the point where I could learn quickly from being the primary care giver. I just waited and it fell into place. Or actually was put into place. :)
The day was a great one and full of learning experiences. Small but valuable. I didn't have my patient up in the chair yet when cardiac rehab came up to work with her. They were fine about it, especially because they had not given me a specific time, but I was still sad to have forgotten I needed to have her up before they came. I will now never forget that cardiac rehab likes the patient to be up when they get there if possible. Then after the rehab session, what should my pt call me into the room with but severe chest pain - radiating to left arm and jaw, she felt nauseous and was short of breath - classic chest pain. Let me tell you I was so thankful that I had read over the chest pain protocol for my floor that very morning. And thank goodness for preceptors. . . And nitroglycerine. But I remembered protocol and the meds to give, and she was ok an hour later. Time can almost crawl by when all you have are meds, but once someone is possibly having cardiac arrest in front of your eyes, time flies by and you wonder where it went. I also learned that I was better at keeping my cool this time than the last time this happened. I felt better because I knew what was expected of me. I also learned today that chest pain is really not that exciting on a cardiac floor. In fact, because there were not any changes in the 12-lead EKG strip, we did not even call her doctor. Chest pain is ok. Chest pain that is treated before oxygen deprivation results in cardiac death is a regular occurance on my unit. It took a while to settle the patient back down because she was upset that she would now have to stay in the hospital longer than before. But over all it was a great expereince. Lots of learning happening. I am going to love the day when I can think clearly and problem solve without panicking first. :)
Today I also had a Bosnian who spoke no English. His family left a list of 8 words that might come in handy in finding out what he needs. We are trying to figure out exactly what is wrong with him, it is a little more complicated than it originally appears. This pt. is really great though. We are getting to where we can communicate pretty well through motions, a few key words, and sound effects. Today I was beeping like the monitor to try to explain that when he heard the alarm go off he needed to put his oxygen mask back on. It took a few demonstrations, but I am pretty good at this whole beeping and miming thing. :) I may offer my services as an interpretor for those rare people for whom we have no interpretor on staff or call for their rare language needs. I think I kept him entertained. By the end of the day I had this huge stoic man waving back at me and giving me the thumbs up sign when I walked past his doorway in the hall. I love my job.
It is pretty amazing how much better your pt. and family receive care and respond to you if you take a little time in the beginning to establish a really good rapport. I love working with the families that come in. It is time-consuming, but when everyone is at ease, the pt. does so much better. I am beginning to have bigger aspirations about my career. I am still pondering them. Several are very appealing though. I hope I live long enough to carry out a couple of them. :)
Tonight I came out victorious in a battle with a cochroach for dominion over the living room. He kept scuttling out of dark corners all evening until he met his fate at my hand, delivered by one of Rachel's flip-flops. He was huge and ugly. I don't mind most bugs, but I do hate cochroaches. I think it is partially due to the horrible crunch their shell makes when you smash them, and partially due to the fact that I woke up one morning while I was at school and found one in my hair. That is a horrible start to a morning let me tell you.
I am singing in a Christmas cantata performed by the church that I have been attending so far. It is fun to be singing again. There are several songs that I like and the people are really fun. The director is pretty good too.
I have also been meeting lots of families with young children at church. Last week I babysat for a couple with 2 l ittle girls and a 14 month old boy. Tomorrow night I am keeping three little girls. I think soon I will be able to fill all the off days I want with child-care. And that makes me happy because I don't like life quite as much if I can't be in constant contact with children and babies. :)
It is turning to fall here. I hope it is breathtaking. Lots of people say it is not going to be a very good fall here because it has been so warm right up until we have started getting frost. I am optimistic however that my first coastal fall will be a beautiful one.
There is so much more I want to write, but not tonight. I am exhausted from my day and need some sleep/ This is my third day in a row at work. So glad tomorrow I am off and don't sit until evening. I can rest and catch up. I have been feeling old because my ankles, knees, and back ache after 12 hours on my feet. I have go to invest in some good shoes. I feel arthritic tonight. I think I will go prop up my feet. :) More to come I am sure.

*** So this is a slightly edited version of my post. I read over my post this morning and it was pretty crazy. I guess I was more tired than I felt at the time. The subject matter jumped so randomly from topic to topic, and the composition and spelling were atrocious. I have just made a few necessary revisions because many of the sentences made no sense to me this morning and were definitely not what I was trying to say. I made a few absolutely necessary editions and I will try not to compose that late at night again. I find it interesting that I included my late-night battle with a cockroach. Sorry if it is a little gross. :)

Fun day off

Hi everyone.
I hope you all had a wonderful Saturday. Mine was wonderful except for the feelings of guilt I experienced all day because I fell asleep last night before I called my friend for his 21st birthday. :(
However, despite these feelings I had a wonderful day. My 2 house-mates and I woke up super early this morning and took off at 7 for the Biltmore Estate in Ashville. It was a perfect day to be outside. When we got there it was still really foggy and cool, but by the time we were done touring the house the fog had burned off and the day was beautifully sunny and blue skyed. The house was absolutely amazingly beautiful and the three of us had a great day of bonding.
The gardens surrounding the house are beyond description. And even the estate land which is used for nothing in particular right now is so beautiful. It is just one of those lovely spots in the world. The house itself is wonderful and beautiful. Much better than I had expected.
We had seen commercials for their harvest celebration which included a lot of cool old folk arts and crafts. One of the advertised amusements was grape stomping and we set out to make sure this was included in our agenda. We had worked ourselves up only to be dashed to reality. We walked up to the winery and instead of the romantic wooden tubs in the vineyard there was a plastic banner proclaiming here was a grape stomping. There was a little black plastic tub containing store-bought produce isle grapes, and there was a place for you to dip your feet in purple paint and place your footprints on a large sheet of paper proclaiming you had stomped grapes at the Biltmore mansion. Sadly it was true. We were the crushed victims of false advertising. As it was we were hysterical with laughter at our situation, but we were still somewhat disillusioned and the romance was stripped from the event. As soon as I get an album for this trip compiled I will post the address so you can view it if you want. We also visited the old horse barn and there indulged in a maze made of hay bales. It is not quite as challenging when you can see over the tops, but it is really fun to see your friends' heads bobbing along.
If any of you are planning to come to this area of the country I highly recommend visiting this estate. There is so much tot see and we didn't even see it all. I plan to go back again as soon as I can. Hope everyone has a great week.

Big Day!

Well, family and friends…
Today is a momentous marker in my history. This was my first day on a hospital floor as a really-and-truly nurse. I tell you, there is nothing like it. It was quite the rush to tell my patients when I met them for the first time that I was one of the nurses that would be caring for them today. Despite the fact that they all knew it was my first day on the unit, it was very gratifying to see their respect and trust instead of the masked terror or skepticism I sometimes saw when I announced I was their student nurse for the day. It is also amazing what a difference having that RN at the end of your name makes in your confidence level. Not that I was by any means cocky, let me assure you. There is so much that I don’t know, or sadly didn’t realize I had forgotten. However, at the end of my first 12-hour shift I still had enjoyed the day and wanted to go back. I wasn’t even completely overwhelmed. I had confidence in my education. Thanks to Benner’s Model (a book we utilized in nursing school to find ourselves on a continuum of a nurse’s practice) and all my cultural awareness classes I realize that I am in the “honeymoon” phase of life as a nurse – but hey, if I am going be wonderfully optimistic, I might as well enjoy it.
I loved today, even thought I was a crazy day according to all the nurses. (That is rephrased and putting it nicely – again according to the nurses on my unit. And the nurses on my unit have much cleaner mouths than some units I have been on). My unit is a cardiac intensive care step-down unit/transitional cardiac care unit. However, today it was almost a catch-all acute med-surg unit. I think I am going to get some great experience here. Plus I am going to be cross-trained for the acute side of the CCU and another short-stay cardiac unit where people go for diagnostic cardiac tests (like heart caths). I think I will try to paint you a picture of my day. A little diabetic renal failure with a badly infected stint (port for dialysis treatments) in him arm, a clotted femoral catheter (for dialysis until the arm is no longer infected) that halted dialysis and blood transfusions. To make this pt. even better, not much Heparin (anti-coagulant/blood thinner) allowed because of GI Bleed. Oh yes! How about a little heart cath. How about a little 60 second flatline after a bolus of medication sent up from the ER with atrial flutter. I got to auscultate (listen with my stethescope) to the atrial flutter and that was really cool. And finally how about a LOT of psych nursing! Of course! I wouldn’t want to break my record by having any sort of time on the floor without a psych patient. They are always mine … Picture this one: blind in both eyes, in for seizure activity, rare coherent moments, abundance of meaningless strings of words (or at least I was not able to decode most of them), 4-point restraints (and not for lack of trying other options – they just all ended up with the patient trying to tear things off and throw self out of bed). And yet there were amazing though few moments of lucidness when we actually were able to communicate. It was challenging and very interesting and I really enjoyed it. I was able to try other options and see what worked best for the patients. This pt. was actually in for observation of seizure activity.
My unit is great. There were all really welcoming and helpful and found lots for me to do, but also helped me whenever I needed it. I have a great orientation program and a bajillion classes to attend and competencies to pass and check off on. I also have several other really nice new grads who I am in weekly and later monthly classes with. My first 2 weeks I am orienting with a year post-graduation nurse. Then for the next 10 weeks I will be with one of the most experienced nurses on the unit. I am excited and hope I will learn sooooooo much. Tomorrow I am going to practice reading rhythm strips (heart monitoring rhythms) again and review my cardiac meds.
Today was open house for my unit. On Monday we are moving to a brand-new state-of-the-art cardiac unit. I have my very own locker and I got to practice my combination today! The director laughed at me and said it was like junior high all over again, but I was like, “no way, this is a first for me – my junior high didn’t have lockers”. The closest I ever came was my mailbox at Harding. I had forgotten how much your legs hurt after 12 hours on the floor. I will definitely be investing in new shoes and support hose when I have capital again. If anyone is interested nurses always have varicose veins at young ages because of the all day on their feet thing. Sigh. I think I managed to tell you all my pt information without breaking HIPPA – at least I hope so. I sat through several classes on HIPPA already this week. It is hard not being able to debrief after the clinical day the way we could in nursing school. I have to be very careful at the dinner table.
So sorry to all of you my non-nursing friends. I hope this wasn’t to boring for you and that you could understand what I was saying. I really practiced restraint and tried not to be too nursy in my language. And I tried not to speak in the Harding College of Nursing dialect. I know I threw Benner’s Model in there, but I think I was pretty good other wise. If you did find this epistle boring I am sorry and I promise all my entries won’t be like this. At least the extensive nursing languange. I can't really help the randomness of my self-expression.

Today is another beautiful day!

Well, thanks to my many readers I have recieved pointers on my spelling. I warned you all about that but I guess I could use spell check from now on. I was going to tell you all that pictures of my new house are available for veiwing at the following web site: