tag:blogger.com,1999:blog-894076934743513832024-03-14T01:43:08.734-04:00From RPN/LPN to Registered Nurse (RN) - Now for the rest of my life what do I do?!It's been a long road! I was discriminated when I took my BSN the 1st time so I took a yr off school to think about what to do. During that time, I met & married hubby & he convinced me to go back to school to at least complete my practical nrsg. It was a long journey of distance Ed - completing my LPN to BSN degree in six yrs as I faced so many health challenges. But I made it through!!! Now I'm on the road to being the RN I've always dreamed of being - look at me shinePractical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.comBlogger357125tag:blogger.com,1999:blog-89407693474351383.post-25684811727923569682021-06-27T22:14:00.005-04:002021-06-27T22:14:54.509-04:00Spare the little ones<p> Recently had a CPS case (Child Protective Service) where I was brought a little one with suspected child abuse.</p><p>And the signs of abuse were so unbelievably obvious, there was no mistaking that this precious little person was abused. </p><p>Makes me angry because while I know what it feels like to be a young mom and to be in an abusive relationship and to be basically in charge of the care of a little one and not really know how to care for a little one and having points in time where I was angry at my little one.</p><p>But never once did I take that out on my little one. Whenever I got to that point, little one would go into their crib so that I could take a breather. Even if that means that little one would be screaming their head off. </p><p>You can't take care of a little one if you aren't taking care of yourself first..... but that doesn't mean that you forget that you're the sole person who is responsible for the care of the person who can't live without you.</p><p>I hope I don't have to take care of any more CPS cases. It just makes me so sad for the little ones and so angry at the people who swear they love this little one.</p><p><br /></p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-72136835611204244032021-06-19T19:24:00.001-04:002021-06-19T19:24:25.660-04:00Backstabbers and two faced<p> Started the new job. I think I've done about one week of orientation and I get called into the manager's office (my union rep is present as well). </p><p>None of the complaints had to do with my ability to be a nurse. It was all two people in particular and their complaints against me, including the fact that my husband googled someone and they didn't like that!</p><p>Actually, I was told that I breached confidentiality - I was like, OH HELL NO! Then they told me that it was the confidentiality of my coworker and I scoffed. I couldn't believe that they were saying that because I found information about my coworker that that somehow meant that I broke confidentiality.</p><p>Since when is it against confidentiality to not be able to find info into your coworkers if you so choose?!</p><p>Then I was told that I "sit too much" - I told them to pull the charts from the shifts and see how many of them had my writing on it and then tell me how much I was sitting if I was doing all the triaging and work?! Plus cleaning beds afterwards. Such bullshit!</p><p>And because this is a new workplace, I'm still in the midst on learning the policies and procedures, the ins and outs and what stuff I need in order to do my job.... I get shown a tool once or twice and am expected to use it and remember to use it.... instead of asking my preceptor about things.... the tool had to do with medications and because I asked my coworker about a medication and how they mix it here, it was used against me in the meeting. That I was shown that tool and should have just used that.... that I wasn't "receptive to learning from others"..... all because I forgot about the damn tool!</p><p>Needless to say I feel very much once bitten twice shy.</p><p>The next shift I worked after that I worked with a couple of nurses who were very different and advised me that there are certain people within the department that I should be "careful" around and avoid if possible. Hopefully I can. Otherwise, I'll be moving to travel nursing and then I'll end up being separated from family again.... something I would prefer to avoid at this time.</p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-62992495370715444792021-05-26T23:00:00.000-04:002021-05-26T23:00:08.729-04:00Big life change<p> Life is about to change in a big way....</p><p>Just worked my last shift at my hospital cuz we're out of here.</p><p>Hubby finished his training and got a job in the field that he's been pining for for the last <b>five</b> years. As such, we are moving where his new job is.... several provinces away. </p><p>When we told my family, my mother says "you sure you want to move <b>allllll</b> the way there, it's going to be cold"..... such a silly sort of thing to say considering I was raised in northern ontario! It's not like I'm not used to cold - not that I like it either, but it's not like I plan on living in the outdoors!</p><p>So now we're packing up all our stuff and purging the stuff we don't need or want, etc... Hubby keeps asking me, "you sure you don't want to keep that". Ya I'm Marie Kondo'ing - if I don't love the thing and use it all the time then it's "out of here" as the saying goes. I'm definitely in the process of getting rid of a lot of things. </p><p>What surprised the hell out of me is that hubby said he wants to buy things new when we get to our destination.... it's going to cost a bloody fortune but he's sticking to what he says (at least for now!). Knowing him, once the price tag keeps going up and our bank account keeps going down he'll change his mind and say I need to hold off. I suppose I should make a list and prioritize things I need immediately vs things I can wait for. </p><p>I'm absolutely excited to going. Little tyke is staying behind for now. I'm not happy about it but I've been advised that my say doesn't really count. Little tyke wants to stay behind for now and my MIL wants to keep her with her - we'll see how long that lasts! Little tyke is now 12 and has major attitude and tends to only listen to myself and my SIL - so I can see the fights that will ensue when I leave. I told my MIL that if she keeps her, I don't want to get a phone call from her saying that little tyke isn't listening or is being a brat, etc.... and if she does, then she's responsible for getting my daughter to me in the other province. I have a bet going that she'll bring her to me by august, december at the very latest. We'll see if I'm right.</p><p>So for now it's just hubby and I going.... which isn't too bad. I like that I get time with just us, no one else around. Right now there's NINE people in our household, it's hard to get alone time with your spouse outside of your bedroom. So it'll be wonderful to have that, we haven't had it since we were married for like 6 months. I suppose with it just being us there it'll make it easier to try to have a baby - hahaha</p><p><br /></p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-29044967924452436362021-05-11T19:32:00.004-04:002021-05-11T19:32:46.311-04:00It's exquisite<p> I took care of this really sweet patient over the weeend. </p><p>Sepsis caused him to become delerious and he kept asking for something to drink. The first shift I had with him he was NPO (nothing by mouth) and so I couldn't give him what he desperately asked for. My second shift he was allowed to have clear fluids and he kept asking for water... he was also on D10 (sugar water basically) and so I told him that if he was thirsty that we would give him some apple juice.</p><p>When I advised him that I was going to give him apple juice the conversation went like this:</p><p>him: "I don't want apple juice, why do I need that, why can't I just have water"</p><p>me: "because the apple juice has sugar in it and you need that right now"</p><p>him: "but that's exactly it, apple juice has too much sugar in it, that's why I don't like it"</p><p>me: thinking in my head - yep then you will DEFINATELY like our apple juice cuz it does NOT taste sweet! - instead I said to him - "how bout we try it out, I'll even make it really cold and add some ice"</p><p>him: "well if you're going to add ice, I'll try it"</p><p>me - make his apple juice with a ton of ice and bring it to him, give him a sip</p><p>him: "my, I don't know what you did but this is exquisite!"</p><p>hahahaha - I laughed so hard let me tell you. He was just so earnest. He would take a sip and kept commenting about how wonderful and delicious and how it was hitting "just the right spot". Oh he was so cute. He just made my heart melt.</p><p>Same patient the next night I was getting him all tucked into bed to sleep, got his pillows all fluffed and set up all around his head, tucked his blankets in all around him and under his chin and he turns to me and says: "thank you for being you, I love you, thank you for taking such great care of me".... and subsequently closed his eyes and went to sleep.</p><p><b>Melt my heart!</b></p><p>These sort of moments make me realize even more why I love being a nurse.</p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-81640993646129579482021-03-21T22:18:00.002-04:002021-03-21T22:18:30.860-04:00When Dr's kill patients<p>I'm so very sad to say that one of my patients died because of physician negligence, this is their story...</p><p>I had a patient return to our unit after getting several heart stents. I got this patient 5 hours after they returned.</p><p>I worked night shift and the report I got was this:</p><p>Such and such a year old person, full code, just returned from getting several stents. Have been busy because said patient is having diarrhea. A&Ox3, no neuro issues. NSR, BP stable. Pt is SOB (which I interjected and asked if the SOB was new or not, did it improve at all post stents, is it worse with exertion, is the pt SOB with rest) - to which the person giving said report was unsure about some of the answers and so we stopped report so that they could give me these answers. Then we continued with report - I was told that the patient had diarrhea, has had it since admission, CDiff pending. I get told that pt has a foley and output for last 5 hrs was 150cc total, and that the pt got a dose of Lasix upon returning from the other hospital. I again interjected and commented that that is the bare minimum for the pt to have.... and that means that the patient didn't diurese at all, and that is something that should have been told to the physician before they went off duty. I asked if blood work was done upon returning and they said that it was, and find out that the patient's creatinine is sitting at 262 - and am told that the patient's baseline is in the 200's. The nurse basically said, oops, my bad.... and we completed report.</p><p>Now, I don't know about you folks but we are doing team nursing and so I got report on all but because there were other patients who were worse off and I had a cardiology nurse who was redeployed to be my "team nursing" person, I made this patient their focus....</p><p>Now fast forward a couple of hours and the redeployed nurse came to me to give report for their break and they proceed to tell me in passing that the patient's urine output "isn't too great".... which I made them give me a definitive u/o per hour - and when I'm told 10-15cc/hr I asked for how long that's been the case and I was told basically since we started shift. I was miffed to say the least and told them that they needed to now call the on-call MRP and advise them of everything.</p><p>While waiting for the MRP to call back, we looked up the blood work from before going to the other hospital and getting the stents done, and compare it to what it is upon returning..... to find out that creatinine rose from 97 to 262 and GFR (how well the kidneys are filtering) went from 40 to 15.... so ya not good!</p><p>When the MRP called back, the other nurse told em everything and the Doc asked, well how is the BP and oxygen requirements - MRP is advised that BP is stable and O2 requirements haven't changed and so is told that "it's a days issue" and completes the call. I told the other nurse to document the crap out of that (they were shocked I told them to do this, but advised them that that way if anything bad happens because of their decision, that it's on their license and not ours!) and they go and document said call. I then take over care of the patient and when I went to go tip the urometer to see the hourly u/o I find out that the patient doesn't even have a urometer.... so how in the hell is everyone checking the hourly output, I doubt that they are emptying the bag every time and measuring it. So I proceed to swapping it out for a urometer so that I can actually know an accurate hourly output.</p><p>I do my 0600hr blood work and the results show that creatinine is up to 403 and GFR is down to 9 - and the hourly u/o is <5cc/hr - so I call the MRP again and advise him of this. I get asked what the BP is and O2 requirements. I advise him that they haven't changed <b>yet</b> but asked if there was anything that they wanted done. I'm told <b>again</b> that it's a "days issue" and they could deal with it on the day shift. I commented that isn't there something that we should be doing now. I'm told, "well they could try a dose of Lasix" - I responded with "well we already tried that and there was no response, the patient didn't diurese when the patient got back from the other hospital" then the Doc said "well they could try some fluid" and I told him that the patient's already SOB and overloaded and her BNP was 4000+ and so more fluid when she wasn't making any urine was <strike>probably </strike> not going to help. I got shot down and am told that this could be dealt with by the days MRP. And the call was ended.</p><p>When the next nurse came onto shift - same nurse that gave me report.... I told her all that had transpired and what she had screwed up. The nurse felt bad for not catching the errors of her way and doing something to fix it. I told the nurse that the patient needed a STAT nephro consult and if the MRP wasn't on unit by 10am to call them and advise them what was happening.... then I go off shift after finishing report.</p><p>I come back for my second night shift and as soon as i'm on the unit the patient is being packed up to go somewhere.... come to find out that nephro had only shown up at like 1800/1900hr and had ordered a STAT kidney u/s and so off the current nurse and I go and I get report while we head out. She goes on to tell me that the MRP did <b>not</b> arrive before 10am and had to get a hold of her. Then the Doc goes and gives the nurse a hell of a time because she wasn't informed what was going on with the patient. I told the nurse not to fret about it because that wasn't her fault overnight because that's on the other Doc - she shouldn't be getting upset with her because the other Doc didn't call her and advise her what was going on with her patient overnight. I get told that nephro did come onto the unit and the nurse did try to get him to see the patient but wouldn't listen to the nurse and instead saw the other patient that had a pending nephro consult - even though the nurse had advised him that this other patient required it more than the one he came to see.</p><p>Regardless, I take over responsibility for this patient and am told that this patient was going to be transferred from the step down area to the main ICU area... but that we needed to do a bed swap first. The nurse tells me that nephro indicated that after the u/s results came back that he wanted to be advised of the results and had left his number on the chart. So about 45min goes by and in this time the RT comes by to see one of the other patient and I comment to her that my patient's work of breathing had significantly worsened since the previous shift and I wondered whether they would benefit from some optiflow.... because they were stable on the amount of oxygen they were on but I thought would benefit from extra flow because the patient indicated that they felt like they couldn't take a deep breath. So the RT went over and talked a min with my pt and said that she thought that a ABG would be a better bet to see where they stood and sort of go from there. So the RT did that and I waited fro that result to come back.</p><p>About the same time I get the results of the u/s and the ABG and proceed to call the nephrologist. I get his voicemail and I proceed to leave one, with my direct extension. Then I wait another 30 min and don't hear anything so I call the daytime Doc who is ultimately responsible for this patient but that isn't on but does have a history of wanting to know what's going on with her patients.... so I go ahead and call her and advise her that I've called the nephrologist, left a voicemail and haven't heard back from him. I told her the results of the ABG and the u/s and she tells me that nephro is aware of the results and will be calling in orders. BTW, the ABG showed that the patient was in metabolic acidosis with a pH of 7.26 and a bicarb that I think was sitting at 5, and lactate was sitting at 7 if I remember correctly. So pt totally needs some dialysis.</p><p>Another hour goes by and I don't hear from any Docs but I get the other patient up in that time and then the nurse who's taking this patient shows up to bring her to the main ICU and I proceed to give her report, telling her evyerhing that has gone down. She then tells me that nephro called orders to our charge nurse. Which miffed me for sure. It'd the equivalent to me calling the chief of physicians to get orders. Ya I was pissed but whatever. </p><p>Then the pt gets handed off, I wish them good luck and tell them that a few rounds of dialysis and they'll be back in business. I truely thought that at the time. </p><p>I finish my shift and when I get to the main ICU and ask how the pt is doing, I find out that the patient crumped at like 5am and required intubation.... that their ABG showed pH at 6.97 and bicarb sitting at 2 I think.... so not good. And that the patient did NOT get a dialysis line put in after they were transferred and didn't get dialysis like they should have.</p><p>And by then it was too late.... two days later and the patient died. For no reason. If these Docs had just done their jobs.</p><p>I can't quite fathom why nephro went home after ordering that kidney u/s and not putting in a dialysis line. Having the u/s done wouldn't have changed the need for dialysis. I just don't understand it all. I don't understand how the night shift Doc put it off on the dayshift Doc, how nephro wouldn't see the sickest patient and doesn't come see the patient til the end of the day and then chooses NOT to line the patient before they leave.... or don't return when they hear that the patient is doing so bad.</p><p>This patient didn't have to die. It's so sad and really angers me. It's such a senseless death. And THIS is what gives nurses emotional burnout!</p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-17320154933153098462021-02-24T06:06:00.005-05:002021-02-24T06:06:45.066-05:00ETOH is out of control<p> It seems that COVID has hit ppl hard right now. So many of our patients are in due to ETOH abuse/detox issues. </p><p>I wonder what happens in one's life for a person to give up sobriety and hit it so hard that you cause yourself to have a seizure from hyponatremia?!</p><p>Any of you know about hyponatremia and why it can be so dangerous? When you have someone's Na level so low that they have a seizure or fall into a coma, you really want to make sure that it increases slowly. If it increases too quickly, you can get demyelination, brain edema or brain herniation.</p><p>Unfortunately, my patient had other thoughts in mind. </p><p>We were doing serial q4hr electrolyte checks to make sure we were aware of where the sodium levels stood. I checked the level and then my partner encouraged me to go on break. I advised her that she needed to make sure she was looking for this value and to ensure that the MD was made aware of the level.</p><p>I came back from break, our usual time frame and yet there was still no level back. We are in the midst of doing team nursing and so I had four patients to tend to - one needy patient, one trying to climb out of bed and pull lines, and then I had a legit sick patient.... plus all the usual hourly things that I was responsible for.</p><p>So of course the sodium level was overlooked, and lab didn't call me because said level normalized and they don't call anyone for "normal" values.... shitty in this case.</p><p>Long story short, the value rose much too quickly - like by 13 points in like 4 hours.... damn. And the MD comes down the hall saying "hey, why didn't you call me with this value like I told you I needed you to? They patient has been getting too much of this kind of fluid for at least 2 hours".... I advised him that I couldn't help it, when I got back from break the value wasn't returned and then I got busy with these other ICU patients.... thankfully he's an understanding MD and was like, ok, change the fluid.... which I did promptly.</p><p>Doing q1hrly neuro checks denoted no changes in said patient's neuro status thankfully. Even 24 hours later, no obvious damage was noted. It didn't seem to matter what fluid we put this patient on, because the sodium value still rose of its own accord.</p><p>I'm sure that in a couple of days the patient be back in their own abode, going back to the alcohol that put them in the ICU in the first place. Such a shame.</p><p><br /></p><p><br /></p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-69695769780831824362021-01-19T17:51:00.001-05:002021-01-19T17:51:17.745-05:00Long term effects from COVID 19<p> Being on the front lines and seeing this terrible illness ravage people is not easy. I regularly get frustrated that the population at large just don't seem to grasp the fact that COVID is not just life threatening but even when you have a "mild case" of it, that it can affect you for the rest of your life.</p><p>I've recently cared for someone who caught COVID and is now extubated and "recovering".... but is left with permanent cognitive issues because he was starving for air for too long and it starved his brain of the oxygen it requires, leaving him with an anoxic brain injury. Never will he work again because he can hardly talk, can barely move, and the brain injury makes it difficult for him to even respond. It will take him years probably to walk again, with many months of physiotherapy involvement to gain strength. He will need speech-language pathology involved so that he can learn to swallow and talk again. He will need occupational therapy to help with the daily activity of living.... with being able to manipulate a cup, spoon and hair brush. Things that we absolutely take for granted.</p><p>I know of two staff members who have caught COVID from work. Both are young and healthy. Thankfully they did not need to be hospitalized but required months to get back to functioning levels. Both state that they have lingering lung issues almost a year after they caught this illness. They say that going up a set of stairs makes them gasp for breath and forget being able to work out, that's just not possible. </p><p>There are many patients that our ICU has cared for who have caught this illness and while they weren't hospitalized because of COVID but because they are experiencing the after effects of this illness - having a stroke or a heart attack. Or experiencing renal failure because their body sent tiny clots to areas of their bodies and caused damage. We've had patients go into DKA because of COVID after the fact because it taxed their system and it couldn't cope with stupid COVID.</p><p>But I also wonder about the after effects that COVID will have on the rest of us who don't catch COVID, but still are affected by it because we're wearing these masks for such extended periods of time. I wonder how much CO2 we are rebreathing. If anyone has seen someone whose CO2 has risen, they can attest that these ppl kinda go coo koo. Anyone who is relatively healthy has a pretty good buffer system in play and so their body buffers this rising CO2 - but it has to have lasting effects on our body. I wonder about the kids who have to wear masks for 8+hrs a day when they go to school. Are we going to see issues with psychiatric conditions in 10+ years? Are us adults in 10-15years going to see more psych conditions or dementia/alzheimers? </p><p>I wish that people would stop being so damn selfish and stay home and away from people. Stop visiting anyone, unless they are bedridden and require daily care. Otherwise, stay away. People don't understand or just don't care - or they think "that won't be me" - but with the way the numbers are going - damn right it will be - it will be you.... or someone you love. And then what?! Are you going to turn around and be "20/20 is hindsight, golly I wish I had done things differently". How is that going to help when you no long have your parent/grandparent/spouse/brother/sister/cousin, etc.... around because you just <b>had</b> to go visit them. </p><p>You and they will survive being apart for a bit. If it keeps ya all alive, it's worth it!</p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-66536596320226938032021-01-14T19:30:00.001-05:002021-01-14T19:30:30.652-05:00Taking care of crazy in this crazy time<p> There was a mix up in one of my shifts the other week so I ended up going into work late. When I get there I am advised to seek out our teammate and inquire what pt she wanted me to take from her. On the board I saw that one of them was CIWA = ++++work.</p><p>And of course when I asked said teammate, she responded with me taking on the CIWA. I joked with said teammate about me seeing what type of teammate she is, giving me that CIWA.... ok, np I shall take up this noble cause.</p><p>Then when I opened our charting program, I see on the board that the other pt she could have given me is a recovering COVID pt..... one that I can't even take in the first place. So I would have been stuck with the CIWA anyways. Guess it was just my lot in life for this shift to end up taking this on.</p><p>Well so be it....</p><p>Then we got into the thick of it.... the CIWA pt telling me that I took away their scissors and how I should give them back and that it was against the law to take them and if I didn't give them back that they were going to sue me! Ha, have fun with that one coo koo.</p><p>Oh did I forget to mention that this person is bat shit crazy and in 4 point pinel restraints?! Ya person's a frickin crazy and on CIWA! Oh yay!!!</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://lh3.googleusercontent.com/-kvYhFVJs39Q/YADeeXXMpmI/AAAAAAAAMrM/_EHD--Z-cTE827hRy6oBnoFEB7-ck2-1ACLcBGAsYHQ/image.png" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="525" data-original-width="468" height="240" src="https://lh3.googleusercontent.com/-kvYhFVJs39Q/YADeeXXMpmI/AAAAAAAAMrM/_EHD--Z-cTE827hRy6oBnoFEB7-ck2-1ACLcBGAsYHQ/image.png" width="214" /></a></div><br /><p></p><p>I told them that they could go right ahead and sue... sue away!</p><p>Then I was told that I shouldn't lay my hands on them - when my hands were within their eye sight and holding onto the side rail up by their head!</p><p>Then I had a colleague come in and "suggest" that we pull said pt up. I was like, hell why not. So away we go and do that, and she turns to me and says "touch me and I'll fuck you up!" - oh goodness we had a good laugh at that one..... she's in 4 point pinel restraints. She aint doing any touching!</p><p>A couple of hours of trying to keep her in the friggin bed, then she's all serious when I go in and check on the levels of meds running through the pump and she turns to me all serious and says, "when I get out of here, I'm going to find and kill you". I didn't even deam to respond and simply nodded my head and walked out of the room. No point in even responding to the delusional. Besides, even if she could follow through on that, I am highly unfindable as I have an unregistered phone number and the house I live in doesn't belong to me.... so go ahead and try!</p><p>This person was nearly impossible to reorient, but I did try several times. You can only help crazy so much. </p><p>Hell, the person was trying to climb out of bed with 10mg/hr of Versed infusing as well as them getting Valium 10mg IV q1hr PRN.... like I said, crazy!</p><p>And that's what I dealt with all night long... it was a long shift to say the least. Thank goodness I don't have to deal with CIWA pts often.</p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-88733937128198884572020-11-18T08:52:00.005-05:002020-11-18T08:52:43.128-05:0014+ units and counting<p> It's hard to believe that amount of blood one has inside the body.... unit it starts to be expelled from the body.</p><p>I had a pt who had a GI bleed... and anyone in healthcare will know the smell that the breakdown of blood creates.... the smell of melena stool.</p><p>I was lucky enough that my pt was expelling things fast enough that it wasn't smelling like that. When I got the pt, he had had several procedures in an attempt to stop the bleeding internally. We thought it successful.... during my shift he only had two BMs - and it didn't have the clots and bulk that it did before. I thought I was pretty fortunate. I also thought the procedure successful.</p><p>Until the next shift when I ended up cleaning up six BMs. Again, no real melena smell. I figure where they thought that they had an issue and thought that they had fixed was what would stop the bleeding. Clearly though they did not... based on what the stool looked like, I imagine it to be small bowel, but close to the large bowel. Because it's not like it was bright frank blood but it was broken down some - but clearly it wasn't in his bowels long enough for the blood to be broken down to the point where the enzymes interacted with it and caused the typical melena smell.</p><p>Another scope another time. Hopefully this time it was successful.</p><p>For all the bleeding this poor soul has undertaken, he ended up with 14+ units of PRBCs.... his blood volume replaced twice+ over. Hard to believe, but hey, the human body is miraculous.</p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-77496016221461184282020-11-16T17:53:00.001-05:002020-11-16T17:53:15.966-05:00Full of bullshit<p> We're almost at a point in our ICU that we can't accept any other patients. COVID's second wave is starting to take over our ICU. At last point we had 5 pts in our ICU and another 7 pts on the wards. And of course our numbers in the province are only getting larger not smaller so it's inevitable before we get inundated with COVID pts.</p><p>I previously asked our manager what the plan was for <b>non</b>-COVID ICU pts when our ICU is COVID pts - the powers that be indicated that they would cross that bridge when they come to it.</p><p>The last wave had some of our staff in the unit above with COVID ICU pts - a dangerous endeavor as the monitors for the pts were all inside the rooms, so it made it difficult to monitor pts accordingly. I'm sure they will be doing the same thing very soon.</p><p>Being that I have a workplace accommodation that I don't have to work with these pts, I've asked what they plan to do with ICU-trained staff who all have accommodations.... there's always going to be ICU pts that still need assistance.... until such a time when our hospital is overtaken with COVID pts. I'm sure that it will happen, look and see what's happening in the large cities in the US. Guaranteed that's what's going to happen here in Canada.</p><p>Hell, it happened with the first wave and everyone is saying that this wave is going to be worse. So I can't see us not getting hit this time around. We were actually quite fortunate that we weren't inundated with COVID pts the first wave. Sure we had our fair share, but at least it was manageable. I have no idea what they're going to do this time around.</p><p>I also think that the powers that be need to sort their shit out on who they provide resources to. I mean, intubating a 90yr old (IMO) is just a waste of resources when the second wave is just beginning. It's not likely that they're going to survive COVID, so why not just attempt to make their death as comfortable as can be?!</p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-77691502965026843302020-10-24T00:38:00.000-04:002020-10-24T00:38:02.518-04:00On to markings<p> Received a pt a little bit ago, he had gone to our sister hospital for a cardiac catheterization.</p><p>They attempted to do a radial approach and was unsuccessful so they did the approach through the femoral artery. Now, one of the known complications is nicking the artery and causing bleeding. This poor soul was one of the unlucky few who experienced this and ended up with a retroperitoneal bleed - essentially, where they nicked had bled into his abdomen, creating a large blood clot when it stabilized.</p><p>It's obviously a medical emergency because your belly is a LARGE area and you can bleed into it quite quickly so the nurses that were there were laying all their body weight onto the poor gent in attempts to save his life.</p><p>Unfortunately, they didn't think it prudent enough to both to tell the poor gent that they were trying to save his life by doing just this. Now, do remember that this action is EXTREMELY painful to the pt. So of course this pt was fighting the poor nurses trying to save his life. I'm sure they could have saved some of the grief that they were receiving by just simply teaching the guy a few things!</p><p>So when I got him he was bruised, but not overly so. As soon as I received him on shift I examined his groin, how much bruising he had to the area and his abdomen for any subtle or blatant bruising, as well as his lower back because it can show up there as well. All things to keep an eye on. Stupid me though didn't mark the borders of his bruising (more on why that's important in a just a min) but just made a mental note of where and how much bruising was there in the area. I also checked out what was going on with his dressings to make sure that they were dry and intact, or whether there was any previous or active bleeding (femoral and radial areas). Both were as they should be, clean, dry and intact.</p><p>So off my pt goes to sleepy town and in the morning when I wake him for blood work, he tells me that his belly really hurts. I asked him if he needed to void, he told me no but I told him that he needed to attempt to void anyways. So off he goes, does just that and questions why he had to pee so much when he didn't feel the urge to go. So some education time later, I told him I needed to see his nether region to check out the bruising and whether there was any swelling. One of my red flags went up because I noted that his mons pubis (where all your hair is above you lady/gent bits) was more swollen than at the start of the shift and another flag went up when I saw that his bruising had extended in towards his mister bits. </p><p>I asked if his pain had changed since voiding, thankfully he indicated that it had lessened but was still present. I went an looked to see whether my CBC was back and examine what his Hgb (red blood cells) were and how much things had changed.</p><p>From my pt returning and having his Hgb checked at ~1000hrs it was 127 then at 1600hrs it was 121 but when I got the result at 0600hrs it was 108 - so in almost 24hrs it had dropped 19points - <b>significant!</b> </p><p>Off I went to tell my charge nurse all this and ensure that i was doing the right thing by getting a hold of the physician... she agreed and off I went to call him.</p><p>I advised the Dr of all of the above and asked what they wanted done.... I got complete silence. I understood that I likely woke the Dr up but still expected something more. So I asked whether he wanted me to just monitor it or do something more extensive. I was told to monitor it. I asked how normal the spreading of the bruising was... I was told that gravity would naturally spread the bruising down the leg and into the groin and nether bits, but that marking is prudent. I advised that I had done this prior to calling. Then I got silence again. I was expecting more from this Dr, some sort of direction to take. I asked if he wanted me to repeat the CBC, say like 6hrs later.... I got a "ya, sure". Ok, I guess I'll take it. The good thing was that at least I could document it all. I did my part in all this.</p><p>Marking my pt was quite interesting, having to get down and dirty really.... getting handsy with his bits and pieces so that I could mark where the boundaries of the bruising were. He was a sport though and took it all in stride.... "oh I wish this could have happened when I was a 19 yr old!" HA! </p><p>Unfortunately, when I came back 12 hrs later, he was transferred out to give the bed to someone who was sicker so I don't have any notion as to how things ended. wahwahwah. C'est la vie, such is the life of a ER/ICU nurse.... we don't always get to know the outcome of our pts after they head out of our area.</p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-82549057324092159452020-09-07T19:15:00.000-04:002020-09-07T19:15:04.319-04:00COVID baloney<p> Friggin Covid. I'm sure there's a consensus that it sucks. For me personally, I haven't had to have much to deal with this on a patient level. When we started to get COVID pt's in our ICU, I got a workplace accomodation as I have a IgG deficiency and I also take Humira which further decreases my immunity levels. My IgG deficiency tends to affect my lungs in particular and so I had a conversation with my MD about the accomodation to not have any suspected, presumptive or confirmed cases of COVID. The notion is is that if I <i>were</i> to contract it, that I would be one of the unfortunate few who would require ICU admittance and probably be intubated. So to protect me, I got it done. Paperwork was sent off to Oc Health and it was granted.</p><p>Then when they were reevaluating the accommodation status of everyone in the hospital, mine was as well. I explained to them why I needed the accommodation and what not and they told me that they would speak to the Oc Health Dr and get back to me. They did, and I was told that the Dr had advised that I be redeployed <b>permanently</b> out of bedside nursing!!! I told them that I appreciated that they care enough to recommend that but that I was kindly declining that. I told them that I had mitigated my risk by leaving ER and moving to ICU... that in the ICU I am generally 1:1 or 1:2, unlike in the ER when you could be up to 1:5/6.... and when the pt finally gets to ICU, we generally have an idea of what they have and there are generally treatments available for whatever ails them and so IF I were to catch whatever a patient has, there is the treatment available. And if there redeployed me elsewhere, med-surg is generally 1:4 and up to 1:8.... and if they put me in a clinic I could be exposed to as many people as 100 per day.... so obviously the risk is smaller in the ICU when I'm only going to be exposed to as many as 2 ppl. </p><p>When I explained it that way they responded that I had clearly given this some thought.... of course, it is my health and life we're talking about!</p><p>So I've been trudging along in the ICU, not having to care for COVID pts when an unexpected thing happened...</p><p>I had gotten my hot drink from the coffee place in our hospital and was walking to my unit and somehow pinched a nerve in my neck. Holy crap was it painful! So I was on modified for a bit and when our area of the world opened up a bit and I could go see a chiropractor and he put me on further modified duties and so I was taken out of ICU because they couldn't accommodate my restrictions.... no bending/twisting, no lifting over 10 lbs, no raising my arms above my shoulders and no pushing or pulling. He figured that I was compensating for my neck with my lower back. So then I became a COVID screener and have been there since, goodness I miss being a nurse!</p><p>Well then one particular day I had a particularly busy shift and when I went to the chiropractor and did an adjustment on my back, a very minor one on my lower back in particular, I couldn't put <b>any</b> pressure on my lower back, I had crazy pain travelling down both of my legs and I couldn't stand up. The chiropractor gave me some numbing cream to put on the area and in about 20 min I was finally able to stand, but lifting my feet was still an issue and it still hurt to do so. These symptoms got better with time thankfully but the chiropractor thinks there's something structurally wrong with my lower back and stated that I need a MRI to figure out what's going on and that I shouldn't go back to full duties until I get this done. Not that hubby agrees with this. He wants me back in the ICU ASAP, be damned if I get hurt again or more.</p><p>So for the time being I screen ppl for COVID symptoms as they're coming into the ICU... behind glass and in proper PPE. I hate it, but it's an easy job for sure. We'll see where this takes me.</p><p><br /></p><p><br /></p>Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-47606071269639468962020-07-04T15:59:00.001-04:002020-07-04T15:59:58.094-04:00WTF OR?!To hand someone over that is basically dead and say that they are only hemodynamically unstable in not OK.<br />
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We knew that we were getting a patient who went from our sister hospital's ER and transferred to our hospital's OR for emergent surgery. We were told that this person required massive blood transfusions - weren't told what they received but that the code for the massive blood transfusions was cancelled - making us believe that the person we were getting was stabilized. I told everyone that it was going to be a "gong show".<br />
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We tried to look up in the system something about this person because all we knew was that they were really young and they had an inferior vena cava filter and that it had eroded there and the pt was bleeding. We knew that clearly this person had other shit going on if they were that young and required this. The crazy thing is that the chart had NO information from doctors from the last four days worth of ER visits! No information listed to blood work that was done over the last couple of days. How in the world could this person not have ANY blood work any of the previous days considering they were on blood thinners and had this filter in place. You would think that they would do blood work (BW) - such a basic thing. On the fourth day they finally did and their INR was 12!!!!! Oh, and their Hgb was 30!!! Shame on the ER for not doing BW on any of the other days, they for sure would have caught things declining a whole lot sooner.<br />
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I was the assist nurse that shift, helping those who received admissions. The nurse had indicated that they hadn't done an admission yet - surprising cuz this person had been there longer than I. So I advised them that when the OR called to ensure that a proper report was given because often they will just tell us that they are coming and asking whether we're ready. So I told her to make sure that she found out what state that this person was in. I advised her to find out what meds that this person was on because I absolutely believed that this patient would be on meds to support their BP, guaranteed and you don't want to be chasing your tail when they arrive, trying to get these meds infusing while trying to settle your patient. For some unknown reason the pumps they use in the OR is different than the ones used in the rest of the hospital. Therefore it was pertinent to find out the meds they were on so that they could be ready to change over to our system. Of course I was right when they called and advised that they would be coming in 10-15 min and then subsequently hung up. The nurse, listening to me, called them back and received a proper report.<br />
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When the OR people brought the patient to us the lines were a mess! While myself and another nurse were getting things sorted out and attached to our cardiac monitor, I pulled all the blankets off and saw that they had two intraosseus (IO) and several peripheral IV lines and then a single lumen central line (SLIC) - and they had pressors running but no blood or even IV fluid. The pt also had a art line showing their BP and when attached to our monitoring system we could see immediately that the art line BP was seriously low => something in the area of 50/25.... not enough to sustain life for sure. And the nurse asked the anethetist WTF and was told that the art line wasn't accurate so a BP cuff is quickly put on and the BP was basically unchanged - so immediately the ICU Dr asks for a pulse check.... nope, no pulse and so we immediately start coding this pt.<br />
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We restarted the massive transfusion protocol and start pumping fluids in, hoping that we can revive this person. Sadly we coded this person for quite a long time and couldn't get them back.<br />
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Now I'm left with the feelings of this whole situation. I don't understand why the OR would cancel the transfusion code... did they even check pulses before sending us this person. Were they just trying to offload this person on the ICU so that they could be relieved of the fact that this person did NOT die in the OR?!<br />
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We had a debrief after TOD was called. We talked through this all. We talked about how hard it was for information to be found about this person's current medical condition and any recent blood work. We couldn't understand how the OR did NO blood work while the patient was in the OR. Why would they cancel the transfusion protocol if they had no numbers to back up cancelling it. They had NO idea what this patient's Hgb/Hct was when they brought them to us in the ICU.<br />
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ICU didn't stand a chance of saving this person because so many people before us failed this person. To learn that this person just celebrated their birthday and then to learn that they were a refugee made this death even worse. Such a short life to be cut short when so many other steps could have been taken to save this person.<br />
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<br />Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-52221883075543063402020-05-29T16:08:00.002-04:002020-05-29T16:08:28.853-04:00OuchWe have a coffee shop in our hospital and several weeks back I picked up my tea and headed to my unit. But on the way up I managed to hurt my neck. Couldn't tell you how.<br />
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I went home that day, goodness the pain was intense. But it gradually eased up and I went back to work after a bunch of days off. I got lucky that I had cardiac patients and it wasn't hard on my neck and got through my couple of shifts. </div>
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This last week however, I had a typical ICU patient and managed to tweak my neck again. Goodness it hurts. I get this shocking pain down my neck, through my shoulder and down into my fingers. I know I pinched a nerve at about C6-ish. Confirmed by the ER MD. No test though, so don't really know why exactly it happened.</div>
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Regardless, I lost another day of work and had a couple more days off afterwards so I rested as much as I could - doing my physio to help myself.</div>
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But to no avail, still hurts like a mother sucker - so I let my family MD know about it and so now I'm on modified duties. Also, I need to have physio and a chiropractor would be helpful, but can't because everything is still shut down. Sad face!</div>
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Had to work last night, thankfully we had an ICU patient that didn't require any pushing/pulling,turning/lifting - a nice stable DKA for me thank you very much.</div>
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Even having a pt like this caused pain - but at least it was manageable. We'll see what this weekend holds as it's my weekend to work. So this should be interesting to say the least.</div>
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Wish me a speedy recovery.</div>
Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-87485254684140271032020-05-13T02:31:00.000-04:002020-05-28T19:04:27.168-04:00When the will is overrun by family decisionsHow does it come to be that families can make the decisions for family members in critical care, when they themselves have made it known what they would choose for their life <i>and </i>their death?!<br />
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When someone comes in for a fairly basic surgery (albeit an emergent one) and have a perioperative MI and when they are woken are told what has occured and that they require a cardiac catheterization - to which they decide that they would prefer to not undertake this.<br />
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The surgeon (or whoever it actually was - a MD none the less) had a frank conversation with said patient and indicated that the catheterization wasn't performed, that a major heart attack would occur.<br />
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The patient, in right mind, made the decision that they would not have this procedure performed, even if that meant that they would have a heart attack.<br />
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Then advised that they could die if this occurs, the patient indicated that that was alright and that should a heart attack occur, no CPR/defib or intubation occur. Meaning that nothing should be undertaken if a heart attack is to occur and survival not be possible.<br />
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Now the twist in this entire story is the fact that the health care person who had this conversation, and could write it down and make it official, DIDN'T WRITE AN ORDER!!! All they did was put it in their notes. Friggin idiot!<br />
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So of course this person had a massive heart attack and went into an unsurvivable cardiac rhythm (VF to VT) and they called a code and managed to get this person back.<br />
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Then of course it's family who decides what the next steps will be. Even though the family find out what the patient said to the MD, they still decide to do everything in our power to get this person through this.<br />
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Now after some time has passed, this person is basicly a vegetable - doing very little more than lying in bed and existing.<br />
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I feel for this patient - ending up in this state after indicating exactly what they don't want and because of an oversight, ended up having everything done they didn't want. Now they have to live with the consequences of this and what their family is choosing for them.<br />
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If I were them, I'd come back and haunt my family after I actually get to die. That's the least that they deserve for making me suffer as a vegetable in bed. Such a pity of a life. No quality at all.Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-7332759265260473652020-05-11T23:17:00.000-04:002020-05-11T23:17:17.887-04:00Heart to heartAs I've indicated, I work in a combined CCU/ICU and so there are times when I have to take care of people who have heart issues as their main issue. That's what I got to take care of one shift, I started out with a completely different assignment but because of my workplace accomodation, didn't have to remain on that assignment and was traded for someone else's. I ended up with a little old lady (LOL), a 96 yr old gal who had a NSTEMI - perfectly stable thankfully. More of a watch and see. She just wanted to be medically managed and be made better. That's what she got in the end.<br />
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My other bed was empty at the beginning of the shift but I was told that I would be getting a new admit from the ER. Another NSTEMI but with an extensive cardiac history and was on chemo for some kind of cancer that metasticized elsewhere. Never a good thing. Chemo is <b>HARD </b>on the body I say, and of course that also takes a toll on the heart.<br />
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He was a sweet old sole. When I first met him, in the first 10 minutes became significantly unstable. I spent my entire shift on the phone calling the most responsible physician (MRP) for orders or follow up - this that and the other thing. I felt like I was calling them constantly. All for good reasons too. Turns out that ER didn't bother to tell me that this fellow had an inferior MI and the good ER docs went and ordered Nitro and morphine for my fellow. Now this is VITAL information for a person who is to take care of ppl like these. Shame on me for not asking really. I figured this type of info a person would readily share with someone else. But nope....<br />
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When I got report from the ER nurse I was advised that she had given Nitro and my fellow's chest pain (CP) had been relieved with this. So when he came to me complaining of CP again, I went and did what my previous counterpart did and give Nitro. Well if I had been told about the inferior bit I certainly wouldn't have done this! It did as expected and relieved his CP but also sent him into cardiogenic shock. So I spent the rest of my shift trying to keep him alive because of the unintended consequence of this action.<br />
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What should have happened was that they should have taken him straight to our sister hospital and figured out his heart issues and tried to help him. But they said no so we had to hold on to him until morning when the cardiologist could force sister hospital to take him. Which happened and so I started shift two with him post transfer from sister hospital - being told that his 5 vessel CABG done almost 20 yrs ago had basically all clotted off and his heart was pooched. There wasn't anything they could do and stopped their PCI and sent him back to us.<br />
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So sad to come on shift to a sweet fellow and hear that there wasn't anything they could do for him. Kick in the pants I tell ya. So I went in to my patient, and had a frank heart to heart with him about what HE wanted. I asked him if the guys at the sister hospital had told him what they found, they did thankfully and so I asked him what he wanted out of all this. He understood that his life was in jeopardy, even if he did survive this current event. He told me that he just wanted to spend more time with his family. He was a father of three and still married. He indicated that if he could just get another month or two, that was all he wanted.<br />
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So I spent the rest of my shift, trying to make him comfortable and trying to prolong his life as best we could. I made it to the end of my shift and when I came back on he was still in my CCU. So another shift was started together.<br />
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I started this new shift in good spirits, he was requiring less heart support than when I had left and things were looking up. During the day shift I guess the Docs had a good discussion with him, after I had laid some seeds about CPR and intubation - that would he really want to pass with us pounding on an already impaired heart? That it wouldn't be a good death and he would still end up dying likely. So I was happy to see that post discussion with the Docs that he had decided a NO CPR/Dfib/Intubation for his care. I think he made the right decision, certainly for him anyways.<br />
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In the middle of the night things turned south though. Of course it all happened just as I was coming back from break He began to have ischemic events and his heart rhythm changed as did his BP - requiring more support to support it. I called the MRP and advised them and they came to assess him. I started him <i><b>again </b></i>on an antirhythmic and bolused him twice, hoping that he would convert. We kept at it for several hours and he did come out of the atrial flutter into atrial fibrilation but not for long unfortunately. I let the MRP know of this and she indicated that she would have to come perform a cardioversion. I let her know that I wasn't sure his heart would survive it, given that he's so clotted everywhere and he's having ischemic events right now and going into poor rhythms - ones that really are unsustainable.<br />
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So we decided together that we would call in his family and let them be together. I had to seek out approval for this because of the pandemic and no visitors are allowed unless death is expected. And although my fellow wasn't actively dying it wasn't expected that he would survive. And who knew if he even could survive with or without the cardioversion.<br />
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I had a frank conversation with my patient again about the impact of cardioversion - how it hurts like hell (don't know it personally but professionally) and we don't even know if it will improve his chances of survival. So he asked if he could speak with the MRP to ask this. Shockingly the MRP put this task onto another Doc - saying that it should be the cardiologist who has this conversation with him. But of course I find out after the fact that the MRP who said this IS a cardiologist herself!!!! That's what happens when you're too new and don't know everyone! So when I left my final rotation shift, my patient was still on the antirhythmic and requiring a cardioversion but wanting to speak with the Dr.<br />
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I came back several days to find out that when the Docs did go and talk to him he decided to <i style="font-weight: bold;">not</i> take the cardioversion and decided that he would live out his final days with his family surrounding him. I found out that this, however, took several days to come to fruit because palliative care Docs wouldn't take responsibility until pushed to.<br />
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But at least he got to palliative care and can spend the rest of his days surrounded by his family - the way he wanted it.Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-82401785361489252712020-05-11T01:06:00.001-04:002020-05-11T01:42:26.984-04:00How the times have changedSo I know that my last update was like 3 years ago. Feels like the time has flown. I really thought that I was going to keep up with the blog but that fell to the wayside when my life kept taking turn after turn.<br />
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I was kindly "advised that NICU isn't the place for me to do nursing" - all because my cares on teeny tiny babies was too slow. Sheesh I was learning. It's not like I did any placements in NICU but I was expected to know how to make such tiny babies eat and be fast when changing their diapers or changing their linens.<br />
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So I essentially gave up on my dream - I gave it a shot at least and came back to my family. We spent some time figuring things out. I had to work for an agency and do part time work as a RPN/LPN until my NNAS (National Nurses Assessment Service) - for them to determine whether my education and experience is enough to receive equivalency for the college in my province to give me the ability to practice as a RN. That process took about 9 months and thank the Lord that I did (I'm pretty darn lucky as far as I've heard).<br />
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Then I started working in an ER (third busiest in my province) while I was taking MORE education - my critical care certificate (CCC)... so that I would be more prepared for what I would see in the ER or <i>IF </i>I wanted to move to the ICU, that I would be prepared for that as well. I was planning to stay in the ER but was getting screwed over where I was. They were promoting people to the more serious area before me - ones who had less nursing experience, were in the ER less time than me and didn't have the CCC - hell one of them didn't even have cardiac care 1 - which would mean that these people would at least have the knowledge, skill and judgement to take care of people who are under continuous cardiac monitoring. So I cut out of there and started applying to hospitals in the area in which I live. I got several job interviews and in the end, got a job offer during one of the interviews in fact! I ended up taking the ICU job - started that in January.<br />
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So I've been learning a TON working in the ICU with adults. It really is a different can of worms than working with babies in the NICU. I'm enjoying it for the most part. Until COVID hit that is.<br />
<br />
I can't really remember how much I've said about my immunity issues (I think I've talked about it all) - but long story short - I have immunity issues. I have IgG deficiencies and I'm also taking Humira for an autoimmune condition (Hidrdinitis Supprativa - AKA Acne Inversa) - and we know that my immune system isn't the best at the best of times (though I have been lucky that I've been pretty healthy lately). So when COVID hit I requested that I not have to take any of these patients. I had a couple of good charge nurses who were alright with it until there was one that threw a fit and then I had to take it to the manager and start the official steps. So then I contacted occupational health (with whom I had sent all my health documentation to about my immune system issues) and asked them for a workplace accommodation. Of course they were giving me issues and so I took this information to my physician and asked for a letter to give them. Thankfully he did, mainly because he agreed that if I did get one of these patients and I contracted COVID, that I would likely end up on a ventilator. So once I handed in the documentation I finally got the workplace accommodation to not take any COVID suspected, presumptive or confirmed cases.<br />
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Of course there are some people, including my manager who question why I even work in the ICU if I have such a compromised immune system. Which I mean, I get. But the thing is is that the vast majority of people that we take care of in the ICU have treatments available that I could receive <i>IF </i>I were to catch anything that they have. Unfortunately, at this time the same can't be said about COVID at this point in time. I mean, even if we were to get inundated with COVID patients, there are always going to be ICU patients, or CCU patients (ours is a combined unit). I've convinced a lot of people with this next argument - wouldn't you rather me take care of ICU patients while you take care of COVID patients (or other ICU patients), meaning that we're both on a 1:1 - instead of me working elsewhere and then that potentially means that you would be doubled with an ICU patient. Of course when people hear this aspect, they always agree and drop the argument. So I haven't been reassigned elsewhere. To which I am quite thankful for. I didn't start working in ICU to be reassigned elsewhere.<br />
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As all this is occuring, I'm trying to convince hubby to FINALLY have another baby. He keeps saying "soon" - but 11yrs have come and gone with him constantly saying "soon". This has made me quite upset with him cuz I've given him 10+ yrs to get on with the soon bit. He kept saying that I had to do this task or meet this provision - all of which I did. But alas, he still says "soon". Now he wants me to do my critical care certification - and my nurse practitioner (NP) but I've told him I won't do any of it until such a time that I am pregnant with our next bambino/ini. He tells me that because he is accepted into a training opportunity (he doesn't want me putting it out into the world where he's been accepted because he hasn't yet gone for training) he doesn't want me to be pregnant while he is away. Also, he wants to be secured in knowing that he will succeed at training and will go forward to be placed that then he'd be willing to have more children. And of course because of this damn COVID pandemic, his training got cancelled until who knows when. I just don't know if he understands how difficult it may make becoming pregnant the longer he keeps putting this off. He thinks that once and done. I'm no longer young - it may take some time and much practice to be pregnant again. Also, it hurts my feelings (not that I think he cares much of that) that he continues to put this off.<br />
<br />
Throughout the years I have willingly put off having more babies because it was in our best interests to put it off. It would have been more difficult because we didn't have the space for more kiddos, and it would have made getting my education completed more difficult as well. Hell it was hard enough having one little one, let alone more. Though I have learned that I can muster through my education regardless of having littles running around.<br />
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I have sacrificed a TON being married to my hubby. I moved because he hated the city we were in. I have lived in a tiny house, in the basement for MANY years. I have suffered being under the same house as his family - with frequent fighting. I have put off having more children because hubby deems it so. At what point does he start giving me what I need? What he agreed to when we got married. It's not like we're hurting financially either. He told me just this past year that if I saved up like $6000 that he would agree to more - well I've certainly done that, and more! And yet he still says the same damn thing - SOON. God I hate that word. It certainly doesn't denote the same meaning it once did. But I don't know how to convince him to just say yes, now we can.<br />
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UGGGGGHHHHHHH - I just want to scream at him.<br />
<br />
Honestly I told him that I would leave him on my bday - it happens next month. I will though, if that's what it takes for him to finally relent. I hate that it would have to come to that. But clearly his priorities for our family aren't the same as mine. I'm done putting this off. I don't want to take any longer than this has already. It's a shame that he'll have to choose between having me and having more babies or losing me because he doesn't want any more babies. Stupid that he's acting that way, also that I have to make this decision. But I will if I have to. I thought we were aligned in the important aspects, but this is clearly one major area that we don't - or do we?Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-11600489588612401952017-07-22T02:52:00.001-04:002017-07-22T02:52:08.441-04:00My place in the new worldI know it's been such a long time since I've updated.<br />
<br />
I've gotten through the first part of training. I've gotten into NICU, but learned only recently that I'm not starting the next part of my training for another MONTH (which is almost complete I must add)!!!!<br />
<br />
So I'm going home to visit!<br />
<br />
But in the meantime, I'm moving out of the hotel that my hospital put me up in and moving into a house with two other ppl - a male and a female. I only got to meet the guy - he's from Venezuela, but he's young. The girl is from Pennsylvania, but that's all I know.<br />
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The program that I have gone through, so far, I have to say has been pretty awesome. I feel like it has given me the information that I lacked from the other place.<br />
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I found a text book I want to buy that educates me all about NICU. Especially because part of my evaluation has to do with my knowledge bit. So I figure that this will help with that. But I know that people see a "know it all" and so I worry that if I don't have the knowledge that I will suffer but that if I do, then this will rear its ugly head again.<br />
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When I do return I have a day to settle in (tho that involves a lot of other things called running around!) and unpacking and when I did "move in" to said new place, I pretty much dumped all my stuf into my room and that was that. So when I do get back, I have to "unpack" my room and put things in their rightful place. I still have to meet my other house mate. I sure do hope that she's nice and sweet and a good house mate.<br />
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Then the next day I have simulation, where I meet my "play mates" - my colleagues who are to be with me on my trek thru this new adventure this next year thru. Unlike the rest of them, I'm in it for at least three years (more if I have it my way!) but the rest of them do not have a contract and so they're just in it for a year because we're all in under "new grad orientation program" banner. I was told that there's 14 in the peds section, but I'm not sure how many in the NICU in particular, but I know for sure that there's only 9 preceptors for NICU ppl including me - unless that's changed.... at least that's what I was told. Hopefully this group will e more like friends and less like a clique - I'm not really holding out much hope.<br />
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While I've been here I've had the chance to go North and visit my family in hometown - I went out to my parents cottage and it was awesome....<br />
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This is my happy place<br />
<br />
Best of all was that my best friend was on maternity leave and so she was able to spend days with me. And my mom took a couple of days off to spend time with us. I spent a lovely week there hanging out with family and loving on my kids and my parents and my best friend.<br />
<br />
However, that trip cost me dearly as I stopped for "speeding" not once but TWICE!!! I couldn't even believe it because when I had been stopped the first time, I ensure that I didn't move the car until I knew how to use the rental car's cruise control, cause that's what helped cause the first speeding, cause I couldn't figure it out in the first place and so I wasn't using it and I wasn't paying attention to how fast I was actually going. My fault for sure. But the second time I made sure to use it and so there was no way that I was speeding, so I don't know how I managed that one! Both cops were right assholes. And ppl wonder why no one likes them, they never give proper people any kind of leeway or freebies. Such dicks! Cost me a pretty penny to say the least. Almost cost me my trip to Disney!<br />
<br />
Because hubby has decided that come September, we're going to go to Disney! YAY! I'm excited, I've always wanted to go but my parents have always said that we were too poor (or that Disney was too expensive - which ever way you want to take it). So it's pretty special that hubby and I get to bring little tyke and it's all our first times together. I'm really really looking forward to it. Now I'm in the planning phase. I was looking at doing the princess tea party.... it's $135 ya'll!!!!! OMG that's bloody expensive. I couldn't believe it. AND, the "gifts" that of course little tyke will want cost $150!!! Geeze.... how in the WORLD can they believe that those things that they peddle are worth that amount?! Goodness knows. Wowzers! So now we're thinking a meal at Cinderella's table. We'll see if we can get in though.<br />
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For now I'm spending time with little tyke. My migraines have been pretty bad. I think it's probably to do with the stress level around here, the noise level and where we are above sea level. Who knows really. Either way, when I get back I'm going to try to get in to see the headache clinic that I found. I'm hoping that my insurance covers them. When I get back, shortly thereafter I have an appointment with a new GP to set up things with one. Supposedly this one is pretty new out of school so hopefully they have a pretty open mind and are good working with me. We'll see though. Like I said... finding my place in the new world!<br />
<br />Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-63159856567195576312017-05-07T00:42:00.002-04:002017-05-07T00:42:44.005-04:00ConfirmedOff on a new adventure I go again.<br />
<br />
I leave from little tyke in t- 28 hrs. Hubby's coming with me to help pack up and move me from my current apartment in my present US state, to a more southern US state and into a hotel for 10 weeks that my hospital is footing the bill for!!! Sweet right! At least this way, it'll give me an opportunity to figure out the city and where I want to live and where the best restaurants and stores are. Get my feet in the door at least before figuring a few things out.<br />
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I'm really hoping that this time I will get a fair shake and that the people that are <b>supposed</b> to be supporting me and <b>helping</b> me to succeed will actually do so.<br />
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I don't know whether I'll be working in the NICU or whether I'm going to be in PCU (progressive care unit - ie step-down ICU). I will be meeting with my person who is going to determine that all by the end of next week. So I'm keeping my fingers crossed that I end up in the NICU because that's really where my heart lies but who knows what God's plan is and what this person who is assessing me will determine!<br />
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At the end of the week, hubby and I are hitting up the water park. We're pretty excited about that. Hubby doesn't like rollar coasters but for some reasons water park rides he's ok with, either way, I'm alright with that! So we're going to make a day or two of it and spend some nice quality tim together.<br />
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We tend to argue when we travel (if he wouldn't be so stressed out and stop listening and stop being patient, it would be alright.... but alas, he's soooooooooo bad) so I'm hoping against hope that <b>THIS</b> time is going to be different. I'm delusional, but who knows, maybe he'll surprise me. HA! We'll see. Anyways, it'll be a few days before I get on here again I'm sure. Wish me luck!Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com1tag:blogger.com,1999:blog-89407693474351383.post-91179107972937450662017-04-15T17:17:00.000-04:002017-04-15T17:17:19.749-04:00Long time awayI know I've been away a long time from here, it's with good reason.<br />
<br />
America's been a bitch to me ya'll. Not the patients (mostly), it's the nurses.<br />
<br />
My hospital has renigged on the deal for my TN visa and pretty much fucked me over. So starting out over here has just started out on the wrong foot. And it's just continued that way.<br />
<br />
My co hort for my nurse residency seem to hate me. I understand that I'm an intense person, but I'm friendly and outgoing. I'm loyal and awesome and yet not ONE has been willing to befriend me! I'm an outcast! I want to say to them all "fuck you all, I don't need you". But it's not worth my time and effort. It does make me sad though. I'm lonely here because hubby and little tyke are back home and I'm here all by myself.<br />
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The units I've gone to, my preceptors for the most part have been two-faced. They say nice things to my face, about how good I'm doing and then after I'm done my week of experience there, several have contacted my coordinator and then turned around and said things that should have been discussed with me face-to-face.<br />
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I only found this out when I was 3/4 done this whole thing, so I couldn't even try to attempt to "fix" whatever these ppl were complaining about, they weren't giving me the opportunity. But from that point on, every preceptor I had, the first day I talked to them and told them flat out that I wanted feedback from them real-time, not at a later date and if they felt that I had done something wrong or against policy (considering I'm new and don't know policy yet), advise me what the policy IS at this facility, instead of keeping quiet but then saying that I told ppl things against policy - to my coordinator.<br />
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Because of the TN issue, hubby (who is a natural researcher) was looking to see what's out there in terms of sponsorships (expecting that things would take like 6+ months), because we were done getting screwed over by using the TN visa. Well he found one and they contacted me and we talked and right off the bat they asked if I would come work for them!!!<br />
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Now, I should tell you at this point that this hospital offered me this the day after I had a meeting with current hospital who put me on "final written notice" because ppl were c/o me instead of talking to my face - but because I'm still in the "learning phase", the ownership is on me, not on others. Such BS!!! So when <b>new</b> hospital offered a job, it seemed like God was intervening and that this was the path I needed to go down.<br />
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Well I got my official offer yesterday, contract and all. I'm nervous as heck. I haven't told current hospital. I don't know what I'm going to tell them. It's frustrating that I moved my entire life here and I get treated like this. But I also want them to know that I appreciate the fact that they offered me this chance.<br />
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With new hospital, I don't know yet whether I'm going into NICU or progressive care (step-down ICU) - we're going to figure that part out when I get there. I'm really really hoping that they're good with me going into the NICU. I LOVE LOVE LOVE NICU. It feels like that's where I'm meant to be.<br />
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So now I start to pack up this apartment, and begin the search for a new one!Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com1tag:blogger.com,1999:blog-89407693474351383.post-85154988003416225222017-03-11T19:11:00.002-05:002017-03-11T19:11:51.523-05:00I found my nicheOh my goodness I love the NICU! I cannot say how much I love it. I'm saddened by the fact that I am only unable to spend 24 hours there in my residency. But alas, we must move on.<br />
<br />
I got to spend time with some feeder-growers, but ones that kept us on our toes. One of which would brady and have hold their breath - a septic work up showed an infection brewing but cultures didn't grow anything in the blood or urine. 48 hours of IV antibiotics and the poor baby seemed to be over the hump. Hopefully that's all that was needed.<br />
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Our other baby has chronic lung disease and provided us lots of frustrating moments because the baby would be low sating - setting off the monitor.... then a moment later be high sating, again sestting off the monitor as the expectation is that if a baby is high sating for more than a few minutes, then the nurse should turn down the FiO2. But if the baby was turned down, then we would end up with the monitor showing a SpO2 of 50-60%!!! Not where you want a NICU baby! But we couldn't be chasing this baby all day long with the FiO2.<br />
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I was lucky to have a coach who showed me the ropes, but gave me the ability to show what I could do. By the second shift, I felt like I could try my hand at taking care of the babies - gavage feedings, tube feedings, changing diapers while the baby is still in the isolette, assessments, etc... And by the third day I was doing all the babies myself as well as the charting - and my coach was just checking my work afterwards to make sure I didn't miss anything.<br />
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I seriously hope that I end up there. It was seriously my cup of tea. Oh how I loved cuddling the babies and taking care of their needs.Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com1tag:blogger.com,1999:blog-89407693474351383.post-20677620667842880782017-02-25T01:52:00.001-05:002017-02-25T01:52:20.917-05:00So nastyI rushed to move into this apartment. I don't know what condition the former tenants left the place in before I came in but when I moved it it wasn't terrible so I was willing to move in when it wasn't 100%.<br />
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I'm rather regretting moving in, or moving here....<br />
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I'm dealing with COCKROACHES!!!!<br />
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Ewwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww<br />
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These things gives me the <b>BIGGEST </b>heebies and I'm dealing with them in my bathroom and kitchen primarily - and yes I understand this as they like the moist environments and with the kitchen there's always the microscopic (I keep it pretty clean) bits of food.<br />
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They were supposed to "bomb" my place today while I was at work today and when I came home I found my cupboard doors open which means that they did but when I came home and went in to my bathroom to use it, there was one.... just crawling around.... ewwwwwww...... ya, I squished that mother ***er!<br />
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Then later I made some tea on the stove (I haven't bought a kettle yet) and I put the tea bags in a container after I had used them and when I came back to throw them out about an hour later there was one on my stove!!! Ya I killed that one real fast too!!! ICK!!!!<br />
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Then don't you know I go to open my silverware drawer and there's one in there!!!! ARGGGGGGG Of alllllllllllllllllllllllllllll the places for them to be!!! Now I have to wash all my silverware, because there is NOOOOOOOOOOOOOO way that I'm using them with the possibility that that sucker has been on the stuff that will be going into my mouth! Yucky yucky yucky!!!!!! That one I killed the fastest I think.<br />
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Holy frig I'm sickened out by these! I don't know how ppl can handle these in their place. I've also ordered cockroach killing bait and as soon as that stuff comes in (Monday), that stuff is going<br />
E V E R Y W H E R E !!!!!!! No joke. Goodness these things creep me out big time. I hate them!Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com1tag:blogger.com,1999:blog-89407693474351383.post-90438827721725517972017-02-21T22:44:00.001-05:002017-02-21T22:44:21.338-05:00I haven't forgotten I've just been busySo I know I haven't been posting a whole lot, it's not that I haven't had much to say. Oh the contrary. I've been so busy with my residency. And with moving into my apartment. And of course with EVERYTHING, things have gone wrong and tipsy turvy.<br />
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So for my residency we do 15 weeks where we have 24 hours on the unit with a preceptor and 12 hours in the classroom learning various things that are pertinent to our respective residency routes. Mine is newborn-peds (YAY!!!) - but I'm also having a smidgen of time (a week exactly) on mother-baby (ie post-partum).... this area I'm ok with b/c at least at that point mom has already had the baby and so less to do with mom and there's stuff to do with baby. <b>That</b> I can handle! L&D has too much mom and not enough baby - plus too much complication potential.<br />
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Then I get to have a week of NICU then two weeks of PICU and then a week of something (TBA) then two weeks of Peds then the rest are TBA. Then once we are in the last week, our academy director/facilitator has a discussion with all the unit directors (ie managers) about us academcy nurses and how we performed and whether we would be a good fit for their unit and it's basically match day because we're expected to decide on our top 3 choices on hospitals and units that we want our home unit to be after wk 15 for the rest of the year (or permanently as I believe it).<br />
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So it's kinda crazy how this is going to go because there's only me and another girl in my route because the third girl failed her NCLEX exam and had to drop out of the academy. I just hope that there's plenty of jobs, and not just one that is between her or I getting. The information that I have to learn includes EKG and PALS - hopefully it's not too complicated and overwhelming. Oh the things that I will learn....Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-11072810451018865362017-02-08T20:56:00.000-05:002017-02-08T20:56:00.064-05:0077 degrees vs. 25cmSo what do those have in common you wonder? Obviously me, but besides that little. The 77 degrees refers to the temperature in the state in which I reside. OMG the weather is awesome! Once we arrived, we come to find out that 25cm of snow hit our city back home!!! Boy did we leave in time! I guess that's a blessing in disguise.<br />
<br />
But thing quickly started falling apart. When we got to the border the customs guy took my paper work and asked "what would you do if you don't get approved?" - my response was that I would be "fucking screwed" - I was honest. In hindsight, too honest. I didn't have my filter on. I was nervous and forgot who I was talking to! Ooops. Either way, he let me through and told me to go through to the side and park and go into the building and wait to be called by an agent in the building. Okay then!<br />
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Not fun considering I had little tyke with us who is almost eight and has a patience level of about 5 seconds. Plus in the building it states that you are not permitted to utilize ANY electronic devices, and so she couldn't even use her nintendo DS to keep her occupied or anything, or a cell phone. And remember that these ppl can find <b>any</b> reason to deny me entry. If they find my child irritating or me or my husband unappealing in any fashion, I could be denied my visa! So I had to some how keep her calm. Easier said than done! I managed it long enough for me to be called.<br />
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I had everything they could want and some extra. <b>BUT</b> and it's a really <b>big</b> BUT the offer letter that the company supplied, I knew was going to be the issue. We had asked the company to revise it because it was missing information - specifically the contract information required for the visa. Because for TN visas in particular, I can only stay in the US for a maximum of three years at a time. As such, my letter must indicate that there is a definate end date because the expectation is that I will return <b>back</b> to my country and <b>share</b> the information I have learned, with my fellow colleagues/nurses. The problem was was that they were unwilling to stipulate that and so we tried to bypass this by indicating it in a personal letter addressed to US customs and border protection. The agent appeared as though he was just going to flat out refuse me entry but then gave me the chance to try to contact my recruiter. I tried. I really tried. But no one would return my damn call. WTH!!!! Then he took my stuff into the back room and talked to his supervisor/manager who then came out while I was on the phone and got upset with me because I was on the phone in the area that was <b>clearly</b> marked EVERYWHERE that you cannot be on any electronic device and I was silently shitting my pants because I didn't want to say anything perceived to be negative to this boss! <b>Thankfully</b> the other agent who was working on my case spoke up indicating that he had given me permission to use my cell phone! So once I was off the phone (I was trying to get a hold of the recruiter again), I was called back up to the desk by the both of them....<br />
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And told that although the terms weren't indicated, that they were going to give me a year visa and that that would give me the chance to fix the discrepancy or that I would have to return home... or find a new employer.<br />
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I guess I'll have to put it in those terms to my new employer. We'll see whether they'll be more willing to change their tune once I start the residency and all.Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0tag:blogger.com,1999:blog-89407693474351383.post-453693149955547482017-02-04T02:27:00.000-05:002017-02-05T00:10:36.167-05:00The time has comeFor things to change.... a LOT<br />
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We <b>FINALLY</b> got word that my visa stuff got approved and so things have started to move quickly!<br />
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We told the family yesterday that I would be moving on monday - four days from now! And why should I not be surprised but they were <b>not </b>happy for me. To be honest, I think that they were shocked. They were upset that I was going by myself and that I would be leaving little tyke and hubby here in Canada and going and living by myself in the southern US.<br />
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Now I'm in a bit of a panic to get everything done - my medical records to take with me (done today!), I also have to pack (still have to start that - heck I still have to get boxes!), get my prescription meds done for the next 6 months (at least then I won't have to feel pressured to find doctors where I will be working/living. This turned into a nightmare and maybe I'll write a whole post on it, we'll see! Man, my life is never boring!<br />
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Tomorrow I have to go to the DMV to go get my driver's abstract because when I return to Canada then there will be a history of my driving record, otherwise I will have to start ALL OVER AGAIN and I have a pretty darn good driving record if I do say so myself! Because as soon as I go to the DMV in the state where I settle (which is required in the first 6 weeks) I have to surrender my Canadian license to the DMV.<br />
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Tomorrow (which is now today because I had to continue writing the post on the next day) I went and got money exchanged and paid child support of Big boy who lives in home town, that should be interesting experience once I move and have to pay it - maybe it'll be hubby paying it on my behalf - we'll see. Right now I have to pay it once a month by a certain date and pay it directly into their account and so I just go to the bank and get it done. At least that's one thing checked off my list of things to get done before I leave!<br />
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Then I had to go procur some boxes! Of course for free! Who doesn't like something for free?! I do, I do!!! Well my mom works in a grocery store and she taught me a long time ago that they have the best boxes for moving - for free!!! If you go and see the produce ppl, ask them for apple boxes in particular - they are built stronger and have really nice lids. Then my next choice would be banana boxes - as long as <i>they</i> have lids - if not, I leave them. The thing about banana boxes though is that on the bottom there is an area in the middle where there is no bottom - so you kinda have to do a bit of arts and crafts if you're willing to take these boxes - simply take other boxes, rip them apart and run a section down the middle of the box to help support the bottom of the box from the inside. Plus for larger boxes all you have to do is look to the grocery area and talk to the ppl there and ask for the bigger boxes and normally all they'll ask you for is your name and ask you to come back for them at a certain time because they'll save them for you. Either way - this is the stage that I'm at... I have to go get my boxes tomorrow morning.<br />
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Then I had to talk to my recruiter (who is the senior recruiting manager thankfully) about drafting another offer letter as there were items missing or things that I needed added to it for when I need to go across US/Canadian border monday morning. But of course, in my life, things never go according to plan and so I had to track them down again later down in the day because the letter had to be changed yet again but in the end was able to get to a satisfactory point. Hubby was able to help me with finding the rest of the information on the CBP website in order to write my own letter that supplements my offer letter because my recruiter couldn't couldn't put certain information in it. Point is is that my work wants me but won't sponsor me to stay around forever and so I must go with a NAFTA (I'm sure you've heard about this in the news lately) related visa in which it runs out at the end of three years and must be renewed if I want to stay at this hospital in this position.<br />
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So pretty much Saturday will be spent trying to get the med situation figured out - seriously, it's a shit show! And I also have to pack - EVERYTHING - I seriously haven't packed a thing yet. I also have some organizing that needs to be done. Because once I leave, hubby needs to still be a dad - I don't want him to come back here and check out of being a dad - letting his mom take over all the responsibilities of being the parent of little tyke. So these next few days are going to be <b>very very </b>busy! So I suppose I should go to bed and get some sleep. Those boxes aren't going to fill themselves!<br />
<br />Practical nurse to RNhttp://www.blogger.com/profile/00837227076541800312noreply@blogger.com0