It Has Been Too Long

Wow...I have been away for a long time.  I started to read my blog this past week and thought...I really did a great job and I miss this.
Needless to say,  a lot has happened since I last wrote.  In summary, my Dad past away December 16th 2014...He was everyone's rock and hero....I was with him when he passed. He was on hospice on the inpatient unit I had worked....It has been difficult with his passing.. Mostly, my Mom has had a lot of emotional ups and downs.. She also has had some minor physical ailments....We are all trying hard to help in what ways we know.

Work has changed significantly. I am still working at the same place and same unit; however, the patient mix is different. We are now a SNF instead of Short term medical unit. We had to downsize one provider and many nurses and bed count.  It has been a challenge.  I am still not sure administration knows what we are...I try my best to remember my priority is the patient....and stay out of the politics.
VA has finally passed ruling of Full Practice Authority for Advanced Practice Nurses.  Our VA is slow on moving on this..but we will get there.  I am sure there will be challenges on the way.  Most immediate is educating others on what this means...
My Daughter relocated 4 years ago to Indianapolis from Maryland....she finally is back on the East coast living in Baltimore...It is a good feeling to know she is close by. Most importantly, she has achieved a goal she has set out for herself ....So very proud of her.
I am a great aunt x2...Nephew 3 years ago and niece this past January....We also had 2 weddings in our family ( my niece and a nephew 2 years ago). Another wedding for next year (another niece).
My husband and I will be celebrating our 25th Wedding anniversary in November...We have tentative plans to celebrate with a dinner with close friends and family.

I have been precepting a lot of Nurse Practitioner students.  When I first started doing this, I wasn't sure if I liked it or not.   It has been a full filling experience....It is exciting to see how they grow throughout their time with me. The downsize on my unit gets stagnant with patient experience and it may not benefit in the NP students' learning experience in the long run.  I have decided to take a break from this for a semester or two....then we will see where time takes me.

My career is slowly winding down... I do feel burnt out sometimes.  I feel I have lost the effort to learn and be challenged.  I am growing tired of fighting with those who don't understand what I and my fellow peers do on a day to day basis.  I find myself constantly refocusing on what matters...my patients.

I am looking at retiring in the next few years, but I feel I still can share my thoughts and experiences until then.  I really missed this and I hope I you will enjoy my thoughts and experiences through this blog.

Back In the Saddle

I am sorry I haven't written in a while but life got in the way ...Mostly family things. My Dad was really sick last year and was in and out of the hospital. He had problems with CHF and kidney failure. The doctors tried to keep him comfortable on a medication regime as long as possible. However, in September, this was no longer working and he succumbed to dialysis. It was touch in go at first. His body took a while to get use to dialysis. There was even a point where the hospice word came up. It was very difficult being the daughter and keeping the NP role that I possess out of this but I succeeded. He is doing much better now. His quality of life has improved tremendously. He is doing things now that he couldn't do before.

As far as my life as an NP...I keep rolling..today was one of those days that it started before I was ready with a patient in respiratory failure and running a code to get this patient in a better place than where he was....we got him there and his respiratory status improved tremendously....I still have the fire burning despite a lot of days wondering when I can retire...today was a good day.. made me realize I have a lot to offer.....I am going to end with this but before I go...I would love to hear from you all regarding NP's as Independent License Practitioners....what are your thoughts about this???

Let me know.....until the next time...which will be a lot sooner that the last time

The Geek years...

Ok so not only was I a geek to be a volunteen...I became more of a geek in high school...I was determined to do well in school so I could go on to be a nurse...Let me back up a little and tell you about my scholar skills prior to going to high school...As I mentioned before, I was shy and clumsy and some would say not have much common sense...I didn't apply myself in school as much as I should..My school career didn't really get a good jump start...My parents sent me to parochial school...Let me first preface by saying ..parochial schools are very good and one could get a very good education..however, in the 1960's the class size was was over 50 kids in a class. Each class had the kids sit in alphabetical order. There were no teacher aides. Nuns taught the majority of classes and there wasn't any room for individualizing student needs....So my parents sent me from 1st grad to 3rd grade...Oh and did I mention there wasn't any kindergarten when I was little. So...it was up to Mom to teach you what would normally learn in kidergarten...Already that put me at a disadvantage...so needless to say.....my parents finally got the jist that I wasn't really learning well and they decided to put me in public school in 4th grade....I was really behind in math,reading and spelling and struggled to keep up with the rest of my class. I managed to improve in my learning through grade school....middle school got better but still was average...then I had a revelation...I need to be more organized in my studies...I need to study every night...and I need to read and comprehend every assignment..... I was very disciplined in highschool...wanting to keep up with my studies I would study my notes everynight...Read and re read my reading assignment....I would even study on the weekends....I did try to expand beyond my studies and get involved with Marching band in high school...but I pretty much limited my social scene to Marching band in the fall and concentrate on my studies pretty much the rest of them time....well by junior year it paid off...I got inducted into the National Honor Society and was ranked 6th in a class of 400 kids....I was able to take advanced science classes in my junior and senior year to preprare me for my nursing curriculum in college....I will never forget my chemistry teacher..he was the best and I did really well in chemistry.....I got an A ...and when it was time to take college chemistry I...believe it or not it was a review of my high school chemistry class....all the kids in my college chemistry class were struggling and I was brezzing through it....Needless to say my social lfe sucked in high school...I was a geek...everyone knew who I was but didn't want me to be in their "in" group....I didn't go to any proms or dances or wild parties....I couldn't wait to graduate from high school...I did make an impression on the school nurse... She helped my apply for a couple lf scholarships...I did manage to get one for 3 years of college....Oh did I say college...yes .....when I declared to my parents I wanted to go to college and not a 3 year nursing school they looked at me as if I had 3 heads...This was something new...going to college to be a nurse... I think it was as early as 1972 when the first college prepared program was developed. I graduated high school in 1976. My parents didn't know much about the college route...but I made sure they quickly learned... I was accepted to 2 different colleges ( not many were around) and was so excited when I got accepted to West Chester State College.... this was going to be my ticket to being a nurse...Alleluha...

The Revelation

So I am getting a little sentimental in my old age and want to share as much possible with the younger generation to help them put into perspective how things have developed into what they are now. I would like to share my story and my life with all of you. I want start at the very beginning because I still want to keep the Nurse thing in my theme ...So I will start where it all began...when I realized I wanted to be a nurse. I never thought of being anything else but a nurse...I can't remember when or how this thought came into my mind. I can't remember any particular event that made me want to be a nurse...I think I was just born realizing I wanted to be a nurse...No one in my family had any job related to the health care field. As far back as I can think, I always rationalized and did things differently than the rest of my family. I was clumsy, absent minded and shy...Unlike my siblings who were atheletic, percise and spoke their mind. Since I made my mind up about wanting to be a nurse, I thought it would be a good idea to be a candystripper. The hospital where I volunteered called us Volunteens and we didn't wear the pin-stripped uniforms as one would thinks. We wore a yellow apron instead. We would record our volunteer hours and at the end of the year receive awards for the amount of hours we volunteered.. I remember my oldest brother jeering at me says,"why would you want to volunteer instead of working somewhere and making money instead?" I would always brush him off. I knew deep inside that this is what I wanted. Money was not what I was interested in, the exposure was most important. So I would go in every Saturday from 1-3 and do my duty as a Volunteen. I would report to the unit I was assigned to shyly asking the nurses what they would want me to do. They always saved the water pitchers for me. Now, you need to know that the water pitcher were metal. They had a metal tray and the glasses were real glass. So I was incharge of collecting all of the water pitchers,trays and glasses. Then I would take them to the kitchenette and wash them with them with dish soap and water. Refill with water and ice. Then make sure everyone got a clean water pitcher,tray and glass. My next chore was to pass out the mail, water flowers. I would also help make beds every once and awhile. Do you know what was different about making beds back then. They used rubbber pad under the pull sheet. Imagine how hot that was for the patient.
I would volunteer on Saturday afternoons during school year. During the summer, I would volunteer several 1/2 days during the week. The most exciting assignment one summer was volunteering in the Emergency room. My biggist job in the ER was washing and wrapping instruments to be sterilized. Yes, no disposable suture kits, etc. All re useable. Even there syringes were glass. I was also incharge of stipping the liters and washing /clean them down after a patient was discharged from the ER....washing off dried blood from the litter frames were the toughest. The ER doctor would call me in to watch him suture...I was devasted the one time when I almost fainted. The staff took care of me but I was so upset that this meant I would never be able to be a nurse.....the staff assured me that this didn't mean anything and I would certainly be able to pursue my career goals.
The other place I liked to volunteer was Maternity....I loved taking the babies back to the nursery after their Mothers fed them....I never really spent anytime in the labor room...but got really good at making beds in postpartum unit and watching the babies in the nursery.....
I did get a lot of exposure during these years as a volunteen...The experience definitely confirmed my desire to be a nurse......So the journey began .....the next step was to do good in school and take the right classes so I could be accepted in nursing school...

Teaching...helping my mind and soul

So sorry that another month has gone by and not writing...again my personnal life has taken precedent in caring for my parents....My Mom had a small CVA last month and Dad was in the hospital shortly thereafter with CHF ...I believe it isn't going to stop from here on in...the struggles of caring for your parents with declining health ontop on my family and job get a little overwhelming...but I do try to put things into perspective...my husband is the best and helps with house and yard stuff...and usually has a meal ready when I get home...I have my faith that keeps me strong and focus..
My work has also been a saving grace lately...I have a new challenge of precepting an NP student this semester...Usually I find this to be a negative challenge and frustration due to past experiences...but I am enjoying this student. She is mature and experienced and very knowledgeable and willing to learn and help as much as possible...She is even willing to take on complicated patients...wow...So I oblige and set her loose...I think the most memorable experience for her thus far was to watch my interaction and discussion with a patient who was diagnosed with infiltrative hepatic cellular carcinoma...this one day the patient had a rough weekend and was accepting the fact that he wouldn't be able to go home on hospice and would have to be transferred to our inpatient hospice unit...My discussion with him went well and very smoothly...we discussed his wishes of transfer ....At this time I needed to discuss the fact that being a Full Code, as he had currently was designated ,would be futile upon transfer to hospice...he agreed and accepted to be a DNR...I actually looked at this scenerio and wonder how the student took this in ..the conversation that I have had with other patients in the past ...once found it to be a difficult conversation...is now part of my demeanour of being an NP now....This in itself makes me realize how far I have come and able to mentour those who are learing to be an NP preform such and heartful and emotionally discussion such as end of life wishes...
We have had several complicated patients thus far ...it keeps me on my toes and my mind straight and narrow...she has asked some good questions and I have been able to provide her with excellent resources for her upcoming projects and presentations.... I can hosestly say this has been good medicine for my mind and soul...keeps me focused on the days tasks and goals...
I hope I can write in a more timely fashion from here on in..but not promising anything...I do enjoy writing and sharing my experiences....hopefully you are still enjoying as well...thanks for your patience.

Challenges

My personal life has been a little crazy so I haven't been able to keep up with my blog the way I would like to..so sorry for those who are following me...I usually don't like to divulge into my private life but since it has to do with being on the other side of being an NP I am allowing myself this one time to do so....My parents are in their 80's and have been in good health up until a couple of years ago...my Dad was the first to have medical problems...he was diagnosed with CML a few years ago but is in remission now...However, he has other medical problems that have been making his good days of feeling well fewer and fewer...He has an array of heart, lung and renal problems..His has more days of not breathing well than good days...he can't even help my Mom with light housekeeping chores without fatiguing and getting dyspnic.....he has been to more specialist than I can count on my 2 hands and they come up with the same conclusions...Multi factorial causes to his declining quality of life...My Mom has been the rock for him during this time...making sure he takes he medications;getting him to the doctors; and providing love and emotional support....today my Mother ended up in the ER with TIA....I went to visit her at the hospital tonight and she is devastated that she can't be there for my Father and take care of him....she is his rock...with tears in my eyes I told her it will be ok..that is why you have us ...as much as my parents don't want to be a burden and face the reality that the day is here..they need us to help them...it breaks my heart I see this everyday as a Nurse Practitioner caring for my patients...families that are faced with the challenges of elder parents and providing for their elders...I am there I am one of them ...I am wearing the other shoe..I am on the other side of the fence...I am in a fog right now to tell you how I am feeling..reality hasn't set in quite yet..but I know from experience it is creeping up on me...As I sat in the hospital room listening to my Mom telling me how she is so concern for my Dad...I told my self this is my time to be the rock for my parents.....they deserve it...they have given me a good life and lots of love in their own way..right now I just want to be a daughter and not a health care provider....

The TOP memorable patients in my career

Ok I am sure Jay Leno is known to all especially with his Top 10 whatever...so this gave me an idea to post the Top most memorable patients that I have come across thus far in my career:

16 year old female who was raped by her father became pregnant and is raising the child..

20+ year old female who complained have not having her menses for 6months and claimed she never was sexually active in her life....guess what...yep she was 6 months pregnant

26 year old healthy male who came to the office thinking he had a cold...chest xray revealed empyema

80 year old women never wanted a hernia repair ....it literally hung down to her knees

Elderly female who thought she had the virus came in with nausea vomiting back pain...ekg showed inferior MI...to the hospital with you!!!

Amish male came to office with nail from a nail gun through his leg

Schizophrenic young adult male came in for his depokote shot and closed the exam room door and cornered me and was irate...then he runs out of the office building onto a busy highway

Homeless man complaining of foot pain...unwrapped the soil dressing he had covering the painful area to find and foul smelling magot infested wound

so it is only 8 but I am sure I will have many more found memories to be added to this list