Nurse Sean (dot) com

Yes, it has been more than a month since my last post. However, after about seven years of blogging, I’m quite aware that my desire to post ebbs and flows. There will be times where I excitedly blog every day. Other times, I will go weeks without posting. Lets face it, blogging is a lot of work! I think the only regret I have is that regular posting generally equals regular readers. I crave the hordes of readers other bloggers have, but they typically post at LEAST once a day.

That’s enough talk about how often I post! Too many of my posts start with a similar speech. I also want to mention that I’m aware that I have been tagged for the “eight random things” meme. I will try writing that in the next couple days. For now, I would like to update my last few weeks!

Believe it or not, I took a vacation! It was the first time I had more than two or three days off in a row since I went to Boston for ten days…four years ago! And before my Boston trip, I hadn’t had more than two or three days off in a row since 1997 when I went to Seattle. One vacation in ten years is insanity! My habit was to just get my vacation paid out.

So, to have two weeks off felt great! I didn’t go anywhere and I didn’t do anything. I watched a lot of television, walked my dog often, played on the Internet, and read. The most exciting experience was buying my new car! I bought a 2007 Galaxy Grey Honda Civic LX coupe with a manual transmission.

The absolute highlight of my vacation was my David Lynch film festival. I watched Eraserhead, Blue Velvet, Mulholland Dr., and several episodes of Twin Peaks…all in the same day. This weekend I am going to see his new movie, INLAND EMPIRE. I’ve heard it described as one of the craziest movie going experiences of all time. Apparently it makes no sense…and well…what else would I expect from David Lynch?

Charlie really is driving me to the brink of insanity. He’s a walking contradiction! He is so easy to train with simple obedience exercises. He has no problem learning how to sit, lie down, loose leash walk, and his recalls are nearly flawless and reliable. Unfortunately, his potty training is getting worse every day (despite taking him out every 2-3 hours and watching closely for signals that he has to pee. He is also SO destructive when it comes to ripping up paper. And after trying everything in the books and out of the mouths of our obedience trainers…he still bites…A LOT! So, sometimes it feels as though we have the greatest, smartest dog, and other times I’m nearly in tears wondering what I’m doing wrong.

Charlie is actually done his puppy classes (sadness). They were incredibly fun! A lot of it involved him just running around socializing (playing) with other dogs. Charlie loves chasing puppies, being chased by puppies, and play fighting with puppies. Even more than that, we adored our Friday nights watching dozens of incredibly cute puppies running and jumping. As one woman put it, “you can feel your blood pressure going down by the minute!”

He will be starting true obedience classes on June 7th. It’s time to get a bit more serious with the training! He will learn to increase his attention span, gain self-control, and all the usual basics (sit, lie down, loose leash walking, etc. etc.). I truly love the facility I’m using. They are so incredibly friendly and knowledgeable!

Well, I have worked three shifts since the end of my vacation. I feel calm and at peace while at work. There is definitely a different vibe within myself while I go about my day. I will admit that I lucked out with my patient assignment, but in general, I feel as though I am starting to really enjoy this career.

Which reminds me!!! I received my RN license in the mail! When people ask me if I’m an RN, I no longer have to answer, “Sort of…I have my degree…and I passed my test…but I’m waiting for my license to arrive in the mail.” Yes, it’s all over and official, I’m the real deal!

It has been fun during the last few days watching the undergraduate nurses starting their jobs on the unit. I’m fascinated by the fact that only one year ago I was exactly where they are now. I am amazed and proud of how far I have come since then. It has been one hell of a year!

Of course, I celebrated my graduation from school and my registration as a nurse by promptly signing up for the “Advanced Studies in Critical Care Nursing” program at Mount Royal College. It is five courses long (physiology, pathophysiology, pharmacology, and assessment of critical care patients, followed by a practicum) and will provide me with the beginning training needed to transition to the ICU or ER. So yes, starting in fall, I will once again be a nursing student! I’m still very disappointed in the lack of critical training in Canadian schools as a basic part of becoming an RN!

Well, after going a month without posting, I could go on for ages. However, this post is getting long! So, I have decided to stop here. I will try to be a better blogger in the coming weeks.

First of all, thank you everyone for your kind messages following my last post declaring that I passed my exam and am now a Registered Nurse (god, just writing that made me swoon with joy). I need to correct myself by stating that I am not a registered nurse quite yet. Let me explain…

I wrote my exam February 7th, 2007. I received my results and I passed, but that does not automatically make me a registered nurse. I do indeed need to actually register with the College and Association of Registered Nurses of Alberta. So, I am still a Grad Nurse in the meantime.

The process to register will probably take awhile. I will be sending them my registration form tomorrow; however, they cannot register me until they receive my transcripts from the University showing that they have granted my degree. Even though I finished my course work in December, the University will not grant my degree until June 14th. So, I probably won’t receive my license until July. Did that make any sense?

The odd thing is that when I receive my license, it is valid retro to February 7th when I wrote my exam. So, Today on April 5th, 2007 I am not a Registered Nurse. However, when I receive my license in July, I will be able to say I was a Registered Nurse on April 5th, 2007. CRAZY!

They definitely need to find an easier way to do this….

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I’m not sure how the continued competencies work elsewhere, but here in Alberta they have a system in which we tell them what we want to learn and how we plan to learn it, then we need to provide evidence that we followed through.

However, you cannot just choose random things to learn. Instead, you have to study CARNA’s list of what they call “indicators,” or competencies that they expect Registered Nurses to have. They expect you to choose 1-3 of these indicators to work on. I chose the following:

1.) “I follow current legislation, standards and policies relevant to my profession and my practice setting.”

I chose this indicator because I feel I rely too much on other nurses when I need to learn a skill. What I mean is, if I don’t know how to do a task, I will just pull aside another nurse and beg for help. I would instead like to focus more on learning from our policies that are set out for us. This way I will learn to do things properly and without bad habits. Furthermore, these policies are in place because they are based on evidence, and even better, they are SAFE!

2.) “I question policies and procedures inconsistent with therapeutic patient/client outcomes, best practices and safety standards”

I am a new nurse and occasionally naive. Far too often I perform orders from doctors without second thought because I trust that they are practicing safely. As we all know, that is not a safe way for ME to practice. An example would be questioning why the doctor has unexpectedly ordered a large bolus of fluid with no real apparent reasons. I would like to work on becoming more comfortable questioning doctor’s orders (and of course the practice of other health care workers).

3.) “I support decisions with evidence-based rationale”

I will admit it…I am a nurse geek. I love researching articles and pouring over the information they supply. What I would like to do is start a collection of journal articles pertinent to the surgical oncology focus of my unit.

I chose number one and number two because I immediately recognized them as weaknesses and have already put effort into improving these indicators, and I recognized number three as something I am passionate about and love to do.

The evidence of my learning will be journals for number one and number two that outline my experiences specific to these indicators and what I learned from these experiences. For number three I plan to create an annotated bibliography that I can add to over time. I may even attempt to organize an online journal club for my unit.

Fortunately, this process is fairly second nature for me since we visited these indicators numerous times throughout my degree, and we even did an extensive and exhaustive version of this for my final focus practicum.

I still think nurses should be paid for this extra work…

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I stood up to the old, cranky, scary nurse on our unit a couple days ago during report following a night shift. A patient had TID insulin ordered 30 min. before meals. The computer had it scheduled for 07:00, 11:00, 17:00. Unfortunately our meals come at 8:30, 12:30, and 18:30. So, I reschedule the medication for 08:00, 12:00, and 18:00. As an extra bonus, the 7:00 insulin no longer fell on my shift and I would not have to check the patient’s blood sugar and draw up the insulin…but this was not the motivation for making the change.

The oncoming nurse was furious that I changed the schedule, since, according to her, the plan was to keep it at the original times. I pressed her for a reason (the first hint that I had more confidence…questioning her is grounds for a yellin’) over and over again but she could not give me one. She just kept saying, “It’s what I decided.” She called me lazy and accused me of changing the schedule so I wouldn’t have to give it.

But, I stood up to her and reminded her that it was ordered 30 min. before meals and for me to give it at 07:00 would be a med error…not to mention not safe. I explained to her that it had been drilled into my head over and over that insulin should be given right before a meal. My last instructor before graduating even insisted that patients had their meal tray in front of them and ready to go before I could give the insulin.

The cranky old nurse stomped away to grumble and complain about me. I went home proud of myself for taking a chance by standing for something I believed in…and I slept well with the belief that I was completely correct in my decision.

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Charlie went to his Bright Puppy classes earlier tonight. What a blast! He spent some time visiting with the other small puppies, worked on sitting and lying down on command, played in all different sizes/types of crates, and played on grooming tables. He has so much fun at these classes (ok, I probably have more fun hanging out with lots and lots of super cute puppies) and it mentally stimulates him into exhaustion!

We are still struggling to get him to go pee/poo on is pad. No matter how diligent we are (we’ve caught him in the act 100% of the time over the past week since deciding we were getting lazy and refocusing our energy), he just randomly picks a spot and goes. Ugh! I hope he figures it out soon. Even a little sign of understanding would be nice. There’s nothing like grown men running across an apartment with a still peeing dog in one hand and a bag of treats in the other…

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My sister had a baby girl a couple of days ago! She had it in the hospital I work in, right before I began my night shift.

YAY!

If you can believe it, I still haven’t gone to see the baby. I will be meeting her for the first time on Sunday at Easter dinner. I can’t wait!

Charlie is doing great! Even though he has a splint, he’s been bounding around the house. We haven’t been able to convince him that he’s hurt and needs to REST! We went to our vet today to have the splilnt changed (it is now bright yellow…she promised we could have purple next time), and she gave us some advice on curbing his activity. So, we have him on his lead at all times…he’s either attached to the coffee table or one of our belts. And it’s working! He can no longer fly up and down the hallway or chase after us, or practice trying to get up on the couch.

But the real bonus is that it will help us with house training. We will be able to keep an eye on him at all times. No more sneaking down the hallway to go pee!

We actually took him to puppy playtime on Friday. We were worried about him playing too hard (puppy playtime is all about the puppies running around and play fighting), but we knew that the gentlemen that runs it is a vet and would be able to give us advice. Our plan was to keep him on a lead and just hold him back, letting dogs come to him. He suggested letting him walk around socializing, and only holding him back if he gets out of control.

For most of the time he just hid behind my legs (apparently this is the norm for the first couple times). However, he started to interact and play with dogs in the last ten minutes. He didn’t start playing too hard, but I could tell he wanted to. I can’t wait until his splint is off and he can go full throttle!!!

On top of everything, the vet found a lovely (yet massive) yeast infection in his ear. So, we get to put drops in his ear twice a day! Puppies sure are a handful!!! Not to mention expensive.

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My day shifts on Thurs/Friday were chaos! Thursday I walked into a mess. One of my patients was receiving hefty blood transfusions and had a surgical dressing that was saturated despite being reinforced, changed, and reinforced again. The second patient had dimentia and was agitated all night and needed to be transferred to a stretcher, then it was discovered that many of his meds had duplicate/conflicting orders that needed to be organized. My third patient’s meds (about a dozen meds) had been ordered, but not scheduled, so the pharmacy hadn’t sent any up to the unit, and my fourth patient was having pain control issues that hadn’t been resolved.

I just took a deep breath, dug in, and organized! I worked my ass off and by noon, everything was fixed, solved, and settled. I was very proud of myself for taking on an enormous chunk of chaos and fixed it!

Friday, I was sure it would be a good day. I had done so well organizing my patients care the day before that I knew it would be a much better day….wrong.

It started out by finding the dimentia patient on the floor, flat on his back, and covered in blood from all the IVs that were pulled out. He had fallen while trying to get to the bathroom. *deep breath* and called for help! Another patient had a complex discharge that needed to be organized…and on and on and on. Again, I dug in, worked my ass off, and organized everything.

I’m proud of the work I did this week (Sean gives himself a pat on the back).

And now, it’s back to night shifts for two weeks. YAY!

So, last night Charlie had his first venture into emergency vet care. While running after Charlie while playing, Richard managed to step on his front left paw.

I have never heard a dog yelp so loud and long! We waited about an hour to see if he would “walk it off” and start doing better. When he put wait on it at one point he started yelping long and loud again. So, we scooped him up and ran to the vet.

$600 later he had a big blue cast on his leg, which makes him look even more cute and innocent (pictures to follow later today). Unfotunately he’s still a little devil!

We were told to limit his activity and make sure he stays off his splint. However, he’s convinced that nothing has changed and keeps scooting around on it…arg! How do you convince an 12 week old puppy to stay off his feet?

I’m MOST sad because he was scheduled to start puppy classes tomorrow and now that will have to be put on hold for five weeks when the splint comes off. I was looking forward to seeing him jump around and play with other dogs.

*sigh*

I’m so tired!

Puppies are a lot of work. I’m starting to understand the pain of having a newborn baby. I have to get up several times a night to take him to his potty matt. When he’s awake, I need to watch him 100% or he will pee/poo in the wrong spot, or chew things up. I always have to think about how I act toward him, or react to his behaviors, because it could have an effect on him forever.

Fortunately, unlike a baby, I can leave him alone and go out. Even better is that in several weeks he should be completely potty trained. Then, I will need to buy a carpet cleaner to get rid of some of his accidents…ugh!

The only downside is that I can’t put him in front of the television and have some alone time. He depends on me for almost all his entertainment. Thankfully, he’s learned to play fetch already. Playing is much easier when I can stay still and he does all the running.

I adore our walks together. I slap on my Sirius radio, listen to OutQ or the Broadway channel and walk walk walk. I just wish Charlie was a little bit better at going for walks. He can be so stubborn and defiant! He occassionally will stop or get distracted and refuse to go anywhere.

His first Vet appointment is on Tuesday! He’ll be getting a full exam and a vaccination booster. I can’t wait to take him! It’s so fun seeing him going through all sorts of new experiences. I’m also signing him up for a Bright Puppies class. In this class there’s some basic fundamentals like housetraining and stopping them from nipping/biting etc., but for the most part it’s just a chance for them to run, play, and socialize with other dogs and people. They even do interesting things like play CDs of thunderstorms so your dog isn’t afraid of them when he/she grows up.

He definitely needs the outlet for all his energy! I feel so bad on the days where Richard and I both work day shift and he has to be alone for several hours. When I get home, I can tell just how much energy he’s built up!

Anyway, I just thought I would write a little more about my new “baby.” I can’t wait until he gets a little bit older and more controllable.

I would like to introduce everyone to our new baby. His name is Charlie! He’s as bratty as he is cute! We’re up several times a night so he can pee (occassionally in the right place even), and he whines and cries whenever we leave him. Fortunately, he’s a very smart puppy and is learning very quickly!!! We are very exhausted parents though…

He’s 8.5 weeks old (Born January 2nd 2007), and is a crass between a Shetland Sheep Dog and a German Klein Spitz. His mother was 14 inches tall, and his Dad was 7 inches tall…so he should stay fairly small.