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!