When will I feel good enough?

I am certified, passed the CCRN.

As I studied and prepared for the exam which was harder than NCLEX I might add, I felt like I was so smart and getting smarter by the day.

My first night at work after passing the exam I thought I would feel more confident, instead I realized how much I do not know and doubting my own judgement.

I once heard somewhere "The most dangerous person is an incompetent person that does not know they are incompetent".

The more I learn and know the more I know there is so much more to learn. Perhaps I am just suffering from the "down" after feeling so high.

Courage does not always roar

Sometimes courage is the quiet voice

At the end of the day saying

"I will try again tomorrow"

Mary Anee Radmacher

Why did you come here?

I've never heard anyone say:

"I want to become a nurse so that I can help people who don't want my help."

"I want to become a nurse so that I can take verbal and physical abuse from people who are angry, confused, insane, drunk, high or just weren't raised better."

"I want to become a nurse so that I can see my tax dollars being spent to save people who don't care how much it cost because someone else will pay for their care."

"I want to become a nurse so that I can wrestle with +400 lbs of flesh so that owner of flesh doesn't get bed sores."

These thoughts were inspired by one patient. I guess this would be the ugly in:

I love this job; the good, the bad, the UGLY, and the stupid.

Who's running that place down there?

So I'm doing the charge thing the other night. It is kind of slow so about 1100 pm I start cruising the ED census looking for potential playmates also known as patients. I see 4 chest pains in the census, 2 been there since 630 not likely canidates and 2 that just rolled in at 1030 pm. Aha, these have potential.

The phone rings while I am looking at the stats on these two guys. Its bed control; Whatcha got for me? I ask. My friend tells me the name and I explain that this is not one of the potentials that I had been looking at. He says no its a Neuro ICU overflow. Okay I say, we can due a neuro case. Change in LOC he says. Okay I'm on it. And off I go to investigate this new case.

WHOA?! WTF, this change in LOC has been sitting in an ED bay since 1:30 in the afternoon. Upon further research I find that she has a history of UTI's that present with change in LOC. I call my friend in bed control and explain that this patient has been in the ED for a while and could we get a fresher patient. He assures me this one will probably be plenty fresh.

Upon further investigation the hospitalist has not ordered any neuro checks for this patient, her VS have remained stable since arrival at 1:30 in the afternoon, there are no IV drips, meds or even fluids ordered for this patient. I am seeing no indications of possible sepsis. Maybe she looks worse in person than she does on paper I think.

Ok so the patient arrives from the ED, she is in late stages of alzhiemer's with bilateral foot drop and upper extremity contractures. Her full time sitter will be staying with her. Skin looks great shes clean warm and dry. Again I ask myself "Why is she in the Cardiac ICU".

That was our only admission for the night. I wonder what ever happened to the CPs,wonder if they ended up on some med-surge floor infarcting.

Oh well, I love this job the good, the bad and the stupid.

Who wants a Cert?

Testing straight ahead. October 28, 2009. Oh no what have I done, if I don't pass everyone will know that I am not as smart as I think that I am. I will know that I am not as smart as I think that I am.

I kind of like living in the perceived reality of my own greatness. What it I do pass, will my perceived greatness improve, will my quality of life improve in some way. I certainly know that my paycheck will not reflect this proof of my greatness.

Calm down, this is only a test. If this were a real emergency you would be instructed...

Ahhh, I feel much better now. Well back to the books, Laura, David, and Denise are waiting, these are the CCRN exam gurus who have collected my money and promised that with their help I willl pass the CCRN. I will keep you posted on how that works out.

If you don't want swine flu don't eat the barbecue at the buffet!!

I am by no means a germ-a-phobe but here are a couple of things that I keep in mind:

I am a firm believer in good hand hygiene, not just antibacterial gel (although that is good too) but old fashioned hand washing with hot water scrubbing your hands while you sing "happy birthday" in your head and then drying off with a fresh paper towel and using that towel to open the bathroom door as you leave. I do this before I sit down to eat in a restaurant. If more people did this I would think that I would meet them in the bathroom but unfortunately I don't.

DO NOT EAT AT THE ALL YOU CAN EAT BUFFET!! My family finds it amusing that I balk each time they mention going to the local buffet. I gown up to enter the room of a patient that has MRSA but next week that same person may be dishing out their greens from the food bar right in front of me.

AVOID HANDLING CASH! Some women chose to carry it in their bra. It's used as tips at strip clubs, you don't know who's G-string that money came out of. Just think of all the cash only business and unfortunately money laundering does not mean germ free.

Do not go to the ED unless you are bleeding profusely, having crushing chest pain and/or guaranteed that you will be taken back to a bay immediately. I once had a pt's family member request a change in seating because the person next to them had a cough his statement went something like..."that person is sick, I don't want to catch it"...then go home what do you expect to find at the freaking hospital, the ED no less.

Keep your head out of your ass, use common sense, and keep it all in perspective. Remember most people will recover without complications, many will not even require hospitalization. In a couple of weeks there will be something else to capture the headlines and cause a new media frenzy that will send an already hyperventilating public into another panic.

Well I found the remote for the dish and there is still nothing on worth watching. I am sooooo bored. Nothing happened at work that is really blog worthy. I don't know if I am just cranky or bored. Thank God I work with such a great group of people, they make the shift entertaining but I can't write about them.

My patients were all extremely stable, I kept them entertained and amused during the shift at least until they all went to sleep by 2330. I am looking to move to an ICU that has more critical patients more of the time. Not that I want people to be sick I just want to feel challenged and stretched and be available for those who are really in need of ICU nursing care.

We got a flash pulmonary edema transferred from the floor no cardiac symptoms involved. Lasix and bipap and he was doing fine within an hour. The family arrived bringing with them the aroma of stale cigrettes-it was enough to send the staff into resp distress. One of the family members asked "When are you going to defibrillate". I have to admit I was speechless for a moment but I did think of some amusing responses. Thank goodness I have been practicing; stop and think before you speak. I began to explain the etiology, treatment plan and expected outcomes to the family. The family could not seem to understand why the patient had not or was not going to get 200 joules of electricity through the heart to help with the CHF. The physician tried to explain to the family what had happened and that the patient had already had a significant improvement. As the Dr left the unit he was shaking his head and wishing us good luck. Ever heard the saying "Nursing would be a great career if it weren't for the families"

Right now I will just bide my time, let the new grads get oriented and settled. In the fall when the leaves change hopefully so will I.