Struggling

I’m struggling. This pathopharmacology class is killing me. I have no interest in it so it’s hard for me to focus on it. I’ve been procrastinating terribly. I can’t seem to make myself write the essay that I need to complete the class.

I can’t focus.

I am so aggravated with myself for not being able to just get this class done. I hate that I am in this funk and I’m starting to feel guilty and depressed.

I’ve got to focus. I’ve got to sit down and make sh*t happen!

I’m hoping I can get over this hump…

It’s that time of year again…

It’s flu season!

Yaaaaaayyyyyy!

That means it’s time for myths, inaccuracies, and “internet doctors” to try and convince everyone the flu vaccine is evil.

Let’s address some of the foolishness, shall we?

  1. The flu vaccine does not give people the flu. If they get the flu after the vaccine there is a good chance they were already exposed to the flu virus before vaccination or right after receiving the vaccine (it can take up to 2 weeks to develop immunity).
  2. The flu vaccine is not made with a live flu virus. The virus used in the vaccine is dead.
  3. People still need to get the vaccine every year.
  4. Vaccines DO NOT cause autism (let’s let this lie finally die, ok?)
  5. Yes, there are sometimes multiple strains of the flu virus. That does not mean there is no point in getting vaccinated.
  6. While it is recommended for the young and the elderly, even healthy young people can benefit from getting the vaccine for protection.
  7. For those people that think getting the flu will help build your immunity better than getting the vaccine, no. Just… no. The flu can be deadly. Don’t play with your health like that!
  8. It is considered safe to get the vaccine while pregnant.
  9. Yes, the vaccine contains some additives, however, they are in small amounts and considered safe (Here is a list of what’s in the typical flu vaccine and why).
  10. Those “essential oils” are not going to effectively protect against the flu.

Flu season occurs every year and every year the same misconceptions pop up. As health care providers, it is our duty to educate and provide as much accurate information as possible. There is a wealth of information (like this, or this, and this) that can help us provide evidence-based information to our patients whenever possible. Of course we won’t be able to convince every patient we talk to but hey, we can try!

Guilt

I’m on school break and restart October 1st.

I didn’t have to take a break because of life events or anything like that. I am on term break until classes restart. I finished my 4 classes for the first term and had 5 weeks left until next term starts. If I had finished my last class a little earlier I would have had 6 weeks left which would have been enough time to add in another class. Since there, technically wasn’t enough time left, my advisor told me to take a break until the next term starts.

OK, cool, I earned a break…

Yet I feel guilty… Anxious. I feel like I should be doing something school related right now. I feel like I should be logging in to see if I can get the requirements for the next class. Not doing something school related makes me feel guilty.

I shouldn’t feel like this. I know that. However, I’ve been a full-time nurse and full-time student for so long that I don’t know what to do with free time. I’ve been playing Final Fantasy, enjoying friends, I even picked back up on learning how to knit. Yet I still feel this anxiety about school. My mind keeps telling me I am wasting my time and should be doing something, anything related to school… EVEN THOUGH THERE IS NOTHING I CAN ACTUALLY DO!

I hate that I have used school and work to occupy my time for so long that I feel guilt about free time. That’s not fair to me… And now you see why I’m in therapy…

One down

So, term one is done.

One down, three terms to go to finally get my master’s.

I’m proud of myself. When I started school I really thought I might have been making a mistake. I didn’t think I was ready. I thought I was in over my head. My first paper got sent back and recommended for the writing center because it was so bad.

I had forgotten everything about APA formatting! I felt like an idiot. I took the recommendation and used the writing center for help. My papers are much better now. I feel more like a student, like I kind of know what I’m doing.

I still second guess myself. That’s just me. However, I feel more at ease. It’s tough, papers suck, I’m tired all the time, but I see that I can do it.

I know that it will get harder from here. More 14 page papers, projects to do, and soon, clinicals. I’m going to gripe, moan, groan, curse, and complain. I’m also going to get sh*t done.

I can do this. I’m ready…

July…

It’s July. For some of you that’s no big deal. However, if you work in a teaching hospital July means something deeper… Darker…

The “brand new” residents begin their rotations…

Chaos ensues.

If you have had the pleasure of avoiding the July rush, you’re lucky. For the rest of us, there’s a sense of impending doom.

So many orders. Most make no sense.

-pediatric doses ordered for adults.

-level one head CT for “AMS” on your 98 year old patient with known dementia.

-12.5 mcg of fentanyl q3hrs for your chronic pain patient.

-one unit of blood for an hgb of 5.

-MRI of the ankle to look for osteomyolitis of the toe.

Many, many more orders from an alternate reality…

In this moment, it is your time to shine! You are the only barrier between your patient and a doctor that is still getting their bearings. You’re going to have to speak up, a lot. You’re going to have to advocate. You may even have to knock a new doc off their self-appointed pedestal (when they tell you you’re “just a nurse” please refrain from punching them in the throat).

You can do this. Take a deep breath and remember: you’ve made it through many July’s and you’ll make it through many more…

Does nursing education need an update?

I am going to share my thought on nursing education:

The way nursing teaches feels like it’s 20 years behind.

There, I said it.

What we are teaching our students and how we are teaching them is outdated.

I graduated with my Associates in nursing almost 10 years ago. Why in God’s name did I have to calculate drip rates? Not once in my almost decade of being a nurse have I EVER had to calculate a drip rate! In fact, most hospitals prefer meds to be given through the IV pump to help avoid mistakes in how fast an IV medication is given. Another thing I learned in school that is absolutely obsolete is how to give the “perfect” nursing bath. Let me just tell you that the bath you are taught and the bath you will be given are not the same. No one has the time to give this elaborate bath and many facilities are moving away from basin baths and moving towards the chlorohexidine wipes. However, those are mminor things that need to be updated.

What I really am appalled by is how nursing school made me feel like I would be all on my own. I spent so long trying to memorize every medication my poor brain could store because I was made to feel like I had to know them all. I tried to memorize all the side effects. I wanted to know contraindications, interactions, dosages…

I needed to know it all because I alone am responsible.

Yeah, no.

I have always had a wonderful relationship with pharmacy. I have no problem with calling pharmacy and asking about a dosage, an interaction, how often it can be given, etc. As a nurse you are actually not alone. If all else fails, there are several apps that can be downloaded to your phone that can provide a wealth of medication information (think Epocrates, Medscape, and so on).

And that is my next gripe, technology.

Why are nursing programs not incorporating the wealth of technology into their nursing programs? Just about eveyone has a phone now with access to Google. This idea that we have to memorize everything because we have no one to turn to is very obsolete. There is literally a wealth of information at our fingertips. We are in the information age and it’s time nursing realizes that.

But nothing, and I mean nothing, is probably more obsolete than those damn careplans! Hours and hours spent writing thorough nursing plans, while thumbing through the nursing diagnosis books and for what? Most careplans are now documented in the online charting systems (Epic, Cerner and such). Furthermore, NO ONE looks at them but the TJC when they come to visit!

Something is wrong with nursing education. Many Associates prepared nurses are coming out of school with plenty of knowledge on how to complete tasks. A lot of ADN programs teach tasks with no real time spent going over critical thinking. There are Bachelors prepared nurses have all the knowledge of theory and delegation but no real idea on how to apply that knowledge in the real world.

This is a problem. We are hammering nurses with knowledge and theory but not showing nurses how to apply what they have learned with REAL patients. Don’t get me wrong, as individuals providing health care we need the knowledge we are given. However, we need to learn how to teach nurses to apply what they have learned. We need to learn how to teach nurses how to reflect and resolve when problems do arise. This idea that nurses have to do it all and be perfect needs to die. Quickly.

Our future nurses deserve better.

Arch nemesis

Classes have started for me. In fact, I’ve already completed one class. I’m liking the program so far but my fight with my old arch nemesis has reignited:

APA formatting 😒😐

I despise APA. I don’t even understand its point. Margins of this size, very particular page headers, citations that are done *just* so, reference pages with indentions done differently than the actual paper, references sited differently depending on what they are…

Why can’t I just write this damn paper and send it in?!

I get that APA formatting is to help maintain consistancy with how research is published and readability. What I don’t understand is why make it so damn complicated? It almost feels like the creators made it complicated because it made them feel smart.

I hate it.

APA has always been a thorn in my side. I’ve never been very good at it. I find the rules convoluted.

As you can see, I’m already over it…

Stress

I am about to start school. Another one of my coworkers is about to start clinicals for her NP. Another coworker is about to start her NP program. Needless to say, we are all stressed. At least I’m not alone, right?

I decided, however, I’m not going to let myself break under the stress of school and work. I am going to make sure I have some kind of kind outlet.

The first time I went to nursing school my friends and I would go out as a way to celebrate completing a semester. We would dance and let loose. It helped, it gave us a little something to look forward to. When I went back for my BSN my brother would notice I was stressed and drag me to Starbucks or Barnes and Noble (two of my favorite places) to have a moment of of the house. He would also make me do my studying there where there were no distractions (like the TV 😐) to steal my attention. It worked.

So now I’m trying to figure out what my de-stress plan will be for this go round. I know I’ll be doing the “out of house” studying. I think it may be time to bring back the end of semester party night as well! I just know I can’t let myself break under pressure. I’ve got to figure out what my self care will be for this experience…

Decision made…

So…

If you remember some blogs ago, I posted about applying for NP school.

I didn’t get in.

sad failure

I felt like sh*t. I felt small. I felt insignificant. I felt like a failure. I was super bummed about it.

Was…

You know how you make a plan and then allow the opinions of others to make you veer from your plan? Yeah, that happened. Let’s go back a little, shall we?

If you have been with me for a while then you know I have been wanting to go back for a Master’s degree for quite some time. I have bounced between where in the nursing field I wanted to specialize. I have had people tell me I would make a great teacher. I love teaching people about things I know. Teaching is something I have grown to really, dare I say, love. Months ago I was talking to one of my coworkers that has been a nurse forever. I told him about wanting to get my DNP ultimately. His response? “Great! Get your MSN in education and then come back here (the academic hospital where we work) and get your DNP! You’ll make a good teacher”. Prior to even talking to him, the “education” path had been floating around in my mind. I kept pushing it away because according to everyone else, that’s not the “money making” field. As far as most people are concerned, there’s no reason to go back to school unless it’s to get a degree that is going to make you way more money. Forget doing what I like to do. Forget wanting to make a difference in the medical field. Forget wanting to help others. Will it make me more money?

I got sucked into that mindset.  A DNP will make me more money and I need to get it now. Forget getting an MSN and then a DNP, that’ll take too long. Nope, I’m going BSN-DNP STAT!

I was introduced to a program that had the BSN-DNP option. Great! I expressed interest and quickly found out I did not have the GPA currently to do the DNP program.

denied

I could do one of the NP tracks though. Oh… Okay, I guess. I mean, I wasn’t really looking to be an NP but according to everyone else, it was the way to go. So I applied for the NP option. I filled out the application (3 times because the system kept losing it which was probably my first red flag), updated and sent in my resume, completed the essay, and got glowing references (which I ended up having to scan to my email to send to the advisor because the reference link wouldn’t link back to my application because of a glitch, second red flag), and I waited…

And waited…

And waited…

For four weeks.

And then the rejection email and the pity party.

So after all of that, I had to really sit down and think all of this through.

What do I enjoy doing? Where do see my career going? How do feel I can be the best benefit to others? What do really want to do?

I. Like. Educating.

DAMMIT SHAUNELLE, YOU’RE AN EDUCATOR!!!!

I am planning to start school in April. I got accepted into an MSN in education program at the same university that I obtained my BSN from. I should have my degree in about 1.5-2 years if I can buckle down and do this full time. I am not doing what everyone else wants me to do. I am not going for the big bucks (if I wanted big bucks nursing is probably not where I should have headed anyway). I am going to do what I feel is going to make me happy in the long run. It may take an extra step or two but I am going to do things my way.

 

 

 

CIDP

In nursing, we are always learning something new. Sometimes we learn about a new med. Sometimes we learn about a new use for a med. Sometimes it’s a new side effect. Sometimes it’s a disease you weren’t aware of.

As I’m writing this, I just came across a disease I never knew existed: chronic inflammatory demyelinating polyneuropathy.

Say that five times fast!

I had a patient that had an MRI of the brain and complete spine ordered (that’s at least two hours) and the reason was “CIDP”. I have never come across this abbreviation before so I had to hit up good ol’ Google to find out what it is.

Turned out to be very interesting, at least to me.

What is it?

CIDP is rare. It’s a disorder where there is inflammation in the nerve roots and peripheral nerves. It also destroys the myelin sheath over the nerves. This inflammation and destruction interfere with signal transmission. Patients notice muscle weakness, impaired motor function, and it’s typically noticed on both sides of the body.

How is it diagnosed?

According to the rare disease database put together by NORD (National Organization for Rare Diseases), the symptoms of CIDP progress slowly. Patients notice “symmetric weakness of both muscles around the hip and shoulder as well as of the hands and feet”. These symptoms must continue for at least eight weeks without improvement to be considered CIDP. Patients may also undergo EMG’S, nerve conduction studies, lumbar punctures, and MRI’S to help lead physicians to the diagnosis.

Why do symptoms have to persist for so long, you ask? Great question.

Turns out, Guillain-Barré syndrome is kind of an acute form of inflammatory demyelinating polyneuropathy. With GBS there’s typically a preceding virus or illness. GBS progresses over three or four weeks. The symptoms plateau, get better, and don’t re-occur.

The extended period of time is to differentiate CIDP from the acute forms. With CIDP, the symptoms don’t get better without treatment. GBS is usually related to an illness while CIDP doesn’t really have a known cause yet.

How is it treated?

Corticosteroids and immunosuppresants are the standard treatments. According to the NORD article I linked to, IVIG has also been proven effective. It seems that plasma exchange has also been an effective form of treatment. However, both forms of therapy only last a few weeks and the patient may need intermittent treatments.

I spent about an hour reading about this disease because it was so new to me. That’s something I’m trying to make sure I do, read up and learn about the new things I come in contact with here in the hospital. I know I can’t learn everything. That isn’t going to stop me from trying though!