Friday, March 28, 2008

The last day of clinical

Though I am quite proficient at complaining, I cannot find much to complain about in being done with clinicals. All the early frigid mornings, the endless patient preparations, and the pre- and post-clinical wrap-ups are officially at an end. The next time I take care of a patient, I expect I will be getting paid for it.

As far as last days go, it was about as uneventful a day as you could ask for. The hardest part was not staring gape mouthed at the clock for the entirety of the shift. My patient had plenty that was/is wrong with her, but none of it was affecting her in any discernible manner on this day, so she was being discharged (eventually.....getting discharged from the hospital is akin to waiting on cable repair, there is a broad range of time when it might happen). Her mother took care of her feeding, washing, and changing. I was left to do little more than collect vital signs (twice) and check in periodically to see if anything had gone awry. Thankfully, nothing did. I am sure this did little to impress my clinical instructor, but aside from hiding out under my patient's crib I didn't see much way around moseying about the nurses station with my chart in my hand.

Tomorrow will be a simulation day. Well, mostly. It will involve a few hours of simulation and a few hours of lecture and a few hours of post conference and............well, and who gives a shit its over!!! The chapter officially closes on PEDs this coming week with a Monday exam and a midweek NCLEX style challenge for extra points. There are plenty of other things to do, but it is a HUGE relief that clinicals will not be one of them. Would I have liked to deal with full patient loads and other things that would better prepare me? Absolutely! But, UR places more emphasis on other things. Hopefully that emphasis will not prove misplaced.

The fire sale continues on our belongings and, happily, are selling briskly. We may yet condense our belongings enough. It remains to be seen of course, but optimism abounds until you actually start trying to pack it all. I will truly loathe that part. Tia's chinchilla cage weighs more than an offensive lineman and is just as big. Maybe we can strap it to the top of the trailer?

Off to some Nyquil dreams (my allergies will be the death of me yet).

Tuesday, March 25, 2008

This blog for sale. Slightly warn. $50 obo.

Now comes the point in our adventure when we have to start selling off our belongings (and by 'our' belongings I predominately mean Tia's belongings as my accumulation of tangible goods is rivaled by any cart-pushing vagrant) and begin, slowly at first and then with alarming rapidity, to devolve back into "first apartment in college living." The kind of living that has everyone seated around a coffee table that used to serve another purpose (like a spool for cable) until a friend finds a dining set under the stairwell that is so covered in cobwebs that the Addams family would reject it. Somehow I doubt things will go that far....but we will for sure find ourselves slumbering on an inflatable mattress, dining without benefit of a table, and sitting on the living room floor for at least a few weeks. Perhaps we will look back fondly and laugh at such inconsequential hardships, but in the interim it will be really annoying for all involved.

What this means in the long term is that we will likely be hitching up a trailer and driving across the country that way. I am sure my brother-in-law can relate to the fun that that will yield, but at least we will not be taking any mountain passes of substance until Idaho. I don't anticipate the nasty weather we encountered there in early May to be present in early June. But then again, I am incredibly naive.

I now have to actually write a fake letter to a representative about a policy issue. You might assume that my program was hijacked by a high school civics teacher, but you would be wrong. This is actual college work. Seriously.

Sunday, March 23, 2008

Childe Roland to the Dark Tower came

Another week of clinicals has been put to rest. This week was harder than most, but not for any particular reason. Just the sense that things are winding down makes it seemingly harder to concentrate on the most immediate tasks and not concern yourself with what lies down the road. I understand this, but it makes it no easier. You can sense it from those around me who are settled in a job and a place. I don't want to label it a sense of inner peace, which sounds an altogether too ethereal for what it is, but they are definitely more at ease. I can't help but wonder how we will figure out what needs to come with us when we move such as: where the money for the move will come from; how to determine the value of things you have to sell vs. the cost of re-buying items you need vs. the cost of moving some of those things vs. all of them; whether or not to sell a car or keep them both; and, of a lesser concern only because I am impotent to do anything about it at the moment, where and when I will be employed both immediately upon my return to PDX and in the Fall. All of this plus trying to tie together details for the wedding and maintaining course work. May will be both a huge stressor and an enormous relief.

As for clinicals, my patients were all in good spirits in spite of their ailments. You have to give kids credit for that. They are so resilient in the face of what lies ahead, both because it is their nature and because they cannot possibly comprehend the bigger picture. The more I am there, the more I wonder about possibly working with this population down the road. We will have to wait and see. I love being able to interact with the parents and the children, but hate to see children dealing with chronic ailments. Definitely on the table. Just need to develop a better comfort level with the really little ones. I have no familiarity at all.

I finished the Dark Tower series (septology?) finally. It was quite a literary journey, but a really enjoyable one at that. As with any series as long as that, there are many places that could be trimmed and streamlined, but overall there was a whole lot to like. Now I have to find something else to tide me over when I am not knee deep in reading about pediatric neuromuscular disorders.

I hope everyone is having a good Easter Sunday howsoever you celebrate it. I don't tie any particularly religious connotations to the day, but I definitely miss being around family, snacking on chocolate and closing the day by eating an overlarge meal. Here there is just Tia and myself and, quite frankly, little is even open and operating today. It is beautiful and sunny, but still far too cold to be outside soaking it in. Maybe fate is trying to force me to study......I will do my best to fight it off.

Wednesday, March 19, 2008

Escape from New York (Snake Plissken edition)

What can I say about NYC? It is one of those places that has a distinct feel to it to be sure and those are few and far between with the homogenizing of America. Most cities nowadays all have the same restaurants, malls with the same stores, and the same look. The few that don't that I have visited in the US are San Francisco, Las Vegas, NYC, Washington DC, San Antonio, New Orleans, Portland, and Miami (I had hopes for others like Seattle, but take away the waterfront, and you could stick that city anywhere. I still think it looks like the Pearl in Portland, only through the whole city). That isn't to say that any of these cities are places I would want to live nor is it to say that they have a feel that is necessarily good or bad, but they stand out and thrum with a distinct energy. NYC is too dirty, expensive, noisy, and crowded for me to ever want to life there. But, it had its beauty too around Central Park and in some of the neighborhoods. It isn't a place that I will be compelled to come visit again, but I am glad i had a chance to see and explore it and that is more than I can say about a lot of places I have seen (such as Rochester).

School continues to be an overwhelming pain in the ass, but it is a muted pain anymore (perhaps a dull ache). The clock is winding down and the classes are less strenuous than they were last term. At this point, I just need to show up sober at the last few clinicals to pass PEDs, force out a few papers for Ethics and tie up a group project (and poster presentation........i hope we get to use fingerpaint!) in Management. Nice.

That said, I did just find out that that UR will be discontinuing both the management and ethics course and replacing them with more simulation time and more time in clinicals working with a larger patient load. Part of me understands that I ultimately have an easier path with those two god-awful useless courses, but part of me cant help but be upset that they always make changes that would better prepare you for the actual career the year AFTER I finish a program (I had a similar experience in elementary ed). The opportunity to work with a full patient load under the tutelage of a nurse will have to wait until I start working, which is fine if I stayed here where that is understood by local hospitals, but potentially a bit more of a problem out West. Only potentially though since I dont know what preparation occurs out West. As usual, fake it til you make it........at least I will be ethical and understand the principles of followership while doing so! :)

Lesa asked me a question that was, I thought, quite poignant, "Do I feel well prepared?" I could only answer that I do............and I don't. On one hand, I think I will be as well prepared clinically as any other student having spent a lot of time with patients on the floor. On the other hand, I will not have had more than 2 patients in any given shift. That will have to be learned and is usually part of training. On the other hand, ss for pharmacology, I am a bit underwhelmed by our preparation and feel like I wish I knew more than I do. That knowledge will also come in time and will be fairly rote once you see them over and over again on a unit. Still, I have a lot to learn. Mercifully, it is not my job or within the scope of my ability to prescribe anything. So, ultimately I think I have the tools to be trained to be a nurse, but I certainly wish I felt more confident about certain subjects within the profession.

On a completely other note, check out the show Dexter if you haven't. I don't think you will find another show (and hopefully not in real life either) where you blatantly root for the serial killer to win out in the end. Michael Hall is great in the lead role.

There is little else to tell. The countdown is most assuredly on. Less than 50 days and counting until classes recede into fading memories. Less than 75 before we are back in the Pacific NW. Hopefully less than 125 before I find someone to pay me for all this schooling.

Wednesday, March 12, 2008

Happy Hump Day

Hump day is Wednesday..........get your mind out of the gutter! :)

I am shocked that it is already Wednesday. My spring break is fast becoming a memory and I have little 'break' to show for it. I have been working on papers and my packet for Legacy for the most part. That will all change tomorrow though. Tomorrow Tia and I head down to NYC for what I hope will be a fun time. I think it will anyway as we are staying with a friend of Tia's there who happens to have time off to show us around. Very nice. I am not sure what we are going to do once there, but I want to see Central Park, Chinatown, and Times Square of course. There will be so much to do and see. Especially when compared to Rochester.

We had our first (probably only) moving estimate today. If we take it all, looks like $2500ish. Could be more if we take the couches. Bare bones, nearly $2000. That is juxtaposed with renting a trailer and putting a hitch on Tia's car which will be about $1000 all told, but will significantly limit our space and require some hard choices to be made. I, of course, would rather save the money than have things that we can do without in the short term. Buy some Ikea chairs and the bare minimum furniture that will get us by until I start working and pick up things like a sofa later. Short term it would work, but it isn't necessarily the most financially prudent thing long term. But, then again, I am nomadic by nature and don't like to accumulate much in the first place. Tia, on the other hand, has a much stronger affinity for things. Hard to blame her totally, most things are hers to begin with. My belongings would still all fit in my car.
However, when faced with the distinct possibility of not being gainfully employed in my profession until August and the likelihood that I will need to take a very low-paying job in the meantime, it certainly appears preferable to spend down the road. We are even discussing selling my car if we can get a good price. It should net us a few thousand, after paying it off, and we can buy something new once I find employment (something compact with exceptional gas mileage since gas is supposed to go up significantly by the summer). It would save car payments for a few months as well which would be good. I never thought I would be at a more precarious point financially out of school than in it. At least Tia is gainfully employed and can float us for awhile if we find reasonably inexpensive accommodations out in Portland. We will have to talk about my allowance first of course :)

I need to finish up my cover letter and resolve a hypothetical ethical issue for class on Monday. I will write of my NYC adventures upon return to the artic tundra in which we reside.

Monday, March 10, 2008

Job update

Since I know you are interested in my becoming financially solvent, I thought I would let you know what I have found out thus far regarding applying for positions out in Portland/Vancouver:

Providence: Applications should be held until at least late April/early May, preferably until after graduation (but can be submitted prior to NCLEX).

Legacy: Applications accepted only through internship program (which I am applying to). 1-2 positions per unit twice a year (fingers crossed so hard they are becoming cyanotic).

Kaiser Permanente: applications should be held until after graduation and preferably until NCLEX has been passed or they are screened out by recruiters and don't go to nurse managers (meaning you WILL NOT be getting hired period unless you have passed already).

SW Med: wait until graduation. 3 references needed from clinical instructors.

OHSU: wait until license. Highly competitive with low turnover according to recruiter. She kind of made it sound like a NYC apartment, like I should scan the obits and see if an OHSU nurse died so I could apply for her newly vacant position.

So, it looks EXTREMELY unlikely I will have so much as an interview prior to moving unless the Legacy internship comes through.

This is all a bit discouraging, but hopefully it just means I need to bide my time and something will come through once I get out there.

Sunday, March 09, 2008

Spring Break and another foot

How spectacular to only have to think a modicum about school over the next week. I wish I could say that I intended to not think about school at all, but there are a few assignments due immediately upon the culmination of the break. Who does that? University of Rochester SON thats who. Oh yeah, and it snowed a little over a foot the past two days. We are now jsut shy of 100 inches for the winter. I miss grass, leaves on trees, and my car not being covered in more salt than an Auntie Anne pretzel.

Interesting SON story. A fellow student, lets call her M for the sake of anonymity, had an altercation with a clinical instructor, lets call her D, who already has a poor reputation within the school that, through teacher evals should bear out if not through direct complaints. Anyway, M had a rough go in her clinical with D, and thought that the attacks seemed personal rather than having anything to do with her performance. Her final student evaluation was passing, but a lot of the comments were quite negative. M was disheartened, but could really do little accept complain through her teacher eval of D. However, evidently D decided to talk to someone about M and said something to the effect that she purposefully gave her a negative write-up and thought it was funny. M was pissed and went to the school to complain about her confidential student information being made public and the fact that D was acting completely unprofessionally. Contacting a lawyer was brought up. The school reacted to that.........well, kind of. D was talked to (scolded?) and the next day D came up to M at work with a new student evaluation that has nothing but stellar things to say about M. She told M that the other eval 'was a goof' and that she hadn't meant to give it to her really. She asked M to sign it so that everyone could move on. To M's credit she told her to kiss off. It wasn't about the evaluation, but rather was about confidential information, her information, being broadcast to third parties and about the complete lack of professionalism that D had displayed. M says had she not closed the term with a very positive alternate site placement or she would have dropped out then and there. This complaint was not the first that I have heard about D.....and I am sure I have not heard them all.

Multiple choice: The school, threatened with litigation because of D, has decided to:
A. Immediately terminate her contract in light of the mounting evidence against her.
B. Suspended her while they investigated the matter further
C. Reassigned her to a non-clinical role
D. Did absolutely nothing except give her a tongue lashing

Don't think too hard about it, because you can probably guess based on my other observations that the school not only did very little, but that she is teaching another group RIGHT now. Re-god-damn-diculous!

I had an interesting clinical day yesterday. I ended up working with 2 young girls, 11mo and 14mo respectively. One had a brain tumor and had shunts in her skull to relieve the pressure. The other had a disorder that, without getting too medical, basically led to her urine going back up to her kidneys from her bladder. The girl with cancer had an NG tube, so I had to do some feedings through it and change my second ever diaper. The other girl was in the hospital for her 27th UTI infection since birth and had to be straight-cathed 4 times a day to get urine. So, I ended up straight cathing her. I am definitely getting some experiences, but I truly dislike seeing little kids in such bad places. I cannot imagine working in PEDs any more than I could imagine working in long term care. I think I would be an alcoholic by the third month.

Off to enjoy my lazy Sunday without a pressing need to read some textbook or another. Feels nice. A guy could get used to this.

Friday, March 07, 2008

Pulling out my hair

Just taking a break from my patient prep. I need to tie up a few loose ends before submitting it tomorrow morning. Also, I need to prep for both my patients tomorrow (it will be half-assed to say the least. I am not passing meds so I plan on acquiring only a passing knowledge of their uses). I spent today down in the acute care clinical for pediatrics which was surprisingly a lot better experience than I was led to believe it would be. It was fast-paced with a lot of variety, and that is what I prefer in relation to hospital care. I saw chemo therapy delivered through a spinal infusion, spinal fluid collected for testing, port access for meds, kids with colds through cancer, and even got to listen in on some phone calls from parents. Overall, about 10 times better than the babysitting we predominantly do on the pediatric unit. Oh well, like it or not, I have to get through it.

Speaking of getting through.......I am writing out of lucid hours and I have a lot to get accomplished before I do.

Thursday, March 06, 2008

Some people can't find the needle, I can't find the haystack

Things are taking a turn towards both the interesting and the frustrating of late.

Out here, the recruiters seem to smell blood in the water when you contact them. It is getting kind of ridiculous how desperately they circle. They call and call, even if you schedule a set day that you will call them. It is nice to be wooed and wanted, but it almost feels a little too good to be true. Of course, considering the relatively low pay, mediocre benefits, being charged for parking and living in one of the snowiest and most crime-ridden cities in the country per capita is a dead give-away that it most assuredly isn't all that good.

It is the opposite out in the Pacific Northwest. To continue with the aquatic theme, Portland is much more akin to chumming the water hoping for a dorsal fin to pop up over the breaking surf and getting nothing. There is no sense of urgency at all. The recruiters there seem to have a "dont call us, we'll call you" mentality. This to live where we want to, instead of where we are with significantly better pay and benefits.

Both situations make me a little edgy because I feel most comfortable somewhere in the middle. I don't need to be sold on a job, any job, just because there is an opening that needs to be filled. However, I also don't want to be pushed off like I am bothering them by applying. It is discouraging. The hardest thing about Portland is that I KNOW there are jobs. Plenty of them in fact. They have innumerable opportunities at almost every hospital on their websites. Some have been posted for months and are still vacant.

Speaking of jobs, I am now trying to get my ducks in a row for an internship at Legacy. I think this illustrates the difference between Portland and Rochester pretty clearly. In Rochester, I applied with just a resume and a smile. At Legacy, I applied and was told I need to apply through the internship because that is the only way they will hire new graduates. The application opened up on the 3rd (I found out on the 4th) and will close on the 21st. In the meantime I need to get two reference forms filled out by clinical instructors. Sounds easy right? Well, it kind of is and kind of isn't. The forms have to be filled out and signed somehow by me and the clinical person, which isn't easy to do since I don't work with these people any longer. So, I thought I would just email them instead. Well, this is an issue because the forms then need to be sealed and signed across the seal (and also cannot be folded or stapled or breathed on incorrectly) while somehow I sign it too. This is in addition to a few other pieces of paperwork that also need to be included in the application. Then I have to hope that I can get an interview dependent upon my application and what two areas I select to apply to (which is its own issue because you have to guess how many new hires might be accepted and there is a possibility that some areas may not hire anyone).

On a funny job side note, I got a call from Rochester Psychiatric hospital today where I had previously interviewed. They are literally sending letters to my last three places of employment and needed the address for the school in Korea. I shit you not. I explained that they would be better served writing to just the US locales because of the English barrier, but they weren't sure what they were going to do. The chances of me working there went from 5% to less than 1% both because they aren't likely to get much of a reference from overseas and because if they are working on a letter writing campaign, by the time they would even get around to offering me a job, we will be long gone from this area. I am glad to see it is 1982 and physical letters are still be used for references. I am half surprised they didn't tie a note to a carrier pigeon's leg or send it by donkey.

I really ought to get back to work on my patient assignment, but I keep getting distracted by everything else going on. I plan on continuing to try to pester places into taking my resume next week. In the meantime, if anyone knows anyone who might be able to help with the hunt, it would be most appreciated. I am not opposed to begging. Unless a perfect job presents itself here, there is pretty much ZERO chance we will stay in ROC. Even if it does, the chance maybe creeps into numbers congruent with the weather here in the dead of winter....high teens, but a 'feels like' chance of much less.

Two more days of clinical and then a week off for Spring Break. Sweet sweet freedom.

Sunday, March 02, 2008

I can't study any more today

Thought I would evade reality for a bit and post up some thoughts while I had a few minutes.

My first thought is that I must NEVER eat at Taco Bell again. I am sure there are those among the people who read this with iron constitutions who might disagree, but probably more than that who have already learned the hard lesson about eating there. Suffice to say, I think I learned my lesson this time. Damn you Montezuma and your intolerably pungent vengeance!

My second thought is that PEDS nursing is okay and quite a noble profession, but not my bag. The patient I worked with was as pleasant as he could be considering that he was restricted to his room because of ORSA precautions. It is hard to be cooped up for 2 weeks in a house, let alone being cooped up in a single room with the patience and and energy level of a 7 year old boy. I would be going insane. On top of that, he has to sit in a pneumatic vest 4 times a day (30 minutes each time) that pummels his chest and back to loosen up the thick mucus from his CF. I saw another child, also with CF but two years younger, who had had a stomach, kidney and small intestine transplant already and two young girls with cancer. D-E-P-R-E-S-S-I-N-G.

I don't know if I have a third thought at the moment other than I really don't want to wake up early the next two days to take exams, but hopefully I know just enough and all will end well. Once I get through this week it really will be the home stretch. Two months from today is the official endpoint (well, the last day of classes which is official enough for me). I can't believe I have made it successfully this far.

Josh - I will pick you up a garnet ring too. I could sense the jealousy.