Sunday, June 27, 2010


I've been a bit missing in action due to family issues, but everything seems okay now. As okay as it is going to get, anyway.

Besides that, I got called off today and yesterday! I'm not complaining because I've had some things to take care of, so it is a welcome break, even if my PTO is probably at zero now.

Honestly, since my last post, I've felt so happy! I'm the kind of person who loves to have a plan and a goal to work towards. And now that I have decided on a graduate program and  a time-frame, I feel great.

Starting on July 1st, I will begin studying for my CCRN, as well as the GRE. Currently, I am planning on taking the GRE probably in October, and the CCRN in December.

Sometimes I feel like I care too much about what someone might think or say when I tell them my plans. But recently, I talked to the nurse practitioner on my unit, and she told me I should definitely go for it and that I have PLENTY of experience. Once the program begins (Fall 2011), I would have 3 years of RN experience, 2 of which in the ICU, and then of course, I would still be working while in school, giving me even more experience. Plus, they are teaching you what you need to know!

You can't sit around worrying about what other people might say or think! You need to just go out there and live your life, and do what you think is best.
Once I have a goal in my mind, there is generally nothing that can stop me. Nothing. I get out there, and I do it.
And I succeed.
"The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather in a lack of will."

Right now, I'm waiting on my study guides to come in the mail that I ordered from, and tomorrow and Tuesday my hospital has Laura Gasparis Vonfrolio giving a 2 day CCRN review class. To me, this is the perfect way to kick off my CCRN studying!


As far as Tri training goes, I ran yesterday on the treadmill! It was just so hot by the time I woke up. I am on week 8 of the couch to 5k. It was difficult. Actually, I think that running outside is almost easier.  Just running and not getting anywhere, and focusing on the time glaring in my face was too distracting.
Today I am taking the day off because behind my left knee is killing me. It's the weirdest thing, I got a terrible muscle cramp in my leg the other night while watching TV. I tried to walk it off for about 10 minutes, but it wouldn't go away! I ended up taking a hot bath and it felt better, but now, the back of my knee is killing me! It's almost like I strained my muscle from it being contracted for so long. Argh, injuries. Tomorrow is a new day, I suppose.

Tuesday, June 22, 2010


This is kind of just me thinking out loud and working some things out in my head...very new and dependent on a lot of situations...

I think i have found something that I might be interested in doing. As you may or may not know, by 2015, they will be phasing out the Masters of nursing programs and in order to practice as a nurse practitioner, you will need a doctorate degree
 Well, the University of Florida in Gainseville has already begun doing this, and actually has an Acute care track for BSN TO DNP (USF does not..), AND they have the option of internet based online courses for those who do not live in that area. It states you would need to still meet at least one time per semester for evaluation purposes, but not more than 3 times.You would do everything else in your area (including clinicals). This sounds like an amazing program because 1. we can stay here in my current hospitall) 2. Florida degree=cheaper 3. I would be a freakin' doctor (ha!).

The only crappy part is that I would need to take the GRE and as a part time student, it would be 4 1/2years of school (ouch), but I will have no choice either way if I need to be a DNP for the requirements. They only accept applicants once a year, and the deadline is March 14th for the fall. I think my goal/plan will work out something like this:
1. July 1st=start studying for CCRN
2. Get CCRN by Dec/Jan
3. Continue to work in my current position as an RN
4. Apply March 2012..

I would say apply this coming March 2011, but I dunno!! aaaah

I suppose I could take the GRE in between Dec and March, but that seems to be cutting it close, and seeing as I do not expect to do well on this sort of standardized exam, I would like to give myself time.
And also, part of me is super duper anxious to get back to school and get on the ball with things (I'm not getting any younger, har har), but another part of me wants to keep getting more experience in the ICU. I don't really think I want to do primary care as a nurse practitioner, so that is why this program sounds so great for me because I can stay in this area (pending whatever is going on with Mirza at this time), and become an Acute Care Nurse Practitioner.


Edit: After some thought, I have realized that I rock and I think I am capable of studying for the CCRN and the GRE together. Seriously, what is stopping me besides my own thoughts?!! YEAAH, I ROCK.
Technically, once the program begins, I would have 3 years of nursing experience, and TWO years of ICU experience. I think that gives me a good, solid base. And then I will still be working full time for 4 freakin' years while in the program for as long as I can!!

Honestly though, I miss having something to study. I'm a total geek.
Let the studying commence.
I miss school and am determined to start FALL 2011. 
Once I get an idea/goal, I am pretty determined...nothing is going to stop me, muahah!

Sunday, June 20, 2010

Everyday should be a good day to die

I've been missing in action the last few days.  Mostly just working and being lazy.

I am happy to report that I finished Week  7 of the Couch to 5k program today. Two more weeks to go!
 I have resorted to allowing myself walking breaks. Sorry, but it is not feasible to run for 25 minutes straight in this weather. They are only 30 second breaks at a time, but totally help. And I finally bought a hat (had to buy child size. Apparently, I have a tiny head?), which has helped more than I thought with the heat/sun.

I took an unscheduled rest day yesterday. After I work two twelve hour shifts, I feel dead the next day. I never understand how people do three 12's in a row! I am weak. Nursing is physical.

(source: duke nursing)

Friday was a bit of an emotionally and physically draining day. My older something patient with a DNR was septic, maxed out on levophed (with her BP still in 70/30 with MAP of 40-50's), received numerous liters of fluid, and deteriorating pretty quickly.

 I spoke with the family member who was quite realistic about the situation and after retrieving a blood gas and relaying that the patient needed to be intubated or he/she would die, the family member made the right decision to go CMO. I was so glad. I absolutely hate to watch people suffer through death.
This was still a difficult decision for the family member, of course. I had to call another family member and explain the situation while everyone cried.
At first, we were going to wait for 2 other family members to arrive that night before we stopped everything besides morphine/ativan, but then the 1st family member just said he/she did not want his/her mom/dad/sister/brother to suffer any longer, and the rest of the family on the phone agreed.

Finally, I shut off the levophed, all fluids, and turned the monitor around. I stayed in the room with the lone family member behind the monitor and we talked about his/her mom/dad/brother/sister, the kind of life he/she led, how strong he/she was, etc. He/She passed in about 15 minutes. And then I let the family member stay with him/her for as long as he/she wanted.

I felt good about the job I did because the family member kept saying thank you and how grateful he/she was to have such a wonderful nurse.

Is it weird that I still talk to the patient after they die? For instance, as I was removing tape, etc., I continued to explain to the patient, "ok, i'm just going to pull off some tape here..." I suppose I am just used to talking to people who don't respond (sedation/vented,etc).

Everyone dies. EVERYONE.

And to make this post a little less serious...something light for your viewing pleasure. The comic genius of Mr. Carlin...

Tuesday, June 15, 2010

20 miles!

All before 9am yesterday, I completed 20 miles on the bike!

This was my longest ride EVER and I did it in 1 hour and 32 minutes. I'm pretty proud of this. I had planned to go out and do 16, but as I started riding, I thought how solid TWENTY would be. Plus, it just sounds better. And so there, at mile 5, I determined I would drive for 20.

On my ride, I encountered a lot of animals...squirrels (no count), blue jays, pelican (on a boat), egrids, a weird grey crane, about 5 bunnies (including one hauling ass across an open field. I yelled," GO BUNNY, GOOO..."), a black fluffy cat who meowed at me, a turtle against a fence, and two kittens, one tiger/one black walking on top of a wall. Too cute!

I took these two right at the start of my ride. Sadly, no dolphins:(

After my ride, I was a mess. Does anyone else get super dirty from cycling?

I may have been dirty and red,but I felt GREAT and accomplished.

I was also hungry! I had one thing in mind: French toast!!

I ended up eating two french toast, one egg over easy, and three pieces of watermelon. Totally hit the spot after 20 miles...

Max watched me eat. I assured him that he did not like French toast...

Later that night, I met up with Callie at her job for a 750 yard swim! This is where I need the most practice. I hope we can meet up and do some open water swims, too. 

And this morning I did Week 7, Day 2 of the Couch to 5K, which is a 25 minute run straight. I did 24. The sun was so hot. It was making me emotional. I felt like crying. I pushed through, but when he said "One minute left," I gave myself permission to walk. Usually, I would say, "I can do anything for one minute," but at that moment, the sun felt like sharp needles on my hot, burning face and my entire body was soaking, dripping wet. It was miserable. And it's done now.

The goal for tomorrow is swim and then some sort of strength exercise, like weights or yoga.

Jumping ahead a bit, I just threw together some random ingredients and came out with this:

Comment for the recipe! I must go get ready. There is a community forum tonight downtown about the oil spill. 

Here is the agenda:

6:00 p.m. Welcoming Remarks
Susan Glickman, Florida Business Network for a Clean Energy Economy
6:10 – 7:00 p.m. Panel 1: About the Gulf Oil Spill
Moderated by Laurie Macdonald, Defenders of Wildlife
Dr. Ian MacDonald, Florida State University
William Hogarth, Dean, College of Marine Science at USF
Dan Berard, Geophysical Engineer
DT Minich, Visit St. Petersburg & Clearwater
7:10 – 8:00 p.m. Panel 2: The Media’s Perspective
Moderated by Ernest Hooper, St. Petersburg Times
Preston Rudie, Channel 10 CBS WTSP-TV
Rob Lorei, WMNF Radio, and WEDU-TV
John Hill, St. Petersburg Times
Mitch Perry, Creative Loafing
Jan Hollingsworth, reporter & editor
8:10 - 9:00 p.m. Panel 3: Solutions
Moderated by Darden Rice, Gulf Restoration Network
Cynthia Sarthou, Gulf Restoration Network
Susan Glickman, Florida Business Network for a Clean Energy
David Friedman, Union of Concerned Scientists
David Pettit, Natural Resources Defense Council

Looks pretty good!

Monday, June 14, 2010

You're bigger

I got called off!!!! yay! When the census is low, that can happen in nursing. I am using paid time off right now. So, essentially, I will get paid to sit in my house or go for a bike ride, whatever.

Yesterday was a lazy Sunday spent with my lovely Mirza. He came over around 10am and we watched the WORLD CUP between Ghana and Serbia. Since Mirza is Bosnian, I am sure you can guess that we were all about Ghana. And of course, they kicked some booty, so we were happy:)

After the game, I made us some Mac-Uncheese.
This is Mac-n-cheese made with nutritional yeast.

But it is NOT vegan because I used REAL butter and a little bit of REAL mayo (I just do not have these vegan items in my kitchen. Someday?). I am surprised how much the nutritional yeast does taste like cheese in this recipe. I topped mine with tomato.
Recipe was adapted from a vegan booklet I got at the Green Expo. If you would like to see the recipe, then leave a comment and I will update the page.

After eating, we went for a fun swim at the apartment. The water was luke warm, like bath temperature. It still felt good.

And then it was almost time for the next game. Germany versus Australia. Since Mirza lived in Germany from the ages of about 7-9 and spoke the language fluently, he was rooting for them. I decided to go with Australia because I love to vote for the underdog, in general. Unfortunately, Australia did not do so hot.

After the game (and after eating some homemade chocolate brownies. Sorry, no photos), I flipped through the channels and saw that the 2009 Clearwater, Fl Ironman 70.3 was on NBC!!!! I missed the swim portion, but caught the rest and it was so inspiring. I believe this was the course that runs or bikes right by my apartment complex! I saw signs for it,but had to work on that day, and missed it.

 So inspiring, in fact, that even though I deemed yesterday to be a "rest day," I was determined to go out for a run. Keep in mind, it is 5pm, 93 outside (feels like temperature over 98). I think I might be slightly insane.
I went with it. If you would have asked me two months ago if I would have ever said, "I feel like going out for a run!! I really want to run" I would have laughed.

This was supposed to be Week 7, Day 1. Run 25 minutes straight, which I did do last week for W6D3. I told Mirza I may need to walk some, but I didn't care and wouldn't take it as a failure.

The first ten minutes, no walks. I felt okay. I ran with water. When I got to my turn-around point, I told myself I could walk for 30 seconds. And I did. And I subsequently walked 3 more times for a total of 30 seconds each.
After 10 minutes of that, I knew it was time to end the run 5 minutes early. The sun was just too hot and it was feeling dangerous.
I am still proud of myself and I do count it as a victory and will move on with the program.

Mirza then made us dinner...

Doesn't that just look like a plate of summer goodness? 
He marinated portobello mushrooms in Greek dressing, and then sauteed them in olive oil with onions. Truly delicious. On the side, we had baked red potatoes, corn on the cob, and leftover dressing for the salad. I also had the other half of my tomato. Mirza is so good in the kitchen. I love to just eat a huge plate of veggies, how 'bout you?

Friday, June 11, 2010

what happens during HALF of my day?

Have  you ever wondered what a typical day is like for an RN in the ICU? Well, I must say, there usually is no such thing as "typical" since patients are not on any real schedule. The day follows however their condition warrants. But I have decided to record what occurs during HALF of my 12 hour shift to the best of my ability...

Timeline of my day:

415 alarm

416 shower
425 out
426 feed cat, put lunch into bag, prepare breakfast
435 eat/check computer
445 dry hair, get dressed
458 leave house
520 arrive to work
528 clock in after riding my bus, etc.
530 after putting away bag, venture into the ICU
532 check board for name, see who I have, get paper and sticker, print ekg strips from monitors
535 begin getting report on two icu patients. Info includes, name, age, allergies, code status, past medical history, dr’s/consults, history of present illness, mentation, respiration, cardiac, gi/gu, lines and drips, skin, family, labs, cultures, pending…
0600 Look through chart, write down times for meds/accuchecks, read quick progress md notes
0605 write down labs, not abnormals
0610 chart 0600 vital signs, including: blood pressure, HR, Rhythm, sats and O2 %, temperature, RASS scale, dump urine for the hour and note milliliters.
0612 Begin head to toe assessment: listen to lungs, heart, bowels, check pulses—radial and pedal. If pt alert, ask if they have pain, how they slept, follow-up with concerns. If ventilated and sedated, make note of ventilator settings, suction the patient if needed, tidy up the room (!!), check pupils. Zero any alines, cvp’s, ScVO2 monitors, check alarms on monitor, adjust to personal setting. Check room, make sure ambu bag, enough flushes in the drawers/make sure room is stocked for a code!
0620 if patient or family does not need anything, such as blanket, ice, bed pan, water, etc. then begin   to chart assessment on flow sheet (approx 3 pages). Go through chart and if not already done, update special treatment pages, education, graphics for IV access, treatment/plan of care, remove 234234 extra papers that do not belong in the nurse’s chart, reprint patient id stickers.
0630 Onto patient #2… chart 0600 vital signs, including: blood pressure, HR, Rhythm, sats and O2 %, temperature, RASS scale, dump urine for the hour and note milliliters.
0632 Begin head to toe assessment: listen to lungs, heart, bowels, check pulses—radial and pedal. If pt alert, ask if they have pain, how they slept, follow-up with concerns. If ventilated and sedated, make note of ventilator settings, suction the patient if needed, tidy up the room (!!), check pupils. Zero any alines, cvp’s, ScVO2 monitors, check alarms on monitor, adjust to personal setting. Check room, make sure ambu bag, enough flushes in the drawers/make sure room is stocked for a code!
0640 if patient or family does not need anything, such as blanket, ice, bed pan, water, etc. then begin   to chart assessment on flow sheet (approx 3 pages). Go through chart and if not already done, update special treatment pages, education, graphics for IV access, treatment/plan of care, remove 234234 extra papers that do not belong in the nurse’s chart, reprint patient id stickers.
0650 Breathe. Recheck all patient’s. Hang any meds for abnormal labs, like potassium.
0700 Patient #2 has temp 103.4. Order Tylenol, wait for Tylenol, bring patient water, call to have the room temperature turned down. Receive Tylenol, check patient name band to medication record, give Tylenol. Check blood glucose, adjust insulin drip. Tell patient to go back to sleep for now. Record 0700 vitals, dump urine and account for that hour’s output.
0720 Record VS, dump urine. Suction patient. Try to get him to open eyes. No luck. Measure serosangenous fluid in chest tube, clean bloody mouth.
0730 Recheck patient #2 temp. Still 103, continue to check.
0735 make note of patient’s increased HR
0740 MD walks by, give tiny update, nods and says ok.
0750 Orders from another doctor on patient #2..blood cultures x 2 from port and peripheral, AM labs.
0800 draw labs. Call phlebotomy for peripheral after failed attempt.  Record vitals, dump urine.
0810 record patient #1 vital signs, check blood glucose, give SQ insulin, dump urine. Record all.
0830 Rechecking patient #2 glucose, interrupted by respiratory. Want Pt #1 off sedation to do a breathing trial. Un-don gloves, wash hands, excuse self. Walk across hall, press “Stop” on Fentanyl drip, and tell them he is off. Walk back across hall and finish checking blood gluce.
0830-0900 General maintenance…talking to family, grabbing water, helping with turns, waiting on phlebotomy Give meds, hang antibiotics. Order more drips from pharm.
Pt fails breathing trial. Placed back on fentanyl drip. Speak with daughter along with ARNP regarding end of life.

0900 ROUNDS. MD with Charge RN, RT, pharmacy, nutrition stand in front of room and I give my update on the patient. We discuss care, what to do, etc. repeat at each room.
0915 Scan all new orders, write new drugs on the Medication record.
Record 0900 Vitals, dump urine.
0920-1015 Note pt #2 HR to be labile, jumping up to 160’s for a few seconds. Tell intensivist, order 12 lead ekg, find patient is now in atrial fibrillation. Order cardizem drip, give 10 mg bolus, and start the drip. Monitoring BP and keeping MAP>65. Pt tolerating well…
In the meantime, also speaking with husband about care, and talking with patient #1 daughter while giving AM meds…crushed through small bowel feeding tube, some through IV…
Recording Vitals, dumping urine, monitoring output.
Reassess both patients for the 4 hour head to toe assessment (see 0632 for what this entails), rechart in flow sheet. All the while making notes in the progress record.
1100 repeat. Suction, turn, glucose, vitals, titrating drips, discussing comfort measures only with family, drawing labs…
1145-1215 eat lunch and watch part of the World cup!
1220 Return to floor. Chart vitals, urine output, check on everybody. Retrieved ice, blankets, etc. Give meds, hang antibiotics
Echocardiogram arrives for #2. Check blood glucose, adjust insulin drip. Note that she returns to sinus rhythm. Await pending cardiology for further orders on the cardizem drip.
1225 glucose on #1. Waiting for renal to decide if pt can be diuresed..up 60lbs since admission.

And there you have it, half of my 12 hour day. The funny part is that it all seems so simple, but at every and any given moment, I am literally doing 20 things at once. Monitoring the patient, thinking about the disease process, correlating what I see in real life with what the patient is presenting on paper, talking to families,  waiting for MD’s to call back, coordinating with other disciplines like respiratory, trying to think ahead to worst case scenario...what is going on with the patient? What could happen? Monitoring tiny changes in blood pressure, heart rate, temperature, urine output, weight... Calling pharmacy for meds that aren’t loaded, giving ice to family, patient’s. Answering countless questions from patients, doctors, families. Explaining disease processes to families..Helping other RN’s with turns and clean up's…

CrAZY=the life of an RN.
If you or your family member is ever in the hospital, try to remember that the nurse is doing 2354234 things at once and is doing the best he or she possibly can. We get that you're stressed and sick and maybe scared. We do! I promise. We're right there with you. 


Thursday, June 10, 2010

Slap me

I just went on a crazy cleaning spree!! This is exactly what I should not be doing right now. Right now, at almost 8pm Thursday night, I should not be getting worked up about the apartment. I need to be relaxing. Why? Because after 6 glorious days off, I go back to work tomorrow. Up at 4am to face another 12 hour shift, and then do it all over again on Saturday. Truly though, I had some awesome days off, so I am not complaining. But at this hour? I need to be winding down, not up, got me?

I suppose I should discuss what I did today, since this is a blog of my life, no?

I had one goal in mind today and that was to swim. I have been neglecting the swim portion of my triathlon training. Why? Because I SUCK. I hate to say it because just 7 weeks ago, I would have said the same thing about running, and now I can run 25 minutes straight without stopping. But alas, I have not put the time and commitment into swimming like I should have, so as a result, it gives me anxiety. The pool that I decided to swim at is 50meters x 25yards. This morning they had the short lanes open, so it would be a 25yard length. My goal was to just swim for 30 minutes and practice my technique. Let's just say I need work. I get over halfway through the 25yards and lose focus, panic, and consume way too much oxygen in the process, leaving me breathless. At least I know what to work on, right?

I definitely need to swim at least two times per week. And it's on my calendar now. No excuses.

After my swim, I waited for Mirza to finish studying, and then we made our way to Weedon Island Preserve.  Apparently this area was inhabited by humans before the pyramids! It is an archaeological area and giant park with mangroves, hiking trails, tons and tons of wildlife, and a great place to go kayaking or canoeing!

I confess, the past few years I have been knockin' Florida, saying it sucks, there is nothing to do...nothing but rednecks, Disney, buildings, pavement, tourist destinations, blabla whine, whine. But I deserve to be slapped upside the head for my lack of creativity and motivation to actively search out and explore my surroundings. If you've been reading this blog even for just the past couple of weeks, you have seen some of the amazing parks I have visited. All for free. Shame on me!!!

I digress...

As you might know, it is HOT here in good 'ol Pinellas County, Fl., but we ventured out anyway because we're two lovers on a mission for "something to do." (what do you want to do? I dunno, what do you want to do? i dunno, there is NOTHING TO DO! <--ever have that convo?)

The cultural and natural history center is amazing. I cannot believe they do not charge for this. Maybe I'm a geek  (or a 5th grader at heart....hey, last week I was called a 60-70 year old for wanting to bird watch?), but it's full of little education information about the park, environment, archeology, preservation, native americans who habited the area, etc.
My pictures inside of the center do not do justice, and I apologize for the lack of quality.

I never knew so much history is right in my backyard...

Pinellas County...

The center was truly awesome and we did not even come close to looking at everything and reading it all. We were eager to get outdoors, to be honest.
I wanted to go on the hiking trails since we've been on a lot of cement/boardwalks lately, but we somehow veered off and got onto a 2.5 mile boardwalk...

We were surrounded by green. Trying to capture the depth of everything was not easy with my crappy digital.

We finally made it off the boardwalk and happily because it was mostly open and the sun was beating on us. I'm pretty sure the heat index was well over 100 today. And Mirza did not apply sunscreen, silly boy.
I tried to convince him that we should hike on one of the little trails, but he just wasn't up for it. He assured me that we could come back anytime.

If you look close, you will see a racoon above!

I think y'all get the picture.

There's still so much to see!!! I want to go back now.

On the way home, we stopped at our favorite bakery and got the last loaf of Sundried Tomato bread, ate pieces in the car, and then scarfed down some food...

And now I must sleep. 2 long days ahead of me...
Question: Do you make sure the kitchen is clean before going to bed or do you leave it for the morning? I'm always trying to make sure it is spotless when I wake up, but sometimes I just get lazy...and regret it in the morning. Any tips? It is spotless right now!

I'm also wondering, do you prefer to see a lot of photos on blogs (like above) or just a snippet! I personally love to take 253234 photos, so it is hard to choose which ones to post. Hope it isn't overloaded!