My hot spot

Lately, I feel overwhelmed that I either:

 A., have nothing to blog about
or
B., have so much to say, and no idea where to start.

In the end, I write nothing, and as a result, I have not posted in months, as you all can see.

Let me break it down for my own (in)sanity:

We'll make this post about school and nursing:
Last month I began  a new semester taking, "Advanced Diagnostics and Procedures," and "Organizational and Professional Dimensions of Nurse Practice."

Both of them are going well, and although it is a lot of work, I am certain that when I graduate, it will all be worth it!

Yesterday, we learned to suture, so that was certainly something I looked forward to doing. At the beginning of grad school, we take a lot of theory-type courses, so to delve into the hands-on, and nitty-gritty aspects of being a Family Nurse Practitioner has been quite rewarding and exciting.

 We practice our suturing on pig's feet.  I practiced tying the knot and over and over until my hands just moved fluidly without thinking. In all honesty, as an RN, I've never been all that enthusiastic about little procedures/tasks, like IV insertions, phlebotomy, insertion of small bowel feeding tubes, etc., so I was kind of nervous about how I would do. I suppose you could say that my confidence was low! But, I believe that I did great and with practice I could even love suturing. It was definitely fun!

Next semester I begin clinicals, and I am nervous!!!

I know that once I'm with a patient that I am fine, calm, and natural, but the anticipation is killing me. In addition, just talking to classmates ahead of me, I know it will be a ton of time consuming work, especially with a full-time position. In fact, I may need to cut down my hours in the ICU, but it would only be to one less day per pay period. I can probably swing the minor pay-cut if it will save my mind and body the extra stress.

^^ Prior to my OSCE head-to-toe...attempting to "look like" an Advanced Practice Nurse. I did great, by the way, and my actor-patient dude told me that I did excellent, and he said that although he did not know how long I've been a nurse, that I seemed "very comfortable," like I knew what I was doing! Score.

The other day at work I was joking around with the pharmacist after he told me how much they make right out of school ($$$), and I said I might need to switch careers. Immediately, the ARNP in our ICU said something along the lines of, "No way, you love the bedside. I see how you interact and talk to your patients--you love it! Don't try to deny it otherwise." I smiled on the inside because it made me happy to think this is how I portray myself inadvertently to the world. I do like my job and I do have a passion for helping me, but oftentimes, during a long, 12 hour shift in the ICU, you don't necessarily feel all lovey-dovey towards everyone, or that you're actually even making a difference. However, he genuinely meant what he said, and that makes me happy. It also gives me the drive to continue on with school because it is a lot of work.

During this political season, I'm feeling especially fiery towards certain topics in healthcare, and I feel like I want to take action and be involved in organizations and legislation.

I am currently obsessed with what Jeffrey Brenner, MD has done in Camden, NJ with "hot spotting."  If you haven't heard about the Camden Coalition or Dr. Brenner then you definitely need to check out a few sources because I suspect that these types of programs/organizations will be popping up all over the country. Or at least I hope!

First, this video from Frontline 



and this piece by Atul Guwande from the New Yorker, "The Hot Spotters: Can we Lower Medical Costs by Giving the Neediest Patients Better Care?" 

When I read these articles, and watch these videos about the Camden Coalition, I feel a huge spark! I want to tell everyone what they're doing because I think it's the wave of the future. I seriously feel excited about what is going on, and this to me shows that I am in the right field...or should I say, I've found my own "hot spot." I LOVE being an ICU nurse. Just telling people you work in the ICU sounds cool in and of itself, I have to admit. But there's something calling from within me and that is primary care. I just know that I'm going to be doing some awesome work!!

"Angie" and 6 months CrossFit

This morning we did a partner "Angie."
-100 pull ups
-100 push ups
-100 sit ups
-100 squats

That's not all, though...while one person is doing the work, the other has to hold a 95lb/65lb barbell in the deadlift hand position. If you drop the bar at any time, 3 burpees, both of you.

 We chose 85lb to compromise because Mirza and I wanted to work together...what. the. heck. was. I. THINKING????????

It was horrible.
The entire thing.
Halfway through we had to switch to 65lbs. There was no rest for either of us. Ever.
It was worse than running...

My muscles...all of them...screaming right now.

The pull ups are the worst. We used a blue band. I ripped my callus and it hurts like hell!!
I honestly did not think this would be so bad, but it was. CrossFit is definitely not pretty at times.

However, I killed it during the squats. I did not want anything to do with that barbell.

In 4 days, it will be my "6 month CrossFit anniversary." I can't believe I'm going to share this, but I'm proud of my results, so here it goes.

When I first started CrossFit, I took a before photo. And then a 3 month photo. I wanted to see if I could notice any results from this whole CrossFit thing.

The final picture is now. 6 months into CrossFit..

You can enlarge if you like, but there is a noticeable difference in my mid section. This isn't a post about looks because that is NOT why I do CrossFit or why I even started. I do CrossFit because I love it! It's a ton of work, but a lot of fun. Like I mentioned in my last post, it is the one thing I look forward to most in my day. CrossFit helps me feel stronger and enables me to do things I never thought possible.

CrossFit makes me an overall better person. And I love it.

Busy Bee

Work, school, and life are kicking my ass!


Nurse Practitioner school is no-joke and I'm not even doing clinicals yet. Right now I'm in Advanced Assessment and Advanced Pharmacology. I wish I could tell you some good things about Pharm, but I was forced to take it online for the summer semester, and it is absolutely horrible. I'm honestly not learning much. In fact, it gives me severe anxiety knowing I am teaching this to myself from reading a stupid book. I'm worried about how I will fair when clinicals begin--will I be prepared?


Assessment is just a ton of work. In a few weeks, we are doing something called an OSCE (observed structured clinical exam). Basically, we go into a mock outpatient office with an actor/patient, and we will be observed behind a two-way mirror (like in the cop shows!) by our instructor. We'll also be videotaped. The patient will have "something wrong with them," and basically we go through a health history and focused exam. They are "professional patients." We will do this again at the end of the semester, but it will be a "well-visit" and we'll do a complete head-to-toe assessment. Just the thought of it is scary! However, I have to keep reminding myself that I've been a RN for 4 years and every single day, I walk into a patient's room and I ask them questions and do an assessment. They are not scary. Except now? I have to figure out what is wrong with them and order meds, labs, diagnostic tests, etc. I'm freaking out, but also proud of how far I have come. I definitely do not know how people with no nursing background could ever go through a program like mine. My clinical experience and background has been the only clutch I have to lean on, especially when writing case studies.

This is pretty much my life right now: work full-time (bla!), school "part-time," which is not part time because every hour that I am not at work, I am focused on school. The other bits of time I focus on staying healthy, which is of course with CROSSFIT. It's pretty much the only awesome part of my day. Oh, and wedding planning.


I'm a busy woman!


CrossFit has been nothing short of awesome. I am getting stronger everyday. I look and feel it! We also did a 6 week paleo challenge at the box. Mirza lost 3 inches from his belly! I lost 1.5 inches. I did it mostly to kick the sugar habit, and it has definitely helped my mood, performance, etc. Like I said, CrossFit has been a lifesaver for my crazy, hectic life. It's what I look forward to most in my days.
Mirza has made huge gains in CrossFit, as well. I'm so happy that we've both found something to be passionate about together. It's so much fun! 

Taken on May 24th--Mirza's birthday

This morning we did a Team WOD together.

The Saturday WOD

Team WOD:  Partners pair up according to experience.  We want each team mate to be close to partner’s abilities in time and work capacity.

• 30 HSPU’s

• 400 Meter  overhead plate carry 45/35lbs

• 100 Hand release push ups.

• 100 m. Walking lunge (to the first speed bump)

• 100 m.Burpee broad jump(from the first bump to the second bump)

• 200 m. Sprint (back to the “box”) both teammates must be at the box before starting the pull-ups.

• 100 pull ups

For this WOD each member will share the work.  ONE works while the other counts.  At no time can both athletes work at the same time other than the runs, but that is because one is no good without the other.  During any run or the plate carry, the work cannot resume until both are in attendance.

 It took us 30:11! The coolest part of the day for me was during the warm-up when I did 2 unassisted, strict pull-ups!! I've come such a long way. My knees came up a bit, but I know I'm getting stronger everyday. 

box jumps during CrossFit for Hope

A couple of weekends ago, I climbed the rope!! Of course, Mirza got a crappy photo of me at the top, so it's impossible to see if it's me, but I swear, I climbed the rope. On my SECOND attempt, I tired out and ALMOST got to the top. He took a video.



Of course, I have no technique and need to work on my feet, but yay!! rope climbs rock.

Other than CrossFit, one excellent aspect to life is this:

That right there is me holding a receipt for final payment of my CAR LOAN! I PAID IT OFF. I officially OWN.MY.CAR. What a great feeling!

Until next time!


Hope I still have a few straggler readers out there!
I'd like to start a conversation: What is the one thing you look forward to most during your day? As said, mine is CrossFit (when I'm able to go!!!). Oh, and of course, the nice, hot long lavender bubble bath after a rough day. I think I'll go take one right...about...now!

Mud Crusade 2012

This morning I ran, jumped, crawled, and dragged myself through a mud obstacle course 5k known as the MUD CRUSADE!

I somehow convinced Mirza to do it with me, and a few people from our CrossFit box.
Photos courtesy of my box's Facebook page...

 We were expecting harsh thunderstorms, but lucked out and it was just a beautiful, overcast morning...

Here we are at the start of the race...

This was Mirza's first race of any kind, and I have to say that he did excellent. If I hadn't asked him to wait for me a few times, he would have finished way, way ahead of me!

We were in the first wave, which I am thankful for since that meant we would be the first ones in the mud! Although, I have to say, this mud was more like clay than anything else...

I am in the back coming down the hill...

We ran over hills, through muddy water...

We scaled walls, crawled under ground through dark, wet trenches, and clung to nets...

We even crossed monkey bars over a muddy pit!

And managed to take a few goofy pics along the way...

Exhibit A.

The BEST part of the race was this slide...

Mirza and I managed to catch up with each and went down the slide together. I'm really hoping the professional photographer got a photo because it was insane. Halfway down, I ended up turning and going down backwards. As soon as we hit the water, it was like a tidal wave of muddy water straight to the face!!!

There we are getting up afterwards! I was screaming with muddy water coming out of my nose.

At the end, we climbed hill after hill, over and under walls, and under nets, and eventually jumping over two small fire pits!

The end was a mud pit of water covered with barbed wire, forcing you to crawl through the mud..

FINISH!

I had so much fun! Of all the races I've done, this was by far the best...

 Mirza lost both of the soles to his shoes! The other one is somewhere out on the course...

I would most definitely do another one!

CrossFit>Therapy

I had to make a blog post just to share this video.



What an excellent interview with someone who exemplifies how CrossFit can transform you. I've only been at CrossFit for about 2.5 months, and in that short time, it has honestly made my life so much better. It's hard to be sad, depressed, or angry about crappy things in life after doing a WOD, even if you come in last (as i often, do, hehe); just the act of trying and pushing through makes you a stronger person everyday. It has not been a great past year, but CrossFit has helped turn it around for me ♥ . This guy expresses this wonderfully. 


CrossFit>therapy

Still at it...

Still CrossFitting, still loving it. 

Jumping during the 7 minute Burpee's from open WOD 12.1 

Tuesdays and Thursdays at our box is strength training day. We use the Wendler 5/3/1 method and mix it up a bit each week. Usually, Tuesday is front squats and power cleans, while Thursday consists of deadlifts and push press.

I love all of the olympic style weight lifting, so it's hard for me to pick a "favorite," per se, but if I had to choose, it would be front squats and power cleans. There is just something about squatting with that much weight on the front of your shoulders that makes you feel strong. And power cleans? Yes, you do feel powerful if done correctly.

This chick looks roughly about my height/size and she's front squatting 185lbs!


My max is...85!
She rocks.

Our coach says he "loves" to watch me lift because I have "great form. " This is nice to hear since I don't seem to have much speed or stamina during the WODs, hehe. 

I am also continually working on getting stronger. I'm no where near where I want to be! 

Right now, my one rep max for deadlift is officially 160 (and my body weight is approximately 120lbs), but after our Wendler program last week, we calculated that I am probably closer to 175 at this point.

Ideally, I need to be over 200lbs. 

I asked our coach how I should go about setting goals, and he said it's really up to the person. He said I that I definitely have my form down, so it's all about building strength at this point. I'm not sure if it's too short of a time, but I'd like to give myself the following short-term goals.

By May 1st:

-Deadlift 200lbs

-1 unassisted pull-up

-Finish a WOD rx, and not come in last.

In general, I need to work on speed and stamina, but those will be continuous.

 For running, I'm still so slow compared to everyone.  BUT, I know that I do have speed in me. For instance, Saturday's WOD involved a ton of running. Here it was:

• Run 200 meters forward
• Run 200 meters backward
• 25 push ups
• 25 air squats
• 200 m overhead plate walk* 45lbs/25lbs. bumper plate
• 200 m run
• 25 slam balls 20/10lbs.
• 25 wall balls 20/14lbs.
• 200 m. run
• 200 m. overhead plate walk**(pick up plate you took the first time)
• Finish with:

20 BURPEES

Run 400 meters

Looking at it, I didn't think it would be so tough, but man, oh man, I was dying. Carrying the overhead plate nearly killed me. I think I finished in 29 minutes, which was dead-last. Back to the whole speed thing--during the last maybe 200 meters, I GUNNED it. I ran as fast as I possibly could. It just shows that I can do it, but I just don't for some reason.

Other little things: sit-up time. I can do sit-ups just fine, but I seem to be a lot slower than everyone else. In fact, I find this odd because my core seems to be the strongest part of my body. I think I really engage my abs so much during sit-ups because they tend to seize, contract, and stay that way. It's painful!!

I also get winded fairly quick. I don't think I have such a poor cardio-respiratory system, so I'm not sure why I get out of breath so much quicker than everyone else. Or maybe everyone hides it better and pushes on through? ;)

As for pull-ups, I'm using a band now, but trying to "graduate" to a less-resistant band during WODs. I mentioned to our coach about wanting to do an unassisted pull-up, so today he had me working on a negative pull-up. This involves starting at the top of the bar with arms flexed and slowly lowering yourself down to arms extended. 

I WILL GET THERE....

Or maybe I will just continue to make confused faces, like this...

This is my, "ugh, this bar is too damn high" face.

In other CrossFit news, I bought new shoes! Awaiting their arrival in the mail...

On a mission...

After hearing all of my pathophysiology instructor's stories about her mission trip to Africa through a different university, my interests have definitely been piqued.

Since then, I've been on the hunt for my own medical mission trip. I'm looking for something short; less than 2 weeks, and during the summer time, probably 2013 after my own classes.

 The problem is that I cannot seem to find one that is not affiliated with religion. It seems like all of them are doing a wonderful job of helping the sick and poor in providing medical care, but then the underlying theme is to spread the word of Jesus Christ. Listen, that's all fine and dandy, but I cannot go along with that. I don't believe in any of that and I would feel incredibly uncomfortable, cynical, and annoyed if I had to sit around and preach, pray, or try to convert people to some superstitious ideology. Or even just listen to it...at all. To clarify, I know that if/when I go to these countries, they will have their own religions and I may even participate in some way based out of respect for another culture. I get that.


Why can't people just want to help others out of the goodness of the heart because it is the right thing to do for mankind, as opposed to for religion? Hm?!



So, that being said. ahem.

I did find one organization that goes to Africa, specifically for nurses. I'm not going to give away the name of the organization, but a google search will provide immediate results. Based on their website, it doesn't seem religious. Of course, now that I've received the application, it does contain some quotes from the bible, which...fine, whatever. They apply to the situation, I suppose. I can deal with that. But then the application asks about our willingness to attend a "Christian worship service as part of the experience...if not, explain." Ok, well, it seems as if they're giving me a way to opt out. I mean, I could be Jewish or Muslim. I doubt they would accept the whole atheist thing, though.
I have emailed back to inquire further into their religious affiliation. Awaiting a reply.

There is still hope for my dream of going on a medical mission trip.

I happened to email my instructor and ask about opportunities through the university, and she reminded me that every summer, as part of the undergraduate Community rotation, they go to Panama for 3 weeks.  I remember this! I wanted to go so badly, but alas, I was broke. She did mention that a few graduate students have gone in the past. Score!! A way in?
I emailed the director.

(the same woman who "pinned" me during our graduation ceremony...)

I spoke with her by phone a few weeks ago. Before we spoke, I looked at my schedule. During summer 2013, I will be in my Women's health rotation. PERFECT. I know that they provide tons of women's health services when they go to Panama. Perhaps I would be able to fulfill some of my clinical hours?
She thought this sounded like a wonderful idea, and even better, the Women's health instructor had expressed the desire to go, as well. Maybe she could be your preceptor? Even better!

Since the time is so far away, and I'm still so new in my graduate classes, everything is up in the air. But I'm going to hold out hope that it works out.

Also, the Africa trip is $3200. The Panama trip: $1200. And I could get credits for clinical hours, so that's even more of an incentive. I have to admit though, going to Africa just sounds way cooler. The downside to the trip to Panama is the length--3 weeks. That would be difficult with taking time off from work.

If anyone reading this knows of a medical mission trip that is not religiously affiliated, please comment! Or, if you've been on your own medical mission trip, I'd love to hear about it.

Nursing stuff

I've been wanting to update the ol' blog here, but feel like I have "nothing worthwhile to say."
I'm just going to write.

Right now, I'm in the middle of my spring break. I coincided my work schedule with school, so I would have 7 glorious days off. Of course, during this break, I need to study for a pathophysiology quiz and write a paper! If I ever become a teacher (not likely), I will make sure all papers and quizzes are due the week prior to spring break, so the students can actually get a break. What a concept!

Work has been good. I'm precepting a student for her final semester of nursing school. This is my first time precepting someone for this many hours (180), and it's been good, but challenging at times. The thing is, this student is pretty good. She isn't afraid of doing basic nursing skills, not afraid of patients or families, etc. It's great. She is confident and should be proud of the work she is doing...but there is a fine line between confidence and over confidence. It can be dangerous. The experienced nurses will know what I mean. As for me, precepting a student has been a real eye opener as far as my own knowledge and skills. I found that I almost had to brush up on a few things. At first, I felt kind of embarrassed if trying to explain something, and realizing, hmmm, maybe I need to look this up, but I have to remember: I do not know everything, and never will. However, with nearly 4 years of experience under my belt, I am a damn good nurse, and I have come a long, long way. Lately, I've felt my own confidence levels shift. I am no longer worried in certain situations and while I still ask tons of questions, I'm definitely feeling more seasoned. It is a lot less stressful to go to work in the ICU because I feel like I know what I am doing. The whole critical thinking thing has definitely matured. I love how I can totally see and feel this shift in myself.

Nursing is cool like that.

The best part about precepting: for every 70 hours, I get 3 credit hours at my university. Um, hello free money! Since I'm doing 180 hours, it's approximately 2.5 classes!! Graduate school classes.

While on the subject of graduate school, as I mentioned in my previous post, I've been thinking about changing to the Family Nurse Practitioner track (from Adult). On March 2nd, I went ahead and submitted...

I was also required to write a letter of explanation. It has not been officially approved, but I don't suspect this will be an issue. Hopefully...because now I am 100% certain about my decision!

While I love working in the ICU and being a "critical care nurse," I do not see myself doing critical care for my entire career, or even working in the hospital!

 Critical care was always my goal as an RN, and for awhile, I even saw myself working in the ICU as a Nurse Practitioner, too, but...not anymore. The ICU is awesome. I would never, ever want to work anywhere in the hospital besides the ICU. I'm still learning and growing as an RN, and the ICU has afforded me huge opportunities in developing into an autonomous nurse. I did not have this autonomy on the floor, and I doubt I would have grown much in that environment. When I graduate in May 2014, I will have 6 years of nursing experience, with 5 of those in the ICU. When the day comes that I can no longer call myself an ICU nurse, I will be sad. I love the ICU.

But, I see a huge need in the community for preventive primary care. Long term, this is where I picture myself as a nurse practitioner. I see myself working initially in a tough environment--like a rural or inner-city community health center clinic providing primary care to those who cannot afford it. I understand this environment will be rough, but something about it calls to me. The whole public health nursing...talk about a stark difference when compared to the ICU.

My school of thought is that no one should go sick or die because they cannot afford healthcare. If you don't agree with this, then I honestly think something is wrong with you morally and ethically. Yes.

I would love to move somewhere that is lacking in medical care and open up a small practice, operating as the sole primary care provider for that community. I know I'm being pretty idealistic, but I'm a student, so that's allowed, right?

We will see where my career leads me!