I finally got down to the board of nursing to find out why my application was taking so long to process. They informed me that they needed some more information regarding my background. This is fine, except that there is no indication anyone ever planned to let me know what they needed. If I hadn’t gone down there, my application would have sat there forever. The “specialist” authorized my test right there, but the application must be referred to the board for review. Again, no problem, except I missed the deadline to get on this month’s agenda (by five days), so my application won’t be reviewed until November 19th. I turned my application in on the 1st of September, but the BON staff didn’t receive it until the 29th.The earliest I will get my liscense now is 25th of November.
Serenity Now!!
The most frustrating part is that the new grad program I was hoping to get into starts November 16th. So I must move on to Plan B: get a job as a Nurse Intern until the end of the year, and try for the next NGP. This, of course, sets our plans to move to Amarillo back as much as a year. Grrr…
I am not doing well with with this period of stagnation. I feel stuck, boggy, just waiting for that all-important Authorization To Test. There is, of course, no shortage of things I should be doing. The initial clean sweep of my home is losing it’s luster, for one. I also need to be trained to volunteer at my son’s high school nurse office. I do study, haphazardly and without enthusiasm, for NCLEX. Mostly, I sleep. Not well, mind you. My dreams are weirder than usual, tedious and distressing at the same time. I may be coming down with the flu, or perhaps I am just missing being in the one place I belong, doing the one thing that I can do well.
My thirteen-year-old is home with the flu. I’m not saying it’s THE flu, but there are several confirmed and dozens more suspected cases in the state, so anything is possible. I’d take care of him the same either way–rest, fluids, anti-pyretics–and reserve a trip to the doctor for severe symptoms such as change in consciousness, breathing problems, or dehydration. He’d rather be at his dad’s, but I told him he shouldn’t get his dad sick. His dad has to wor- well, his dad has to do something, I’m sure.
The turnaround time for the Board of Nursing is proving to be about three days for many of my classmates. It’s one of the benefits of an off-season graduation, I suppose. Of course, this means I could be picking a test date as soon as tomorrow. Yikes! I haven’t been studying very hard. I do answer at least 75 NCLEX prep questions a day, but I just started the online review I signed up for last month.
Of course, my application might take a little more… umm, contemplation in the part of the BON, which in turn could delay my application. I really just want to get this over with! I am nervous about the test, but more importantly, I am dying of boredom. I just want to work! Hopefully I can still work at the temp agency for a few months until my dream hospital opens up a position.
Jamey’s back pain is getting worse every day. A year of medical interventions has provided little relief, so we visited a neurosurgeon last week. I was immediately impressed with the Dr. N’s candor and professionalism. Dr. Y, the doctor that referred Jamey to the surgeon, had warned he might not be a candidate for surgery–Jamey’s MRIs show only a slight disc bulge–but Dr. N thinks Jamey has been in pain too long. He said he sees such patients all the time: patients whose pain is out of proportion to the mechanical injury visible on the MRI. Dr. N made a point of telling Jamey he believes his pain is real despite the MRI.
Dr. Y has always believed him as well, and never hesitated to adjust his pain medicine. In that regard, we have been lucky. I don’t know what I would do if, one top of everything else, we had to worry about being accused of drug-seeking. Jamey hates the drugs; they make him tired and sick to his stomach. Oh, and they don’t even work well enough for him to function. Despite this, Jamey somehow finds the strength to get up each morning and go to work to support his family.
He’s my hero.
He’ll be able to quit his job soon, though. I got a call from a temp agency that saw my resume online, and they don’t mind that I will only be able to work as a CNA for six or eight weeks before moving on. When I get my license, I have another temp job lined up with a flu clinic until the hospital new grad programs start in mid-November. I still have to be accepted, of course, but it looks good.
Next week we will be going to a pain specialist to get what is called a provocative discogram. Apparently the outer ring of the disc itself is innervated with pain receptors. By injecting dye into the disc and then doing a CAT scan, one can determine where there might be imperfections in the disc, if not frank tears or holes. If the doctor finds something, this is indicative of a good surgical outcome.
eMedicine has recently published an article entitled Pressure Ulcers, Nonsurgical Treatment and Principles. Because of Medicare’s decision that hospital-aquired pressure sores are a “never event” (Medicare will no longer pay in full for care related to such events), doctors are responsible for identifying skin issues upon admission. The stakes are high in that they affect the top two concerns facing most hospitals today: patient outcomes and reimbursement. As nurses, we need to support our colleagues with thorough assessment and documentation.
In 2007, the National Pressure Ulcer Advisory Panel updated its classifications for pressure ulcers. This system consists of 4 stages of ulceration, and is designed to describe the degree of tissue damage observed at the specific time of examination and is meant to facilitate multidisciplinary communication.
- (Suspected) Deep Tissue Injury: This is the most recent addition to the staging system. This stage is described as a “purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.”stage may be difficult to detect in individuals with dark skin.
- Stage I: This classification represents intact skin with signs of impending ulceration. Initially, this presents as blanchable erythema indicating reactive hyperemia. When tissue becomes temporarily ischemic, relief of pressure causes hyperemia, which is probably a protective mechanism of increased blood flow designed to oxygenate the tissues and remove potentially harmful products of metabolism. Reactive hyperemia should resolve within 24 hours of the relief of pressure. Warmth and induration also may be present. Continued pressure creates erythema that does not blanch with pressure and may well represent the first outward sign of tissue destruction. Finally, the skin may appear white from ischemia.
- Stage II: This classification represents a partial-thickness loss of skin involving epidermis and dermis that appears as an open shallow ulcer with a pink wound bed.
- Stage III: This classification represents a full-thickness loss of skin with extension into subcutaneous tissue but not through the underlying fascia. This lesion presents as an ulcer that may include undermining and tunneling of adjacent tissue. Bone, tendon, and fascia are not exposed.
- Stage IV: This classification represents full-thickness tissue loss with extension into muscle, bone, tendon, or joint capsule. Slough or eschar may be present in the wound. Osteomyelitis with bone destruction and dislocations or pathologic fractures may be present. Sinus tracts and severe undermining are commonly present.
- Unstageable: An unstageable ulcer is defined as full-thickness tissue loss in which the base of the ulcer is covered by slough or eschar such that the full depth of the wound cannot be appreciated. Only when the slough or eschar is removed can the depth of the ulcer be evaluated and correctly staged.
After a drawn-out , it was announced last week that a Catholic charity has acquired the hospital where I did my practicum. This means the possibility of more money to finish the hospital’s remodel, but changing the hospital philosophy to that of Catholic health care ethics could be dicey. I love that hospital, and I really want to start my career there, but do I really want to work at a Catholic hospital?
Iam less concerned about reproductive rights than I am end-of-life rights. The directives in the area are somewhat subjective. According to the United States Conference of Catholic Bishops directives:
A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community…
There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.
What is “sufficient benefit”? And isn’t prolonging life that no longer has any quality a “burden” to the patient? I don’t know the answers. Perhaps I can get myself on the ethics committee. I do like the part about not imposing excessive expense on the family or community. Will they still have a multidisciplinary ethics committee?
My final class came and went with a noticeable lack of pomp and circumstance. Deli sandwiches and well-wishes from a few of our past instructors and it was all over as abruptly as it began. A girlfriend had to point it out, but the director of our program was not one of those to congratulate us. Not even an email, actually. While it is no secret the Class of 2009 was not one of her favorites, she could have made an effort to keep up appearances.
Graduation has finally come, and with it, a new blog site:
The other day, my mother mentioned that she reads my blog. The only comment was how disgusting she found my header. Seeing as this was the only thing she found to complain about (at least to me) I went ahead and changed it.
Speaking of changes, in a few weeks I will moving this blog to a new domain in celebration of my graduation from “somedaynurse” to real, live novice nurse. I really appreciate everyone who has followed me on this journey. I promise, I’m just getting started! Watch this space for details!
