Monday, November 26, 2007

holiday! celebrate!

I'm on holiday from work for the next week, and headed to Florida.

I have a fun red-eye flight ahead of me, and am actually sitting here in the SeaTac Airport, typing this oh-so-interesting entry.

In work-related news: I have another job offer. When it rains, it pours, people.

This job offer is in a combined Burn and Pediatric ICU. Pros: I think wounds are interesting. (I can also talk, while eating, about digitally disimpacting feces and other people's vomitus without batting an eyelash or turning my own stomach. What I can't do is ride in a car without feeling nauseous and needing Dramamine. I am cursed, I tell you.) Cons: Burns are painful and disfiguring enough-- taking care of burned and traumatized children strikes me, on the whole, as much, much worse than taking care of burned and traumatized adults.

And while I think of intubated, sedated adults with complex medical and surgical problems as interesting nursing, I think of intubated, sedated children as completely sad and tragic.

No more work. Must think of sunshine and beaches and mostly no work.






Sunday, November 25, 2007

worker bee, buzzing away!

As any one who has been within 5 feet of me (or, e-mail recepient or telephoe capable) lately can attest, I have been Freaking Out About The Job.

I could outline the Freaking Out About The Job thing, but, I hated when they made us do outlines in school. Does any one remember that crap? I do. Because, like I said I hated it.

I think I hated it because I never really needed to outline my crappy ideas--they just flowed organically, like so much crap.

In any case, it's kind of like a showdown: TICU vs. CVICU.

Oh, did I tell you? Another friggin' two job offers. One on Beloved Stepdown Floor, With The Cool Peeps, and another one at Happy Hospital's CVICU.

For the record, the job version of NBA playoff proportions reads: TICU vs CICU vs CVICU vs Stepdown.

(Continuing the lame sports metaphor, this job debate would make for some great WWF wrestling match ups, too.)

Any way.

One of the sub debates I'm having involves my own work ethic, which is really kind of crappy, from an attendance point-of-view.

I'm usually a very good worker, when I show up. It's just the showing up part I have trouble with. I think I'd be fired more often, if the nursing shortage wasn't so bad, and my work was remotely shoddy, or I quarreled with my colleagues frequently, or smelled badly.

My work ethic actually puzzles me somewhat, because I was very diligent about showing up for school (well, until certain parts of undergrad, and grad school). I'm sure I won lame Attendance Awards--which I'd like to show to my current employers, to show them I wasn't this loser-ish all of my life.

In my defense, the high stress and the physical bullwork of the job has me succumbing to various minor illness (and the evil tummy issues, which are Largely Mysterious, not to mention very painful). I don't like to go to work feeling sub par, because I'm always afraid I'm going to get a very heavy, taxing assignment, and screw something up, and kill someone accidentally. I'm less worried about the latter than I was two years ago as a new grad, obviously, but, I still worry about it.

Any way, this nattering on about work ethic all dovetails into my current "Which job should I take?" because I realize ICU is gonna be hard. I'm basically going to be a new grad all over again, and the patients are going to be, by definition, more unstable and a lot sicker, and I'm really going to need to be in top physical and mental form to do the job properly.

Only, I don't feel top form at all. I feel sort of soft-around-the-middle, like I've lost my edge. Maybe I freak out less because I know my job better, but then sometimes I worry I've become some lazy ass second rater.

I also don't feel physically up to it, on a lot of levels. The part of me that deeply wishes not only to avoid hard work, but also preserve my joints and ligaments for a slothful old age of bitching about my nursing home amenities, feels a bit worn out. That part of me wants to be Part Time Jamie, with the cushy eight hour shifts, on evenings, a schedule with which my body can actually cope semi-decently.

I don't really want to do twelve hour shifts (because oh! The PAIN! IT BURNS! I say). I've never been a twelve hour shift kind of girl. Because anything over eight hours in a work day = slave labor, in my book.

I don't really want to do nights either, because I don't remember much about my life on night shift last year, except that I was constantly sleep deprived and very, very very cranky. Plus, I was continually disoriented. It was a bleary, post-hangover way to live, without the fun of imbibing or indeed, ever being drunk in the first place.

Unfortunately, I seem to have about 36 years left until I can retire and collect my Fake Social Security. Thanks, Baby Boomers, for consigning me to a few more years of pointless, soul crushing employment!

Any way, my biggest fear (other than learning a brand new job, and staying awake at night--oh, excuse me, I mean, during the day, when I'm supposed to be sleeping--wondering if I accidentally killed someone, even someone on tons of life support) is failing at a) showing up to work at all and b) staying awake on night shift long enough to learn anything about not killing my patients.

There are many, many more tedious sub-debates about this whole Job Debacle, which I subject my loved ones to in a constant, monotonous litany ("What if it sucks?!" and "No, seriously, what if it really, really sucks?!" being the top two favorite variants of the same damn thing). Maybe I'll treat my erstwhile readers to a few of them, in good time.

However, I'm trying not to alienate everyone with my boring prattle, and considering the same people who read this blog also probably are getting fifty e-mails a day debating the de/merits of each and every single facet of my oh-so-fascinating dilemma, I think I'll stop, and spare everyone the grief of recounting it again, in IMAX like proportions.








Friday, November 16, 2007

geeky geekiness

A couple of nights ago, I dreamed I was in Latin class.

Duuuuuuuude.

I soooooooo need some better drugs.

I mean, come on Jamie, how geeky can you get?

Let us count the ways:

1) Dreams about Latin
2) Dreams about enjoying Latin class in a happy, blissful way most people associate with eating their favorite dessert, or watching the world unite in utter peaceful harmony (over Latin, of course).
3) While dreaming, criticizes the choice of textbook used and laments the absence of Wheelock, the One True Latin Textbook.

I think in many ways #3 is even geekier than my favorite Latin dream, which is the one where I'm winning University Honors in Latin.

Oh well. I suppose this beats the dreams I have where a patient is coding and I'm immobolized with fear and dread, whilst others about me beat me on the head to do something, stat.





trauma drama.

I know this this is gonna come as a shock, but I am seriously considering a job offer in a Surgical Trauma ICU at a level one reigional trauma and burn teaching hospital.

I know, I know.

What happened to CVICU Bitch Goddess dreams, Jamie?

Well, you'll be happy to know that those dreams haven't really gone anywhere, they just might need to be delayed in favor of Mega-Awesome Hardcore Trauma ICU Job That Will Kick My Ass.

I really hadn't given serious thought to changing my specialty. Believe me, I was like, 'CVICU or Bust' last week.

The problem is, CVICU at Happy Hospital where I currently work (and despite the bitching, actually really like) was dragging their heels about an interview, and Lofty University Teaching Hospital 's CVICU isn't hiring.

So, I decided to go for what I thought was a second choice, and interview at a hospital I like to call 'Crack Ho's Evil Twin's Inn'--the facility best known for its sexy, hardcore ICUs on the one hand and "charity care," on the other."

Nota bene: "charity care" is hospital corporate speak for "We treat all the crack/meth heads in town." And "sexy, hardcore ICUs" is Jamie speak for "And then, all the crack/meth heads go directly to stepdown or MICU, so TICU doesn't have to take their crappy overflow.")

Suffice it to say I wasn't stoked about that patient population (we often get this hospital's overflow "fake chest pain for narcs" at Happy Hospital, and we begrudingly joke, "Why couldn't Heroin Addicted Bitch go have her totally fake chest pain in [Crack Ho Hospital's] ER?")

Not a place I ever thought I would consider in my ugliest nursing nightmares, in other words.

So, how did I get lured over to the Dark Side?

Well, it certainly wasn't the money (ugh, staff wages again!) nor was it the opportunity to become, once again Vampyre/Shift Work Disorder Bitch Jamie (night shift, alas).

It was, however, a pretty impressive interview and tour, and the unit manager talked up this unit, and every single nurse I've talked to thinks this is the sine qua non of ICU experiences in the metropolitan area.

Plus, the Mega Geek, Mega Type A Bitch in me got seduced by the elitism of it all. This is the floor for which the hospital built a brand new wing! This is the floor that typically has a waiting list of RNs! This is The Floor.

Any way, that was the schtick and schmooze I was sold on, and believe me, that manager must've had my number down when she looked at my application and saw what a dork I was, going to all that school.

I like sick hearts and open heart surgery better, but, I think I'd kick myself in the ass later on if I didn't take this job.

And, I knew, no matter how painful and sleep deprived next year is gonna be, that I was meant to be an ICU nurse when I saw intubated, vented sedated patients on a dozen drips, with more invasive lines than Jesus had disciples, and the first thought I had wasn't "My God! Run away! Run far, far away!" but rather, "RAWK! Patients who can't talk to you or get out of bed! No ambulating those poor bastards to a commode! Beautiful!"

Don't get me wrong. The sight of patients more complex and sicker than any other patients I've ever seen terrified the shit out of me.

But, sick bitch that I am, it was also kind of... well, my version of interesting nursing, where the focus of nursing care isn't a stroll around the nursing unit for a post CABG patient, it's the patient's illness and management of their comorbidities, period.

I feel I'm a better nurse when I don't have to talk to the patient, and can focus on things like memorizing their lab values. I'm not a good "talk and teach" nurse, who's into stepdown type activities like progressive ambulation and breathing exercises. I find I don't care that much about coordinating their discharges with social work to skilled nursing facilities, or any of that psychosocial crap.

On the other hand, give me the medical side of the nursing bullshit, especially on a patient who's about to go south, and I'm all over it.

Like, if I were a patient on stepdown, and I somehow had some version of me as a nurse--I'd think I was kind of bitchy and perhaps, even a bit clueless about stuff I wanted to know about, like whether or not I'm going to get my dinner tray on time, or if I can get up and go to the bathroom.

But, I'd want a nurse like me around if I was on a stepdown unit, getting acutely sicker. Sure, I'd probably remember to thank the sweeter, nicer nurse who arranged my pillows in exactly the geodesic dome shape I had taken the trouble to diagram prior to my hospital admission. On the other hand, I'd be around to thank her because Bitchatolla Jamie Nurse--who I only vaguely remember as The Bitchy Nurse who barely took the trouble to conceal a sigh of deep annoyance when I asked to be ambulated to the commode--was around to get me back to the unit before I respiratory arrested, or something like that.

I'm not saying ICU is gonna be bullshit free, because if anything, it's gonna be more bullshit. But, at least it's gonna be highstakes, hardcore bullshit, and not some lame drama over a patient who didn't like what the brand of yogurt that had been brought up on the dinner tray.

And, I'm going to probably suck at my job, and feel incompetent for at least a good year after orientation, and this is probably good for me, so I can remember those sweet, innocent days of stepdown nursing and all the complaining I did over largely stable patients.

Well, any way, all this is outloud talk. I reserve the right to tuck tail and pass on picking this particular professional poison, and stay at Happy Hospital, on Friendly Fun Unit, with my peeps, all hanging out and joking for at least part of the shift. After we ambulate our patients and tuck them into bed for the night, that is.




Wednesday, November 14, 2007

why work is a wanker.

I've managed to figure out a major distinction in my Why I Currently Hate My Life's Work.

It's not really about the job. The job itself, at this particular hospital, on this particular floor, is fine. The people I work with are really nice and mostly sane, and most of the time, I can get a marginal amount of shit done during a shift (which is saying something, given the usual conditions of hospital nursing).

It's more about the profession itself, and the basic job description of a nurse.

For example, I think, baseline, I'm supposed to care about my patient. And I think I do care, in so far as I deliver mostly safe, medically sound nursing care.

But, lately, I care less and less about the patient, and more and more about how very, very bored and frustrated I am with a job that is starting to feel increasingly stultifying and pointless, and never really made me particularly happy in the first place.

I'm tired of the subservience and general all around lack of social status associated with nursing. Nursing, for all its aspirations to be taken seriously as an actual profession, still is and always has been a pink collar job.

I'm all for degrees and professional advancement, I just don't think it's necessary in bedside nursing, and there's a reason why there are multiple points of degree entry that all culminate in the same licensing process and boards: because baseline, being a bedside hospital nurse requires some common sense, an ability to multitask, and a deep enjoyment of being treated like a servile wench.

It doesn't require years of college, however, and I have always thought that my years of schooling are an impediment to tolerating my working conditions, which often require me to modify my vocabulary and communication skills to that of an average seven year old in order to "reach" a "challenging patient" (read: noncompliant asshole).

For indeed, I find half to three quarters of my job duties, while requiring excellent organizational skills, feel to me as if a moderately intelligent fifteen-year-old with a solid babysitting background could probably manage independently if given minimal direction.

Practically nothing that potentially interests or attracts me about the profession (treating and managing disease) is actually in my purview or scope of practice, and ambulating patients to the commode and warning them about sternal precautions and using their incentive spirometer, day after day, frankly, gets a little old.

In short, it's hard to be stuck in a job when frankly, you know your intellectual capacities far outstrip the job requirements. I imagine most nurses end up feeling this way, at some point or another.

I'm really kind of over the profession, to tell you the truth. Going to work feels more like some kind of crappy adult version of detention, complete with writing lines.

I thought, maybe, doing ICU would make me feel more of a bad ass, but, on the whole, I think after a year or two, I'll simply feel like a monkey who's been trained to pull a few more levers and push a few more buttons. And that monkey will probably be even more stressed out, bitter, and overworked. So, I'm not sure I should really do it, even though the annoyingly type A, bitchy competitive part of me wants to do it.

Sadly, I'm currently all out of ideas as to what I should do, or what new stupid job I should pursue. The bad thing about being in a profession you hate is that it kind of starts crushing your soul after awhile, and you end up in this anhedonic, borderline depressive state which pisses off and alienates all your loved ones and colleagues. Especially when the whole ICU application process seems like a never ending scene from a Tarkovsky film.

I suppose it wouldn't hurt to try ICU, though. I mean if it sucks, that's basically par for the course , and I can do something else.

There's always the annual post-end-to-Daylight-Saving-Time depressive funk to resort to, as well, in which Jamie loses interest in her life and takes to sleeping 16 hours a day when not at work.

But, that doesn't sound very healthy, either.

Sunday, November 11, 2007

blanket statement

It's been All Blankets, All the TIme Around here. Behold: Christmas Blanket 2007 (Christmas Blanket 2006 met an unfortunate fate in mom's washer, and has been demoted to the lowly status of Erstwhile, Would-Be Potholder 2007).

And, below, my take on a Gee's Bend Quilt.

This blanket was a birthday present for David, although Piper claimed it several times during its inception and completion:

David has brought up the suggestion that I knit a blanket for Piper, so he doesn't have to look all pathetic and sleep on the back of the couch, blanketless, in this pathetic manner:

I'm convinced PIper should be spokesdog for those charity commercials: Save the Endangered Couch Dwelling Dog. I mean, look at the pathos in that pose!

wolly bully.

Piper, status post bath.

why, hello there, may I help you?

Sunday, November 04, 2007

it's like you never left. because you never did.

Because the end of Daylight Saving Time came later, I worked a 17 hour shift, from 3p.m. until 7a.m.

Just saying that makes me think of some kind of bizarre preamble to Kiefer Sutherland's 24: The following takes place between 3p.m. and 7a.m.

Bonus: I warded off the scabies/MRSA/fungus admission. This poor person went to another floor, actually. Because the words "open heart surgery patients" should never be used in the same sentence as "scabies" and "fungus." (Really, MRSA should never be used in the same sentence, either, but we'll give ourselves credit for doling out that one all by ourselves!)

Not-so-bonus: I got, instead, a "drug-seeking" chest pain admission.

Amusing part of the shift:

ADMISSION NURSE:
So, what meds are you on at home?

CHEST PAIN GUY:
[in thick working class Worcester, MA accent]
I take Cah-di-zam.

ADMISSION NURSE:
Wha'?

CHEST PAIN GUY
[clearly annoyed by the need to repeat himself for these special needs, developmentally delayed West Coast bitches]:
Cah-di-zam.

JAMIE:
[quickly intervening/translating]
He means Cardizem.

ADMISSION NURSE:
[vaguely huffy]
Yeah, I know.


Not-so-amusing part of the shift:

CLOCK:
2 a.m.

CLOCK:
[one hour later, thanks to the End of Daylight Saving Time]
2 a.m.