hillarygayle: (Nurse Sakura)
Worked all last weekend. You wouldn't believe how many hand lacerations I've repaired. I'm going to need to ask everyone in my geographical area to please step away from the heavy & sharp objects. I've had 3 crush injuries and at least 6 lacerations in the last 4 shifts I worked. The most impressive damage was someone who accidentally put their arm through a glass & metal door. Y'all, don't expect a door will hold your weight!

I've also had 2-3 admissions, which is unusual for the area of emergency in which I work. They try to send the lower acuity folks over to the Annex (where I work) because there are fewer infrastructure type resources (heart monitors, vital sign machines, only a Omnicell & supply Pyxis), so most of what I see are simple laceration repairs, twisted ankles, sore throats, chronic low back pain that magically became an emergency at 6pm on a random Tuesday, krunny noses, & the occasional N/V/D (nausea, vomiting, diarrhea). Every so often, a VERY high acuity patient sneaks in because they simply don't look bad to the naked eye--it takes some digging to find the real problem. In the last year I've admitted a major heart attack who came in because of a cold, a hip fracture (bad enough to need next-morning surgery) that walked in, a pneumonia patient who had no fever, no cough, and just a little shortness of breath, and a back pain that turned out to be a ruptured kidney! My admissions this week were along those lines: walk in looking not bad at all--run a white blood cell count or get an x-ray or two and OH hey, why don't you come in & stay for a night?

Of course it hasn't helped that I was sick this week. Bryan went to a teacher training last week in the exotic far away lands of Arkadelphia and he brought home this upper respiratory virus which he then thoughtfully gave to me. Booooo. I was okay on Tuesday, sick on Wednesday, and then yesterday was REALLY bad. Fortunately I didn't have anyone who checked in with cold symptoms, because I probably would've stomped on their foot. When you're rocking pseudoephedrine, prednisone, acetaminophen/ibuprofen combo, and oxymetazoline nasal spray just to function enough to come to work, and someone comes in with a runny nose wanting a work excuse? Breeds just a touch of resentment.

I do believe things are about to change a bit though. We recently hired several more nurse practitioners. It's enough that M, the physician owner of the staffing agency for whom I work, has decided to start staffing the Main ER with 4 NPs per day: 2 from 09:00-17:00, and 2 from 17:00-03:00. This is in addition to the Annex, staffed by 1 NP from 09:00-21:00 and one from 11:00-23:00 (usually me). As the 2nd most senior employee, I get to state a preference for more shifts in Main or Annex, and I'm going to go for Main for sure. Not only am I specifically trained for that, I'm almost a year into my practice. I'm comfortable with my work flow and my processes, and once that happens it's only a matter of time until boredom strikes. UNLESS I'm learning new things, that is--which is what happens over in the Main ER with the very ill patients who come in. Lots more experiences interpreting labs, which is something I'd like to get better at.

My RV really wants to go somewhere! Ganon's birthday is Monday, and between that & my work schedule, there's no time for us to take the RV anywhere before school starts back. I'm going to plan us a trip to northwest Arkansas anyway, though. That can be done in just a couple of days. We can stay at an RV park over in Bentonville or Bella Vista and see the Crystal Bridges Museum of American Art and the Amazeum. A trip like that might even be MORE fun on a random weekend during the fall, when the heat is less unbearable. Even later in the fall would give us the gorgeous foliage of the Ozarks.

We're going to our first Dragon*Con over Labor Day weekend! I'm so excited! My mom is working on a costume for Ganon to dress as Link from BotW. I can't wait for...

Ganon: I'm Ganon.
Fan: Don't you mean Link?
Ganon: No, I'm cosplaying as Link. My NAME is Ganon. :D

I'm taking one cosplay outfit: my Pokémon professor costume from last Halloween. It's incredibly easy. It's just one of my old lab coats to which I sewed a Pokéball patch on the front. Put that on over one of my cute dresses, and *poof*! Pokémon professor! I already have a bit of an animated look, with my colorful hair and my professor-type glasses and my stand out makeup. When I wore it last Halloween, people knew instantly--even the parents at houses we went trick or treating at. Other than that, I think I'm going to stick with my geeky shirts & skirts from Her Universe & Tee Fury.

Right now, however--I am craving pizza with mushrooms, and I just found that Lost Pizza now supports online ordering. It's go time!
hillarygayle: (Hillary Dark Queen)
HOW UNFAIR! I hate when I have nightmares about work! *cry*

First, church and work were in the same building, so I went to church for a short while and when I came back, all of the computers had disappeared so I had no way of knowing which patients were mine.

The next one was a set of parents who were mad at me because they thought I had treated their kid for an asthma attack and sent them home on an antibiotic. The kid was out of my scope of practice age range (I don't take kids younger than 15 for anything except clear-cut orthopedic cases, in which case I don't go lower than 13 as my hard limit), which made me anxious right off the bat. Turned out another nurse practitioner had cared for them and prescribed an antibiotic for asthma exacerbation the way we do for COPD exacerbation--it's a preventative measure, which isn't really done under any other circumstances but COPD. Turns out, the other nurse practitioner was...Adele. The singer. I voiced my concern that, though she is a very talented singer, perhaps that did not make her terribly qualified to be a nurse practitioner. Then I woke up.

Looking back, that 2nd one is sorta funny but it was stressful at the time!
hillarygayle: (Hillary Dark Queen)
By 9pm I was working 10 patients by myself and holding down the entire Express Care area. I finally got out at 11:30 when I should've gotten off at 11, but that's a hell of a lot better than the 2 extra hours I used to put in as an RN.

I have to get back up at 9am to do this all over again. I AM A TIRED NURSE. But I did not have to turn over care of any patients to the physicians at the end of the night, and on a night as hectic and stuffed full of crazy as tonight was? That feels like a badge of freaking honor. Somebody hand me my crown.
hillarygayle: (Hillary Deepwood House)
There is definitely something I need to take up with my advisor in the program at UTHSC, though.

During my time in the program, we were given VERY little information about vaginal, uterine, & cervical problems. We were acute care, and there was a women's health program, and never the twain shall meet! In fact, I once asked if I could do a written report on the ICU management of a post-delivery patient who was on the vent, and my advisor specifically told me that was women's health and we didn't do it. Okay, sure, it started with the delivery of a baby, but are you telling me the OB-GYN is going to manage that patient in the ICU? Naw, it ain't gonna happen. But the only training we got was for swabbing for sexually transmitted infections.

So here I am working in emergency, with my adult and geriatric patients, and guess what? It turns out about half the people I see in the ED have uteruses, vaginas, and cervixes! And sometimes those people are having problems with those things, and they are not sexually transmitted infections! WEIRD, THAT.
hillarygayle: (Nurse Hillary)
I finally got a paycheck! We stumbled right before the finish line, as we didn't realize one of my credit cards was set to auto pay. It was the one I'd used to get my DEA number, so it was a very LARGE sum of money taken from our checking account all at once and put us in danger of having a series of cascading overdraft fees. Fortunately we were able to get it refunded very quickly, and they refunded the one overdraft fee that did happen. Whew!

My paycheck for September landed the day after that. Man, it could've saved us a lot of trouble a few days earlier, but whatever. We are once again financially solvent! We celebrated yesterday by eating sushi at Sumo and going out for some not-really-necessities shopping. :) I feel like we've had the hatches all battened down financially for the last few months, and it's caused us to be pretty hermit-like to avoid unnecessary expenditures. The spending moratorium was lifted yesterday, and I got myself a new foundation, a new Urban Decay lipstick (one of the classic colors from the 90s!) in Smog, and a new Ava & Viv t-shirt for work. Bought Ganon a plush Eevee. He was thrilled.

Work is still going well. I'm trying to get my perfectionist tendencies under control so I don't beat myself up every time I fail to know something. I get really anxious when I find something I don't know and have to ask, which is bad for my mental health and not logical at all. So in addition to my Socratic questioning method, I've also purchased Barkley's Guidelines for Acute Care Nurse Practitioners and Tintinalli's Emergency Medicine, which are on my iPad. Between those, Sanford's Guide to Antibiotic Therapy, and my forthcoming Up To Date login, I should have enough resources to back myself up on anything I need.

Had a few other "firsts," such as the first person to whom I had to say "There is nothing about this situation that's an emergency, and this was not an acceptable use of the emergency room." Had the first person I asked for the appropriate pronouns (their gender presentation was off from their stated gender, so rather than be damaging, I asked) and was treated to the most genuine, soul-deep "thank you" from the relatively young patient and their father, who have had nothing but bad experiences with medical situations up to this point. Had my first person curse at me, turning their back to me and muttering "fucking liar" under their breath when I explained for the 4th time that radiology was not reading our plain films in a timely fashion and that was causing their excessive wait.

It remains a very intense job, as it always will in the emergency department, but I love it so far. It could be a honeymoon period, but somehow I doubt it. Somehow I feel like emergency medicine, with all it's mundanities, repetition, and moments of fire, screaming, and excrement hitting air circulation devices, is my spot.
hillarygayle: (Hillary Dark Queen)
I must highly recommend the chocolate chip pancakes at Eggcellent Cafe. Even if I could only finish about a third of the stack!

My chocolate chip pancakes from yesterday. They were so good, but WOW that's a lot of pancake.

The board at work today. 😆 Thanks to Dr. Lane.

Normally they don't write the name of the advanced practice provider (the collective name for NPs/PAs) who's working the main ER up on the board, but Dr. Lane couldn't handle that mine wasn't up there, so this happened. LOL! Unsurprisingly perhaps, incidences of getting called "Creecher" peak around Halloween.

Working on some ARNA educational content this morning. I need more coffee. And maybe a mint Oreo.
hillarygayle: (Hillary Top Hat Flowers)

Last night was choir rehearsal at Dr.

Read more... )


Sep. 28th, 2016 09:36 am
hillarygayle: (Nurse Sakura)
I think I've figured out the balance between the two different emergency room settings, and because of that, I am happy that I get to work in both at different times.

Express Care is where triage levels 3 & lower go. These are people who need simple sutures, who have nausea, vomiting & abdominal pain but no vital sign changes, migraines, and other such stuff. People who come in complaining they've had leg pain since 1999. Seriously that happened to me. Main ER is obviously where all the more serious stuff goes. It's the thing you think of when you think of emergency.

I've decided the trade off is this: in the main ER, there's excitement and new things and adrenaline, but there's also uncertainty and self-doubt. I'm a "newbie" over there, and I ask a ton of questions. I'm learning all the things I realize my program didn't really prepare us for--mainly, the intial stabilization of a critically ill patient (we got much more experience managing critical patients when they were already inpatient and relatively stable). In EC, there's tedium and sometimes eye-rolling, but there's also comfort in the relative certainty that I know what I'm doing over there. I am far more confident in my diagnoses and ask fewer questions regarding workup and treatment.

So. Having sorted that out in my head, I'm quite happy that I get to work both places. There are major benefits to both.
hillarygayle: (Agent Smith Not So Bad)

I had to email a photo of it for billing purposes at the hospital, so I thought I'd go ahead & share it here too. Just to be a show off. 😜 Women don't show off their accomplishments as much as we should. I would love to see an #accomplishedwomen hashtag blow up with all the amazing stuff we've done.

I had to email a photo of it for billing purposes at the hospital, so I thought I'd go ahead & share it here too. Just to be a show off. 😜 Women don't show off their accomplishments as much as we should. I would love to see an #accomplishedwomen hashtag blow up with all the amazing stuff we've done.

I spent more than 2 hours signing papers in the hospital yesterday. I wrote my name so many times it started to look funny. I had to fill out applications for billing in 4 or 5 different systems so that no matter what insurance someone has, the hospital can bill that insurance for my services. I did Medicare/Medicaid, Missouri Medicare/Medicaid, Humana, Sharp, Tricare, and I think one or 2 others I can't remember the names of. The Sharp application is a 2-part; they send the first part in and then I have to come back and sign MORE papers. Sharp is the one that wanted this image of my diploma, as well as a copy of my ANCC certificate AND a more detailed version of my CV, with month/year dates on everything I'd ever done: experience and education.

Today at 12:30 we have an actual APPOINTMENT WITH UROLOGY! Bryan has either become a total BAMF and gotten accustomed to the pain of a kidney stone or something has happened, because he hasn't been in excruciating pain for a little more than a week. He's got my least favorite of the urologists, but seriously at this point I don't really even care. I just want to know what these stones are made of so we can alter his diet, put him on medication, or whatever else needs to happen. I also want to know if the 7mm one is still hanging around so we know if we need to do something about that.

You may or may not be a Pokémon Go trainer, but I'm so excited that I gotta say it: I got my first 10K egg! For those who don't play, the game will give you eggs every so often. The eggs each require a certain distance to be walked in-game in order to hatch: some are 2K, some are 5K, and some are 10K. The more distance the egg requires, the cooler the Pokémon that will hatch from it! Everyone I know has had a 10K egg at some point except me! Another thing that has me excited: the Apple Watch is getting a Pokémon Go app! According to yesterday's Apple announcement, they're also going to try for better (read: ANY) integration with the step counter on the phone!! That is TREMENDOUS. Up until then, the distance you cover in-game relies on GPS signal, which has some flaws. GPS paints in broad strokes, not steps. You have to move so many yards for GPS to have registered any movement at all. If you walk a straight line, that's all well and good, but the minute you start adding turns, GPS gets less accurate because it's counting when you move out of a certain radius, not the number of steps you took. Also: GPS doesn't work indoors, so I was just expecting that none of the steps I took at work would count toward my eggs hatching. Step tracking would be a wonderful addition to the game.
hillarygayle: (Hillary Dark Queen)
It seems that when you don't have any money, you manage to continually come across things you desperately want but can't justify. Today that's the Nyx Soft Matte Lip Cream vault. I cannot even begin to express to you how much I want that, but alas! Still no work.

That's not to say there hasn't been some progress, because oh mercy there HAS! Today the floodgates opened with the arrival of my prescriptive certificate number! I don't get the document in hand for a day or 2; it's going out from the Board of Nursing today in the mail, but the number is the thing! When I called the BoN this morning, they gave it to me, and I emailed CH, the credentialing coordinator. She asked if I had an NPI number, and I was extremely disheartened. I didn't even know it was required, but it's the unique provider number assigned by Medicare/Medicaid, so it's quite important for billing. I went online and applied, thinking I might get my number sometime next week...and behold. It came in an email 5 minutes later. Are you KIDDING ME? Nothing governmental has ever been that efficient. I still don't have a DEA #, but that's not prohibitive for practice. It just means I cannot yet prescribe Schedules III-V on my own; I have to get a collaborating physician to order it. That's not a problem in an ER, where you can't throw a rock without hitting a physician. I will apply for the DEA number and when it comes in, I can stop getting orders from collaborators.

After I got that done, CH submitted my credentialing application for approval, and not even 5 minutes later I got an email from Dr. Mc with instructions to get myself added to the group malpractice insurance policy. I did that. Then I got an email with 2 appointments at the hospital next Monday for orientations with 2 different departments. It's happening, folks!

In honor of my very good mood at such progress, have my new favorite song from Steven Universe!
hillarygayle: (Hillary Bright Cowl)
To use a term I shamelessly lifted from [livejournal.com profile] pondhopper, I'm feeling a bit dull. I usually feel this way by the end of the summer here in Arkansas, but it's so much worse this time thanks to the enforced boredom of not being able to work. I don't do well with idleness anyway, but in this weird limbo of having a job but not yet being allowed by the hospital to do it, it's making me a thousand times more restless than it normally would. We REALLY need the income, as well. I have neither the student loan influx nor the ASU clinical instructor paycheck I've had at this time during the past, and Bryan's paycheck is feeling the strain.

I get quite a bit accomplished when I'm like this, though, especially if I go ahead and take my methylphenidate even though I don't technically NEED it. I've done 5 loads of laundry today, mopped the basement, unloaded and reloaded the dishwasher, and finished the class & written exam portion of the Advanced Cardiac Life Support recertification. You must be ACLS certified in an emergency department, since people try to die on you more than normal there. I only had to re-cert, since I've been ACLS certified in the past and simply let it lapse. It was really difficult to find classes to join for recertification when I didn't have an employer setting them up. I passed the written exam with a 98% and the education coordinator at St. B is going to perform the in-person "check off" portion for me on Thursday.

Also, thanks to [livejournal.com profile] thejessone, I have a new memory aid in keeping two medications straight!This went a little long, and is about medication names & Southern accents )

I haven't written much here about my latest favorite TV show, so I figured it was time I fixed that.

I started watching Steven Universe upon the recommendation of several friends who have preferences in media that are really similar to mine, most notably [livejournal.com profile] wintersweet. I didn't get the chance to really sit down with it for a while because of 2 things: 1) grad school, and 2) Ganon REALLY wanted us to watch it as a family after seeing the first 2 episodes. Since we currently weren't watching anything as a family (having finished both Avatar series that way), and seeing that the first few episodes looked funny, light-hearted with a somewhat serious undertone, and like they might teach valuable lessons, I was inclined to grant this request. But that meant our viewing time was limited to times when we were all home and in the mood to watch, and graduate school just really murdered that timing.

Then I graduated in May, and this summer we determined to watch through all the episodes. And oh my goodness. Part way through Season 1 it became clear the serious undertones weren't always going to stay "under." Thanks to Tumblr, I'd been spoiled through Season 1 & I knew the big reveal that happened regarding one of the characters. I'll put this in a cut for spoilers )
If you want to know why I recommend it without reading the spoilers, it all boils down to good characterization, lots of depth in the backstory revealed in tidbits, and an amazing soundtrack. Additionally, here are lessons I've noticed in this show:

# Relationships can be healthy & beneficial, even when others disapprove
# Good relationships make people better than the sum of their parts, but can fall apart if the team members aren't in sync
# You can't avoid consequences or feelings
# Some relationships are unhealthy, & some people feel compelled to continue them for the wrong reasons
# Sometimes you're gonna have to fix problems you didn't make
# Bad things may have happened to you in the past, but you need to communicate with others about them and accept them or they'll eat you up
# Sometimes good people do terrible things
# The world is complicated!
hillarygayle: (BPAL Fire Pig)
It's the Friday Five, on a Saturday! Get yours here: [livejournal.com profile] thefridayfive.

1. What’s your favorite way to stay cool in late summer?

Air conditioning! I live in the southern US (Arkansas, specifically), and it's both hot and humid here. There's really no way to defeat both of those things together without A/C, and the vast majority of homes built here have central A/C. Leaving that aside, I also drink my coffee iced in the summer, and I really love swimming and water parks! This summer I've been obsessed with iced green tea lattes from Starbucks.

2. Are you ready for autumn yet?
Autumn is my favorite season and I am SO VERY READY for it! I'm always ready for both autumn and spring. Extremes in temperature are not my thing, especially when they go on for very long. I'm always ready for it to warm up in March and to cool off in September (although it really doesn't cool off dramatically here until October). I like pumpkin, cinnamon, nutmeg, and the smell of smoke. I like jeans and skirts with cardigan sets and jackets. I like ruby red, topaz yellow, and all the bold, dark, saturdated jewel tones that come into style during fall.

3. What do you have left to do before summer ends?
Working on getting all the physician signatures for my collaborative practice agreement to work in the emergency department. I'm hoping to have it done by the end of August so I can start working in September.

4. Has it been a good summer for you?
You know, it really has. At the beginning, I graduated with my doctorate in nursing. Then I went to Chicago for the first time and took a review course for boards. Had a couple of trips here and there and everywhere, and took a 3 week exercise course at the local university as a volunteer for training personal trainer students. Went to interview with the emergency room and was hired after the world's shortest interview. Studied like a madwoman throughout, and then finally passed my nurse practitioner boards on August 2...only to find out immediately that my dad-in-law needed heart surgery. That went well, though he's currently dealing with some gall bladder issues now. It's been much too busy for my taste, but most everything that happened this summer has worked out in my favor, so I'm very satisfied. I worked hard, and it's paid off. Now, to start work so I can actually get PAID! :)

5. Have you started Christmas shopping yet?




Aug. 12th, 2016 06:12 pm
hillarygayle: (Ganon Cute Overlord)
My Arkansas nurse practitioner license number came through today! I've spent all day working on collaborative practice agreements and prescriptive authority. I'm sleepy and HAPPY.


hillarygayle: (Default)

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