futurebsngrad2010

I am in my final semester of nursing school and I am planning on moving to Dothan, AL. I am hoping to get some input on the hospitals there. There are two hospitals: Flowers Hospital (for-profit) and Southeast Alabama Medical Center (not for-profit). I just have been told from many people that I should stay away from for-profit hospitals. I would love to hear from someone that knows about these two hospitals and has any advice for me. I have compared them both on the hospital compare website. Flowers seems to have much better scores and statistics. I like the idea of Flowers because they are a smaller hospital but I am just confused about how their profit status will affect job satisfaction. Any help, advice, or other information would be greatly appreciated.

I came across two articles this morning and thought you might find my story interesting! I have attached the links to the two articles and I emailed the National Sleep Foundation telling my story in hopes it may help someone else someday, I am also pasting it here so maybe it will help someone else! I have already posted on this thread several months ago but a lot has changed since then so sorry for the long post . I am a 23 year old female, currently a senior nursing student, diagnosed with Narcolepsy w/Cataplexy and REM behavioral sleep disorder in May 2008. Since I was little I have had crazy, wild, scary, vivid dreams. There was definitely one episode of sleep walking that I am sure of, I walked from my bedroom on one end of the house to the other end into my parents room, looked into their bathroom and walked back to my room to go to bed. My parents saw the entire thing. I frequently woke up as a child screaming because I "saw a spider on my bed", but now that I have learned more about sleep disorders I truly think there was never a spider it was just a hallucination because my parents would always come in and never could find whatever it was I thought I saw. For as long as I can remember I have talked in my sleep, cried, yelled, kicked, punched, etc. For the past 5-6 years the sleep talking and violence in my sleep has worsened and especially the hallucinating as I am falling asleep (which happens soon after my head hits the pillow. For my sleep study for narcolepsy my Neurologist/sleep specialist was dumbfounded as he went over my sleep study results with me. During the night study I moved around, talked, sat up in bed and yelled out, and the confusing part was my pattern of sleep cycles. I go straight into REM sleep as soon as I go to bed. Literally my boyfriend can tell when I have fallen asleep (I jerk pretty hard the moment I fall asleep) then moments later I begin to talk, depending on the dream I have cried my eyes out dreaming of something really sad, screamed/cursed/woke up angry and mad at my boyfriend and accused him in the middle of the night for whatever i thought he had done to make me mad. I have nearly broken several of my friends and my mom's noses, punched my poor dog in my sleep, texted my roommate in my sleep swearing up and down that someone was beating on our front door, I could go on and on with the craziness of my nighttime sleep. On to the daytime...for many many years I was deamed to be "just another Lazy (last name) Kid" (everyone jokes that our family is sleepy ppl, just couldnt put my last name on here lol) or just a lazy person, or the "napper". I never thought I could have narcolepsy. It took me going off to college, starting the nursing program, doing so horrible in the first class that actually REQUIRES tons and tons of reading and studying to pass (pathophysiology), having to withdraw from the class and sit out the next semester of nursing to wait until patho was offered again in the summer, then I BARELY passed the 2nd time but they didn't have enough spots for me to continue with my class, I was allowed to take pharmocology that fall and FINALLY I was able to start 2nd semester (first semester with clinicals) in the spring and struggled through and failed with a 74 (75 is passing), next I came home for the summer and it didn't take long for my mom to realize something else was going on that was really causing me to struggle with school, it wasnt until we were driving to the nearest mall (an hour drive) and my mom screamed out "(MYNAME)!! you have been driving for the past few miles ASLEEP! We went to the family Dr the next day and he referred me to a neurologist/sleep specialist, i had an appt the next day. I saw the specialist and scheduled a sleep study for that night. Sure enough I have narcolepsy w/cataplexy (dreamed in 3 out of 5 naps, and was asleep in 1-2 mins. each time) and REM behavioral sleep disorder. I have tried provigil/provigil & ritalin/ritalin LA and IR/adderall XR and IR/back to provigil and ritalin/back to adderall XR and IR/adderall IR twice a day/and now I am on adderrall IR twice a day plus I just started Xyrem two weeks ago. FINALLY I am starting to see amazing improvements. Since being diagnosed with narcolepsy the nighttime behaviors have only gotten worse. With Xyrem I do not move a muscle, I sleep FINALLY and my body rests! I woke up after the first night and the first thing I couldn't wait to tell my mom was I DON'T REMEMBER A SINGLE DREAM! She slept with me the first two nights to make sure I did ok and she said once she meds kicked in I didnt move or say a word! After 9 days on xyrem treatment my epworth score went from a 16 before starting xyrem, to 9 on the 9th day! Back to my nursing progress, sorry this is so long, after being diagnosed in May 2008 I started back to nursing school and had to retake the 2nd semester (its a 5 semester program), It was amazing the information that I would have sworn they didn't cover in class the first time but I heard it the 2nd time because I was AWAKE! I improved quite a bit but still struggled to sit and read to study etc. I was just happy to be able to learn in the classroom and be more* awake during exams. In the spring of 2009 I was in the 3rd semester of nursing and did ok but because the meds really weren't doing much for me anymore I struggled. Finally someone told me at the end of the semester that I was eligible for testing accomodations and I had double time to take the final exams for that semester. That helped a lot because I had time to get sleepy but recover from it and continue with my exam instead of dozing then waking up with 10 mins left and 30 questions left to answer!! At this point our school decided to implement a new policy, at the end of each semester we take a HESI exam for each clinical course we have that semester. Because so many seniors weren't passing the FINAL HESI exit exam after 3 trys they had to take action and figure out a way to fix the problem. Well they decided to require us to answer 14steps/questions on each topic for each question we missed (so I missed 23 questions on my MedSurg HESI therefore I had to answer 14 questions on the topic for every missed question, all written BY HAND). You can begin to see the struggle a person with narcolepsy might have doing this. Granted I tried to work on it at the beginning of the summer but quit because I was falling asleep EVERYTIME I sat down to work on it. I took off work two weeks before school started back (I have worked every semester since being in college) and I ended up not being finished in time and turned it in one day late. I was removed from my registered courses the day before the semester started because in the contract/policy we signed it states zero tolerance policy it must be turned in two days before class starts. Anyways...I had to take classes to finish my minor and be full time. I started back in nursing for 4th semester in the Spring of 2010. I was so excited because it was finally the classes I was interested in (Peds, OB), I did ok but I am pretty upset because I know that I could have done excellent if I didn't have NARCOLEPSY :'(. I was finally able to get my request for retro-active medical withdrawal approved from the Spring 08 semester that I failed by 1 point and was diagnosed to narcolepsy, so at least that isn't on my transcript and I got my tuition back. Anyway, so this summer I have had 51 questions missed total from all 3 classes and 14questions to answer for each. I had planned to try xyrem this summer and hopefully get my sleep improved and be ready to start the fall semester as awake as possible . My Dr didn't get the xyrem set up until July so for the entire month of June my narcolepsy daytime sleepiness and nighttime crazy dreams/hallucinations upon falling asleep and waking all seemed to spiral out of control. I couldn't stay awake for anything. I would get up take my dog out, eat breakfast, go back to bed and sleep til 12 or 1 and get up eat lunch, stay awake for a few hrs, take a nap for a few hours, then awake for a few, then back to sleep for the night. I got in this awful cycle and couldn't break it. Obviously I coudn't get any work done, worked for 3 weeks on one topic (1 set of 14steps/questions)! I ended up going to the Dr with my mom and was put on antidepressant because I was very emotional and really didn't have any desire to get out of the house all I wanted to do was sleep. I was ill with everyone because all I heard when I was awake was "this is rediculous, you know what happened last time, you have got to do your 14 steps, etc etc", I had all I could handle (my family doesn't really fully understand the sleep disorders or wanna listen to me explain them) so I finally just broke down and had a melt down. I started the antidepressants and he adjusted my adderall to 30mg IR twice a day and made sure the xyrem was being set up. I started xyrem July 19th and in 9 days I did 8 sets of 14 steps! As the daytime sleepiness is improving I am picking up the pace, I am able to sit and work on this for 10+ straight hours at a time. I am still pretty sleepy the first couple hours I am awake but nothing like before, and my parents sure do appreciate the added effect of xyrem making me stop talking/hallucinating/screaming/crying during the night :). I read this article relating REM behavioral disorder (my nighttime sleep disorder) to the later development of Parkinson's disease or possibly Alzheimer's/dementia etc. I also read where most of the patients with REM behavioral disorder are men in their 40s and 50s, I remember my Dr. saying something about my sleep study when he was explaining how stunned he was after looking at the results because I have the problems that usually only 40-50 yr old men have not to mention the crazy backwards odd patterns of my sleep cycles. Also, I feel confident, and my mom agrees, that my paternal grandfather has narcolepsy and pretty extreme cataplexy. He takes naps all day and talks in his sleep during his naps, and anytime he is upset/sad/something makes him angry/if you say something that he absolutely doesn't agree with, he has a cataplexy attack. I didn't realize it until I was diagnosed and realized that my symptoms were actually cataplexy then I realized that my papaw has done this for as long as I can remember. Also on my fathers side, my dad's sister most likely has narcolepsy and sleep apnea, her doctor thinks so and wanted to schedule a sleep study but she put it off til' who knows when. Also, my maternal grandmother is the most classic case of narcolepsy EVER, she won't go do the sleep study until she has her bladder surgery because she is afraid she will be up going to the bathroom all night haha! I wish so bad that she would have the study done, but without a doubt she has narcolepsy and possibly sleep apnea. I say all this to show I likely have family history of sleep disorders on both sides of my family. No one that I know of has Parkinson's but we do have a history of Alzheimer's. My mom's grandfather had alzheimer's and dementia, and my mom's dad is in the early stages of alzheimer's but wouldn't take his medicine :'(. I tell you my whole life story in hopes that it may help someone else. I am interested in the research being done on REM behavioral sleep disorder and hope that more will be done for narcolepsy. I know from personal experiences/trials/struggles that even the most educated medical professionals and nursing leaders/educators do not know much at all about sleep disorders nor do they sympathize with students who deal with them. I hope to finish my 5th and final semester of nursing school in December 10' and plan to get involved in promoting research and attention for narcolepsy and other sleep disorders. I know that the study of sleep is very new and I hope and pray that more will be discovered to help people suffering from these disorders. My hope is to educate others, especially school teachers about narcolepsy and sleep disorders and what signs to look for because if my teachers had been aware and instead of scolding me and embarrassing me for sleeping in class, they could have recommended help for me long before I graduated and started this 6 year long struggle to graduate college. I refuse to give up though! I have read on many sleep forums on narcolepsy and I have seen the really sad stories from people that really live miserable lives. These people can't even function, can't work, can't get out of the house, lose relationships, etc. I think of all that and I feel very proud to have overcome everything I have been through so far. I have come to far to give up now. I hope someone sees this, actually reads it, and maybe it will inspire new studies or help someone else that is dealing with the same problems, especially someone who hasn't found the Dr. willing to take them seriously. Narcolepsy is just as devastating and miserable as any other chronic medical diagnosis and medical professionals, especially nurses/educators, need to be better educated on sleep disorders. I know for nursing students in my program we had one lecture on sleep and comfort and maybe spent 2-3 minutes on Narcolepsy! Everytime I had to sit down with the Director and ball my eyes out because I had hit another "roadblock" in the program, she made me feel like the biggest failure, like I was such a disappointment and especially after being diagnosed with narcolepsy she for sure rolled her eyes and dismissed me. She does not remotely understand what I have dealt with, I think she is just sick of dealing with me. I can not wait until the day I walk across that stage and graduate. I will prove to her (and everyone else) that I do deserve to be a nurse despite her lack support and confidence in me. Thank you all for reading my story and sharing yours because I think it really helps to hear from other nurses/nursing students/ppl with narcolepsy and know that I am not alone. Together we can help each other and those struggling to make it through school or their own daily lives dealing with these horrible sleep disorders! Here are the links to the two articles I read this morning! :) http://health.msn.com/health-topics/alzheimers-disease/articlepage.aspx?cp-documentid=100261632 http://www.sleepfoundation.org/article/sleep-related-problems/rem-behavior-disorder-and-sleep

I came across your post while searching for sickle cell-hydration. I missed a question on the HESI for PEDS and we have to answer 14questions on the topic of every question we missed. I missed a question on "sickle cell-hydration". I just found in our Peds textbook (Wong's Essentials of Pediatric Nursing, Hockenberry & Wilson, 8th edition, 2009, p.919-920) it says..Severe hypoxia must be prevented because this causes massive systemic sickling that can be fatal. Although oxygen may prevent more sickling, it usually is not effective in reversing sickling because the oxygen is unable to reach the enmeshed sickled erythrocytes in clogged vessels according to Perkins & Chiocca (as cited in Hockenberry & Wilson, 2009, p.919-920). In addition, prolonged administration can depress bone marrow, further aggravating the anemia according to Khoury & Grimsley, Dover & Platt (as cited in Hockenberry & Wilson, 2009, p. 920). So the way I understand it is in a sickle cell crisis hydration must come first because oxygen can't even reach the cells once the sickling has begun. Once hydration has begun, electrolytes replaced to correct metabolic acidosis due to hypoxia, pain management instituted, blood replaced, and antibiotics for any infection, then the oxygen can be administered to prevent more sickling. At least thats how I understand it. If you have the same text book you can look it up on pg. 918-920. Hope this helps someone because I know I always have a hard time with sickle cell. :)

WOW Its so good to hear that someone else experiences the exact same thing I do! It started with me the very first time I went to a blood drive to give blood for my friend who had been in a car accident. They inserted the needle and as they were setting up the rest of their equipment I passed out. I remembered everything getting blurry and I couldn't hear them around me and it was like I took an extremely long nap lol. The next time I had to be put in the hospital for some tests and before the nurse started my IV both my mother and I told her that I tend to pass out when the actual physical part of the need is going into my vein. She didnt get it on the first stick so she is redirecting and jabbing in my arm and I passed out immediately...I TRIED TO TELL HER LOL! But I don't just pass out, like I draw up and it looks like I am having a seizure or something everyone says! I worked at a hospital and was trained as a phlebotomist and I drew blood for eight hours straight sometimes and never once got sick or passed out! In nursing school I have seen many many things that have not made me have that response. I am in my 4th semester out of 5 and this semester for some reason I have gotten very close to passing out twice, but it usually has something to do with me going to see a surgery without having eaten breakfast or if I become emotionally attached to a patient and then I see them in pain or I have to do something that causes them pain, then I just about pass out. However strange this may be it has not stopped me from continuing in the nursing program! I could not see myself in any other profession and despite having to repeat classes and wait out semesters for my turn to get back on track, and being diagnosed with Narcolepsy..I am still here in the program and hopefully will graduate by the grace of God in December 2010! Good luck to you and just NEVER GIVE UP!!!

hello! I am absolutely blown away by this! I have made it a point to tell my instructors both in lecture and in clinical, that I have narcolepsy. I want them to know when I begin to slow down or get quiet its because I am getting tired and sleepy. I usually get into slumps before my meds kick in, especially after lunch/supper break. My teachers have proceeded to say, wow what are they giving you to help with it. I just the other day told my clinical instructor about how I started on Provigil and that did nothing, then went to provigil with ritalin, but that didn't help long and then switched to adderrall which I am currently taking. I still am not getting what I need out of my meds and I am almost on the max dose. I guess for me it helps to just come right out and inform my teachers and fellow clinical students that I have narcolepsy so they don't think something wierd if they see me get super sleepy or doze off if I am sitting still. I feel like you need to contact the office of disabilty services at your school. I didn't know how much they could help me with different issues until I met with the director of the ODS office. They are amazing here at my school (I am in a BSN program, finally in my 4th of 5 semesters). Its a very big deal for them to respect your privacy and not punish you for something that is a medically diagnosed disorder and you can't help this!!! I would also speak to the previous clinical instructors that graded you in clinical and on your care plan. Do not give up, I have had the worlds longest experience in a nursing program and I have had to wait my turn and retake classes and butt heads with upper authorities and believe me I do not get any sympathy. Its so hard for me to understand how a nurse that has had so very many years experience and education can dismiss someone's medical diagnosis and make them feel like they are lazy or a failure. So take it from someone that has had many obstacles and road blocks in my coursework and since being diagnosed with Narcolepsy only 1 1/2 yrs ago! Please keep me updated on this and I hope it all works out for you, it may help to get a letter from your physician and actually you will need this for Disability Services if you haven't already signed up with them. I know it has helped me A LOT to have double time on my exams and a reduced distraction environment (since I do have ADHD). There is help out there you just need to do some searching and find out what all is available to you and don't give up!

WOW!! You all have no idea how good it is to finally find a forum for nurses/nursing students with narcolepsy. I am currently in my 4th Semester of 5 in a BSN program. I was admitted to the program in the Fall of 2006 and before nursing school I was able to do well in my classes by just learning as much as I could in class and "skimming" the material before tests. Well WOW was I in for a wake up call when I started my first semester of nursing school. I did fine in all courses except Patho! I was doing HORRIBLE, I would sit to study and fall asleep after reading a paragraph, I would try to make notecards and take notes in class and not be able to read them afterwards from dozing . My classmates and closest friends just deemed me the "sleepy one". They all just knew I was going to fall asleep in class and they would try their best to get me caught up with notes but it was just too much. I had to sit out a semester until Patho was offered again the next summer. I took courses to get a minor in Psychology in the mean time. In the summer of 2007 I retook Patho and BARELY passed but even then there were not enough spots in 2nd semester for me to continue. So there I was in limbo again, I was able to take Pharmacology and Nursing Research in the Fall of 07 and passed them both. I didn't do great in Pharmacology but I was just thankful to pass. All this time I was still struggling to get by in my courses. I knew I was capable of doing much better but I just did not have the energy or the ability in me to stay awake and do the necessary reading and studying that nursing courses demand. I was able to start my first clinical course in the Spring of 08 and I really struggled just to pass and ended up with a 74 and 75 is passing in nursing school :'(! My roommate at the time was in that group so it was even more devastating to see her go on without me. I just need to mention all this time my family had always just told me I was a very lazy person and just all I wanted to do was nap nap nap. After failing my first clinical course I came home to my family for the summer to wait until the fall of 08 to retake Fundamentals. I was devastated because I tried so hard and I knew in my heart that I was struggling for a reason that was beyond my control. My mother began to notice while riding long distances with me that I was dozing while driving and finally she said maybe we just need to go see our family physician and see what he thinks. I explained to the Dr. that I could not stay awake to read/study/sit in class and take notes etc. My mom explained how terrified she was to see me dozing off behind the wheel. I told him that I suspected that I may have narcolepsy, I also explained how I didnt sleep well at night AT ALL. I told him about how the second I fall asleep I am dreaming AND talking in my sleep, and kicking/punching/acting out my dreams lol. He said YES I definitely think you need a sleep study, he drew labs in the office to check my iron, thyroid levels, check for Lyme Disease, etc. He called then and there while I was in the office and made an appointment with a Neurologist-Sleep Specialist for that next morning. I went to the Neurologist and he scheduled me for a sleep study that afternoon! I had to stay all night to check for sleep apnea/etc, and then they woke me up very early to eat breakfast and then start taking the scheduled "naps". After going home I went back to see the Neurologist the next day and he was speechless. He said I am just baffled by your sleep study results. He said you definitely have full blown narcolepsy (and I have cataplexy), each time they came in the room to tell me to get in bed and go to sleep I was asleep within 2-2 1/2 mins each time and I had dreams in 3 out of 5 naps. I did not have sleep apnea but I have what they call REM-Behavioral Sleep Disorder. Instead of going to sleep and having several hours of non-REM sleep, I go directly into REM sleep. So not only am I excessively sleepy during the daytime but I don't rest well at night because I am dreaming vivid/wild/sad/crazy/scary dreams ALL NIGHT LONG. I disturb anyone that can hear me talking/yelling/cursing/kicking etc in my sleep haha! Its something EVERYONE thinks is hilarious and my boyfriend has taken a few fists to the jaw in the middle of the night lol! But anyway after getting the diagnosis my Dr. also said I probably have some ADHD but its hard to distinguish between the effects of the narcolepsy and ADHD. I first started Provigil which at first seemed to be the miracle medication! However I soon had migraine headaches constantly and became very irritable, emotional, depressed type mood swings. My Dr switched me to a lower dose of Provigil in combination with Ritalin which was "OK" for a month or so and I just didn't feel the provigil was helping at all, soon I realized the Ritalin was just not working either. Now I am on Adderall and nearly at the max dose and I really really STRUGGLE! my dr has mentioned several times trying the xyrem med but I have just been too scared/hesitant to try it. I mean I have a crazy schedule and I am just afraid that I wouldn't be able to get up and going on time in the mornings. ANYWAY after being diagnosed I successfully completed my 2nd semester of nursing in the fall of 08. In the spring of 09 I also successfully completed 3rd semester. This past summer I was to complete this crazy HESI review questions for every item missed on the HESI for adult health. I sat down many times to work on them and just could not stay awake to get anything done. So I decided to take off from work for 2weeks before school and do nothing else but get them done. Well I really really messed up and turned them in late :'(. Because they made us sign a "contract" I was removed from 4th semester classes and told that I would just have to sit out the semester and start in the spring. So here I am in 4th semester classes and doing decent so far but I know I am capable of really kicking butt on these classes because I enjoy them so much (Peds/Community/OB). I am considering going to see my Dr. and trying the xyrem. what do you all think about that? As far as acceptance with the diagnosis of Narcolepsy, the one person in the Faculty I have had to deal with most, she has not sympathized with me AT ALL!! Basically I am just a failure and I know better and she expected better out of me. I feel like I am just this annoying student that has lingered around the nursing program and just will not disappear! However, I refuse to give up. I have the rest of this semester and then we will have the summer off before our final semester this fall. I am soooooo ready to begin my nursing career and show all those ppl that have doubted me and made fun of me and told me that I was just lazy or faking being sleepy ALL THE TIME, I CAN'T WAIT TO SHOW THEM WHAT I AM CAPABLE OF!! I know it has taken my an unbelievably long time to get through nursing school but it will be worth it all in the end. I know i have just went on and on but I could type forever and ask questions from you all but my hands are falling off and I have to get ready for class tomorrow :'(. But if I can get through this nursing program with Narcolepsy then ANYONE CAN!! Any advice/suggestions/encouragement is greatly appreciated :-).