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  1. morecoffeepls

    On Becoming a Nurse

    I was a banker when I met my wife. Before that, among other things, a silver-tongued used car salesman. A lifetime ago, I was in the Human Services field, helping people with special needs and struggling to pay my bills. I've had several careers and a myriad of jobs. When my wife's family persuaded me to manage their successful restaurant with an imminent ownership carrot, I felt my future was secured; however, when my wife became pregnant with our first son, working twelve hours a day seven days a week wasn't an option any longer. So we sold the business and I started nursing school. There was a nursing shortage at the time, and I wanted to have a career where I felt like I was helping people beyond satisfying their consumer needs. That was about seven years ago and my wife is now fairly pregnant with our fourth son. Presently, I am a psychiatric nurse. I love my job, and am able to pay my bills. I am content. I look at my three boys and my expanding wife and am grateful for the choices and paths that led me to them and to where we are today. Then I realize that my oldest son is going to be nine years old soon, and I remember one of the more obscure or profound reasons why I became a nurse. The memory is a little ambiguous, and the twinge of nostalgia is bittersweet. I was severely asthmatic as a child. It began and quickly developed when I was nine. I couldn't say if it was allergies, genetics, my somatic response to a burgeoning understanding of the world, or any other dumb guess, but my autoimmune system hijacked an otherwise pretty idyllic childhood. I became a regular at the local hospital emergency room and at the nurse's office when I actually attended school. I remember the anxiety when my restricted airways failed to respond to a rescue inhaler. I remember the kidney-shaped bowl my mother would hold for me as I vomited phlegm in-between racking coughs; the look on her face. Or when the Albuterol and Salmeterol nebulizer treatments didn't touch me and they'd have to inject me with adrenaline. I recall an attack that required a series of more of these shots than usual, and being laughed at by the doctor when I asked if I could go run around the parking lot for a while. One time on vacation I had a bad attack and didn't want to go to an unfamiliar hospital, so I tried to be stoic as I sat rigidly on the edge of that hotel room bed feigning indifference and the ability to breathe. By the time I got to the hospital, one of my lungs had partially collapsed. I was admitted to the PICU for a week of observation when the frequency and severity of attacks became excessive. This was an entirely different world from the ER. I was excited when I saw they had video games, and then embarrassed and disappointed when I asked if I could play and was told that they were just a different type of vital signs monitor than I was used to. In my defense, they did resemble Donkey Kong. That week felt interminable. I realize now how brief a period of time those seven days were. In the room next to me, separated by a glass partition, was a boy who had been in the local news for a while. I still remember his name - David Yarmush. He had been hit by a car and was in a coma and on life support. We were the same age. I believe staring at him all day and night and the people who came to visit him changed and shaped my perspective. Boys like us get hurt, we get sick; sometimes badly enough to die. I was frightened and melancholy; sinking into myself. The kindness of strangers kept me afloat. I want to say I remember each nurse from each shift distinctly; their names, their scents, their individual voices or laughter. I can't, though. As human and warm as they were then, they have become a set of ideals to me now, a paradigm. One name I remember is Sarah, "with an a-i-t-c-h". One nurse was so achingly beautiful and smelled so unbearably pleasant that I blame her for an early onset of puberty. An older nurse with an accent softly hummed the same song incessantly, like some chronic disorder ('La Vie en Rose'). I do recall that each nurse I encountered was an authentic presence. They genuinely wanted to be there; to see to my needs and that I was not embarrassed by them; to help me and to listen; to comfort me; and, ultimately, to teach me compassion. However, it was watching them take care of the boy next to me that made me fall in love them. They were as genuine with this tragic, unresponsive victim of circumstance as they were with the scared, overly polite boy who watched him incessantly and imagined the life of the mind within that broken body. I wondered a few months later, after the news of his death had been broadcast, if he had been able to appreciate the kindness of these women. In the romanticized version, the summation of David's internal responses to these nurses - to the scent of an intensely adult woman's hair as she reaches over you to "unkink" an IV tube, the sharp staccato laughter of the chubby little night nurse, to being awoken by the benign touch of a foreign woman's cool hand against your cheek and forehead, and so on - was the same as mine: profound gratitude. In that version, Edith Piaf echoed over the verdant landscape of his deep sleep. I still prefer this naive, apocryphal version of an unfortunate boy's last days over any rational, neurobiological understanding. I allow myself to idealize my role as a nurse because of that experience. Those exceptional women taught me the virtue of kindness. I am able to channel them, to try to be a Good Samaritan with each clinical encounter. This is why I am a nurse: I am afforded the opportunity to give comfort to strangers. In dreams, I have been assigned as a nurse to those two little boys. I am kind to them, I ease their suffering, and they break my heart and change me into something better than I am. In dreams, I am David, on the other side of that glass partition, alone and dying inside a ravaged body, and I feel a gentle hand touch my skin, I smell something clean and mildly intoxicating, I hear distant music or laughter resonate; then I slowly rise from the bed and walk out of the room, away from what I know, and with alarming suddenness, I burst out laughing and start running.
  2. morecoffeepls

    2014 Winter Article Contest

    I was too vague: there are a variety of forums categorized under 'General Nursing' (e.g., 'Nurses Rock', 'Nursing and Spirituality') - are these ineligible?
  3. morecoffeepls

    2014 Winter Article Contest

    Hi Joe, What would be some examples of appropriate/eligible forums for article submissions?
  4. morecoffeepls

    A question for night shift psych nurses - do you limit PRNs...

    I am the lone night nurse on a small community hospital acute inpatient psychiatric unit. I agree with several salient points made by the OP & commenters. I value an "uneventful" night (no string of admissions, no one actively psychotic or suicidal, no falls, etc.) as much as the next nurse with three kids and a second job; however, when it is slow and a patient is having issues, I feel very fortunate to have the time to spend with that person. In fact, I sometimes feel these exchanges have been the only genuinely important moments of my nursing career so far. Med-seeking, whether by habit or a deficiency in coping skills, and somatic complaints are often regarded with contention or indifference by some of my co-workers. I am neither naive nor a pushover, but I have a hard time being overly annoyed by needy, manipulative, or borderline behaviors. For the most part. I also have a hard time giving a prn for reasons other than their indications. There are obviously exceptions - like a Neurontin for pain if other prns are exhausted and it's neurogenic. Your concern with giving prns that are not as innocuous is a really valid one. We're not pill-pushers, and of course alternative therapies in addition to - as opposed to in lieu of - appropriate administration of prns are essential. Teaching moments (med education, coping skills, whatever) are invaluable if you can get through before an eruption or someone shuts down. I have many advantages working nights on this small unit, including a certain level of autonomy being alone and having a brilliant psychiatrist that keeps bizarre hours and is accessible to me in person. If he's not here, I don't hesitate to page the on-call if I need something. We are fairly liberal when it comes to passing prns (as someone commented, there is an evidence base to support the practice); however, unless it's appropriate, I can't give something like a Haldol/Ativan/Benadryl cocktail. Also, how do you document this? As one astute commenter stated - we are not the prescribers. We are, however, responsible when it comes to safe and appropriate administration of medication, regardless of the culture or environment in which we practice. Just be careful & who cares what your co-workers think, say, or do if it makes you uneasy ... CYA
  5. morecoffeepls

    The Boy at the Bottom of the Stairs

    Happy holidays again. No wonder I'm a psych nurse:
  6. morecoffeepls

    Why should I become a Psych RN?

    The only reason I went to nursing school was to become a nurse anesthetist; then I did a few psych rotations and I was hooked. If you suspect this specialty is something you would especially like for some reason (vague, specific, whatever), or that perhaps your innate nature would lend itself to, then you're probably a psych nurse. You'll have people (instructors, experienced nurses) tell you that you need med-surg experience first, but why not delve right into it if you become convinced it's what you want? I truly enjoyed clinicals in psych, and believe in the whole "authentic presence" approach to interpersonal/therapeutic communication. I was hired as a new grad as the FT night nurse on the unit where I did my first psych clinical rotation (at a great hospital with a holistic philosophy of care). I was lucky because jobs were scarce for my graduating class. I didn't expect to be paid more because psych is a specialty, but between the charge, shift, and weekend differentials, then tacking on a few bucks an hour after getting ANCC certified and climbing the clinical ladder, I make about 30-40 % more than if I hadn't bought out my tuition contract to work on my unit. It's been about 4 years and a few kids later, and I'm convinced I have found my calling. I recently started working psych home care per diem as well, which is satisfying and probably the future of nursing/health care. That all being said, if you're not convinced, or start off in psych then change your mind, you'll have some real difficulty when the time comes. I always feel like my experience has been an anomoly because I am a male nurse, but 2 cents is 2 cents. It's such an intriguing, rewarding specialty replete with moments that remind you what it means to be a human being in this world. Good luck.
  7. morecoffeepls

    The Boy at the Bottom of the Stairs

    Thx, all. Happy Thanksgiving. Who else is working the holiday?
  8. morecoffeepls

    Sacred heart University MSN

    I finished SHU's RN-BSN online program about a year ago (its inaugural class). It took two years and seemed interminable, but I'm glad I did it. The only reason I enrolled was to be able to get into a decent NP program (Yale and Fairfield are the only two schools in the state that offer a Psych NP track), but with the whole DNP conversion being imminent, I'm strongly considering changing to an MSN program. Fairfield has already phased out at least one Master's level NP program. Instead of prattling on about my own issues, I'll try to provide some insight into the online experience. Blackboard does seem a bit antiquated, and there were some technical issues at times, but once you get used to it, it's fine. I've looked at the MSN curriculum, and I don't see a lot that would differentiate it from what I went through; so, hopefully this information is pertinent enough to help. Maybe it's just my personal learning style, but I might just prefer the online experience to traditional classrooms. Showing up and listening to someone read off a Powerpoint was always difficult for me. It's my belief/assumption that instructors compensate for the online format with the volume of work assigned; however, if you're able to make the time and have a decent understanding of APA (Purdue's OWL site is good in a pinch) it's easy to get accustomed to it and develop good habits. My experience may have been anomalous, though, in that I'd rather write than speak and I had down-time at my job to complete assignments. Two classes per 8-week module (or whatever they call it) doesn't sound like a lot, but working full-time with kids made it stressful. I actually spoke with someone from Admissions recently, and my fear that not having enrolled in the RN-MSN program initially may cause some overlap or redundancies, but I don't think that is the case. Obviously, this thread has me thinking about my own situation, and I apologize for focusing on it. I had it in my head that I needed a good GPA for the BSN program based on the initial reason I enrolled and my fear that online programs are looked down upon by decent graduate schools, so maybe I hurt myself a little attempting to do that. (Shameless aside: 4.0 & a Gold Medal for Excellence in Nursing looks good on a resume/application). But the reality is that I did learn a lot and have that piece of paper and some more letters after my name now, which is all that actually matters. I'll end up enrolling at SHU again if I decide to get a Master's degree. Also: Please feel free to ask any specific questions so that I don't go on another tangent about my own considerations.
  9. morecoffeepls

    Win CASH! 12th Nursing Caption Contest - $100

    The three of us walk into a bar ...
  10. morecoffeepls

    The Boy at the Bottom of the Stairs

    We try to teach our children how to be good. Being innocent isn't necessarily the same thing, and some day, when the sheen has worn off, becoming a virtuous person in this world will mean making hard decisions and choosing difficult paths. I was fortunate enough to have a saint for a mother, and two sisters with Down Syndrome who taught me everything I will ever know about compassion. My moral upbringing and idyllic childhood are how the world and my place in it were given meaning - and why, I believe, I was chosen to become a nurse. To be entrusted with the well-being of another human being, and to respond to this duty with competence and caring are the things that inform my practice. They are also, if I am mindful of them, what will help me try to be a deserving parent. Fortunately for them, the responsibility to raise my three sons isn't mine alone, and it's a wonder to me that each day is an opportunity for them to learn or experience something for the first time, and each person they encounter may have a lesson to offer. In turn, my kids teach me something new every day (about the world, about myself, about what's important), and I will never get over that. My oldest is six now. He is one of those kids that have no shame, and you hope never will. Anything for a laugh. Too funny, too friendly - no such thing as either, but there are times. Whereas I'm a stocky, seemingly unapproachable angry or pensive bear in appearance, my son is a lean, piano-fingered, open-faced, winsome boy. His dark brown eyes are big, like a Keane waif, and he needs to grow into his head some day. When he was two, we started calling him "The Mayor" - fearless in a crowd, among strangers, and engaging. My favorite example of his absurd social prowess is the time he crashed my sister-in-law's boss's swanky Sweet Sixteen party for his daughter. They had just popped in to drop off some paperwork, and he knew no one, but he insisted on staying for a song or two. He was working the dance floor alone for a while before he decided to pull the initially reluctant partygoers out of their seats and make some things happen. My wife told me that before long, all the girls had formed a circle around him and were chanting his name: "Go Leo! Go Leo!" She said the manager of the banquet hall approached them on their way out and thanked my son profusely for saving the party. Powermoves. He is also quick to tears, which concerns me a little, but not really. He has a soft heart. When the waterworks are appropriate and genuine, it's touching as hell. If I mention the piggy bank that "nana gave me when I was born!" and was accidently shattered last year, or Mimi, his favorite stuffed cat (it's a dog, actually), that got a haircut when my wife decided putting it in the washing machine was a good idea, he wells up and turns away. I am proud of his sensitivity, moved by its depth and authenticity. Recently, my wife and I somehow managed to watch an entire movie without interruption. It was pretty decent, primarily because of its insistent and unapologetic adherence to formula; a real tearjerker. Leo wandered into the room, barely noticed, about halfway through. Two brothers are fighting during the climax, and although one is severely injured, the other is forced to continue to punish him. When the physical and emotional anguish was coming to a head, my son burst out laughing. When we turned, his face was streaming tears and he was pointing to it: "I can't believe I'm crying so hard! This is so sad!" We all started laughing, but he broke my heart and I had to get up and walk into another room. Last year around this time, my son taught us a lesson about what the holidays should mean. We were picking up another of my wife's sisters at the train station downtown a few days before Thanksgiving. We were early, and my son wanted to walk across the street to look in the windows of the antique stores. He likes old things. The storeowners really respond to this kid. My son asks good questions, makes astute observations and clever jokes, is respectful; invariably, they quickly establish a rapport that excludes me. The guy at Salvage Alley calls me Leo's Dad, and has offered to take him on as a horologist apprentice. I think he meant it. Ever since Leo first walked into his shop, picked out an ornate, curved handle sword cane, assumed a fancy English gentleman's pose and said, "Ello Govna" to himself in a mirror, this crusty old bastard decided he and my son would be friends. "Soldiers, daddy," in a goofy baby voice because that was how he used to pronounce it; so, I hoisted him on my shoulders, and off we went. I was still explaining how someone had put a three-masted fully rigged ship inside a bottle he had spied in some dark corner of Vestige in a Bottle when we heard a girl shout. She was backing out of a doorway, and quickly covered her mouth with both hands. I let my son down, and he latched onto my arm as we approached the scene. The girl told us that she and her boyfriend were about to start walking up the stairs when an old man fell backwards from "almost all the way". As she was saying this, I noticed a few people standing over the man, and one of them was trying to get him up. I bolted over and intervened. We carefully lowered him back to the floor, and I looked up for my son. He was walking toward me, holding the shaken, top-heavy teenage girl's hand. I asked that people clear some space, but I think that only brought more attention to the situation from passers-by. I scanned the advancing crowd again for my son, and saw him saying something into his pretty new friend's ear. She promptly walked over and told everyone to make some room and that I was a nurse. Some nudging, the shuffling of feet, and in an instant, the doorway was empty. People were either looking on at a significant distance, or had simply walked away into the remainder of their otherwise uneventful night. It's an odd thing, and not the first time this has happened to me. An old woman gets dizzy at a wedding, I mention that I'm a registered nurse, and someone grabs me by the arm and clears a path. (Diagnosis: too many ouzo martinis and circle dances.) I believe as far as most of the people on the sidewalk that night were concerned, the situation was being handled. However, as I started to assess the man, I realized he was in trouble. He was struggling to sit up, but I gently redirected him. I was asking him questions, but he simply stared at me. His affect was blunted, and I noticed a very slight droop on the right side of his ashen face. I asked him to squeeze my hands, but I couldn't tell whether or not he could understand me. I had heard someone calling 911 when I first approached the scene, and now there were sirens in the distance. I could feel my son standing directly behind my shoulder, and the man's blank gaze shifted from my face to his. I looked over at my son to make sure he was all right when he simply lifted his hand and said, "Hi." When I looked back at the fallen man, his brow furrowed slightly. Then he spoke. "Hi ... What's your name?" It was mildly garbled, but clear enough. "Leonidas," proudly, without hesitation, then, "I'm 5 and a half. I have a band called Glaciers." A hint of a lopsided smile, then the gentleman relaxed his posture and his breathing. The ambulance pulled up, and I happened to know one of the EMTs. I told him what I could, and we withdrew. As we were walking back to the car, my son beamed and put his hand up for a high-five then asked me for a ride. He felt like a victory garland on my neck. I answered his questions, and made convincing assurances that the man would be okay. Then I asked him why he told him his age and about Glaciers. He started laughing and said he didn't know, that he was nervous or something. Then we were both laughing like idiots and couldn't stop. Thanksgiving came, and I was grateful for food and family, and food again. Leonidas, when it was his turn to offer grace said that he was "thankful the guy was okay." He had told the story many times already, so everyone knew what he meant. The day passed, then a few weeks. The two of us were walking downtown again. Leo had asked to use some of his own money to buy "something old for nana because she's old, too". We were walking past the window of a little railroad-themed greasy spoon when my son abruptly stopped in his tracks. His improvised song 'Tiny Moby Dick Inside a Bottle' had started falling apart anyway, but had included a catchy rap hook that paraphrased something we had read recently: "Don't talk to me about blasphemy; I'd strike the sun if it insulted me." I was impressed. How does he remember everything? "There he is." I asked him who. "The man at the bottom of the stairs." And there he was, eating alone in an empty cafe. Leo insisted we go in. "Excuse me." He looked up from his hashbrowns. "I remember you. Do you remember me?" He didn't, but then stood up and shook our hands when Leo told him about that night. He asked us to sit down, and we did. He had a brace on his wrist, which was sprained, and told us he had suffered a mini-stroke. A haggard Jimmy Rodgers was the image that came to mind as I looked at his face, and he was swimming in his hickory stripe bib overalls. The three of us proceeded to have a conversation about transient ischemic attacks, the holidays, family, old stuff, and various other topics. We learned his name was Richard, that he was a widower with no children and lived alone in an apartment above the liquor store next door, and that he ate lunch at the Track and Trestle Beanery every day. It was nice to see him, and to know that he wasn't injured badly and was recovering well. He insisted on giving my son a silver dollar, and wouldn't let us refuse. Why do people do that? We stopped by for lunch fairly regularly after that. Leo couldn't get enough stories about World War II or Richard's life as a train brakeman. Just before Christmas, the whole family went to the Track and Trestle for lunch with Richard. My son had made a nice card, and asked that we give him a mug because he loved coffee so much. He gave Leo a vintage tinplate caboose, and said it was the exact one he used to work on. My son, in return, reached into his coat pockets and pulled out the two halves of his favorite geode. My wife and I had no idea. He explained to Richard that "inside the chalcedony shell of the rock are celestite crystals" and that they would each keep a half "forever". It was a grand gesture, and the first time they hugged. What becomes evident when I reflect on that time in my family's life is that the spirit of nursing and the spirit of the holidays are not terribly dissimilar. I consider myself lucky to be a nurse. Although I may tend to idealize or romanticize my role, the fact of the matter is that I get paid to help people. I try to give back by being there - by holding myself accountable, by being an authentic presence, and by being mindful of what motivated me to become a nurse in the first place. Essentially, the guiding principle of nursing is reflected in the parable of the Good Samaritan, and although I'm not a particularly religious person, it is something that comes readily to mind when considering what nursing, the holidays, and trying to be a decent father have come to mean to me. Helping someone in need is how we make a difference in this world; picking someone up when they have fallen, if and when they are ready to be picked up, is how we make our lives worthwhile. Sure, this clich�d sentiment is a bit thick, but, like that movie that made my 6-year-old little boy weep, I don't really care to apologize and, rather, have to insist on its ability to affect people profoundly. If I am able to teach my children how to recognize this principle, to know and appreciate it when they see others performing acts of kindness, to treat people in accordance with it, then I feel like I am doing something right by propagating its message. I look out my window at the leaves or the snow, and I realize that the holidays are meant to be about expressing gratitude and good will. I am lucky, and I am humbled: I look at my son, Leonidas of Glaciers, and I see a truly good person. He's the best of us, Jerry, the best! He is my gift to the world.
  11. morecoffeepls

    allnurses.com 2012 Article Contest 3rd Quarter

    Do rights return to author if original allnurses.com publication acknowledged?
  12. Communicate with your state board as much as possible before registering for school. Congratulations on being accepted, by the way. They may give you ambiguous responses, but save the communication (emails, in all likelihood) and perhaps they'll contain verbiage that might mean something in court, if need be. Being a convicted felon made the decision to become a nurse extremely anxiety-inducing. Imagine not being able to take the NCLEX after all the sacrifice and hard work of nursing school? If the BON implies that you will not be able to obtain licensure regardless of the things you listed, then choose a different path and don't look back. Did you have to compose a letter to these schools concerning your criminal record? I did, and I believe I may have had to submit something similar to the state. I wrote what I felt to be true, and believe this may have made all the difference. Do not minimize whatever it was that you did, be accountable for it, and cross your fingers. I attended nursing school not knowing whether I'd be able to obtain state licensure. It was a level of stress I hope to never revisit. There are people on this message board, as in "real life", who are quick to judge, slow to forgive, and have difficulty seeing beyond their own self-importance/righteous indignation/skewed moral compasses. If that sounds defensive, you're right. But I know who I am, and could care less about the opinions of these people (probably the only salient advice in this post, lchavez). That being said, the "idiocy of a young impoverished girl" is a cop-out. No one cares about your station, feels sorry for you, or should; nor should you upon reflection. I know that's not what you meant; however, you were an idiot and those were your circumstances. Own that, and if it prevents you from becoming a nurse, then so bet it. If fate determines that the call to nursing is something that you can realize one day, then wonderful. One of the better decision I've made in my adult life, that's for sure. You're obviously a good person who made some mistakes. You'll be fine, either way.
  13. morecoffeepls

    allnurses.com Article Contest - 4th Quarter 2011

    I know you guys are probably swimming in headaches since the upgrade, but I woke up this morning feeling a little upset. I submitted an article after the 15th evidently, but had received some very nice feedback and, last time I checked, 20 kudos. I don't know if I would have been in contention for a prize, but it seems a little unfair that, despite being unavoidable, that story ('The Man at the Bottom of the Stairs', ring a bell?) simply disappeared and will not be considered. Just a little pre-coffee vent. Thx.
  14. morecoffeepls

    allnurses.com Article Contest - 4th Quarter 2011

    No problem. Thanks for the prompt response, sir. Is the contest over? Should I bother? Honest answer, please, because I would prefer to not submit if there's no point. Also, change is good. You're probably getting inundated with small issues, but it'll be worth it. Keep up the good work.
  15. morecoffeepls

    allnurses.com Article Contest - 4th Quarter 2011

    My article seems to have disappeared. Oh well.