NuggetsHuman

Board exam passed! Y'all... we did the thing!

MSN is complete and will be awarded August 31st! Next stop board exam!

Hi All, Coming back for yet another update on this saga. Now 2 semesters away from graduation with my MSN! My clinical last semester was an inpatient geropsych hospital. Spring will be general outpatient mental health clinic. I'm still working on Summer because I'm trying my best to be able to spend time at camp as well as finish my program. Thanks for continuing to ride along on this epic project.

Leaving on Friday for 3 weeks in Pisgah National Forest. It will be my first camp nurse experience. Prior to that I worked at a special needs Summer camp 2004/2005 taking kids off camp for outdoor adventures, then travel camp (45 teenagers in a bus for 4 weeks covering 6 states... what was I thinking?!?)

Forgot to say that I stumbled into teaching undergrad psych nursing this Spring and Summer. It's really fun. Generally, my MO is to assume most of the people are not remotely interested in psych nursing. My goal is to have them not be stigmatizing asshats to my patients when my patients show up in their practice settings.

Oh, hi there. So here's what's happened since the last update. 1) I completed several courses in 2021-2022 year toward the MSN that qualifies to sit for the PMHNP board exam. Ironically or not, one of the classes was "family systems in primary care" (arguably the MOST social work-ey class I've encountered in nursing thus far). Assignments were, not kidding, "describe a family system experiencing a significant health stressor." [I just laughed, and said WOW!, and described my family dealing with my dad waiting for a liver transplant and decompensating by the day.] 2) I was taking advanced pathophysiology last fall while my dad was acutely dying from liver failure. (Did I mention COVID ruins EVERYTHING including organ transplants?!?) He died not quite half-way through the semester. I'm incredibly grateful for the nursing education in combo with my social work education in addition to the general ability to be present with *** going down... so I could literally and emotionally be present with my dad the night that he died. My mom has repeatedly said how she "can never thank" me enough for being there overnight with my dad when he died. She was *beyond* exhausted and really needed to go home. We had just made arrangements for my dad to get set up with hospice the next day, but for many, many reasons I had both a hunch and strongly suspected he wouldn't make it through the night. (Of course, this prompted me to fall down a rabbit hole later about the role of intuition in nursing care... you know... your patients "just don't look right".) Initially, I was afraid that I didn't do right by my dad when he was actively taking his last agonal breaths. There's a part of me that wishes I had reached out and held his hand. And at the same time, I have to remember that I only had book learning about agonal breaths and no practical knowledge about what I was seeing. Also, I woke up from a dead (not really a pun and not intended) sleep about 3:45am to my dad gasping for breath. In spite of how much pain he was in from being revived by CPR and having diminished lung capacity from his overwhelming ascites--his heart stopped earlier in the day when they were trying to give him a dialysis so the providers declined to give him paracentesis--I woke up to my dad sitting kind of upright and turned toward me with his eyes open wide while he took his last breaths. I'm not sure if I saw fear or wonder in his eyes, but I suspect it was both, coupled with a strange kind of childlike innocence. ❤️ I have some really great friends who were able to remind me that it's not about what I did/didn't do in that one moment, but ALL the moments of showing up over the last few years, particularly when my dad was ill and dying. One of them graciously said, "Love turns toward what it needs." To what degree that's objectively true, I will never know. But I have found it immensely comforting when I think about those last moments with my dad. This is one of the hardest, though not the hardest, things I have ever done in my life thus far. It feels weirdly dismissive to say that, but trauma be like that. Weirdly--this is my own personal work, btw--my mom also said she appreciated how gentle and informative I was with information about my dad's health that helped her prepare for him to die. [They were married for 53 years, HS sweeties since 1967.] These are not the kind of conversations I'm used to having with my mom. All I can think is that I'm grateful for my professional training as a social worker and nurse. 3) So... in advanced core (patho, pharm, health assessment) and clinical courses, one has to get a B in order to progress. A B- is not sufficient. If I had taken a grade in my patho class for the fall, I would have a B- and lose one of my two chances to pass with a B. 4) All that to say I'm retaking patho this Spring semester. It sets me back a full year in my program so that I will potentially graduate in August 2025 instead of 2024 if there are no other hiccups. 5) Since I get to have no classes this Summer, I am running away to Summer camp to be a camp nurse for a few weeks in the mountains of North Carolina. 6) I quit my full time LCSW job in October, 2022 when my dad died. There's nothing like a little existential questioning to rethink how one is "doing one's life". I decided time is truly my most limited resource, and I'd like to spend it with some more life-affirming activities for the time being (see also Summer camp nurse).

Oh... Also... Question for the old hats out there if you can remember. Was there a point in your NP Program where you had a momentary freak out (or 5) about becoming the person who drives a care plan and/or is deciding which meds among the crapshoot that is currently psych meds you'd pick for your patients?

Currently in the MSN from LaSalle University in Philadelphia, PA where I did my BSN. There are faster options, but I also like my full-time job. Currently taking population health... and happen to be independently working on a QA improvement project for primary care access for our MOUD clinic patients. :)

BUAHAHAHAHAHAHAHAHAHAHAH!!! I took my NCLEX this morning. Given feedback from my nurse coworkers, and the Pearson Vue "trick" one of them told me about, I'm reasonably confident I passed. Onward to the MSN application(s)!

Ahahahaahhahahahahah!! Just waiting for my authorization to test from the state board of nursing!!! Everything else is done and checked off. SO CLOSE to being done with the BSN!

Latest update... An arts and crafts break from Critical Care studying. The days between now and BSN assuming all else goes well Giving the exit HESI some *SERIOUS* side eye right about now.

Thanks for the pro-tips, umbdude. I appreciate your following this thread over the years. I was trying to talk the nursing program into applying for a workforce development grant that would pay stipends to NP, MSW, MFT, and Substance Abuse Counselors. Alas, nobody had the bandwidth to take it on because COVID ruins everything. It's pretty likely that I could do at least some of my NP student hours where I currently work, but would have a different role. I know it's good to get experience at different places and it would be helpful to keep an open mind about all kinds of things. Ironically or not--still not sure-- my spouse has an MBA and his answer about full time vs part time when I muse about it out loud is "There's a cost-benefit analysis spreadsheet on the internet for that, you know." I *did* finally get back in my office to update the scorecard... but between lag time for post-travel COVID testing, spouse getting fever and presumptive quarantine until he was cleared, followed by a couple of snow days, it wasn't until the first week of February. This semester we have public health and leadership. It makes me stupidly happy to have this index card and be able to fill in the boxes. Summer semester is going to SUCK. A lot. Our clinicals for Adult Health/Critical Care will be back to back 12-14 hour days because we have to somehow get 168 hours of clinical in during an 11 week semester. My current plan is to take Mondays off from my job to have a day to do laundry and make food for the next week. But this also still depends a little on the family health issue. No transplant yet...

I figured I could be 50 and be a psychNP, or I could be 50 and keep on with being an LCSW. Either option is fine. But if I don't keep going with nursing education, I won't have the option to work as a psychNP. We aren't too old. We're just used to a regular schedule! ?

I feel you so much on this, Community. The barriers to accessing appropriate and quality mental health care for our FQHC patients are astounding and so many people don't actually understand what those barriers are, and why they're so insurmountable.

Two semesters left for the BSN! Whoooop! I'd like to update the little index card that hangs in my office soon because there are only 4 squares of coursework left to fill in. However, I'm currently with my parents to help out with a health issue (liver and/or liver-kidney transplant for someone). I've been here since just before Halloween, and am hoping to be home before Christmas, but it really just depends on what happens with organ offers. I've suddenly become the person in my family who interprets what doctors say. It's cool to see my knowledge of underlying disease processes come into play. Also glad that I already know the phrase, "I don't know the answer to that. Let's put it on the list of questions for next time" from social worker life. I'm currently negotiating with myself about full-time vs part-time for the MSN. There are quite a few people at my community health center saying things like, "Just hurry up and get it done because we need you, and you can do your clinical placements here." That feels like a nice vote of confidence. I have been imagining part time MSN due to financial reasons, but there is a cost-benefit argument to be made for getting done sooner because my salary will increase significantly when I'm working as a psychNP compared to LCSW, even in a community health center. The bad news is my work has no tuition benefit. The good news is we are a "high need" scorer for mental health under the HRSA scoring.

Checking back in... 67% finished with the BSN! We had Genetics and Genomics on line for the Summer. Child and Family 2 was peds, which also was on line because COVID ruins everything. Clinicals were also on line as well, which I understand but feel like I'm missing out when we do case studies instead of actual hands-on patient care. On the flip side, I'm grateful we won't have to delay graduation or make up hours. Heading into psych MH for 5 semester credits and a 1 credit senior seminar that seems to be geared toward NCLEX prep. I suspect I'll appreciate that seminar more since we haven't been able to take HESI exit exams. The university physically closed mid-March and will be re-opening for on-campus students in Sept. The original plan was to have classes on line for the first 2 weeks so students living on campus but traveling from out of state could quarantine. The new plan is our psych MH class will be on line, and our clinicals will also be on line this semester. I'm really grateful for that as a non-traditional student who works in community health. I'm also a little sad that my cohort won't get in person clinicals for psychMH because this is the only time many of them will get the opportunity to try psych. Ah well, we improvise and adapt, and continue to move forward.

I'm not a nurse yet, just a nursing student. I will say that my "everyday carry" includes 2 pens: Pilot Frixion 4 color refillable pen (erasable), and a Pilot G2 extra fine black pen for anything that needs a legal signature.

Next week is midterms. Officially half-way through with the BSN. ? Right now we are in Child/Family I, which is OB. Clinicals are 7 hours every Saturday. OB clinicals seem to be a lot of observation and not as much hands-on. Yesterday my primary job was to snuggle a 2 week old baby in the NICU for NAS. Also in Research right now, which I would LOVE to be able to test out of. Unfortunately testing out isn't an option for my program "because you have to have a nursing evidence based practice class." I've more or less made made my peace with it. I keep this index card by the bookshelf in my office at work. It's really gratifying to check off classes at the end of each semester.

Echoing adventure_RN, BSN that staying on top of studying for pharm is really important. I had a couple lapses last semester in pharm and getting back on top of it was more challenging than keeping up with it... not unlike laundry and dishes, now that I think of it. I think how you study might depend on how you learn best combined with how your course will be taught. Rote memorization is tough for me, but writing things out makes it easier. Something you could do now if you're not a great memorizer is to start writing out lists of drugs by category and if there's a common word part (stem/suffix etc). For example, all the ACE inibitors end in -pril and all the ARBs end in -sartan. But all the monocolnal antibody drugs have "mab" somewhere in their name, not just at the end.

Other than having a bugger of a time getting into the EHR, clinical is going well. I try really hard to make myself useful to my staff nurse with basic things that I can do. She really took a shine to me last Sunday for some reason. “What’d you in clinical yesterday, Nugget's Human?” *singing 12 Days of Christmas* On the 4th day of Fundamentals clinical, my staff nurse gave to me... Fiiiiiiiiiive sub Q injections Four PO med passes Three Accuchecks Two up and dressed with weights And a bunch of meds in a PEG tube

Hi All, Rather random question that I'm having a hard time finding an answer for. I want to do a nursing diagnosis of "risk for impaired gas exchange" because my patient has stage 4 lung cancer widespread bilaterally, history of smoking, exposure to second hand smoke, etc. and is likely to have impaired of oxygenation as her cancer progresses. She's s/p suboccipial craniotomy to remove a cerebellar mass brain metastasis. I've already got risk for falls r/t alterations in gait/balance/coordination; risk for situational low self esteem r/t decreased independence; acute pain r/t craniotomy; and risk for infection r/t a bunch of concomittant factors. She does not currently have any s/sx of impaired gas exchange: 36.5°C temp, 87 bpm HR, 18 breaths per minute unlabored, 100/52 BP (which is not alarming to the unit nurse), SpO2 98% room air. Breath sounds diminished at bases bilaterally. Effectively clears her own airway. Unfortunately I only have a PaCO2 for labs, which is 26, high end of normal. (No pH or HCO3 available to me.) Is there such a thing as RISK FOR impaired gas exchange? Or should I be barking up a different tree? Thanks.

Thanks, Leedeedee. I'm curious to see what Sweat Block is made of and will look into it when I have a litte more time. So far I can attest the dri-fit/wicking undershirts are great! Underwear, not so much. TMI??? ?

(also my typos are appalling!!!)

Thanks, @barcode120x, for the input. It sounds like the dri-fit undershirts are helpful for you and are worth checking out. We have a surprisingly decent set of colors for our student nurse uniform: white or black shoes and socks (the black shoe/sock combo was apparently hard fought battle that just went through), navy bottoms, and "ceil blue" scrub top (or ultramarine blue polo for lab or community clinicals). The light blue tops look nice in contrast with the navy bottoms, but alas, don't do bubkis for sweat. I've found some decent athletic socks that are comfy and seem to work well to keep my feet dry. Weirdly, they are labeled L/R at a time in my life when I'm lucky to remember where my keys are at!

Nugget will do anything for food. Can't you tell nobody ever feeds or pets or loves this poor doggle? ? Truly, though, she is cross trained as a therapy dog, so she's got therapeutic communication nailed.