Decisions, Decisions...

I am trying to decide what to do with this blog.  It still gets consistent hits each week, but I don't feel like I have anything that exciting to talk about.  Since I'm no longer in school, I don't have advice to give nursing students like I did in the past.

I considered going back to school for my BSN or MSN, but the reality is that I can't afford to go back to school.  I already have a huge amount of debt from my first degree in 1997 and my time in nursing school, and we are trying to sell our house right now in order to pay all of it off.  I have a child starting college in five years, and I want to be able to help him out.  Plus, a BSN won't help me pay-wise in the school district (since I have a previous Bachelor's degree and 8 years of service as a teacher).  The only thing it would do for me would be to allow me to take the test to be a National Certified School Nurse.  It would be cool to have some more initials after my name, but I really would not benefit in any other way.  I think I would get $1500 more per year if I got my MSN, and I'm willing to bet that getting that degree would cost more than that.  I intend to retire from school nursing, so it would almost be pointless to get my Master's.  I have toyed with the idea of becoming a nurse educator, so maybe that is something I will do in the distant future.  I'm pretty comfortable right now, though.

I've never worked in a hospital, so I can't relate to that, either.  While I was in school and doing my clinicals, I was really turned off by hospital nursing.  I didn't have the greatest instructors my last two semesters, so I am sure that influenced my thinking.  I admit it, I'm lazy.  I don't thrive on incredibly fast-paced situations; instead I prefer to take my time to make decisions.  Being on my feet for 12 hours at a time is not appealing to me, I like having weekends and holidays off, and no one yells at me in the school.  Yes, it does get lonely at times, and it would be great to have someone else to help or provide support, but most of the time, I like being the only health professional on my campus.  There are over 50 other schools in my district, and those nurses are only a phone call or email away.  I like only working 187 days per year, and I really like the school environment.

When I first graduated and worked in home health, I thought I would like being out and about all day, and still only working 8-5.  I liked getting to know the patients and seeing their health improve over several visits, and I thought wound care was pretty interesting.   Little did I know that I would be working for peanuts, driving up to 120 miles per day, going into some neighborhoods and apartment complexes where I didn't feel safe, and there would be pressure to work 7 days per week.  I am so thankful that I only had to do that for two months.

I did really enjoy my last job, doing triage in a privately owned pediatric practice.  I loved getting to know all of the families, and watching the babies grow up.  I thrived on the additional responsibility that I was given over time; ordering supplies, helping to supervise the medical assistants, doing patient education, and assisting the doctors with different things.  What I didn't enjoy was the fact that I felt like no matter how hard I worked, it was never good enough.  I would be blamed for things that weren't my responsibility, and sometimes, things I had no knowledge even existed.  I rarely finished work by 5, and didn't take a vacation for over a year.  The pay wasn't great, either.  I am glad I had that experience, but it was time to move on.

All right, anyone have anything you want to ask me about being a school nurse?  Any suggestions for posts?  I'm open to ideas.  I'm not going to shut this blog down, but probably won't start posting more often unless I get some ideas.

I just read this article, and it gave me a lot to think about.  How many children are misdiagnosed and taking unnecessary medications?  I went through a similar experience with my son, but not nearly as serious at the girl in the article experienced.

In the fall of 2010, my son started complaining of knee pain, and his pediatrician noticed it was slightly swollen when we went in for an ADHD follow-up visit.  Even though he had not had any recent illnesses, she suspected reactive or post-strep arthritis, so she immediately ordered blood work to check for strep antibodies and a chest x-ray to make sure there was no heart damage.  The blood work came back positive and the x-ray was negative, so we embarked on six months of bicillin injections, which are painful and expensive.

Thankfully, everything turned out fine and he recovered completely.  I am so glad that we have such a thorough and caring pediatrician, and she was able to catch that.  With my students, I am so vigilant that students who I suspect have strep are taken to the doctor and treated.

I hope everyone's semester/school year is going well; we are starting to wind things up here.  State testing ended yesterday, and I am making my list of my end of the year tasks.  I hope to be back here soon!  If you have any questions or topics you'd like me to write a post about, please let me know in the comments.

Ready or Not...

So, I have completed my first week of working for a school district.  In my former life, I was a teacher with this same district, and went through orientation with them back in 2001.  Returning as a school nurse, they weren't quite sure what to do with me, and I was told to attend their Novice Teacher Academy last week.  They have a great, week-long program for new teachers who are new to teaching or new to the district, but don't have a clue how to support new nurses.  After two days of attending sessions that did not benefit me in any way, I was able to attend a training specifically for nurses.

We met at one of the high schools, and were given guidance on how to use the online documentation system that is used district-wide.  Somehow, I don't have access to that software yet, and cannot enter in my new students into the system.  We were also given information on how to handle specific situations that might arise as a school nurse, and that was very helpful.  Thursday, I worked on setting up and organizing the clinic, and Friday, I had a day off for the first time in what feels like forever.

Tomorrow is the first day that all of the teachers return.  I am looking forward to meeting everyone at my school, and continuing to figure out my role as a new school nurse.  I can plan and prepare all that I want, but reality sets in on the 26th when the students return for their first day of school.  Eek!

August is National Immunization Awareness Month

Working in a pediatrician's office and now a public school, I am constantly reviewing vaccine records to ensure that children are up to date on their vaccines.  All students entering public school in Texas (and elsewhere) need to have a tetanus booster (TDaP), their first meningitis vaccine, two doses of Varicella (chicken pox) and two doses of Hepatitis A before they can attend seventh grade.  It's also not too early to get flu vaccine for the coming season; Flumist is being distributed to providers already, with injectable flu vaccine not too far behind.

Vaccines can be received as part of the yearly well child exam, at some pharmacies or clinics inside grocery stores/drug stores, or in free clinics offered in certain areas.  Local health departments give vaccines, as well.  Texas discontinued their free Shots Across Texas program in 2012 due to less children qualifying for the Vaccines for Children (VFC) program.

August is National Immunization Awareness Month, so I want to remind parents to keep a current copy of your child's vaccines and review them annually to ensure there are none needed.  If your child has yearly wellness exams, your doctor will review his/her vaccine record at that visit.

Here are some good resources with information regarding vaccines:

• Get Important Shots 
• Get a Pneumonia Shot
•  Get Your Child’s Shots on Schedule
• Get Your Pre-teen’s Shots on Schedule
• Prepare for a Flu Pandemic
• Protect Yourself from Seasonal Flu 

Going back to school

No, I'm not going back to school as a student, though I really should do that someday; instead, I finally got hired for my dream job, as a school nurse.  I am so excited, yet terrified!  This is what I've wanted for quite a while now; it's more money, and I will be off when my kids are.  I haven't seen the clinic yet, but am anxiously looking forward to it.  Anyone have any great school nurse blogs to share?  I need ideas for bulletin boards, supplies to get, resources that would be useful, etc...

I love scrubs!

I love being able to wear scrubs for work, since it is like being able to wear stylish pajamas every day. I prefer to wear the ones that are mainly polyester, because I am too lazy to iron, and they can be hung up and sprayed with water at bedtime, then are wrinkle-free when I go to get dressed in the morning.  I also prefer solid colors.  Working in a pediatric office, I could get away with printed and holiday-themed scrubs, but I just can't bring myself to wear them.  I guess that's one advantage to working in a doctor's office; no standardized colors for me!

I was contacted by someone at Uniformed Scrubs and asked if I would do a review of one of their scrub tops.  I was sent a maroon 3-pocket v-neck tunic top made by Adar Scrub Tops to try out and review.  The top that I received appeared to be well-made, is very roomy and comfortable, and is a pretty color.  I prefer my scrubs to be a little more tailored, but if you like tops that have a generous fit and large front pockets to hold all your stuff, then be sure to check out the Nurse Scrubs found on the Uniformed Scrubs website.  They are a Texas-based company (yay!), carry several brands of scrubs and nursing shoes at REALLY good prices, and offer free shipping on orders of $100 or more.

If you are a reader of this blog, receive a 15% discount during the month of July for entering the code "trueblue" at check-out.  You can also check out Uniformed Scrubs in several other places:

Facebook: https://www.facebook.com/uniformedscrubs
Blog: http://uniformedscrubs.wordpress.com/

Google Plus: https://plus.google.com/102649430487593258176/about

Twitter: @UniformedScrubs
Pinterest: http://pinterest.com/uniformedscrubs/

Continuing Education

For those of us who graduated from nursing school in 2011, the time has come to renew our nursing licenses.  If you are like me and are lucky enough to have a birthday later in the year than your license date, you may have already had to renew your license last fall.

In my state, we do not have to do continuing education hours during our first licensing period, but do have to complete 20 hours every two years afterward.  Free courses are available with an hour here and there, but rarely do they pertain to a topic that I am interested in, or that would benefit my job.

Someone recommended trying Nurse.com, because they offer unlimited continuing education hours for a flat rate, and have courses offered in many subjects.  Does anyone out there have experience with that site, or do you have a better one to recommend?  Please leave me a comment; I'd love to hear from you!

Update:  Texas Health Steps has lots of free CE courses that you can take.  Also, many professional organizations offer free courses.  I belong to the National Association of School Nurses, and they offer many free or discounted CE courses with your membership.  I'll update this post as I find more.  Feel free to leave additional suggestions in the comments.

Updating...

I'd love to update my blogroll and list of helpful sites; what's new out there that student nurses should know about?

I'll be back soon with tales of pedi triage, but have two clogged toilets to deal with tonight, courtesy of my kids.  Ugh.

Seeking School Nurses

Any school nurses out there?  Since I am a former teacher, it's something I am considering for the future, or even teaching health classes to high school students.  If you have an experience as a school nurse to share, (good or bad) please contact me.  I'd love to hear different opinions on the subject.  I'm open to guest posts, too...

Breastfeeding resource site

Another helpful website that I have found is this one.  It is sponsored by WIC, and gives a lot of good information on breastfeeding, including preparation, pumping, storing breastmilk, etc  I hope you find it helpful, as well.

Are you monitoring peak flow readings?

We have many children in our practice who we see for various forms of coughing/wheezing/asthma-type symptoms.  Signs and symptoms of respiratory distress are always a concern, and are more of an emergency in babies, of course.

A great way to monitor children with a history of asthma is to use a peak flow meter.  Children above the age of 6 should be able to use one fairly accurately, and they are inexpensive and portable.  There is some great information here, with a video, on how to use a peak flow meter.  Acceptable ranges should be set by your child's physician, based on their height.  Once you have that information, you can plug in their height and peak flow reading on this calculator to see if he/she is in the green range.  Using a peak flow meter to manage asthma should go hand in hand with an asthma action plan, set up by your child's physician, reviewed yearly, and a copy should be given to your child's school nurse, along with any rescue medications he or she might need at school.

**Just to be clear, this is to be taken as informational only, not as medical advice.  I don't know you or your children, and I am not acting as a representative of the medical practice where I work.  If your child does have asthma or other respiratory issues, you should contact your child's physician.

Pediatric Advisor

I've been a pediatric triage nurse for 10 months now, and on the days when I am not rooming patients, doing procedures, completing monthly VFC reports, ordering supplies, or training new employees, I answer phone notes on the computer from patients' parents who call in for advice.  Most of the calls are fairly simple, but others become more complex, due to the patient being out of town, not wanting to come in for an office visit, having an unclear diagnosis, etc.

One of the resources that we use at work is Pediatric Advisor.  It's an alphabetical index of different conditions that pediatric patients might have, and it gives clear, simple information.  It's a great tool to use for reference, but not as a substitute for advice from your child's physician, of course.  Think of it as supplemental reading material...

The saga of my first nursing job, part 3

If you are just starting to read this, you may want to read part 1 and part 2 first, so that this makes more sense to you. I know it's been months since I last posted, but I really want to finish this series and not leave the few of you who are still reading this hanging. I started my first nursing job in July of 2011 and was so excited/nervous. I was hired at the recommendation of a classmate of mine from nursing school, who I knew, but not well. She offered me to ride to the office with her in the beginning, because she was still in training, and not out in the field on her own yet.

 I spent my first few days of work in the office, completing paperwork and learning policies and procedures. I was itching to go and see patients, even though I had no idea what to expect. I knew that the job would be heavy on wound care, medication management, and admitting patients for physical therapy. I had my equipment ready to take vital signs, and was given a glucometer and finger pulse oximeter. My friend and I were so excited the day we received those, and packed up our very own plastic tub of wound care supplies.

 For the first few weeks of being "out in the field", I would ride along with one of the agency's experienced nurses to see patients. I saw areas of the city that I had never been to, and the long days of riding in the car in the hot summer sun were exhausting, after commuting over an hour to reach the office. I received training on two different kinds of wound vacuums, and also on the online documentation system that the agency used. The most fun that I had during that time was trying different restaurants for lunch in the different parts of the city. I started out slowly with my own patients, tag-teaming with my friend. Between the two of us, we would see 5-6 patients per day, all over the city. Some days, we would go back to the office to complete paperwork or pick up supplies, and other days, we would finish early enough with patients to go home and chart. We really enjoyed working with each other and getting to know each other.

 For the few weeks that we worked together, we continued to inquire as to when our territories would be established, and when we would start seeing patients in the area where we live, as promised. The answer was always vague, because I don't believe there really was a plan for this. The owner of the agency wanted to establish in the area where we live, but didn't have enough contacts, nor did he have therapists in the area, so that eliminated the number of patients who we could see. There began to be a lot of pressure to take patients on the weekends, and my friend ended up taking a couple of weekend patients, but I refused. Weekend pay was less than my normal hourly rate, and with the gas and time required to see weekend patients, it was not worth the time away from my family to me. Plus, I was not willing to work seven days a week. Because I would not see weekend patients (even though I specifically asked about that in my interview), I began to be "punished" by being assigned patients even farther away from my home (120 miles roundtrip with no compensation for mileage), or being told that I had to go and sit at the office on the days that I did not have a full patient schedule. While I enjoyed the patients, I began to really regret my decision to accept the first nursing position that I was offered.

 Near the end of this time, I was contacted by a friend of mine, who was the administrator of a pediatric practice, asking if I would be interested in a job. His wife was one of the pediatricians in the practice, and I had done some interning with them while I was in school. This is also the pediatrician who my children see, and the practice is five minutes from my house. I REALLY wanted to work with children, and felt that this would be my dream job, if I were hired. They brought me in for an interview, and I didn't hear anything back from them for several days. I was so excited when I was finally offered a position as triage nurse. I was so relieved to know that my days on the road were coming to a close. I gave two weeks' notice at the home health agency, ended up working just one more week for them, and started my new job the day after Labor Day 2011. That's the story; I know it would have been more detailed had I not waited almost a year to finish it, but I have just reached the point where I am feeling a little more comfortable juggling work and life.

The saga does continue...

I promise I will be back soon; life has been crazy lately with working full-time M-F, my son's soccer season, and Cub Scouts. Bear with me...

The saga of my first nursing job, part 2

If you're just starting to read this, please read part 1 here first. This story will make way more sense that way.

After I was turned down for the hospital internship, I continued to send out applications to local hospitals, but wasn't expecting too much in return. I knew they didn't send out rejection letters, and also felt like having my RN would have a greater advantage. I chose to concentrate on passing NCLEX, and I would worry about looking for a job afterward.

I took NCLEX on June 28th, and paid for early results, which I received on June 30th. We decided to go out to dinner that night with some friends to celebrate, and had to wait a really long time for a table. During one of the numerous trips to the bathroom with my daughter, I saw one of my nursing classmates at a table, and stopped by to say hello. She told me that she had gotten a job in home health, and they were looking for one more nurse who lived in our area. She gave me the owner's contact information, and I emailed him my resume that night.

Early the next morning, I received a phone call from the home health agency's owner, and he interviewed me over the phone, and basically offered me the job. I told him that I was concerned about having to drive long distances, and he reassured me that I would be seeing patients in the area where I live after I completed training, which would be before school started for the fall. The office is 45 miles from me, and includes 6 tolls on each roundtrip. I also told the owner that I did not want to work weekends, and he said that they were optional, and that he paid extra for weekend work. I told him that I would think about it and call him back. The pay wasn't great, but I knew that I had to start somewhere to gain experience.

I thought about it for a couple of hours, made childcare arrangements, and called the owner back to accept the job. He asked me to start the day after Independence Day, and I agreed. We spent the weekend cleaning the house and preparing ourselves for some long days ahead. I was to be in the office from 8-5, leaving at 6:45 in the morning to arrive on time. My husband would wake the kids up and take them to daycare so they could sleep a little later. I went shopping for some non-school-colored scrubs, and was so excited to have my first nursing position!

To be continued...

The saga of my first nursing job

Here I am, three and a half months after graduation, and I have already been through my first nursing job. When I graduated, I was still optimistic that I would find that perfect L and D position; I just might have to work nights or a less than optimal shift. Little did I know...

I started sending out applications to all of the local hospitals as soon as the excitement from graduation was over. I never received a single response, not even a "No, thank you." The hospitals advertised internship programs, but I think you would have had to work for them as a PCA while in school to have a chance for a slot. I heard that some of the hospitals weren't even having their internships, even though there were positions posted.

I did get an interview with an infectious disease doctor, but they were looking for someone to start right away, and I wanted to wait to start working until my kids were out of school for the summer. I didn't realize that would cost me the job, but apparently it did. I never received an official rejection from them, but when weeks passed and I didn't receive a phone call, I put two and two together.

In early June, I received a phone call from someone in HR at one of the local hospitals; someone had dropped out of their graduate nurse academy before it started, and I was recommended as a candidate. I was extremely excited about the opportunity, and went in for what I thought was a successful interview. The nurse manager who interviewed me assured me that I would hear from him whether I got the job or not, and they were trying to make a quick decision, because the program started soon.

During the second week in June, I volunteered as the camp nurse at Cub Scout day camp. It was my job to clean out the nurse's station and make it presentable, (and clean enough so that I felt I could treat patients), shop for first-aid supplies within a budget, administer medications, and treat campers and adults for cuts and scratches, as well as heat exhaustion. I learned that a popsicle can go a long way toward making a child feel better! I sent one child to the hospital that week with a broken arm, and only one other child had to go home, because he was vomiting. It was a lot of fun, and I made a contact that week with the local county's hospital district. He asked me to send him my resume, which he would forward to a recruiter.

I was scheduled to take NCLEX on June 28th, and decided to focus my time for the next couple of weeks on studying, and not worrying about looking for a job. After all, being an RN and not a GN would make me much more desirable...I called the hospital where I had interviewed, because I never heard a word back from them...they went with another candidate who had some nursing experience. That confused me, because the job was part of their Graduate Nurse Academy; we were going to be trained on every aspect of the job, and everyone was a new nurse. I was disappointed, but not discouraged yet.

...To be continued

I'm still here...

I am going to try really hard to get a post up about graduation, pinning, taking NCLEX, and starting a job. I am still trying to get used to my new schedule, and it's exhausting. I haven't forgotten about the blog; please email me at stethoscopesandscrubs@gmail.com if you need to get in touch with me.

Pinning Details

I ordered my dress for pinning, and you can see it here: Scrubs - White Cross Tie Back Scrub Dress | Lydias Scrubs and Nursing Uniforms We have the option of wearing white scrubs or a white dress, and I figure this is probably the one and only time I will wear the white nursing dress, so why not? I ordered my pin from my school, but I think I was one of the few students in my class who did. Everyone complained about the price, but we were given a price sheet back in November, and it is something special that I will look back on and be glad that I have. I am also wearing the traditional white nursing cap, and already have that tucked away in my closet. I can't wait to put the whole outfit together, and recite the Florence Nightingale oath with my classmates. I just have to get through HESI first!

HESI Results

I went into the HESI exam last Friday feeling like I was completely unprepared and nauseated. I spent two hours taking the tests, having to sit on my hands at times, because I am an extremely fast test-taker, and I really wanted to slow down and read the questions carefully. I took one break when I was halfway through, but I just wanted to get it over with and put it behind me. There were a few questions that had terminology that I was unsure of, and there were many questions that had me staring at the screen, trying to decide between two answer choices.

I was shocked when I submitted my final question, and saw my score of 804. I kept my composure as I reviewed the rationales for the questions that I missed, then went to the room where the score analysis sheets were printing. I talked briefly with our program director, who was monitoring the printing room, and left as quickly as I could. My goal was to not talk to anyone before I reached my car, and I managed to hold it together until I reached the parking lot.

That afternoon, Facebook was all abuzz with celebration, and I didn't have good news to share, so I kept quiet. I had a long talk with my husband, and he realized that I need more time without the kids to study. I researched online test review programs, as well as more books on Amazon, trying to decide what my plan of action is going to be in order to be better prepared when I retake the test on May 10th.

So, here's my plan: I met with my clinical instructor to analyze my results, and she has suggested rereading the chapters in my med/surg book relating to assessment (that was my weakest category), and rereading my psych book. I know I can't possibly make it through all of my review books in the next month, but I took a diagnostic test on the CD that came with my Saunders book, and it gave me a 6-week plan for chapters to tackle each day. Since I only have 4 weeks, I do have to condense that a bit. I am going to continue with Hesistudy, and I've registered for the online Kaplan review. BTW, if your school subscribes to the Kaplan program, you can take the class for $300 if you call them to register.

So, basically I am going to try to live and breathe HESI for the next month. The dishes will have to wait, the kids might watch a little too much TV, but I am determined to graduate in May. I have three more clinical days, one more unit exam, and a comprehensive final standing between me and graduation. I can't wait to get my life back!

HESI is next Friday!

Eek! I haven't studied nearly enough. Several students in my program attended review classes that focused on HESI and NCLEX over Spring Break. The ones that I heard about were the Kaplan program, and the Hurst review. I've heard good and bad points about both programs, but chose to spend Spring Break with my children instead of attending a review class.

I have four review books for HESI/NCLEX, and we have a weekly schedule that we are supposed to be following to study for the tests. I haven't kept up with it, for several reasons. First, there's just not enough time to prep for class, attend class, study notes from class, prep for clinical, attend clinical, complete clinical paperwork, keep with the kids, the house, the husband, cooking, grocery shopping, Cub Scouts, etc, plus do hundreds of review questions each week. I've been focusing on the questions that relate to the subject that we are studying in class each week, and that has helped me to further understand the pathophysiology, symptoms, nursing diagnoses, tests, treatments, etc. for each disease or disorder. I do plan to spend some time in the next week going over subjects from earlier in nursing school, but it is a standardized test, and with such a broad subject area, it's so hard to study effectively. I hope this doesn't come back to bite me!