Guest Post: Erin @ masterofnursing.org

As y'all know, I struggle immensely with balancing life outside of grad school as evidence by this post so when Erin @ mastersofnursing.org contacted me recently in regards to writing a guest post for the 'Burb, I immediately thought, "Absolutely!" Then, of course, life got in the way and it took me about three weeks to post the article she graciously took the time to write but after a week like last, I am using her helpful tips to manage this week's school/life balance a little better... especially tip #2... and #5.. and #6... and #7.. and #8. Without further adieu... 

Helpful Tips for Managing Life and Grad School

Grad school is stressful enough on its own, but all grad students have a life to handle as well. If you have roommates, a spouse, or a family, managing your time effectively becomes even more important. Here are some helpful tips for managing your life while in grad school.

1. Keep in contact with old professors. Just because you’ve left your undergraduate institution doesn’t mean you have to stop talking to your old professors. They can offer you recommendations for fellowships and jobs, as well as moral support when you’re stressed – after all, they’ve been to grad school too!

2. Know your workload. Between classes, reading, and research, grad school can be very time-consuming. Ask professors and current students how much time they devote to their studies. Can you handle the same amount of time, or even more, with your current lifestyle?

3. Set a budget. Make sure you are set financially for your full time in grad school. Whether this means saving up money or applying for financial aid and scholarships, you need to have a plan before you start classes. Perhaps this means a part-time job or taking on student loans.

4. Choose transportation wisely. If you plan on taking public transportation, look into getting monthly passes and student discounts. Some programs even cover transportation costs for students. If you want something more reliable, having your own vehicle will save you time, but it will cost more for gas, insurance, and parking.

5. Work now, play later. Many beginning grad students don’t realize that their workload will be far greater than what they had as an undergrad. If you want to prioritize your education, you should plan to give up some (but not all!) recreation and entertainment while you’re in school.

6. Have a support system. Grad school can be quite stressful at times, so it helps to have a trusted support system of friends and family. They will emotionally support you but also respect that you’ll need more time on your own for studying.

7. Make a schedule. Having a schedule is an easy way to organize your study time, especially if you live with others. Post your schedule where everyone can see it so that they know when it’s best not to disturb you – unless there’s an emergency. Even if you live on your own, setting a schedule will help you stay committed to your studies.

8. Be active. Everyone needs a break, especially from sitting and staring at a book or computer for hours on end. Exercising regularly will help you relieve stress from grad school and give you energy to dive back into your studies. 

Thanks, Erin! For more information on getting a Master's Degree in Nursing, check out Erin's website @ mastersofnursing.org! 

small world, after all.

I realized last week that my watch was still set on London time... Astonished by how fast these first few weeks of twenty12 have flown by, I decided to leave it as is... blue, sparkly and six hours too fast. It's my own little shiny accessory-of-a- reminder to slow the eff down. How is it already February First? Five weeks left of winter quarter. Two weeks left of unemployment. One week 'til Florida... I promised myself I would stay put in this new year and I've already boarded four planes... and have two more next week... Perhaps, I should abolish routine/schedule/monotony from my vocabulary and just accept the fact that the only thing that will ever be constant in my life is change... until I get to where I'm going, of course.    

It has been an insane few days... starting with a flight to Northern California which turned in to a three day stretch where my morals were challenged immensely as the ethical dilemma before me weighed heavy on my heart... The assignment ended better than okay yesterday but I had been up since 430 AM and as I landed back in Seattle last night at 1:00 AM knowing I would be getting up in a few short hours for an eight hour day of class, followed by two more eight-hour days of lecture and my first clinical day on Saturday, I could not be more elated to be back, exhausted & drained but also safe & sound... with a heightened awareness of who I am... and definitely who I am not.

The trip wasn't entirely awful, though... I did get to eat great sushi two nights in a row, visit with my biddy, soak in the San Francisco sunshine, taste test a lot of Ghirardelli chocolate and use a groupon that was randomly expiring in eight days... Oh, and the highlight... The highlight of my weekend was running in to someone who said, "I know you from somewhere!?... Did you used to teach kickboxing classes at UF?" My response, "Oh my word!! Yes, yes, yes! One, two, threeee! EeEEEEE yaay! Having that been said...Jab/cross!!!" Well, not really but it made my heart smile to meet a past participant of A. Aerobix... on the opposite side of the country, no less... it really is a small world, after all. 


...even if said small world is super scary at times. Albeit its constant evolutions and revolutions and what not, there is always an element of home to be found within to alleviate the scariness and add back in the happiness, of the heart-smiling-variety.  

mean the world.

Three years ago today I walked across the stage of the University of Florida's College of Nursing and received a Bachelor of Science in Nursing degree. I knew I was beginning a career that would define a huge part of who I am... or as it was best said by my card reader, Linda:

You must work in humanities. It is your calling. You innately excel at your job because it is a reflection of who you are: kind, compassionate & incredibly sensitive to the needs of people around you. You have your passion figured out & that is half your life's work. What a remarkable gift!


Albeit challenging, stressful, frustrating & incredibly sad at times, I love my career. There is no other job in the world that offers the opportunity for an infinite amount of learning in a critical, face-paced environment! Where you can touch the lives of every client you come in contact with. Some shifts you spend rocking babies all day and other days you critically think so much that your head hurts and your heart is racing from adrenaline as you just saved a life for twelve hours straight. Everyday you make a difference + it. is. awesome.

There are days that I complain (I'm working on this!) about the patient assignments, the ignorance of doctors or the difficulty of parents because my job is incredibly hard but it is these struggles that make me a better nurse. I spent most of the last year feeling so defeated by socialized medicine + the hostile environment created by nursing unions I honestly wanted to quit my career most days. I had lost the passion that used to drive me to get up at 5:00am excited to go to work on my days off to learn something new or stay over for 20 hour shifts or participate in committee work but now that I am back in an exciting environment where I know the babies are receiving the absolute best care possible, the fire has reignited inside me! I absolutely cannot wait to start grad school in June and take on an advanced role in saving lives of the most fragile patient population!!

I experienced my favourite part of the job the other night. I came on shift to a micropreemie who had been too unstable for the new mama to hold. She had just carried this baby with her everywhere for 7 months and I could tell by the look of exhaustion in her eyes and sound of helplessness in her voice that she was feeling the stress that having a baby in the NICU places on parents, especially when touching the baby is overstimulating. While the baby had a bunch of lines/tubes/wires/bili lights/breathing machines, the babe had been pretty stable and would be okay if he wasn't under the lights for a few minutes. I carefully secured every wire & tube, swaddled the baby in warmed blankets & put on the smallest hat which was still too big and asked the mama if she wanted to hold her baby. She immediately sprung out of her seat and her eyes filled with tears and said, "That would mean the world to me." I fought back tears as I took pictures for them and they repeatedly thanked me. It was a fabulous night at work & their appreciation was a little confirmation for me as to why I do what I do.

Second part of this story: A few days later, I was logging out at the nurse's station when the charge nurse (who was sitting on the other side) asked me what kind of shoes I wore. I thought I was going to be in trouble because of a snide remark (nurses' are snarky. point blank.) made about the professionalism of my shoes? so I shyly said, "umm... converse..." Much to my relief, she flashed a huge smile and said, "I knew it had to be you! A mom called the other day raving about how much she loved the nurse she had the other night but couldn't remember her name. She said you wore Chuck Taylors, had a really soft voice and smiled a lot!" Melted my heart to hear this... Confirmation #2! I guess I'm not known as "the traveler who always wore a braid", after all but I'll take "the nurse who wore Chuck Taylors, had a really soft voice and smiled a lot!" any day! =)

Super excited for the next three thirty years of my career in nursing!!

much-to-celebrate-monday.

I have two weeks worth of celebrating to do (last Monday I was not in the celebrating mood) so this post got a little bit long + the pictures are a little bit random but I kinda like it that way.

First + foremost, I am celebrating the life of my ninety-four-year-old great-great aunt that passed away yesterday. She was the sharpest old lady I have ever known and I'm so sad that she is gone but I find comfort in knowing she's happy in her heaven playing bridge with her sisters.

I am celebrating that this was the view I took in as I sipped my morning coffee, read USA Today's review of the Grammys + finished the crossword puzzle (its monday; it was easy).

I am celebrating the sunshine + the warmth of its rays as it graces my skin; an invigorating feeling that is long overdue. My suntanned toes are celebrating the fact that they had their first pedicure of the new year and are loving getting to breathe in flip flops again.

& of course, I am celebrating with the pretty little girl I love most. We are celebrating how great our week is going to be following a really awesome weekend with old friends. It's Reese + I's last week together "just us" but let's not talk about it because I don't know how I'm ever going to part with my new best friend who has literally been attached to my hip the last 2 months. Cue waterworks.

We are celebrating not one but two job offers I received this week in not one but two awesome cities and the potential of not one but two old roommates becoming my roommates again!!!

We are celebrating how on my run today I saw Bambi + his mom.. yes! she's ALIVE but more on that another time... because that is monumental (or maybe just mental?) + it deserves its own post.

We are celebrating the incredible progress a former patient of mine is making, breathing on his own, defying every odd + truly healing in a miraculous way. I had the honour of taking care of him in my final days in the Tundra and he (and his beautiful parents) touched my heart in a way that has changed me. Changed my opinion on the power of prayer. Changed the way in which I view the world. Made me believe in the existence of angels, here on Earth. I met one. His name is Gideon + you can read about his story here + here... be sure to watch the video on CTV's website... it will make you believe, too.

Have a fabulous week, friends + CELEBRATE life; you've only got one.

M.F.T. #24: Neonatal Nursing + having a passion.

Not everyone is lucky enough to know exactly what they want to do with their lives ... and even those that have figured out this small feat, don't actually get to do it... but I am one of the lucky ones that gets to have her cake and eat it, too so to speak... and that is why Neonatal Nursing is M.F.T. #24. A card reader (yes, you read that right) recently told me that the fact that I have a career that I am passionate about means that I have half of my life figured out, the hardest part... and the idealization that my "job" will never feel, not even for one day, like work will make for a very happy life. =) And I believe it! Being a nurse is an incredibly rewarding profession. How many people get to wake up every day, even if it is before the sun rises, and know that the work that they have in store for them that day will genuinely make a difference in someone's life? How lucky am I to possess the skills and knowledge that enable me to care for the most vulnerable of populations?! How rewarding is it that I am in the business of saving lives... and do just that... every single day! One of the greatest things about being a {neonatal} nurse is that no two days are the same. There is nothing mundane about any shift and to say that I am never bored at work is an understatement. I used to find the amount of infinite learning to be done overwhelming but with 2+ years of experience in my specialty, I finally feel like I have a good grasp on the basics and now I spend the few spare moments in a day refining my skills. The job in itself is fabulous but the passion that drives me to reach my highest potential every day is really my favorite thing about neonatal nursing.  I'm soo excited at the prospect of advancing my career this upcoming year! Often people acquire certain jobs because it pays the bills or makes ends meet but to know that money is just an added bonus to doing what I love makes my career wonderful!

date of death.

One enters the medical field knowing that as much as your top priority is to help patients get better, sometimes death is imminent. In my specialty, technology has given us the gift to keep even the tiniest miracles alive. Ventilators assist damaged lungs. Dialysis replaces damaged kidneys. Medications can ease pain but it is these great advancements that consequently put us in incredible predicaments of not knowing when to stop providing care. How are we to decide that the interventions are causing more harm than good? Where do we even begin to define the quality of life of a little angel sweetly swaddled in a bassinet trapped inside a body paralyzed by faulty DNA?

It is never an easy decision... one that ultimately the parents have to make. The decision that furthering care is only prolonging the inevitable. That while we can sustain a life, she will not actually live one day of it. How do you decide? How do you set the date of death?

All cases in the NICU are super sad but every once in a while, there are certain patient's stories that hit me harder than others; mostly the ones without the happy endings. The ones that I can't rationalize in my head that it is okay. The ones that I find myself at the bedside constantly asking myself why bad things happen to good people? Why the sweetest families that truly appreciate all the care provided for them and their baby seem to always have the worst outcomes.

I think I have cried every day at work for the past month observing a situation you can only hope you yourself will never have to face; the ultimate test of strength. Strength as a mom. Strength as a wife. Strength as a person. The strength to let go. The strength to overcome. The strength to move on.

As I left the hospital tonight, I shed my usual tears but this time it was tears of relief, knowing you will finally be in a better place. You touched the hearts of many people in your short little life. Rest in peace, baby girl.

why I do what I do.

I often struggle at my job with whether or not we are doing the right thing by saving some of the tiny lives that we do. Their lungs are underdeveloped requiring a ventilator to breathe for them. Their brains are so fragile, the deliveries often cause bleeds that leave them with developmental delays. Their tummies are too premature to digest food right away and often don't tolerate being fed long after they leave the NICU. They have faulty immune systems that don't fight infections effectively and the tiniest bug can spread throughout every organ in their body. They often have vision problems and hearing problems too.

Being premature literally affects every part of their tiny body and while we now have the technology to help them survive, I often fear their quality of life will not be worth the amount of pain they endure just to reach their due date. Its like we're committing daily little acts of torture on their tiny bodies when as something as simple as taking a temperature can cause them pain having immature pain receptors. I struggle with this everyday at my job wishing we would just know the outcomes of all the painful interventions we as nurses must do to keep these little babies alive. On the days that I struggle the most, I remind myself of my good friend Katie's tiny miracle who was born at 26 weeks gestation weighing less than 2 pounds and survived her two month NICU stay problem-free! Kylie is happy and healthy as can be! Living in California when she was born (in Florida at Christopher's NICU), I wondered when I would ever get to meet her. Maybe you remember me blogging about running in to her last summer in the Minneapolis airport but I was super excited when we drove up to Winnipeg last October and got to stop in Albuquerque to see them again! Its real miracles like little Kylie Marie that remind me why I do what I do!

keeping up with the hofers.

When I did my practicum my senior year of nursing school, my very first day I went back for a delivery. We brought the baby to the NICU and stabilized him with Dad right by his side. This was my very first moment shared with the Hofers. Over the next eight weeks, I shared many more milestones with Charlie and Kelli and their tiny baby, Weston. Their graduation from the NICU took place not long after my grad from UF last spring. Kelli has been wonderful about keeping us updated on Weston's progress! When in Nashville last week, they graciously met me downtown so I could see just how wonderful he really is doing. He is just perfect. Bonding with fabulous families like the Hofers confirmed for me that the NICU was my niche in nursing! =)

allow natural death.

One of my favorite parts about being a nurse is how much you never stop learning. I can honestly say I learn something new (more often like ten new things) every night and it's exciting to me that no shift is the same. No patient is the same. No disease is the same. And most certainly, no twelve hours are the same. While this is the most exciting aspects of my job, at times, it is also the scariest. I have spent the last three years desperately seeking all the knowledge I can in order to make the most informed decisions when advocating for my patients. I spent the first two of those years learning an overwhelming amount of information that felt like was spoken in a foreign language. Once I became fluent and started being in a practical setting where I can apply all that I have learned, I realized I wasn't taught anything that I use on a daily basis and honestly do not apply any what I learned in nursing school. Neonatal nursing is so specialized, we didn't learn much of anything that is applicable on my unit and unfortunately, I feel like I have forgotten so much of it already -hypertension, diabetes, etc. It would be impossible to have a Guide to Nursing for Dummies containing everything you need to know because you just cannot be taught it all in a classroom and I have learned to be conscious of the fact that I don't know what all that I don't know and still frequently ask questions just to triple check; I have a tiny life in my hands and the smallest mistake could mean life or death in a neonate.

As a nurse, you strive to do everything in your power to heal your patient. It's that innate drive to want to rid someone of their pain, to help them to heal and grow stronger... but what do you do when you are ordered not to? What questions do you ask when your patient is too sick and any intervention would just be causing more pain? Delaying the inevitable? When there is nothing else we can do. When no medical intervention would serve any purpose but to prolong death. When treatment would only cause more harm than good. This is the ethical dilemma that is becoming more familiar to me ... to allow natural death. By setting aside all the life-saving skills I have been taught. By watching a mother stand over her child helplessly crying at the bedside. By watching a patient slowly deteriorate until finally they are at peace.

It's a strange phenomenon that it appears as though certain defects or diseases come in waves on my unit. Trisomy 18, gastroschisis, TAPVR... and the current theme: Allow Natural Death. As I sit here for the fourth night in two weeks watching a baby gasp as he takes his final breaths, I try to look at it from a medical prospective. The baby is better off. He is no longer in pain. He is no longer suffering but there is a part of me that cannot disengage. Cannot let go of the fact that this is not just a disease; it's somebody's child. A baby with a name, two eyes, one nose, ten fingers, ten toes...

As I watched a family be informed that there was nothing else we could do to save their baby for the first time back in December, the chaplain that was called to the bedside told me "The day you stop crying is the day you should quit your job". Fearing I might drown in my own tears tonight, I have a feeling I will be a nurse for a long time.

ninety-nine balloons.

People often ask me what is special about my unit... why it has a national reputation, why it is a Level 4 NICCU, why it has two "c"s. The Newborn and Infant Critical Care Unit is different than your typical NICU (Neonatal Intensive Care Unit) because while we do get preemies (when they are extra small.... weighing less than a kg... the smallest I've seen is less than one pound) we are not a birthing hospital so we really only get babies when they get too sick or their situation is too complicated for the hospital they were born at to handle. We do ECMO which is a heart/lung bypass machine (much like dialysis is for your kidneys) and get super sick babies from all over (as far as Las Vegas) to treat meconium aspirations and pulmonary hypertension. We have some of the top pediatric surgeons in the world so we get a lot of babies born with congenital defects especially of the heart (hypoplastic left heart, double outlet right ventricle, TAPVR) and stomach (necrotizing enterocolitis, gastroschisis, omphalocele). One of the hardest diagnoses for me to handle is that of the rare genetic disorders that are incompatible with life. This a video about a baby boy prenatally diagnosed with Trisomy 18 much like the little baby I admitted recently who was sent to us for a genetic work-up to make the terminal diagnosis of Edward's Syndrome. This is just one of the many challenges I face daily at my job but I absolutely learn something new everyday (usually more like ten new things) and am enjoying the challenge that comes with no twelve hours being the same! 

Versant RN Residency Graduation.

[Click on the title of this post to see the slideshow of my residency!]

Today I graduated from the Versant RN Residency Program! It was a fabulous celebration! When I first moved out here, I quickly befriended all the people in my cohort that were also from out of state that much like myself, didn't know much about LA or know many other people here. L to R: Afton (Minnesota), me (Florida), Stephanie (Delaware), Troy (Michigan), Laurel (NYC), Adam (Philadelphia), Rebecca (Connecticut) and Sydney (St. Louis).

Carly was able to sneak away from the bungalow for a couple of hours and be a part of my celebration. It was super fab having her there as she has been there for me after every shift that I return to the apt in tears emotionally traumatized by what I had experienced on the unit that day. She even got her own tour of the unit and got to sneak a peek at all the super sick babies.

Adam, my Pennsylvanian passion from the PICU, has been an extra special element to the program definitely aiding in the highly encouraged "take care of yourself first" mantra... always available to try new restaurants, go on stress-relieving hikes, browse the boutiques in Los Feliz or hit up happy hour at breweries within walking distance of the hospital after class. 

 It was a fabulous celebration filled with all my fabulous friends I have made the past 6 months at CHLA including these four lovely ladies who work in the NICCU with me! It's been so wonderful having them to share my neonatal residency experience with!

Having preceptors to give me wings to fly on my own (my first independent shift is this Sunday!) has been the most beneficial aspect of the program. I have learned so much from Kim (pictured above) and have made a best friend in my saving grace, Dana (pictured below)! I am soooo lucky to have them in my life and cannot thank them enough for all their support and encouragement!

 

A marathon runner, avid spinner, lover of Lulu lemon, married to a Gator alum and owner of a yellow lab named Gracie ... could we have been more of a perfect match?! I think not! 

the ceremony.

Much like at my graduation from nursing school last spring, I walked across a stage and received my diploma, was pinned with the Magnet pin and then read the Magnet Oath. It's an honor to work at a Magnet hospital; only 3% of hospitals in California and only 5% of hospitals in the US are recognized as being a magnet hospital. It was super special when Mary Dee Hacker, our CNO, gave us each a replica of the "two-story house" that was the first CHLA building in 1901 which only had one (volunteer) doctor and a few nurses. Later on, I got to talk to Mary Dee at our luncheon and she told me she drove out to California in 1975 with her college roommate after getting snowed in for two days at the hospital she was working at in the midwest. Much like me, she had never even been to Cali before she made the move across the country with her college roommate! ha.

i can do anything for two years.

It's a rarity to find your traditional "feeder/growers" in my neonatal unit. I was super excited the other night to get my hands on a baby stable enough to be held. Most nights I am titrating drips to maintain adequate blood pressures, increasing oxygenation to normalize blood gases or starting IVs to gain additional access to our tiny babies (I've successfully started three in the past 2 weeks!). I don't think a NICU exists quite like Children's Hospital's anywhere else. I've seen the rarest disease processes (babies without brains), cared for the sickest/smallest micropreemies (weighing less than a pound), and even made my first trip to the morgue the other night... At times, my job is incredibly challenging but the knowledge I'm gaining will be so valuable to the rest of my career. I can do anything for two years, right Megalina?

first breath.

Life isn't measured by the number of breaths you take, but the number of moments that take your breath away.  -Anonymous

This quote took on a whole new meaning today when I looped to the Cardiothoracic Intensive Care Unit and witnessed my patient (a 16 y/0 girl) take her first breath with her new lungs after waiting five months on a donor list in an extremely hypoxic state. She said to me later on "These are my new lungs? I'm a normal girl now?" It was incredibly moving and even more humbling as I was reminded how much I tend to take for granted, things as overlooked as having two healthy lungs.

i.v. league

I am currently in a nurse residency program which consists of about 75% of the time working as an RN in the NICCU and 25% of the time in a classroom. The first few weeks are loaded with lectures and then slowly we've been spending less time in class and more time on the unit. In about 2 weeks, we will be down to 2 class days every other week for the remainder of the program with the majority of the time on the floor. Last week we had a skills lab day where we given the opportunity to start intravenous lines on each other, for many of us it was our first time! I did not volunteer my own veins because I am extremely afraid of needles and get diaphoretic/tachycardic when I even smell the alcohol swipe getting close to my skin. If only my tiny patients' baby veins were as easy to stick as these ones...

NICCU Reunion

The first weekend that I started my job, I was invited to attend the NICCU reunion- an annual event to see how all the past patients are doing. 3 of the Nurse Residents who are also NICCU nurses joined me (and over 900 past patients and their families) for snow cones, cotton candy, train rides and live music in Griffith Park - a massive state park in the center of LA with trails, horseback riding and even a zoo. I can't wait for next year's reunion when I get to see babies I've actually taken care of happy and healthy.  

Childrens Hospital Los Angeles

My first week of work went incredible! While it was mostly orientation lectures, I met a lot of great people (my co-workers!) and had a lot of fun swiping my ID badge to learn my way around CHLA! Here are some random things I learned this week: 1. Childrens was established over 100 years ago in 1901. That's crazy! 2. About 8,000 people are in and out of the hospital in a day. That would be like if the entire town I lived in this summer all came to see me at work on Monday (which I would love it if they did ... I kinda miss that place!) 3. We are among the top children's hospitals in the world and receive patients and visit patients (I'm currently investigating how to be a part of the team that does this) from LA to China to Africa. 4. The hospital is only 6 miles from my apartment. For every minute later I leave (after 6:45), it adds and extra 5 minutes onto my drive. I've made it there in less than 10 minutes but I have also made it there in over 45 minutes. 5. The Versant Nurse Residency Program was founded at CHLA 10 years ago and is now at over 50 hospitals in the country. I am the 19th cohort to be in the program and will graduate (and get life back!) in February! =)    

J. Kirk, RN

I wrote (and passed) the NCLEX last week and I am excited to announce that I am officially a registered nurse! Leaving for California two weeks from today, I will be starting my career as a neonatal nurse at the Children's Hospital Los Angeles in a Level III NICCU. I have been accepted into a 22-week pediatric nurse residency program, where I will be able to hone in on my skills specific to neonatal nursing through an intense preceptorship 75% of the time and in a didactic classroom the other 25%. I am super excited for this next chapter to begin!

Pinning Ceremony

The pinning ceremony is a tradition in nursing. It is a symbolic welcoming of new nursing graduates into the profession of nursing. Our ceremony was gorgeous! Held in the University Auditorium, we recited our rendition of the Florence Nightingale pledge after receiving our pins. I was so honored to be able to use my Auntie Paulette's pin!

Nursing Formal

The singles... a rarity in nursing school...

First... and last... on the dance floor!

Kissy faces.