Another Week Down

No one who knew me in the South would believe it but I am positively WARM everyday at work. I used to have to wear sweatshirts and long sleeved shirts to work everyday including the summer months. At home in NC I was often found underneath a down blanket and my thermostat was set at 76 degrees year round. Now in NH the temperatures are near zero outside and yet I was able to wear a short sleeved shirt and stay quite toasty! My thermostat is set on 70 and that is the high! I am not running around anymore at work so I can't explain the temperature flip that I seem to have undergone.

I have a different role now in my patient's life. I am no longer in charge of every thing that goes on in the patient room. In the CCU if anything was going on with my patient I knew about it or what went on went through me. Now I am involved in my patient's life in a more indirect way. I write the orders but am not standing at their bedside to see that they are carried out. For the controlling ICU nurse in me it is difficult to let go of some of the patient care tasks that I so enjoyed. However, I need to adjust to my new role and trust in the nursing team that is at the bedside.

Three patients have sincerely thanked me for my care upon leaving. They mentioned that they felt very safe with me as their nurse practitioner. For this new NP that is the best feedback I could receive.

Tomorrow I am going to watch the movie that I have been told is based on my life as a bridesmaid...27 Dresses. I am even going to be joined by one of my former brides so it will be a fun afternoon for both of us...even if I have to travel to Maine to do it!

Work has begun, sleeping in is over

I am two weeks into the job and there is so much to take in. No computer provider order entry for one thing. Hand written orders in triplicate is so out of mode but it is what we do. It is said that POE is coming but I guess that has been the rumor for the past couple years. I am destined to begin jobs where there is no POE and by the time I leave it is there. Does that make me the POE fairy godmother.

The caliber of the attendings is wonderful and their teaching on rounds has been outstanding. I learned so much yesterday...now I have to look up so much stuff this weekend. I have good supportive people around me. Another NP was hired for our team and she started a month before me. She has been a NP for 4 years but she was in a clinic doing internal medicine so cardiology is all new to her. I am new to being a NP so we are a match set when you put us together. I have really enjoyed taking care of my patients and they really are MY patients. I make their consults, write the orders and make their follow up appointments.

We type EVERYTHING. H&Ps, daily notes, discharge summaries so my typing is bound to improve more than I ever thought possible!! I am finding learning all the systems too slow for my own liking, but there are so many of them. I will get it... I just want to get over the novice period as soon as possible. My friend Lindsay who used to work at UNC is here and works as one of the care coordinators (arranging VNA, rehab, meds for folks without money). It is nice to know that there is a friendly face here if needed.

One of the attendings went to my high school and had a biology teacher that was still there when I went through (although I didn't have him it but the other biology teacher). One of our pharmacists is married to someone who was a year behind me in school. I am so used to working in areas where I am anonymous that it is weird to have people know my hometown or even know me!!

I have my first official business card as a NP but am still waiting for my white coats. I am still wearing my horrible poly-blend coat from clinical. It is so gross even after soaking it in OxiClean all last weekend.

My parents are here this weekend for a visit (and have taken me out to dinner twice!) It is nice to be close to home and my parents don't have to arrange this trip weeks in advance. The snow is looking beautiful again so any and all takers are welcome!

On the Floor

My new home away from home (minus the 2 feet of snow)... :)



I survived my first day on the floor. It is a lot like traveling to a foreign country. There is so much to take in...new people, the environment, the systems. The day starts shortly after 7am and continues until the work is over. As most of the admissions are transfers and they come at all times there will be no 'typical' day. My preceptor is currently tackling two of us that are new to the service. I feel bad that I can't help her more but I don't know what to do and as it is the first day I am just short of useless. I met nurses, case managers, pharmacists, and physicians. Everyone is less formal that I expected. Patients call their doctors by first name so not only do I need to know last names but first names as well. Let the quizzing begin, perhaps flash cards would be beneficial. I just hope that most folks wear their name tags.
I received my technology... beeper, computer, and phone. Now to only learn how to use all the computer programs. The system is windows based so that is helpful but not the easiest to use. The more I use it the better it will be I just need to remember that it will be frustrating for a little while until I have everything formatted to my liking.
I wrote my first H&P but no orders yet. The first patient had Flolan infusing (a drug used for pulmonary HTN) which is not a favorite of mine. If the IV infusion is ever stopped the rebound hypertension in the lungs can be fatal. It isn't exactly a benign easily administered drug. My patient was admitted with it already infusing so I just had to treat it as one of her normal meds like aspirin or prilosec. Yikes. Thankfully my preceptor handled the orders and setting up the hospital infusion so I could focus on the note. I left after 6pm so the 10 hour day is more of a guideline than actuality. The service went from 13 patients to 25 and it is only a 32 bed unit. Talk about a crazy day to try and get acclimated. At least I could say that it was my first day and I didn't know what exactly was going on .... I don't think that saying that it is my second day is going to excuse me from anything. It was a one day only deal. Now I just need to catch up and learn the system as best as possible.
An attending grew up in my hometown and went to my high school. The pharmacist's wife was a year behind me in school. I am so used to working in an environment that is completely anonymous. No one knew my hometown, or me in any of the places I used to live. As my friend Paul would say...'interesting'. Hopefully I can represent my self, my hometown, and all the people and places that have had an impact on me in a positive light.
If you are ever traveling in New England in the winter and you see a little building on a trailer I will explain what it is... The building is so small that it would be barely big enough to contain a lawn mower if it was called a shed. No this building can't even be called a shed, it is a shack. A shack on wheels being carefully transported to the next available location. Why move a shack... it is an ice fishing shack. The only structure that will prevent the cold breeze across the lake from turning you into a popsicle. Brr.

2nd Day

I got TONS of paperwork to review 'at my leisure' today. There was only two providers starting today and we had completely separate sessions. That means that I had an individual meeting with the coding, billing, and benefits people. Talk about one on one attention to welcome you!

I did get my email address and had an orientation to the computer system used for patient documentation. I get my beeper, laptop and will have my lab coat fitting tomorrow. Scary...lab coat fitting. I usually just buy the least offensive polyester one that I can find maybe I can get one in cotton.

I am off on Friday and Monday. The scheduler counted my two orientation days and the holiday so only one more day of work this week before a four day weekend. Who knows when this will happen again so I had better enjoy my extra long weekend. I will be following my preceptor's schedule for a little while until I get a little grip on the system.

I have a desk in the office with a window view (of the main roof). It took my Dad 20 years to get an office with a window so I hope that he won't be too jealous. The only drawback is that I have no direct shelf space above my head but there is space on the side wall and that is completely ok with me. There is another new NP who started two weeks ago so there will be two newbies. She is experienced as an NP but is new to cardiology. I am old to cardiology but new to being an NP so hopefully we will balance each other out. My coworkers have been really friendly and seem quite dedicated. I will be working on the floor and with the patients starting tomorrow.

I have my stethoscope, pocket guides, and calipers ready to go. My lab coat is hanging over my rocking chair (which used to sit on my porch and now is in my living room as there is no porch in NH!)

NH broke it's December snowfall total of 44 inches in Concord. It is the most snow in December since they started keeping track. And I am loving it! Let it snow, let it snow!

New Year New Job

Happy 2008! Celebrating a new year wasn't enough this year so I am celebrating a new career as well. I have been attending hospital orientations in various forms since I was 14 where I was wearing a red and white striped jumper (yes the standard candy outfit). Off the top of my head I have attended at least five hospital orientations. and have sat through at least five that I can recall. Today's was no different. Wear gloves, recycle, shred patient information, however there were some interesting tidbits that I learned:

• The closest hazardous material landfill is North Carolina.
• The chemotherapeutic/radioactive landfill is located in Ohio. (I guess these state residents lost the Not In My Backyard fight.)
• The hospital creates 6 tons of trash daily.

Boy am I glad that we recycle over 30% of the trash. I moved from a town that was renown for its recycling and a hospital that barely recycled, to an apartment complex that doesn't recycle and the hospital is leading the nation with its reuse/recycle/reduce efforts. As my friend Paul would say, "Interesting." After so many hospital orientations I must admit that this is the first one that had an entire 30 minutes donated to discussing trash.

Another interesting fact....in the code of conduct we are instructed to not call patients by their first names unless invited to do so. This is the way I grew up and thought it was just a regional custom however here it is in the hospital manual. I would like to believe that this won't be a problem for me as this is the way that I was raised (Some neighbors that I have known for 25 years are still Mr and Mrs. despite my trying to use their first names but it is too weird). However, I must admit although I kept my northern accent mostly intact, I did slip into the "Hey honey/darling" habit. "Hay is for horses" so the sing songy He-ay stretched over two syllables I used to greet coworkers with (after 0800) needs to come to an end. I will be working with a former UNC coworker here in NH so she will be able to support me through these regional differences.

I had agonized about my orientation outfit. The overriding question... Will I be cold? (which is always a driving concern of mine no matter where I live...hence the number of turtle necks and pairs of long underwear in my closet :) Is there too much snow to dress up (a fresh five inches was on the ground this morning)? Should I dress up as I will be sitting most of the day and cute shoes are better for sitting than standing? I should not have worried so much as to what I was wearing as some of the department chairs that spoke to newbies today were wearing jeans, fleece vests and the majority were wearing boots! The dress code is nice and relaxed here in NH and seeing as though the closest Ann Taylor is 76 miles and the closest Loft is a state away it is nice to know that I shouldn't have worried. (I did wear a cowl neck sweater and was quite warm sitting in class all day! Ahhh.)