Long time, no see

Hi readers of Nurse Jess,

It has been nearly a year since I posted on my blog. Some readers (aka a few junior anesthesia students) have met me and wondered if I’ve fallen off. Nope, I am right here!

Every time I considered posting, an exam, a care plan, paper, or even the limited time off to do nothing, pulled me away. But now I’m back.

I have so much to say and yet so little time to do it. I could write a lot, as I often do, to convey all of my thoughts. But I will try to keep it short to encourage me to post more.

Since the beginning, I’ve done over 700 cases and over 1800 clinical hours. And there’s still 4.5 months left of anesthesia school. It may seem like a lot, or a little, depending on who you are.

That time doesn’t include class days, the preparation for clinical, the preparation for anesthesia school (GRE, CCRN), the intensive care unit hours, the bachelor of science in nursing AND biology. In my mind, it’s been ten years of training. Wow.

I have to admit, the beginning of anesthesia school was tough. What makes the training challenging is at first, you are learning the basics of airway management (intubation, LMA, oral and nasal airway, chin-lift, jaw-thrust, etc.) and the anesthesia flow for each type of surgery and unique to each patient (preoperative, intraoperative, postoperative course). Not only that, but each anesthesia provider (CRNA and anesthesiologist) have their preferences and expectations of you. Even during the short breaks, one CRNA may be ok with your choice, but another CRNA would reprimand the choice. The only thing you can do is to understand their choice (What’s the rationale?). As they say, there are a 1000 ways to skin a cat.

Now, there’s less anxiety and more of a discussion, even as I go to different clinical sites. It’s much easier to anticipate changes and adapt to the circumstance. For example, just today there was a switch in the schedule. Last year, I felt more frantic and had to think about my each step more carefully (especially in pediatric cases when there’s a change in age and weight that require a change in equipment size and drugs). Today, it changed from a two-year-old, 15kg to a 6-year-old, 25kg for ear tubes (*real age and weight are changed). What are the appropriate emergency drug doses I would give? What equipment changes do I need to make? I switched a size 3 to a size 4 mask, and had a 5.5 ETT (endotracheal tube or breathing tube) with a MAC2 blade, and thought –

  • atropine 0.02mg/kg = 0.5mg = 1.25ml,
  • succinylcholine 4mg/kg IM = 100mg = 5ml,
  • epinephrine (1:10,000 or 0.1mg/ml or the big stick) 0.01mg/kg = 0.25mg = 2.5ml.

Anyways, that’s it for today.

Jess

Michigan vs MSU

All this week, there’s been so much hype about the Michigan vs MSU. With Coach Jim Harbargh at Michigan, Michigan football is doing better than ever. Usually, I don’t really follow but my fiancé is a huge fan (he listens to podcasts and even submits questions via Twitter, haha) and now I’m a student!!

Anyways, Michigan has been dominating the last 4 games although MSU has won all five games undefeated thus far.

Apparently people all over the country are driving or flying in, staying in the cheapest hotel almost 30 minutes area at $250, with the cheapest tickets going at $175 this year (unless you’re a student who got season tickets).

Guy Fiori is going to be at Meijers this morning. “Game Day” is happening at the Diag. Somehow my friend talked me into going so I woke up early to get some studying done before I take a morning break and start back up in the afternoon.

It’s gonna be a lot of fun.

Speaking of studying, there’s a lot of new material. There’s a final exam in physical assessment and a principles exam coming up on pediatrics, fluid and electrolytes, blood products, and part I of the anesthesia workstation (yes, I can draw the oxygen molecule from the hospital outside, through the entire machine, and to the patient circuit— wow!).

I definitely feel on edge at a much higher rate than ever before. I’m usually a pretty calm person but now more than ever, I can feel my heart racing and getting anxious. And that’s almost everyday. I try to calm my nerves by either studying more, or setting time aside to go for a walk or watch some funny TV. Taking care of myself is probably one of the most important things I can do to endure through the program.

I learned this week (amongst other things), that a “sugar high” isn’t really a sugar high. As a tasty candy bar, full of “simple sugars” or glucose or monosaccharides readily available for insulin to act on, glucose is too quickly shoved into cells, causing a hypoglycemic effect. The alpha cells in the pancreas senses the hypoglycemia and releases glucagon. Epinephrine is also released from nerve endings and adrenals. Both glucagon and epinephrine go to the liver, which then undergoes glycogenolysis, breaking down glucagon into glucose and releasing it back to the bloodstream.

However, image the little kid full of epinephrine, setting off the sympathetic nervous system, causing him to run around like crazy during recess or banging his head against the wall. So a “sugar high” is really caused by “hypoglycemia” that’s induced by our more primitive insulin that floods our bloodstream when sensing a huge amount of glucose. If instead the ingested glucose was complex such as a starch, then our insulin is a much better match, releasing the appropriate amount of insulin without going overboard.

I did a few spinals this week (how cool and amazing it is!!) but next week I will try to do more general cases. All right, enough updating. Until next time.

Jessica

PS. I know the first round of interviews is coming up so I just want to say good luck to anyone who’s interviewing at UM.

PSS. The double rainbow outside my window on Thursday is the featured photo. Nature is beautiful.

How to get a Michigan RN License from Out of State

Fonature pathr a number of reasons, we travel to a new state, such as Michigan, after we’ve already obtain our first nursing license. Since I plan on working in Michigan, I have to get my Michigan Nursing License first. Here’s how I’m doing it and the related costs.

Ease – Easy
Time to Invest – 2 days
Time to Completion – from 1 to 3 months
Total Cost Minimum / Maximum – $146.50 / $181.75
This does not include the cost of an envelope and stamp to mail. If possible, use credit or check to pay. Otherwise getting a money order may cost more.

Step 1 Go to the Michigan Nursing License website and download the RN by Endorsement Application. Fill it out, attach a check for the State of Michigan ($54 or for $10 more, you can get a temporary license first for those who currently have 2 licenses), and snail mail the form.

Step 2 Decide if you will get your fingerprints done in Michigan or Out of State. If done in Michigan, go to www.identogo.com. Pick a location, book an appointment (date and time — it’s suggested to schedule your fingerprints 7-10 days AFTER you’ve submitted the RN by Endorsement Application), fill out your information, and submit $62.50 with credit or pay at the site with a check. After your fingerprinting appointment, keep the Livescan Fingerprint Request Form and receipt as it will contain the TCN Number.

If done Out of State, go to your local police state, get a hard stock fingerprint card (in New York State, it’s $25), and mail in the fingerprint card WITH the Livescan Fingerprint Request Form (page 11) and check of $62.75.

Step 3 Have your nursing license verified through www.nursys.com. They will send the verification for you for $30.

Step 4 Wait for the State of Michigan to process your application. After about 3 weeks, you should receive a Application Confirmation containing your customer number, which you can use to check your status online at www.michigan.gov/appstatus. According to others on allnurses.com, if it’s been over 8 weeks, contact your local rep or senate with your complaint. Typically, they find that the application is completed shortly after that.

Edit (12/31/14):

Step 5 If after 8 weeks, you can call them (I waited 25 minutes!) or email bhcshelp@michigan.gov with your TCN number that is found on it Livescan Fingerprint Request Form, and your customer ID number. They emailed me 2 days after stating that they found my fingerprint and they will forward it to the processor. 2 days after that, I got my license. I hope your experience is smooth.

Jess

Help by voting please! Affordable senior care depends on you!

help by voting!

Future and current nurses please help!!
And friends and families of nurses!
And those touched by a nurse! Please help!

My parents have helped over 100s of seniors and their families over the last 20 years by providing quality care in Assisted Living homes. However, costs have skyrocketed! Help us provide affordable quality care by voting. Since we need 250 votes by November 15, please vote and have your friends vote too! It’ll take 2 minutes but it will make a big difference. If each Life With Jess reader voted, we can reach the goal in 5 days. Thank you for your help!

More information about the Assisted Living Homes:
In the early 1990s, my mom was working on her Masters thesis on providing affordable quality care to seniors while working as a registered nurse. She put her thesis to the test. Since then, Citizens for Quality Care (CQC) has been home to 100s of seniors in Southeast Michigan and has made a great difference in families’ lives.

More information about the Chase Mission Main Street Grants:
Chase Bank is offering $250,000 for 12 businesses this year. In order to be considered for the grant, we need 250 votes by November 15. The grant will be used to replace an old boiler that would reduce the cost by thousands each month. While we saved a hospital from demolition by converting it into a beautiful Assisted Living home, some expensive parts need financial help to replace for us to continue to provide affordable quality care.

More information about voting:
A Facebook account is needed to vote at the website: https://www.missionmainstreetgrants.com/business/detail/137710! You can also enter https://www.missionmainstreetgrants.com/, type in 49221 and click on CQC Stephenson Home. Thank you for your help and please share!

Feel free to ask questions in the comment section.