I’m not your little baby anymore…

May 6, 2013:  My interview at the Children’s Hospital for a position in the neonatal intensive care unit (NICU).

May 9, 2013:  Offered and accepted the position at the Children’s Hospital.

June 14, 2013:  I graduated and was pinned as a Bachelor of Nursing Science (BSN).

July 16, 2013:  I took the National Council Licensure Examination (NCLEX).

July 19, 2013:  I officially became a Registered Nurse (RN).

August 5, 2013:  My first day at the Children’s Hospital…

I can remember the drive to work on August 5^th so clearly.  Per usual, I left forty-five minutes early for my projected seven-minute drive.  As I was waiting at the red light at the intersection of La Veta and the 22 Freeway off-ramp, I remember thinking to myself, “I am an adult, driving in my own car, by myself, no mom or dad, to my dream job.  This is really happening… there’s no turning back.”  The first couple of weeks of the RN residency program, I was just grappling with the idea that I could take care of myself now.  Sure, I was pretty independent throughout high school and college, but now I could pay for more than food; I have a retirement plan at twenty-two years of age!  I felt like I was in a dream world, but no, I was really working at a top children’s hospital with my favorite people, babies.   Once our preceptorship started, I was forced to deal with reality and just accept that I’m not only responsible for myself but for the lives of little loved ones.

Infants do not get sick and they do not die.  In a perfect world, this would be the case.  However, with poverty, poor education, lack of prenatal care, disease, genetic anomalies, and other evils of this world, the necessity for my dream career came about.  But how can I say that this, taking care of sick children, is my dream career?  I am a nurse.  I can focus on the fact that my income is made on other people’s sickness and sadness, but that is not why I stand here today, proud to be an RN.  No, my pride comes from knowing that every day I not only have the opportunity to make a difference in others’ lives, but I seize it.  I am not only a nurse, but also a teacher, healer, nanny, and friend, all in one.

When I cross the bridge from the parking structure to the hospital, I can feel this weight building on my shoulders.  I think about the new people I will have to work with, the new babies, the new diagnoses, the parents, the doctors, the residents.  This weight is fear; fear of the unknown. It is the kind that keeps me in line.  It is the fear that there is more that I could be doing; the fear that I could be doing better.  It keeps me on my toes, always asking questions and studying.  This is not a fear of weakness; it is one that produces strength.  As weeks have gone by, the weight has started lifting.  However, I dread the day that the weight completely disappears.  The day that I believe I am done, that I have learned all that I can, that day will be my downfall.

Day in and day out, there is one mantra that plays out in my mind: home, happy, and healthy.  My goal for each of my patients is that one day they can be at home with their loving families, growing up to be happy and healthy children.  Upon admission, I watch as fathers accompany their new child into our unit.  This was never part of their plan, to be standing alone next to a clear box with their tiny child within.  Where is their wife? Why isn’t she holding her child?  Where are all the happy delivery room memories?  That moment when mothers see their child in the NICU, for the first time since birth, I witness the tears, guilt, anger, happiness, and sadness.  You see it all in that first touch when she reaches over and caresses his or her face, when she holds her child for the first time since they were whisked away.  I watch love grow right before my eyes as parents bond with these new lives they have created.  At discharge, I cannot contain my joy.  Having watched these babies fight for their lives for this very moment, I am thankful we were able to get so far in their healthcare.  It is the knowing that these children are going home, to the place they should have been weeks or months before, to the place where they will be loved and nurtured for the years to come; it is knowing this that gets my tears flowing.

What about the young ones that never make it home?  I try to convince myself that sometimes it is the best outcome for the patient and the parents to not live in pain and disability for the rest of their lives, but there is always that child who was in the womb for the perfect amount of time, who looks healthy and seemingly perfect from the outside.  The sadness is derived from that one untreatable defect, maybe in the heart, the brain, or the gut.  Why does this beautiful child have to go?  Why do these parents leave the hospital empty-handed when they expected a plus one, two, three, etc?  I may never know why, but I can try and be strong.  Is this not why I became a nurse?  To be strong for others in their greatest time of need?  It is.  That is why I shall carry on and continue to live, learn, and love neonatal nursing.

Baby Heart

I have to admit the cardiovascular system is not my favorite topic.  Throughout my residency, we have had several cardiac classes.  When we discuss congenital heart defects and the things that affect my patient population directly my ears perk up, but otherwise I need that grande iced white chocolate mocha to keep my own blood pumping!  Today’s lecture was a bit easier to pay attention to, maybe it’s because our lecturer threw in this video:

 

Although I attribute my knowledge of fetal and adult circulation to my college professors, I’ll have the fond memory of these babies dancing every time someone mentions the ductus arteriosus or the foramen ovale.  On night shift, I sometimes have time to study up on NICU-specific topics.  I started my own “NICU Bible.”  It’s just a plain old marble notebook with information on random questions I encounter on the job.  A nurse at my psych clinical rotation showed me her own “Bible” and it inspired me to make my own.  I finally finished my thermoregulation chapter after a debate between co-workers sparked my interest. It took me a month… I’m thinking my next chapter will be hemodynamics or congenital heart defects.  I’m kind of excited to break out my colored pencils and draw diagrams.  My nerd inside is so excited!

Baby, This Is The Night {Shift}

Boy, does time fly!  Three months have passed since I began the RN Residency.  I am so thankful to have been blessed with a job that I love.  I am excited each and every day to go to work.  Last week, I began my preceptorship on night shift.  Although I am really sad that I had to leave all the friendly faces of the day shift staff, night shift has a slower pace that provides this newbie some peace of mind!  I don’t want to make the mistake of saying night shift is “easier” because it comes with its own challenges (less specialists, the weird hours, lack of parental input, etc.), but it definitely has its perks.  I really feel like I am able to look into the whole picture of my patients.  Instead of a quick glance at a reference, I can do my cares, charting, planning, etc., and have time to read on journal articles regarding rare disorders and disease processes.  I was a little wary about starting nights, not really knowing any of the staff and how I was going to figure out a sleep schedule, but everything has worked out for the best.  The NOC shift nurses have been pretty welcoming and I figured out my own little routine: stay up late the night before, sleep until 3, 4, or 5 PM, work my 12 hour, come home, shower and do some busy work for an hour or so, knock out for as long as possible, eat breakfast/lunch/dinner (whatever you want to call it) then try and sleep again until 3, 4, or 5 and start all over again.  So far it’s been going pretty well; sometimes I survive the whole 12 hour shift without a sip of caffeine.  My first three shifts were pretty easy, I felt like I could handle the assignments all by myself.  The next two were very different!  The first night I had a 1:1 which was fine, I could take care of the baby pretty well with just my RT, no preceptor.  However, it was the first time a patient in the unit had passed during my shift.  It was emotionally draining watching the team try to keep that little heart beating, but nice to see how well the team worked together to support each other and the baby’s family.  I haven’t cried yet, not because it wasn’t sad, because believe me it was sad, but because I knew that the team did all that they could. I’m sure the tears are pending…  The second night, I had a baby I was quite familiar with and a new transfer.  Admissions are definitely something I struggle with right now.  I have participated in 6 so far and I still can’t remember every little thing that needs to be done/charted.  Of course, none of these things are life-threatening, but they’re the little things that are important (the common labs, orders, etc.).  My co-workers assure me that it will all come with time, but I’m hard on myself; I want to know everything now!  Practice makes perfect, right?

Purr Baby

It’s been about two months since my last post.  Where I left off, I was just beginning the RN Residency program and having an absolute wonderful time transitioning into my new career.  As weeks have flown by, many things have changed, but one thing remains the same– I LOVE MY JOB!  Although my one day on, on day off schedule has been hard to get used to, I wake up tired, but still pumped for the day ahead.  I love my days with my preceptors.  They allow just enough freedom for me to conceptualize the day-to-day workings of the intensive care unit, but still fill in the gaps.  I love being able to pick and choose the way each nurse does things and make it my own.

For the most part, I have been getting high acuity assignments with my preceptors, assignments that do not reflect ones that I will have when I have graduated the program.  I have had amazing learning experiences during these shifts and have been able to practice skills I will be able to perform without a preceptor.  This last week, I asked for assignments that are more like the ones I will have on my own, just to see if I can handle it.  On Friday, I worked with a more seasoned NICU nurse on a tripled assignment of “feeder-growers.”  Although these babies mostly require work on their feeding, weight gain, and parental education, the challenges include time management, charting pretty much everything you do on every baby, feeding them when they cue you, educating and supporting parents, and supporting your team of nurses.  When I found out that all three babies were cue based (meaning I feed them when they signal to me they are hungry (pretty much every 3 hours or less), I was a little anxious about being able to complete all of my assessments, feed them, and chart.  However, once I got past the first round of assessments and charting the day was really nice and relaxing.  I did the whole assignment by myself, really only asking my preceptor to run and grab breast-milk 😛  It was actually one of only two days that I have been able to bottle-feed and just hold a patient.  It’s nice to see the difference in the really critical patients and the patients that our team has been able to heal, and even nicer to watch parents that have bonded with their babies.  There hasn’t been a day in which I haven’t had to keep myself from spilling the tears filling my lower lid.  What we do every day is amazing.  I can’t wait to be back on the unit.  🙂

In addition to growing increasingly more in love with my job every day, Robert/Justin and I have welcomed a new purr baby, Tigger, into our home.  We loved our family (Robert/Justin, Printz, and myself) the way we were, but when my friend showed me this kitten we couldn’t resist.  He has made us feel more like a family.  We love watching him and Printz wrestle, chase each other around the house, and groom each other.  Printz has gracefully stepped into the big brother role, sharing his food with Tigger, letting Tigger gnaw at his ears/tail, and snuggling with Tigger at night.  They’re just so darn cute!

Precious Cargo

As a young nurse, I like to think that all health care professionals think with non-maleficence permanently on the brain. However, each day, as I drive home from work, I am reminded of just how naive I can be. After my residency classes, I walk with my new friends to the parking structure, laughing and smiling all the way. I get in my car, plug in my phone, put my seat belt on, and start my car. I reverse out of my spot and proceed to join the line of cars that has built its way up the levels of the structure. As I make my way lower and lower, I watch my fellow associates allow other cars out of their spots and to join our cue. I smile to myself thinking how kind each one is for allowing someone before them. As we cross the threshold of the security gate there is a dramatic shift. These associates I momentarily regarded as thoughtful and safe become highway heathens. They run stop signs, cut each other off, ride bumper to bumper, block intersections, and cause near accidents merging onto the freeway. My jaw drops and I shake my head in disbelief, all the while trying to distance myself from any potential harm. How can people who hold the fate of young lives in their hands suddenly change mind sets so rapidly? As healthcare professionals we see patients come through our doors with horrible injuries sustained in car or motorcycle accidents. We spend so much energy educating on safety, yet such persons put these same lives we strive to protect in harm’s way.  I am not saying I am a perfect driver, but I will always stop before the first white line of a crosswalk, make eye contact with pedestrians, wait until pedestrians with children make it at least halfway across the intersection, leave enough distance between myself and my fellow drivers, etc.  It only takes a few of us to remember why we got into this business and to promote caring and the protection of life outside the walls of our workplace.

 

A Little RNR

This week, I officially began my career as a new neonatal nurse in the RN Residency (RNR) program at my dream hospital. I am reminded each and every day of how lucky I am to be doing what I love, especially because our director likes to tell us that if we mess up, there are at least 1,180 people just waiting to take our spot!

Day 1: Hospital Orientation

Our first day was a general hospital orientation. We were reminded of the mission, values, and principles of the hospital and that we must emulate these each day in our work. I was excited to be spoken to by our CNO (who had an awesome English/Irish/Scottish (?) accent). We ended the day learning through computer modules and getting fit tested for N95 masks.

Day 2: Clinical Orientation

Our second day was a general orientation for persons involved in direct patient care. We learned about our affiliation with the Ronald McDonald Foundation. The presentation was particularly heart-warming, I needed to look away to prevent myself from tearing. We also practiced some point of care testing.

Day 3: 1st RNR Class Day

The third day was RNR specific, so it was only the twenty new graduate nurses and our directors. We were educated on our Versant training program and given an outline of what to expect in the coming months. A lot of burning questions were answered and some stress of the unknown alleviated.  Myself and the other NICU girls were able to meet with our clinical educator and get some information specific to our growth. We ended the day with a tour of the new hospital building, which I found extremely helpful. The new tower of the hospital opened during my preceptorship, but I did not have access to explore. The new additions make this hospital just even more amazing. I can’t wait to see what the future holds for our community!

Day 4: RNR 2nd Class Day

The fourth day was freezing!! The building we were in had this wonky thermostat that went from cold to frigid every 10 minutes. We learned a lot of pediatric specific information regarding pain, asthma, charting, and nutrition. The nutrition presentation was especially fun because we were able to try baby formulas and various supplemental products. Only some of us were so brave…

I am excited to see what activities and learning opportunities this coming week holds.  I have been enjoying getting to know my fellow residents.  The girls I have had the pleasure of speaking with are complete sweethearts!

Spring Conception & Prematurity

Although I love every moment in the NICU, in an ideal world neonatal nurses would be out of a job.  Congenital defects, genetic disorders, prematurity, etc. would never come to pass.  However, this is not the case.  All we can do is try to give our patients the best care possible and use new research to continually better our practice.    In my opinion, knowledge of good prenatal care and the will to educate pregnant mothers may prevent the occupation of some of our cribs.  That is why my ears perked up when I saw the article, “Really? Babies Conceived in the Spring Are More Likely to Be Premature” on The New York Times website (1).

According to the author, there is a large amount of medical literature discussing seasonal patterns and the risk of chronic conditions.  Despite the quantity of such research, the method of approach is often flawed.  Nevertheless, a study published in Proceedings of the National Academy of Sciences may be the largest and most persuasive connection between seasonal gestation and conditions, specifically conception in the spring and preterm birth (2).

The article, “Within-mother analysis of seasonal patterns in health at birth,” discusses the seasonality of gestation of about 1.4 million children.  The same mothers were followed over time to eliminate differences in maternal characteristics.  This accounts for socioeconomic differences of mothers who are likely to conceive in different months according to individual status.  The researchers claim that women who conceive in May are 10% more likely to experience preterm birth.  They attribute this pattern to the spike in influenza cases in January and February when the mothers are nearing full term.  Influenza has been studied and shown to cause adverse birth outcomes, possibly due to the inflammatory response which can cascade into labor.  In addition, studies have shown that vaccinated mothers are less likely to deliver prematurely than unvaccinated mothers.

The Take-Aways:

–  Women who are nonwhite, less educated, less likely to be married, and more likely to smoke during pregnancy, conceive in the first half of the year.

–  When controlled for maternal and birth characteristics, gestational length decreases about 0.8 week when conception occurs from January to May.

–  There is a strong correlation between influenza infection and shortened gestation.

–  Newborns conceived in the first 5 months of the year are of significantly lower birth weight than those conceived in the second half of the year.

–  Average maternal weight gain increases by 0.8 pounds in the first half of the year, plateaus in June and August, then returns to the January level (may account for pattern in birth weights).

References:

1) http://well.blogs.nytimes.com/2013/07/15/really-babies-conceived-in-the-spring-are-more-likely-to-be-premature/?ref=health

2) http://www.ncbi.nlm.nih.gov/pubmed/23836632 (If you would like access to the full text, please let me know.)

The Controversy of Mother Teresa

Whenever I am trying to introduce myself to someone in a loud environment, either myself or my new acquaintance will use the phrase “like mother teresa (?).”  For the rest of the evening, I find myself being referred to as “Mother Teresa.”  I have always felt undeserving of such a nickname, however, my friend brought it to my attention that this character may not be as all-around kind-hearted as proclaimed.  I brought my curiosity home to my parents.  My mother told me about this novel she read written by a former Order of the Missionaries of Charity (OMC) sister.  This nun discussed the disparities between the care Mother Teresa allowed the poor versus her own congregation.  She also reminded me that one of our family friends was a former sister of this congregation.  She left because she did not agree with their particularities and wanted to continue to help people in a different way; she is now a chaplain nurse.  I couldn’t let myself continue to hold this woman in such high esteem until I completed my own research.

Canadian researchers published an article called “The Dark Side of Mother Teresa” in the journal Studies in Religion.  They suggest that the Vatican should have studied her views and ability to handle money a little closer before her beatification.  It is believed that her beatification was a well-organized media stunt.  During her lifetime, Mother Teresa opened 500 missions, but doctors describe them as “homes for the dying.”  The conditions of these missions were unhygienic and the people were given inadequate care.  Despite the millions of dollars the OMC raised, Mother Teresa was more generous with her prayers than monetary aid.  At one point, she even said, “There is something beautiful in seeing the poor accept their lot, to suffer it like Christ’s Passion. The world gains much from their suffering.”  During various disasters, she was more likely to provide prayer and medallions.  The researchers claim her beatification was a stunt to revive the Catholic church, but also agree that such media coverage did inspire humanitarianism.

“I know God won’t give me anything I can’t handle. I just wish he didn’t trust me so much.” – Mother Teresa

Her belief that the poor and sick were given their hardships in God’s plan is one that I partially share.  I believe that everything happens in life for a reason.  If you have the will to overcome the trials you are dealt, you can experience a great deal of individual growth.  However, where Mother Teresa loses me is that she claimed to want to help people, but she did not use all the resources she could. If she believed that God created every circumstance, she should have believed in medicine more and provided proper healthcare to the sick.   I believe in prayer, but we all have the ability to change our course and I believe that is why we have been graced with our intelligence and the right to choose for ourselves.  The power of prayer can be strong, but just because I pray doesn’t mean I can sit back and wait to have things handed to me.  I need to know that I did everything I could to get what I deserve, to show that I am worthy.

There is no doubt that Mother Teresa could have learned something from Florence Nightingale.  A little more hygiene could have done wonders for the people she “served.”  Despite the debate of her work, thanks to the media and the Catholic church, Mother Teresa will always represent altruism and humanitarian work.  Her work and quotes have inspired a lot of people to better themselves and to help others, and for this, I am thankful.  As for the nickname, if it helps them remember my name it can’t hurt right?

Teresa Thomas Vellaringattu, RN, BSN

At 6:58 AM, I decided to check the CA BRN website for the third time this morning.  When I clicked “Find” I was expecting the same message, but this time I was greeted by my name and license number.  I cannot describe the feeling of relief that came over me.

On July 16th, I took my NCLEX-RN examination.  I walked in feeling confident after scoring 80s and 90s on my Kaplan review practice tests for a week.  However, when my test kept going after question 75 I started to get nervous (I blame the Select All That Apply’s).  After each question, I prayed that it would be the last and that I passed, but I kept clicking through until question 251.  At 251 my computer directed me to the exit survey.  I finished the survey, grabbed my personal items, and left the testing center.  I immediately called my mom and began to sob.  I was so scared that I had sat in that testing center for 4 hours, studied for weeks, and received a job offer for my dream job just to have it all taken away.

The last couple of days have been extremely bittersweet.  I didn’t know whether I should be celebrating or studying for the retake. The Pearson Vue NCLEX trick helped keep the hope alive.  I was definitely skeptical at first, even though I looked through five pages worth of Google search results that claimed its 100% accuracy.  Despite my success with the trick, I continued to do practice questions on my iPhone app, just in case.  Everyone kept telling me to enjoy myself, but I couldn’t until I knew for sure.  But now that I know, I can enjoy a couple of weeks at home!

I can’t wait to get started as a neonatal nurse.  These next couple of weeks will be filled with daydreams of what it will all be like to work in an amazing children’s hospital.  I’m really thankful for all the triumphs I have been given these past couple of months: I have a loving family, friends, boyfriend, and kitty, I graduated from college with a BSN, I passed the hardest test I have ever taken, I am a licensed RN, and I have my dream job.

It’s good to be me, Teresa Thomas Vellaringattu RN, BSN. 🙂

It’s a Girl, a Boy, and… Another Girl!

The Wedding Ring Test

For as long as I was old enough to sit with the aunties at family parties, I can remember my mother being revered for her skill at predicting the number and gender of children women would have.  I would watch as my mother tied a strand of hair on each woman’s wedding band, stabilized it on the side of their palm, and then watched it sway side to side (boy) or in a strong circle (girl).  She would always reject my own inquiry into my future progeny, claiming I was too young or shouldn’t be thinking about children just yet.  Finally, today, during a dinner party at a family friend’s home, my wait was over.  I cannot remember how the topic was started, but the second she offered, I had pulled a hair from my head and tied it onto her diamond ring.  They all asked what my ideal number and genders would be.  I answered with at least two and the first was to be a son.  Seconds later we were watching the ring dance above my left palm in large circles and my mom proclaimed the first would be a girl.  During the second round, the prediction was a boy.  When we checked for a third, it wasn’t looking so promising.  The ring hung limp over my palm, but after a bit it started swinging in circles again and she announced another girl.

For fun, my mom called Robert/Justin over.  She laughed and said she had to make sure our predictions matched or else we’d have some trouble.  Luckily, his prediction was the same: girl, boy, LONG PAUSE, girl.  I already knew my parents liked Robert/Justin, but this discussion of our future together was even more validation that they have accepted him as family. 🙂 Sigh, my parents are the coolest…

Now, I will have you all know that this prediction thing may seem like a bunch of bologna, but my mother has yet to be wrong.  You are all my witness.  As of July 5th, 2013 I am predicted to have a girl, a boy, and another girl, in that order.  Ten to fifteen years from now, this blog may not be active, but we shall see if she was right.