Blog posts : "Nursing"

LPN - I am a Professional

I received a certificate in the mail yesterday. It states I am a professional. It states I can append the letters L.P.N. to the end of my name. Oh my goodness, what a feeling it was to read that. I've been practicing as a nurse for half a year, but the graduation date, date of the licensing exam, and time it took for licensure to take effect spanned out over 5-6 months. I've, rightfully, been calling myself a nurse for multiple months now, but now I have a certificate I can hang on my wall and I have the right to append acronyms to my name. Wow. What a feeling...

That said, let's take a look at some common myths I've already run into as a practical nurse.

"LPNs can't give injections," said by an RN and read in NRGH's training manual on first floor (cardiac). Wrong. LPNs are trained to give injections in the same manner and style as RNs. The only medications we cannot give thus far is IV medications (includes central lines). Read that again -- LPNs receive the same training as RNs for injections. We can put in subcutaneous butterflies, too. Pretty darn easy skill... I was pretty taken back when this surprised one of my coworkers, but I guess there isn't much effort put towards educated people on the ever-changing role of the LPN.

"LPNs only work in nursing homes." Said by a very friendly coworker of my boyfriend. Actually, LPNs are respected assets to hospitals all across Canada. We work with stable patients. This is where the line blurs -- RNs will take unstable patients while LPNs will care for stable ones. Keep in mind that LPNs/LVNs in Canada are not the same as LPNs in the USA.

"LPNs don't work in maternity wards." I won't beat around the bush, the charge nurse at NRGH's maternity ward was nothing short of rude to my entire class during or practicum. She did her best to make us feel unwelcome and questioned us being there for the entirety of our stay. I really ought to return to the ward to extend my sincere gratitude to the RNs there that welcomed us to the ward with open arms and took us under their wings. For licensing, LPNs are required to have at least one day of maternity during our practicum... Why? Because LPNs can work on all floors -- we are trained to care for the full life span. Our scope of practice expands from newborns to the elderly. We can take all ages, so long as the patient or resident/client is stable. In more remote hospitals, LPNs are sometimes the only nurse on duty in maternity wards and can assist with deliveries. Unfortunately, less remote hospitals are not as open to change and still sees LPNs as having the scope of practice they had nearly a decade ago -- back before we even gave oral medications.

LPNs can... insert urinary catheters, be trained for ear irrigation, trained for dis-impaction,trained for mechanical debridement, soon BC LPNs will be doing IV starts, we can remove surgical drains, perform dressing changes, remove stitches and staples, take all vitals, per rectal medications, oral medications, subcutaneous medications (butterfly or injection), intramuscular injections, can be trained for vaccination administration, topical medication, eye and ear drops, all personal care, assist with ambulation post-surgery, assist with vaginal deliveries, perform newborn baby assessments, baby baths, weights/vitals, etc., etc.

Our scope has changed. We are now what RNs were a decade or two ago. RNs are moving up, too! In fact, I believe they have just had stitches added to their scope! Awesome :D

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Labor Relations...

If you work in a location that does not have a union, just remember that British Columbia has laws to cover your buttocks. Please see the BCLaws website:

Click here for the massive webpage outlining laws for BC employers.

Your time is valuable and you are entitled to certain pays, even if you are "casual," or "part time," rather than a full time employee. Assuming you do not have an agreement with your employer that states otherwise, you are entitled to time and a half for any hours you've worked over 40 during any given week. You are also entitled to time and a half if you are working a stat, have been an employee for more than 30 days, and have worked 15 shifts in the last 30 days leading up to the stat holiday... Unless you choose to move your stat to another day -- i.e. work the stat, but then take another day off in its place; then you are not entitled to the overtime pay.

Anyway, that was just my "light" reading for this morning as I strap on my white shoes and head on out to brighten up some lives and pop a few hundred pills out of their packets while reciting 9 rights aloud, three times in a row. Right drug, right dose, right time, right route, right reason, right person, right documentation, and the patient has the right to refuse and the right to be educated about the drug. There's your NINE. count 'em nine rights. Oi! I think the RNs in BC have recently started doing 10 rights? Anyone know what the 10th right is?

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Done Like Butter

As of 11:00 PM/2300 last night, I am a Practical Nurse. I'm undecided if I'm licensed or not... I received a registration card from the College of Licensed Practical Nurses of British Columbia which gives me the authority to practice as a licensed practical nurse... LPN or PN, I'm all done with school! Pop open the bubbly.

It was a long hall... Even though it was only 12 months long. 12 months without any breaks sans the winter break. I see why grade schools have summer breaks. by the time you make it to the summer, your brain is fully fried.

The time passed quickly though it seems like I've always been in school. It seems like just yesterday I got the call that a spot opened up for the class I had just recently added my name to for the waiting list. I had two weeks to get ready, which ended up perfect.

I carefully composed my two week notice letter for my boss and handed it in feeling guilty -- I had only been there for 5 months. Then was the subject of parking passes, text books, financing, daycare issues, and so forth. I was so excited to start school that I had everything dealt with by the next two days. Then was the longest wait of my life.

I sat in the classroom for the first month asking the dumbest questions since it had been 7 years since I had sat with a teacher in front of me. This time, I was completely enthralled in all that she was saying. Taking notes that would make little-to-no sense to anyone else. Highlighting full paragraphs in my text books... I definitely won't be able to resell these, but why would I? They are filled with information that I still find interesting.

I think I've invested my time very wisely... I have enjoyed all of my practicums and all of my preceptorship. I've learned life stories I wouldn't have otherwise. I've experienced pain second-hand while administering a PRN morphine subcutaneously. Been up to my elbows in someone else's poop without flinching. Changed pus-filled bandages. I enjoy every second of it without a second thought.

Odd how after the first or second time, poop just becomes another normal part of the job. I don't see changing a brief or helping with a post-toilet clean-up as any different than helping someone brush their hair.

I'm really going to miss rehab. I hope I can land a job on the unit eventually :)

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New Preceptor!

Very, very last minute and with little-to-no warning, an LPN on Rehab agreed to take me on for my preceptorship. Wahoo! My instructor and I were getting quite desperate about finding one.

I had the first shift yesterday. It was a very relaxed environment, but it was also quite slow. Tonight, I'll be bringing some nursing books to keep me occupied for the shift in between doing our tasks.

I'm pretty darn upset, though. The schedule that I have is rock solid -- I need every hour that I have been given, but those hours include Halloween evening/night. I'm really torn about this. I've been getting my daughter all amped up for Halloween since I was getting the night off on my previous schedule. This is the first year that she's actually excited about Halloween and I missed Halloween last year because of a wind storm: she was visiting her grandma in a town an hour away across a long strip of highway known for its absolutely brutal driving conditions in wind storms. Just ask my mom - she flipped an SUV on that same highway during a wind storm.

She's going to be a raccoon, dang it! A part of me will wither away if I miss this Halloween. This is school, not a job.

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Quick Post: Heparin

A quick post to ask a question to those of you whom are familiar with injections. In school, we were taught to use an air lock with subcutaneous injections of heparin (and any other anticoagulation that might be gven s/c). I forget if the dalteparin shots I gave included an airlock in it alreadyor not... Can't find any literature saying if it has one or not. Edit: Looked today before I gave a couple of dalteparins and they did, indeed, have airlocks in them. Guess that answers my question!

Anyway... The person I was "preceptoring" with the other night got very weirded out when I asked her if she used an airlock with her heparins. I then asked her if she'd be okay with me using one since that is what I was taught to do (to prevent bruising) and she said no. Fair enough, it's her lisence I'm working under so I did what she was comfortable with.

So, the question is Do you use an airlock in heparin or other anticoagulation injections that are s/c?

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No Preceptor!

I managed to work 3 12 hour shifts this week... The last one was a night shift. I decided with my teacher to not return for tonight's 12 hour shift because it wasn't realy being beneficial to me. My preceptor, whom I've never met, will not be returning for another few weeks :( Poor girl!

My instructor is working hard to find me a last minute preceptor in the hospital, but I will be okay with a long term care facility... Just so long as I get my experience in, I'll be a happy camper.

Quick note to self: no matter how tired you are... Pack a good lunch. Avoid packing "quick," processed foods. If makes you feel really bad! haha  I feel pretty nauseous coming off that night shift. There was a pot luck  among the staff - lots of junk food was splayed out in the office. I tried to avoid it... Oh, how I tried to avoid it. Pies, chocolate triffles, sherry triffles... Oh, the temptations.

Oh how sick I feel now.

Half-way through my last day shift, I think they switched the soap in the dispenser (which was empty half-way through the shift, i should note). My hands were red and burning with each handwash for the last 1.5 shifts. Kind of sucked, not going to lie! No matter... I fixed it with my Sugar Cookie Show of Hands Instant Manicure from BeautiControl. I swear I'm not trying to toot their own, but I am in love with each of their products. Followed up the instant manicure with the Regeneration Extreme Hand Repair cream. So smooth :D

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12 Hours is Kinda Hard

I worked my first 12 hour shift -- ever! It wasn't too bad. My feet certainly hurt right now, but it was still good. I didn't have an actual preceptor with me since mine is off on worker's compensation for a work-injury, though she should be back within 3-4 days... Hopefully.

I was paired up with an LPN who was a casual to that floor. She was pretty darn good. I hadn't yet seen a working nurse with such good asepsis practice, thurough assessments, and good patient-centered care. She did things, small things that nurses tend to cut corners on, such as putting on slippers before a person's foot hits the ground... Did you know that the hospital floor is considered the dirtiest place in the whole building? Before, I never cringed at seeing people running around barefoot or in socks, but now I certainly do. There has been blood, urine, feces, probably even pus or other drainage on the floor. Sure, they disinfect it, but by no means are the poo molecules fully picked up in the disinfection process.

Congratulations on the disinfected poop on your socks :D

I was at least given the opportunity to give some medications, which included a subcutaneous injection (yay). The nurse also let me "take the team" which was only 4 very stable patients. In the end, I'm pretty sure she did more work even though I "had the team (of patients)." There are some things that she thought to do long before it ever began to cross into my mind. I'm hoping I'll be able to do that with experience and I'm sure it will come.

Vaguest post ever. That's what happens after 12 hours -- what can I say? ha

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Starting Preceptorship

I sit here, writing this in bed as I try to fall asleep early in order to get enough sleep to keep me energized for my first 12 hour shift tomorrow. I wonder how this will work out! I will not see my daughter much at all tomorrow since I will be gone before she gets out of bed and by the time I get back home, it will be past her bedtime. On the lighter side, we have agreed to extend her bedtime by an hour so that I can tuck her in and read her a bedtime story like I normally do. Yay! I enjoy story time the most <3

I got my Skinlogics Clear set today and used it for the first time tonight... I was pretty darn excited to try it and I definitely wasn't let down! My skin feels just ridiculously soft and clean right now. I can't wait to see how well it works against the gnarly acne I have right now.

Being an adult with acne sucks. I mentioned it before, but I have adult onset nodular acne. This means that my blemishes are underneath the surface of my skin. You won't see any 'white' tips -- these breakouts are not at the surface and it's rare that they actually push through the surface enough to be seen. It's a little embarassing, but I try to not think about it.

I have a doctor's appointment in two weeks so we shall see how this BeautiControl product works from now until then! If all goes well, then I can cancel the appointment ;)

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Done Like Butta

Done. I am done! Done practicum that is. The very last practicum of this course! Now I am off for a few days until my preceptorship starts. I am very excited to get started on that! I'm just absolutely shocked at how quickly this praticum passed. I'm also pretty amazed at how far I've come.

I started off a little on the shy side with my patients... I was a little uneasy ever interrupting them to be able to finish my assessments. I was uneasy putting my foot down at all. In essence, I wasn't overly confident. I didn't come off confident. By the end of the practicum, I charged down the hall knowing exactly what my plan of action was. I talked openly to patients no matter how new they were to me. I was able to finish assessments in completeness, no matter how many interruptions there were.

I almost feel like a new person coming out of this. I see myself more able to "Sell myself" when needed. Alright, I'm coming off a little cocky here, which I'm not. Just sayin'  :P

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Wound Care Courses and LPNs

I am very interested in getting into wound care, but due to my experience with some RNs and the general attitude towards LPNs, I'm almost determined to not become an RN... At least not for a long time. It bugs me that people still fail to realize that RNs and LPNs are not stages of nurses. They are two completely separate nursing types with two different scopes of practice... They should not be compared to one another. One is not lesser than the other.

Uh... Back to my point! I would love to invest myself into wound management as an LPN. There are a few courses I will be qualified to take once I am finished my schooling. Have any LPNs found that courses on specialties like wound care management make them more appealing to employers at all? Is it a worthy investment, or should I just focus on getting all the practical experience I can get and look into courses further down the road?

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Practicum is Going Well

I can't believe it. I only have 6 days left of practicum! I get to go to maternity tomorrow... I have my fingers crossed for seeing a vaginal delivery. A c-section would be awesome to watch, but I'd prefer to see a mom go through a delivery she has planned for. Unless it's a planned C-section... Obviously :D

I was on the pediatric floor on Sunday, but there wasn't a whole lot that happened there. I got to freak out a mom by gearing up for droplet precautions (booties, bonnet, face mask with an eye shield, gown, and gloves). Apparently, the "droplet precaution" sign at her door was there just for safety measures. The little kid actually didn't have anything that warranted droplet precautions to be taken. Sorry, mom! Didn't mean to scare you like that, haha. Luckily, the little kid didn't mind one bit.

I'm on a medical-surgical floor now, which is nice. I had a very pleasant patient today. Aside from a few organizational issues due to being on the floor for the very first time, my day went very well. I got a few new skills in and I'm pretty satisfied with the quality of work I did on and for my patient.

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Day Two of Practicum

Karma SutraAlthough my morning practicum shifts don't start until 7:15 AM, I am up and out of bed at 5:00 AM. This gives me enough time to shower, do my hair, get ready, pack two lunches, and enjoy at least one mug of delicious coffee... Right now, I'm drinking Karma Sutra, which is made by a Vancouver Island company.

I have been drinking Karma brand coffee on and off for a few years now... This is not a paid blog post, if you are wondering :P  I believe Lefty's restaurant uses Karma brand as well: "Karma Kazee". I used to drink that, but I really enjoy Karma Sutra. If you haven't tried it yet, it's in most local grocery stores and they sell some online as well at their website: Karma Coffee.

Anyway... I started this blog to complain about how tired I am, which naturally lead to a discussion about coffee.

I am on the floor working by 7:15 AM and I am to be off by 1:00 PM. I'm out of the house by 6:10 AM and got home at 3:00 PM. Debriefing + Ferry traffic + long drive home = 3 hours apparently.

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Eventful Day at Practicum

Nurses in BC get a lot of great education before they go out into practicum, especially into the hospital. If you are in school, pay special attention to the CVA and dementia classes. You will come into a lot of it in practice.

From my practicum experience today, all I can say is it's very important to try and understand the underlying cause of certain actions. A post-CVA patient may have inappropriate behaviors, even compative behaviors. These are not always because of the patienthaving a mean spirit. They could very well be sweethearts. They could also be watching themselves exhibiting these behaviors without knowing how to stop themselves. They have actual damage to their brain that can cause them to lose their self control... These may or may not be temporary.

Sometimes, their verbal communication is much different from their physical. For example, they might be yelling or cursing at you, but they're being gentle and listening to you when you ask them to do things. They may be perectly fine and cracking jokes while at the same time muttering disturbing words.

That's the basic theme that I had for today: Reasonings behind certain behaviors.

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Orientation Complete

Orientation went well. There isn't really a lot to say about it. We toured a few floors and went over some ground rules. My group was fortunate enough to be assigned our own patients for tomorrow. Some groups are just shadowing staff this week.

I'm excited to see how it all goes tomorrow! I'm not too sure what to expect... Our last practicum was quite different from this one! Our instructor is split across two floors, so she won't always be there for us and there is a high expectation that we work with the staff. That means that a good deal of our experience will depend on the staff actually wanting us there. We better make ourselves super useful tomorrow!

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Mom and AThere's nothing I love more than when my daughter wakes up before I have to leave in the mornings. This is one of the reasons why I love orientation days: they always start in the later morning.

I actually took the time to take some pictures... I try to take pictures of my daughter and I whenever I get the chance. It's amazing how seldom a mom and her children are photographed together by other people, so I took the initiative to take pictures of us together. Next time, perhaps I wil wear makeup... haha

I'm pretty darn excited to start orientation today! This will be my very first experience with working in a hospital setting. I say "working", but really it's unpaid work/learning. Weee!

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