Back Again...

Being a nurse practitioner is a wonderful career! Here I sit at work, typing away on the iPad my employer has supplied--I can read a book, write a book, surf the WWW, watch Netflix...the list goes on. No, my employer won't get on to me for doing these things--as my co-worker and fellow NP said, "we don't get paid for what we do, we get paid for what we can potentially do." That's what my current locum tenens job is about. I'm waiting on a job to open up in a rural hospital--where I will work full time with a work seven 12 hour days and then be off for seven days. I took this temporary position as it offered more money than what I had been making (being honest--Medicare doesn't pay well) and I needed a little break before I started the 7/7 job. This job is 3/12 hour days a week rotating every 3 weeks so nobody is stuck always working the weekend (except Sunday--this office is closed on Sunday). See, a career in nursing (as a NP) is a great thing. The job market is wide open. The work is generally rewarding--it's a lot what you make it. The responsibility is awesome as a nurse practitioner--I remember when I first started I would lay awake at night or be jarred awake by the thought that I'd forgotten to check for allergies to certain medication or the dose of furosemide I ordered was gonna shoot their kidneys--or worse, what if that nurse didn't take the order off that I wrote or forgot to take the warfarin out of the med cart because I d/c'd it 5 days ago but the INR kept going up--only to find the night nurse HAD been giving it. There's a lot of what ifs. Eventually, you calm down and become a skilled, knowledgeable, overall "well seasoned" NP. Remembering to check for drug/drug interactions, allergies, noting of risk/benefit--all become second nature. For the time being, this job is a mini-break from the serious, chronic health challenges I had been faced with daily at my previous job. The worst thing here so far is poison ivy rashes otherwise it's DOT/CDL physicals, urine drug screens, breathalizer testing, occasional gluing someones skin back together, various injections for minor problems. We are prepared to suture if needed. Nothing REALLY life threatening, and for that I am thankful. Now don't get me wrong, I still love little frail old people and I'm sure the base population at the hospital will be these folks. I'm just being honest about the pay and getting a break from the stress of trying to keep old worn out bodies working and anxious and unrealistic family members breathing down your neck. I still say, there should be a law passed that declares it illegal to make a person with a "terminal illness" or in "end stage" disease a full code. Please, let them go with dignity. More later.

Thanksgiving

I worked yesterday and am off today. I follow many blogs and a few of the ones I follow are blogging on what things they are thankful for. I am thankful to finally have a position where I CAN be off on Thanksgiving...and the day after. I've got a great position, not to say that it's perfect, but it's pretty darn close. I still see geriatric patients and now I'm able to focus on prevention. I don't treat, I just review medications, the patient's social, family, medical and surgical history and perform a physical exam. Then I do a fall risk assessment and discuss all my findings with the patient. Sometimes, during the exam, I discover that the little elderly lady in front of me who's denying all problems has a temperature, or abnormal lung sounds--which require further investigation. That's when I either contact their primary provider (physician, Nurse Practitioner or PA) or their DPA (Durable Power of Attorney) and advise them of the findings. It's good to find out you've nipped something in the bud--preventing an hospital admission hopefully. It's so much better for the patient, if they aren't too sick, if they stay at home in their own environment. Hospitals are the WORST place for a sick person--sounds absurd doesn't it? There are so many germs there just waiting to hitch a ride on your body and it can wreak havoc on the elderly--especially the frail elderly.
Hey, did you hear? Tennessee ranks THIRD in the nation for over prescribing of antibiotics. I'm not surprised. In defense, when I was working in primary care (Family Practice Clinic) I had patients to chew me out and say they would go find another "doctor" to give them an antibiotic. People just don't want to hear it and don't believe that they don't need an antibiotic. I always say, "lets let your body try to fight it, I don't think you really need an antibiotic for this". Some listen, most don't. Onward...
I'm not cooking Thanksgiving dinner today. I'm thankful for that. Instead, I'm headed to my niece's home for the Thanksgiving meal. I was asked to bring "something chocolaty" and so, I will. It's called 'Lawson's Chocolate Psychosis', after my nephew Lawson who made this chocolate cake on Thanksgiving in 1998. It was a hit! He hasn't baked since. I wish I would have had the forethought to snap a few pictures during the process of mixing the batter, removing from cake pans, etc., but anyhow here's a picture with the "undercoating" of icing












Then, I took the cake over to the sink, where there is more light so you could see the finished product. (I'll try uploading pic later)

So, there you have it. Hoping above all that we all enjoy today's offerings what ever they may be and those that travel a safe going and return. Peace to all. Joyous Thanksgiving!

Home...at last. Did I tell you I was moving?

This place is me. It's got character and not easily shaken. We've had some pretty rough storms this spring, lost a few tree limbs off the newer trees (I now consider the Bradford Pear a "trash" tree) and like me, it is a work in progress. My motto is, "Rome was not built in a day" and I'm not trying to stress myself out over wallpaper I don't care for or paint colors I don't care for. All in good time.
While the weather is warm, I am spending a lot of time outside figuring out the gardens---there are still unidentified plants (yet to bloom) and doing lots of weeding. I have a small garden beside the garage where I am growing tomatoes and a few herbs.
As a nurse practitioner, I have to keep my knowledge up to date and so, I am heading to Cape Cod for a few days to do just that---attend a continuing education seminar. I am looking forward to the trip up and the return. On the way, I plan on stopping at a few places--namely the Greenwood Gourmet Grocery, The Inn at Little Washington, I plan on making a quick detour to Portland, Maine to see my Dad, pick up some Maine lobsters, Amato's Italian Sandwiches, canolli shells from Shaw's Supermarket and head back south---to my glorious retreat of a home. I was just thinking the other day, "how many people get to drive to work each day admiring the scenery on the commute?". I feel very blessed to have this place and call it my home.

Healthy Banana Bread

Happy and Healthy New Year to us all!
I haven't blogged in a while, no floods, just my daughter's wedding, putting my house on the market, and Christmas--all enough to keep me too tired to post.
Haven't heard much talk of resolutions this time around. Strange, usually that's all one hears around this time of year--"This year, I'm gonna..." and so it goes. I like what Nike says, "JUST DO IT".
And, that's what I did. I was reading over my favorite food blogs and came across this recipe for 'healthy' banana bread. As you can see by the picture, I had on hand some ready bananas. I like to say they are all freckled instead of 'over-ripe'. So, instead of oohing and aahing over the pictures I just made the bread.

See, I did it. and it looks just like hers! It really does taste very good and even better the next morning lightly toasted with a smear of butter.

I've attempted to give a link to her blog so that you too may try the recipe. (click on highlighted area for link).

Meatless Monday: Curried Pumpkin Soup

Meatless Monday: Curried Pumpkin Soup

It's fall y'all! This is the time of year I love to sit with a bowl of soup and savor each spoonful as I watch the leaves falling. I haven't tried this soup yet but The Wizard made dinner for me Thursday evening--Shrimp and Vegetable Curry. He served it over rice. I ate two helpings. I LOVE curry, coconut curry even more. So, I thought what better soup to make to usher in the cool fall days and nights than a pumpkin curry. Hope you try it.

Work Schedule

This week I'm starting a new work schedule--self imposed in an attempt to make better use of my time at the facility. Yesterday went fairly well, slow and easy pace. The lady with the labile blood sugars seems to have fared better on the new regimen I started for her--that's a relief.
I am happy to have a job where I have a flexible schedule, what a blessing! Sometimes I do miss working in an office environment where I have my own desk, computer, pictures and set hours. There are office pot lucks, birthdays, drug rep lunches not to mention someone who schedules who I see and when, no hunting around for someone to see because you're worried you won't make your quota for the month. Again, that's where I am fortunate in having a doc that is understanding. He knows you can't just go see a patient because they are sitting in front of you, there must be a medical necessity or it's considered fraud--Medicare fraud. That carries a HEFTY fine and I never want to commit that crime.
I have to mention that yesterday I wrote discharge orders on someone that I never thought I would. He was a patient that had come to our facility after a stroke. He was depressed. He was weak and had essentially given up his will to live. He was to the point that in order to survive he had to be fed liquid nutrition through a tube.
I've seen this done a lot and the outcome has never been good. Well, wonders never cease. He made a 360 and has gained almost 30 pounds, is eating on his own, talking, laughing, a happy man. Truly, he is a success story. It does my soul good to see him and know where he was 2 months ago and see where he is today. Today, he's going home! My best to you Mr.____, you've renewed my faith in PEG tubes!

If I had a dime...

Oh if I had a dime for every time I said I was going to be faithful and make a post daily or weekly I could...what? What would I do with all those dimes? Never mind, here I am again with the best of intentions.
As I looked at the last post with the picture of the broccoli, I saw there were no weeds in the garden. I need to take some pictures to show you just what it looks like now. I have had the best harvest ever, put up a freezer full of summer veggies. We've had lots of heat and rain and I've had little time or interest to weed in the hot humid garden. Ugh!
Yeah, I don't have enough time to fully engage in all my hobby delights and thus the weeds have grown tall, the insects are filling their little bellies on most of what's left in the garden. My friend CS, a.k.a. "The Wizard", has been too busy himself to come help out in the garden. I've even thought of renting out a room upstairs to someone if they would agree to be my "handy man" and help keep the house and garden in order. I sure could use the help.