Back Ache

Last Monday I worked, then was on the road for about 5 hours taking a friend to see another sick friend in a hospital about 100 miles away.

Tuesday afternoon, my back started to ache. By Tuesday evening I could hardly walk or stand. I didn't work on Wednesday. I treated it with ibuprofen, acetaminophen, and ice, and rest, and by Thursday was feeling much better. I worked Friday, but didn't lift my patient.

I FEEL all recovered today, but my hip is still very sore/painful when I get out of the car even after driving for just a few minutes. I hope this is not becoming a chronic problem!

I feel so bad for nurses (and anyone, for that matter!) who faces back pain every single day. Or any type of chronic pain, for that matter! It was very frustrating to me to have my everyday activities curtailed for even a few days . . . it would be very difficult to face that every day.

I received a very interesting business proposal last week. I'm praying about it and considering it from all angles. If I do take it, it would mean that within a few months I could quit my nursing job! I will continue to work at it at least several days a month in order to fulfil the requirements for keeping my license active , and keeping active with the company I now work for.

I didn't realize how much this job is getting me down, even just working a few days a week, until I seriously considered the prospect of possibly being able to, for the most part, quit.

Things that Annoy Me

My husband becomes annoyed with me when we watch medical shows together. I can't help but commenting on the inaccuracies on so many shows--the patient rooms are huge, CPR is rarely done correctly, nurses sometimes behave like idiots (I particularly dislike when nurses are portrayed inaccurately) . . .

I used to love the show House. What I enjoyed the most was House's attitude, and how he said what sometimes I would love to say to people! However, the medical situations are so unbelievable to anyone with any knowledge of medicine, I can't watch it anymore. I'm too distracted by the medical aspects that just cannot take place. I don't understand why they can't make the show at least somewhat believeable.

One of my dream jobs would be as an OB nurse, so I occasionally watch some of the shows about birth. They irritate me too! I realize that time constraings prohbit them following a laboring lady through her whole labor, but it seems so many times they show a lady laboring on her back, in bed . . . announce she's not making progress, and immediately decide to do a C-section. There are soooo many interventions that can assist the progress of labor--walking, changing position, squatting, slow dancing, and so on and so on and so on! I know many pregnant women watch these shows, and if labor were portrayed just a little more accurately, women might realize the things they could do to assist labor.

It's our job as nurses to educate people--about innacuracies portrayed in TV shows as well as many other things. It's overwhelming to try to do this, however, in the face of so many shows, watched by so many people.

Simple Solutions

I've found that sometimes it's simple to make tasks easier. My patient's home is small and crowded, and for several years I struggled with turning her wheelchair around in her room, after I'd gotten it from the closet in which it was stashed between uses. One day it hit me--why not BACK the wheelchair down the hallway, and up to her bed? I also back into the room when I take her back to bed, saving myself from having to turn it around again in the very limited space in her room. This had made a tremendous difference in the time, effort, and back ache involved in transfering her several times a day. {I felt rather silly when I told the other nurses about this great discovery, and they replied that they'd been doing this for years!}

SL's mom fixed up a small cart in another room, which contains items for dressing changes, IV flushes and supplies, and other procedures we routinely perform. One day I decided that instead of trying to get all of the supplies to her room, I'd take the whole cart to her room! WOW--what a difference! I didn't have to worry about forgetting anything, and if I dropped something on the floor or needed different or more supplies, they were right there.

What can you do to make your job easier? We all develop our own methods and routines in getting through our days, whether we're nurses, mothers, students, carpenters, or cooks (or fill all of those roles during our day). Think about what you can do to make any job easier.

Monday Again

I've had enough days off between work days to not dread going to work. Actually, I rarely dread going . . . some days I even look forward to the change in routine. The routine is a bit different every day, so it's nice to have that variety.

There wasn't a nurse Saturday or last night, so SL was extra "funky-no-bath" smelling when I got there. UGH. I think I get her cleaner when I give her a bedbath--I can get to all of her "parts," including her back, much better than I can in the shower. But her mom really likes her to have a shower, so today I gave her one.

She has a custom-built shower chair, and we use a lift to transfer her from her bed to the shower. She's a tall girl, so it's tricky to get her from the bed to the shower without bumping her head or feet on something. Today I was thinking thru the process and realized that if I turned the shower chair the other way, I would not have to turn SL completely around between her bed and the shower, and again on the way back to her bed.

I got her undressed completely and got the sling positioned under her in bed. I took a few minutes to make sure everything was set up in the bathroom, and then transfered her to the shower chair. The shower went OK . . .but my legs got soaked! I'm not the most graceful person in the world when it comes to water . . .

I did SL's trach and g-tube care while she was in the shower; it was nice to do it in the bathroom where all the supplies are located. I enjoy doing those technical tasks; it makes me really feel like I'm using my nursing education.

When I went to put pads and a towel on the bed before I took SL back to bed, I discovered that in the time she'd been on the sling and before I took her to the tub, she'd urinated a LOT--and I had to do a quick linen change. ARGH! Monday.

SL did NOT like her shower . . . and it took longer than giving her a bedbath and washing her hair in bed . . . plus I had to wash her back and bottom when I got her back in bed, to complete the bath. I know it's important to her mom . . . so I'll continue to do it, at least once in awhile!

Private Duty/Home Health nursing is different than acute care nursing in that family preferences and routine dictate OUR routine much more than they do in the hospital. This can be good . . . or bad! Most of the parents are extremely knowledgeable about their child's illness or condition and medications and treatments. All the parents I've met in doing private duty/home health nursing have had at least one quirk relating to the care of their child . . . but then again, ALL of us have quirks when dealing with our children! The majority of the parents have been easy to work around, at least for me.

Part of what I love about private duty/home health (from now on known as PD/HH) nursing IS the usually relaxed pace of only having one patient. Even if the patient has multiple medications and treatments, and/or needs constant supervision . . . the nurse can do everything without that feeling of having three more patients down the hall waiting for their own medication/treatment/cares, etc.

Time to check my other patient . . . my son! More about him tomorrow.

Trip to the Doctor, Four Hours; Time in the Doctor's Office, Five Minutes

Her mom and I took SL to see her pulmonologist for a routine visit. He's in a large town about 100 miles away. The drive was two hours--each way. We sat in the waiting room less than 3 minutes (literally; I timed it!). The nurse got her vitals, and we sat in the exam room long enough for me to start her charting (I'd done her assessment and vitals before we left).

The Pulmonologist came in, took a cursory look at the chart (he'd seen her one other time, about a year ago), and asked me if she'd been coughing. I replied that she hadn't been coughing much, her secretions were think and white, and her SpO2's had been in the 94-96% range.

He took out his stethescope and listened to her chest . . . in exactly two places. OVER her shirt. He made the brilliant observation that, "Her color looks good!" said to make no changes and come back in a year.

I think SL's respiratory status has been very good, but wouldn't you think a specialist would want to do a more thorough exam?

Oh well. It made for a quick day at work and I think SL enjoyed the change in routine.

Charting on Sick Kids

Teenage Son (from here on out known as "TS") was still having abdominal pain yesterday. I called the doctor's office and left a message with the receptionist, describing his symptoms. (sidenote: I really like my doctor . . . but after going to several of my patient's doctors with her, I like his office less and less. SL gets into the exam room within MINUTES of walking in the door, and so do any other patients sitting there. It routinely takes more than 30 minutes to get into the exam room at my doctor's office, even if the appointment was set up far in advance.)


The nurse called back within an hour (another complaint; usually it's at least 2-3 hrs. before they call back), saying the doctor wanted to see TS for an office visit.


TS was very unhappy to have to go to the doctor; he's generally very healthy so not used to going. To make matters worse, the visit began with a blood draw. He HATES needles (which is much better in my mind than LIKING them!), but didn't want to hold my hand, or even have me near the table he was lying on when the blood was drawn. He DID, however, have his cell phone in a death grip . . . I guess somehow that helped him feel connected to and comforted by his girlfriend and other friends, who he'd been texting throughout the visit (when the doctor and nurse were not in the room, of course).


A few minutes after the blood was drawn, the doctor came in to examine TS. His tentative diagnosis leaned toward mono; his bowel sounds were normal, his WBC count was not up, and the location of the pain wasn't typical of that for appendicitis, although the doctor did say that often the appendix was in an atypical position, producing atypical pain. The doctor did a throat swab also, saying he'd had several cases of kids presenting with both mono and strep. YIKES!


A few minutes later the doctor was back with the diagnosis of mono; the pain was from his liver and spleen being enlarged and inflamed. The doctor talked about the importance of rest and avoiding any type of contact sport, like sledding (potential of running into a tree, but humorous as it's been 80+ degrees and any potential snow is months away!), belly flop contests, and bull riding. I appreciated that the doctor took the time to talk directly to my son, and answer any and all of our questions.


The strep test came back negative, but the rapid tests often give false negatives, so it's been sent to a lab. TS's throat isn't sore today, so I don't think strep is part of this illness.


Before the doctor left the room he said that he wanted to check liver enzymes, too. TS made a face at the prospect of another blood draw, but the doctor said that his nurses were used to him ordering additional tests after examining the patient, so they always drew extra blood right away--smart nurses! I was impressed.


The enzymes were up, so son is now on a decreasing dose of steroids. The instructions were not complicated--three tablets a day for three days, two tablets a day for three days, and so on . . . but I can't keep track of meds that have to be taken more than once a day, not to mention keeping track of how many days I've taken how many meds . . . so I made a medication chart. TS asked a very pertinent question; "Do I have to take them an equal number of hours apart, through the night, or just while I'm awake?"


TS has been happy to take it easy today. I think, however, in a few days he'll be itching to get back to his normal active routine! I'm thankful it wasn't something serious, or appendicitis . . . although TS did point out that if it would have been, he'd have been "better" much quicker.

Mondays

I work every Monday. I don't mind working every Monday; in fact, it gets the week off to a productive start. What does bother me is what goes on--or does not go on--with my patient all weekend when there are no nurses there.

It's certainly not abuse, and couldn't be defined as neglect, either. It's just that SL is not getting as good of care as she should. When I get there Monday morning her lips are coated with "gunk". Her limbs are tight; I don't think her mom does range-of-motion all weekend. Her mom doesn't get her up in her wheelchair all weekend, after having wrist surgery--more than a year ago (she's been OK's by the doctor--months ago--to resume every activity, including lifting, that she did before the surgery. Besides, there's a lift she could use)! SL's back is red; thankfully there have been no open areas--at least not yet. But it's clear that she doesn't get repositioned regularly. Her hair is very greasy, and while her body odor is not terrible, it definitely falls into the category of "funky and unbathed for two days."

I feel bad for my patient; those basic nursing cares--oral care, repositioning, getting up, and so on--are necessary health-wise as well as comfort-wise. I think we have a duty to make our patients comfortable, no matter what their level of alertness or mental status.

It also bothers me because performing these very basic nursing cares--oral care, repositioning, getting a patient up in her wheelchair, and so on--are so important to preventing potentially dangerous complications like mouth sores, skin ulcers, blood clots, pneumonia, and so on. My patient is only in her 20's, and I think that's why she's been able to fend off these complications . . . at least so far. However, it's not a given that she'll be able to resist complications indefinitely! Her respiratory status is poor to begin with, and she had a UTI a few weeks ago. Performing these cares and basic tasks would probably take less than an hour, at the most, every day. Yet her mom doesn't do them.

Today, shortly after I arrived, SL was wet. She was also moving her legs kind of like riding a bicycle--very UNcharacteristic for her. When I changed her, I noted that her peri area was extremely red, almost raw in some places. Obviously it was very painful when her urine touched those areas. I washed the area off with a soft cloth and left it open to air for about 15 minutes, and the redness was dramatically decreased. I told her mom I'd done this, hoping that she would leave her bottom open to air when she was in bed later in the day. Before I left, I positioned SL on her side, with her brief open, to get the pressure off of her bottom and leave the area open to air. I told her mom I'd done this, too, but got the impression her mom was unhappy, because later she'd have to remove the pillows and reposition SL on her back again.

The other nurses and I are in a tough spot. SL's mom DOES change her brief whenever she is wet or has a BM (although there is often some BM in the cracks {sorry!} when I change her the next time she's wet and do peri care). She DOES give SL her meds and formula on time. She just doesn't do the basics that she probably feels are "extras" . . . but nurses know are part of basic good care. We do all the teaching we can . . . we all reinforce what the other nurses have said. But if we "push" too hard, SL's mom gets defensive and is less likely to listen to us.

But I can't say that SL would be better off in a long-term-care unit . . . although if she was there, she would get much more stimulation, PT, etc. Maybe. Depending on staffing and how good the particular staff members were. We have absolutely no basis for "turning her in" to social services or even calling the doctor about it. SL's mom has successfully kept her at home for more than 20 years--who are we to question what she does???

All we can do is teach why it's important, and give the care WE know is the best we can give. When I put her arm braces on before I leave, I know they'll be on at least a few hours until her mom gives her meds later in the afternoon and takes them off. When I position her on her side, I know she will be that way for at least a few hours, too. When I give peri care I know she will have no BM on her skin until she has another BM, usually not until the next day. When I clean her mouth and lips, I know she is refreshed for at least a few hours.

Although it's all I can do for her . . . some Mondays it feels like it's not quite enough.

Sick Kids

No, I'm not talking about Pediatrics in the hospital . . . I'm talking about the difference between sick "patients" and when your own kids are sick.

Thankfully, my kids have only been seriously ill or hurt a small number of times. The scariest was when our son was in 1st grade and developed asthma. When I got him to the ER his SpO2 was only 84% . . . very scary! A couple of nebulizer treatments turned him around very quickly . . . and I never forgot the lesson of going to the ER sooner rather than later when it comes to respiratory problems. Thankfully he outgrew the asthma but during the years he had asthma I had inhalers in every vehicle, every home he regularly went to, every purse I carried . . .

Our son rarely gets sick, but when he's sick, he's SICK, and not just a little bit. He's usually in bed for at least a day or two. Yesterday we were out of town and he complained about having a bad headache and a stomach ache. . . within half an hour he was laying in the truck, napping, which he did for several hours while our daughter participated in her events. Of course, being a nurse, I didn't think about him having eaten bad fast food or anything simple like that. I thought about pancreatitis, a kidney infection, stomach ulcers . . . sometimes nurses know too much!

It was difficult when the kids were babies, and couldn't tell us where it hurt or what was wrong. I remember feeling soooo helpless when they cried, and cried, and cried, and we couldn't figure out what was wrong. All we could do was rock, hold, and cuddle them. Those memories are bittersweet; of course I didn't want the kids to be sick, but there is something that touches a mom to the core to know that she, and only she, can comfort a sick child.

Now the kids can tell us what is wrong when they don't feel good . . . IF they feel like it. Our daughter is usually more than willing to detail all aspects of any ache or pain . . . while son is often reluctant to do so. His side of the conversation this morning went like this: "I don't know where I don't feel good, I just feel bad . . . yes, my head hurts . . . I can't rate it on the pain scale! . . . my stomach doesn't feel good . . . I don't know if I feel like throwing up . . . I don't WANT to rate it on the pain scale . . . OK, FINE, it's about a 5 or 6 . . . what do you mean by 'localized or general pain'? "

Five or 6 on the pain scale is where I start to get concerned, but it's been steady or decreasing since then so I'm not too worried. He's been eating and drinking a little throughout the day, and the pain has not localized, as it would with appendicitis or anything more serious. I will take him to the doctor tomorrow if it gets worse. He's been sleeping much of the day, so I think it's some type of virus/flu that's been going around.

Sick teenagers are crabby, just like sick babies. The only trouble is, my sick teenage boy won't let me "cuddle" him ("Mom, you're WEIRD!"). He has, however, kept his cell phone close all afternoon. In between questions about his pain, going to the bathroom ("Mom, that's SICK to talk about!"), and eating and drinking, I found out that he's texting his girlfriend. I guess when you're a teenager in 2008, texting your girlfriend when you're sick takes the place of cuddling with your mom.

An Open Mind

I went to an interesting workshop yesterday and today, on the topic of psychiatric nursing. I enjoyed it very much. The instructors were very good--they had a sense of humor and gave pertinent, interesting, useful information.

I learned that Psych Nursing is one of the oldest nursing specialties, as the McLean Hospital in NY began training nurses in psych in the late 1800's.

From the information they gave I diagnosed a 'friend'/former friend with a personality disorder (I'm not sure exactly which one, but one of them for sure!) and my father-in-law with Narcissistic Personality Disorder. (One day this week he asked when I was going to let my hair go back to its original blond color and let it grow long again, because HE liked it better that way . . . yesterday I bought another box of red hair dye and this week I'm going to get it cut again!) I had a few signs and symptoms of Generalized Anxiety Disorder but not enough to make that diagnosis on myself (WHEW!).

We didn't have time to get into "Inability to put Dishes into the Dishwasher" or "Permanent Cell-Phone to Ear" (for my husband), or "Chronic Bickering" or "'I Didn't Hear You Say That' Syndrome," both of which would fit my teenagers.

I think if we studied the whole DSM-IV, we could come up with a diagnoses (or two, or three!) for everyone in our lives, including ourselves!

A neat part of psych nursing is that it can be used in ALL areas of nursing, and in personal relationships, too. When we know more about why people behave the way they do (whether it's part of their personality or a disorder or disease), we can learn techniques to deal with the those aspects of their personalities.

Even simple communications techniques that are used with patients--active listening, paraphrasing, clarification, reflecting, etc--can be used when talking with friends and family. ("So, son, from the look on your face and the way you're struggling to get away from me, I sense that you are uncomfortable with the words 'penis,' 'teenage sex--DON'T DO IT!!!!' and 'erection'" . . . )

Psych nursing is my favorite area of nursing. I find the way the mind works fascinating! It's interesting to learn about the "why's" of people acting the way they do. Sometimes it seems there are more questions than answers--do people develop disorders due to biology, or environment? Certainly both are factors, but how much of a factor does each play? Or are some people predisposed to disorders and environment and stress brings them out? Can any of these diseases be cured? IS everything listed in the DSM really a disease? How much of the behavioral aspects of these "diseases" or diseases can be controlled? What part should medication play?

One of the nurses today told us that taking some medications can actually change the chemistry of the brain, potentially "curing" depression and anxiety permanently. WOW! Our daughter suffered from panic attacks after changing schools last fall, and took Lexapro for about 9 months. She has begun to wean herself off of the medication because she's tired of taking it. Thankfully, she had no serious side effects from it. It has been, and probably always will be in my mind that perhaps she's at higher risk of suffering from anxiety and/or depression later in life . . . it was nice to hear of the possibility of her brain chemicals being permanently changed for the positive from her time on the medication.

My first job out of nursing school was in a small psych hospital for children and adolescents. I absolutely loved working there--the other staff members were wonderful, and I learned so much. I don't know, however, if I would have the patience to work in psych again. I do know, though, that attending this workshop sparked my interest in psych again, and reminded me why I love nursing.

My Favorite Patient

My favorite patient is my private duty patient. I've had a longer relationship with her than with any other patient--so far about 2 1/2 years.

She was born "normal" (as normal as any of us are!) but sustained a brain injury when she was a toddler. The injury left her totally dependent on others. She cannot dress, bathe, reposition, or feed herself. She's in her 20's now, and it's amazing that she is as stable as she is!

She cannot talk . . . but I can tell she knows me from the look of recognition on her face when I say "hello" to her in the morning when I arrive for my shift. She expresses her likes and dislikes by her facial expressions, also.

She's on multiple medications for her seizures and other hazards of immobility. She's fed through a g-tube, and receives medication through an implanted port periodically to treat her osteoporosis. She has a trach, although I'm not sure it was necessary to perform as she's never been on a ventilator. Her past records are not in the chart, and her mom isn't clear on the reasons for the trach, either.

I've found that in this situation I care for the family (especially her mom) as much as for my patient, who I'll call SL (NOT her real initials!). DL, her mom, has built her life around SL. There are a lot of interesting interpersonal facets to the family, which also includes DL's husband, KL, and their other children (who are on their own), CL and GL. I enjoy using my Behavioral Science/Psych training with all of them!

I enjoy the job because I am able to use my technical skills, but am not pressured by having several patients to care for at a time. I can take my time with SL and spend time talking with her mom, when she needs to talk.

It's time to make supper for my family now (hamburgers on the George Foreman grill), but I'll be back within the next few days!

Reassurance

I recently read that one of the most trusted professions was nursing.

I've noticed that having the title of "nurse" provides reassurance to anyone worried about a health matter, no matter how simple or complex the question or problem.

Just the act of asking a nurse a question (no matter how simple), and getting an informed answer (even if the answer could have been easily found in a book or on the internet), makes people feel better.

Anyone can learn to take a blood pressure . . . but when a nurse does it, the readings are more credible.

My grandpa's doctor can tell him something, but when he gets the same information from me, he usually acts on it. When he was in the hospital, I called grandpa's nurse every day. When I then talked to mom and dad and reported, they would say, "That's what his nurse said, too." They were obviously reassured to hear that information again.

As nurses, we have a tremendous responsibility when we care for people who are sick or hurt. We perform high-tech tasks. . . . we know the dosage and side effects of medications . . . we know the "whys" of complex diseases . . . but sometimes the most meaningful tasks--answering a question or performing a basic procedure--are the most simple ones.

Vicarious Nursing . . . or Why I Decided to Write a Blog

Mr. Webster defines "vicarious" as, "experienced or realized through imaginative or sympathetic participation in the experience of another."

I am a vicarious nurse. I dream of having a job in a huge hospital--in labor and delivery or on the transplant unit, perhaps. I see myself efficiently carrying out tasks, professionally juggling all of my duties, and saving a life or two every day. (read the above definition again; it does contain the word "imaginative"!)

Of course I know that there is NO ideal job . . . but it's my dream so I can dream how I want to!

When I was in nursing school I considered moving far from where I lived at that time--a small town in the midwest (and for you "big city" people, "small town" is NOT 30,000--a "small town" is more like 5,000 or less . . . . the town in which I grew up had only about 1,000 people)--to a huge city with huge and specialty hospitals.

During my last year in college, the Army and Navy were recruiting and a group of nursing students went on several trips sponsored by those services (who wouldn't pass up three days in Florida in February, or three days in SW Texas in March???). The benefits were great, I'd always wanted to travel, and I seriously consdered signing up.

However, my then-boyfriend, afraid I really WOULD disappear on my world-wide travels, proposed, and all of my thoughts of joining the Army disappeared in a cloud of wedding preparations. A few years later we moved back to the family ranch . . . and here I am today, with teenagers, living in the country, and the dream of working a big-time job in a big-time hospital is not going to happen in this life.

Not that I regret it (most of the time, anyway!). I know I've idealized those big-time jobs . . . and there's no way I could be an active mom in my family if I did have a full-time big-time job. Some moms have an undending supply of energy, but not me!

But I think everyone in my situation, about my age (I recently celebrated the 23rd anniversary of my 18th birthday), thinks about "what could have been." That's where the "vicarious nursing" comes in. I love to read other nurses' blogs (some of my favorites are listed in the sidebar) and imagine, even if just for a few minutes, being a part of a big organization, learning new skills, and really making a difference.

I know there are a lot of unhappy nurses out there. I think I would probably be one of them if I was working in a big facility, too--my absolute priority is patient care and that's very difficult to provide with all of the restrictions, paperwork, and administrative tasks nurses have to do, as well as simply having too few nurses.

I hope this blog will encourage nurses--nurses who are just starting out, and nurses who are perhaps burned out or tired of the profession. I hope that nurses who are not working in the field right now, other "vicarious" nurses, might enjoy this blog as I've enjoyed others.

My job is almost perfect . . . but still has its difficulties and frustrations. This blog, therefore, will have several purposes--therapy, for me, and hopefully encouragement for you, my readers.

I look forward to your questions, comments, and suggestions.

Bandaids on Dolls and IV's from Straws

I've wanted to be a nurse for as long as I can remember.

When I was a little girl, I didn't play "house", I played "hospital," with my dolls (or sisters, when I could talk them into it) as my patients. They had pen dots all over their little bodies from the "shots" I gave them, and "IV's" made of pens taped together, draped through their "hospital" room.

I went to nursing college in the late 1980's. Looking back, it was a historical time, in a way . . . nurses were just starting to use universal precautions and I can remember experienced nurses discussing the necessity of doing so.

For the most part I loved nursing school! I was surprised to find I hated my pediatric rotation and loved psych. I decided to minor in Behavioral Science and have used that training often . . . both with patients and my (sometimes very dysfunctional) family and friends.

Throughout my nursing career I've had many jobs--some I've loved, some I've hated. As I've gotten older and more experienced, I realize that at least some of my jobs would have been a lot more pleasant if I'd asserted myself as I should have. I also see that nurses are so willing to accept all that's put on them . . . and people are more than willing to pile more tasks and responsibilities on nurses. (A list of the jobs I've had as a nurse appears on the bottom of my home page).

I always knew that when I became a mom, I would stay home with my kids. I've been blessed with a husband who agrees, and works hard enough that I was able to be home with them for many years.

I know there are many drawbacks to a nursing career. However, I've been additionally blessed to have found several part-time jobs over the years that allow me to contribute (in a small way) to our family finances and work enough to keep up my nursing license. For the last 2 1/2 years I've had a private duty job only about 8 miles from home. I'll blog more about that at a later time--it's my almost perfect job in nursing.

I'm thankful for my education in nursing, perhaps more at this time in my life than any other. My husband's parents are aging and having more health problems. Since they live less than a mile from us (remember, I told you there was dysfunction here!) I'm often called in when someone has a seizure or needs their blood pressure checked.

My own grandfather (who lives two states away, next door to my parents . . . theirs is a different kind of dysfunction!) is ill and my parents just do not know how to deal with him, either medically or emotionally (putting my behavioral science degree to use again).

Even if I'm not working in a "traditional" nursing job, I know I'll be using what I've learned, every day of my life.