I’ve graduated, passed boards, been duly board certified, applied for licensure in two states, and can now proudly claim to be an Advanced Registered Nurse Practitioner (ARNP) in the state of Washington. All I’m lacking now is a DEA number to prescribe controlled substances. Until then, all I can prescribe are “legacy drugs,” which basically means aspirin.

I’m still awaiting for my Oregon licensure to be finalized. It was a much more tedious process and took me a lot longer to finish, so I predict it will also take them longer to complete. That’s okay though, because I’ve got to get in some more overtime before I can afford a second DEA number. They don’t come cheap.

Meanwhile, I’m trying to figure out what to put on my business cards. In Washington, I am an ARNP, while in Oregon, I will be a PMHNP (Psychiatric and Mental Health Nurse Practitioner). Do I get different cards for each state? Or put both titles on one card, in which case there’s not room left for much else?

Ahh, conundrums.

Dear Ruth,
Please tell me you can move to wherever there are jobs. If you cannot I am so very sorry but I cannot help you. My focus is on meeting the needs of my communities and find them candidates who will practice there. It is not, sorry, on focusing on the candidate’s specific job needs. EXCEPT as to how they meet the needs of “my” communities.
And I have to say, unfortunately I do not have hardly any communities with which I work in SW Washington, not to say there is not need. And I don’t do Oregon.
Look forward to your response and I do hope we can work together. Sorry for seeming so blunt but I find being honest and to the point saves us all a lot of time.

Apparently, this person got my information from one of the job posting websites I’ve browsed through while seeing what potential nurse practitioner jobs there might be in my area. So as far as I’m concerned, this was a cold contact by a recruiter, connecting with a potential job candidate in a profession for which there is a HUGE demand. I wonder how many eager new recruits they have rushing to work with them?

Here’s my response, which I wrote instead of going to sleep after night shift like I was supposed to be doing:

Dear ***,

I’m confused. If I had actually approached you with a list of totally unrealistic expectations and asked you, at great inconvenience to yourself, to go out of your way to help me find a job, perhaps such an unprofessional response might have some merit.

But I didn’t. YOU contacted ME, and as far as I could tell at first, completely out of the blue. It wasn’t until after I’d been bowled over by your message that I reached the bottom where the information from *** was attached, and realized why you were even emailing me in the first place.

I have absolutely no prior knowledge of who you are, what you do or don’t do, or what constraints you operate under. Nor do I have any expectations of your doing anything for me that won’t benefit you (or your clients). So basic societal norms (read: cultural competence!) would indicate that you don’t start right off making assumptions and blasting me for daring to not have the exact qualifications you are looking for, or for being interested in jobs in a state that you don’t handle.

Perhaps a friendly introductory letter explaining your focus, describing your territory and the rural locations of the available jobs, and offering the fact that relocation is usually a requirement, would convey the same message at the same level of honesty, while not souring potential candidates on the idea of having anything to do with you whatsoever.

Being a busy grad student and nurse meant I thought I didn’t have time for DIY projects, so my original intent was to purchase a pre-made coop and chicken run. To my amazement, I found a chicken tractor on Amazon.com–with FREE super saver shipping! I happily placed my order.

A week later, Amazon informed me my order had been canceled due to unavailability. Frustration set in. I searched in vain for another source, but couldn’t find anything I liked as much that was within my price range. It seemed that building my own was my only option, but I didn’t see how I possibly could. For one thing, we don’t have much in the way of woodworking tools. Also, finals week was fast approaching, and “spare” time was at a premium. I needed to come up with something I could do quickly and easily, without too many fancy tools. Here’s what I came up with:

I bought a Rubbermaid storage shed at Home Depot.

Inside, I added a roost and a rack to hold the “nestbuckets” made from Home Depot buckets. I also made a screened wall on one side, so that one door can be left open for ventilation during nice weather.

To secure the wooden fixtures, I drilled holes through the walls of the coop and screwed wood screws through from the outside into the wood pieces. Where possible, I took advantage of the shapes and depressions of the plastic to add additional support. The screen wall is fastened to the wall of the coop and also to the roosts. The nestbuckets are not permanently fastened to the rack they sit on — I use a bungee cord to hold them securely in place.

In the back of the coop, beneath the nestbuckets, I cut an opening for the chickens to use for going in and out. I made a mistake and made it flush with the floor, before realizing that there should be a “lip” to hold the bedding in, so I added a scrap piece of lumber across the bottom for that purpose. I used strips of trim to “frame” the opening and hide the hollow walls of the Rubbermaid container.

Since there’s no way to keep the right-hand door closed when the left-hand one is open, I added gate latches on the inside to fasten it to the screen door. I can easily reach the lower one by reaching down through the top of the coop, but for people whose arms aren’t as long as mine, a pull string could be rigged for that purpose.

The last step was to add four eye bolts to the outside of the coop, to secure it to the run (I’m using bungee cords for this purpose), and to add strips of 2×2″ lumber to use as handles, since the smooth plastic makes it hard to get a grip on it for transporting the coop.

The run is made from two cattle panels with 2×4″ openings, using pig rings to secure the pieces together. The sides and top are each a half panel. The remaining piece was cut into 3 parts. Two of them form the end of the run farthest from the coop. The bottom half is fastened permanently in place, and the top half is fastened only at the top, forming a hinge that allows it to be swung up onto the top of the run for access to the inside. Again, I used a bungee cord to fasten the access panel in place when it is closed. I’m tall enough to easily step over the lower piece, but someone without my height advantage might need to modify the design to work for them. The remaining thin piece of cattle panel was fastened vertically to one side of the end of the run next to the coop. It adds some structural stability as well as allowing for the fact that the coop is not quite as wide as the run. A 2-foot wide strip of hardware cloth with 1/2″ openings was fastened all the way around the lower portion of the run, to keep raccoons from reaching through to grab the chickens.

Finally, I fastened a tarp over the run at one end to protect the feed from rain. Here’s the finished product, complete with chickens:

My particular vestibular disorder, Menieres Disease (aka endolymphatic hydrops) is caused by excess fluid in the inner ear’s hearing and balance structures. Normally these structures are independent of the body’s fluid system, but in Menieres Disease the independent fluid control is lost, causing fluctuating fluid volumes and concentrations in the inner ear, which in turn causes pressure, tinnitus, dizziness/imbalance, and loss of hearing.

For years, people with Menieres have been told to go on low sodium diets. Increased sodium means increased fluid retention, as we all learned in high school biology. But in nursing school physiology I learned that the body regulates sodium balance in the kidneys, so I knew that although eating too much salt would definitely cause increased volumes, eating less salt would, at least to some extent, just mean my body would excrete less of it in order to keep things balanced. Nevertheless, once I had cut back on sodium, I could cause instant symptoms of dizziness and vertigo just by eating something that was too salty, so I could definitely tell it had an effect. As a result, I have spent the last 10 years or so carefully avoiding foods I knew have more sodium than I can tolerate.

Last month, I started seeing a new vestibular specialist. My symptoms have been pretty well controlled, but my previous specialist retired about 3 years ago, and I figured it was probably about time to have a checkup. My new doctor explained to me that the fluid volumes in my inner ear are governed by the overall chemical / hormonal / electrolyte balance of the body fluids as a whole. The driving factor behind that overall balance is not sodium, but insulin.

The key to symptom management, as well as minimizing the permanent damage being done to the inner ear and even trying to restore some function, is managing the level of insulin in the blood and trying to keep it as steady as possible. The more consistent my insulin levels are, the less fluctuation there will be in the fluid volumes in my inner ears.

The diet he wants me to follow (and this is the sobering part: FOR THE REST OF MY LIFE!) is based on the Zone Diet. Where the Zone Diet uses 3 meals and 2 snacks per day, however, this version uses 6 equal small meals evenly distributed throughout the each day. The first one is to be eaten within an hour of waking up, and the last one before bedtime is the most important one, because of the long gap before the next meal.

Each meal consists of the same proportions of protein, carbohydrates, and fats. Carbohydrates, as probably everybody knows, increase the level of glucose in the bloodstream, which causes a corresponding rise in insulin levels. Protein causes the release of glucagon, which regulates insulin levels. And fats control various hormones that also work to keep insulin levels controlled. So the whole point is to balance intake in order to keep insulin at a relatively steady level.

At the Zone website there are lists of “Zone food blocks.” There are three types: a protein block contains 7 grams of protein; a carbohydrate block contains 9 grams of carbs (not counting fiber), and a fat block contains 3 grams of fat. There is also a “body fat calculator” that tells you how many “blocks” per day you should consume. I’m supposed to eat 12 blocks per day of each of the 3 types, so with 6 meals, that’s 2 blocks of each type per meal. I’m to eat every 2-3 hours, never going more than 5 hours between meals during the daytime.

The approach that the nurse recommended to me is to make lists of the foods I’m interested in in each of the 3 lists, stockpile those foods, and as much as possible, have them pre-prepared in block-sized portions. Then I can just mix and match for each meal. For the first 4 weeks, I’m not supposed to eat from the “less favorable carbohydrates” list, so that means the only grain I’m allowed to have right now is steel cut oats. Fortunately, that’s my favorite breakfast.

I’m also supposed to carry “emergency food.” One stick of string cheese is one protein block, and they don’t have to be refrigerated. One apple is two carbohydrate blocks; you can get your hands on an apple just about anywhere. Applesauce also comes in single-serving containers, and one of those is one block. Fat is easy – three almonds is one block. There are also Zone Balance bars and another brand called Balance Bare that have the right proportions and amounts for one 2:2:2 meal. And 6 ounces of 2% milk is a perfect 1:1:1 food, so in a pinch I can drink a half glass of milk and go a little longer before my next meal.

Besides the protein : carb : fat ratios, there are some other things that I have to monitor in my diet. Splenda and stevia are the only sweeteners I can use — all of the others can affect glucose levels. Caffeine increases insulin secretion, so ideally I should avoid it, although for people who just have to have a cup of coffee in the morning, my doctor says to do it consistently — the same amount at the same time every day. MSG is also to be avoided, as are aspirin and all other non-steroidal anti-inflammatory drugs. (I will have to ask again what the reason is, because I’ve already forgotten, but they do something that affects fluid balance in the inner ears.) And I’m supposed to drink a minimum of 64 ounces of water per day, evenly spaced throughout the day.

As for sodium, it’s to be avoided in large amounts. Like everything else, my meals should contain similar amounts of sodium — but the plan is to titrate me back up to within the ADA recommended 2000-3000 mg daily consumption range. Oh, and I’m supposed to eat a 1:1:1 snack 20 minutes before exercising.

It’s actually been kind of fun creating my meals, since I’m not cooking for a family any more, which means they can be as weird as I want. I’ve loaded the freezer with frozen protein servings (turkey sausage, chicken breasts, etc.) and frozen fruits, stocked the fridge with boiled eggs, tofu, apples, oranges, kiwi, and Mozzarella cheese, and stashed single-serving containers of salmon, tuna, sardines, and different flavors of applesauce in the pantry.

For breakfast today I ate 2 links of turkey sausage, and 2/3 cup of steel-cut oats with Splenda and 2/3 tsp of butter. I could have had 1/3 cup of oatmeal and mixed in 1/2 cup of blueberries instead — maybe I’ll do that tomorrow. I had a Balance Bare bar for one of my meals, and it was actually quite tasty. My latest meal was 3 oz. of canned salmon, 1/4 cup hummus, 1 kiwi, and 6 almonds.

I’m also expected to keep a diary of the foods I eat every day, what time I ate them, what time I noticed feeling hungry, my fluid intake, and my symptoms. That way, over time we’ll be able to fine-tune my diet to my needs. My diary is also supposed to show the barometric pressure each day — that’s the wildcard in the equation; it’s the one thing that can’t be controlled. (I still have to go buy a barometer.)

I’m the least-regimented person on the fact of the planet, but I’m determined to make this work. Wish me luck! Better yet, join me; then we can share ideas for making it painless and fun!

Official “7 Things” Meme Rules:

1. Link your original tagger(s), and list these rules on your blog.
2. Share seven facts about yourself in the post — some random, some weird.
3. Tag seven people at the end of your post by leaving their names and the links to their blogs.
4. Let them know they’ve been tagged by leaving a comment on their blogs and/or Twitter.

Tagged By:

Thinking I was about to be tagged for this meme, and knowing that after this weekend I wouldn’t have time to blog for at least the next month, I dutifully prepared my entry ahead of time. As it turned out, the friend I thought was going to tag me was merciful and chose 7 others. But by then I’d already gone to all the trouble of writing the post, and I’d hate to think I wasted a perfectly good free afternoon this close to the beginning of the semester. So I’ve decided to publish my post anyway, and credit Felicity with the tag, in hopes the meme gods will be merciful to her for flaunting their rules and not tagging anyone.

Tag, You’re It:

• Jeff
• Etmorpi
• ByGolly
• Greystork
• Weasel
• Rasama
• Enrico

What’s done is done.

There is no longer a choice of candidates before us – what’s before us now is a choice between sitting on our butts complaining to whoever will listen because our guy didn’t get elected and we don’t think the new guy is going to be any good, or rolling up our sleeves and finding a way to make America great again. I know what I choose. I’m not going to sit around waiting for a rude awakening — for me or anybody else. I’m not going to scrutinize the man’s every move for fault-finding opportunities. I’m certainly not going to hope something bad happens so I can say, “I told you so!”

I’m going to put my trust and faith in President Obama. I’m going to pray for him to make the right decisions as he moves forward. Since I firmly believe that every thought we think is a prayer, I’m also going to think positive thoughts toward him as he takes office and starts working for our country.

The United States of America wasn’t founded by complainers and fault-finders. It also wasn’t founded by perfect people who always did everything right and never made any mistakes. It was founded by doers, and by people who were willing to take what they had to work with, and do the best they could. And that’s the kind of American I want to be.

I love this stuff. This one seemed to peg me pretty well, actually. The link to the site where you can take the test is down there at the bottom.

NBPC – The Daydreamer

Nature, Background, Big Picture, and Color

Take The Perception Personality Image Test at HelloQuizzy

As someone who attended nursing school after a successful career in the tech industry, it was disconcerting to be expected to forfeit my adulthood and life experiences and submit to being treated as though I were a naive and inexperienced 18-year-old just out of high school. I had lived in a foreign country and six different US states, owned homes and businesses, raised three children to adulthood, was a degreed engineer with two decades of experience, had been a manager and department head and earned a six-figure salary, and was practically the same age as many of my instructors. The condescending attitudes I encountered as a nursing student, therefore, were appalling. Even if I *had* been an inexperienced 18-year-old, I would have deserved more respect than some of them showed.

It’s no wonder that nursing instructors often complain of the lack of respect they receive from their students. Respect is a two-way street; you have to give it in order to get it. As both a parent and a manager, I could have told them that; tried to tell them that, in fact, but because I was a college student, I had nothing of value to offer them, so they couldn’t hear me.

There were exceptions among our faculty, of course, as I’m sure there are at all nursing schools. A few did appreciate the diversity of experience and knowledge brought to their classrooms by the increasing numbers of “nontraditional” second-career students. They were usually the same ones who showed common courtesy and respect to all of their students, regardless of age or background. Unfortunately, they were in the minority. As I’ve moved on since graduation, encountering other nurses trained at other institutions, I’ve come to realize that my experience was far from unique. Megan D., a current nursing student, tells a story eerily similar to one of my own experiences in her blog post, Lateral Violence in Nursing School.

In a profession whose most important qualities are empathy, caring, and appreciation for cultural diversity, the treatment of students is sadly lacking in any of these things. “Nursing school eats its young” is a common remark, as is, “it’s too bad it has to be that way, but that’s how it’s always been.” Well, here’s another thing I learned as an engineer: the fact that “this is how it’s always been done” does not qualify a process as “the best way to do it.”

Here’s only one of many examples from my own experience: I failed a math test for the first time in my life, in my third year of nursing school. I used to write complex equations full of imaginary numbers and integrals and LaPlace and Fourier transforms that completely described the functional capabilities of electromechanical systems. Yet in nursing school, I failed a test whose most challenging calculations were unit conversions and simple division of real integers.

I didn’t get any of the answers wrong.That wasn’t the problem. The problem was that I derived my answers engineering-style, using the unit cancellations to check my work as I went, rather than plugging numbers into a memorized equation. My instructor (who was fully aware of my engineering background) explained to me that although I had arrived at all of the correct answers, the fact that I had not used the “need over have” nursing equation told her that I did not fully understand the relationships between the numbers. “You’re a nurse now,” she admonished me soberly, “and that means you really have to know what you’re doing, because when nurses make mistakes — they can kill people!”

After more than 2 years of having my engineering, management, and intercultural experience repeatedly dismissed as completely irrelevant to nursing, you might have thought I’d have gotten used to it. I hadn’t. I was stunned speechless.

If I had been able to speak I could have pointed out to her that nurses, no matter how badly they screw up, can only ever kill one person at a time. Engineers, on the other hand, can kill them by the dozens, or hundreds, with a single miscalculation. Shoot, in the right circumstances, they might possibly even kill them by the thousands. This would tell any logical person that engineers are probably trained pretty stringently in how to avoid making stupid mistakes. But logic is one of those things I had been repeatedly told was irrelevant in my new career choice. “Oh, Ruth,” they would sigh, “you’re a nurse now. You’ve got to stop thinking like an engineer.”

As it was, when I reported to the instructor doing the mandatory remedial math tutoring sessions for those who failed the test, and encountered the open-mouthed stare of disbelief from one of the rare faculty members who actually understood and appreciated the meaning of a degree in electrical engineering from one of the nation’s top engineering schools, I got to have a nice therapeutic venting session, and I ended up not having to repeat the exam.

I didn’t get to keep the test, though. I really wanted to frame it and hang it on my wall. I’ll just have to be satisfied with telling the story, I suppose.

This is everybody but Ryan (my oldest) and Felicity, gathered in Galveston for Mom & Dad’s 50th anniversary. Click through to Flickr for labels telling who each person is.