#dnp school

NO IDEA HOW.

I DO NOT FEEL LIKE I MADE THAT GRADE.

AHHHHH.

My brain is absolute mush.

I'm crying, I'm so thankful.

this term is so stressful 😭 I have a presentation due in 24 hours, and then another one due Sunday evening. I did my midterm today (it’s week 3… but that’s what happens when class is 5 weeks long!), which I feel okay about, but ugh it was so stressful. I have to read for Wednesday. I’m trying to balance my school life with work (work is INSANE. The emails never end, then add actually thoughtfully grading two courses is a LOT), and doing fun things. Like yesterday I went out and played Pokemon and went shopping for some stuff and Costco. I have the Fjorester wedding on Wednesday immediately after class and ep 3 of CR4 on Thursday.

AND I’m in this training future faculty program and anxious about what I’ll do for the teaching observations. We do a micro teaching and then two teaching obs - and like, I guess I could do one of my presentations but it also doesn’t feel like teaching? I’ll ask. But there is work for that on top of stuff and I feel very overwhelmed.

Season 1: Episode 6 "Spark of Rebellion"

Season 2: Episode 8 "Echo Tree"

Season 3: I admit ALL of them fucking SLAP hard (ughhhh), but I guess I had to actually narrow it down to Episode 2 "Prisoners of Ank'Harel" and Episode 12 "Souls in Darkness;". (and 3 and 7 and 8 and - like I said, all of them!)

I admit Season 3 was my favorite. I have two fanfics brewing in my head right now. I'm just waiting to get on my cruise to actually sit and write because I have to take *one more* final today, work my ass off on these class notes for the Winter term, and prepare for said cruise by packing, cleaning, and doing the shit asked of me because it is the Holiday season. Family drama is lit!

Loadedddd question, haha!

I technically don't have to land on a project until this coming Spring term (April 2025), but I have been thinking about it. Since my DNP is associated with also becoming an NP, our instructors would like us to focus on how to implement things on the provider side of things versus nursing (though I think that is a bit unfair, considering the majority of my knowledge is nursing, and I'm also here to improve patient lives and outcomes, not just the provider process... but ya know).

So far my ideas include the process of implementing and managing blood glucose in stem cell transplant patients who have acute/chronic graft versus host disease, are in the inpatient setting, and are on high-dose steroids. Steroid-induced DM, or just exacerbate someone's DM! Right now, it is pretty well known that we are okay with blood glucose levels below 180 (typically between 140-180 is tolerated), but steroids make life a lot more tricky, especially when these patients can be on these steroids for *months*. I'm hoping I get to do a rotation on the transplant unit to find out their process (since I don't currently work there). This one is directly tied to how providers order and institute blood glucose management (insulin, sliding scales, etc), and I believe we can always do better when it comes to managing blood glucose.

My second idea (that likely has NO literature on it whatsoever, so it is unlikely to be a process I get to change any time soon, plus it is directly tied to nursing medication administration and not the provider side of medicine) is how we administer Daratumumab (a monoclonal antibody for multiple myeloma). It is frequently given as a subcutaneous injection these days (IV formulation still available), and it is 15 mLs over 5 minutes into the stomach once a week for about 8 weeks, then every two weeks for another 8 weeks, and then once a month until progression of disease. In this case, as someone who has given this drug hundreds of times at two different institutions, I wanted to see if I could implement a new quality improvement on how the drug is administered (a straight needle versus a butterfly needle).

Anecdotally, I have heard from nurses and patients that the butterfly needle is typically preferred. Some patients reported decreased discomfort with the butterfly needle, both during administration and hours after, and others didn't even notice. If you push the med too fast (15 mLs is a lot at once!), there can be discomfort. As for the nurses, we have better control over the syringe and have better ergonomics with a butterfly needle. When using a straight needle, you are holding the needle and syringe up against the skin and are leaning over the patient, which can be uncomfortable for the back and shoulders. You have the ability to sit back more and have more steady control over pushing the syringe when utilizing the butterfly needle. (We typically taped the butterfly needle down, which I think also decreases unnecessary needle movement). At least from what I have seen, there is no standard across the board for administration (just subcutaneous into the abdominal area).

I would love to compile some data on patient and nursing feedback on both administration techniques to get the ball rolling (but it sounds more research-based than quality improvement, and I guess I kind of disagree, but my instructors would argue with me... especially after this summer term. However, it is nursing-focused, not provider-focused, and there is unlikely to be any literature (multiple myeloma is a very small subset of blood cancer, and I pigeon-holed myself on data during my first research course in this program. I ran with it, but it was slim evidence to work with, and it was just around multiple myeloma and stem cell transplantation. I doubt anyone has even considered nursing preference in administration technique for one specific immunotherapy drug *laughs*). I'll get to this one day! Unfortunately, while I talked about it a lot with my fellow nurses in both Denver and here in Portland, I never had a way to implement a change or gather data (though before I left Denver, we changed from the straight technique to the butterfly needle. No idea what data was behind it, but the pharmacy drew up the drug and provided it with the butterfly needle. Daratumumab isn't hazardous, so my Portland job just gave us the bottle, lol)

I am also interested in palliative care (though that might be a project too big to chew for the size we have to limit ourselves to. My mentor Patti literally did her project on the barriers to mass transfusion protocol documentation. All she did was obtain qualitative data from the trauma ICU nurses voluntarily). Our mock project for our quality improvement course this summer was on palliative care in heart failure, and I know my classmate wants to take that and run with it. I also am far more interested in palliative care in oncology. But I couldn't say what I would want to do for a project other than something in palliative care and oncology.

Our instructors (and the class ahead of us, haha) would also love it if we took a previous project and continued it, but none of the current third years have a project I want to continue (no oncology!). I don't want to do a project I am not invested in or interested in.

I may come up with other ideas once we get further into our management courses and start clinicals in February (kajsdlkfjklajsdfl), but I am pretty passionate about DM treatment/management, stem cell transplants, oncology, and palliative care.

now 12 days of panic over if I get selected for the cohort.

There were 11 of us who interviewed. They will select 4.

I think some interviews went well, while others were not my strongest. A few tricky questions I was not prepared for and knew it.

But all I can do is rely on what I said and did, recognize that there are and can be other individuals who deserve the spot more, and know that wherever God wants me, He will guide me in the right direction. For all I know, this was good practice.