Finding balance as a mom


No matter who you are or what you do for a living, being a mom is tough. A common theme I see written about on blogs and talked about among women is "Can you have it all?" This is usually in reference to having a family, career, staying fit and fashionable. I devoted several blog posts on finding balance with a career and family, and have taken advice from many others in the medical field I follow on social media. This is an important topic to me, because as a new mom starting a new career, finding balance was a huge challenge for me. I know that I am not the only one facing this challenge, as I hear about this struggle from many other women in my life and on social media. I would like to share what I have found to be true in work-life balance.

1. Find Inspiration from others, but don't compare
I see some working moms on Instagram, etc. that seem to have it all figured out. Laura Scott the woman behind the blog A Little Bit of Lacquer is an immensely successful blogger, mom of two with one on the way, married to another successful doctor both in the competitive residencies, all while she manages to stay fashionable and positive. Her posts are wildly popular for the fact that she seems to have found a perfect balance. I find women of this caliber immensely inspirational, but I also know that everyone's situation including mine, is not hers. Everyone has their own threshold for stress and academic ability. Everyone has different levels of support systems. What has worked for her, may not work for every person. What I'm saying, is to not compare yourself to others, because all our situations are unique.

2. Find a mentor
I have heard this from several successful women , in particular Laura Devigan a plastic surgeon and mother of five. In her session on medtakovers on snapchat she explained the importance of mentor-ship, and how it's important to find someone in your field 5 years ahead of you on your projected career path. When I started the BSN program, we were assigned a seasoned registered nurse as a mentor. My mentor was an experienced PICU RN, that was in the process of applying to graduate nursing programs, and also newly married. She was very helpful in guiding me in the BSN program, but also in terms of answering questions about work-life balance. In my first year as a NP, I found another NP that I worked with, who not only helped me develop my skills, but also was especially helpful as someone I could talk about issues as a mom. It's important to have a mentor, whether it be formal or informal that you can relate to and seek advice from both professionally and personally.

3. Accept your limits
As I mentioned before, everyone has their own threshold for stress. I have found I don't always know mine until I have exceeded them, which has happened many times during my pregnancies and first years of being a new parent. It's also important to know that your threshold for stress can change at different times in our lives. I've also  had to lower my levels of stress due to pregnancy and becoming a parent. This was hard to accept at first that I had to scale back some responsibilities and other activities before I had a child, but does also not mean I was a failure. This also in big part was accepting what my support system was, which leads me to my next point.

4. Be aware of your level of support
As a working mother outside of the home, your support system is huge. This is not to say a mother who works at home does not rely on support systems, however when you work outside the home especially in fields with long hours, on-call hours, or variable shifts your support system is crucial to your ability to perform your job. In my honest opinion,  those whom succeed in demanding professions almost always have in-home help with their children, although we as women don't always talk about this. In her book Year of Yes, Shonda Rhimes talks about how there is some stimga among working women about having in-home help. She writes "I don't think powerful, famous women hide the fact hat they have nannies or some kind of help at home because they are being unkind to other people. I mean, these women aren't at home laughing and laughing at how everyone in America is tring to do it all all and can't because they don't know that the secret is that NO ONE CAN DO IT ALL! HA! HA! We foolded you! SUCKA!. " She goes on to explain that women don't always disclose the help they get at home, because we have been shamed into thinking we have to be able to do it all at work AND at home. After my son was born I broke down and got a housekeeper once a month. I felt guilty about this at first, but what I paid for this service was equivalent to eating out a couple times a month, and saved me a great deal of stress trying to keep up with deep cleaning our house. What assistance you have a home is not only important, but it's also important to know the amount of support you have at work. Some employers have on-site child care, allow for flex time, long baby bonding times, and  breast-pumping stations. Having a "family friendly" employer can make all the difference in the world. I personally hate when people say "Don't be afraid to ask for help." as if women are these timid creatures that don't know how to do that. I have in my past years definitely asked for help, but realistically sometimes you have to accept you are not going to get 100% of the help you need. I had to make changes with my work schedule and even change employers after evaluating what resources I had to help me as a parent. Being realistic about your level of support is crucial, because trying to do it all without an adequate support system will leave you feeling burnt out and feeling like a failure.

5. Let go of the guilt
As a mother, someone is always trying to make you feel guilty, whether it be your kids, your parents, your employer, your spouse, your child's daycare, or your friends and peers.  There will never be enough of you to go around, and someone will always have something to say about how you parent. You will fail some people at some times, but that doesn't mean you are a failure, and you are not a bad person. Feeling guilty will do nothing to help you, so you have to put it aside. It's also extremely important not to feel guilty about setting aside time for yourself. It's unrealistic to say that you will ever be able to have the same leisure time as you had before children, but not taking any time for yourself is a hazard not only to your own health, but that of your ability to be functional as a mother, partner, and employee. I have a fraction of the free time I used to, but I do make a point to make time to work out at least three times a week, an occasional monthly date with my husband, and time to read or blog by myself a couple times a week. Furthermore, let go of feeling guilty of not having it all together all the time.

6. Let go of negativity
This one is hard for me. I frequently throw myself pity parties when I feel overwhelmed. In the past year I have worked hard to keep a positive attitude and mindset. I try to vent out my feelings in healthy ways. I make time to work out, which really helps me stay positive. My family started attending church, which I find gives me a more positive outlook throughout the week. I have trimmed down a lot of contact with negative people, and incorporated more contact from those that inspire me. I also am guilty of holding on to negative thoughts and interactions. I have had to learn to try to deal with a conflict or negative emotion head on and then let it go, or realize it's not worth it to deal with it, and move forward. Letting these emotions fester only takes away from your ability to be present for your family, job, and self. Instead, I try to focus on what a privilege it is to have both the family and career I do have. There are so many little joys I experience on a daily basis, and I try to make these more significant impacts on my mood than the set-backs.

In conclusion, no one can "have it all", but you can find a balance. Everyone's balance is unique to who they may be, and their is no perfect formula. I am continuing my journey on finding this balance in 2017 and with the arrival of our new baby! Stay tuned!

Winter Maternity Wardrobe

During my last pregnancy I got away with hardly buying any actual maternity clothes, due the fact that my work uniforms were scrubs, and I was pregnant during the summer so I could wear stretchy cotton dresses. This time around it's a little more tricky due to the fact that I work in an office setting, and during the winter months. Although I want to maintain a sense of fashion as my bump grows, I also want to be realistic about budget and buying clothes that are transitional and functional after pregnancy. Here are my suggestions on shopping for a winter maternity wardrobe.
Buy dark solid-colored pieces (they are more slimming and will go with more).
Shop on bargain sites (zullily is the best I've found, and haven't spent more than $30.00 on any maternity item. The shipping takes forever, so don't buy anything you need immediately).
Buy button up or zip down shirts, cardigans, or jackets a size up from your pre-pregnancy size that will accommodate a growing belly and breastfeeding.
Invest in a pair of black maternity jeans (can be worn casually and dressed up).
Get a couple dark and light solid colored maternity tops that can be worn under blouses or cardigans
Invest in nursing bras and tanks a size up from your pre-pregnancy size.
Invest in sweat pants or yoga pants a size up from your pre-pregnancy size, they don't have to be "maternity" that can be worn during the post-partum months.
Invest in a couple stretchy jersey dresses or pencil skirts (can be worn after you are pregnant too).
Accessorize your basic dark colored pieces with colorful statement necklaces, scarves, blazers,  or shoes that make your wardrobe seem larger than it is.

Don't pay full price on any maternity item you don't plan on wearing after you are pregnant.
Avoid lighter colors, prints, horizontal stripes if possible (I bought a tribal print maternity dress, which looked horrific).
Avoid buying a lot of pieces that will only work while you are pregnant.

Last book Review of 2016, Born a Crime


My last book review was of the memoir of comedian and Daily Show Host, Trevor Noah,Born a Crime: Stories from a South African Childhood. I love a good memoir, and this was no exception. I would even go so far as to pronounce this my favorite book of 2016. For the past year as Trevor Noah has taken over the role of host on the Daily Show, my husband and I have watched the show almost religiously. From the show and his stand-up specials, I was familiarized with bits and pieces of his upbringing in South Africa, however this book went in much greater depth and detail on his earlier years. During my family's road trip up to the Bay Area, I downloaded a couple books on audible to pass the time. We started listening to Girl on the Train, actually we listened to it for a full 5 hours, before my husband and I both decided this book was not going anywhere and started listening to Born a Crime instead. Trevor Noah narrates the audible version, and being the performer he is, really brought the stories to life. This book has everything of a good memoir; suspense, comedy, tragedy, and a bit of a history lesson. The relationship between Trevor and his mother, was perhaps my favorite part of the book. I highly recommend this book on your 2017 reading list.

Since I have been reviewing a book nearly monthly for the past year, I want to start a "book of the month" series on my blog. I have not yet decided if I should stick with a theme or genre of literature, or just whatever I happen to pick up that month. Reading is something I truly love, and while I was in school I never had the time, so I love having the time to read and share my favorites. Stay posted for more reviews on 2017!

Wrapping up the end of pregnancy, holidays, and 2016

As I enter the last trimester nearing the end of my pregnancy, and as the holidays and 2016 draw near to an end, I have been doing a lot of looking back, and looking forward.

I'm now in the third trimester, and exhaustion is starting to sink in. My energy levels, and patience levels have dropped from half of where they started at the beginning of my pregnancy. I can barely stay awake past 9:00 pm most nights. If I don't bundle all of my tasks to do early in the day, there is no way I will have the energy to complete them. I have no patience for arguments or nonproductive banter that takes up time, with anyone for any reason. I still am doing walking as much as I can and Tracy Anderson pregnancy workouts three times a week, which have been my saving grace. I feel so much more fit than last pregnancy, which I'm hoping will help with my labor and delivery as well as post-partum recovery. Over the Thanksgiving Holiday I had an unexpected long weekend, so we drove up to the Bay Area and spent it with my husband's extended family. We drove around the city, and even did a hike in Muir Woods, which I actually had enough stamina to complete. I am happy our family had a chance to do a road trip together as a family of three while I still had the energy. However, a six hour drive while 7 months pregnant and having an energetic two year old, was still exhausting. Because my energy levels have really dropped, my enthusiasm and holiday preparation have been almost nonexistent as well. We have put up our tree, however the remainder of our house has no decorations, and I have only bought one present. However, I am okay with having more simple holidays which are less stress and allow for more quality time with my family. We have had the chance to go on a few family outings over the weekends, and even had my son meet Santa.
This leads me to reflect on  2016, and looking forward to 2017. 2016 has been challenging for me for many reasons. If nothing else 2016 has taught me to prioritize and make time for what I value. This year I turned 33, and I wrote some about the differences between my twenties and my thirties. Like many millennials, I put off getting married, buying a house, and having kids until the beginning of my thirties. In my twenties, without an established relationship, career or home, I really had no accountability to anyone but myself. My leisure time was bountiful and how I spent it was my decision. Although I didn't have a lot of money, it was all my own to spend. I could take a day and drive to the beach myself, I could go on a spontaneous vacation, and any poor decision I made would be my own and only my own to deal with. This year in particular my career has launched off, my family is growing, and in general my responsibilities have grown exponentially. What I have found most challenging, and I anticipate as a greater challenge in 2017, is prioritizing my time. Time has never been so valuable as it has been this year, and now I will be splitting my time even further between two little people. In contrast to my twenties where I lived by some respects "self-indulgently", in my thirties I feel I have to be selfish in order to maintain my mental health, be there for my family, and be successful in my career. I mean selfish in the fact that I have to minimize interactions and activities that do not serve mine or my family's best interests in order to prioritize what I do value. This hasn't been easy, especially with starting a work schedule that is five days a week instead of my previous three. This leaves me with only two days a week to catch up on errands, cleaning, quality family time and a few minutes to myself. In the coming year I will have 12 weeks of maternity leave, and I plan on staying home and taking as much quality time with my son and daughter as possible. After my son was born, I spent much of my maternity leave finishing clinical hours, finishing my master's thesis, studying for the NP board exams, and hunting for new jobs. This time I want to relish and enjoy this time for myself and my kids, because that is ultimately that is what is most valuable to me. I'm wishing everyone a beautiful holiday season, and a hopeful new year!

Gift Guide for the Medical Professional


Those in the medical field know we don't do our work for the "thank yous", but it's always nice to receive a token of appreciation in the form of a gift. Below are some fun and creative gifts from Etsy, that also support small businesses, which are a fun way to show your favorite dentist, doctor, nurse, nurse practitioner, physical therapist, respiratory therapist, medical assistant, or caregiver  appreciation this holiday season.

1.Heartbeat necklace  -A fashionable gift for the cardiac nurse or others that work in the cardiac field.
2.Coffee Mug-A fun gift for those working long hours,on-call hours, and overnight shifts, fueled by caffeine.
 3.Lab Coat Hanger-This personalized hanger is the perfect gift to keep a lab coat crisp in the office or a locker.
4.Stethoscope Tag - This makes a great gift for anyone who works in a hospital where it is easy it is to misplace your stethoscope (and reminds those who"borrow" your stethoscope to give it back).
5.Anatomy Wall Art Prints-These human anatomy prints on vintage dictionary pages, make great decorative pieces to display in an office. A variety of anatomical sketches are available.
6.Anatomy Cookie Cutter-These human anatomy cookie cutters make great gifts for those in the medical field who also love to bake. These would be perfect for my former charge nurse, who would religiously bake cookies for all the ER staff to have as our "afternoon snack".

For more creative and personalized holiday gift ideas that will allow you to avoid the stress of department stores, check out the editors picks on Etsy.

Winter Book Review: Fates and Furies


Fates and Furies: A Novel was another pick from my husband about marriage and deceit, so I don't know what message he is trying to send me. This novel was however, on the New York Times best-seller list, and the synopsis on the back sounded intriguing and suspenseful, so I thought I'd give it a shot. I still have mixed feelings on this novel, and it was by no means a page-turner, taking me a good two months to get through it. Midway, I almost tossed it aside because I felt it was going no where and the two main characters were less than likable, but I manage to stick it out because I'm not a quitter dammit! The novel is a look at the layers of the marriage between couple Lotto and Mathilde. The first part of the novel the "Fates" starts with Lotto's story, and the second part the "Furies" ends with Mathilde's. Lotto is a of a piece of work, a self-indulgent heir to a bottled-water fortune, who is loved and adored by everyone. When he meets the aloof, mysterious, and gorgeous Mathilde in his senior year of college, they start a whirlwind romance marrying within quick two weeks of dating, resulting in Lotto being cut off from his family fortune. He and Mathilde, who is also estranged from her family, start a life in New York together, as Lotto attempts to make it as an actor. In the first half of the novel we know nothing of Mathilde, other than she has an undying devotion to Lotto. Lotto is as devoted to Mathilde as she is to him, but seems to be somewhat clueless or not in tune with who his wife truly is. This becomes more apparent in the second half of the novel from Mathilde's perspective. Mathilde's side of the story was more interesting, and gave more depth to her character than in the first half of the book, but still left me with lukewarm feelings towards her character. I imagine the author intended readers to question how much intimacy and transparency are actually needed in a marriage. Mathilde and Lotto's love was without question deep and committed to one another, but lacked in the area of transparency, which lea me to question how sincere their devotion actually was. Although Mathilde was not exactly forthcoming about her past life, and some of current life with Lotto, Lotto did not ever bother to ask her some general questions you should ask a spouse, such as, " Why don't you talk to your family? , Do you want children and why? What was your childhood like? Is Mathilde even your real name?" (spoiler alert, it's not). It made no sense to me at all why Lotto never had any interest in knowing his wife more. Their marriage spans over 20 years in this novel, so it's not as though Lotto never had the opportunity to get to know his wife a little better. Furthermore, this story did leave me asking, how much of their devotion to each other was out of codependency rather than love? The author is a gifted writer (although her style was a bit much for me to wade through at times) but the plot was stagnant with some gaping holes, and I just never felt a connection to either of the characters. If you've read this novel leave your comments below. I am also looking to get some good reads to put on the kindle for after the baby is born, since that was a great way to pass the time while breast feeding in the wee hours of the night last time. If you have any good light reading suggestions please leave them below also.

Life of a Family Nurse Practitioner

Happy Nurse Practitioner Week to the current 220,000 licensed NPs in the U.S.! I often get the question from family and friends, "what do you do?" I have written several posts about my decision to pursue this career path, and the training and certifications required, but I will now write about what it is I actually "do. As a family nurse practitioner or FNP, I work in an outpatient internal medicine clinic with an urgent care. This means I see patients over 16 years of age and treat many chronic conditions as well as acute conditions that can be managed in an outpatient setting. I prescribe medications, treatments, order and interpret diagnostic tests, and refer to specialist care when needed. What types of illnesses do I treat? I see literally everything. In a typical day I treat and manage an elderly diabetic patient, a young twenty year old female with irregular menstrual cycle, a middle aged man with severe depression,  a 20 year old male with cerebral palsy who has been confined to a wheelchair his whole life, and routine physical exams to ensure all preventative care is taken on all types of patients based on age and risk factors. My main role is to keep people healthy and out of the hospital. I often refer to specialists, however with insurance roadblocks (more on that later) referrals often take time, so I  manage care of these patients until they can see a specialist.

What I love about my job
Continuity of care. Working in the ER I rarely knew the outcome of a patient, and it was hard to follow up on any prescribed treatment. Here I see most patients frequently and I can modify plans of care based on my assessment and the unique needs of each patient.

Variety. Although I feel sometimes as I am a "master of none" having to have such a broad knowledge of every medical condition, I love having such a variety in what I see on a daily basis. It keeps me sharp and forces me to keep learning.

Preventative Medicine. An ounce of prevention is worth an.. I don't know the whole saying, but it makes me feel so rewarded when  I have a role in preventing a bad outcome with a disease, and that is what primary care is for.

Challenges of my Job

Insurance roadblocks. HMO insurances are the bane of my existence. I see many patients with HMOs, and they all require authorization for most treatments, whether it be as simple as an ear lavage or pap smear. I've had to refer to ENT specialists for an ear lavage, which is a simple procedure that can be done in any primary care office, simply because the HMO will  not reimburse for this. This also goes for routine immunizations and some medications that can be given in the office, which is also counter intuitive. Finding specialists for mental health conditions and pain management is especially difficult and require long periods of waiting, which brings me to my second biggest challenge.

Prescription drug abuse. I have a whole other post on this. It's such a problem that spans across all genders, ages, races, and socioeconomic levels. It's so exhausting dealing with this on a daily basis, and there are very few resources for patients that need help withdrawing or dealing with addiction from these drugs.

Time Management-In primary care new patients, and existing patients will often bombard me with a laundry list of complaints, from toenail fungus, to tingling in the feet, and blood in the stool, all during one visit. Most days I have patients scheduled every fifteen to twenty minutes so it's completely unrealistic to thoroughly address more than one complaint per visit. It's difficult for me to cut someone off, or tell them to reschedule to address another concern, but in order to give quality care this is often necessary. It's also my job to prioritize the most pressing concern, even if it's not what is concerning to the patient. For example, many times a patient comes in for a visit related to a minor cold or refill of medications, and his or her blood pressure will be sky-rocket high. I need to address this before other needs of the patient. Because increased blood pressure often produces no physical symptoms to the patient, the patient sometimes will not agree with my decisions to address this concern first.

What can't I do. I'm not very limited to what I can do by my training. I do everything in the office that the MDs I work with can do. I can do minor procedures, such as drainage of abscesses, wound care and suturing, splinting, although I rarely do these procedures. Most of the time these patients are treated in an ER setting or I cannot get reimbursement through insurance for some of these minor procedures. There are some strange laws prohibiting NPs from ordering certain medical equipment and supplies, such as diabetic shoes, which is counter-intuitive since I can order diabetic medications, including insulin. I also do not do hospital admissions. This is not to say that NPs cannot do hospital admissions, but I do not have admitting privileges to any local hospitals. This means if I have a patient that requires a hospital admission I have to refer them through the ER for evaluation rather than do a direct admission, and I do not round or see my patients if they are hospitalized. Although there are drawbacks to this lack of continuity of care once my patients are admitted to the hospital, I like that I have regular hours and do not have to be on call with my current job.

How does my job compare to a Registered Nurse As a nurse practitioner I have to keep my registered nurse license active, and thus I am still licensed to do all tasks under the scope of a RN. At my current practice, I sometimes start IVs and monitor IV infusions in our clinic, for example. However, as a nurse practitioner I can prescribe medications and medical treatments, unlike a registered nurse. I did work as a registered nurse for four years before a nurse practitioner, and the jobs are very different. I enjoyed working as a registered nurse, and I was challenged mentally, physically and emotionally daily. My work now in an outpatient setting is much less physical, and less of an adrenaline rush than when I worked ER, but still very mentally and emotionally taxing at times. Overall the stress level I feel currently at work is much less than my previous work as a RN, although this is not to say that I am not challenged or stressed at my current job.

If you have more questions about the role nurse practitioners play in our health care system, please visit the American Association of Nurse Practitioner website here.

The morning after

I really, really, did not want to write about the election. I refrained all election season about posting much on social media or the blog that was connected to the presidential campaigns. I was as sick as everyone else was of election coverage. I was sick of the late-night Trump impersonations, I was sick of the attack ads, I was sick of non-stop coverage and analysis of the polls, and sick of scandal after scandal. But, here we are, and I feel that I can't keep quiet and move on and write a lifestyle post, or pretend that everything is okay. I, like many, had my reservations about Hillary, but her ideology and experience made my decision to vote for her easy. I really felt the country would eventually rally behind her. We really couldn't be that angry at the last 8 years? We insured millions, unemployment rates are at record lows, and people are back on their feet after losing everything in the recession. I personally remember how I struggled during the recession during the G.W. Bush administration after just graduating college. I remember watching family members and friends get laid off, and I remember two hospitals I worked for going through rounds of lay-offs and cut backs, and the nursing staff being bare-boned. Flash-forward 4 years from when the hospital I worked for was offering severance for staff"voluntary separation" as they called it, to now where they are offering nurses $10,000 sign-on bonuses. Before Obamacare if you had a diagnosis of cancer or another "pre-existing" condition, good luck getting affordable insurance. We now stand to lose all of that progress. For what? There's talk of how gender and race influenced this race, and that many Americans weren't ready for that change. I don't think we can deny the influence of racial and gender bias in the many Americans decision to vote for Donald Trump, and that of disturbs me most of all. It saddens me that Americans are okay with blatant bigotry and sexism. But that being said, I am not going to Canada. I am not going to feel that this is the end, or our country is entering an Apocalypse. There will be major changes in many people's lives, and I living within the insulation of a culturally diverse and tolerate region of the country, not from a family of immigrants,young and healthy, and with a recession-proof job will probably not be the first to feel these changes, but unfortunately many others will. Taking a stand and having a voice matters more now than ever, so I encourage you to share yours.

Medical Social Media Favorites


My use of social media has drastically shifted over the past few years, and I have found so many intriguing social media personalities, if you will, that I find inspiring. I have found there is such a large presence of medical professionals, sites, and apps on social media, that I find both educational and inspirational. I have listed a few social media favorites of mine below that fall into the medical realm.

Figure 1.-
This is an app that is available to anyone within the medical field (techs, medical students, PAs, dentists, etc.) that can share interesting case studies (compliant with HIPPA of course). I really like testing myself and reading the comments and others professionals plans of care on these cases. I have yet to upload any cases myself, but I plan on doing this in the future

I resisted joining snapchat forever, simply because I was trying to limit my social media use and it seems so ridiculous with all the filters. I still think snapchat is a bit ridiculous and rarely post to snapchat, but I've found a few accounts I like to follow. One in particular is medtakovers. On this account a different health professional or student "takes over" the account and fields questions regarding their career and career path. I really enjoy these takeovers and the exposure to all sorts of medical careers.

@mrs_angemi -This account features all sorts of interesting pathology cases. The pictures are often very gruesome, so not for the faint of heart.
@dr.majestik_md-This is the account of an Orange County ER physician that posts on a lot of interesting ER topics, as well as general health and wellness posts.
@drlindseyfitzharris-This account are posts all about medical history and photos of  historic medical equipment and surgical illustrations. I find this a fascinating look at medicine.

Ask Dr. Angela-This is a podcast from a Ob/Gyn Dr. Angela that answers women's health questions. She's very upbeat and has a wealth of information on various women's health topics.
The Nurse Practitioner Show-Another podcast (available in app form) run by a nurse practitioenr with guest speakers on variety of medical topics.

Kevin Pho-@kevinmd- A prominent social media influencer whose site ( has so many articles on relevant health care policy issues.
STAT news-I follow this medical health news site for links to articles on current healthcare issues.

There are plenty more, and a bunch of vloggers and youtube accounts that I have been meaning to check out. If you have any suggestions on accounts in the medical or healthcare field that interest you, leave them in the comments below.

Daycare Dilema


Daycare has been both a blessing and a curse in my life. As my husband and I have prepared for our second child, we have tried to figure out how to balance work, our budget, and needs of our children into our decisions for childcare. My greatest anxiety while pregnant for the first time was around childcare. Unfortunately my husband and I both drew the short stick when it came to family help, and although it sometimes seems like we are the only ones that are in this boat, it's not the case. We happened to find a preschool and infant center close to where we lived when I was about 8 months pregnant, and put our son on the list after touring and talking with the staff. I had sent out a few inquiries at other day care centers, and signed up for, as well as sent out an ad for a babysitter to nursing students at my school. I ended up opting for the daycare option because of affordability and the socialization for my son. My husband and I are both the only ones with kids on both sides of our families, and thus my son's interaction with other kids has mostly been at daycare.

What I like about daycare:
 He has had interaction with a diverse teacher and student body from infancy.
His language skills have developed in leaps and bounds (he knows the whole alphabet, and has been learning to count in Spanish).
 He has learned about "taking turns" and waiting in lines.
They do fun crafts at school daily, and other cultural activities, such as learning about Day of the Dead or Chinese New Year.
It's tax deductible (Hey, I'm married to an accountant).
It's media free, meaning there are no TVs, ipads, etc. in the classrooms.
All teachers and aides are CPR certified.
I don't have to worry about having someone come to my home and the concerns with that (keeping the house in order, caring for our dogs, safety, etc,)

The hard parts of daycare:
It was hard to leave him at first and I felt guilty
My son became sick often during the first year.
We have to miss work if my son is ill or has a fever.
There is not flexibility on scheduled days and times (when I did not have a consistent work schedule, I had to constantly trade days at work, my husband would have to occasionally take a sick day to cover, or I would have to beg daycare to let us swap a day. If you are late you are charged an additional fee for every fifteen minutes late).
It's expensive
Not a lot of individualized 1:1 care.

I put my son in daycare at two months so I could complete my clinical hours for grad school. For the first few months he was only at daycare  two days a week, and when went back to work full time when he was five months he started three days a week. Now that he is two, he goes four days a week. By now he is well adjusted to the routine of daycare. I feel he is safe and well taken care of, and that the curriculum  helps with his cognitive and social development. That being said, I really do not want to put my daughter in day care as early as I did for my son. We already had to put her on a waiting list to start at the infant center, but I still have reservations. I anticipate her starting at about 5 or six months, but ideally I would wait a year. I would like to wait longer this time so I can have more time to breastfeed, establish a sleep schedule, and for her immune system to develop.  I will not have the flexibility in my schedule as I did with my son to start part-time daycare, which also gives me pause. The daycare option still seems to be preferential with the second child due to affordability, convenience, socialization, and educational components.
With a household with two full-time working parents without any family assistance, there is no easy solution to childcare. Our monthly expense on daycare exceeds all other bills besides our mortgage. We have been stretched to our max making ends meet with our first child, and I don't anticipate things getting easier with number two. I often feel frustrated that there is such little help for parents. If you are not living below the poverty level, have a special needs child, or have family to help you out, society pretty much tells you "you made the decision to have children, now figure it out." I often feel angry about the lack of support, from family and our current government. I'm definitely not in the worst situation as a parent, and I remind myself of this when I find myself getting angry. However it does take a village to raise a child, and most days I feel like I'm on an island as a parent. I will stop my rant for now, but I would be interested how other working parents have found solutions to their childcare needs.

Making room for two: What to toss, keep, and buy

With the first baby I was clueless about what to buy to prepare for our baby. Reading about baby products and talking to other new moms helped, but there is a huge market for baby products that can inundate a new mom . I have not bought anything in preparation for my baby on the way, but I do want to make room for her, and inventory what I have and what I actually need to get. As I started this process I realize there were plenty of items we bought or were gifted last time that were unnecessary, and some items I would have like to have that I never bought last time. This lead me to my list of Toss, Keep, and  Buy.


Swaddle blankets-I'm referring to the so-called make it easy to swaddle blankets with Velcro or snaps. My son was able to bust out of these in a couple of minutes, and really were not useful to me at all. I preferred the larger Muslin blankets that can be used for swaddling and also when the baby outgrows the swaddling phase.

Baby Monitor-Let's get real, unless you sleep on another floor than your baby there is no way you are going to sleep through or miss hearing your newborn's cry. There was really no immediate need or use for this other than some false sense of security.

Diaper Genie-We registered for the expensive Tomee Tepee diaper disposal system that supposedly seals off the smell and makes disposal easier. It still ended up smelling like a landfill, and I eventually just moved it out of the house because I couldn't take the stench. The refills of the plastic sealers were super expensive, and honestly it's just a good habit to take out the dirty diapers daily anyhow.

Changing table-We never invested in this, and never had the need for it. A dresser with a changing pad worked fine, although you have to be a little cautious when the baby starts to roll.

Bouncer or vibrating chair-I picked one up at a yard sale, and it had a working music box and vibration setting. My son hated this and would scream the whole time he was in it.

Teething rings-I tried several different brands and shapes, including the infamous Sophie the Giraffe, and they all did nothing for his teething pain. He would just throw these on the floor in a matter of minutes.

Dr. Brown's Bottles- I wrote about these in another post, but they are the most pain in the butt to assemble, disassemble, and clean. The claim on these is they decrease gas pains and colic, but I have my doubts. In terms of efficiency and ease these get a major fail from me.

Humidifier-At about five months my son got RSV and his cough was keeping him up all night. I tried several humidifiers, including the Vicks brand and some weird looking Owl shaped humidifier that supposedly won a parent's choice award. Honestly, they did nothing to help with cough and nasal congestion. Putting my son in a steamy bathroom did more good than any of the humidifiers.

snap-jammies- changing a baby in the middle of the night and then trying to figure out all the snaps on the PJs is beyond frustrating. I am only using zip-up jammies this time.

Swing-This was a lifesaver! I don't think the brand really matters, but this was the only thing that would calm my son down and let me have a break those first few months.

Umbrella stroller-I didn't invest in this until almost a year after my son was born, but having a small stroller that you can squeeze into restaurants and stores makes life so much easier.

Digital thermometer-As a former ER nurse I know how important it is to monitor the baby's temperature during the first months. A rectal temperature is the most accurate, but who really wants subject their baby to a rectal probe every time they measure the temperature.

Aden and Ansis  47x47 blankets -These are so soft and have so many functions. They are a little expensive, but I think well worth the price. They can be used to swaddle, for burping, for covering the baby in the car seat or stroller, and for a cover-up when breast feeding. I highly recommend these, and will be buying more this time around.

Bassinet-Also as a former ER nurse I was super paranoid about SIDS, and did not co-sleep at all. A bassinet next to my bed worked really well for the first few months before we transitioned my son to the crib.

Baby sunscreen- Infants need a physical sunscreen that is non-irritating to the skin. As we took our son out frequently in the warmer months, this was essential.

zip-up jammies-see above

The Medela hands-free breast pump-I got  the Medela Freestyle Breast Pump top of the line pump covered through my insurance. I loved it, and intend to use it again this time around. Pumping early made my life so much easier when I had to go back to school and work. I bought the microwavable sterilizing bags for the parts, and all the Medela bottles, but these were not necessities. You can sterilize the parts with boiling water, and there are many other brands of bottles that fit onto the Medela pump, including the Dr. Brown bottles. I also bought a lot of the freezer bags for storing breast milk, which were very useful.

Sleep sacks-Again, I am super paranoid about SIDs, so in the first six months I only used sleep sacks when my son was past the swaddling stage

A sturdy crib- We bought this convertible crib from target with a coupon. It was expensive, but has worked very well, and my son at almost 2 and half still uses it and is unable to get out on his own. Eventually we will convert it to a toddler bed. Target currently has a sale on furniture and you can save $75 when spending $300, plus 10% off with the code FALLHOME link here.

These are items I did not get last time, and want to get this time. Please leave your comments or suggestions on what products you liked below.

Travel system-I bought convertible cars seats last time around, but I definitely want a travel system this time, plus my son is still using the car seats we bought two years ago. Any suggestions as to what brand or model?

Pack n Play-Also, this would have come in handy the many times we have traveled with our infant son. There are so many, I don't know which one to choose from.

Diaper Bag-I have been through couple cheap ones that didn't have much room for organization and fell apart. Now that I will have two kiddos in diapers I want to invest in a good one that is stylish and functional. Thinking of this one.

The breast friend-My good friend recommended this to me, and claims it is the best for positioning while breast feeding. Thoughts?

The nasal Frieda-I used the bulb syringes to suction my son's snot as a baby, but have since been informed that these harbor loads of bacteria. I'm thinking of trying the nasal frieda this time, although it looks a bit disturbing.

A double stroller-I'm very hesitant to try one of these, simply because they look like they take up so much room, but I definitely see the need in the future.  Any suggestions leave them below.

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Fall Book Review: Girl with the Lower Back Tattoo


I've been under the weather the past week, and being cooped up in the house I've been catching up on some reading. I picked up The Girl with the Lower Back Tattoo, because I am for one a fan of Amy Schumer's show and stand-up, two I wanted a light read, and three I am a sucker for a good memoir. From the intro, and based on Amy's comedy, I expected this book to be similar to Chelsea Handler's memoirs. I have read a few of Chelsea's books, which have made me laugh literally out loud, and are full of drunken sexual escapades. Amy's intro to this memoir started in the direction of a raunchy stand-up routine, with a letter to her "pussy." I realized however, this wasn't entirely the "light" read I had signed up for, when into the first couple of chapters there were a lot of serious undertones, and parts that were even depressing. Although some of her memoir details her sexual encounters, and other raunchy material typical of her stand-up, there was a lot of reflection about who she is apart from her comedy. She reflects on being an introvert, lack of confidence, and unhealthy past relationships. I feel a lot of similarities with her experiences, and perhaps because we are of the same generation, I can relate to a lot of her experiences growing up. I laughed at many of her childhood and early adult experiences simply because I had been there. She recounts how her mother wouldn't allow any junk food in the house so she developed the habit of binge eating junk food at friends houses, and would eat her roommates junk food in college. I had this experience, to the point where when I would go to one particular friend's house as a kid who had a pantry brimming with unhealthy snacks, I would pick to hide in the pantry during hide-and-go seek games so I could raid it. I also have the same horrible habit linger into adulthood, where I would eat any junk food left unattended by roommates, family, or coworkers. She also discusses her low points of self-confidence and settling for really crappy men and situations during her early twenties, also similar to my own experiences. One particular shining moment in my early twenties when my self-worth wasn't that great, I somehow fell for a hot-tempered alcoholic line cook with a mustache tattooed on his index finger, but back to Amy's story. I particularly loved the accounts her family, and her experiences growing up with an alcoholic chronically ill father, a manipulative mother without any boundaries, and how she's come to terms with their flaws. She also tackles some heavy issues, including gun violence, sexual assault, body-shaming, and domestic abuse, all with personal stories that are both comical and heart-wrenching. This isn't a hysterical collection of essays, nor a poignant tale of overcoming adversity, but somewhere in between that, and inspirational nonetheless.

on having a girl

When I hear of people waiting to find out the sex of their baby, I'm always a bit in awe. For one, I don't do surprises. I have found out about literally every surprise from Christmas presents to surprise parties people have tried to throw me, simply because I am very impatient. Although it seems like a fun idea to be surprised by my baby's gender, I knew going into my pregnancies this was in no way realistic for me. I also wanted to have some level of preparation for one sex or the other. As much as I like to think I am a forward thinker when it comes to gender, I definitely think there are a lot of gender differences in raising boys v. girls that I would like to prepare for. Also, as progressive as I like to think I am, I also wanted to know what colors of clothes to buy my bundle of joy, as I still fully plan on dressing my baby girl up in a ridiculous amount of pink and ruffles. I was thrilled when I found out I am having a girl. I was so excited, in fact when I found out I cried. Don't get me wrong, another son would have been amazing too. I love having a boy. As I've heard from many experienced parents, there are unique challenges that come with raising the different genders. I do believe this. For example, potty training my son has been slow-going, which I hear is pretty common with boys. I think the personality of child however, is more influential than gender when it comes to the challenges faced as a parent. I can't wait to see how her unique personality is, and how different or the same she is from her brother.

Tips for searching for a job as a new nurse practitioner

I've been to quite a number of job interviews as a new nurse practitioner, and nailed several and bombed several. I have some take away points I hope new graduates out there may find helpful in finding and landing a job.


Get a CV together and make the information relevant to the job applied for. For example, I did some work in aesthetics per diem, which is hardly relevant to urgent care jobs or family practice jobs so I eliminated that experience for certain positions I applied for. Highlight any seminars, publications, and awards or training you have completed in addition to your required education. For example, I did a three day skills workshop for minor procedures and emergent care. Play up your duties at your previous positions, especially if you were involved in any quality improvement projects, employee training, or management positions.


Some employers will want to do a pre-interview phone screening before an in-person interview, which I hate. In past when I have had these screenings I have felt ambushed and completely unprepared when I got the phone call . My advice is if you get a call wanting a pre-interview phone screening to reschedule it at a time when you are free of distractions, and make sure you prepare as you would for any interview, as often the questions are the same. I also hate when employers want to do an interview the same week or next day. I always try to get at least a weeks notice to prepare. This gives me time to update my CV, get my interview attire dry-cleaned, research the employer, practice interview questions, and find out how to navigate myself to the interview location.

Keep it as simple, comfortable and as conservative as possible. Wear a suit (it doesn't have to be expensive, see examples below). I've often felt overdressed at some interviews, but it's definitely better to be on the overdressed side.

Again, be over-prepared. Bring three professional references (at least one who has supervised you), three copies of your CV, your RN and NP licenses. Many times I have not been asked for any of these items, but always have them. I like to carry all of these in a leather folder, such as the one below, to keep them flat and readily available. I also keep a notepad in the folder to jot down notes during the interview.

If you are interviewing for a larger organization chances are you will be asked a standard set of the same questions as all candidates. The most common ones are:
*Describe your strengths and weaknesses.
*Describe a time you've had a conflict with a coworker and what was the outcome, or alternatively a conflict with a patient and how you changed the outcome.
*Why do you want to work for this organization?
*How have you implemented a change at your previous workplace?
*How would your former coworkers describe you?
*How many patients do you feel comfortable seeing in a day, or how many patients do you see per day at your current job?

The most important thing to prepare for these questions is to use specific examples. It's okay to embellish, but don't just say, "I'm a hard worker" Give specific accomplishments to back up your statements that are directly relevant to the position you are interviewing for. When describing your conflicts and weaknesses, make sure you use examples that have had good outcomes, not a time you nearly killed a patient, or were fired over a conflict.

If you are interviewing at a smaller practice, you may get a few of these questions, but the interview tends to be much more informal and just getting to know you better in terms of your skill set and personality.


What is the expected patient load per day?
Some employers are very number driven, and expect 2.5-3 patients an hour in an ER/urgent care setting, and some want 20-25 patients seen a day in primary care.  Some employers may include a quota in your contract. These are challenging expectations to start off as a new graduate, so it's important to know if you are expected to hit these numbers straight off the bat.
What support staff do you have?
You will generally have a medical assistant in the outpatient setting, and a techs or RNs in the inpatient setting, however the duties can be greatly different in each setting. It's also important to know if you have access to diabetic educators, social workers, or case managers.
Some ER or other acute care settings will have scribes, whom are immensely helpful. As a new NP, the more support staff you have access to the better.

If you work in a state requiring a collaborative agreement, ask about your level of autonomy and if standardized procedures are in place. Some places of practice will require you to have your charts and orders cosigned by a physician.

State laws dictating NP authority vary greatly from state to state. Make sure the employer is in line with state requirements. As a new NP you do not want to start at a location without any supervision or person to refer to, however you do not want to start at a place where you are given no autonomy either, as this will not allow you to grow professionally.

Ask about training periods. Some jobs may expect you to jump in and start without any training. My first job offered a three month paid training period, where I was supervised and expected to be asking for help. This training period was profoundly helpful, and I had incredible mentors helping me.


It is completely acceptable to send a follow up email in this day and age. Make sure you always thank the potential employer for their time promptly after the interview.
A few things to consider when accepting an offer with a new NP position.
First and foremost, salary. Many employers will ask you at the interview what your salary expectations are, and DO NOT ANSWER THIS QUESTION DIRECTLY. I have been burned doing this, and it leaves you no room to negotiate. Many employers, especially public sector jobs and larger organizations have pay grade levels based on experiences, and thus will be no room for negotiation. Some employers, such as agencies that contract with hospitals, will pay a flat rate to all employees regardless of years of experience, and give bonuses for productivity. If you are interviewing at a smaller office or practice you do have room for negotiation, so the best answer if asked about salary requirements is say you expect a competitive rate that will take into consideration experience (if you have some), benefits (or lack there of) licensing, malpractice insurance, and CEU fees. If a position does not offer any benefits, as some do not, you can negotiate a higher rate to compensate for this. If you are a new nurse practitioner without any paid experience, don't be too picky about your starting salary. The most important thing is that you are getting a fair rate.
The second thing to consider when accepting an offer is, do I actually want this job? If you are only interested in a high salary or are unsure of your ability to perform to the required expectations of the job, think twice. As a new NP it is crucial to get experience in the field of your interest. I interviewed for jobs in aesthetics and pain management, both with lucrative salaries, but did not take these jobs as I knew I wanted to get experience in family practice. Although you may get a higher salary offer in a field outside of your interest, make sure this field interests you, and have the qualifications for the position. I also got calls to interview for  hospitalist positions, which I did not interview for because I felt in no way in my experience or training prepared me for these types of roles. If you are considering a position in a specialty, consider doing additional training, such as a residency. post-masters degree, or additional certification. Nurse practitioners are not required to do a residency, and thus being adequately prepared for a highly specialized role such as in oncology or cardiology may be challenging without adequate training. If you have previously worked as an RN in a specialized field however, this may have provided enough experience. I did interview and accept a position as NP in the ER, however I had previous experience as a RN in the ER. Had I not had this experience, I would have in no way felt prepared through my education alone for this position. AANP is now offering a certifications for FNPs specializing in ER. Another piece of advice I have to offer is if you are offered a position with an employer for which you have interned, or previously worked as a RN,  take the position. As a new nurse practitioner already being familiarized with a workplace setting will allow you to focus on the new role, rather than getting to know the charting system, new coworkers, and resources. Lastly, think about work-life balance. What is important to you in terms of hours and flexibility. When I was interviewing for my first job as a NP, I did not want a traditional 9-5 hours due to childcare issues, but I knew that meant working holiday, evening and weekend hours. Think about what your priorities are for a job, whether it be money, location, area of expertise, experience, or flexible schedule. Chances are you will have to make some compromises, so know what is most important to you, and what your long-term career goals are.

As a new nurse practitioner you want to be in an environment that is supportive. If you sense that you will have a supervisor that is not approachable, will not have adequate training or support staff, think twice about accepting the position. If you sense disorganization, also think twice about accepting the position. At one interview for a new NP position I was kept in the waiting area for an hour after I had arrived promptly for the scheduled interview time. After an hour of waiting and reminding the front office staff I was waiting, I was directed to take a typing test. By this point, I realized this was not an employer I would care to work for, so I told them I was no longer interested and got up and left. At another interview, the person conducting the interview answered her cell phone and took a personal call during the interview. This seemed very disrespectful and disorganized to me.


Licensing and board certification can take several months. If you accept a job requiring credentialing, this can take up to six months. Some public sector jobs, and larger hospital organizations require a lengthy application process that can take several month to up to a year. Hang on to your current job if you are working, and don't get discouraged in the process.

Staying active during pregnancy


Being a full time working mother, it's hard to get exercise in, especially with the exhaustion of pregnancy. I've written in this previous post about my 55 pound weight gain during my last pregnancy, and this time in my second pregnancy I am determined to avoid such a drastic weight gain. Maintaining a healthy weight gain during pregnancy has the benefits of reducing the risk of stretch marks, varicose veins, hemorrhoids, and more importantly, gestational diabetes, hypertension, and a complicated delivery.  In addition, exercise can help you "train" for your delivery (my last labor was 22 hours long), and will also help reduce stress. During my last pregnancy, the only exercise I did was walking, and even that was restricted in my third trimester. So far I have had no complications with my current pregnancy that would keep me from exercising, so I am trying to incorporate a variety of activity into my busy schedule, which often means fitting exercise in whenever and wherever I can. After my first pregnancy I started using the Jillian Michaels workouts, and loved them, and have continued during this pregnancy with modifications. In the morning before my son wakes up I do her beginner shred, which is a 20 minute workout including cardio, strength, and abs. Since I became pregnant I use only 3 lb weights, and I don't do any of the exercises flat on my back. I also found the DVD series the pregnancy project to be a fantastic prenatal workout. There is a separate workout for each month of pregnancy. At first after doing the Jillian Michaels workouts, these seemed too easy for me, but they are surprisingly challenging. The workouts are longer than Jillianps, approximately 45 minutes, and focus more on strength and stretching, rather than cardio. Tracy Anderson, the instructor who is pregnant during these workouts, has you doing series after series of variations of donkey kicks. My gluts are burning after these workouts. Unfortunately I do not always have time in the mornings for a 45 minute workout, so I can only do these once about once a week.

I track my steps using a fitbit, and aim for at least 10,000 steps in a day, I do a mile or two walk with my son in the stroller. Whenever I have a free moment usually before work after I have dropped my son off at preschool or on the weekends I will go to a local park and hike the stairs with my dogs. When I don't have a full patient load at work, and when the temperature is not in the triple digits, I will take a walk on my lunch break at work.

I've also have incorporated some yoga into my exercise routine. I tried a drop in prenatal class at a local yoga studio, and loved it. It's also fun to be around of other pregnant women, so I don't feel as silly doing the poses with a belly. Yoga is not only relaxing, but helps maintain your flexibility during pregnancy. Unfortunately with my busy schedule it's not always easy to make time to go to a yoga studio.

I keep myself cool by putting a fan on when I'm exercising at home, and walking early in the day to avoid overheating, and drinking as much water as I possibly can. Of course check with your OB/GYN before starting any new exercise program if you are pregnant. If you were not active before pregnancy, it's best to take exercise very slow and light. Naturally, don't do any potentially dangerous activity, such as alpine skying or horse back-riding, although I don't know what pregnant woman would have the energy to do these activities in the first place. What ways do you stay active during pregnancy?

one year blog anniversary

It's been a year since my blog's genesis. I have always loved reading blogs of all sorts (see my last post), because I think it's such a great platform to express your own opinions.So much of social media is so abbreviated and trite, and blogging seems like a way to actually in-depth talk about interests and opinions. I started by only writing on my life outside of work. I had spent so many hours dedicated to studying and at the hospital without much life outside of that, this seemed like a fun way to talk about my life apart from work and school. I realized after several months that I did have a lot to say about my life as a nurse and a nurse practitioner too, and that I wanted to also incorporate that into the blog. Refining and promoting the blog has been a lot more work than I realized. It's no wonder why people blog as their full time job. I did a lot of work making it aesthetically pleasing and appealing to an audience, finding ways to capture new readers through social media outlets and connecting with other bloggers, trying to finding a focus, and creating fresh ideas to write about. I'm thrilled when I check the stats, that I have readers from literally all over the globe, from South Africa to Russia! I still have a lot of areas I want to improve on, and am constantly reading blogs on blogs and trying out new ideas and formats. I have grappled with my content and whether or not I should refine to one subject matter. Many of the successful blogs have a content-specific site, whether it be nursing, cooking, decorating, or parenting. I like having a variety of content and I like being able to write about all of the areas of my life. My most popular posts, however are those related to nursing and advance practice, so I plan to focus my blog more on these topics. The reason I don't want to refine my blog to one subject completely is that I am not a one dimensional person, I have a work and home life, and I care about politics,literature, as well as lifestyle topics. Often I think women are expected to stay in a box and be one dimensional. I struggle often with what to share, is a topic taboo, is this offensive, am I sharing too many details regarding my personal life, or to little? At first I didn't want to talk about politics or topics that would offend people, but now I like writing on these issues. I try to write on topics that may be controversial from several angles, and to go more in-depth than the often polarized views of race, gender, and politics found on most major media sites, which is not helpful in creating any dialogue at all. As far as details of my life that are unflattering or portray me in a negative light, well I'm not perfect and I like to write honestly about my life experiences. I also like to write about things that are fun, like cooking and gardening, and online shopping. As far as goals for the blog, I want to make it more polished and provide more clean pictures and editing. I don't have a crystal clear vision on where I want to go with my blog, but I know I want for it to continue to be interesting and fun to me, but also informative, interesting and fun to readers. If you have any feedback or topics you'd like to see more or less of please comment or message me. I'd love to hear from you!