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  • Apr 5 '13

    We all have bad days.

    I remember when I was new, bright eyed, bushy tailed, rampantly sarcastic (look, some things never change, alright?) and I used to look about and wonder why in the world it never seemed like the most awesome of the awesome never had a bad day, a hair out of place, a drop of sweat on their brow, or their teeth set so hard they were gritted down to nubs.

    I used to pray to be so unflappable. I used to dream of the time when I would be viewed through that blushing lens of being labeled the go-to, the machine, the reference, the "strong" nurse.

    And then one afternoon, I'm roosting in the lounge with a pack of saltines and a glass of ginger ale (be sure to take care of your stomachs, my friends. Ulcers are no laughing matter), and this new nurse marches up to me and steals one of my saltines.

    Okay, fair enough. That is one way to get my undivided attention.

    Yet before I can question what spurred this random theft of my stomach appeasing snack, there is gesturing, crumbs speckling through the air like confetti and the firm demand, "Tell me what makes you so special?!" christened on the end of a pointing index finger.

    The beauty of the OR? We let our eyes talk for us. And as I had a mouth full of saltine, I allowed for therapeutic silence and some good old fashioned eye contact.

    She nibbled her cracker with a defeated sigh. "Nothing seems to faze you. You...you're just awesome."

    So let me tell you what I told her: No, I'm not awesome. I just do what I do the same way every day. I still have a lot to learn. And yes, a lot fazes me. The rest? What you see? Well that's just acting.

    I pretend, therefore I am.

    It is in this spirit of leveling, of "dipping my hand" so to speak, that I will now tell you about my day of epicness so astounding, so thrilling, so riddled with KaBAM power, that you may have to avert your eyes or at the very least wear sunglasses:

    My day began as any other, sans hair conditioner. Now, to some this doesn't sound like a big deal, but with my hair which hangs down to my rump, no conditioner generally equals doing battle with the equivalent of a premenstrual yeti suffering from a septic hang nail and a case of mange.

    Hair finally subdued, dressed, etc etc, I attempt to leave only to lock my keys....all of my keys... securely in my house. Thank goodness this time I was actually dressed when it happened so I could go to my neighbor and fetch my emergency key.

    Key fiasco squared away, off to work I go. Now at work, in fact, I'm still at work (yay for call), my journey (which the bards shall sing of for ages to come) continued thusly:

    Coffee maker remains broken. I remain sad. Surgeons having screaming matches with anesthesia in the hall for reasons equaling something along the lines of: He won't give me my Slinky! A frisky patient attempted to goose my ta-ta <--yes that is a technical term. My favorite pen fell out of my pocket during a patient transfer and was discovered over in PACU when the patient kept complaining of "something poking my thigh".

    A kidlet, who was supposedly NPO, spewing <--again with the technical terms, Spaghettio's all over and more importantly down my scrub top which lead to a demise of a well loved undergarment (huzzah for ace wraps) and a need for change of scrubs #1. And cue surgeon yelling at anesthesia. ::sigh::

    My favorite trauma shears snapped in half while cutting through a patient's pants and, of course, the surgeon looks at me like I'm some nit-wit that had nothing better to do than set him up with a sure to implode pair of scissors. Later in that same case, while flipping the foley up in order to shift the patient over to the inpatient bed, the foley bag exploded, yes, that's right, exploded. You guessed it: demise of lower region undergarment and change of scrubs #2. By the way, if any of you are interested, the mesh pants commonly given to patients as dressing or in L&D are actually quite comfortable. Make a note of it. Moving along.

    Blah blah blah, a case and a half later, I'm in the middle of a lap chole turned open, when I'm scuttling across the room, trip over the kick bucket (how in the world do you miss a bucket?! A bucket that you put there?!), and catch myself from falling by deploying my forehead against the wall as a make shift kick stand. Dragging my wounded pride with me, I managed to get everything for the field and things seem settled until I'm answering the surgeon's pager and he's giving me the eye. I'm annoyed and in no mood so after a hissed, "What!?" He gives a little jabbing motion with his chin and answers, "How are you liking the breeze?" The scrub tech is snickering, anesthesia is about a split second away from aspirating his mask and I am dumbfounded.

    My friends, apparently under the strain of fighting gravity, my pants had exploded. I'm not talking ripped a little or split a seam or even became threadbare. I'm talking shredded like a pair curtains shut in with eighteen cats on a catnip bender. How in the world I didn't feel anything...I will never know.

    But thank heaven for mesh pants.

    And so here I sit, nibbling saltines and nursing a ginger ale and wanting you all to know: We all have days where we doubt, where we question, where we wonder why in the world do I do what I do.

    We all have bad days.

    But in the end we have to hang on, learn what we can, hike up our mesh pants, move forward and keep in mind that, if nothing else, it makes for an interesting story.

    Keep the faith,

    ~~CP~~

  • Apr 5 '13

    Today is my day off after working three days in a row. However, my eyes popped open at 0530 and would not close again. My brain immediately went into review mode. Shoot! I forgot to give that detail in report! Did I do enough with that brand new admission? Should I have done more before handing over care? Did I miss anything with that patient who did not have a great urine output yesterday? My fellow new grad RN seemed so competent when she took that new ER admission. Do I seem that way to her?

    And on it goes. As a new grad RN on the step down unit of a small community hospital, I can make a full-time job out of worrying about my full-time job. Every day brings a fresh set of worries. I have been working six months now, and a new worry for me is that I am still worrying. Shouldn't I feel more competent and relaxed by now?

    Nursing school prepares you to take the NCLEX. It really does not prepare you for the reality of taking care of 5 acutely ill patients. I was lucky. My employer has a great new grad RN program, and I was gifted with 13 total weeks of orientation (2 weeks in the classroom, 11 weeks on the floor with a preceptor). This sounded like such a huge amount of time when I first started. It didn't seem near long enough when it was time for me to cut my ties with my preceptor and go it alone.

    I am a type A personality with OCD tendencies. I like things orderly and neat. Like Santa, I like to make a list and check it twice. I like to have a plan, and I like things to go as planned. The problem with all of this, of course, is that in nursing nothing ever goes as planned. Unexpected things happen all the time. And there is no TIME to make a list and check it twice. There are constant interruptions to your train of thought, and you just have to be able to roll with that. Veteran nurses may be able to roll with five patients all needing a long list of medication at the exact same time while simultaneously dealing with head-to-toe assessments, call bells, order changes, lab results, critical labs, telemetry monitoring, and charting, but this new grad nurse finds it overwhelming to say the least. On my best days, the stars align and I am able to whisk from room to room and get everything done in a timely manner. On my worst days, one or two patients can take most of my time while my other three are left to wonder where the heck their nurse is with their morning medications.

    For me, the crisis of confidence I am experiencing is the worst part of being a new grad. I am a person who came into nursing later in life (I was 39 when I graduated from nursing school). I have been successful at past vocations. I have a great work ethic and have always been considered a valued employee by past employers. I was successful in nursing school and graduated with the highest GPA in my nursing class. However, as a new grad I am constantly questioning my ability to do this job. I worry that I am annoying my coworkers with my seemingly endless stream of questions. I worry that I am annoying the hospitalists with my barrage of pages. I worry that I am not going to get any better at starting IVs. I worry that my patients are going to realize I have only performed whatever skill I am performing a few times before and that I will appear incompetent. I worry that my employer is secretly sorry they hired me. I worry that I am never going to feel more confident and improve my speed and efficiency, and then I worry that as a result I will never get to spend the time I would like with my patients, as I will always be rushing to the next thing, the next item on my mental list. Most importantly, I worry that no matter how hard I try, I am going to miss something and something bad is going to happen to one of my patients. I worry. I worry. I worry.

    In order to combat this incessant worrying, I find myself seeking constant reassurance from coworkers and fellow new grads. I hate to admit this, as it makes me sound callous, but I am comforted by the fact that my fellow new grad RN cries in the shower when she gets home. I am comforted when one of my nursing school classmates jokes, "Some days I want to drive my car into a tree on the way home." This makes me think that maybe my sobbing car rides home from work are not entirely out of the realm of normal. Coworkers in whom I have confided my feelings tell me that it will take a solid year before I feel like I know what I am doing. I find comfort in their words, but still I worry that I will be the exception.

    In the face of all of this constant worry and stress, all I can do is continue to try my hardest to be the best nurse I can be for my patients and not lose sight of the fact that I am working for them and only them. I will continue to hope that as long as I keep my patients and their safety and well-being foremost in my thoughts, the rest will fall into place, so that one day I will be the one saying to a terrified new grad RN, "Don't worry. Give it a year. You're doing well. You'll get it. Trust me. No, really. Trust me."

  • Apr 5 '13

    This is a very good article! I think that you packaged and wrapped the feelings of a new grad RN very well. It was a reminder to me of how I felt when I was brand new. I think everyone who has been a nurse has felt this way starting out. (If they say they never did they are probably either lying, incompetent or both *gasp*
    Even after being a RN for awhile there are still moments of worry, stress and self doubt. Focus on the good, hang on and pray through the bad and you will get there.
    I once asked a nurse I respected "Do you think that I'm smart?" when I was having a self doubt mini crisis after a really long and crazy shift. She replied as a matter of fact "Of course you are smart. Anyone who makes it through nursing school is smart. You just need a little more experience." And that was just the encouragement that I needed. We did make it through nursing school, even though that seems so long ago..
    You ARE a RN, You ARE a good nurse and you ARE making it! I wish you all the best!

  • Mar 27 '13

    I mix chocolate milk, chocolate ice cream, prune juice and milk of magnesia. It's called a "brown cow". Makes it seem like a treat!

  • Mar 27 '13

    "Hey, you should've been there when I finally let Arwen have it," Sarah (not her real name) tells me as we sit down in the nondescript break room of our assisted living facility to sip go-go juice and discuss our weekends. She's telling me this because I think her live-in dipwad---excuse me, significant other---is a horse's patootie who sponges off her and treats her like last week's garbage. "You'd have been proud of me...I threw all his junk out the window, then I told him where to go and how to entertain himself when he got there!"

    The mental imagery of shy, five-foot-nothing Sarah screaming curses at the POS in question and flinging his fishing gear out the window of their second-floor apartment tickles my funny bone, but of course I bite down on the laughter because I know she's completely serious. I also know this isn't the first time she's been serious, nor will it be the last: she always forgives him and lets him come back home no matter HOW rotten he is. And I let her pretend that she really means it this time.

    You see, it's like this in employee break rooms all over the world.....this is where you really get to know your co-workers as people, not just people you work with. Confidences are shared, grievances aired, tears shed, hugs given. And unlike Vegas---or most places on earth, for that matter---what happens in the break room stays in the break room.

    Except.......

    Have you ever heard healthcare workers discuss bodily functions in terms of food? Yeah......me too. The other day, one of our CNAs ran into the break room with no two hairs going in the same direction, and she was panting like a black dog in July. "Did you give Benny the Hot Slider this morning?" she demanded, glaring at me as though I'd just betrayed some dirty, dark secret. (FYI: this "slider" is a concoction made up of 240 mL prune juice, 30 mL of Lactulose or MOM, and two pats of butter---zap for 45 seconds in the microwave, stir well, and drink daily PRN for constipation. It's failed only twice that I can recall, and since I've spent most of my career in geriatrics, you KNOW I've mixed this brew a time or ten.)

    "Yes, I did. He hasn't 'gone' in almost a week," was my explanation, to which the aide promptly responded with an outraged sigh. "Well, he's more'n made up for it. You should SEE the river of (brown word) I just cleaned up in there---it was pourin' off the bed like uncooked brownie mix!!"

    The break room is also where one goes to hear fascinating tidbits about co-workers' personal lives, whether one wishes to or not. It's where I discovered that not one, but four of my staff were expecting babies.....all of them in the third week of August! After finding out that two more were due in mid-September and early October, I wondered about how safe the drinking water in the place is.....and while pregnancy at my stage of life would be next to impossible, I'm bringing in my own bottled H2O anyway.

    And then there the tales from the dark side that are told in the break room....

    Some days it's like Comedy Central in there; others, it's more like a morgue. But either way, it's often instructive and always entertaining. Here's an exchange between several staff members that I walked into recently:

    A CNA with dripping hair and a slightly greenish cast to her face was standing by the refrigerator, evidently trying to decide whether or not she really wanted her turkey sandwich as she told the story about her most recent encounter with "Ed", a resident who is notorious throughout our community for his eye for the ladies, his poor hygiene, and his resistance toward any procedure that involves water or might scrape more than a millimeter of dirt off his ornery hide.

    "......and THEN what did he do?" Uncomfortable laughter and a few grimaces.

    "Ugh, he put his (brown word)-stained hand on my back and started playing with my hair!"

    Expressions of disgust followed. "Eeewwww!" "Gross!!" "Oh, barf!" "What did you do after that?"

    "I told him, very nicely, that I didn't want him to do that. Then I got the (fritz) out of there and stuck my head under the whirlpool sprayer till it ran cold."

    "Nice work, Candace," agreed another CNA. "But is Ed still running around with (again with the brown word) all over his hands?"

    "I dunno. Maybe Marsha got to him and took care of it. All's I know is that I'd-a puked if I'd stayed there a second longer."

    More cries of "Yeccccccchhhhhhh!" and fake dry-heaves along with snorted laughter and a hint of eau de poop filled the air, briefly pushing aside the day's chosen Scentsy fragrance. And what I learned from this lovely little tale is that I never want to be demented, incontinent, and living in a place where fingerpainting is not allowed and the employees run away when I try to pet them.

    Such is life among the denizens of our dingy, poorly-lit oasis, hidden behind a dented door with a sign that reads "Employees Only". What's yours like?

  • Mar 27 '13

    Two mornings ago I received a distraught phone call from my mother telling me that my dad, who is suffering with end stage COPD, spine compression fractures, and a distinct lack of proper narcotic metabolism, became flighty, picky and squirrelly to such a point that he was assigned a sitter.

    Look, I've been around. I know what can be said about sitters. I know that for every one that understands the amount of sheer effort and work that goes into trying to keep someone in bed, calm and intact, there are several more misguided individuals that think sitting is easy, requires little effort and even less work.

    Obviously those individuals need to meet my dad when he is blitzed out of his brain on Fentanyl and Vicodin. Let's just say that when my family decides to lose it, we don't just misplace our minds, we straight up blast them into orbit never to be seen or heard from again.

    Maybe it's the southern mentality: go big or go home.

    We pride ourselves on hearing the blankets whisper, seeing shadows slip through the walls, and having full out conversations with no one physical. We sing with gossamer birds, swat at oily, ethereal spiders, undress, and boot scoot boogie down the hall, crumpled spine and inability to breathe be damned. We talk back at the television (even though it's off), recite bits of poetry, and try to lick our meatloaf. We load pills in the end of water straws and attempt to "tranq" the "elephants" in our room. And yes, the nurse would just so happen to be the elephant in question. Perhaps wearing grey scrubs in the presence of one no longer operating on this plane of reality was a mistake. Just sayin'.

    But regardless of all the insanity, of the wandering, flitting hands that pluck at skin tears, scrape at desperately needed picc lines, and fidget with the oxygen in his nose, and never, ever rest, he is safe, cared for, and, although gently, patiently re-oriented again and again, he is even kept company in his joyful delusions.

    I went to see him the other night only to walk up to the room to hear him murmuring, "The birds...do you hear them?"

    "Yes, sir. I think they are canaries. Let's lay still and see if they come back to sing to you."

    "Okay."

    And there he was, staring at the upper corner of the ceiling as if watching a menagerie in the zoo, rapt, still, his hands resting lightly on his bedding. The sitter, Margaret, greeted me and explained everything he had been up to in a hushed whisper.

    After all, we were waiting for the canaries to return.

    And then last night, a half mad, partially naked Humpty Dumpty decided to have a great fall.

    It would seem that someone decided to tap into their inner ninja and attempt to vault the bed rails and make a beeline for the room exit. The gown was apparently trying to rat him out, so it was discarded for the sake of security (thankfully, he didn't manage to totally disrobe).

    Mission impossible music may or not have been involved.

    The sitter only looked away for a second. And you know what? I totally believe her. I've seen my dad move when properly motivated.

    But it is not because of any "blame" issues regarding his escape attempt that she caught my attention. No.

    It is because she was fast behind him, and when his foot caught and his burst of strength gave, she swiftly, skillfully guided him safely to the floor, cushioning his head on the soft toe of her shoe.

    Because of her knowledge, her quick thinking, fast reflexes and sure hands, I am not writing a grieved announcement of my dad's need for a crani or an intermedullary rodding of a femur.

    Because of her, I get to watch him listen to the sweet chatter of the blankets and blow bubbles in his soda.

    And although that may sound like the strangest thing you have ever heard, I could not, ever, be more grateful.

    It may not be much, but thank you.

    Thank you.

    Thank you for giving him the same dedication you would give your own loved one. Thank you for never yelling, never losing your cool. Thank you for laughing with me because crying is not something built into my coping mechanism. Thank you for not laughing at him. Thank you for speaking calmly with my hysterical mother when I could not be reached.

    Above all, thank you for "doing nothing".

    Most sincerely,

    ~~CheesePotato~~

  • Mar 27 '13

    I attended massage school many years ago and would like to get my license. I need to take one of the national exams to apply for licensure in my state. Does anyone know of a refresher course anywhere in the country??? I need a short, intensive workshop or weekend type course. Thank you!

  • Mar 27 '13

    As I have progressed in my career as a nurse I discovered a passion. Stress management. Stress management touches all aspects of our lives with increasing urgency. As we move forward each day we are expected to manage more, accept more, think more, and accommodate more. For more what do you ask? For more of everything. In our home lives we are expected to be Pinterest parents, cooks, home makers, and community leaders. At work we are expected to carry more patients, give ever increasing levels of customer service, contribute to shared governance, chart with legal precision, and still have compassion left for our patients. On Facebook we are expected to offer comfort to friends, get excited about petitions, try to get the best deals and sale prices on goods, and make sure we are sending back gifts in frivolous online games.

    While one can say, "Well just stop doing X, Y, Z and you will be fine" have you ever stopped to ask yourself "Do I even know how to recognize that there is too much on my plate?"

    Nursing and Stress Management

    Prior to the birth of my first child, and while completing my undergraduate requirements, I started brewing a plan of stress management tailored for acute care hospital nurses. I chose this population because, well, I was one of those nurses. I knew the limitations, expectations, and resources available. I also knew the anxiety and stress that could come with it.

    As I began formulating my plan I started asking questions of co-workers such as:

    "Would you go to a group therapy session of all nurses?"

    "Would you consider one- on-one counseling if it were available once or twice a month?"

    "Would you want debriefing time after a traumatic patient event?"

    Many of the responses were dismissive, uninterested, and withdrawn. I was surprised by this because I often found discussion to be a therapeutic route for myself, so I wondered "Where is the disconnect happening?"
    I didn't realize it until I was hospitalized for a weekend during my first trimester of my second pregnancy for suicidal ideation.

    From the Bed of the Depressed

    In November of 2012 I went into my OB-GYN in tears. We had discussed Zoloft as a possibility for post-partum depression, which I had read can be much worse with two children. I knew I had PPD with my first, and was worried it would be worse this time around, so I wanted to be prepared. My tears and discussion of thoughts of swallowing Tide laundry pods because I was so miserable with morning sickness scared my practitioner and settled me in for three days in the High Risk Perinatal ward.

    For three days I felt what others have felt when admitted for anything mentally related. I felt pitied, tip-toed around, and brushed off. Even though I had been cleared of all suicidal tendencies within hours of being admitted, I was still treated differently. During this time I was dehydrated from vomiting, anxious, and miserable. Most of these ailments were related to my morning sickness, which is notoriously bad.

    When I was discharged that Sunday, I went home with a prescription of Zoloft. For two weeks I convalesced at my in-laws battling to find passion for my daughter again and to gain some reprieve from my nausea and anxiety. Thankfully, after getting to 100mg/day I was finally coming around. I found myself engaging with my daughter again, feeling less anxious, and feeling the ability to participate in my life again.

    Shortly after my discharge I started therapy sessions with a psychologist who specialized in women's health issues and Eye Movement Desensitization Reprocessing (EMDR) therapies. EMDR is a treatment used primarily in Post-Traumatic Stress Disorder (PTSD) patients, but also has benefits for depression and anxiety. In a nutshell EMDR teaches you how to reprocess memories so that they no longer haunt or hold you back. I was skeptical of this approach, however after my first session I was a believer. The process of EMDR helped guide me down pathways I had never seen before in processing my anxiety.

    Currently I have completed several sessions of EMDR, which has reduced anxiety over past circumstances, helped me develop new coping mechanisms, and is helping me wean off my Zoloft completely prior to delivery of my second child in May. So how does this all affect my perceptions of stress management in nursing?

    Stress and Nursing

    Stigma
    Mental health fears
    Weakness
    Vulnerability
    Incompetence

    After I was first prescribed Zoloft I was open with everyone about it, because it was helping tremendously. It felt amazing to feel like myself again, to be able to move, function, and love my life again. So when people asked about my pregnancy I would admit it was rough and that I was on Zoloft, but doing well. I was met with basically the same reaction from nearly everyone. Moderate discomfort.

    For comparison, when you tell someone you are on a new medication for any chronic or acute disease most people will show enthusiasm for you. Often praising the wonders of medication, telling you how glad they are that you are feeling better, or agreeing that maybe they should look into this option for themselves. This is not true of medications for mental wellness. The idea that you might be imbalanced somehow outweighs that you are working hard to manage both on a pharmaceutical and therapeutic level. While I was never swayed to silence my story by this reaction, it did make me understand why nurses are reluctant to seek stress-management options.

    No nurse wants the stigma of weakness, vulnerability, or incompetence tagged to their credentials. We often think of being blamed first for drug diversion if we are on Xanax or Zoloft. We fear lawsuits if something goes wrong with a patient because we have been in therapy for depression. For me I had seen first-hand, from the bed, how those diagnosed with mental ailments were treated, and I understood all too well why most nurses I talked to cringed at even the thought of therapeutic conversations about work.

    As my therapy, pregnancy, and time on Zoloft have come to end I have learned a valuable lesson, despite stigma, stress can be addressed without creating labels on the nurses participating. Getting to the root of stress related problems can help prevent occurrences of depression and pharmaceutical intervention; it just has to be presented in the preventative health arena.

    My Commitment

    From here on forward I am committed to bridging the gap between prevention and mental health awareness. I am committed to finding a way to let nurses recognize areas of stress and reduce them without being afraid of being labeled. My commitment starts with my own openness about my struggles and revelations, available here, in this story.



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