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An unrelinquishing hammer foot on the pedal of your day will certainly make things go by quicker- but at what cost? The moments of your day are cumulative, and as they pass you by, so do the opportunities to make them as meaningful as possible. As we have seen throughout human history, the means never justifies the end- so why is it that we sometimes approach our care this way? Well, many factors impact the schedules of our day, both in task timing and completion. These factors include: staffing shortages, high patient census, high acuity patients, and the list goes on. The difference between a day of chaos and a day devoid of perturbations is certainly significant- cumulatively, the impetus of a meaningful practice is much more likely in the latter scenario than the former. A truism or closely held belief in nursing is that the quality of our practice is sometimes perhaps measured by the amount of devoted time in being present with our patient(s) (Enns & Sawatzky, 2016; Rivaz et al. 2017). This, unfortunately, creates confusion surrounding what it means to care- which is already quite elusive and difficult to conceptualize within the scientific literature (Cook & Peden, 2017; Davidson, Ray, & Turkel, 2011). Time can not and should not be the final straw to break the camel’s back. Far too many instances within a nurse's practice are predicated upon time- generating plenty of added stress and angst to both well adjusted veterans and novice nurses (Enns & Sawatzky, 2016; Rivaz et al. 2017). So why should we give authority to the pressures that limit it? This notion appears to be a non-zero sum game- lose if you try, and lose if you don’t. A missed bed bath as a byproduct of a day filled with family updates, short or limited staff, critically ill patients, patient bed moves, transfers, tests, discharges, admissions, and the remaining tasks that are typical of a nurses day does not define the character of a nurse. The earth will remain on its axis and will continue to spin at one thousand miles per hour. Your colleagues will look at you the same, and you can go home knowing that your efforts are long standing. If the basis of interventions to treat burnout (both mental and physical) and the psychological sequelae such as depersonalization is mind based or treated from the purview of the psyche, then it is clear that how we feel and how we are made to feel from the conditions of our day can compound overtime- the result either being good or bad. The message here is to take each moment, each shift, each patient, one step at a time. Appreciate the moments of pristine clarity, but equally as important, respect the moments where it feels like everything is falling apart. Ask for help. Reflect on your day- ponder what went right and what went wrong, a seemingly simple task that takes moments of brain power with effects that can potentiate a distressed mind. Hug your significant other. Pet your dog. Take your foot off the pedal, cruise at 30mph-this is a school zone for Pete's sake. References Cook, L. B., & Peden, A. (2017). Finding a focus for nursing: The caring concept. Advances in Nursing Science, 40(1), 12–23. doi:10.1097/ANS.0000000000000137 Davidson, A. W., Ray, M. A., & Turkel, M. C. (2011). Nursing, Caring, and Complexity Science: For Human-Environment Well-Being. Springer Publishing Company. Enns, C. L., & Sawatzky, J.-A. V. (2016). Emergency Nurses’ Perspectives: Factors Affecting Caring. Journal of Emergency Nursing, 42(3), 240–245. https://doi.org/10.1016/j.jen.2015.12.003 Nowrouzi, B., Lightfoot, N., Larivière, M., Carter, L., Rukholm, E., Schinke, R., & Belanger-Gardner, D. (2015). Occupational stress management and burnout interventions in nursing and their implications for healthy work environments: A literature review. Workplace health & safety, 63(7), 308-315. Rivaz, M., Momennasab, M., Yektatalab, S., & Ebadi, A. (2017). Adequate Resources as Essential Component in the Nursing Practice Environment: A Qualitative Study. Journal of clinical and diagnostic research : JCDR, 11(6), IC01–IC04. https://doi.org/10.7860/JCDR/2017/25349.9986

The Present Moment The present moment is an esoteric concept when considered from a contemplative purview, however is one of the most simplistic and liberating feelings when actualized in our day to day lives. Mindfulness, presence, spiritual enlightenment are all synonymous with relinquishing the Ego, and submitting to the inevitabilities of each moment as they as us by. The totality of each moment experienced as it is, and all that is can be reconciled for what it is, no more or no less. The mind, in its most acute state of awareness, unshackled from the unnecessary dead weight and mind tricks or self-sabotage, can truly bear witness to the luminous beauty that our reality of Self and Self & Other can afford us. We experience brief moments in which we are fully present. A feeling consisting of pure ecstasy and love. Like those moments where you are alone, in nature, and you stare at a field of trees or dense forest, and you begin to comprehend the beauty before you. You think about the still image in front of you, and you have no words to describe the feeling that it elicits. The very Thinghood or Isness of the vast field or dense landscape evades your concept of time and space for a brief moment. You then begin to feel a warm cloak of love wrap itself around your heart and you appreciate the life that you have been able to lead and you become fascinated with what is to come. This is true presence in its naked form. It is imperative that we do not get lost in the appearance of occupation or status. Our actions must not be viewed as a means to an end. Rather a means to new beginnings for ourselves and our patients. We must be equipped to bear the burdens of others. Our minds must be clear, and pointed narrowly to acute remedy and the promotion of actualization tantamount to the “good life”. We must be at peace with ourselves in order to balance the scales of order and chaos. And most of all, we must love ourselves for the very reasons that we are loved by others. We must be present, as all that matters is the present moment.

Power: A Professional Responsibility Power is both a necessary evil and a potential obstruction both fundamentally, and within the field of nursing. It is certainly a game of computational hierarchy and I think that we can all agree that nurses have their hands in most pots and come to understand almost every aspect of their patient’s lives. We become so involved, and with this level of invasiveness, as professionals, with knowledge of the human entity and its innumerable processes, we become a figure of power in some odd way. We understand, and with this understanding, we can act appropriately. So does this imply that knowledge is directly related to the outcome of power? So would argue yes, and some would contest this notion. An interesting perspective paper written on the topic of power and empowerment within the nurse-client relationship elucidates that power is self-identified.[2] Discerning between “power to” versus “power over” is what separates outcomes of empowerment and oppression through dominance hierarchies respectively.[2] It seems that a matter of balancing intention and outcome is predicated on our conceptualizations of power. Even more, power can be separated based on scale. Macro versus micro sources of power present a middle ground with respect to definition and context. Macro level power is defined as a system or societal power stemming from oppressed populations and perpetuated by those at the top of the dominance hierarchy.[2] While micro level power lives within interpersonal relationships and is perpetuated by transactional relations.[2] Regardless of definition or conceptualization with regards to morphology, it has been argued that the concept of power and one's understanding of it are determined from within.[2] As nurses, we carry knowledge from an array of domains. When we are conflicted with a medical dilemma, we recall our scientific understanding of human physiology and our capacity to change with illness. Our expansive knowledge base related to what is happening in our patient’s continuum of care is what separates us from them. It has to, or else our roles would be put up for review. The obvious exception being if our patient’s identify as medical professionals by trade, however this goes without saying. If a hospitalized patient of yours begins experiencing symptoms reflective of ACS, it is your duty to act upon what you notice through assessment and respond through coordination with multiple partners within the care team.[5] This process begins with noticing and ends with your reflection of the entire process, which includes, but is not limited to your action(s). And with our knowledge and sensibilities to act in an ethical manner, it seems that we are powerful beyond recognition. We can contribute to the change of disease states both expediently and long term. In fact, we can oftentimes lead our patients down a path that we feel to be the best for them, which guides their future thoughts and actions within their own lives. But what is the cost? And is this power inherently “good” or “bad”? The example above reflects both the nurses ability to enact “power over” and “power to”. However, this example is far from perfect in execution. And as we know, the care of another person can oftentimes be far from perfect. Sometimes we are fooled by our patients' assumed docility based on hierarchical dogma that is predisposed from designation and knowledge base. But what would happen if our patient in the example above refused your interventions? This particular patient being of sound mind and body, decided not to pursue treatment for their coronary syndrome. What then? Well, the power you thought you had is no longer. A paradigm shift has occurred in your world, and you can either accept it or become resentful. The power you thought that you once had- power that you once thought was instantiated into the role that you assume as a nurse can sometimes be a guise or falsification of a perceived authoritative position because the patient allows it to happen.[3] Whether it be the image that you created of yourself, the patients acceptance of their lack of knowledge or level of understanding, or perhaps a combination of both - it is imperative that you ensure that you approach is not disempowering.[4] Power can easily become abused, especially when it becomes tied up within one’s identity both personally and professionally. It can undoubtedly become a game of status among health professionals and between nurse and the patient.[3] And when this becomes the case, the relationship crumbles and those involved become cynical and designations such as “uncooperative” or “stubborn” are irresponsibility ordained into the language of care. The idea that power somehow makes a nurse “whole” and therefore viewed as powerful within the healthcare regime is not a new one.[3] The literature on the topic of power is quite expansive and is investigated from multiple domains.[3] What complicates things more is the concept of “empowerment” that we spoke of previously. Attempting to define either topics has also proven to be a difficult one as both can be seen as interdependent and also mutually exclusive.[3] I am under the opinion that a “holier than God” approach is not good for anyone involved. Moreover, the literature shows us that the oppressed take on the attitude of the oppressor, which leads to poor outcomes.[3] On the flip side, an inherent disregard of the importance of empowered nurses and the effectiveness that said power brings about within the continuum of care is no different than the latter.[3] So how do we balance the intention to do “good” with the potential to negatively impact the care we provide through the use of power? Surely both extremes of forgoing the power we hold inherently and total abuse of said power are not tenable alternatives. Perhaps taking a more lax approach to what we perceive as power socially, organizationally, and psychosocially as it relates to hierarchy and status, and adopting a more productive view of power is necessary to realize all that power truly can be is empowering yourself and the patients that you care for. Sharing is caring, and having the ability to share the power that both nurse and client possess is both a professional responsibility and moral obligation. [1] References [1]College of Nurses of Ontario. (2006). Therapeutic Nurse-Client Relationship, Revised 2006. Retrieved from: https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf [2]Du Plat-Jones, J. (1999) ‘Power and representation in nursing: A literature review. Nursing Standard, vol 13(49), 39–42. Retrieved from: https://search.proquest.com/openview/a72099bae6d634b6979e7d5bc03046f8/1?pq-origsite=gscholar&cbl=30130 [3]Jones, C. B. , Sambrook, S. , & Irvine, F. (2007). Power and empowerment in nursing: a fourth theoretical approach. Journal of Advanced Nursing, vol 62(2), 258-266. doi: 10.1111/j.1365-2648.2008.04598.x [4]Oudshoorn, A. (2005). Power and empowerment: Critical concepts in the nurse-client relationship. Contemporary Nurse, vol 20(1), 57-65. DOI: 10.5172/conu.20.1.57 [5]Tanner, C.A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45 (6), 204-211. Retrieved from: http://www.healio.com/journals/jne

Cur Autem (latin translation for “the why”) Friedrich Nietzsche said it best, "If we have our own why in life, we shall get along with almost any how[1]." Now upon first read, you may be wondering what this has to do with your position as a nurse. In fact, you may question how this even relates to you as a person. But I assure you that many aspects of your life as a nurse, and in general, is predicated on your sense of meaning and the application of this meaning to the various aspects of your life. Which in turn, offers you the paradoxical why that so many need to lead a purpose driven life. If Viktor E. Frankl, a published psychiatrist and author of the book titled, “Man’s Search for Meaning”, and also a man who had endured torture, famine, and tyranny to the most inexplable extent, can find meaning in the nothingness that being a prisoner of the Nazi regimen endowed, then I am confident that you can too. Frankl wrote that almost every aspect of a man’s life can be taken away, except for the human freedom of choice. He said that despite all the suffering, he would often see men give away the last of their food rations to others who needed it more. Demonstrating that one’s attitude can be preserved even in the greatest extremes of suffering, and out of it, meaning and purpose can be derived, that is sacrificing despite circumstance and reason, and nourishment as the latter. Frankl then went on to publish about a type of existential analytic therapy coined Logotherapy, which can be described as a therapeutic approach in which the derivation of meaning in one’s life is the goal and transcendence the means. But I digress. Those who were suffering, often stripped of every last piece of their Being, right down to the core, found purpose in their existence. This is a very powerful sentiment. That the vestige of human freedom of choice, to do good, can be preserved in suffering and as a result, what appeared to be an existence in which living meant torture and starvation could be one of meaning and purpose. Recognizing this idea, we can not ignore the fact that meaning derived from purpose is all that matters, even in the extremes endured by Frankl. Similiterque in Caelo Speramus (latin translation for “in reflection we trust”) While the nursing profession itself does not have to endure the same misfortunes of that of Mr. Vikor Frankl to find meaning, we do, however, have the moral responsibility to find meaning in the suffering of others. As a nurse, we have the responsibility of a liaison of sorts; that is comprised of a healthcare professional, a shoulder to cry on, a person to provide comfort to patients & families during illness and in death. This translates to boundless opportunities to improve upon yourself and your approach to practice. If it took one experience as a prisoner in the Nazi regimen for Mr. Frankl to contribute to the psychoanalytic process, then by comparison, nurses should have the capacity to move mountains by way of the suffering that we witness on a daily basis. And indeed, many do. While not on the same stratum of the tyrannical regimen that Adolf Hitler operated, illness, tragedy, and death of patients and their families certainly does bring plenty to the table. Those handwritten sentiments from the families of deceased patient’s indicating their appreciation for all the members of the team, the hard work and care demonstrated to make the final moments of their mothers or fathers life a dignified one is just one of many examples of this. But what does the path to finding meaning look like? How can we emulate what the malnourished prisoners of war did in our practice? Well the answer is an obvious one, however, is something that the everyday hustle and bustle of life gets in the way of. This my friends, is the wondermants of reflective practice. So much of healthcare is predominantly empiric in nature, however the practice of nursing is one in which art can cascade with the healing process. Take in, process, and disperse your metaphysical understanding of what you see and how it makes you feel. Put these feelings into words, categorize them and develop yourself and your approach to practice. Allow that dying patient, surrounded by loved ones, or perhaps the opposite, alone and withering away unaccompanied, impact your approach to that Form 1 patient who is indecisive about life and death and unsure if life is worth the suffering it brings. ... Without reflection, there is no thought. Without introspection towards the woe’s that our profession endures, we can not derive meaning or purpose to justify our roles as nurses, but even more troubling, as Beings. The most desolate of places to be is inside an Existential Vacuum in which what you ought to do is dictated by others, which is deadly game of conformism, or what you do is for others, which is contrary to the governing bodies perception of autonomous practice. Final thoughts; So much of what we read in the nursing literature related to our practice, whether it be our “ways of knowing”, which is eloquently cloaked by the empirics incessant need to categorize and label, but can be easily described as an underpinning of what we do and how we go about it. Or the nurse-client relationship as guidelines as to what ought to be done and boundaries demarcated by the ethical parameters of our practice; is based on choice. Our choice, as nurses to transcend the boundaries of what could be, or choose to just let be. Interesting Read for those who are curious to explore the existential aspect of nursing: Udo, C. (2014). The concept and relevance of existential issues in nursing. European Journal of Oncology Nursing, vol. 18, 347-354. http://dx.doi.org/10.1016/j.ejon.2014.04.002 1462-3889/ References: [1] Frankly, V. E. (1946). Man’s Search for Meaning: Revised and Updated. New York: POCKET BOOKS.

Ideas are all we have. Opinions towards these ideas dictate the outcome of them (good or bad). I hope your opinions towards your day to day efforts haven't skewed away from the potential for meaningful change. I hope you haven't shot down the "great ideas" implemented by those above you (or perhaps among those on your level- those who feel that they are not limited by their experience). I am new to the profession. I am smart. I learn quickly and effectively. And I will not be discouraged by your comment. Have a good day

Communication: A Vital Utility Communication can be defined simply as the sharing of information. Even more broadly, communication can be distilled down to the act of a sender producing the content of a message in any of the many forms available to us, to then transfer this information from one entity to another at varying speeds.[5] A receiver intercepts the incoming message, then proceeds to decode the content into terms that are easy to comprehend, and that reduces the chances of error.[5] In healthcare, error is evaded at all costs as the consequences can be catastrophic, and in some instances, permanent. That is why so much effort is put forth to ensure that the means of communication is operating at peak effectiveness at all levels and why simply communicating with one another is not as straightforward as it may seem. How we communicate with one another in practice is largely based on the mode by which information is transferred from one provider to the next. Even more, the logistics of the message, that is, the organization of the content, word choice, and use of clinical terms is also seen as paramount to the productiveness of communication.[4] "Huddle" is one of the numerous communication strategies that is recommended by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) in response to a publication from 1999 titled, To Err is Human, which presented what seemed to be an inconceivable figure of annual mortality rates due to medical errors.[3] This figure presented an astonishing 98,000 deaths annually due to what is defined as failure to do what was intended or failure to implement the correct plan to accomplish a common goal.[3] Among the contributory factors, failure of communication, however defined, was implicated in this avoidable reality.[3] An entire curriculum had been created in response to these issues as existing team-based training programs lack sufficient evidence in regards to their effectiveness, and were not designed to retrofit or conceive new programs based on their existing architecture.[4] At some point between 2001 & 2003, AHRQ and DoD almost decided to base their program on the Federal Aviation Administration (FAA) circular for airworthiness for commercial and private aviation. However, this was scrapped and TeamSTEPPS was created.[3] TeamSTEPPS is an acronym that reads; Team Strategies and Tools to Enhance Performance and Patient Safety. It is a curriculum aimed at practice investigators and those at the institutional level to implement, to, well, strategize the team approach and to streamline the care process, while improving upon patient safety. This U.S based program is making its way to Canada in collaboration with the Canadian Patient Safety Institute.[2] So, whichever preconceived notions you had regarding the utility of a.m team huddle, as you can see, there is a reason for it, and more importantly, there are people who see a larger vision over the horizon- as you should too. Team huddle is just one of many interventions aimed at improving communication.[1] (See pocket guide). What Does "Huddle" Mean? Team huddle is an event that typically takes place at routinely scheduled times on a daily basis and involves relevant members of the care team. It is a meeting that tends to take place early on in the day and lasts for about 10-20 minutes.[8] The goal of team huddle is to communicate pertinent information regarding patient care as well as unit and hospital operation. It is a tool used to facilitate communication between team members face to face, in an open forum, usually at or near the nurses station.[8] Similar to a town hall event, participants are there to listen and share without fear of judgment or being penalized for holding a certain opinion or thought. Team huddle gives team members the opportunity to adapt their workflow for the day and prioritize patient and unit needs.[8] Members of the team are given the opportunity to communicate information that brings necessary parties to the forefront of an imminent problem or concern, and in turn, contribute to the formation of a timely solution. Typically those involved in huddle include front line providers, management, unit attendees, clerical staff, and any one of the many other important stakeholders involved in patient care.[8] However, this does vary on an institutional basis. Team huddle can be seen as a preventative strategy that allows the unit to run smoothly and efficiently. Time can then be spent focusing on quality patient care, instead of putting out fires that could have been prevented. Huddle should be held at the right time, at the right place, and with the right people.[8] Why Are Team Huddles Effective? Team huddles provide a forum in which open discussion can take place regarding patient care. Topics that are typically discussed include goals for the day, patients to be discharged or transferred, patient-specific care plans such as falls prevention, unit census, workload/assignments, etc.[6] Discussing patient care using prioritization hierarchies and anticipating patient needs allows front line staff to plan out their day right from the get-go. This allows the team to be efficient, flexible, and adaptive for when the high volumes, heavy workloads, and admission/discharges begin to consume the day. And of equal importance, huddle provides the opportunity to connect leaders with front line staff and to bring awareness to safety and quality control concerns from both ends.[7] "Plan to Prioritize and Prioritize with a Plan" Huddles are most engaging when they are structured, but brief, and perceived as valuable. This fosters engagement from members of the team, and hopefully over time, becomes a staple within the units practice culture. Having everyone on the same page in such a fast-paced and high acuity environment is paramount. This can only be accomplished through effective communication and joint effort among those involved. Going Forward ... What may seem like a sacrifice of your time may actually be a time-saver in the long run. I guarantee that no one in healthcare has ever said "too much information is bad" or "less information is more". I am certain that having the opportunity to mention that the confused 90yr old in room 424 (1) is known to bed exit and does not yet have a plan in place to prevent falls, will surely save you more time in the long run. Because post-fall orders, calling family, charting, speaking to the multidisciplinary team, and dealing with avoidable injury would suck more time out of your day than spending 10 minutes attending huddle. Bar none. And of course, the care we work so desperately hard to hold to the highest standard would be flagged as preventable if appropriate intervention had been taken. We certainly do not want that for our patients. Nor do we want to foster a culture in which we become complacent with being "reactive" as opposed to "proactive" towards our day to day efforts. References [1] Pocket Guide: Team Strategies and Tools to Enhance Performance and Patient Safety [2] Use Team Strategies and Tools to Enhance Performance and Patient Safety [3] To Err is Human: Building A Safer Health System [4] TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety [5] Mosaic. Communication Theory [White Paper] [6] Nursing: Patient Centered Care and Education [7] How Every Hospital Should Start the Day [8] Daily Team Huddles: Boost Productivity and Team Morale

The practice of medicine lies on a continuum. An event that takes place within practice, and that changes an approach previously viewed as "best" means that the axiom by which previous thought and process was perceived has now ventured down a new path-one that is novel and continuously transfiguring based on the purpose it serves. So EBP is new, not relative to date of inception, but to the utility of the proposition that practice can be, and perhaps should be subjugated by the scientific method. So the sentiment goes: EBP is another stop along the voyage to an effective and well equipped profession that services the public and the health of the population. Think about it; maybe one day healthcare, either the entirety or a sub component of it (perhaps palliation & end of life) could be based upon Greek dogmatic ideology-that could perhaps help navigate the grey areas of palliative care in relation to suffering, reality of life, and purpose. Who knows? But until then, the novelty of practice will continue to be predicated on the most relevant school of thought, from which, preceding approaches once reigned supreme,and were inevitably outgrown by a necessity for CHANGE.

Have you ever tried to change the ingredients in your mother’s chicken pot pie recipe and lived to hear the repercussions of such a malevolent crime? The answer is probably yes. But following what appears to be an act of treason from the perspective of your mother, you simply take it to the chin and pray that you never have the audacity to change any of your mother’s cooking again. You will proceed to eat the same pot pie that you have been accustomed since the age of 7 and your life will go on relatively unchanged for better or for worse. This, however, can not be spoken of in the same context of your nursing practice, and especially so when it comes to the concept of change. Nursing Practice and ChangeTo attempt to change your mother's special pot pie recipe and fail miserably is the equivalent to a slap on the wrist. But to take the same approach to your practice is not only a tragedy, but an act of negligence that has the potential to do more harm than good. You see, almost every action that you perform as a nurse, and every thought you have towards an inquiry along the continuum of your critical thinking has been answered or proven in some way. Whether it be the type of fluid solution, antiseptic, medication to treat blood pressure, or the type of dressing to use for a wound, somewhere, somehow, it has been proven to either be effective or ineffective, shown to perform a certain mechanism that was previously unknown, and/or claimed to be the “gold standard” with 95% certainty. There are only two certainties with respect to the ways of knowing in nursing and in science, that is, objective truth and subjective truth. We simply do not play “pin the tail on the donkey” when it comes to answering a research question. The scientific method is employed, a hypothesis is created, an experiment is performed, and results are tabulated. This idea of “method” can be traced back to the Platonic era, in which truth was established using geometry and deductive reasoning [4]. Florence Nightingale and ChangeSkipping ahead to the 19th century, we see the emergence of what is referred to today as “evidence-based medicine” and the beginning of a new era and approach to the practice of medicine and nursing. To speak about the concept of evidence-based medicine without first paying homage to the individual who began the conversation would be inappropriate [1]. Florence Nightingale, the face of nursing, and her contributions to the Crimean War in the mid-1800s, precipitated a change in perspective that we see today in the practice of nursing. If it wasn’t for Nightingale's astute eye, and perhaps outlook on her role in the grander scheme, it could be concluded that the number of casualties caused by the war would be far greater and topics such as asepsis and infection prevention would not be where they are today [1]. Fast forward to present day, and we literally have information at our fingertips. From RNAO Best Practice Guidelines to medical periodicals, peer-reviewed journals, etc. It would be ungrateful for us as a collective to do “what has always been done” and simply ignore a proven truth. While there are barriers that exist with respect to the implementation of evidence base(s) into practice, which include, but are not limited to nursing characteristics, organizational culture, and clinical context, there are ways to promote change [2]. Evidence-based practice is the new kid on the block. Underneath lies improved patient outcomes, a stepping stone for future research, improved cost savings, and equally as important, provides accountability and transparency within the decision making process [3]. Change is ConstantAnd with that said, the only constant here is change. Change in the way things are done. Just because something is ALWAYS done a certain way, it does not mean that it’s the right way to go about it. Owe it to yourself, and most importantly, your patient, to be up to date on the happenings around you. You will be better for it and so will the practice of nursing. We owe it to Nightingale.

"Nurses eat their young". I read this phrase in utter disappointment. I feel disappointment towards the destructive nature of this very sentiment. The idea that experienced nurses and their behavior towards students or novice nurses shape succeeding generations of front line nursing staff. We are, in this instance, the very people who hold the key to the fate of the profession. By "fate", I am not referring to its survival, but rather its vitality. Imagine going to work everyday with the expectation that the very last bit of self-confidence you had had would somehow, in someway be stripped away by a snarky comment or backhanded compliment. Now, dig a bit deeper and tack this onto the responsibilities of the job, the stresses that it brings, and the collaborative obligation you have to operate around others, who, according to your negative experiences, do not appear to want anything to do with you. Then, consider anyone in their right mind and the quality or quantity of motivation that they have to get up in the morning and do their job. Its a system waiting to fail. A bomb about to implode. Perhaps a nurse ready to give up and move on from the negativity. The origin of this phenomenon would be interesting to dissect in terms of its conception into the practice of nursing and how it was first perceived. But more importantly, the motivation that lies beneath this behavior is even more interesting. In my estimation the motivation can either be obligatory in nature or an unjust reality. Nurses can choose to behave less than optimally towards those with fewer miles under their belt purely due to the culture that has developed surrounding the "student" & "master" ideology. Perhaps the idea that "experience" trumps "knowledge" or weighs more heavily in favor of time spent in practice is what sparks the fire (so to speak) in response to an underlying fear of powerlessness by way of the knowledge that the novice brings. I suspect that its a bit of both. A little bit of influence from nursing culture and a hint of our own fear apparently makes for a poor or sub-optimal experience for those who will proceed the next generation of nurses. But I digress. What is more troubling to me is that in a very nonsensical way we are contributing to the degradation of the profession. In other words, we are being our own worst enemies. Allowing the unnecessary torment of the novice nurse will lead to burnout, resignation, poor mental health (confidence, self image, etc), and a level of vitality that continues to suffer one jaded nurse at a time.

I read that. That's great for those with terminal dx's. If there wishes are to remain at home, and that seems to be the best approach/most appropriate to end of life care, than that's great. However, over 50% of deaths are still occurring in facilities and are dependent on the most relevant dx.

@brownbook Of course my post is theoretical. Each concept or idea I mentioned has some sort of theoretical basis based upon the derivation of its knowledge. Whether it be through the scientific method or story telling. Whether it’s been applied into practice or not is the concern here. The “messiness” of the above topics is part of the reason why there is no clear-cut solution as for an approach or philosophy to guide practice.

I am always curious to hear others thoughts and opinions related to a topic that is on everyone's minds, in private conversation with colleges, and sometimes inferred in conversation with patients and families, however, that is never really explored head on, for what it truly is. How do you reconcile preserving life if it is not one of quality? Is it that preserving life is easier to justify ethically because attempting to create parameters for a quality life & describe what that should entail is far more difficult? The answer is probably yes. But what do you think? Do we attempt to rationalize certain things in medicine that perhaps aren't rationale by themselves, at there core? Topics such as mortality, suffering, and self-determination? Who says these problems are based solely in medicine? I see philosophical, ethical, and sociological dilemmas here. Also, anthropological and theological implications. The human condition is so characteristically subjective. To each of there own, our experiences are simply different from one another. The way we think, learn, believe. On the contrary, medicine is predominately objective (with a few exceptions of course) in nature. How do we reconcile tackling both realities and spitting out a universal truth that is applicable to both. I believe the answer is, you don't. And this is where the messy grey areas begin to infest. A reality that most ignore, but should come to recognize as chief importance to the quality of individual and collective life. Comment below ?

The way that your post is organized is two fold. YOU are depressed and anxious. Also, you are currently in school to become a LPN and its going well. I want to EMPHASIZE this, "IT'S GOING WELL". You finish your post by asking the community whether you should drop out and become a CNA because, from what I can tell, you are afraid that your mental health, in future, will effect your capacity to be nurse. So you are associating a potential cause, which is your mental health, to a foreseen effect towards a future that has not yet manifested itself? I am not criticizing you, nor am I making an attempt to draw conclusions. What I am doing is laying out the facts. This is what I do when I am in a rut and desperately need a direction to springboard a potential solution. You mention that you have anxiety and depression. From my experience, one will cripple you and make every important endeavor in your life a difficult one. And the other will suppress your ability to "see the positive" and creates an aura of hopelessness that manifests itself as a grey cloud that hangs over top, waiting for you to feel a glimmer of hope. I will not get into how I believe that BOTH are a combination of the manifestations of our own minds, combined with existential disorientation and physiology. But I digress. You probably second guess every decision and your ability to execute constantly. Adding to this, you probably think that the high stakes nature of your future job will further perpetuate your anxiety/depression, and more directly, your performance. This is normal. Those with mental health concerns similar to yours have been or are currently sharing the same feelings/thoughts as you currently are. As have I in my endeavors. But here is the reality. You are ahead of the game. You are self aware. Either from experience or a premonition of future difficulty. Its okay to be concerned, to recognize a need for improvement and reach out for a helping hand. You have not even experienced what its like to work as a nurse in the "real" world. Autonomous and bearing the responsibility of life and death. So how could you give up now? Why would you allow your future concerns impact what has not yet been written in time? What I recommend you do is find a mentor. Faculty to speak to regarding your concerns. Sometimes you just need reassurances. Sometimes its the "fear of the unknown" that causes us to convince ourselves of some make-believe deficiency that we may not really acquire. Which in turn, perpetuates further doubt in ourselves and our Beings. Additionally, I recommend keeping a journal. Write down your thoughts. Arrange it like this: PERCEIVED PROBLEM ---> MY CURRENT FEELINGS ---> WHAT THIS PROBLEM WOULD MEAN IF IT MANIFESTED ITSELF ---> WHAT I AM GOING TO DO ABOUT IT. All the best.

The days feel like centuries, and I do not know if I can continue. Being a student is all I have and my journey is coming to an end. What will I do after this? I have nothing. No relationships. No supports. Just a family that I neglect to share my feelings with and ultimately feeling like a stranger in my own home. I am tired all the time. I feel tired before I go to bed and when I wake up. Even after a full nights sleep on my days off (~10hrs). I still have motivation, but not for long. I feel alone, even when I am around people. I am introverted and do not allow people into my life. I feel as though they will let me down. As a result, I am alone. I feel like no one cares about me or my existence. I feel like the world is against me and I am constantly fighting a silent war. I do not know who is winning. All that I know is that I am not. I have a 10 point GPA (on a 12 point scale) and I feel like this is all I have. I thought that once I finished my education, I will be happy. But more recently, as I get closer to beginning my own life, thinking about financial goals, where I want to be in 5 years, relationships, etc, I have come to discover that I will never be happy as I will always be waiting for the next "thing"- at which point I will utter, "I will be happy when...". I am at a loss and do not know what to do. I have never been diagnosed with any form of mental health ailment, nor do I want to entertain the possibility of being diagnosed and therefore labelled. The "D" word brings a realness to things that I have no interest in entertaining. I would feel weak and defeated if I ever let someone tell me that I am sad and this is something that I will have to deal with the rest of my life.

Thank you all for taking the time to respond. It is greatly appreciated!