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dzadzey MSN, RN

Dialysis, Hospice, Critical care
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dzadzey has 19 years experience as a MSN, RN and specializes in Dialysis, Hospice, Critical care.

dzadzey's Latest Activity

  1. Nursing theory is a guide...not writ in stone absolutes...a guide, to nursing practice. Nursing practice is wholly contextual, and nursing theory, nursing experience, life experience, and a whole host of other subjective personal experience contribute to how we provide nursing care in the context of caring for a given patient.
  2. dzadzey

    Nurses' Week - Upended.

    National Nurses Week - The one week of the year hospital administrators pretend to care about the well-being of nursing staff.
  3. dzadzey

    Any Buddhist Nurses?

    I took refuge in the Kagyu lineage of Tibetan Buddhism back in the 90's and, like you, the philosophy of Buddhism speaks more strongly to me than the metaphysics of Buddhism, although it is still relevant. Having worked in ICU for 10 years, meditation has helped me deal with the stresses that occur on a daily basis. I also work closely with our chaplains and palliative care team in addressing goals of care, family issues and end of life issues for those patients of different faiths.
  4. dzadzey

    About National Nurses Week

    National Nurses Week...my reaction this year, moreso than last was, "Meh." Our hospital administration went all out this year, no cheap trinkets this year. Instead we got coupons for a free ice-cream sandwich from a local artisanal ice-cream company. At the unit level, we got flower-pots to paint and flowers to plant in them. Forgive my cynicism, but my first thought was, "Is this arts & crafts day at the senior center?" And, of course, there was plenty of sugar, salt and cholesterol laden food to go around. Until nurse demand...and secure... a place at the table with physicians and hospital administration in determining how we conduct our practice and our profession, National Nurse's Week will be just three words.
  5. dzadzey

    Where Is Our "Safe Haven"?

    The profession of nursing carries with it a high risk for burnout and compassion fatigue. While these two terms may seem synonymous, there are some significant differences. These differences aside, however, the issue of how nurses can successfully cope with the potentially debilitating emotional and physical exhaustion that come with the close and intense contact with the emotions of patients and their families as we provide nursing care, needs to be addressed. There are a number of tools and techniques available, but are we making the most effective use of them? This signage, in the current context, begs the question of, "Where is the safe haven for nurses?" It's a question, the answer to which, nurses must be seeking from the administrators of acute and long term care facilities alike. Compassion Fatigue and Burnout Compassion fatigue and burnout may seem to be interchangeable concepts, and have some similarities, but they are separate and distinct. In both cases, we see "added coping and adaptational demands on nurses" (Boyle, 2011). The most significant distinction lies in their acuity, with burnout occurring over time and compassion fatigue presenting more acutely (Boyle, 2011). Additionally, burnout is generally a reaction to stresses experienced in the workplace, while compassion fatigue is a consequence of the experiences of the pain and suffering nurses are exposed to while caring for their patients (Boyle, 2011). In terms of those with a tendency to suffer from compassion fatigue, older nurses (≥ 50 years of age) seem to suffer less from compassion fatigue than do their younger co-workers. This may be attributed to their greater clinical and life experience (Sacco, Ciurzynski, Harvey, & Ingersol, 2015). Regardless of age and experience, compassion fatigue can have leave its mark on any nurse or other member of the patient care team. So, what can we do to make that "safe haven"? That place where we can take the time to recover our spent energies, our emotional and spiritual equilibrium? Building a "Safe Haven" There are three key components to creating the safe havens nurses and other members of the healthcare team need to foster recovery from the stresses leading to compassion fatigue. These are prevention, assessment and mitigation of the consequences that can arise while caring for acutely and critically ill patients. Work-life balance is a crucial aspect of this process, as it provides nurses the time and opportunity to take time to establish and follow a plan of self-care so that they can effectively care for their patients (Boyle, 2011). But this plan must be scrupulously and "relentlessly carried out in an attempt to enhance a calm state" (Boyle, 2011). This latter point, in my mind however, seems to be self-defeating. How can one achieve a measure of calmness, serenity and equanimity through such relentless pursuit? Mindfulness and diligence are more appropriate for this endeavor. As care givers, we have to recognize a very fundamental fact: we simply cannot face the suffering of patients and their families on a daily basis and remain unscathed by that experience (Boyle, 2011). Such an expectation is unrealistic at best and self-deceiving at worst. On an individual level, it requires mindfulness of our own internal states, and the knowledge to recognize the signs of our own compassion fatigue... Symptoms of Compassion Fatigue WORK RELATED: Avoidance or dread of working with certain patients Reduced ability to feel empathy towards patients or families Frequent use of sick days Lack of joyfulness EMOTIONAL: Mood swings Restlessness Irritability Oversensitivity Anxiety Excessive use of substances: nicotine, alcohol, illicit drugs Depression Anger and resentment Loss of objectivity Memory issues Poor concentration, focus, and judgment PHYSICAL: Headaches Digestive problems: diarrhea, constipation, upset stomach Muscle tension Sleep disturbances: inability to sleep, insomnia, too much sleep Fatigue Cardiac symptoms: chest pain/pressure, palpitations, tachycardia Source: (Lombardo & Eyre, 2011) At the organizational level, we see Employee Assistance Programs (EAP) and Pastoral Care providing support for nurses coming up against the wall that is compassion fatigue (Lombardo & Eyre, 2011). These, however, seem to be more reactive than proactive strategies. More proactive strategies would include having EAP counselors available on site for those nurses facing an emotionally challenging patients and/or families; debriefing sessions to aid in identifying stressors nurses face in caring for patients; making time for support groups during working hours to aid nurses in coping with the emotional fallout; and interventions to aid in bereavement for those patients who passed and making space on the unit or other space in the facility where nurses can find that safe haven (Boyle, 2011). Conclusion Dealing with compassion fatigue requires effort...proactive effort...on the part of individual nurses and the organizations they work for. On the individual level, we need to be mindful of our internal state and diligence in following a process by which we care for ourselves so that we can better care for our patients. We must, in this process, be gentle with ourselves. We will make missteps and mistakes in the process, the expectation of perfection is both unrealistic and counterproductive (Chordron, 1991). We must be proactive instead of reactive. At the organizational level a proactive stance is essential to prevent and ameliorate the effects of compassion fatigue for nurses and other caregivers. If organizational support is limited, or difficult to obtain, nurses need to step up and insist on having that "safe haven". Our health, and that of our patients, depends on it. References: Boyle, D. A. (2011). Countering Compassion Fatigue: A Requisite Nursing Agenda. The Online Journal of Issues in Nursing, Vol. 16, No. 1. Chodron, P. (1991). The Wisdom of No Escape and the Path of Loving-Kindness. Boston, MA: Shambala. Lombardo, B., & Eyre, C. (2011, January 31). Compassion Fatigue: A Nurse's Primer. The Online Journal of Issues in Nursing, Vol. 16, No. 1, Manuscript 3. Saakvitne, K. W., Tennen, H., & Affleck, G. (1998). Exploring Thriving in the Context of Clinical Trauma Theory: Constructivist Self Development Theory. Journal of Social Issues, Vol. 54, No. 2, 279-299. Retrieved from Exploring Thriving in the Context of Clinical Trauma Theory: Constructivist Self Development Theory Sabo, B. (2011). Reflecting on the Concept of Compassion Fatigue. The Online Journal of Issues in Nursing, Vol 16. Sacco, T. L., Ciurzynski, S. M., Harvey, M. E., & Ingersol, G. L. (2015). Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses. CriticalCareNurse, Vol. 35, No. 4, 32-43. Retrieved from Critical Care Nurse
  6. dzadzey

    Why Do Nurses Eat Their Own?

    All cliches aside, there is an element here which goes unrecognized, and that is the inability, or unwillingness of too many nurses to stand up for themselves. Hospital administrators expect the nurses at bedside to do more...with less. And, in large part, nurses quietly do so. They grumble amongst themselves, the frustrations spill over, resulting in cliques and a general unwillingness to look beyond what is immediately before us...The patients. If we can't see beyond what is in front of us, desperately important though it is, we won't be able to provide our patients the care they deserve. We must take care of ourselves by demanding as much from hospital administration as they demand from us. And we can't do this if we fall victim to the cliquishness and back-stabbing we see...all to often...among our co-workers. To paraphrase another cliche, we must hang together or hospital administrations will cheerfully hag us separately.
  7. dzadzey

    What is your Nursing Kryptonite?

    Had one family the other day crowded in a room after the patient passed, the room smelled like a wet ashtray even after is was cleaned.
  8. dzadzey

    What is your Nursing Kryptonite?

    "Sputum... of any kind. Especially have an aversion to trachs... ya know, when they cough and a glob will fly across the room. I just can't even. But along this same topic, does anyone find that their ability to handle blood/bodily fluids is getting worse, rather than getting better? This seems to be the case for me. Most things seemed not to bother me early on, but as my career gains length, I'm getting grossed out more." Hasn't bothered me for years. I do, however find it amusing that casual conversation among nurses eventually turns to poop... ;)"
  9. dzadzey

    What is your Nursing Kryptonite?

    Patients and families with an overweening sense of entitlement, treating nurses and our support staff as if we were wait staff at a Waffle House.
  10. dzadzey

    Why are so many nurses against unions?

    National Nurses United (National Nurses United) is a good place to start. They can provide you with the training and resources...online and out of sight of management...you need to begin organizing. As nurses, we either hang together or hospital administrators will cheerfully let us hang separately.
  11. dzadzey

    Where is our "Safe Haven"

    I have passed this sign countless times, and I finally just couldn't stand it anymore. It reminds me of a sign I saw posted in a yard in Norfolk, Virginia when I was stationed there years ago. It read "DOGS AND SAILORS NOT Allowed On Grass". But more to the point, it begs the question of just where the "Safe Haven" for nursing staff is. In our facility, due to extensive remodeling, we lost our employee cafeteria and dining room..no "Safe Haven" in the food court we now have. We take our meals in a small, cramped break room, with no real respite from the needs on the floor thanks to incessant Vocera calls...no "Safe Haven" there. Once we have guided a patient and family through the process and grief of their loved one dying, we get no respite...no "Safe Haven" there. So, where is our "Safe Haven"?
  12. dzadzey

    Education of Nurses in the United States

    While inroads are being made in increasing the number of BSN prepared nurses at the bedside, the number will still fall far short of the recommendations in the 2010 IOM report on The Future of Nursing. Part of this lies in the still high numbers of ADN prepared nurses graduating each year. This latter course allows a quicker and less expensive entry into a job that can lift people into the middle class. The problem of attracting more students to BSN programs is multifaceted, but a couple of issues are glaringly obvious. First, getting your BSN is expensive and time consuming, especially if you're already trying to hold down a job and raise a family. Secondly employers, by and large, do not offer a wage differential for BSN nurses versus ADN nurses. This discrepancy is justified by the position that ADN and BSN nurses sit for the same NCLEX-RN exam. That exam, however, only test for those minimum competencies for providing safe patient care, and fails completely to address the research, collaborative, information systems and other skills BSN prepared nurses bring to the bedside. Until nursing, as a profession, demands a revision of this testing paradigm, employers can continue to get something for nothing.
  13. dzadzey

    Do we need a union? Management is taking advantage of us.

    "I believe that sooner or later nurses and all other workers in hospitals will organize themselves in unions to protect themselves against the injustices of low pay, overwork, overtime without pay, and other intolerable working conditions. Anyone who works in a hospital has as much right as any other worker to a decent standard of living. Hospitals have no more right than industry to offer substandard wages and expect that its employees will accept it gladly because they are being allowed to "serve humanity." This kind of outdated idea is depriving the United States of the nurses it needs." Pauline Higgins, RN, AJN, January, 1955 Written 59 years ago, the truly sad thing is that nothing...has...changed.
  14. dzadzey

    Black listing

    A nurse who I worked with on our unit for several years accepted a position as clinical nurse manager. I said, " I would congratulate you, but admin will throw you under the bus at the drop of a hat". About six months later, our entire unit management was sacked, including the aforementioned CNM. Middle management in nursing is like walking on a tightrope over a pool of hungry sharks with someone at both ends working to cut the rope. Do yourselves a huge favor and just don't do it, no matter how sweet the deal.
  15. dzadzey

    Tired, burned out, and broke...

    We attended our grand-niece's "white-coat" ceremony at OU School of Osteopathic Medicine several years back. It was a wonderful event, with all of these young people being welcomed into the medical profession with open arms. Contrast that with my first day of nursing school in 1997..."Look around you. Half of you will be gone by the end of the program." These words were the first spoken by the faculty member addressing an auditorium full of nursing students in the first minutes of our fist day of nursing school. If nursing is going to continue to progress as a profession, we have to stop eating our own and start demanding the same level of respect afforded our colleagues in the medical profession.
  16. dzadzey

    Do we need a union? Management is taking advantage of us.

    The simple fact of the matter is that, when it comes to setting policy that affects our ability to provide safe, quality and cost effective care, nurses MUST have a seat at the table with hospital and healthcare organization administration. Otherwise, we're on the menu.

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