Arizonarn

This week I, too, became a receiver of care from the "other side of the bedrails." I had fallen at the bowling alley, hitting my left hip hard. Initially, I thought it was only bruised; walked, 1 foot at a time, up the three steps to the main floor; requested an ice pack; told them I would not be completing the game. Within just a few minutes the pain in my upper hip hit, at about 8/10, and I could not change position or put weight on my left leg. I agreed to have them transport me to the hospital for evaluation. I did not think I had a fractured hip, but then I've never had one and don't know how one feels. The EMS folks were great, assisting me to the gurney and talking to me throughout the trip. My only complaint is being called "dear;" I am 63 and have earned the right to be called by my name at all times, unless I give permission otherwise. The ER staff were competent in their tasks, but lacking, most of them, in patient/staff communication skills. First, they called this stranger "sweetheart" or "dear" constantly. No coaching in breathing techniques for pain control during turns. Gave me a bedpan when requested; then left me on it for 30 minutes, right through the doctor's visit and into the arrival of the X-ray tech, who had to go find someone to help clean me up so that I could go to X-ray. The worst part? No call button attached to the side of the gurney, until the X-ray tech did it upon return from X-ray. I remember, all those years ago, the lectures from my instructors on not using endearments with patients; on checking every few minutes when a patient is on the bedpan; on ensuring the call button is within reach. What happened to those "little" things that make a patient feel he/she is still in control of himself/herself?

I work in the non-profit sector as a staff nurse in a variety of settings, as I work through an agency. One setting is a community mental health clinic, where I am responsible for medication management for clients who are severely mentally ill, case management between clients, providers, and pharmacies, and as a nurse educator for clients, families, and staff. In another setting, I work in a crisis clinic where clients come to spend up to 3 days while experiencing an acute episode or detox from ETOH or drugs. The sister unit, where I work about 1/4 of the time, provides up to 2 weeks of stabilization for clients with adjustments to their medications or who are experiencing their first acute episodes or new symptoms.

I have been an RN for 34 years, working in a variety of areas during the early years after graduation. For the past 29 years, I have worked almost exclusively in psychiatric or substance abuse nursing. During that time, I've experienced burnout, or the warning signs that it is beginning to set in again, may times. What works to diffuse it for me? Talking with a trusted friend who knows or is familiar with the responsibilities of nursing. Relaxation in a quiet, beautiful place where the wind blows, or the river runs, or the lake waves lap the shore. Standing in front of a tree or at the side of a large body of water, palms open and facing out; repeating once for each finger, "Please remove the anger, fear, resentment, and fatigue from me." Most of all, reviewing the day to see if, in some small way, I have made a difference to one person just for being there. Sometimes, the last one is the most important for me. I didn't become a nurse to cure illness; I didn't stay in mental health nursing to cure mental illness. I keep going back each scheduled day because I can make a difference. When policies, dictums, interpersonal stress on the unit get too much for me, I go to the desert, or to a lake, or to a river, or to a tree, and repeat the familiar and comforting rituals until my insides relax and the feeling of balance returns. Hope this missive helps. Margaret

On night shift in one facility (8 hr shifts) we worked 6, off 2. It was by a concensus vote by the entire night shift. While the schedule meant we worked 5 weekends in a row (the down side), the two weekends off were both 3-day weekends, we could schedule doctor and dental appointments far in advance, and by scheduling 5 days off between weekends off we could get two weeks' vacation using 1 weeks vacation time (the up side). As a traveler, I found a wide mixture of rotations. In a hospital in Maine, working 12 hr shifts, we worked three, off 2, worked 2, off 3. The 3-day stretches were the weekends (F, Sa, Su). Working 8 hr shifts, I have worked schedules that give every-other-weekend off, with given weekdays off; very predictable. I have also worked in hospitals where we were scheduled a month in advance, but the schedule itself could change month to month. At a facility in my home town, some nurses work weekends and other never work weekends; it is a choice and one knows upon hire to which schedule he/she is assigned. The worse schedule for night shifters is the one that provides only 1 night off at a time; murder on the sleep cycle. Also murder on the sleep cycle is the "mandatory nurse meeting" held at 1pm routinely. How about "mandatory nurse meeting" that rotates through the shifts, so that sometimes dayshifters or evening shifters have to interrupt their sleep to attend ?

On night shift in one facility (8 hr shifts) we worked 6, off 2. It was by a concensus vote by the entire night shift. While the schedule meant we worked 5 weekends in a row (the down side), the two weekends off were both 3-day weekends, we could schedule doctor and dental appointments far in advance, and by scheduling 5 days off between weekends off we could get two weeks' vacation using 1 weeks vacation time (the up side). As a traveler, I found a wide mixture of rotations. In a hospital in Maine, working 12 hr shifts, we worked three, off 2, worked 2, off 3. The 3-day stretches were the weekends (F, Sa, Su). Working 8 hr shifts, I have worked schedules that give every-other-weekend off, with given weekdays off; very predictable. I have also worked in hospitals where we were scheduled a month in advance, but the schedule itself could change month to month. At a facility in my home town, some nurses work weekends and other never work weekends; it is a choice and one knows upon hire to which schedule he/she is assigned.