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nikkulele77 BSN

ED, ICU, Public/Community Health
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nikkulele77 has 19 years experience as a BSN and specializes in ED, ICU, Public/Community Health.

nikkulele77's Latest Activity

  1. nikkulele77

    Texting with Flo

    Texting with Florence Nightingale Yo, Flo! Can u talk right now? (I like saying yo flo) 😊 Talk? Do you mean text? Yeah, I do mean text. Yes. But why do you say talk instead of text? IDK. I know we aren’t literally talking, but ….our fingers do the talking. 👋🏽 Yes, I see. I’m still learning this new technology. What can I help you with? Well….I still can’t believe I’m somehow talking to u. So crazy. 🤪 Anyway, I had a horrible shift the other night and I just wanted to talk it out a bit. If u don’t mind. Oh. OK…. No offense, but I think that may be a little outdated, Flo. It’s 2021. We talk. I think there’s, like, studies and stuff that say debriefing is really important. It helps people process and decompress. And it can lead to action. Changes. Studies, you say? I think so. Ummm, OK. So ... Apologies. You were saying? Yeah. My shift the other night was rough. We were understaffed, like usual, so I had to triple while being charge. Ridiculous! IDK how they expect us to work like that! Patient safety, anyone? Right? It’s just so frustrating when we tell admin over and over and nothing happens. I guess u dealt with that. Getting the men in the military to see that the medical facilities were unhealthy was very difficult. I can only imagine. Anyway, I’m still pretty new at being charge. Any words of wisdom? Ooo, I like that. I’m gonna take it to our unit director. Did you work in the Covid unit? Yep. So so sick of this pandemic. 😷 ??? 😶 I am proud of you for working through such an ordeal. How were your patients? Had a sweet little old lady who always said TY. Seemed lonely, so I gave her an extra long bath last night and talked to her. That was one good thing…. Says the Queen of Hygiene! 👑 Where would we be without u, Flo? I shudder to think…. Haha! True. And some people still suck at hand-washing. This poor lady is getting confused though. Maybe a touch of ICU delirium That interests me. Agreed. My other patient goes berserk whenever we try to wean his sedation. Nearly ripped his tube out. I had just got him settled when the docs came in and just HAD to get their neuro exam. I was like, EM? Let this dude rest! 😡 IDK what sine qua non is, but after they left it took a good half hour for my guy to settle back down. Even the monitor alarms got to him. Remember how I told u about all our monitor and vent alarms? Oh, yes. I must say that bothers me. Sing it, sister. I wish u could come teach us a thing or 2. Most of us could use your wisdom. So you are saying all my CE and classes aren’t a waste of my time? 😉 Flo, did u ever get scared about how nursing would go after u left it and your nursing school? I would be lying if I said I never feared. But I learned that ... I try. I don’t have to tell u how tiring it is. Feels like all I do is work, eat, and try to sleep. I know nursing was like a calling for u, but how did u find any time for urself? Netflix and chill, am I right? 👊🏽 Yes! See, u get it! They can scream self-care at us all day, but until we feel like we are being listened to ... I guess I don’t have to tell u. I don’t mean to complain. Keep that in mind if you want to ignite change. Who was your 3rd patient? Oh, right. I had a 42 yo woman who probably won’t make it. So sad. Married and has 2 kids. She’s been here so long they are starting to talk about what the goals are with her. Like, should we extubate. IDK. Usually I’m pretty on board with it, but this time . . . she’s so young and I don’t think her husband is ready. I know u didn’t deal with this exact thing, but u had some moral dilemmas, right? Oh my ... 👍“The world does nothing but sketch.” I’ve talked to her kids on the phone. So nice. But that just makes it harder knowing she probably won’t make it. Curse Covid! Flo, u dealt with a ton of death. What do u think? It’s never easy. I’m sorry. Remember though ... Hmm. Can I share that with the family if I need to? Of course. 💜 Thx. Hope I don’t have to. I have a few days off and I’m going out for the first time in a long time. TBH, I feel a little guilty. TBH? Guilty? To be honest. Yeah. I guess bc there are all these people and their families who are suffering and here I am going to a movie and eating popcorn. So trivial. Dear, with this pandemic the war you are fighting is different than the one I engaged in. But my response is the same ... Beautiful. TY. Makes me feel better. References Florence Nightingale Quotes from BrainyQuote
  2. Do you remember when you decided and were excited to become a nurse? Or if it is something you’ve always known, do you remember times when just the thought of it filled you with a sense of purpose and eagerness? Maybe you looked up to another nurse in your family and knew that’s what you wanted to do. Maybe it was personal experiences of being a critical part of someone’s life as a caregiver. Or maybe it was just some sense of who you were deep inside, even if you couldn’t explain it. Whatever it was or is now, this feeling of a higher purpose and calling is inspiration. Inspiration is great, isn’t it? It feels good. It opens up possibilities and makes us dare to imagine great things we can be a part of. Sometimes, it even galvanizes us to action. Inspiration is a great motivator An internal motivator (now that we’re not school kids who need the promise of a treat for doing our homework) that helps us focus on the future and keep sight of our goals. Motivation with a capitol M. That’s all we need to keep us going, day in and day out, willing to sacrifice and work tirelessly for that end goal. Right? Okay, reality check. Who is motivated all the time? ALL the time. Answer - no one. Motivation is great, and when a person is feeling inspired they would be wise to take that inspiration, turn it to motivation, and work their dreamy, high expectation butts off. But let’s face it, motivation is a short-lived and fickle friend. That’s because motivation is based on emotion. It’s easy to work hard when we want to work hard. When we are in the right mood. Getting started on that project or studying for that big exam when we are properly motivated is called “tackling” it. It’s not a chore, it’s a game. A game we are primed and pumped up for. That’s what motivation does. But because motivation is based on emotion, it’s going to run out. It’s normal. It’s human. So the question becomes, what do we do when motivation has petered out? After all, homework doesn’t stop. Exams are still coming. Clinicals continue to be demanding. Educational rigor does not coincide with our internal moods and whims. When motivation is running low, the answer is the dreaded D word. That’s right. Discipline. Cue the eye rolls and groans. But hang in there. Keep reading. Discipline Discipline is doing something when we don’t want to. When we’re not in the mood. It sounds hard because it is. But what if discipline had less to do with the person, and more to do with the environment? Maybe then we could get on board to make some changes that actually produce desired outcomes. Distractions Most of us are easily distracted. When we talk about being undisciplined, that’s really a lot of what we mean. We get sidetracked into nonproductive, lazy, energy-sapping activities. (This is different than self-care, which we should engage in.) Distractions are, of course, huge time wasters. So how do we minimize them? Physical space It is helpful to conduct an audit of the physical space where we work. Many of our habits (which lead to distractions) have a visual prompt or trigger. For example, a good book sitting out, a pile of laundry, or a stack of mail all beg for our attention. A beautiful sunshiny day calls for us to go outside. The proximity of food is nearly impossible to ignore, and suddenly we’re starving. There are a multitude of visual cues that sabotage our efforts to stay on task. Our job is to identify what distracts us and remove or hide those things from the physical environment as much as we can. Clutter Clutter can be part of the visual cues. This doesn’t mean we have to Marie Kondo our whole living space in order to study better (unless that's what you want to do). But maybe just moving that clutter or covering it up is enough to do the trick; punt kick that best-selling novel into a different room. It may be worth it to finish up some chores or obligations, like laundry or mail, before studying to close those loops instead of having open-ended obligations running in the back of our heads while trying to concentrate. There’s not a lot we can do about a sunny day, but maybe we can invest in some curtains and open them a crack to let just the right amount of light in. In short, remove the prompt, make it hard access, and the distraction will follow suit. Cell phones Cell phones have got to be ranked number one on the offender’s list of distractions. Is there any way that sneaky little devil can live in a different room while we study? If not, how about silencing the darn thing, or at least turning off less important notifications? Just the ringtone or notification ping disrupts concentration and a good work flow. In fact, a University of California study concluded that when interrupted, it takes an average of 23 minutes to get back to the original task at hand (source). That adds up to a lot of wasted time, and our little pocket buddy cell phones have much to do with that. Cyber space Other visual prompts that are extremely distracting come from our cyber space, not our physical space. Social media, for example, is famous for luring us down rabbit holes. The daily amount of social media use has grown steadily and now rests at over two hours per day (source). School requires students to access online information, but is there a way to avoid those time-wasting distractions? Who is disciplined enough to not watch the adorable kitten swatting at a ribbon? Turns out there are great apps and extensions that block ads, recommendations, comments, and more so that we can stay on track. Some notable ones include: Remove recommendations Youtube vk facebook Momentum Ad blocker Again, controlling the online screen environment can make it so that we don’t have to have the discipline to not click on or scroll through giant time-wasters. The goal is to use social media, not get used by social media. Desirable habits On the flip side, desirable habits and focused behaviors can be stimulated by introducing visual prompts into our environment. Discipline is largely constructed from our behaviors, so anything that encourages good behaviors needs to be accessible. Make those cues for work obvious, easy, and even fun and it becomes easier to play out good habits. A few suggestions: Study materials out and ready, including pencils, paper, calculator, etc. Water bottle Glasses Fan or heater—whatever is needed to keep temperature optimal Earbuds or headphones Playlist (if it helps focus) Tissues Garbage can Mug of coffee Good lighting There’s probably a hundred more items that could be added to the list. Maybe a stress ball. A picture of your kids or pet. Motivational cat poster. The point is, customize it so that whatever items or conditions are needed to keep focused are part of the work space that encourages high concentration and discipline. It need not be dank and dismal to encourage discipline. A bright, cozy work place can provide energy. Having the optimal environment, whatever that looks like for you, will go a long way in the discipline it takes to engage in work when motivation isn’t reliable. Our brains So, yes, environment can definitely aid discipline. But let’s touch on another part of discipline. Perhaps the hardest distraction to acknowledge and control is our own powerful brains. Wandering thoughts are wonderful, creative escapes—in the right setting. This topic could consume entire books, and probably does. The end point, however, is that we can train our brains to stay focused. It is a skill that can be practiced and honed. Our brains are awesome, and when they need a break, we should pay attention to that. But tapping into the flow of a focused state is well worth the effort. We get more done in less time. Sometimes it is just the thought of getting started on something, especially something daunting, that is enough to tempt us into blowing it off and giving into our lazy natures. The inner struggle we engage in to just begin is draining. It steals our energy and desire. The best thing to do? Make the battle short and sweet. We don’t have to be in the mood to do it. Usually just starting is enough to overcome the initial resistance. Co-founder and former CEO of Instagram, Kevin Systrom, abided by a simple trick when he didn’t want to start something. “If you don’t want to do something, make a deal with yourself to do at least five minutes of it.” When our brains are being bogged down by random thoughts, we can’t get into that good, productive focus. Because our brains are as unique as our lives, the intervention for dealing with random, disruptive thoughts requires us to know ourselves and why our thoughts are sabotaging us. Is it sleep deprivation? Unhealthy eating? Do we cope well with stress, or could we use some help in that area? Maybe it’s as simple as training our brains to refocus and maybe it’s more along the lines of needing therapy and a highly structured routine. It’s as individualized as, well, individuals. But here a few tips that might help: Have a plan for studying—what, when, how long, etc. Do some physical activity before getting started. Brain dump before getting started. Write down things bothering you and when you will take care of them (if, indeed, you can). If a thought keeps popping up, write it down and when you will take care of it. Listen to your body and take breaks when needed. Try to make your breaks truly restful. Meditate, take a walk, take a nap, etc. Resist temptations to engage in mindless online content that drains energy. Set up morning and evening routines that include prepping your work environment. And here are some behavior and time management theories that might resonate with some: Pomodoro Technique for time management BJ Fogg Model grounded in behavioral psychology (note: it is meant for managers and change behavior, but can be applied to individuals) Ultradian Rhythm for energy and productivity Our own motivation Motivation is wonderful, and when we’re in it, we should squeeze every last drop of high energy focus and work we can. But motivation isn’t reliable. Discipline then becomes the answer. And really, it gets a bad rap. We sell ourselves short when we say or think we are not disciplined. We’re human, and so sure, we get distracted and waste time. We give in to laziness. And that’s fine! As long as it’s not all the time. Making some changes to our environment and mind set can make a big difference in our ability to stay on task. That looks an awful lot like discipline. When we get good at it, we can do anything. Discipline might not feel good in the moment, but at the end of the day it sure does. And who knows, maybe we can become our own motivation. Our own inspiring selves. Resources What Is the KonMari Method? The Cost of Interrupted Work: More Speed and Stress How Much Time Does The Average Person Spend On Social Media? The 5 minute trick that helps Instagram’s CEO crush procrastination Take it From Someone Who Hates Productivity Hacks—the Pomodoro Technique Actually Works BJ Fogg Model Explained Tapping Into Your Ultradian Rhythms For Max Productivity
  3. nikkulele77

    A Not-Love Letter for Nursing

    Dear Past Self, You don’t love nursing, and that’s okay. I recall the excitement when you made the decision to pursue nursing. It never occurred to you that you couldn’t do it. Some people might label that determination, and although you have a healthy dose of that as part of your personality, it may be that you were just inexperienced at life. In that context, it served you well. You didn’t think about what would happen if you couldn't step up or if you weren’t cut out for the job. You didn’t think twice about the requirements to get into the program or the fact that the deadline was two weeks away. You didn’t even blink an eye when you weren’t accepted that first go around. You were undaunted, but in a very simple, matter-of-fact way. You decided to become a nurse, and that’s what was going to happen, no matter what. Two reasons why knowing what you know now, you still would go into nursing. #1 You dare to potentially fail. And, you dare to keep learning. Nursing school is a bit of a blur. I know you loved learning and challenges. I know clinicals made you nervous, being a more reserved person that sometimes had a hard time knowing what questions to ask, or daring to ask them. But I guess your love of learning plus that mindset of just getting it done must have been enough to shake off your insecurities. You went on to preceptorship in the emergency department with the dream of one day working there. The start of your nursing career coincided with a move and a new baby, so it was a bit rocky. But you had just conquered nursing school and thus had that little jolt of confidence from earning a degree. You experienced that same feeling all new nurses experience—Whoa, did school really prepare me for this? It’s humbling and disheartening to feel incompetent. But you were a fast learner and had the energy and eagerness of a new nurse. You were wise to start out on med/surg, get some good critical thinking and time management skills, and observe seasoned nurses who could handle old school doctors. The mistakes you made were not the monumental, career-crushing mistakes you thought they were at the time. Three years in was the first big change when the crowded ED needed extra help. When the house supervisor asked for a volunteer, you didn’t even hesitate. Your first task was an IV and blood draw, and the delegating nurse was Queen Nurse Ratched of the department. Later, that battleaxe nurse said what impressed her was how you were bold in showing up and asking how you could help. Sometimes I marvel at that, because you are not that person. Not really. You hid your insecurities because you recognized the opportunity, tapped into that deep-down confidence, and bottom-line, you were there to help. If you had learned anything, it was that nurses had each other’s backs, and you were going to at least try. That started a 14 year career as an ED nurse. You had a great team of nurses and doctors, and for a long time, you thought that’s what you would do until you retired. I sometimes miss those days. During your time in the ED, when your youngest child entered kindergarten, you decided to go back to school and finally accomplish your goal of getting your bachelor’s degree. You had a few reservations about going back to school, especially online, but found that writing a paper wasn’t really a big deal, and you now had life experience to draw from. It led you to consider other areas of nursing with the cliche “broaden your horizons.” But that’s just what you did, and aren't you glad? You met wonderful public health nurses with amazing experience and advice. It led to a flex position at the health department where you learned about immunizations, women’s health, and even got to help out with a tuberculosis outbreak in the community. It felt so good to learn new things. And, admittedly, the ED was starting to wear on you. Then came the big move across the country, and subsequent life changes. That was rough. And you questioned your choice of career more than ever. You were tired, stressed, and life had become complicated. You told others to avoid going into nursing. It wasn’t worth it. The healthcare system was broken. You had five jobs in five years: travel ED nurse, free-standing ED nurse, community health nurse, neuro-trauma ICU nurse, and resource nurse. These were obviously your searching years. You were always excited to start the job, and then when the novelty wore off, well . . . you were like the kid a month after Christmas, the new toys shoved into the corner and looking for something else. Those were hard years, but looking back, I’m glad for the struggle. You gained invaluable insight. It was good to go outside your wheelhouse of the ED, venture into new areas. You are a stronger, better nurse for it. I mean, good for all the nurses who do that one thing for their entire careers, and do it exceedingly well, but that’s not you. Even though you had some growing pains, including feelings of incompetence all over again, I’m proud of the way you decided to try new things, keep searching, and continue discovering. Now you’re here in the pandemic. You’re doing the work of a nurse when the world needs you. Needs more like you. Because (gulp) you are a good nurse. You work hard, even on your off days. You still make mistakes, but you’re experienced and confident enough to ignore and let go of unhelpful criticisms (or say screw you with your eyes). You’re smart enough and caring enough to try to work with others, not blame them. And you’ve always done your best for your patients. You don’t need a new program or a survey to tell you that people are people and they deserve to be treated well, especially on their worst days. I think back to that day when you first floated to the ED, quick to volunteer, offering to help even though you weren’t sure you were equal to the task, jumping in with both feet not knowing how to swim. You surprised yourself that day. You weren’t that kind of a person. Bold and competent. But maybe now you are. Before, you had the benefit of not knowing how hard nursing is. You were blissfully unaware and youthfully enthusiastic. Perhaps your ignorance was mislabeled as bold. But now you know of the madness that is healthcare, how it functions, its many, many flaws and unfairness. You even have your share of jadedness. But you don’t let it get the better of you. You take that determination from your youth, that confidence from experience, and that perseverance from difficult times and you dare to try. You dare to potentially fail. And, you dare to keep learning. #2 You have fulfilled a calling in life. Nursing is not a career for everybody. Right now there are a lot of nurses, seasoned and newbies, questioning their choice of career. You’ve been in that boat too, more than once. It’s a boat that definitely rocks. And morale in many places is at an all time low. I’m a big believer that transient doubts are just that—transient. And it is much easier to entertain those doubts during times of crises, either personally or collectively. Sometimes all a person needs to do is ride out those doubts, make some changes, or rekindle a bit of passion or inspiration. But sometimes a person needs to be true to themselves about their level of doubt and burnout or about how nursing simply isn’t for them. It takes courage for a person to acknowledge that. It takes wisdom to know if and when to leave. You pretty much know you’re not in love with nursing. But I don’t regret your choice to become a nurse. Even though someday you may leave the profession, I feel strongly that you have fulfilled a calling in life. When it’s time to go, it doesn’t have to be a bitter departure or filled with regret or guilt. I’m glad for the years you spent learning and growing as a nurse. You helped a lot of people, including family and friends. Life allows for people to change their minds and close a chapter of their lives. If you need to close this chapter of your life, find a way to do it with as little resentment and as much positivity as you can, finding the good things. Because even if you don’t always love it, nursing teaches some great lessons. Especially the ones you didn’t want to learn. If you let it, nursing makes you a better person.
  4. nikkulele77

    Nurses Wanted

    Right? Full steam ahead - like it's so much fun
  5. nikkulele77

    Nurses Wanted

    Nurses Wanted at Saint Joseph's Hospital (Job posted 287 days ago) Rediscover the art of bedside nursing at Saint Joseph’s Hospital and join a team of dedicated professionals in the post-Covid healthcare crisis. Multiple positions open on multiple floors. All shifts needed. Are you a former nurse looking to get back into the field? Do you dream of those days before Covid and the mass nurse exodus? Do you long for the days of being part of a competent team, working in a safe environment, and bringing positive change into the lives of your patients? Then Saint Joseph’s is for you! Featured in the allnurses® Fall 2020 issue... allnurses® Magazine Library Saint Joseph’s is committed to providing nurses with the safety and peace of mind needed so they can focus on patient care. Our staffing ratio is unheard of anywhere else in the country. ICU: 3:1 Stepdown: 5:1 MedSurg: 8:1 Benefits 1 - We provide competitive pay and excellent benefits so that our nurses are confident they are being well compensated. After a minimum of three years on the floor, you will be considered for transfer to our telehealth units. 2 - No more weekly mandatory overtime! We require only 2 weeks of mandatory overtime per pay schedule. You are welcome. Extra incentive shifts are always available and encouraged for those nurses who would like to work a little extra. 3 - Yes, we allow travel! Annual earned leave includes free testing after travel and isolation days if necessary (from employees PTO bank). We take the guesswork out of your destination. Our HR team, in collaboration with epidemiologists, have put together a US map detailing safe, permissible travel destinations. The map is updated daily and the HR team contacts you personally with travel details, including possible cancellations. In order to ensure adequate staffing, employees are provided with 3 choices for the time of year in which they will be able to take their earned leave. 4 - Our Employee Assistance Program (EAP) offers 2 free phone sessions per year plus a hotline for crises. Zoom meetings with a counselor can be arranged at an employee discount. We encourage employees to utilize EAP so that they can successfully deal with and prevent burnout. The mental health of our employees is of utmost importance to us. 5 - Personal protective equipment (PPE) is vital for our nurses to perform quality work. Saint Joseph’s provides the staff with daily surgical masks to be worn at all times on hospital premises. Additionally, select employees are provided with N95 masks that are sterilized using UV radiation. Extra ear loops are also provided for when the seal is compromised (employees are trained on how to effectively attach these). Staff is asked to provide their own approved eyewear (face shield or goggles). Our staff members enjoy some of the best and most adequate PPE anywhere! 6 - Has your nursing license lapsed? No problem. Saint Joseph’s uses a specialized team to get former nurses back on track. We offer a unique 4-week program* that will bring nurses up to snuff on the basics of healthcare, with an additional 2 weeks of area-specific study depending on their chosen specialty. With our rigorous course, nurses can rest assured they will be able to pass the NCREX (National Council Re-licensure Examination) and be ready to enter the healthcare workforce with up-to-date knowledge and mastery of skill. 7 - Ongoing education is required for our nursing staff. We make every attempt at Saint Joseph’s to ensure you have ample opportunity to expand your education with pertinent and applicable courses and lectures you will be able to take right to the bedside. And, because we know you value your time, 90% of education is contained on our online platform, HealthSteam. Easy to access, real-world application courses are available to you 24/7. Full Steam Ahead! Education hours do not count toward mandatory OT. 8 - We know that your number one priority is your family. That is why Saint Joseph’s established Joe’s Daycare and Academy.** Are you concerned your child will not stay on task if you are not there to monitor their online schooling? Then let our tutors take over. Joe’s Daycare and Academy is a 3-story facility complete with computer stations and access to the entire city school district's online platforms. At an extra minimal fee, we offer tutoring to those students struggling with online content. Our daycare is clean, well-maintained, and offers socially distant playtime for toddlers and preschoolers starting at age 2 (must be potty-trained). Join Our Team So what are you waiting for? An exciting, prestigious career in nursing awaits you! At Saint Joseph’s, we value our nurses and recognize their important contributions to the health of our patients and community. Be a positive part of the Covid history and join the Saint Joseph’s team today. Our family welcomes you with open arms! *The program is limited in number of participants, so please inquire early in the application process. **Due to social distancing requirements, there is currently a waitlist for certain age groups at Joe’s Daycare and Academy.
  6. nikkulele77

    Transfer to Roanoke, baby.

    Thank you!
  7. nikkulele77

    Transfer to Roanoke, baby.

    Hello. My family is relocating to Roanoke VA from Oregon this summer. I've done a little homework and am wondering what the Carilion Hospitals are like. Good, bad, whatever people have run into, I'd like a little insight. Also, how is the pay? I know I'll have to take a pay cut, I'm just hoping it won't be too bad. Does the Carilion facilities utilize travel nurses? I'm thinking of taking that route as well. I have 14 years experience, 10 years in ED, the last 6 months as house supervisor. I'm not loving suping, so I'm thinking of going back to ED, but I'm also interested in the pediatric wing of the hospital. How difficult is it to make that jump? Do they train well? Any info is appreciated - thanks!