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jeastridge BSN, RN

Faith Community Nurse (FCN)

BSN, RN, Faith Community Nurse

Content by jeastridge

  1. jeastridge

    New nurse feeling hopeless

    I am sorry to read that you are struggling. Being a newer nurse and working nights is indeed hard. I have been a nurse for 30+ years and I can tell you that it gets so much better! Hang in there. But every time you start a new job, the first 6 months are tough: the learning curve is always there, no matter how much experience you have. I started in the field of hospice about 5 years ago, and as a newbie, I had a lot to learn. I can remember waking up at night and thinking about cases and stressing over decisions. But eventually it eased up. Things will get better. And it will get to be a lot more fun once you feel more competent. Just persevere through this time and reach out to seasoned nurses that can offer you support and encouragement. Joy
  2. jeastridge

    Nursing: How to Pick the Right Job

    Thanks for your great suggestions and for the link! I think this will be helpful to others. Joy
  3. jeastridge

    Nursing: How to Pick the Right Job

    I thought about this and I'm not sure there is a set answer. It would be interesting to hear from others in the community about positions they think would be good. Some thoughts that come to mind include home health, hospice, specialty units, OR, PAC, long term care, rehab...What have you considered? Joy
  4. jeastridge

    Nursing: How to Pick the Right Job

    Sadly, there is a great deal of truth in what you said and it happens in every type of nursing job. Integrity is tough to spot, but it will usually shine through and in the end, it makes all the difference.
  5. jeastridge

    Nursing: How to Pick the Right Job

    Great! I'm so glad this was helpful. All the best with your new position. Joy
  6. The elderly patient stared back at me with watery, vacant eyes while I leaned over to listen to her lungs and complete my assessment. Her lungs were clear and her heart rate remained steady and slow. She reached up to pull at her nasal cannula and her daughter quickly replaced it, saying, "Now, momma, leave that be. It's your oxygen. It's gonna help you." I sat down near the bedside with the daughter and granddaughter and we talked about the patient's course: she had ongoing dementia and recently suffered a fall and a broken hip. After surgery, she had a stroke that affected her ability to swallow and the family was faithful to follow her wishes not to have a feeding tube. Because of some pain from her hip, and some restlessness, we had admitted her to inpatient hospice care for symptom management. Now, two days later, her pain was well controlled and the patient was resting comfortably with no further need for interventions that could only be provided in a hospital/hospice house setting-care often referred to as general inpatient care or GIP. I talked with the family about what had happened over the previous two days: her pain was better. Yes, they agreed. And she was calmer and appeared more comfortable. Yes, they saw that, too. I also pointed out that while she continued to take the occasional bite of ice cream or applesauce, she was not able to take in enough calories to survive over the long term or to be able to go through rehabilitative care. As gently as I could, I told the family she would need to be discharged to home or to a nursing home setting; either place, hospice would come and take care of her there. Although we had covered this thoroughly during the hospice admission process, it seemed to be new news to the family at this stressful time. "What are you talking about? You can't make her go home! We can't take care of her! I have a bad back, and I can't pay caregivers. No! You cannot send her home." She crossed her arms and leaned back in the chair, her face set and angry. I listened and made a conscious effort to open my hands, palms up, while working to keep my facial expression neutral. I asked her a few questions about the home situation, looking for clarification. She raised her voice and became more agitated. Her daughter, a young woman probably in her 20's, put her hand on her mother's arm, obviously trying to calm her down. The daughter got up and stormed out of the room. The daughter raised her eyebrows and shrugged as if to say, "What do you do about that?" Hospice's goal is to primarily take care of people in the home. The team is set up so that the nurses, aids, social workers and chaplains, visit and care for patients in their familiar home setting. Sometimes the "home" is a nursing home or an assisted living or even a family member's home. Wherever "home" is, hospice will come to them there. The hospice services in and of themselves are almost always covered by insurance and they are covered 100% by Medicare. But the "home" itself, is private pay. So if the patient needs to be in a nursing home, hospice comes there to care for them, but they are responsible for the room and board at the facility. While this makes good sense when we are cool and rational, it can come as the final straw for an overwhelmed family who has used up all their emotional, physical and financial resources caring for a loved one who has been ill over a period of time. People generally don't understand or don't remember that this is the place where those who can afford it employ long term care insurance. For others, it can be a time of real financial hardship, taking the last of meager resources. For those who are indigent, Medicaid will often be involved in helping cover the nursing home expenses. During these tense times, the questions can come fast and furious "What do you mean you don't pay for the nursing home?" "What do you mean my loved one has to go home?" "What do you mean she is stable? She is dying!" In hospice, our job is to listen, to be able to show some empathy and to help the family come to the best solution for them. I left the room to allow the family some time and space. After discussing the situation with my managers, I waited until a social worker arrived and we went back in to talk with the family again. After more conversation, we were able to reach a solution that seemed to help the family with what they needed the most: time and rest. We kept the patient in the hospital for a few days of respite, allowing the family time to process, recovery physically, and make arrangements to care for her well at home with a rotation of extended family members. By the end of the day, there were hugs and comforting words all around as the family resolved to go home for a bit and get some "real sleep," but most importantly, the patient was resting, comfortable and appearing to be at peace. What has been your experience with GIP/respite/home care and the interface between these three? Do you have any insights on how to make these transitions easier for everyone?
  7. It's hard to say without just a bit more information. But assuming you are current in your licensure and up to date on continuing education, etc., you might still want to consider a hospice setting where you will have lots of support and help getting started with a good mentor and a large team.
  8. I was relieved to see Helen's car behind me, inching along the gravel road toward our next admission's house. Already four miles in, we crunched along the uneven, one-lane surface back in the "hollers" (local word for deep valley) of our rural community. When the GPS confidently announced, "Arriving at your destination," I looked up to see several signs crowding a small sapling, including, "No trespassing. Trespassers will be prosecuted," and "Beware of the dog." Behind the signs was a steep driveway, full of crater-size potholes. Helen shouted out her window that we should ride up in her car, which had a higher clearance. When we neared the top, we were met by deafening barking from what looked like dozens of dogs (and turned out to be 17), penned behind a feeble fence. We made our way in to what served as the kitchen where we perched out bags on a chair, with the dogs safely behind a fence between the kitchen and the other rooms of the house. A difficult conversation ensued almost immediately since the family couldn't understand why we were not able to see the patient back where the dogs were. Eventually they brought the elderly woman, via wheelchair, to the kitchen and our visit continued. I looked gratefully to Helen, who with great finesse and love and true compassion, talked calmly with the family and the patient. She went on to tell them that she could be a resource in helping them obtain, by donation, some needed items to care for the patient, including a recliner and possibly a rollator walker. In a difficult setting, where there is conflict about how to treat-or where to treat-patients, social workers are an invaluable asset. Always a team approach, hospice works best when all the team members respect one another, understand each other's roles and lean into one another's professional strengths. The medical social worker truly specializes in taking hospice from basic end of life physical care to the next level where it becomes a wholistic and comprehensive approach to the entire spectrum of death and dying. The social worker moves the care outward, beginning with advocacy for the patient to care for the family and the entire support system, and following up with bereavement care after the death. As with any professional partnership, there are bound to be conflicts. When we dance so close together, invariably we step on each others' toes. Whether the nurse is offering advice that conflicts with the social worker's or the social worker is expounding on medical information that is more in the nurse's realm, these moments of tension can and do occur but are not insurmountable obstacles. An attitude of respect, cooperation and unfailing kindness toward one another and toward the patient can bring resolution to even the worse case of mashed toes! Besides the social worker, the hospice team also involves the ministry of the chaplain and sometimes of volunteers. Many times people have ambivalent feelings about their higher power, not stopping during busy lives to assess where they stand. When death becomes more of a reality, urgency steps in and patients and their families often want help in discussing where they are on their journey and how they would like to move forward. The chaplain can also be helpful when there are broken relationships that need healing before death. He/she can be a great listener and ask questions that assist the transition from feeling out of control to taking some concrete action toward resolution. In their role of spiritual counselor, the chaplain works hard to non-judgmentally meet the person right where they are and to work toward goals that the patient and their family define. In our hospice, we try to have a nurse and a social worker at every admission. Since we never know exactly what we will find, we try to make an assessment and then defer to one another based on the needs at hand. As the in the case described above, the patient's physical needs sometimes play a smaller role than environmental needs. When this is the case, the nurse naturally steps into the background while arrangements are discussed. However, at most admissions, the primary needs are related to symptom management. In this case, the nurse takes the lead and guides the conversation moving forward. In both situations, it is critical for the nurse and the social worker to each understand and feel comfortable in their respective roles, deferring to one another and supporting each other through the entire length of the patient's stay in hospice. Maybe you have had a great experience working with your social worker staff. Can you share a time when they have been particularly helpful? What are some of the challenges of working together when there are differences of opinion and role conflicts? As we left the home that day and walked to the car, accompanied by a true cacophony of dogs barking, I smiled broadly at Helen and thanked her for a job well done. She kidded me, "Hey, you let me do all the talking!" I raised by eyebrows and smiled back, "Yep! You had all the right words, my friend. There was nothing I needed to say." As we rode back down the rutted driveway, we felt a sense of satisfaction at a job well done-together.
  9. jeastridge

    Office Nurse: What's It Like?

    You sound like just the kind of office nurse I would want my pediatrician to have! Thanks for all you did! Joy
  10. jeastridge

    Office Nurse: What's It Like?

    Thank you for sharing. You are so right in emphasizing the importance of the role of nurse in a medical office. Joy
  11. jeastridge

    Another Brick in the Wall

    Teach. Repeat. Teach. Repeat. It is frustratingly true that of the 10 things we teach, patients often only grasp 1 or 2 and maybe remember those. I work as a parish nurse and sometimes struggle with feeling like I provide the same information over and over. But it is important work and it gradually chips away at the lack of knowledge. Hang in there! Joy
  12. jeastridge

    Finding the Time for Self-Care

    I meant to add that this list was given to me by Dr. Brynn Welch, philosophy prof at UAB. She takes a great interest in children's books that open the mind and has done a TEDx on it. Anyway, just needed to give her the credit! Thanks again for the article. Great job. Joy
  13. jeastridge

    Finding the Time for Self-Care

    Self-care while reading to kids--what a great idea! And it can happen. I have 3 grandchildren, 2 of them bi-racial. I recently bought a bunch of books that are encouraging for me and for them. I will add that "Ish" and "Dot" make me cry but tears of hope and renewed determination. So maybe order some great books for the kids. Here is the list that I recently invested it: - Corduroy. A classic. - The Snowy Day (really almost anything by Ezra Jack Keats) - The Dot - Ish (The Dot and Ish are my FAVORITES. The books are just outstanding, and the main character just happens to be Black.) - Anything from the Lola series. Lola at the Library, Lola Loves Stories. Lola Reads to Leo - Whose Toes Are Those? - Whose Knees Are These? - Firebird - Please, Baby, Please - Please, Puppy, Please - The Girl Who Got Out of Bed Have a great day and persevere with self-care! Joy
  14. jeastridge

    Parish Nursing: A Variety of Roles

    Hi Jeanne, I hope you will pursue this idea. Parish Nursing can be so rewarding. Starting out, you might mention it to your pastor/priest and gauge how receptive he/she might be to the concept. If you get a green light there, then consider affiliating with a Parish Nurse group near you or take an on line introductory course to get you started. All the best! Joy
  15. jeastridge

    Parish Nursing: A Variety of Roles

    I turned off the car and sat in Linda's driveway for a few minutes, collecting my thoughts before going on in to make what I knew would be my last visit. I had been her Parish Nurse for several years, and accompanied her through her husband's illness and death, through her own cancer diagnosis and treatment and finally her admission to hospice. Her attentive daughter let me in and steered me to the chair beside the hospital bed which sat in the middle of the living room, facing her favorite window and the bird feeder outside. She handed me a box of tissues and said, "People that sit there usually need those." I took the tissue gratefully and with the other hand grasped Linda's which she held outstretched to me. She tried to whisper and I leaned in close. She kissed my cheek and said, "I love you." I told her that I loved her too. Her eyes cleared from the fog of death for a minute and she looked over toward her daughter and repeated, "I love you," and then back at me again, "I love you." Through smiles and tears and even laughter, we repeated the words back and forth. Linda and I had walked a long way on the road of life. Parish Nurses sometimes have the privilege of being the ones to accompany their congregants through many phases of acute and chronic illness, their own and that of their family's and friends. Sometimes, by being professional nurses in the church, we are able to give information, to be advocates, and to serve as a referral source. Parish Nursing, also known as Faith Community Nursing started in the mid-1980's when a chaplain named Grainger Westberg had a vision for nurses working in a cooperative relationship with the church to promote health, encourage wellness and care for those in need. From there the concept has grown to involved several thousand nurses of various backgrounds and numerous denominations. So what exactly do Parish Nurses do? The variety is truly endless but when people ask me, I try to describe it like this: the Parish Nurse blends the roles of a minister of visitation, a case manager, a social worker and a nurse. Visitor Depending on the particular congregation, the nurse makes the types of visits described in this story, as well as visits to check on members who are grieving or who have a new baby or who have a new diagnosis. Contacts can be as formal as appointment times in the office or the home or as casual as hall consultations, text messages and email. Connector A Parish Nurse many times is the "bridge" that puts people who have a need together with people who can fill that need, whether is it caregiving, food, transportation or information. She/he can serve as a project manager, putting in place and administering programs to keep the church family active-walking or hiking programs, sports teams, classes on healthy eating, ideas about using pedometers and fit bits, etc. Source of Information With so much information available via the internet, the Parish Nurse can become a go-to person for deciding what is important and what is not. When a new diagnosis comes, a Parish Nurse can help spread calm where there is fear and perspective where there is loss of vision. Transition Expert By working with the local hospital, the nurse can help visit members and their families while they are ill and prepare for the transition to home or to the next facility. Often the Parish Nurse has visited a number of local facilities and is able to offer personal insights that can help set minds at ease. At times, the Congregational Care Nurse knows what equipment might be helpful to have in the home at the time of discharge and those small things-having that shower chair ready or getting the assistive bedrail-can make the transition smoother for everyone. Advocate The Parish Nurse can advocate for their parishioners. When serious illness strikes or major decisions loom ahead, the professional nurse serving in the church can be a sounding board and a source of clarity in the midst of confusion. When needed, he/she can attend a doctor's appointment or a care meeting at a nursing home. So who pays? While explaining Parish Nursing, I often get this question. Many are volunteers in their own congregations and do it on a part-time basis; others are on staff at their churches and receive a stipend; and still others are employed by hospitals in partnership with their communities. A very few are full-time and paid salaries that are similar to regular nursing salaries. After about ten minutes, I prayed with Linda, gently squeezed her hand and rose to conclude my visit. Following me to the door, her daughter said, "Isn't it wonderful that when everything is stripped away, that is what she says? It's the only thing she keeps saying to me and to everyone that comes. I love you. What beautiful words." I thought to myself, I hope those are my last words, too.
  16. As a young girl who loved to read, I became acquainted with the story of Clara Barton. I idealized the vision of becoming a nurse wearing a starched, white nurses' uniform, complete with squeaky clean white shoes, and a nurse's cap. When people asked me what I wanted to be when I grew up, I knew just what to say and would answer promptly, "I want to be a nurse and if not a nurse, a hairdresser." Despite my confused ideas about what a nurse was and did, I moved toward the goal with purpose. During my college years I began to understand fully the rigorous scientific nature of my chosen profession and my vision of nursing swiftly morphed from an aesthetically pleasing picture to a reality of pursuing accuracy and knowledge and skills in patient care. By necessity, during those first years the focus rested heavily on a desire for proficiency and experience. I knew what a professional nurse was because I saw them in my teachers and in the longer- practicing colleagues around me, but for a number of years I struggled with stepping beyond the confines of my inexperience to live into the deeper calling I felt. Over the years of practicing nursing in a variety of settings, I continued to learn, grow and stretch, gradually gaining the self-knowledge and assurance to be both technically sound and deeply caring toward my patients and co-workers. As my spiritual life began to translate into a daily life of walking with Christ, so my nursing changed into an expression of my faith-not with words but with deeds. When the youngest of the three children was four, I was working very part-time and looking for new ways to grow in my career. I saw a note in our church newsletter that said, "Parish Nurse Needed." The article went on to describe what a parish nurse was and did. I was floored as I had never heart of such a thing! I carefully cut out the article, put a circle around it and wrote, "My dream job." Then I tucked the note away in a drawer. The next month we went on vacation with another couple and their children. My girlfriend was also a nurse and as we walked along the beach I told her about the dream job description. "Did you apply for it?" she asked. "No, I'm sure it's full time and I just can't do that right now." She punched me gently in the arm. "Just go for it, Joy. You'll never know if you don't ask. Apply." And so I did. That was 1997 and the beginning of almost twenty years of parish nursing. During our Parish Nurse Orientation, I learned for the first time about Granger Westberg and his vision for parish nursing. He saw what seems abundantly clear in retrospect: the church and nursing belong together. Looking over the timeline of the history of nursing (Faith Community Nursing Curriculum) we see repeatedly where healthcare and the church joined hands in ministry, acknowledging that true shalom can only exist when body, mind, and spirit are in harmony. As I began my journey in parish nursing, I started out with great enthusiasm for providing plenty of information, brochures, classes, teaching. My philosophy of nursing at the time dictated that if I supplied enough of the correct information then people would want this thing that I was offering: wholistic health. Of course, I say this with some humor because I continue to offer information and classes, but I gradually realized that there is so much more to the human spirit than simply working to transform behavior. I began to understand down deep that Christ wanted more, much more, than just healthy bodies-He was looking for the entire person, every part of each one of us. I recently read with great interest Rev. Frederick W. Reklau's "14 Theses on Healing (and Cure)." His list effectively summarizes the personal transformation I experienced over time-a change from a philosophy centered on cure toward a vision focused on healing and restoration. Some of the 14 points he makes especially stand out to me: Cure may occur without healing; healing may occur without cure. Cure separates body from soul; healing embraces the whole. Cure costs; healing enhances. Cure combats illness; healing fosters wellness. Cure is an act; healing is a process. This vision is reinforced by looking to the example of the Lord, "Jesus traveled through all the cities and villages of that area, teaching in the synagogues and announcing the Good News about the Kingdom. And wherever he went, he healed people of every sort of disease and illness. He felt great pity for the crowds that came, because their problems were so great and they didn't know where to go for help." Matthew 9:35-36 (NLT). Through Jesus I can find and adopt that centered philosophy of nursing that so long eluded me: he shows both balance and purpose, dividing his time wisely between teaching, preaching and healing. He knew how to set his priorities, how to focus in on what really mattered, and how to allow his heart to be poured out for those he met and ministered to. Ultimately, he offered up his whole self, body and spirit, to be broken for us so that we can share in that communion of shalom.
  17. jeastridge

    Palliative Care + Hospice = A+

    Wow, that sounds like a great class and wonderful preparation. I'm so glad you were able to be a part of it. No matter what field of nursing you end up choosing, those lessons will have long term application. The best to you! Joy
  18. jeastridge

    Palliative Care + Hospice = A+

    It would have been part of the doctor's responsibility to have the initial discussion with the family. It would have been nice for you to be present so that you could address questions or concerns related to the discussion. Sometimes after the initial discussion, the physician will write for a hospice evaluation, if that is appropriate. Hospice can then continue to provide appropriate information and support. I hope this helps.
  19. jeastridge

    Be a Real Nurse: Compassion is the Key

    The three siblings stood woodenly to the side in the ICU room, trying to stay out of the way while they waited for the doctor to make her early morning rounds, and fighting the tears that kept creeping into their eyes making it so that they couldn't see clearly, and somehow even affecting their ability to hear and understand. The tears filled their throats, silencing all the questions that had no answers. Just twenty four hours prior, their dad had been active and able, always serving and busy doing good for others. Now he lay comatose and on a vent, his brain overwhelmed by a massive bleed. The shift nurse came in and made a point of setting them at ease by introducing herself and going over to the whiteboard to jot down her name. Then she explained that she would be doing her daily assessment. She moved smoothly about, a gentle expression on her face as she familiarized herself with the patient. When she finished, she took just a moment to ask if they had any questions and to learn their names and relationships. Her manner suggested patience and compassion and the three relaxed just a bit, their shoulders less tense. They answered "yes" when she offered to bring another chair and then followed through. The nurse, if asked, would say she didn't do anything particularly special. But she did. Her attitude, her bearing and her words communicated that she saw them in their pain and that she not only felt for them but also would do what she could to put action behind her feelings. The definition of compassion given by some is: "a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering." So it starts with a feeling but the nebulous emotion is then joined by action. Together, competent action and caring make up the twin bases of excellence in nursing beyond providing basic care. How does true compassion differ from pity and sympathy? If words are kin to one another, then compassion and empathy are cousins who walk around in each other's shoes helping one another out, while pity and sympathy feel bad and sit side-by-side and don't do much. Can you think of a time when you received compassion from a medical professional? What did it mean to you? I remember meeting the nurse in the ER after our son had a bike wreck with a possible head injury. He was in the CT scanner, and I was panicked. She put her hand on my shoulder and make eye contact with me and said something reasonable like, "We are taking care of him right now, and we will let you see him as soon as he gets back." The combination of the human touch and the calm tone of her voice, brought me down from my desperate perch just a notch of two, but enough so that I could take a breath and hold myself together. A few days later, he was fine (save some teeth he lost on the bike trail!), but I never forgot the compassionate touch of the nurse's hand and the even, calm tone of her voice. Compassion manifested through physical touch is key to effective nursing practice. Everyone needs physical contact, but people who are ill are especially vulnerable to its absence, as are their close family members. Along with touch, people note the tone of our voices, the words we chose and even the body language we employ as we communicate. Together, these components merge to further define how our patients see us. Is compassion easy? Never. So here is the tricky question: do these nurses that practice caring and compassion burn out faster than those that stay detached and keep a distance from their patients? I am not sure there is a scientific answer to this question (how to you quantify compassion?) but we can all decipher plainly the results of living out of loving compassion and pulling back into our protective shell of doing the job technically well without getting too attached. We all know the glowing satisfaction of working hard, and doing good. However, notice here that being appreciated or recognized doesn't come into this equation. True compassion in nursing often means offering ourselves in a caring relationship even when the other party doesn't deserve or appreciate it. It's nice when they do, but that is not what feeds compassion. Compassion is an interior state of the heart; an overflow of the Good that resides within. Compassion is not easy, but living and working without it, is not being fully alive to all that we can be as nurses and has human beings. Being a fairly new grandmother, I am reading children's books all over again and loving the experience. One of the ones that I never "got" as a kid was The Velveteen Rabbit. How does getting all banged up and pulled apart, make you "real?" The concept was beyond me as a child, but now it makes me weep. Because the truth is, unless we give ourselves away, to be used up in loving one another, then we are never truly real. As nurses, compassion takes us to a new level, to the place where we become the best we can be-REAL nurses.
  20. jeastridge

    Be a Real Nurse: Compassion is the Key

    This are important and pertinent observations. As you point out, the truly compassionate AND competent nurse does what is best for the patient, not necessarily the most pleasant or popular thing. As I pointed out in the article, the compassionate nurse is not doing it for the praise; often he/she is not praised at all...but there is a great deal of long term satisfaction in practicing nursing with true compassion as the plumb line. Thank you for your comment. Joy
  21. jeastridge

    I can't get "poop" taste out of my mouth?

    There is a distinctive smell associated with the dying patient. I don't know if the patient you were taking care of was in the dying process, but I find that it happens particularly often with edematous patients who have skin breakdown, such as the one your described. Maybe other nurses can confirm this. But I do know what you are talking about and have experienced the sense of not being able to "forget" an odor even hours after the incident. I liked the one suggestion about a peppermint--it's just one of those things that happens sometimes in nursing. Hang in there! Joy
  22. jeastridge

    Be a Real Nurse: Compassion is the Key

    Thank you for sharing from your personal experience. Being a patient is the hardest and the fastest route to understanding the true need for compassion in our profession. What we do truly matters. Every little thing that we do.
  23. jeastridge

    Be a Real Nurse: Compassion is the Key

    Thank you for your comment. You outline well the way proficiency in task-oriented nursing skills gives us freedom to be the compassionate nurses we long to be. Way to go!
  24. jeastridge

    Be a Real Nurse: Compassion is the Key

    Well said! (applause, applause). I love your discussion about "need never ends" and appreciate the way you expressed the importance of holding something back for our very selves and our families.
  25. jeastridge

    Be a Real Nurse: Compassion is the Key

    I appreciate you comment and life you, I know that the line between giving and "giving myself away" is fine but definite. It separates compassion and resentment and we all know when we have put even a big toe over that invisible space. Like you, sometimes I have to pull back and "recover" from times when I go too far, but compassion resides well to this side of the line and makes the nursing profession so much more meaning--full.
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