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jeastridge BSN, RN

Faith Community Nurse (FCN)

BSN, RN, Faith Community Nurse

Posts by jeastridge

  1. 8 hours ago, RNat55 said:

    I found this part interesting. Hmmm? Hope is a way of thinking...interesting. I need to constantly change my thought process to maintain hope. I am intrigued by this. Thank you for sharing.

    Brene Brown always gives me a lot to think about! Thanks for your comment. Joy

  2. Gathering my thoughts and hospice computer, I climbed the outdoor steps to the second-floor apartment. The gloom in the small room was palpable as I entered. Crowded together on the couch sat a group of relatives and sitting close by in a worn recliner was the patient, a man in his late 60’s, jaundiced skin betraying his terminal diagnosis of advanced pancreatic cancer. On the arm of his chair, arm circled protectively around the top sat what appeared to be a daughter.

    After the introductions and greetings, we began to talk about what hospice is and does and how our services might be of help during this time. The patient waved his hand weakly to indicate his desire to speak, “This is it, isn’t it? I don’t have any more hope.”

    It seemed almost as if everyone took a collective breath, held it and turned to me, waiting for some word that would help them through this impossibly difficult moment.

    What would you say at this point?

    As professional nurses, we are present to help people wherever they are on their journey. From pediatrics to geriatrics and everywhere in between, we work to help people recover, rehabilitate, or compensate. Sometimes, we find ourselves in situations such as the one describe above which fits the traditional definition of “hopeless,” and yet, we are there to help inspire some degree of hope, however small.

    What is Hope?

    The stuff of life... 

    As long as we have some hope, we can keep pushing forward.

    A thought process...

    Researcher Brene Brown says, “I was shocked to discover that hope is not an emotion; it's a way of thinking or a cognitive process. Emotions play a supporting role, but hope is really a thought process…” (http://www.bhevolution.org/public/cultivating_hope.page)

    A tool to face the day...

    Sometimes we hear ourselves or our colleagues referring to a reluctance to encourage “false hope,” or the possibility of inspiring unrealistic expectations in our patients. Given the definition above, maybe false hope is not such a concern since hope might be more about giving those in our care the tools they need to face the day, so they can manage to wring out a bit of joy even in the midst of terrible trials.

    Hope fills the balloon of life...

    We talk about hope all the time: I hope it doesn’t rain; I hope I don’t spill spaghetti on my white blouse; I hope he passes his test; I hope he gets better; I hope I will be forgiven. It is the same word, but holds vastly different meanings! Hope is hard to pin down—it fills the balloon of life and floats, held by a string of desire, tightly wound around our fist of determination and strong will. We won’t let go, for as long as there is hope, there is life.

    So what is our role as nurses in inspiring hope?

    Set goals.

    While it is impossible to foresee the future, with our knowledge base, we can help our patients set goals they have the ability to meet. We can help them set goals for today, e.g. “Let’s focus on getting bathed and dressed and sit in the bedside chair for 20 minutes. Does that sound good to you?” Meeting goals, even small ones, helps us to feel a sense of achievement and success which gives us hope for reaching other, more long-term goals.

    Focus.

    When life feels out of control, our patients may need help in focusing their goals and hopes on a more short term accomplishment. After a major stroke, or some other serious health set back, people have a hard time with looking too far ahead. We can help them reframe their thinking and thus give them true hope. By listening carefully and asking questions, we can help guide them to their own goals, zeroing in on what matters most.

    Reframe.

    When we get down to the nuts and bolts of life, time on earth is always rather limited. But when our patients and their families face a hospice nurse at the door, the limitations seem rather glaring and hope appears to take its bright light over into a corner where it is hard to reach. By helping our patients reframe their thinking to goals that are achievable in this new setting, we can help them have hope. For example, finding out what really matters to them in terms of pain management, family time, and closure can help leave them with a measure of hope.

    What to say?

    As I faced the family, I breathed in too, silently praying for inspiration and desperately asking for wisdom. “This is pretty hard, isn’t it? What is the hardest part for you?” I asked. He went on to talk about his fears of being a burden and of having pain that would be out of control. Once I understood his greatest concerns, I was able to help him and the family make plans for caring for him and was also able to describe some of our pain control plans. As we spoke, I could feel the gentle presence of hope re-enter the room. While the hope of eradicating his pancreatic cancer through treatment appeared to no longer be an option, there were other parts of his story that opened themselves up to hope and plans.

    Make each day as good as it can be...

    As I gathered my things two hours later, I touched the patient’s hand and spoke to him and his family, “None of us knows what tomorrow holds. But we will do our very best to care for you and to help make each day as good a day as it can be.”

  3. Bah humbug! 

    Driving to the hospital, I reached over and clicked off the Christmas music that proclaimed a commercialized version of the holiday was fast approaching. I just wasn’t in the mood for “jolly” when all around me, I witnessed sadness, loss and broken hearts. Besides the heaviness for my patients, I also felt burdened by the expectations of others’: gifts, meals, cards, cookies all seemed to sweep through my busy mind, riding on the wings of a tornado-like wind that whipped the whole mess into a funnel cloud and plopped it all in my lap, there to sit with the other normal chores which required attention—just the usual laundry, grocery shopping, car maintenance (yes, mine was in the shop again…) routine.

    The "Right Way"

    I know. I know. It’s supposed to be fun and meaningful. The expectation is that this time of the year, focus solely on the reason for the season (for Christians, that is the birth of Jesus and for others maybe it is family gatherings and gift-giving with love). Whether you have a spiritual bent or not, we all know what it is to feel the pressure to do things the “right” way and the subtle competition to manage it all with great aplomb.

    As a Faith Community Nurse, one of the things I do is visit people when they are in the hospital with a focus on helping them transition to an appropriate post-hospital stay location. For some, that is as simple as suggesting rehab facilities to the family, and for others, it is helping them prepare to take a loved one home to a greater level of care than previously. At Christmas, illness, falls, disease, cancer do not go away. In fact, their prevalence and effect seem more pronounced as others hang garland and put on old Christmas sweaters and indulge in homemade Christmas candy.

    Charlie's Story

    I pulled into a parking space and headed up to visit Charlie, a parishioner who had been in the hospital for an extended stay with complications from a routine surgical procedure. Already elderly, Charlie’s small family was mostly gone, and he had very few resources. I sat down and caught up on the last two days’ news when the Case Manager stopped in to discuss possible placement in a local nursing home. Charlie was sad but resigned, realizing that he couldn’t go home and that he needed the rehabilitation this facility offered. But it was almost Christmas. And it was sad. I saw his eyes sparkle with unshed tears and squeezed his hand, offering the gift of presence and silence. He returned my gaze with a small smile and said, “I’m not worried. I will be ok. I have faith.”

    Charlie’s words both encouraged me and challenged me. His ability to maintain perspective in the midst of great obstacles inspired me to shed some of my feelings of resentment and heaviness and to replace those negative feelings with something that comes from light and life and love. In those few moments, I tried to reframe my own thoughts and ask myself a few questions about how I can face excessive expectations and maintain my morale?

    How to Encourage Others  

    As nurses, how can we keep working to encourage others even when we feel discouraged ourselves?

    1. Keep first things first- Even in the middle of a busy season, let us not forget to maintain our centeredness—whether it is reading a spiritually encouraging book, doing Yoga, going for a brisk walk outside, corporate worship—whatever feeds our spirits needs to take precedence over the other chores that might try to crowd it out. Busyness has a way of wanting to be more important than it really is, doesn’t it?
    2. Get rest and eat right. We can provide well for our patients, our co-workers or our families if we are running on empty. It may mean turning off that TV or letting our Facebook feed rest for a few days, but it is critical care for our bodies to get balanced rest and food, especially during the busy and challenging holidays.
    3. Maybe find someone to talk to. Holidays can bring out our own pasts and our sadness over previous losses. Unfortunately, this has a way of spilling out all over our lives in strange ways. We find ourselves angry and frustrated “for no reason” and over-reacting when someone asks us to bring a side dish to a gathering or participate in a secret Santa exchange…Over the top responses can signal that there is more going on than we are consciously aware of. When we feel like a pressure cooker waiting to explode, it may be time to pro-actively seek out some help in the form of a spiritual adviser or a trained counselor. Working hard in a therapeutic counseling relationship can be some of the best investments we make in time and energy. Working through past trauma and grief pays off big dividends in the present as we try to be the best nurses possible for our patients and the best family members we can be to our families.
    4. Cut yourself some slack. When the external pressures are high, sometimes it helps to acknowledge it and to also accept our own limitations. Perfection can be the enemy of well-being.

    As I wrapped up my visit with Charlie, he said, “Thanks for coming. It will be a good Christmas no matter where I am.” After a quick prayer, I left and walked back toward my car, feeling lighter than when I came, daring the “Bah-humbug” spirit to try to bother me again!

     

  4. A few weeks ago, several of us nurses got together for a cup of coffee outside of work, a rare event but an occasional holiday celebration. We sat around a table, holding our hot drinks and warming our fingers from the bitter cold outside. After some light banter, one of our colleagues shared a recent difficult encounter with a patient, one that left her feeling defeated and out of sorts as a professional. We all listened intently, and it was interesting to observe the various responses from her friends and co-workers. Because our responses were so reflexive, it made me think that we might also respond this way in other situations. Is good listening a skill we can learn and get better at? Consider the responses from around that table and think about how you respond to patients, co-workers, family members that share vulnerably with you.

    3 Responses

    1.  Almost before she could finish her story, one of the group asserted loudly (even pointing a finger in her direction), “I would not take that. I think you should respond by saying…” She went out to detail how the conversation might have gone had she been a participant, laying out clearly what she saw as the answer to her friend’s problem. Her body language, her forcefulness, her certainty all seemed to push the storyteller back in her chair, away from her cup of coffee, as she raised her eyebrows questioningly. “Do you really think so?” She queried, her hurt and confusion visible and audible.

    2.  A second person listened a little longer then said, “Well, I don’t think you should feel that way at all.” She continued to “should” all over the teller, minimizing her struggle and essentially asking her to harness her feelings into something less hurtful than they really were. “Shoulding” is so common, isn’t it?

    3.  The third person, the speaker’s close friend, remained quiet through the various exchanges, allowing the story to have plenty of time and space. She leaned forward a little before quietly offering her empathetic response: “What happened to you really stinks. I am so sorry that you had to go through that.” To me, it felt like she came alongside her friend and figuratively put her arm around her shoulders, sharing the difficult space and sitting with her as she felt the feelings she was feeling.

    Same story, three very different responses. Where do you see yourself? Ideally, we would like to say that we are consistently in #3, but most likely, we vacillate in our responses, employing all 3 from time to time and moving back and forth.

    Adviser

    The advice-giver meant well, but she effectively shut down communication, didn’t she? By delivering her pronouncement, she declared that she knew what was best and how that situation could be resolved. As unrealistic and presumptuous as her response is, we see it and experience it often, don’t we? People want to “set things right” by their standards and don’t want to leave a lot of uncertainty hanging around. While it is possible to offer advice, people rarely really want it, even if they ask. Generally, people need to work out their own individual approaches, their own answers, in their own time. Occasionally, if we have been in the exact same situation (unlikely) we can share what we did, but most of the time, those who share with us are looking for validation, a careful listener, and help in the form of a well-placed question such as, “So how do you feel about things now?”

    The advice-giver’s body language also closed more doors. Finger-pointing rarely feels good to the recipient of the gesture. It can be a strong, power-loaded motion, one that requires careful thought before deployment.

    “Should-er”

    The “shoulding” friend also delivered a put-down, didn’t she? We have the right to our feelings even if our feelings are not right. Feelings are proprietary. We acknowledge them, deal with them in our own way and hopefully find a path to mastery over time but “shoulding” brings some shame into the picture and makes us ask ourselves, “What is wrong with me to feel this way?” Of course the “should-er” doesn’t mean to elicit these feelings at all; she simply wants to make everything “all better” and smooth over discomfort. She longs to fix it, doesn’t she? As nurses, we can be attracted to the profession because we long to help our patients. This charitable desire has a dark side which is the “fixer” of the profession—always knowing what is best for others and letting them know what we think instead of allowing them to feel their own feelings and find their own way. If not carefully monitored, our desire to help can morph into control and manipulation and codependency.

    Empathetic

    The third friend’s empathetic response felt the most compassionate to me as I observed these interactions among friends. While the first two seemed to close doors of communication, the third response pushed the door ajar, allowing for future conversation and more opportunity to discuss the hurtful occurrence and to process it.

    The conversation at the table moved on to less heavy topics and we continued to share and laugh as our coffee cooled, offering healing and support to one another. Long after we went our separate ways, I thought about what I had witnessed and how many times we miss the mark in our responses to others.

    Were #1 and #2 “wrong” and #3 “right?”

    Well, yes and no and maybe. We are not perfect humans. We must offer each other grace and forgiveness every day if we hope to find any joy at all in this life. Friends sometimes say the best thing and sometimes not. We don’t discount their input either way, and we usually try to overcome differences. But such conversations shine a light on how we communicate and can help us to pause and think as we listen to someone’s story, careful as we try to respond with empathy and concern.

     

  5. 9 hours ago, Kooky Korky said:

    I can relate to the bitter, mean girl part.  I have worked with some really unhappy people.  Their personal lives were a mess, they brought their misery to work, they took it out on newbies like me.  40 years later, I recall their ugliness, their meanness, their selfishness.  I should have a fake funeral for them, where I bury them once and for all.  Maybe that would help me forget them.  Of course, they were great examples of how not to be.  Many times, I've been told how helpful, friendly, otherwise wonderful I was by students and by coworkers.  Mainly, I don't talk about personal stuff, I get to work on time and actually do my work, I help others when possible, and try very hard to be friendly and courteous.  

    Yes, I wish I'd known way back when that personal misery came out as ***ery at work.  I took it personally, like I was the one doing wrong.  Later, I figured out it could't have all been me.  From these horse's asses, I learned and have always practiced being a pleasant fellow to all.

    Stand up for yourselves, guys.  No one else will or should have to.

    Thank you for your response and glad you stayed with it! Joy

  6. 4 hours ago, Here.I.Stand said:

    If past trauma isn’t an excuse to be violent on the outside, it isn’t an excuse to be violent with healthcare staff.  

    And frankly as one with PTSD herself..... what the what??  If I am getting violent, staff SHOULD call a Code Green.  However, I won’t be getting violent.  While I may not have complete control over my feelings or internal physiological responses, I am adult and can certainly conduct myself as such.  

    Honestly I am a bit offended by this.  

    Thank you for your honesty. You make excellent point. The staff should always call a code green whenever there is a threat. I'm sorry it feels like the article implies otherwise. That was not my intent. Joy

     

  7. 28 minutes ago, HarleyvQuinn said:

    As someone trained and working in the inpatient psychiatric realm, I want to caution that there is a stark contrast in how you respond to a person who is agitated and acting out and a person who has escalated to violence. This is particularly true if the person is armed with a weapon. De-escalation techniques require training and experience to work at their best. Our facility utilizes a response team for anyone presenting in a behavioral crisis where psychiatric or other trained staff respond similarly to other code situations. Our security staff also receive the same training our psychiatric staff receives on de-escalation and hand-on interventions. Unfortunately, we only offer basic level CPI at this time in our facility. 

    Thank you for your helpful comment. You highlight the importance of preparedness, knowledge and rapid response. Joy

  8. 1 hour ago, V888 said:

    Please just remember this can be a very dangerous way to think. Don't let your sympathy or empathy let you put your safety at risk  

    Someone in psychological crisis can, especially if armed with a weapon, kill you just as easily as a hardened criminal. I believe there was a story on here about a nurse who died after getting caught between a psych crisis patient and a clamshell shield. 

    Defusing and de-escalating are things that are great...until they aren't. 

    I would also push back on the idea that all outbursts or misbehavior is caused solely and directly  by trauma as that idea can be dangerous for society...(minimizing agency and free will, not accounting for rights of victims, etc)

    So well said. Thank you for your thoughtful comment and for sharing your perspective. You make some important points. Joy

  9. “Code Green 5th floor. Code Green 5th floor.”

    The hospital operator’s voice made my pulse skip a beat even though I was far from the announced location. Code Greens [in this case meaning a combative person who may be armed] have become more common as we face more crowds, more recreational drug users, and more angry, frustrated people in our facilities. As nurses, we are sometimes part of situations that lead to the dreaded “Code Green” announcement as we call out for the necessary help. We undergo training in how to respond and follow the required steps, but we do begin to wonder if the number of these types of crises is increasing, and if so, why?

    The Team Approach

    Some hospitals have successfully formed specialized teams to address Code Green situations and to help de-escalate highly charged encounters. At Pinnacle Health System in Harrisburg, Pennsylvania, their Code Green Response Team, started in 2013, has saved personnel and patient injury, money and time away from work. Their example may be trendsetting as other systems look to find ways to decrease violence inside our hospitals. Code green prevents workplace violence

    Trauma-Informed Care

    Another opportunity for learning and forward-thinking is the Trauma Informed Care Project .The training invites participants to acknowledge that past trauma affects daily behaviors. Children are especially vulnerable to the effects of trauma and many childhood experiences accumulate to produce adverse effects leading to the term ACES (Adverse Childhood Experiences). The website goes on to explain that the goal of this foundation and this project is “organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. It emphasizes physical, psychological and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment.”

    During the training, participants are invited to re-think “acting out” and instead of asking “What’s wrong with that child?” Ask instead, “What happened to that child?” These subtle but significant shifts in thinking can help us move from finger-pointing and judging to more constructive patterns of interaction where healing can actually take place.

    Emotional trauma carries over, of course, into our adult years. If unacknowledged, untreated, unresolved, it can surface unexpectedly and often explosively, leading to our current question regarding Code Green. Victims of traumatic incidents can sometimes repress or “forget” the memories of what happened to them only to have those come back during challenging or stressful times —such as times in the hospital with a loved one or being sick and in pain themselves. The post-traumatic stress of past troubles can lead to excessive anxiety, anger, and unstable emotions.

    The Body Keeps the Score

    In his book, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Bessel Van Der Kolk, MD, asserts that past trauma manifests itself in actual physical disease. If unresolved, trauma will eventually lead to physical illness in a variety of diagnoses.

    “Even though the mind may learn to ignore the messages from the emotional brain, the alarm signals don’t stop. The emotional brain keeps working, and stress hormones keep sending signals to the muscles to tense for action or immobilize in collapse. The physical effects on the organs go on unabated until they demand notice when they are expressed as illness. Medications, drugs, and alcohol can also temporarily dull or obliterate unbearable sensations and feelings. But the body continues to keep the score.”(p46)

    Responding Appropriately

    As nurses, we are occasionally faced with responding appropriately to challenging situations: talking an agitated patient down, listening well, knowing when to get help. How can we prepare ourselves to be even better equipped to face difficult encounters?

    Be in the Know

    Take mental health classes that are offered for CME; the Mental Health First Aid class is valuable as are the Trauma-Informed Healing sessions. Learning about mental illness, PTSD, and other psychiatric illnesses gives us a good preparatory knowledge base.

    Responding Empathetically When Possible

    This can help resolve some low-risk situations. Many people long to be heard, really heard. They may even realize that we cannot resolve their situation, but they don’t want to be brushed off. They want to know someone cares. For some, that may be the beginning of healing and just what is needed to get them through a rough patch.

    Call for Help as Needed

    There is simply no substitute for getting help when a crisis arises. Maybe your facility, like Pinnacle Health, can consider starting a Code Green Team which specializes in defusing and de-escalating crisis situations.

    Sadly, Code Greens are more common than we would like for them to be. There are a lot of hurting people out there: both our patients and those that are surrounding them in their time of illness. We have no way of knowing what trauma might have happened to our patients or their families and loved ones previously. But we do know that they carry those hurts with them when they come in for treatment. As nurses, we are often presented with really messy scenarios. Being professionals, we do our best to make the best of even the worst of times.

    What helps you to respond appropriately to tense situations?

  10. 3 minutes ago, TitaniumPlates said:

    Wrong. The person in the example is an experienced, second careerist and a highly educated Chemist.  Which is precisely what some nurses find soOsoOOooooOOOO  intimidating and threatening.

    I've seen this before many times. An older, more mature and life experienced nurse comes in---maybe she's a new grad--but she's certainly not stupid. She ran a household of 5 kids or a department of 27 sales people or a unit of soldiers.

    But nurses do this just like any other profession. Don't give me that crap about "she's just harried and rushed"---sorry---I don't act like an arsehole to people because I am "rushed". I don't say s#itty things or threaten people because I'm "harried".

    If you have to act this way---when your rushed or overworked?  This profession is not for you and this says so much more about YOU than about the new grad.

    It's about time good nurses start walking and finding other places to be. Misery loves company---leave the nasties to each other--maybe they'll drive the unit into being shut down or the patients will complain enough because there isn't a one that can hold their tongue.

    I love how nurses seem to think they're some sort of special sauce that they get to act all crappy and get away with it because...stress. Like nobody else has a stressful job. Just them.

    Best advice is in the article.   document and burn them. Don't sit back and be afraid and don't ever run if you can fight.  I document, document, document. And when they least expect it---they're sitting in HR cooling their heels---and a few times?  Losing their jobs.

    Yeah. I think they deserve it....because now I'll get the "but you cost a nurse her job!"

    No. The nasty  nurse cost herself her job.

     

    You bring up some good points. Thank you for sharing your perspective. Joy

  11. On 11/29/2019 at 3:44 PM, FullGlass said:

    Thank you for a thoughtful article.  Bullying is all too common, and occurs in many different professions.

    Like the example in the article, I switched became an RN then NP in mid-life, after being a business executive.  Looking back on my career, standing up to bullies in the right way generally worked for me.  There were times that I did not, due to fear, and in retrospect, wished I had stood up for myself.

    In my experience, people in the helping professions, or people who are great for advocating for other people, often have trouble standing up for themselves.

    There have been some excellent suggestions given.  I'll add a couple more thoughts:

    - try to find an ally and/or coach.  An experienced RN that you trust and can provide some insight and guidance.

    - it's important to have "f*ck you" money.  A minimum 3 month emergency fund, ideally 6 months, so you can quit a job that is making your life miserable.  Bullies sense weakness and fear.  When you know inside yourself that you can walk away from the job, it will subconsciously give you a more confident air that can deter bullies.  

    - read up on developing assertiveness.  There are many books and videos out there.  There are also books and videos for learning to deal with workplace bullies.

    Best wishes.

    What great suggestions! I especially like the idea of having cash on hand. Money can't do a lot of things but it CAN buy options. It can make life more bearable by providing that escape valve--just in case it is needed. Thank you for sharing your constructive ideas. Joy

  12. On 11/30/2019 at 9:37 AM, Nurse Beth said:

    Great article, thank you.

    I was a new nurse manager when a doctor who was a well-known bully began to berate me at the nurses station bc a lab was not resulted. It was so humiliating. He was tall, imposing, and absolutely withering in his manner.

    I asked him if we could speak in private and amazingly, he agreed. He followed me to my office. I said "Dr. Baker, we both want the same thing. The best for your patients. I will do everything I can to provide the best patient care on this floor, but you cannot undermine me in front of my staff. If you ever have a problem, let me know. In private".

    To this day I have no idea where those words came from!  But it worked and he gave me nothing but respect from then on.

    I learned a lesson that day that I had to use later on with a nurse colleague who bullied me. Another story :).

     

    Great story. Thank you for sharing. I was reading Richard Rohr's book, THE NAKED NOW, this morning and he says, "What you see is what you get. What you seek is also what you get. We mend and renew the world by strengthening inside ourselves what we seek outside ourselves, and not by demanding it of others or trying to force it on others." (p.160). You showed respect and behaved with decorum and integrity. 

  13. 8 hours ago, Leader25 said:

    First they need to stop covering up for abusive nurse managers some can be as bad  or worse than co workers.Stop giving exit interviews while you are still working there.

    They need to stop covering up for the real bullies,just because someone has drinking/money/family  problem is no reason the rest of us have to tolerate the abuse.

    You bring up an important point: our personal lives can "bleed over" into our professional lives so easily. We also can have a tendency to promote co-dependency and tolerance of bad behavior based on excuses. While we all want to be sympathetic to the troubles our managers and co-workers are experiencing, we also want to keep our patients front and center--while at work, they are our #1 concern and responsibility. Thank you for your comment. Joy

  14. 5 hours ago, Snatchedwig said:

    I dont care what anyone says. Bully can only go so far. It takes ONE time to man up and put them in their place, problem solved. Hell the ones that were considered bullies at my job and I get along perfectly well because I put them in their place the first time they tried. 

     

    giphy (3).gif

    You are right. There is a lot of truth to the need to find a way to stand up to bullies and to be firm. But it is easier for some people than for others, and in some cases, bullies make it impossible for victims to have a voice. I have no doubt that you are the kind of person that speaks up for others, as well. Thank you for your comment. Joy

  15. 1 hour ago, Daisy Joyce said:

    One of the issues about bullying in nursing is that the staffing issues and busyness of most floors, cause new nurses to question themselves (“is my preceptor bullying me, or she stressed from an impossible workload and I’m just dragging her down with my slowness?  Is the workload really too hard, or am I just slow—and maybe stupid?”)

    A typical newbie doesn’t have any frame of reference to know.

    Well said and so true. Thank you for your insightful comment. Joy

  16. 3 hours ago, CommunityRNBSN said:

    I am a new nurse, and I work in a very supportive environment. A friend who graduated with me has been working on a busy med-surge floor where bullying and general meanness is rampant. We are now 10 months out of nursing school, and she has just been offered and accepted a job at my health clinic. Meaning that her hospital— which poured a lot of money into selecting and training her— has just lost an excellent, smart, bilingual nurse, who has another 30 years left in her career. In my opinion, that is what the hospital deserves, if they choose to allow nurses to bully new colleagues mercilessly. A good nurse manager would require basic respect among employees. 

    Agreed. Good dynamics on the floor and among staff members often starts right at the top. Joy

  17. Cindy was an older new grad. She went back to school after a long and successful career as a chemist, deciding that she wanted to be a nurse and explore other avenues of service for her “second half” of life. Capable and efficient in her first line of work, it was a shock to find herself as a novice where everything felt unfamiliar and where mastery was a ways off. Her first place of work was on a busy ortho floor. The second week at work, she called me crying. “Their expectations are so high. They keep threatening me.” I tried to listen without judging or offering advice, but something just seemed off. Every few days she texted or called and what she described didn’t seem like anything I had ever experienced as a nurse: where there should have been mentoring, there was censoring; where there should have been guidance, there was abandonment; where there should have been counseling, there was silence and isolation. The source of most of the problems was her preceptor, a young nurse, who my friend described and very physically attractive but unkind. As it turns out, she was a bully.

    Nursing is Not Immune to Bullying

    While we would hope that in such a caring profession, we would find a greater percentage of people with compassionate care agendas, sadly there are also a number of practitioners who exhibit the characteristics of a bully: they are critical,  negative, they isolate their victims, avoid meeting with them, and generally make life miserable.

    According to a study by Etienne, “Bullying in the nursing workplace has been identified as a factor that affects patient outcomes and increases occupational stress and staff turnover.” (Exploring Workplace Bullying in Nursing)

    Signs of Bullying

    The trouble with bullying is that it is often subtle and therefore difficult to recognize as such. While the playground bully may be overt and even violent, the adult bully is usually disguised under heavy layers of professional accomplishment and years of experience with manipulating others. They come in all shapes and sizes, both men and women, old and young. The “mean girls/guys” from 7th grade grow up, don’t they? But sadly, they sometimes don’t leave behind their old ways of treating others, and they bring those tactics with them when they put on their scrubs and head to the nursing workplace.

    One of the primary manifestations of bullying is that the victim often feels that it is all his/her fault. After exposure to the bully’s tactics, they may even think to themselves, “If only I did this or that better, then they would not treat me this way.” The thought processes at the center of the bully/victim relationships can sometimes be lifted straight from our textbooks about abuse. Just as victims of domestic abuse many times blame themselves, nurses who are victims of bullying find themselves looking inward and wondering if there is something wrong with them.

    What are some of the classic signs of a bully boss or co-worker? 20 Subtle Signs of Bullying at Work

    More Subtle Signs

    Deceitful and manipulative- making promises but not keeping them or using promises to purposely disappoint.

    Shaming and blaming- bullies want the victim to blame themselves.

    Ignoring or undermining work- purposely “forgetting” to notify someone of meetings, belittling their work or accomplishments.

    Intimidating and criticizing- setting impossible standards and even threatening.

    Diversion and mood swings- bullies might avoid the victim so that the work issues cannot be resolved in a timely manner; and they are subject to widely varying moods (which boss/co-worker will be coming to work today? The sweet one or the nasty one?)

    Overt Bullying

    Aggression and intrusion- actual physical altercations with the bully entering your personal space.

    Belittling, embarrassing and offensive communication- using their position to cause you harm, either physical, psychological or professional.

    Coercion and threatening- pushing the victim to do things they don’t feel comfortable doing and using threats of termination or other punishment to get compliance with their demands.

    So, if you or someone you know is being bullied in the workplace, what can you do?

    Document- Keep a record of any threatening or inappropriate emails, texts or interactions. Should it become necessary to report the bad behavior, it will be important to have specific occurrences, words used, and frequency of episodes. Also, learn your workplace policies on bullying and what your recourses are.

    Detach- Try to look at the occurrences in light of how this person treats others. Have you been “picked out” for special scrutiny? Bullies are sometimes bullies across the board but at times they pick out a few victims, zero in on those and treat others as allies, making the other staff members into (sometimes) unwitting accomplices for their own bad behavior.

    Dare to Defy- Standing up to a bully is hard and practically can be impossible. Often, persistent bullying requires cutting our losses and moving on to another position. But adult and boss bullies—like those on the playground—can respond to pushback: maintaining eye contact, standing firm, ignoring or not acceding to their demands. This is harder to do than it sounds, because the victim of a bully at work frequently is not in a position to resist and finds themselves being jerked around by the perpetrator’s continually changing and escalating demands, whims and moods.

    Defend- Be on the lookout for bullying behavior around you and if you see something, say something.

    As for Cindy, in the end, she resigned after 3 months and went in search of another job—certainly not the route a new nurse wants to have on her resume—but a physical and psychological necessity given the bullying she experienced. After the rocky start, she went on to have an extremely successful career as a nurse and to find the profession a satisfying fit for her talents.

    Have you witnessed bullying in your workplace? How have you been a victim of bullying?

  18. On 11/16/2019 at 1:24 PM, greytRNtobe said:

    As one of the 12.8 percent who were unlucky enough to get breast cancer, I can tell you it is not all "pink ribbons".  It was one of the worst times of my life-I had no support system-everyone left in a hurry. I had every side effect of every treatment. Even my medical team was useless. They just assumed that since I was a nurse I knew everything about breast cancer. Black women are less likely to get breast cancer but more likely to die of the disease. They are also less likely to have the economic, insurance, physical, psychological or spiritual support to fight such a foe. Many more black women have triple negative tumors that are more aggressive. And younger women are more likely to have more aggressive cancers. If you are unlucky enough to join this club, always, always, always get a second opinion! Cancer is an industry-if you don't like your doctor or the the center, find another. I wish I had. My center is filled with cold-hearted people and I refuse to go back for follow-ups because they are just so heartless. People don't understand this-once you have had cancer-you always have had cancer-there is no cure. We just hope to outlive our recurrence.😨

    Thank you for your comment and for sharing your experience. You have some important views for others to consider. I wish you all the best moving forward. Joy

  19. My phone lit up with a message from a friend in a nearby town. “Let’s get together for lunch this week.” I responded with, “Sure, what’s up?” Her answer made me sit down. “Breast cancer.”

    Breast Cancer Statistics

    The “C” word is met with foreboding by us all, but breast cancer brings along with it a special dread to women: possible breast-altering surgery, treatment that can include chemo and radiation and the increasingly less likely risk of death. With statistics showing that according to the National Cancer Institute (NCI), “12.8% of women born in the United States today will develop breast cancer at some time during their lives,” and “2.6% of women in America will die of breast cancer.1

    As scary as that statistic is, the NCI emphasizes that the same numbers also show that there is a 7 out of 8 chance that an individual woman will NOT have breast cancer in her lifetime. All the statistics invite us to careful monitoring, including regular mammograms after age 40 or 50 for women with average risk. Additionally, many physicians recommend genetic testing such as for BRCA gene if there is a higher than average family history of breast cancer or any ovarian cancer.

    How to Reduce Your Risk

    All women have the opportunity to adhere to healthy lifestyle choices that can help decrease their chances of getting breast cancer including2:

    • Limit alcohol. Greater alcohol intake=greater risk.
    • Don’t smoke.
    • Weight control.
    • Physical activity.
    • Breastfeed.
    • Limit duration and dose of hormone therapy.
    • Avoid radiation and environmental pollution.

    Treatment Options

    As professional nurses, we often get asked questions about breast cancer and treatment options. Unless we are actively working in the field, we are not usually qualified to answer questions and often must refer to others or to reliable published material. However, it is important for us to stay up-to-date and understand some of the more recent changes in breast cancer treatment. 

    Staging

    According to LaCosta Brown, RN, MSN, OCN, a nurse navigator for breast cancer, a lot has changed in staging breast cancer since January 2018. Previously, staging involved one sheet of paper, one chart essentially, and noted tumor size (T), nodal status (N), and metastasis (M). The TNM staging method had been around for a number of years and served as the guide to defining surgery and treatment options. However, for the past 2 years, grade and biomarkers are also taken into consideration. The total picture is the TMN + G + B.

    Grade

    Grade refers to how abnormal the cancer cells are when examined under a microscope and range from G1 - Well-differentiated (low grade) to G3 - Poorly differentiated (high grade). Essentially, the higher the grade the faster the spread of the disease. 

    Biomarkers - HER2neu

    Biomarkers include estrogen receptors, progesterone receptors and HER2neu (Human epidermal growth factor) status. 80% of tumors are hormone-positive and thus respond to treatments that help to curb their growth, treatments that include drugs like Tamoxifen and Arimidex. So if cancer responds to hormones, it is Estrogen or progesterone positive and therefore would respond to these drugs that specifically work to slow down and impede tumor growth and spread. These long term “chemo pills” are generally used for 5 years. This anti-hormonal therapy can prevent breast cancer re-occurrence.

    HER2 is a protein that when present can cause cell growth and survival. Being HER2 positive opens up the possibility of treatment with Herceptin or Perjeta.  HER2 presence is considered, according to Brown, as a “foot on the gas. It is go-go. The treatment modalities of Herceptin and Perjeta put on the brakes and slow or stop the growth of the tumor cells.”

    According to the CDC, if cancer is the “house” the 3 markers are “keys” that can help treatment get inside and destroy or slow down the cancer cell. If the “house” doesn’t have any one of the 3 keys, it is called “triple-negative.”Triple-negative breast cancers, or those that don’t respond to anti-hormonal treatment, make up less than 20% of all breast cancers. Along with surgery, the treatments include chemotherapy.3 

    Immunotherapy for breast cancer is also a growing field and one where promising research is being done. 

    The new methods of precision evaluation breast cancer include genetic profiling of the tumor specimen and are much more specific and helpful in terms of specifying treatment options and helping patients decide how to proceed.

    New Treatment Options  

    In years past, radical mastectomies were the treatment of choice for most breast cancers. As medical knowledge and treatment options have developed in recent years, more women are able to get simple lumpectomies and follow that up with the appropriate treatment given their staging. They may be able to have sentinel node identified at the surgery for biopsy instead of removing all the axillary nodes, reducing the problem of lymphedema of the arm after surgery.

    My friend and I met for lunch and talked at length about her plans for surgery and follow up treatment. Along with the technical and medical conversation, we reconnected with each other’s lives, offering one another emotional and spiritual support, realizing that as important as all of the staging and drugs and treatment info is, so also is the support we offer one another when going through diagnosis and treatment.

    References

    1. American Cancer Society- https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
    2. Mayo Clinic - Breast Cancer Prevention: How to Reduce Your Risk - https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/breast-cancer-prevention/art-20044676
    3. Centers for Disease Control and Prevention: Triple-Negative Breast Cancer https://www.cdc.gov/cancer/breast/triple-negative.htm

     

  20. 11 hours ago, Meagan said:

    I love what you said about compassion being an action rather than an emotion. What I try to do is remember that this "patient" is a "person" that will walk out of my doors and go on about their day. I find that learning a little bit about my patient's personal life helps me to stay grounded with them and I can relate to them on another level than just medical conversation. This has helped me so much in my clinic practice. 

    Dear Meagan, Thank you for sharing this thoughtful comment. As you say, connecting with our patients' "story" in some way, helps us to continue as compassionate professionals--for the long haul. Have a great day as you care for others!  Joy

  21. It happened on July 15, 2017. Loretta Seymour sat in the emergency room of a hospital in Ontario with her dying father. Diagnosed with prostate cancer the year before, he had been transported to the local ED for end of life symptom management. He was on massive amounts of pain medicine, but he continued to suffer, physically and spiritually. Feeling helpless beside her father, Seymour remembers a nurse coming in and providing a comforting presence that night. Her name was Omolara Ishola. When Seymour said her father was afraid of dying, Ishola offered to pray with the dying man. After that, she sang a song and then brought extra blankets to help keep her patient’s feet warm. These acts brought comfort and peace to both Seymour and her dying father.

    Quote

    “As awful as death is, it was a beautiful experience because of her.” - Seymour

    Now, two years later, Seymour recently connected with Ishola via social media and they went on to meet in person. Expressing deep gratitude, Seymour spoke with Ishola through her tears and thanked her for what she had done that night. Characteristically, the nurse responded by saying she felt, “Humbled” by the recognition. She went on to say, “As a nurse, you do what you do not for the recognition. Patient care is provided because you want to make a difference in people’s lives. When you’re a nurse, you step into people’s lives most of the time at a very vulnerable moment and I have learned to understand that every man, every woman, every child, is someone’s relation, not just a number.”

    Ishola’s example is inspiring. Even more, it compels us to examine our own practice for places where we can improve. Even the most seasoned nurses can benefit from taking a step back, from time to time and seeing areas where they might improve their practice.

    How Can We Make More of a Difference?

    Provide spiritual care- Assessing for spiritual care needs and making sure those needs are met is an integral part of excellence in nursing care. While we may not feel comfortable praying with a patient, we can all take steps to call the chaplain or the patient’s spiritual advisor. Ishola’s approach went beyond the ordinary; she made an assessment of the need and realized that she was able to help meet the need.

    Focusing on patient dignity-

    As Ishola said, everyone is someone’s relation, and everyone is more than a number. When we see them in their dying moments, as body functions shut down, and pain is front and center in our list of concerns, we continue to see their humanity. How can we show this in practical terms?

    Employing appropriate touch- 

    When we connect with the patient by touching their hand or shoulder, or trying to warm their feet, we go beyond medical interventions and reach the humanity of our patient. Touch centers them and us in the present, and lets them know we are with them.

    Addressing the patient and family appropriately-

    This nursing care intervention applies at all times, not just in the time surrounding death. Speaking to our patients with dignity and concern, conveys professionalism and can increase trust; trust will ease discomfort and anxiety. Addressing them appropriately goes beyond using surnames (or first names, whichever the patient and family prefer). It extends to talking directly to the patient when possible, using low tones to protect privacy and ease feelings, and not “talking over” the patient.

    Focusing on the environment- 

    Protecting our patients’ dignity also means being conscious of not talking loudly in the hall and being continually self-aware when with the patient and family so as not to increase their distress. The time surrounding the dying process is often difficult and precious time to the family. Of course, circumstances differ: it goes without saying that an untimely death is harder than an expected one, but even so, an elderly 95-year old’s death —even if anticipated—calls on us to be especially respectful and cautious in dealing with the feelings of those at the bedside. It is never easy to say good-bye to a loved one.

    Make Encounters Positive

    For Seymour, who continues to mourn her father’s passing, the nursing care she and her dad received in the emergency room that night made a huge difference. She feels that by contacting Ishola she has completed a task that would have pleased her father, “I feel like my dad’s message of thanks is passed along to her…I can’t tell you how thankful I am for this beautiful soul being there, comforting him.”

    As professional nurses, we have many opportunities to impact our patients on a daily basis. Our approach and our attitude matters. As Ishola said during her encounter with Seymour, “At every point, I remind myself these are human beings, these are people you’re touching and you must make every encounter positive.”

    Resources

    Woman thanks nurse who prayed for dying father

  22. 9 hours ago, JKL33 said:

    I think a lot of people advocate kindness but have it confused with niceness. 

    Niceness is oftentimes what people want since it involves others' compliance deference, politeness, propriety, etc. Niceness can be a façade and can be manipulative; it is a response based on what is expected.

    Kindness is a strong position motivated by genuine regard for others; compassion. I believe it involves self-respect.

    There are a lot of articles online comparing the two. One of them mentions the idea that kindness is rooted in love and niceness is rooted in fear. I'm no expert on the matter but that is consistent with how I think of the two qualities.

    I think nurses could do well all around to contemplate the difference between the two.

    Well said. True kindness sometimes doesn't appear to be "nice" because sometimes what is best for us, our patients and our co-workers doesn't look "nice" superficially. Thank you for your thoughtful comment. Joy

    9 hours ago, SarahLawson2660 said:

    Beautifully stated! As a dialysis nurse, I’ve dealt with my fair share of grumpy patients and some were outright verbally abusive. One thing that’s always helped me keep my kind disposition is putting myself in their shoes. How would I feel if I was tied to a machine at least three days a week for 4 hours at a time to stay alive?! I know that I would be dealing with a handful of emotions and one phase would be anger. So I proceed through my days smiling and displaying kindness to all that I can in hopes to help ease their pain and phases of anger. 

    Well said. True empathy and kindness are related, aren't they? Your patients are blessed to have you as their nurse! Joy

  23. 1 hour ago, tinyRN72 said:

    I think that kindness is very important, especially in the work we do. 

    I find that when you start the shift being kind to your patient, they respond with being nice. I hate getting report and hearing that someone is "mean" because I don't want to start out expecting that. I often find that I have no problem with the "mean" patient. 

    When I have a difficult patient, I try to remember that they don't want to be there. They are in pain. They feel helpless and they have very little control over what is happening to them. I remind myself that this person did not ask for this.... Even if they smoke, drink excessively or use drugs.... They didn't ask for this. 

    It helps me to remember that even if they are rude or less than kind to me, for them this could be the worse day of their life. It's up to me to make it bearable for them. 

    From a selfish standpoint, my extension of kindness comes back to me in the form of a nicer patient who is not yelling at me, cursing me or being rude. It's a win win. 

    We also need to remember to be kind our co-worker. This also comes back to you ... Better teamwork, support, and a better work environment. 

    Just be kind to everyone, anytime you have the opportunity. You can't worry about those who are not nice... But you can choose your behavior and you will be happier for it. 

    Thank you for your thoughtful comment! I appreciate what you shared: kindness generally comes right back at you! 

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