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jeastridge

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  1. jeastridge

    End of Life: The Final Word

    "If anyone is never at fault in what he says, he is a perfect man, able to keep his whole body in check." James 3:2 I reach down to touch Anne's* hand, my own fingers still chilled by the outside morning air. Her eyelids flutter, letting me know she was aware of my presence. I speak gently, trying to not disturb the threads of silence that hang heavily in the room. "How are you doing?" She does not voice a response, but the furrowed brow tells me that she is thinking of how to answer my question. As a hospice nurse, I come on the stage of life when others have played their parts and now stand silently in the wings, witnesses to life and death. The chemo team is gone, the transfusions are mostly over; the doctors with their serious pronouncements have faded into the background. Standing beside the bed are the one best friend, two of the six children, and a few others that come and go to leave their gifts of steaming soup or fragrant flowers, attempts to brighten the long journey home. Anne's eyes open and she looks at me, focusing through the curtain of pain and the blessed numbness of opiates. "I'm ok," slides out in a whisper. I stand by, struggling to find the best words, the question that might help her along the way, the voice that will not hurt, but instead help. At times like these, everything matters and the burden of that knowledge, keeps my mouth still, waiting for the Holy One to fill it with direction. The others leave the room. I hold her fingers in mine, while palpating her pulse, assessing her color, monitoring her respirations, checking her skin for signs of breaks. As I wait, the question spills out, "What is the one thing that bothers you the most about all this?" A single tear, creeps down her tissue dry cheek and she answers, "I'm afraid of leaving the children. I'm afraid that they will grow apart after I am gone. I won't be here for them to come home to." She speaks with some effort, but as the words well up, expressed from her spirit, they also relieve some of the pain, pent up in her aching heart. I have no response. None is needed. Saying the words and shedding the tear, seem to ease the crack in her heart. Her respirations even out, her eyes close, apparently more focused on the beyond. Words matter all the time. It's just that at the end of life, there are so few of them left, that we must count carefully to make sure there is no waste. That awareness keeps us from using them foolishly. As we leave the bedside of the dying, may we carry with us the desire to use our words carefully, every day, not just on the final ones. Dear God, Grant me your words today. Let me be silent or let me speak only at your prompting. Give me a renewed awareness that words matter. Amen. *Name changed to protect privacy.
  2. The doors to the ICU swung open as I swiped my badge and I took a deep breath before stepping forward to face Jane and her family. An elderly woman, 90+, Jane faced day 7 on a vent in the ICU after a serious bout with pneumonia. I greeted her son who sat quietly at her bedside, by now impervious to the low key but constant whirr and beep of the machinery that worked to keep his mom alive. After greeting him, I stepped over to take Jane’s flaccid and swollen hand in mine and greeted her, too. Talking with the son, he related the events of the past 24 hours. He emphasized that the doctors assured him she was “stable” and “not suffering.” Despite her advance directive that stated her preferred wishes not to be intubated, when the time came, she was lucid and changed her mind, giving hurried permission for interventional care. After talking a while, I brought up the idea of talking with the doctor about having a Palliative Care Consult. Emphasizing that this was something the doctor would have to order if she thought it was appropriate, I described the possible perspective they might bring to the overall picture. During our conversation, his internist came in and said, “I have put in for a Palliative Care Consult” clearly seeing the same picture that we were and thinking it might be time to pause and consider how to move forward. After prayer and a moment with scripture, I went on to see others in the hospital before heading over to the church where I have an office. Seeing patients in the ICU is not an everyday occurrence but does happen with a fair degree of regularity. In that environment, the Parish Nurse can serve as a spiritual support person, an interpreter for medical terminology and procedures and a liaison between the family and the staff, especially if difficulties arise. At the church, I briefly checked email and made a note to call Mr. S back about his grief. Having lost his wife of 57 years just a few short months ago, Mr. S told me he felt adrift; one of the things a Parish Nurse can do is help cast out lines of communication and connection, helping him find new ways to anchor himself —social activities, service opportunities, and spiritual comfort. I prepared a devotional thought before going to a Caregiver’s Support Group and sharing an hour with them. Meeting once a month, the group of a dozen or so people helps one another through the thick and thin of caregiving, discussing different topics each month and sometimes even having special speakers from nearby facilities. After a quick lunch at my desk, I joined a weekly meeting with the pastors on congregational care, discussing how we could best address the needs of our members who were going through a variety of crisis. We usually assigned one designated person to be in charge of responding to a particular need, then bring the others in as was necessary. After the meeting, I spent the afternoon returning phone calls, checking on people who were post-op, making notes after each phone call or contact, and working on coordinating some of our outreach ministries: prayer shawls, frozen casseroles, cards, and birthday visits to our “At Home” members. One of the beautiful things about Parish Nursing is that there is not a “typical” day. Every day is different and some more challenging than others. What I have described above could stand as a representative sample of what happens many days. As members of the church staff, Parish Nurses work closely with pastors, collaborating in the wholistic care of their parishioners: body, mind and spirit. Parish Nursing, begun in the 1980s by Grainger Westburg, is a place where nurses can find new ways to use their skills. While my position is a regular part-time position and I receive a small stipend for my work, many Faith Community Nurses are volunteers who work just a few hours a week, checking blood pressures on Sundays and answering questions or making phone calls. There are a number of definitions of Parish Nursing, but they all include most of the following, “A Parish Nurse is a registered nurse with specialized knowledge who is called to ministry and affirmed by a faith community to promote health, healing and wholeness. The role of the parish nurse is to promote the integration of faith and health in a variety of ways that reflect the context of the faith community. Specific examples include: health advocacy, health counseling, health education and resource referral (http://www.capnm.ca/fact_sheet.htm )” If you are interested in being a Parish Nurse, how do you get started? First and foremost you will need to have the support of your church’s leadership to work in this capacity. Talk with your congregation’s governing body and gauge their support. If you feel led to continue after that, you can take an online course in becoming a Parish Nurse to better prepare yourself. You can also seek out other Parish Nurses in your area. Nationally, the Westburg Institute serves as the unifying organization for FCNs, holding an annual symposium, publishing articles and books and providing visionary leadership. After a busy afternoon, I snapped my computer closed, double checked my calendar for the next day and got ready to meet a girlfriend for a walk in the spring sunshine, feeling blessed to be able to be a nurse in a church.
  3. jeastridge

    Nurse on a Mission Trip to Belize

    Well said. A trip like this helps us re-prioritize our lives and examine again what is truly important.
  4. jeastridge

    Nurse on a Mission Trip to Belize

    I left for Belize on a Saturday after running around getting ready to be gone for a week, I almost plopped into my airplane seat, grateful for a few minutes of respite when I began to wonder, “What have I gotten myself in to?” Going was my daughter-in-law’s idea. As a PA, she had been wanting to go serve as part of a medical mission. My husband, a family doctor, and I readily agreed to join a team that gradually grew to 28 to serve for a week in the inland part of the Central American country of Belize. Long a part of the British Commonwealth, the country has English as its official language but with a total population of under 350,000 it remains needy with many parts of it underserved medically. Our team went to work in a compound that housed a medical and dental clinic where foreign doctors came 4-5 times a year. We were there to volunteer doing everything from family medicine and dentistry to screenings, hearing assessments with fitting for solar powered hearing aids and giving out of basic “reader” eyeglasses. The first day we went to church in the morning and then saw 50 people that afternoon. Overwhelmed by the numbers of people and the long lines, we immediately began to work to prioritize, triage and figure out how many people we could realistically serve a day so that we would not end up having people wait all day only to be turned away. We did our very best to work with compassion and efficiency but there were still people we could not get to. As a nurse and a sort of coordinator for the team, it was my job to help match volunteers with jobs they were suited for and to watch over the general work of the clinic, intervening where there might be problems. Together with other nurse volunteers, including a local nurse who helped with translations when people were not fluent in English (Belizians speak a mix of English, Spanish, Creole, and some Mayan languages), we checked vitals, weights, blood sugars, occasional hematocrits and lots of urine samples for infection and pregnancy. Our team had access to on-site X-rays, some ultrasound and EKG. The dental clinic also had X-ray and was fully functional to do most extractions and some restorative work. Some of the patients moved between dental and medical and even on to eye checks and hearing tests to get the full benefit of all the services provided. Modern medicine and cell phones made it possible for our doctors to work with physicians back in the US to assess and offer expertise on cases. One young man, age 15, came in with a bullet lodged in his lower brain. The images were sent to a neurosurgeon stateside and also to a radiologist and a pediatrician. Together they concurred that surgery might do more harm than good and that he should not have it removed because of the risks involved with surgery. When seen, he was 2 weeks out from his injury and walking with minor assistance. The educated opinion of the experts, rendered from far away, were a great help to a family that did not know which way to turn. The most difficult cases we saw were the ones where we felt our hands were tied by circumstances beyond our control. The breast mass, the severe heart murmur in a younger man, the colon cancer, the “spells” that remained undiagnosed—all caused the team anguish as we conferred, prayed, and tried to find a way forward. In a place where few have insurance and the medical system is cash based, not having money for a procedure simply means that it will not happen. In the end, we tried to give some assistance to the hardest cases we faced, but all were daunting as radiation and chemo and surgery are scarce and mostly unavailable. Extended treatments often require travel abroad, something that involves another set of hurdles, including the necessary paperwork and large amounts of cash. After a busy week of seeing hundreds of patients, I was left with one predominant emotion: gratitude. Gratitude for what we were able to do, gratitude for the appreciative response of those we reached out to and those we worked with, and gratitude for all that we have here at home. In spite of the difficulties involved, overseas medical missions is productive in that it refocuses us on things that really matter: relationships, compassion, and the unity of all humanity as we occupy one fragile planet together. Yes, we are different but my goodness, we have so much in common. Whatever nation we are from, our bodies work in much the same way and malfunction in similar ways; our passion for helping our loved ones is undiminished by deprivation and scarcity of resources and our desire to be treated with dignity is uniform. My hope is that we did a world of good in our week in Belize. Realistically, I know that the impact was relatively small. Some would argue that the resources spent in taking so many people was not worth the benefit. However, I would argue the opposite. The seeds of love and care sown will continue to bear fruit for years to come and more than that, our team was changed. We all came back with a bigger vision of our place in the world and our greater responsibility for our neighbors, both here and beyond.
  5. jeastridge

    Nurse on a Mission Trip to Belize

    If you feel a leaning toward doing this, don't hesitate! Joy
  6. jeastridge

    Nurse on a Mission Trip to Belize

    Thank you for your very kind and encouraging words. Joy
  7. jeastridge

    Nurses with Attitude

    Consider two possible scenarios: Nurse A Nurse A enters the emergency department bay where a critical patient, in the process of stroke protocol lies semi-comatose on a gurney, surrounded by anxious family members and friends. She says, “There aren’t any rooms over in ICU. You all will have to spend the night here. I will watch over him, but I have 3 other patients I am taking care of. I think you all should complain to the administration. If you don’t, nothing will change. I know I’m outta here as soon as my husband gets a transfer.” As she leaves the room, her negativity fills the space just as surely as if she trailed toilet paper on her shoe. Nurse B Nurse B enters the same area to start an IV and hang plasma. She does her duties in a professional manner and asks the family if they need anything. “Well, the other nurse told us there aren’t any rooms upstairs. What are we going to do?” She replies, “We will continue to take excellent care of your loved one while he is in our department. We will be just outside the door if you need us. Please don’t hesitate to call. We will also be working diligently to get the patient to the ICU as soon as is possible. Is there anything I can do to help you all be more comfortable while you are here with us?” As she leaves the room, the family sighs but feels re-assured that matters are under control and that they don’t need to be as worried. As a Faith Community Nurse who often visits a variety of Emergency Departments to be with families who are in a time of crisis, I see all kinds of nurses in action and am able to observe their interactions with patients. Unfortunately, I have witnessed some Nurse A’s and a number of Nurse B’s. While many Nurse A’s may feel perfectly justified in their complaints and what they say may be true, it is disheartening to see and hear nurses complain to patients, especially in their moments of true crisis. What would Nurse B’s say to Nurse A’s? She would be polite and not condescending but she would say in no uncertain terms: Don’t vent in any way to patients and their families. Don’t tell them about your life, about how tired you are, about how many shifts you are working, about how low your pay is or about how your car is in the shop. They do not care. They are sick. They need your help. They do not need to be in a position where they feel they need to take care of you. Being a professional means working through the bad times as well as the good times. Work is not always fun. It is work. It can be rewarding but it isn’t always rewarding or fulfilling. There are times when it’s just plain old hard. Get over it. Work anyway. Show up early. Dress professionally. Do a great job. Make your team proud. In the end you will, most likely, experience some sense of satisfaction for doing your best. You are in complete control. You can’t change your circumstances and you can’t change what happens to you but you can always be in charge of how your respond. Your reactions are totally yours. Maintaining control of your attitude is what makes you stand out from other nurses. As Zig Ziglar said, “Your attitude not your aptitude, will determine your altitude.” The Big Picture Every part of your life experience matters and fits together to make a bigger picture. While a “dream job” may never come your way, every job teaches us something. When we are new grads and have to “settle” for something less than we expected, we learn to do our best, to be humble and to persevere, gathering whatever we can and growing through it. As we go through our professional lives, many of us are able to look back and acknowledge with great humility, that yes, that job that we hated so much during that season of life, was critical to helping us get to where we are today, doing what we always dreamed of. Remember, it is always about the patient. It is not about the nurse. Being self-less, not self-absorbed leads us along the path that brings light and life to our spirits. Contrary to our natural inclinations, when we serve others with a joyful heart, we find the true rewards that we were seeking all along. Are You an A or a B? Probably most of us are some combination of a Nurse A and a Nurse B, hoping that we are much more of a Nurse B most of the time. We can help one another along by not feeding the frenzy of complaints and instead by calmly and steadily working together to pursue true professionalism as nurses, setting great examples for one another to follow.
  8. jeastridge

    Nurses with Attitude

    Thank you for sharing. What a great nurse and example you are! And I love that last sentence, "Inspiration goes a lot further than denigration." Amen to that. Joy
  9. "As you can see, the first two steps in resolving practice issues involve identifying the practice issue, then fully exploring the issue and the anticipated outcomes on the quality of patient care and delivery of high-quality nursing practice." Thanks for this discussion. It is well stated.
  10. jeastridge

    Nurses with Attitude

    Thank you for sharing. Well said.
  11. jeastridge

    Nurses with Attitude

    I appreciate your response. Nursing is a tough job, for sure. Thank you for working hard to be a great nurse!
  12. jeastridge

    Nurses with Attitude

    Haha. Yep, rarely does anyone fit either description all the time. But we can inspire one another to do better, right?
  13. jeastridge

    Nurses with Attitude

    I agree. It was embarrassing to hear.
  14. jeastridge

    Gonna Quit: When Nursing Is Rough...

    My friend texted me a short note that spoke volumes, “Gonna quit. Just can’t handle this anymore. Work here is too hard. Help!” I read her note with sadness and tried to respond with a word of encouragement that might last longer than the appearance of the emoticon on her screen. Getting discouraged in our work as nurses happens to all of us from time to time. Studies show that nurses change jobs more than other professionals. In fact, the latest trends show nurses leaving the profession in greater numbers often for other lines of work but sometimes to pursue advanced degrees that will move them beyond the bedside and into higher paying positions. This trend, evolving over the past decade, has led to a large number of nurses with advanced degrees and many fewer who see their calling as staying the course in the arena of bedside nursing. Recently, a friend went to the local ER where she was to be admitted for an appendectomy. The ER was full and there were physical beds upstairs, but the lack of staffing by nurses kept patients on gurneys in the overcrowded spaces downstairs. This problem did not develop overnight but administrators scratched their heads, perplexed as to why they couldn’t attract and retain enough nurses to keep their hospital fully functional. “The RN Work Project reports an average of 33.5% of new RNs leave the bedside within the first two years” (https://minoritynurse.com/why-good-nurses-leave-the-profession/). Staffing levels in emergency departments and intensive care units in some places are better, with less critical shortages. Some have theorized that this is because those areas are seen as stepping stones to leaving the profession to pursue higher education. In other words, nurses apply for ED and ICU jobs more often, stay with them longer, in hopes of going to nurse anesthetist school or getting a nurse practitioner degree. At one hospital, administration is considering requiring nurses to work medical/surgical floors prior to having an ICU or ED job. While this may take care of the problem in the short term, what are some longer-term concerns we need to discuss? While the problem is widely acknowledged, and the proposed solutions are myriad, it seems that at times the remedies are knee-jerk reactions, running around with band-aids to address gaping wounds. While stop gap measures may be required in the short term, is it possible that a longer term vision might serve us all better? What can we do, as nurses, to help influence the conversation? Do we have a place at the table? Are we invited to give our input? What would you tell administration if you could sit down and have an honest conversation? A living wage is important While money is not the main motivator for most nurses, we all have to pay rent/mortgages and car payments. Having a living wage helps to take that off the table. Most nurses don’t go into the profession with the hopes of becoming fabulously wealthy, but all would like to be able to live decently and retire with dignity. Patient ratios matter Administration can ask nurses to do extraordinary duty from time to time but not on a routine basis. Taking care of more patients than you are physically able to is not only dangerous but demoralizing. It sends the message that “what you are doing isn’t all that critical.” By slowly eroding professional pride excessive demands on nurses in the forms of unreasonable staff/patient ratios takes the wind out of the sails of good nurses who thrive on doing a good job, not on cutting corners and making do with less than the best. [There have been a number of articles on this website related to this important issue.] Keep bureaucracy at bay Fears, especially fears of litigation, can lead administrators down the dark and dangerous road of micromanaging and over-control. It is a given that mistakes are bad, perfection is good but the road to excellence is not covered in more forms—it is instead, oddly and perversely opposite to trends, in the freedom to pursue excellence as individual professionals. The fear of mistakes and lawsuits keeps us at times in the straight jackets of compliance, endlessly clicking our computers while the patient suffers the consequences of our inattention, at times resulting in units where nurses spend their time congregated around computer screens and less often doing hands on care. Mentoring matters New nurses need connection, encouragement, supervision, training. When professionals long to flee their field after a few short months, something is very wrong. Part of the answer lies in what we expect from our new grads. Longer term preceptorships, lower expectations of independent function can work together to promote safety, collegiality and well-supported co-workers who want to stay and find reward in their work. While long term preceptorships cost money, they are an investment in the long term health of our institutions. A nurse who feels the brightness of a the future in his or her job will stay with it and be an asset to the profession as a whole. It’s complicated… It is important for all of us to work together to find solutions that fit our situations. With increasing pressures from within and without, hospital administrators daily find themselves in lose-lose situations, working furiously to simply put in place the “less bad” alternative. The answers to our current problems are many are far-reaching, extending from voting to informing our legislators, to speaking with kindness and courtesy to listening carefully. As H. L. Mencken said, “For every complex problem there is an answer that is clear, simple, and wrong.” For my friend who found herself upset and angry, a word of encouragement was just what she needed to get through the day and face a new tomorrow. When the going gets rough, we can all be that voice of hope for our co-workers in need. Joy Eastridge, BSN, RN
  15. jeastridge

    Gonna Quit: When Nursing Is Rough...

    I'm sorry you have had a tough time. You might try your local community college placement office (they often provide services free of charge to the whole community not just their students) and maybe brush up on interview techniques and making a better resume. I hope others will have suggestions for you too. Wishing you the best. Stick with it. Sometimes finding a job can be a full time job in and of itself!
  16. jeastridge

    Gonna Quit: When Nursing Is Rough...

    Well said and good points. Thank you for sharing.
  17. Download allnurses Magazine Nursing As a Profession: Changes Through the Years Reflections from Rosalee Sites, RN, BSN, MA Memories of Early Days Cleaning our own bedpans in the soiled utility room...steaming needles and syringes after checking the needles for burrs...no IV meds...1 nurse and 3 aids on a 52-bed unit...no critical care units...no recovery room after daytime hours...smoking on the wards...doctors smoking!... Growing up in Elkins, West Virginia in the 1940s, Sites remembers wanting to be a doctor. Interested in all things medical, she knew from an early age that medicine was her destiny; but because of financial considerations in her family and some of the limitations of the time, she instead applied for, and received, a nursing scholarship to the Davis Memorial Hospital Program. After 3 years of rigorous studies in the classroom and on the job training which involved staffing the floor, she was awarded the coveted black stripe on her nursing cap along with her pin and headed to work in 1965. Graduating from a degree program during that time, meant that she had to work hard, repeating a good deal of her initial training, to finally get her BSN 8 years later from East Tennessee State University. "Nursing has been a wonderful profession for me, and I would do it all over again if I could." Working the night shifts on the wards meant that she was responsible for as many as 52 patients a night. She remembers making her rounds early in the shift and taking special note of those that might need something right away. One particular night stands out in her mind because it highlighted the importance of her role as a nurse and how the patient perceived her as being someone they could count on. While rounding, she came into one lady's room and the patient said, "You are here. I've been waiting for you." She asked, "Is something wrong?" The woman went on to say that in the daytime she had family around and there were lots of employees working but at night "It is you and me. That is the reason I wanted to meet you." Her statement stamped itself in Sites' mind, helping her clearly understand how important she was to her patients-they trusted her and counted on her honesty and care; she felt a sense of responsibility for their successful treatment and recovery and her role in it. "Nursing assessment skills are the most important tools we have even now. But back in the early days, they were some of the only tools we could employ: skin color, temperature, respiratory rate, nail bed color, clamminess, pupillary response-all of this nursing observation had to take the place of non-existent monitors." Sites says she can remember rolling a patient's bed into the nursing station with her, so that she could watch them while she charted. "There was just so much less that we could do for people during those times. Medications were limited as were tests. We had to do the best with could with limited resources." "Me, God, and the Telephone" Early on, Sites recognized her special skills in administration and after a few years of general nursing began to specialize in administration as house supervisor with coverage of the emergency room, a small 4 bed unit at the time. As house super she had to do bed placement, deliver antibiotics to the floors on her rounds, and cover the ER. "It was me, God, and the telephone," she remembers. Making necessary calls to physicians at home and running the ER which would be considered primitive by our standards today, was all in a days work. "As a nurse, I have been privileged to share very special moments in patients' and families' lives: being with them as their loved one takes their last breath, bringing a smile to a critically ill child, listening to an elderly lady talk about her family, helping a family member get their father who had dementia on his knees as was his nightly custom for prayer..." After getting her Master's in Organizational Management, Sites continued to make important pioneering differences at Holston Valley Hospital in Kingsport, Tennessee where she continues to practice today. She started the first state-of-the-art Emergency Department, beginning with 23 beds. To really understand what was needed and what was available in terms of design and functional capability, she and a team of other employees visited EDs around the country to borrow the best ideas from the all, eventually making the ED at HVH one of the premiers in East Tennessee. She also headed up a group needed to obtain a Trauma Level 1 designation and worked hard to make that hallmark of advanced technology and ultimate care in trauma part of her local hospital. "The Changes Kept Coming" As the years rolled by, intravenous antibiotics became commonplace; roller clamps and marked bottles morphed into bags of fluid which gave way to machines that counted the drops and delivered the necessary medications in the right quantities to patients. Scans, CTs, MRIs, EKGs, ultrasounds, robotic surgery, all become part of the daily routine for a changing profession. "Even though the changes kept coming, I always realized that the role of the nurse remained central in all of the care we provided. Our patients continued to count on us." Sites went on to clarify, "Your patients will remember you giving them medication for pain, for starting their IV, for inserting their NG tube but more importantly, they will remember you for listening to them; we used to have a physician on staff who said, 'If you listen to your patients they will tell you what is wrong with them.'" The advent of CPR and Life Support provided new ways to intervene at the end of life. "The first person I did CPR on was my own dad in 1965. Because he didn't survive, I worried that I had done something wrong, but later I realized that he had a long cardiac history and there was nothing that I could have done." With CPR came ventilation, ICU care and increasingly interventional medical care. "Continued Education is Critical" A lifelong learner, Sites revels in tackling new topics and continues to be a focused student. As a nursing leader at her institution, she took to heart the major importance of encouraging her staff and others to continue learning. She pushed LPNs to get their RNs, made ACLS mandatory for ED nurses (to loud outcries of protest!), prodded along the process of obtaining certifications in ED nursing. Along with all of this, she was visionary in understanding the critical importance of working with and training the EMS staff so that the pre-hospital care maximized the patient's chance of survival. "As professionals, we owe it to our patients to learn all we can and to push ourselves to reach out for more." She objects to ever hearing the phrase, "I'm just a nurse," and emphasizes the unique and special role that we enjoy as nurses who often are the ones seeing the bigger picture, the ones who are able to bring different disciplines together, the ones who translate what is in the EMR to both the physicians and the family. Our role has always been important but never more than now. Nurses as Leaders "Being a nurse has responsibilities and requires leadership." Throughout her career, Sites has taken seriously the role of mentor to other nurses, and finds it deeply disturbing to hear nurses complain about the profession she loves. "Maybe you have not thought o yourself as a leader but that is exactly what you are. You are a professional nurse and you will be a leader in whatever area you may find yourself." As her career progressed, Sites sought out ways to not only improve conditions within her hospital but also in her area. Helping to start a local medical clinic for the working uninsured and serving on a number of boards and committees, Rosalee continues to see part of her role in nursing as someone who takes on community issues as well. She has been known to quote Sir Winston Churchill, "We make a living by what we get, but we make a life by what we give." Evolving Uniforms and Lack of Uniformity In the early days of nursing, compliance with uniform standards was strict and adhered to stringently. Sites remembers, "We polished our shoes, ironed pleats in our aprons and looked forward to the day when we could earn the right to wear the black stripe on our caps." She laughs to think that they were also required to wear girdles so that there would not be any distracting "jiggles!" Sites states, "What we wear can help inspire confidence in our patients, because if we dress well for our role, it can help us and it can help them. Appearances do matter." Nurses in most areas were not allowed to wear pantsuit uniforms until the mid-'70s. Scrubs came out in the mid-'80s and a general loosening of uniform standards continued until recent times when many hospitals have adopted new, more consistent uniforms, including the requirements that all RNs (and other professionals) wear a certain color scrubs so that patients and families can have an easier time distinguishing between providers. Career Changes and New Challenges Most nurses would readily agree that being able to change positions within the nursing profession is one of the great benefits of our training. Sites is no exception. After spending many years in the ED, Sites wrote a grant to the Robert Wood Johnson Foundation and was approved to start a Parish Nurse (also known as Faith Community Nurse) Program in her community. Now, 20+ years later, she continues on as the director of the program, faithfully administering the growth from a start of a handful of nurses and churches to two different programs with almost 50 nurses total. "Our hospital system wanted to find a way to engage with older adults and I saw Parish Nursing as a great way to do this." After receiving the grant and getting the program started, Sites pursued innovations, continuing education for the group, and diligently encouraged all the FCNs under her leadership to meet and exceed expectations. "One of the primary roles of Parish Nurses is advocacy. They need to be informed, knowledgeable and caring. Sometimes, the nurse if the only person who really cares; is there anything more important than that?" she asks. Looking Ahead "We have come from a time when we could do very little for our patients to a technology-heavy environment that threatens to distance us from those we care for." Sites goes on to say that the very technology that improves patient care can also cause us to lose perspective in our personal lives, over-focus us on screen time and diminish the necessary personal interaction. "You must work on being healthy in mind, body and spirit, modeling a healthy lifestyle for others, refueling and renewing your strength so that you can continue to give." When asked about the future of nursing and the ways that we may need to improve, Sites goes back to the basics: education. There she sees systems that are producing new nurses with good textbook knowledge but less practical training; nurses who are equipped to pass the NCLEX but who are less equipped to do basic bedside procedures. "What happens, when we have graduate nurses that are not fully prepared is that they end up leaving the profession. They feel dissatisfied with their jobs and they change jobs, experiencing less support from their peers. "As mentors and nursing educators, we must pursue avenues to do a better job with training so that when nurses hit the floor they are at least able to have some level of proficiency so that they are assets and feel reasonably comfortable in their roles." Parting Words of Wisdom Through a long career in nursing, Sites has seen a lot: evolving from when we could do very little to extend or improve life to an almost hyper-interventional care time, she sees the need for balance, gratitude and grace. She continues to see nursing as one of the most relevant professions in existence, but one that cries out for its nurses to get back to their roots of truly caring for one another, both our patients and our fellow employees.
  18. jeastridge

    Gonna Quit: When Nursing Is Rough...

    Other jobs...Let's see. School nurses, office, insurance, educators, case managers, utilization review...all nursing jobs involve patients, of course, but not all positions are like the ones in the hospital. Finding the perfect fit often takes a while and a dose of perseverance....Maybe other nurses can contribute here on other ideas. All the best!
  19. jeastridge

    Gonna Quit: When Nursing Is Rough...

    You list some serious problems and these that you listed often go unmentioned because they are more subtle--but the pressure is there. Maybe some other nurses can chime in on their strategies for maintaining healthy boundaries in a demanding profession? For me, part of it is simply acknowledging that they have a problem but I can't always be the answer...but it is hard. For sure. Joy
  20. jeastridge

    Gonna Quit: When Nursing Is Rough...

    I hear you. It is hard. In the right place it can be very rewarding but that is not the case with every nursing job. I hope that you find something that is just the right fit for you. Joy
  21. jeastridge

    Gonna Quit: When Nursing Is Rough...

    Dear friend, I was so sorry to hear about your bad experiences, especially the reports of bullying. I hope that you go on to find something that is satisfying and rewarding and can put all these negative experiences in the past. All the best! Joy
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