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  1. I just read an interview on NPR with Lydia Denworth, author of a book on friendship. Denworth says I should work as hard at friendship as I do at working out or eating right. Why? Because research shows that having close friendships plays an important role in my health. I’ve been thinking a lot lately about friendship because my daughter, who is about to be 12, doesn’t seem to have any friends. She comes home almost every day with a sob story about how she sits alone at lunch, how no one wants her in their group, how this person or that person has betrayed her, doesn’t like her, makes fun of her. I worry about my girl so much. She is adopted, she has a history of significant trauma, and she was exposed to oxycontin (and who knows what else) in the womb. I’ll be brutally honest here as well, she is shaped like an adorable little beach ball, and she likes her hair short. She gets called “fat” and she is frequently mistaken for a boy. Top all of that off with her brain, which is round where mine is square and loopy where mine is linear. Her thought processes confound and amaze me, so I am 100% sure she confuses the 11 year-old-girls she is trying to communicate with. I’ve told her, “One of these days, someone is going to come along who gets you, who loves you for who you are. That person is going to be so special. You may have to wait, but you will find her.” But until that day comes…what do I do? She’s part of a small group of kids with similar issues who are now meeting once a week to learn how to make friends. I give her tips on how to handle bullies: yawn, stretch, walk away, laugh, say something kind. I’ve told her, “When those girls are mean to you, just say ‘thank you for making me stronger.’” Or how about the old tried and true, “I’m rubber and you’re glue, whatever you say bounces off me and sticks to you.” And I also try to coach her on friendship skills: listen, ask questions, don’t boast, be yourself, don’t try so hard, but how do you tell an eleven-year-old not to be so…needy? And at the end of the day, after she’s asleep in bed, I cry sometimes, and I worry. I worry because I don’t want her to be lonely, or to fall for the first guy that pays her some attention. My husband doesn’t worry. He believes in her. He tells me, “She’s going to be fine. She’s amazing (we agree on that point). Stop worrying (ha!).” He also pointed out something to me that was right in front of me - something I just couldn’t see. My daughter does have a friend - her sister. My biological daughter is one-and-a-half years younger than my adopted daughter, but they are the bestest of buddies. How could I have missed that? And all you need is ONE. Defining Friendship What is a friend? A person one has an emotional bond with (thank you, dictionary). The definition also says we aren’t in sexual relationships with friends, and they aren’t typically relatives. But are those definitions important? How about defining friendship by how it makes you feel: good, positive, full of warm fuzzies. Friendships are long-lasting and stable. There is cooperation and reciprocity between friends. I think that can happen with your spouse, your sister or any other relative. According to the NPR article, “What matters is the quality of the bond, not its origin.” Friendship and Gender Sally: So you're saying that a man can be friends with a woman he finds unattractive? Harry: No, you pretty much want to nail 'em too. Sally: What if they don't want to have sex with you? Harry: Doesn't matter because the sex thing is already out there so the friendship is ultimately doomed and that is the end of the story. Sally: Well, I guess we're not going to be friends then. Harry: Guess not. Sally: That's too bad. You were the only person that I knew in New York. Remember When Harry Met Sally? Whether you agree or disagree, there’s no arguing that men and women tend to handle friendship differently. According to Denworth, women do friendship face-to-face; we talk out our problems. Men do relationships side-by-side. They do things together. Again, I’m not sure that really matters. What does matter is that men and women value friendship in the same way. There are more similarities than differences. It’s not just men and women making the odd friendship pair. I’m sure you’ve seen the videos of horses and cats making friends. There’s even one of a tiger with a pig: Apparently horses, zebras, hyenas, vampire bats, birds and even fish can form social relationships. Humans, however, we do it in a much more complex way. Two Peas in a Pod? The average number of very close relationships is four. In the NPR article, Denworth says that few people can sustain more than six very close relationships. People tend to choose friends who are much like themselves. We choose those of similar age, race, religion, socioeconomic status, educational level and political stance. Researchers at Princeton used fMRI to track the blood flow in the brains of subjects who watched a wide variety of videos. They found revealing patterns in the nucleus accumbens (in the lower forebrain) and in the superior parietal lobule. In other words, the brains of close friends respond in similar ways, with the same ebb and flow of attention, distraction and boredom. In fact, researchers were able to predict the strength of two people’s bond based on their brain scan. Just like with a love interest, friendship is about good Chemistry. Friends with (Health) Benefits Social relationships can improve the cardiovascular and immune systems, how well you sleep and even your mental health. Research has even shown that people with strong social ties have lower concentrations of fibrinogen, a protein associated with chronic inflammation. Inflammation has been linked to cardiovascular disease, osteoporosis, arthritis, type 2 diabetes, some forms of cancer, Alzheimer's disease, and even periodontal disease. A 2010 meta-analysis of 148 different research studies found that “people with stronger social relationships had a 50 percent increased likelihood of survival than those with weaker social relationships.” There is evidence that a lack of friends is poisonous to your health. Studies have correlated a weak social network with depression, cognitive decline, poor wound healing, and delayed cancer recovery. Loneliness takes a physical and emotional toll similar to risk factors like obesity, high blood pressure, unemployment, lack of exercise and smoking cigarettes. I should know, I was friendless for over 15 years. It. Was. Horrible. I felt like I was on the outside looking in. I would watch Friends and cry instead of laugh. I tried. I got out there, but I couldn’t crack the code. And then one day, I met my best friend. My boyfriend introduced me to the wife of a local shop owner, and we’ve been like salt and pepper ever since. Should We Be Friends with Coworkers? I’ve been invited to social events outside of work many times, and I always decline, though studies show that having friends at work can increase job satisfaction, performance and productivity according to CNN business. I like to be friendly with coworkers, but I need those boundaries in place. I also don’t make friends with my neighbors – same issues, right? If it doesn’t work out, are you going to move? Change jobs? Being friends with coworkers can be problematic if you are in competition for the same position, bonus or raise. You have to be careful who to trust as well. If you share personal details and then they “get out” it can damage not only your feelings, but also your career prospects. What about being friends with a coworker who is not a top performer? That could reflect negatively on you. Or what about work friends who are negative and take venting to a chronic level. The Best Way to Have a Good Friend is to Be One… There’s lots of advice out there for how to make friends. I found these seven guidelines for creating friendship: Take a genuine interest in others Listen closely Empathize Remember Initiate contact Reveal yourself Respect limits Get Out There and Make It Happen So maybe let’s stop taking friendship for granted. Let’s find safety in numbers. When you say, “Let’s get together sometime.” Pull out your calendar and make a date. Instead of feeling guilty when a friend asks you to do something, stop thinking about how your family needs you and remind yourself that you’re doing it for your health. Prioritizing friendship is incredibly important. It can prevent you from getting sick and help you live longer. As you walk out the door on your way to a girl’s night out, waving to your kids as they fuss at the babysitter, tell yourself that you’re doing it for them. What do you think? Do you have lots of friends or one really good one? Do you think men and women can be friends? How about coworkers? What makes a good friend? I’d love to hear your thoughts and stories – please share!
  2. Co-worker conflict can be uncomfortable, casting a dark cloud over the workday. Anyone can have a bad day and it is often played out with irritability, raw emotions and thin patience. But, if a co-worker conflict is affecting your work or causing discontent, it is time to take positive action. Your first reaction may be to avoid the issue or escalate it up to your boss. But, with these 6 tips, you can begin to address the situation yourself. Approaching a co-work may feel awkward at first, but your confidence will build with practice and experience. Tip One: Take time to cool down and reflect. Engaging in conflict resolution with a co-worker when you are angry is the easiest way to shut down open communication. Anger takes away our ability to think and problem solve rationally. Walk away from the situation and take the time needed to cool off and reflect. Tip Two: Think about the problem. The old saying “there are two sides to every story” is true when you begin to reflect on both your own and your co-workers perspective of the problem. To explore your perspective, ask yourself: What is the conflict really about? What is it about the issue that has me upset and angry? Do I have underlying concerns, wants or needs that are not being met? What is needed to improve on my circumstances? To explore the other person's perspective, ask yourself: How might they see the situation? How might they view my actions? What needs might she/he have? What is important to the other person? Keep in mind that assumptions, misperceptions and unmet expectations is at the core of most conflict. Tip Three: Plan out the conversation. One strategy for not allowing your emotions to drive the interaction is to plan out the conversation. Start by removing the relationship you have with your co-worker from the equation and focus on the facts to better deliver the message. Practice describing the problem in a non-blaming and non-personalized way. Be sure to address the problem as mutual (our problem) and use “I” statements to communicate your perspective. Tip Four: Don’t gossip or vent to others. It is tempting to talk to other co-workers and seek validation that you are in the “right”. However, the person you are in conflict with may hear you are talking “behind their back” and escalate the situation. It is best to keep the matter confidential. Tip Four: Choose an appropriate time. Find a time (sooner than later) that is convenient to both you and your co-worker. Also, it is important to have the discussion in a private place with little to no interruptions. Tip Five: Communicate effectively. When you approach your co-worker, make your intentions clear, assuring them you want a good working relationship. Your colleague may initially become defensive and possibly assume you want to continue the disagreement. It helps to describe the problem without blaming, put downs and over-generalizations. Here are a few other tips for effective communication: If you feel you may have had a role in creating the conflict or regret how you handled the situation, sincerely apologize upfront. Ask the person to tell you how they see the situation before you share your grievances. This will help lower their defensiveness. Be ready to listen attentively to the other person’s concerns. You may not realize how you are contributing to the problem or how your behavior is being perceived. Having a face-to-face discussion with effective communication supports conflict resolution in the following ways: Gives the other person a chance to explain themselves Gives the other person a chance to apologize (when appropriate) Gives both of you an opportunity to understand how each views the working relationship Allows negotiation of ways to better work together Tip Six: Work toward a solution together Avoid focusing on who is right and who is wrong. Instead, work with the other person to identify possible solutions that work best, meeting the needs and wants of you both. This may take more than one meeting, so keep working at it. It is worth the effort in the long run. Tip Seven: Ask for help when needed. Sometimes co-workers are unable to resolve workplace conflict between themselves and the working relationship takes a toll on productivity. In this case, you will need to identify the proper channel, such as the supervisor, to further discuss the problem and move forward. Conclusion Working together to solve conflicts within the workplace could lead to a closer and more effective working relationship. Down the road, when you or your co-worker have a bad day, you will find yourselves committed to a better way of handling any conflict situations that arise. Let us hear from you! What do’s or don’ts do you have to share with readers? Want to learn more? Check out these additional resources Seven Steps for Mending Relationships With Colleagues How to Handle Conflict in the Workplace
  3. Nurses eat their young. It happens and people complain about it like it is a bad thing. It may be in your eyes if you are the one being eaten, but in my eyes I am going to eat you alive and spit out your bones into something that resembles a nurse. You are entering the cauldron of fire, so expect to get singed. That above statement is already setting some of you on edge. I understand that and I accept that. I felt the same way at first, but as the years have passed by I have learned why we do it and more importantly, the reason. Let me explain to you why in a way that is not nursing. Imagine if you are a soldier ... Lets take it from there Patient = fire team Pilot = Nurse Practitioner Officers = management Your squad mates = your fellow nurses with more experience Enemy = death MD = (sometimes the enemy) a fellow service member form another branch You enlisted in the service, you passed basic training (nursing school) and now you are ready to join your unit. ( I know I skipped AIT, for those military among us) You show up on the bus all excited and happy to be chosen for this special unit. It is everything you wanted, it is just where you wanted to be. Great, happy to have you aboard, now get out the salt and pepper, or maybe the opposite is true. You do not want to be here, but rather this is the only place you could get to right now. Fine, get out the salt and pepper Be prepared to be eaten. I am your new squad Sargent. I am there to help you get acclimated to the unit and the patrols as FAST AS I CAN. You show up in your new shiny uniforms, new boots and the new weapons (ie: stethoscope, tablet, etc) and look around you and see the older squad mates' uniforms are faded, they may even be a bit tattered, our combat boots may not be shiny, heck they may even be a bit soiled. But you know what, to us your uniform looks uncomfortable on you and those ugly boots we are wearing, they are like a second skin to us and those new ones you got are going to blister your feet. We accept that and realize that with age your boots are going to get broken in and your uniform will fade. Just don't point out to us how yours is better or newer. New does not always mean better, sometimes our weapons that you think are old and stupid are the ones that never fail in combat. You start out like that and I will eat you so hard right there that you will wish you were never born. Your old Drill instructors (nursing instructors) have nothing on me in making you feel small if I choose to. I introduce you to your squad mates and I show you around I know you are new and do not know where everything is, but LISTEN to me when I am talking to you and pointing things out. I know it is a lot of information to digest, but it may save your life and your fire mission's life if you listen. I expect you to ask me questions, but think about the question first. Did I already answer it? Did I not just show you where the supply tent was? Did I not point out where to keep your gear? Did I not show you how to reload your gun or program in the fire coordinates on the fire control computer? I probably did and if you keep asking I am going to start to wonder about you and think maybe you are going to get me killed or the fire team killed. Time for your first patrol The officers come by and gives us our mission. We need to work as a team to complete it, there are no Rambos in our unit. Accept the mission, I will be there to help guide you and keep you alive, for now. I do not want the fire mission to fail at all costs. When I feel you are strong enough to do more of the mission on your own, I am going to let you, whether you think you are not. So now we go into the field for combat against the enemy. I know you learned all these supposedly fancy new ways of combating them, but the enemy doesn't always react the way you were taught it would. Things are different in the field, than in the classroom. Don't tell me how to do something unless I am asking you how it is done the new way. Listen to me how to set up an ambush. I have been fighting these battles many years and I am still alive. Don't look above at the pilots flying around doing their thing while we are in the trenches and say you would rather be there. It takes time to learn to fly, and I skin you and filet you alive if you think you are better than the rest of your squad mates. If you express an interest in learning to fly, I will be happy to help you get to the point you can learn to fly. I want all my squad mates to succeed, because the fire mission will then succeed. I am going to jump on you during the training I give you, I am going to eat you up, I am going to speak bad of you, I am going to report on you to the officers. I will make your life miserable for a while. I may not let you take lunch with your buddies from basic who are now in an another unit in your command. They may have their own mission to conduct, or our mission is going badly. Sometimes I may make you work extra hard helping another soldier out, who is up to their butt in crocodiles. I am also going to praise you when you need it, but don't count on it very often. I am going to ride your butt so hard, you are going to wonder why you even enlisted. You are going to think I am unfair, that I am trying to get you killed, that I am giving you too big of missions at times, but know this. AT ALL COSTS THE FIRE TEAM MUST DO THEIR BEST! Sometimes we don't win all the battles and death does come for the mission. we accept that and expect you to accept it and pick yourself up and carry on soldier. The time to grieve is later in private when it fails, but know this; we old eat their young and are also grieving about the loss, but realize there are other missions we are needed on at that moment. My Goal My goal in eating you up is to toughen you up so that you may lead other soldiers in combat and save the fire missions, maybe even help you get to be a pilot or an officer, which not all of us want. Some of us were previous officers but decided we liked the trenches with the blood and guts and muck better. My goal is to see you succeed and carry on our legacy and eventually replace me when I fall. Which one day I will fall and become a distant memory. Until that moment I am going to eat you up and spit out your bones into proud strong self reliant Nurse. That is why eating our young is not a bad thing. Related topics... Why Do Nurses Eat Their Young? Nurses Eating Their Young Is Not Okay Watch WHY Nurses Eat Their Young?! My Story video...
  4. Not only is it the day hospitals discharge frail elderly patients to the nursing homes en masse, but it seems that they do it in such a way as to maximize the inconvenience for both the new resident and the LTC staff. I mean, it can't be just a coincidence that a) new admissions arrive around 1600, when we have only half the staff that was available at noon and are getting folks ready for the dinner meal; b) they never come with a full set of orders, so the nurse has to try to pin down a physician who's already fled the office for the weekend; and c) no administrative staff are in-house to help with admissions because THEY'VE gone home for the weekend as well. Last Friday was probably one of the five worst I've ever worked. It's common for the skilled wing to get admissions on a Friday, but my luck being what it is, I was working the LTC sections and both scheduled admissions were on my side of the building. Okay, fine, so it would be a long night, but I'm so grateful to be working at all these days that I told the DNS "oh, what the heck, I'll deal with it". That was, of course, when everything hit the fan. First, one of my dialysis patients came home with a BP of 60/38. Then the first admit came in---a thirty-six-year-old kid in a persistent vegetative state with G-tube, catheter, trach, the whole works---and it took four of us just to get his 300 pounds into the bed. His tube-feeding set didn't work with our equipment, so I had to hunt down some different pumps and tubing sets and experiment with them to figure out which went with which. The phone rang; it was our house pharmacy with a question about a resident who'd just gotten an order for Percocet and had a supposed allergy to oxycodone. So I had to stop what I was doing and go ask the resident, who emphatically denied ever being allergic to the drug and told me to make sure her primary care doc took it off her medical record. The pharmacy would not send the Percocet without confirmation from the doctor, however, and since he was (of course) out of town till Monday, she was basically SOL. I told the resident not to worry, that's what we had an E-kit for, and tried calling the surgeon who ordered it in the first place; he too was gone (what do MDs do---gather together in one big happy group on the golf course on Friday afternoon and get so whammered that they can't be held responsible for anything that happens between then and 0800 Monday morning?!). I had my hand on the phone, getting ready to call the pharmacy back, when they called me again. Same med, same patient, different caller. I told the woman on the other end what I'd found out, and hung up. Second admission came in, a walkie-talkie on a 5-day hospice respite. These short-stay residents require just as much paperwork as the permanent ones, and worse, I had to write out all seven of his med sheets by hand because Medical Records had, like everyone else on the planet, gotten the heck out of Dodge while the gettin' was good. Note that I still didn't have the first guy's tube feeding stuff together yet, and as it was almost dinnertime, there were a dozen fingersticks and insulins to be done. The phone rang and I ignored it, only to hear myself being paged overhead yet again: "Marla, XYZ Pharmacy on line 1. Marla, line 1". I picked up---"Hi, this is Hmglmph from XYZ Pharmacy (anyone else ever notice that most of these folks mumble their names?). I need to ask you about Mrs. Ouchmore's new order for Percocet....." "I still haven't heard from the doctor," I told Hmglmph, "and I can't get hold of her surgeon either. The patient is alert and oriented, she's a retired nurse and knows what she is and isn't allergic to." "Well, we can't send the Percocet until we know for sure from the doctor that she's not allergic to it," Hmglmph said, a hint of triumph in her voice. It was on the tip of my tongue to say that I KNEW that, but trying to locate an MD on a Friday night is about as easy as finding a goldfish in the ocean. I said, "Do what you have to.....I'll just use what's in the E-kit." I'd no sooner gotten off the phone with Hmglmph than a fourth call came from XYZ Pharmacy. This one identified herself as "Foozitz", and yep, you guessed it: she wanted to know if I knew that Mrs. Ouchmore's profile listed an allergy to oxycodone. Just then, a crash came from the general direction of the assisted dining room and I let go of the phone and ran to see what (or who) was on the floor. Luckily, it was only a dinner tray and not a resident, so I went back to the phone---by now, I was running half an hour behind with my insulins---to finish my conversation with Foozitz. I managed to get halfway back to my other wing before the phone rang yet again. "If that's XYZ, I'm going to scream," I said through gritted teeth to the aide who was dashing back and forth, trying to answer calls on a hall that was suddenly lit up like a Christmas tree. Sure enough, it was the FIFTH call from XYZ, from yet a fifth person, asking the same question about the same drug and the same patient. That's when I lost my famous cool and screamed. Well, I didn't really scream, but I did make a rather loud "GRRRRRRRRRRRR!!!" sound, and snatched the phone from its cradle. "Do you people ever talk to each other?!" I seethed. "This is the fifth time I've talked to somebody from XYZ about the same medication and the same patient. Don't you ever communicate?" "Excuse me?" said some young-sounding girl (I think her name was something like 'Zoojaflobbets'). "You heard me. You people have called five times in the past twenty minutes about Mrs. Ouchmore and the Percocet order I faxed you this afternoon. I don't have time to deal with all these calls." Zoojaflobbets seemed a trifle offended. "Well, sometimes we have someone from billing call about meds, sometimes it's someone from processing---we have different departments." I couldn't believe it. "BILLING?" I yelped. "Are you serious??!" I was outraged that one or more of those calls had been made by someone who dealt only with the money end of things. "I don't give a rip about who pays for what," I went on. "I'm a nurse, I'm responsible for 40+ people, I've got admits coming in the door and a resident whose BP is in the toilet, I've got a zillion blood sugars to check, and you people keep calling and interrupting me every 3 1/2 minutes to ask me the same thing over and over. I don't have time to play around on the phone just because you all can't pull your crap together enough to fill a simple order." I hung up a little more forcefully than usual, feeling only the slightest twinge of regret for dumping on someone because I was having a bad day. I usually go out of my way to be courteous, even to manic family members and people who try my patience like XYZ Pharmacy was doing that night. But five calls about a single, simple Percocet order?? It's bad enough that they don't group their questions about different patients and get everything straightened out in one shot, but I can understand that. Five calls about one order are four too many, IMHO. Make it SIX calls. I'd been off the phone for a grand total of 90 seconds or so when the overhead pager announced another call for me from XYZ. This time it was the pharmacy supervisor---Zoojaflobbets had apparently run to her and complained about our little chat---and it was clear from Jwanda's tone that she believed she was dealing with a stupid country nurse who needed some "ed-ja-ma-ca-tion" on order clarifications. Well, I may be country, but I'm not stupid, nor am I particularly fond of Portlanders who talk down to us bumpkins because they can. I listened politely for about fifteen seconds, voiced my agreement with the need to clarify orders........and then launched into a description of my day and the reasons why Jwanda's staff needed to figure out who was working on what before they called a facility. I also pointed out that pharmacists, like nurses, hold state licensure and are thus qualified to call a physician themselves if they have a question about an order; that's what our local pharmacists do, and I've worked with other LTC pharmacies that will do this as well. Not XYZ, I found out. "Oh, we don't have the time for that," she replied. It was tempting to ask her why they had the time to call a facility half-a-dozen times in less than 30 minutes, or just what she thought I was doing (eating bonbons? filing my nails?). But after I ever-so-gently dropped the phone---from a height of oh, about three feet---the calls stopped, and while the issue never got resolved that evening, the resident did receive her Percocet from our house narcotics supply, and had no adverse reactions whatsoever. The next afternoon, I had to call the pharmacy for a new E-box---we'd used up all the Percocet---but the pharmacist I spoke to this time obviously had more than a few brain cells to rub together (plus some compassion for both Mrs. Ouchmore and the hardworking nurse taking care of her). Actually, "Lindy's" attitude was downright refreshing: "The patient's doing OK on the Percocet?" she asked me. "She's taken it four times now and there've been no reactions? That's good....I'll fill the order and you'll have it by tonight." Ding-ding-ding, we have a winner!! Needless to say, I thanked Lindy profusely.......and I'm happy to report that her word was as good as her enunciation: before the noc shift came on, I had a full card of Percocet for Mrs. Ouchmore AND a refueled narc box locked in the med room. Sometimes, as a nurse, you find yourself feeling absurdly grateful for the darnedest things. Like finding all the equipment you need in one place. Solving a sticky patient problem even the doctors and specialists couldn't puzzle out. Seeing people actually do what they say they're going to do. And NOT having to work this coming Friday night.

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