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Topics About 'Teamwork'.

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  1. Nicole Innvar

    The Most Priceless Gift I’ve Ever Received

    Especially in recent times, everybody around the world has been hailing nurses as “heroes.” However, what happens when a nurse needs a hero of their own? What constitutes a “nurse hero?” What Inspired You to Become a Nurse? I only graduated from nursing school in May 2019, so my memories are still quite vivid. One of my vivid memories is, almost every semester on the first day of classes, my professor had my classmates and I tell the class what inspired us to go into the profession. A lot of times, my peers said they had a family member or friend who was a nurse and they looked up to them, which is what brought them to nursing school. I could not relate, as I did not even know anyone who was a nurse (or, might I add, even in the healthcare field). But, I always thought it was pretty nifty. Knowing someone made it out alive and was successful with a career, someone you could turn to for help if needed...deep down, I kind of wished I had someone like that. I quickly realized I would need to hold my own, and tried to push away the nagging feeling that I was an underdog. I’m sure others who were in a similar position could relate. New Nurse Trials After the trials and tribulations every nurse endures in school, I happily graduated, and passed the NCLEX. By September, I started a job in an ambulatory surgery setting. I had no idea what to expect, as the only experience I ever had consisted of my clinical rotations in hospitals and my part-time job at a doctor’s office. (This was one of those times I wished I had someone to ask questions to). Co-workers to the Rescue Just as I expected, it was completely different! But before I knew it, weeks turned into months. Recently, I thought back to how much I’ve learned and grown, both professionally and personally. I then realized I couldn’t have done it without all the help from my experienced coworkers who are always willing to teach me something. They answer my questions (even if it means interrupting what they are doing), and willingly listen to my rants. I was deployed in a hospital for part of the COVID-19 pandemic, and my coworkers constantly texted and called to check up on me. Which brings me to my title...the most priceless gift I’ve ever received is the time of any nurse who has supported me in any way. I finally have nurses to look up to as role models...just like I had wanted years ago. Being a 22-year-old with no one older and experienced in your profession to talk to is not easy, which is why I’m so thankful for now having these people in my life. They are the nurses that I want to be like when I am older. I also have to thank my best friend, who is about to go to nursing school, for listening to my stories about the nursing world (I sometimes even throw in re-enactments for dramatic effect). They are all my nurse heroes. Teamwork and Resilience A healthcare setting would not be able to function without the core of teamwork and resilience brought by nurse heroes. By building this, it makes the hospital or facility run smoothly. I have even witnessed firsthand how it makes patients feel at ease. Many patients in the recovery area tend to exclaim: “Everybody seems so nice here!” “This seems like a friendly place to work!” “I was so nervous about this surgery, but you guys made me feel so comfortable.” My own personaI favorite was one day in the recovery area, I was discharging a patient. She stood up and quickly took my hands in hers. I got nervous and asked if she was dizzy. Instead of answering my question, she gave me a kiss on the cheek and said that I, along with everybody else who had taken care of her that day, was wonderful. She even said we were all “linda”(Spanish for “beautiful”). I immediately knew working as a team with my nurse heroes is what gave her that warm feeling. I guess one can say I feel a lot differently these days than I did even one year ago. I have more pride, more confidence, and very importantly for me...I know I have a strong support system from my “nurse heroes.” ...I guess I’m not “alone” anymore after all.
  2. Health systems have to be forward thinking and use creative strategies to recruit good nurses. According to an NSI Nursing Solutions’ 2016 National Healthcare and Retention RN Staffing Report, it costs a conservative estimate of $54,400 to replace each nurse or $373,200 for every percentage point change to the turnover rate. About 81.8% of organizations say retention is a top priority, yet only 51.5% have a formal retention plan in place. Health systems often focus on recruitment efforts and fail to look at internal factors contributing to the high rate of nurse turnover. The reality of the healthcare environment results in nursing caring for sicker patients with more to do and less time. The benefit of nurse satisfaction is improved nurse productivity and patient care. Nurses need to be recognized and valued to remain once they have been hired. Nurses leave a job for a variety of reasons such as lack of professional development opportunities, lack of recognition, not enough staff, too many responsibilities, and better pay. Research shows nurses stay in jobs when the nurses feel valued, respected and appreciated. Managers play an important role in creating a culture that promotes building relationships with nurses and makes them feel important and valued. A study conducted by the Annals of Behavioral Medicine measured the heart rate of 100 nurses at Scottish teaching hospital while they were doing nursing tasks in real-time. They found nurses felt less stress if they felt like they were in control of their activities, valued and appreciated. Recognizing the important contribution of nurses does not have to be complex or time-consuming. Consider these easy ways to improve nurse and leadership relationships. Set a tone of cooperation and teamwork. Management sets the tone for employees and the work environment. Nurse managers must make a conscious effort to create a culture of cooperation and teamwork. Nothing brings down the mood of employees like a nurse manager who goes straight to their desk with an attitude of disengagement. Make communication a priority. Good communication and clear expectations are good for nurse morale. Nurses are more confident when they know what is expected of them. Staff wants to be kept “in the loop” on what is happening in the organization. Transparency makes nurses feel like they are trusted and an important part of the team. Meet with staff regularly to share information, provide praise and recognition and to encourage feedback. Praise more than you criticize. Just think about all the information flowing to nurses from their managers. A nurse frequently is informed of chart audits, holes in staffing, documentation issues and much more. There seems to be no shortage of feedback on working harder and areas identified for improvement. Nurse managers should praise more than they criticize. Share with staff when audit findings improve and benchmarks are met. Giving a sincere “thank-you” or “good job” in real time makes a big difference. Solicit their ideas and opinions. Nurse managers are often perceived as being too removed from bedside nursing and not in touch with the day to day challenges nurses face. Unfortunately, the perception of management disengagement is often an accurate read. Ask what about their jobs is working and what areas need to be addressed. Encourage staff to be part of the solutions for daily challenges. Also, follow up and communicate what is being done to address the issues they identify as a source of job dissatisfaction. Recognize the warning signs of low morale. Nurse managers need to be alert for signs of low morale in staff and themselves. Morale can change quickly and it is important to be in touch with day-to-day events. Remember, morale comes from the top down and staff can recognize when a manager’s attitude shifts. Here are a few warning signs: Negative attitude that lowers patients’ quality of care Low productive Resentment towards coworkers Talking about others negatively Lack of attention to details Increased absenteeism or tardiness Withholding important information When employees feel valued, they are more likely to stay with an organization despite challenges and bumps in the road. Nurse managers have an incentive to retain good nurses- improved performance and patients outcomes. Nursing by nature a stressful job, but perhaps with a sincere effort to make staff feel valued nurse managers can significantly improve the work environment. Resources Article- How to Make Employees Feel Valued Article- Stress Levels Higher for Nurses Who Feel Undervalued
  3. I look back at the past year and half plus and I can hardly believe I am here. I sometimes wish I was still back in school under the watchful eye of a clinical instructor or preceptor, with time to fully review charts and have hour long conversations with my patients, to be able to watch and not have to do. But, alas, those times are behind me and I am a nurse with a degree and a license. I have grown, in good ways I believe, and a lot of it can be attributed to the job, I think. I have seen humanity. Not the full extent of it, but a lot of it. I have seen a lot of diversity. I have learned that there is something to be learned from everyone, from all cultures, and from all generations. I have learned that smiles go very far and mutual respect is paramount to a nurse and patient relationship. I have learned to set boundaries. A firm yet gentle hand keeps your patients safe, eating properly, exercising lungs and legs, and complying with medications and treatments. Did I mention respect? Respect goes a long way. I have seen people ruin their lives. What are the biggest culprits? Alcohol, drug abuse, and noncompliance with diabetes treatment plans. The 42 year old whose mental status reminded me of someone with moderate dementia because of alcohol induced encephalopathy; her speech permanently slurred and gait permanently unsteady. The 25 year old non compliant type one diabetic, who kept having runs of ventricular tachycardia and who is already a dialysis patient, yet insisted on KFC for lunch and refused to self administer insulin. He'll be dead by the time he's 40. That was the thought that floated to my mind. I have learned the importance of teamwork. No man is an island. We need one another and this is especially the case in nursing. I am one of those people who had a hard time delegating. I want to do it all myself. I want to know it was done and it was done well. I forced myself to delegate and now I delegate to the techs without batting an eyelash. Be good to your techs and they will be good to you. I'm still protective over my nursing only duties and I still like doing it myself, but I'm learning. Because you just have to. There's no other way to survive. There are simply not enough hours in the day to do all that is expected of us. Sometimes things have to be left for the next shift, and that's ok. For those nurses who work with psychiatric patients and love what they do, all my hats go off to you. Working with psychiatric patients has been one of the most draining aspects of my job. Setting firm boundaries, as mentioned is very important. I've found that being able to manipulate the manipulator works as well. Setting deals works. Making contracts works. Fortunately, I've been able to implement some of the strategies I learned as a student with moderately good results. I can manage a psychiatric patient in an acute care setting. I can keep them safe and the staff free from harm. However, this all comes at a cost of feeling exceptionally mentally and emotionally drained, so that is why my hats are off to my psychiatric nurse colleagues. Nursing has taught me how to laugh at life. My already dark sided humor has become more enhanced and embellished. There is too much sadness out there in the world and a lot of it comes with people to the hospital. Humor is a coping mechanism that has become a trademark for nursing. As a nurse, you must depersonalize suffering, while having compassion or at least feigning it. Being a nurse gives you a unique perspective into another person's psyche. You get to know your patients in a way people they see every day may never know them. The nurse and patient relationship is superficial, but deep at the same time. It's very hard to describe. I have learned how to extend myself in ways I never thought possible. To truly put others' needs first. To forgo your nutritional needs so others can eat. I can do this but I don't think this is necessarily a good thing. The world needs nurses who are healthy to help people be healthier. I am working on making sure to take my breaks and really sit down and let the documentation rest for half an hour. Unfortunately, it seems there more focus on the documentation and not enough focus on the care that is actually being performed and then documented. For the safety of our patients, this has to be turned around. I have learned to say no. I said 'No' to working a 4th day one week, because, as I told my boss, "My mental health is important to me." It seems my comment has not affected his general impression of my skills as a nurse. I am learning to say no to patient demands for action right then and there. "Action right then and there" generally means: stop the important nursing task you are doing and go into waitress mode. I am learning how to work my way around giving into every single one of their customer service requests, especially when they are not to their benefit. I truly think that the new customer service focus is enabling patients to take advantage of their care providers and is actually detrimental to patient safety and progress. I have also learned the importance of lifelong education and oh, how humbling it can be. No matter how much you know there is always someone who knows more than you do and you may be surprised at who that someone is. An open mind and an open heart go a long way when you're a nurse. When you view yourself as an educated professional and integral part of the healthcare team you won't feel intimidated. You can question orders and ask for interventions without feeling like you're bothering someone. Physicians are our colleagues, not our bosses. Nursing has taught me a lot, yet I still jaded. I am getting tired. I can't stay at the bedside as an RN forever. I am passed the honeymoon phase and am finally fairly comfortable in my practice. I hope to move from acute to critical care, get several years of ICU experience under my belt, and perhaps apply to nurse practitioner school. Somewhere along the way, I would like to work ED, IR, PACU, vascular access, and in a clinic. In nursing there is always something new.
  4. Responsiblities Many new responsibilities and stressors have been placed on nurses shoulders in the last few years. With alterations in insurance coverage, reimbursement, and shortages of hands on deck, the nursing field has been facing many growing struggles that seem to continue with no end. Rehab facilities are bursting at the seams, hospital emergency rooms are holding awaiting beds on inpatient units and long-term care facilities are managing wait lists that grow with each coming day. By no means does any of this touch the hem of the many battles facing nurses in our present day. But with all of the stress, headaches, politics, driving need to succeed and desire to be the best I've noticed one common theme. Teamwork. From speaking with friends, sitting in on international conference calls and just listening to the woes of those around me, I've learned that a major piece of happiness while at work is due to teamwork. Teamwork Teamwork. A well-oiled machine amidst situations of controlled chaos, teamwork has the power to at least overshadow many of the bigger issues that we face in our day to day jobs. Though my personal experience as a nurse has only lent me an understanding of inpatient hospital activity, I've spoken to leagues of nurses from other modalities who all seem to vocalize the same concern. With teamwork there is power, and without it there is a hopelessness among staff that sucks the morale out of people who are naturally powerful, competent, energetic and passionate. Daily Struggles The definite struggle with the desire to provide a lending hand and the ability to do so seems to ride the fence with our daily checklists. We are a driven profession with amazing focus and coveted skills. Yet, with growing lists of what needs to be accomplished during our shift, having the ability to assist our coworkers when they are struggling is truly a difficult thing. Nursing has made giant leaps in history, but I truly feel that the nature of our work hasn't changed. Our desire to help those in great need is at the core of our existence as nurses. This is a wonderful piece of our identity that drives a desperate need to complete those checklists with (hopeful) time to spare. We ourselves have needs while completing our daily tasks, which further adds a small hiccup when those around us need a hand. So, what do we do when everyone is overwhelmed and help seems scarce? Empowerment For me, I make it known to those who are around me. If I'm feeling strung out and the day feels like it is caving in, I'm vocal about it. "Hey, I'm really behind, would you mind helping me with...If you could I would be so grateful and in turn, could help cover your lunch?" There seems to be some form of power in likeness. If your day is flattening you out, along with your resolve, sometimes just in making your coworkers aware of it (along with your supervisors) things have a tendency to get done with an extra bit of assistance. On the flip side, sometimes regardless of what prioritizing you do, how you help others and they help you, the day is long and you end up clocking out far later than expected feeling exhausted. Implementing Teamwork The number of ways to implement teamwork are vast and often require some sacrifices on our part. It truly is a difficult path to traverse when our nature is to help (patients, doctors, family members, fellow staff, etc). I do find comfort in sharing concerns with management (mentioning issues along with possible solutions), participating in shared governance (a team that works for the betterment of the team) and furthermore finding time for my work family when they need support. Teamwork Affects Patients At any time we will need help, whether physical or even emotional. Teamwork doesn't only touch the realm of patient care. It goes as far as being a listening ear to a fellow nurse who has had an emotionally trying day, passing meds for a floor nurse who needs an extra moment to speak with a patient's family, or even saying hello to ancillary staff (who, without them, we'd be lost). Obstacles Through the obstacles that we all face on a daily basis in our profession, there is so much on our plate it is hard to function without that well-oiled machine that teamwork supports and fuels. I applaud all of you for your hard work and dedication in a profession that I find rewarding, challenging, frustrating, empowering and crazy. How do you, in your role, support teamwork? Where have you seen it, and how is it fostered in your workplace? Standing Together There is much ground to cover where nursing is involved. Our numbers become stronger as we stand together to lift each other up. Nursing stands for many things, of which teamwork has some of my greatest regard and praise. Cheers to all of you.
  5. Change is a constant in the nursing profession. However, it can be difficult to maintain professional flexibility in a field with ever changing policies, procedures, and daily routines. Many changes are usually evidence based these days and meant to improve the safety or effectiveness of patient care. With that, most nurses are usually on board and willing to comply despite the discomfort. When leadership demonstrates support and an openness to feedback from staff, it can make or break a new policy change. This is especially true when trying to implement multiple changes in a short time. When staff feel supported and able to voice their difficulty in adjusting to new challenges they are more willing to push through and make it successful. Everyone likes to feel like they are part of a change for good. With nurses pulled in so many directions, being asked to do more with less, frustrations can reach an all time high quickly. Nurses are held to incredibly high standards daily. There is no room for error when handling another human's life. It seems despite our best efforts to always do our best we are constantly told what we could do better - and that can be disheartening over time. We are told, "lower infection rates, increase patient satisfaction, eliminate error rates in specimen collection, increase documentation" and more. Can we handle all of this? Yes. Yes we can, just not when paired with lack of staff. The virus grows... Nurses are resilient. Somehow you find yourself and others banding together, making it work. But now, vacations are being denied. You're constantly being asked via email, text, phone and facebook if you can cover or pick up shifts - either to help your struggling unit stay afloat or allow your fellow comrade attend an event away from work. Discontent continues to grow. You can see the virus spreading; lunch breaks turn into vent sessions, staff meetings are uncomfortable, your peers look tired and as you walk the halls you overhear complaints at every turn. It's everywhere. Coworkers begin to talk about finding other work. Some leave. This only increases the issue at hand, especially if the all mighty budget 'can't support replacing staff at this time'. Puss is starting to form around this growing wound... Desperate for an antidote you look upward to your leadership and administration, hoping for a swift recovery. Have they noticed the rampant spread too? Maybe this virus doesn't grow past the patient ridden halls and call bells, unable to be seen behind a closed office door. Too weak individually, feeling quarantined and isolated the infected begin to voice their concerns as a whole. Here's where either the cure comes or death is near... There is no doubt that on an unit such as this leadership is feeling the pressure too and may likely have their hands tied from those above them. An unfortunate middle man expected to become a shaman with potentially limited resources. But going back to the principles above, simple acknowledgement of discomfort and support of staff frustrations can go a long way. Morale can be a difficult thing to pick back up if the issues at hand are unable to be fixed in the foreseeable future. Difficult but not impossible, there are a few ways around it: Host a pep talk instead of another meeting (letting staff know leadership is aware and commending staff on their survival skills and hard work thus far) Discuss ideas for how to work together with staff on scheduling/vacation requests (instead of just denying with no remedy - as being denied much needed time off on an increasingly stressful unit only increases burnout more rapidly) Suggest/help staff plan a night out (a way to blow off steam, increase rapport and maybe even have a little fun) Collaborate with staff on the issues causing low morale (otherwise, if this looming virus is left unattended, staff simply become more & more disengaged over time, unable to exert any more energy and will eventually go elsewhere to work in a disease free setting) Working on or leading a unit with low morale is trying for all involved. Ultimately it helps to remember that all parties usually just want to be heard, acknowledged and improve current conditions. There is no roadmap to chart this course. No perfect elixir or antibiotic for curing the lingering virus of low morale. When everyone demonstrates open, honest communication with transparency, a more collaborative environment can begin to heal itself.
  6. trixie

    Being a Team Player

    I was fortunate to have been oriented to the world of nursing by wonderful team players. They considered the work to be everyone's work. They were highly organized nurses who put the patient's needs first. If there was work to be done, it didn't matter to whom it was assigned. Not all nurses work according to this principle. There will always be those who, when their assigned work is completed, are not willing to help others. I have heard comments such as "she never helps me, why should I help her?" Early on I tried to differentiate between coworkers that I loved to work with and those that frustrated me. I carefully looked at all of their traits to determine whose work ethic to emulate. The nurses that I most loved working with were ultimate team players. They not only asked if you needed help, they anticipated what you would need and just jumped in to help. No strings attached. I believe that learning to be a team player has allowed me to advance in my organization. I never use the phrases "It's not fair" or "It's not my fault". We all know life isn't fair; there is really no need to point it out or whine about it. I also believe in taking personal responsibility for one's actions (which could be the topic of another article!). If I made a decision or did something, I took responsibility for it. It didn't matter if it was good or bad, I owned up to it. Unfortunately, the majority of people do not do this. When a position would open within our facility, I would often hear people complaining about or at least discussing why certain individuals get promoted, while others languish. Each person is a novice when they start their career. I truly believe after the person has advanced through the novice stage they come to a fork. They can either choose the path of excellence or the path of mediocrity. Those that choose the path of excellence excel in their field. They are excellent team players, take responsibility for their own actions, and advance their careers. They inspire others just by being around them. Their enthusiasm is infectious. They love what they do and strive to make a difference. They are often chosen for promotions. Those that choose the path of mediocrity excel at nothing. They just trudge through each day and are there only to collect a payday. They don't take pride in their work. In fact, their work is just a job, it is not a career and it certainly doesn't define who they are. Instead of being inspiring, they are often dreadful to be around. They take no responsibility for their actions and usually will whine that things aren't fair and that it is someone else's fault. They are rarely promoted. I know what fork in the road that I chose after my novice time was complete. Are you at that fork in the road? Have you long passed it, but realize that you chose the wrong direction? It's never too late to double back, take the right direction, and become a true team player.
  7. Welcome to the world of team nursing, where two nurses and a nursing assistant share the burden of a larger assignment but have the advantage of teamwork. As a nursing student and new nurse, I heard about team nursing from some of the more experienced, seasoned nurses. They spoke about team nursing with nostalgia, not because of the larger assignment, but because everyone worked together as a team, because they had too. I was thinking about team nursing today and its advantages. For one, it is great to have an extra nurse around when you are dealing with a psych patient, even on a non-psychiatric unit. Psychiatric patients and even those without diagnosed psychiatric disorders may practice splitting, which means attempting to turn staff against each other in order to manipulate a particular staff member. One common example of this is when a patient tells a particular nurse that they are much "nicer" or a "better nurse" than their nurse last shift or that the CNA "isn't very friendly." What they are saying may be true, but it could be an attempt to win your favor. Psych patients may also attempt to manipulate staff by making requests and then undoing them. If you call them out on their behavior, they will deny it at times. For example, I had a patient in the ER who had documented psych issues last week. She was very selective about when she spoke or answered my questions. She kept pushing the call bell and when I asked her what she needed, she didn't answer. Finally, after the 3rd time, she said "I need a blanket." I got her a blanket and spread it out on her, and they she took it off and said "I don't want this." This is an example of classic manipulation. Having another nurse there would help curb these behaviors. It can also be helpful for patient compliance because a united front is a stronger front. If you patient is insisting on leaving the unit to smoke for example or doesn't want to ambulate in the hall, having two nurses educating the patient about the healthier choice may encourage them to choose the option that is best for them. When the nurse is sharing your assignment and is therefore in close proximity it is easier to get this kind of help and support when you need it. I think it can also make the shift go much more smoothly. For example, one nurse can focus on doing assessments on the eight, nine, or ten patients assigned to them, while the other nurse can focus solely on passing medications. Nurse #1 who did the assessments will pass off relevant information i.e. abnormal finding in her assessments to Nurse #2 before Nurse #2 starts his med pass. If he gets a phone call, he can safely ignore it and it will go to the other nurse's phone. This can decrease medication errors because the nurse feels less rushed and can focus on the task at hand without interruptions. The CNA can hover between the rooms the nurses have not yet reached to document vital signs and or help patients to the bathroom (to avoid such requests when the nurse comes to pass meds or do an assessment as so commonly happens). An alternative would be the nurses going in together to do assessment, one doing the assessment and the other nurse documenting for her. The nurse doing the assessment would take a quick look at what was documented prior to signing the assessment. This would also help both nurses be informed about each patient's assessment findings. Having another nurse available can also help nurses deal with the emotional and physical parts of the job. By sharing patients, both nurses feel vested in their assignment. When the CNA is busy in another room, one nurse can call the other to help turn or toilet a patient or even to do wound care. When you need a break or a hug, there is always someone there to back you up and support you. Team nursing can also be a good way to help new nurses acclimate to nursing once they are off orientation. Being teamed with a more experienced nurse can be a great learning experience. If there is a problem, the more seasoned nurse can step in and offer a solution. If the novice nurse has questions, there is a more experienced colleague close by to answer questions. However, if tasks are divided and the newer nurse is assigned to do the assessments and the more experienced nurse questions her assessments it can create resentment even if her concerns are legitimate. There has to be a great deal of trust in this arrangement. Team nursing requires trust in another nurse's abilities as well as the ability to get along. A toxic nursing environment that uses team nursing can be detrimental. An industrious CNA make it or break it in primary or team nursing. There would have to be a lot of thought put into the assignment regarding which nurses and CNAs work best together and to make sure skill level is compatible. For example, it would be better to avoid having two nurses fresh off orientation working together. Team nursing can make shifts go more smoothly by minimizing interruptions and helping patients behave better. It can help with the emotional and physical burdens of the job. To me, the challenges seem easy to overcome and a good tradeoff to reap from the many benefits. Post your thoughts below.
  8. How to balance work and home life has been a challenge. As a nurse, I do not know how I have done it through the past 24 years. I have encountered many obstacles and challenges along the way and it doesn't get any easier even with all the practice I have had. The hours as a nurse are often long and not conducive with the 'normal' person who often works 9-5 with clear defined breaks and every weekend off. When I was younger I only hung out with other health care professionals or other emergency service staff because we all worked horrible shifts, every holiday known to mankind and we were all kind of crazy. Back when I started nursing, shops didn't open on a Sunday and they closed early during the week. Shops didn't open on the major holidays and there was no such thing as a 24 hour openings. This meant that nobody in society actually understood the hours nurses kept or the concept of shift rotation. We would go out partying after work; there were social clubs just for us. We talked 'shop' all the time; we laughed a lot at work and at play. It was fun or so it appeared all the time. We worked hard and we played hard, and we laughed a lot. Most nurses worked rotational shifts; we worked 8 hour shifts which could mean a 10 day straight if you wanted a weekend off, you would work a mixture of earlies and lates during that 10 day straight. We also worked 6 weeks days and 2 weeks nights. We all moaned and complained when we went on nights but we had no choice we had to do what we were told. If you had a family some nurses had to give up nursing because they could not manage child care and working the shifts. Nursing was defiantly not child friendly unless you had fantastic home support you could not work. Often Managers and charge nurses would go part time and drop back down to being 'just' the RN on the floor. There was no fast track to nursing in those days and managers had been floor RNs for many years themselves before promotion. Child care was either done by family, a nanny or child minder or you paid through the nose for sending your child to child care facilities, and they were not nurse friendly and often opened way after your shift started. I think this is easier in today's society because a lot of jobs now have shifts and strange hours so child care facilities and child minders have to be more flexible. What I have noticed over the years is that having a baby now does not mean a loss of career with new mothers often returning to work very quickly after the birth of their baby. Most career nurses don't step down out of their charge or managers position, so less promotion and movement of staff. Rarely do we socialize outside of work, the social clubs have disappeared and we don't seem to have a lot of fun in our everyday life. Moaning and complaining have taken over the laughter and fun we would have even when we were run off our feet. Nurses will often frown on other nurses who appear to be laughing and having fun, often believing they can't be working as hard as they are, or their assignment must be unfair. Social activities outside work are rarely planned as we don't always like our co-workers so why would we go out with them. Years ago if you made a list or a plan everybody was involved today few write their names down and it is always the same ones. I know I am generalizing, before you shoot me down. As usual I am giving you food for thought, are we as a nursing society so detached from each other that we do not have fun together so we cannot work better as a team. I ask this because we work so hard now to get each other to be team players, yet years ago we all worked together as a team is this because we connected more on a social level or was it because moaning and complaining was not tolerated so you didn't do it? Team work was a expectation and we didn't seem to work on it, formal education was not needed! We are all so much more educated, we expect more from everybody while putting in a lot less. We are all so frightened of having a relationship with our co-worker than we don't invest in their wellbeing. It is all about 'ME'!
  9. jadelpn

    Instant Gratification

    Indulge me for a moment. Back in the day, nothing was instant but coffee. There was a waiting game for almost every aspect of life. It set people up to have a number of anticipatory feelings. Anticipation is a unusual concept today. Instant answers, instant results, instant communication all lead to question--as a multi-generational team, can nurses really merge the older and younger generations to make things run smoothly? There are a number of seasoned nurses who decide not to retire. They are in a place where they want to work, they need to work, they enjoy the work. Seasoned nurses have experiences of having to wait for the means to the end. Therefore, their nursing practice reflects careful and mindful nursing choices. They have to critcally think the whole picture. Their nursing judgement is looking at the pieces to make the whole. What are we going to do now to make this a positive outcome for the future? Mid career nurses (meaning the generation "X" among us) are in the middle of their nursing practice as well. Some still have kids at home, have to work, have a desire to work for what they want/have to look to the future, however, are mindful of the present. This group may have some thoughts of instant gratification at times in their nursing practice, however, anticipate the worst and practice for the best based on their interventions. Generation "X" nurses are more acutely aware of delayed gratification. Most of their parents used a reward system for most of their childhoods. They were very used to the term "that's not fair". These nurses have a diversity in their work style. They have had to always adapt, so it comes naturally for most nurses in this age group. Failing means to re-group and re-visit and try again. Newer nurses have always had instant gratification. The thought of waiting is not in their mindset, therefore, the level of frustration goes up when their nursing practice doesn't reflect this concept. Well meaning parents had a great deal of flexibility, some on a friendship based parenting style, which can reflect to others as not being respectful. This is rarely the intent, however, can often be a professional faux pas that more seasoned and mid career nurses will take pause to. Failing is not in the thought process at all. So what is helpful in this generation is multiple appropriate interventions to get a positive result. Diversity in the workplace can mean many things, and can be related to a multi-generational work ethic. We can learn a great deal from each other and our styles of nursing. If we take the personalization out of the equation, and look to what each generation brings to the nursing practice as a whole can we build a better team. Often, if we look at what everyone brings to the table, reflect on how to deal with the different generations accordingly can we brainstorm ways to increase patient satisfaction, and a good end result for the patients.
  10. One day, as I walked in to my workplace after my long leave, I noticed a new patient in my ward. Actually, she is not new to the hospital, this lady has been staying in another unit for nearly a month due to non healing wound. I was deployed to that unit earlier on and the nurses there had labeled the patient "fussy". This patient's fussiness is notorious over the other unit. 2 hourly positioning for her is a nightmare for most of the nurses, her groaning haunted me throughout the shift. Besides, she's grumpy, if anything went wrong in her nursing care, she'll start yelling. It was my first day of my night duties that I saw her in my unit. "Oh God, she's here now! What a..." I said to myself, groaning underneath my breath. My colleague passed over to me that this lady had been crying for one whole day when she was transferred to my unit. What has been passed over to me sounds nothing different from what she was known as in the other unit. What a "fantastic" beginning for the night. It is our routine that we check our patient's vital signs in the beginning of every shift, when I went to her, she told me that she is scared. Happen to be new to my unit, she feels lonely. She claimed to be closed to the nurses in the unit where she came from because she has been staying there for more than a month. Suddenly I feel sorry for her. I feel guilty for labeling her as "fussy" without really trying to know what happened in her. She can't sit up on the bed and her body is weak, this means that she requires full nursing care. She has a bedsore at the back, two hourly positioning for her was not only nightmare for the nurses, it is her nightmare of all. She claimed that the nurses in the other unit did a very good job. Instead of dragging or pulling her, they eventually lifted her every time she slide down towards the end of the bed. She doubted our ability to do that because there were only 3 of us working during the night and back in the other unit where she stayed, there were always 4 to 5 of them. I assured her that she'll receive the same quality of care in my unit. I was told that she has involuntary movement on her legs every time when my colleagues tried to change her position in the bed. I saw her suffering the pain caused by the involuntary movement. Me and my colleague decided to stay in her room massaging the legs until the pain is relief before we reposition her to another position. After a few days repetitively doing the same thing for her, she begin to know us by our names. She praised us for treating her well and complimented us. Her husband came and told us that she was anxious on the day when she was transferred to my unit, yet now she feels relief.
  11. Like Phil Jackson once quoted, "The strength of the team is each individual member. The strength of each member is the team" (Jackson, 2014). How true is this quote, we all have our strengths and weaknesses that blended together with other members of the team can only culminate a synergy. The recipe can only be blended when members of the team are aware of each other's strengths and weaknesses, have high respect for each other, and have trust and open communication to assist one another in building those weaknesses to accomplish the unit goal. We all know that in order to have a successful patient outcome everyone caring for that patient must work together and have excellent communication skills. Although, many times communication breaks down somewhere along the line and things get missed. As we have all experienced sometime in our career working with different personalities, and work ethics, not everyone communicates the same or has the same work ethic. Some feel that the minimum is sufficient where others will go beyond what is expected of them knowing that the outcome of a patient is primary. Another team ingredient for a successful result that increases a positive patient outcome is the patient and their family. How many times have we had a patient who has been noncompliant with the care of their disease? Yet, their expectations are demanding and unrealistic. Once upon a story, there was a patient with diabetes mellitus insulin dependent, who was noncompliant with insulin or diet, came into the emergency department with complaints of vomiting and weakness. We had a difficult time starting an IV; the adult patient was moving, kicking and yelling "I don't want an IV". In the process of explaining the importance of the IV in order to improve this patient's outcome, the family started also yelling at us. This brings me to the importance of having the patient and family on board in order to have a good team and a better outcome. After the team (doctor, nurses, and specialist) spoke to the family and explained the process, and how our primary goal was to save a life and improve an outcome, the family then spoke to the patient and calmed the patient down explaining what needed to be done. "Coming together is a beginning, staying together is progress, and working together is success", Henry Ford (Ford, 2014). Building and maintaining a good team is work and will need each member's patience, respect, and excellent communication skills. Teams bring successful outcomes and are being used in all organizations throughout different disciplines. So when any one person thinks that being part of a team is not necessary think again. We have all experienced being part of a team sometime in our professional life or even our personal life. How many of us have experienced satisfaction with a positive outcome. I know I have, making me proud to have been part of that team, and when the outcome could have been better, knowing I could talk to the team to improve things. Teamwork is crucial in building teams. Teams will always be needed to yield excellent outcomes. Excellent outcome is the team's goal as a unit and organization. Organizations will always need team players. Be or become an excellent team player by having an open mind and building excellent communication skills. References Quotes for Teamwork Teamwork Quotes (329 quotes)
  12. Julie Reyes

    We Are a Team!

    I have heard it said that nurses who work with children have big hearts - but I think EVERY nurse working anywhere is truly gifted with a "big heart". Every nurse is unique in their personality, and a field where one nurse loves to work, another nurse would never be able to handle that particular job. Thus, the beauty of the nursing field. Oncology, emergency, L&D, ICU, OR, med-surg, community, schools, companies, occupational health, primary care, educators, etc., nurses can touch the lives of anyone in almost any area you can think of. As nurses we must all must be able to work with our teammates in the field we are in to help improve the outcomes of our patients. Here is a story of how this may happen: It occurred to me as he held my finger in his tiny hand and I looked into his big brown eyes - he trusts me with all of his heart. As a nurse, I have done everything in my power to ease his pain. I have given pain medications and antibiotics, followed the orders of specialists and intensivists, worked along with therapists, all in a great effort to bring him comfort. Still, he only has enough strength to moan weakly and stare at me, imploring me for help with such intensity that it causes my heart to flip and my eyes to swell with tears, and all I can do is put my finger in his tiny hand so he can grip it as hard as he can - which isn't much, but enough for him. I touch his head gently, and he peacefully falls asleep. Sometimes healing comes from a gentle and compassionate touch. Often, you need to bring in the cavalry. In the hospital where I work, school teachers, doctors, nurses, pharmacists, techs, chaplains, therapists, and even our housekeeping team - all of us - we give everything we have to each and every child, no matter who they are. Each child has our whole attention; we give all we have and more to the healing, health, and happiness of this child. Each child is more precious to us than gold, and we value them as a sacred treasure. We understand that we may be the most important people in their life- besides their parents- when they come to us, because their life is in our hands. It is our great honor to serve children with steadfast dedication and undying loyalty. I have seen a busy housekeeper in our ED stop what she was doing because a young girl was crying when she lost her sticker the nurse gave her after an injection. The housekeeper went up to the crying child and said, "I will find you another sticker, and I will give it to you, ok?" The little girl gratefully accepted the sticker from our housekeeper and with timid but thankful eyes, looked up at her and smiled, no longer crying. I have seen our Chaplains and Social Workers hold parents in their arms as the parents collapse when doctors give devastating news or their child dies. I have seen the grace and comfort offered by a simple hug or a touch on the arm by a staff member. I have witnessed LPNs and techs running for equipment that was needed in order to save a child's life and never grumble when asked to run for more items. Techs who take vital signs for their nurses are keyed in on abnormal ranges and report them to nurses, and help save lives. Therapists are amazing in their field. I love to see our RTs work with the patients - they are always so calm in any situation. I have seen them take time to educate student nurses on everything from suctioning intubated patients to inhaler administration techniques. PT, OT, ST - an amazing group of healthcare workers who develop a trusting relationship with patients and parents and help patients improve by leaps and bounds. We work hand in hand with each other to find solutions and treatment for hurt or sick children. We work with children who scream, kick, bite, and cry when we approach them - and are grateful because they are well enough to do these things; and we work with children who cannot respond at all. We fight for each child's life, we scramble for each battle call, and we never stop trying to save the life of a child. All of us - all healthcare workers - are healers to some degree, and when we work as a team, we increase the odds "forever in their favor" for each patient. All of us touch the life of our patient in some very important and special way. We work together in an intricate fashion, directly or indirectly, for health and healing. We are nurses, doctors, therapists, technicians, clergy, social workers, case managers, security, environmental workers, and administration. We work as a team, we fight as a team, we win or lose as a team. Whatever happens, in any situation, we can handle it together. Because we are here - side by side - for the patient.
  13. jadelpn

    Team Sports

    There are many reasons why one becomes a nurse. On the top ten list, taking care of patients is an important role. But usually one that you can't go alone. To be one part of a whole is a best case scenario. Nursing can mean that what one doesn't think could happen more than likely will and does. Most nurses, after the first couple of years, knows what they are capable of. Where their strengths lie. What they are passionate about. The most interesting part is that no two nurses are exactly alike. What one enjoys, another may not. There are even nurses who dislike a task that they are really, really good at. It takes a village to save a patient, and to play to one's strengths can only benefit patient outcome. Even if one questions why it is that Nurse Rachet became a nurse, they are usually the first ones to lead a code to a "T". The best codes are run with a team of people who can anticipate another's moves, compliment their shortcomings, and move on the the next task at hand. I am all for the mock codes. So it comes down to a science. Your recorder is one of the most important references. To be a good recorder, you need to practice active listening. Even in a crowd. You need to write and clock watch. You need to remind and repeat. And that is a task that a number of nurses who may not be the clinically strong can employ. To lead a team that is successful, the art of the staff meeting is also key. Nurses need to hear and practice skills, Be able to express where their strengths are and what they believe that they can do, and do well. Managers need to actively listen and respond to the talents and the not so great skills of the nurses of a unit. If one is not so great, then how can we get better--skills labs? Learn one, teach one, do one? Pro-actively strengthening a team can only benefit patient outcomes. Some units choose to team nurse. This either works well, or not at all, but something to pilot if the conditions are correct. There is usually the assessment and charting whiz, the nurse who can get anyone to take their pills at a moment's notice, and the one who can whip out treatments with a smile. Is that feasible on your unit? Something to bring to the staff meeting. If we take the time to think about how to make a patient better and more functional, how to prepare for the worst case scenarios, to play to a nurse's strengths, improve weakness in practice--these are all things that make a nursing team worth celebrating, improve morale, make one take pause as to "THIS" is the reason I became a nurse--is that a bad thing? Personalities, experience, passions all can and do have a place in a unit's success. In better patient outcomes. Advocate for some changes on your unit should it not be this way. One voice can make a difference, even if it is one patient at a time.
  14. To be a nurse we have to have a collection of strengths to stay in the profession. We have to be able to communicate effectively to people from all walks of life, to our co-workers and other members of the multidisciplinary team (MDT). We have to be able to manage conflict, aggression, distress, pain, happiness and death all in the same hour. We have to be transporters, house keepers, councilors, social workers, supporter, educators, mentors, assessors, experts, smilers and the list goes. In fact we are expected to be 'the font of all knowledge' the oracle! We have to know how to document, document and document, as though we were going to court every day of our lives We have very high expectations of ourselves and our profession, yet we can be cruel, mean and unkind to those who don't meet our expectations. Sometimes we are quick to throw others of our profession under the bus, we have a kind of dog eat dog mentality. Often we don't tolerate mistakes, we gossip and talk about our co-workers when they are less than perfect. We can always and I mean always do better than 'her' or 'him, we often don't understand why the less than perfect becomes a nurse in the first place. Not a lot of nurses support each other, we will scramble over the top of other nurses to be considered 'the cream of the crop'. Even though we believe we do support each other, if we really look inside our hearts we know there is always room for improvement Some of us smile inside knowing that the worse another nurse looks the better you will appear. We don't share our own mistakes in fear that there will be retribution from the hierarchy. This strikes the fear of God in our hearts. We covert our knowledge, not sharing or educating others to make their life easier. As soon as somebody messes up, the whisper around the floor is normally 'she should be written up" 'did she get written up" Why? We should learn from mistakes, we don't want to make them; we want our care to be perfect even though no human being can be perfect all the time. The new wave of thinking which has been around for 20 years plus in healthcare is 'Risk Management" we identify our mistakes, we learn from our mistakes and we teach others how to avoid. Risk Management used effectively is a wonderful tool, yet I have only ever worked in one place where it was used as it should be used. Although my current place of work is trying extremely hard to use this tool well. The problem with 'Risk Management' is the people who use the tool, or should I say in the position to use it are often the ones who really believe that we should do numerous write ups, and get rid of the nurses who are less than perfect. We do hear of those wonderful places where they are all team players and support each other through thick and thin. This is a place where we would all want to work, if only we could only get an interview. Retention is great, and recruitment not a problem. Those places tend to have really good processes in place, really good education and support mechanisms. Often they have a very dynamic leader who is prepared to get their hands dirty and supports their staff. Often when investigating a mistake, you find the process has broken down. Normally there is a deficit of knowledge or experience and often education. Nurses rarely go into a situation where they plan to make mistakes or hurt a patient, it is because their skill set may not be complete or their work load is to excess. Sometimes the process is incomplete, something we have always done was missing a part and it is only when a patient is compromised or hurt do we realize that it is something we should have always done and had just been 'lucky' until now. The investigator needs to look at all the pieces and see what was missing, so to do this they need all the facts. This means honesty from people involved, floors have to offer a safe environment for staff to report without fear of retaliation. When looking for managers or leaders, we need to now ensure that our leaders buy into this mentality and are prepared to support their staff and investigate issues and problems effectively by not pointing fingers of blame. We can ourselves when looking for employment ask about Risk Management in their facility, ask for examples of how mistakes and processes are managed. Remember none of us are exempt from making a mistake, how it is handled is what we should focus on. It is not a mistake to ask the interviewer questions about what their management style is. If they don't know then that is a problem, most managers these days should have a clear understanding of their skill set and style. So until we learn how to work together as a team, support and educate, learn to share mistakes that we make, utilize the skills we have when we are looking after patients when interacting with our co-workers, and most of all stop pointing the finger of blame, then how can we stand strong together as professionals. Even the most experienced nurse 'the oracle' is not complete until she can support good processes such as Risk Management. Nursing doesn't just mean looking after patients, it means looking after each other as well.
  15. CardiacDork


    "5 beats of pulse-less vtach converted to sinus tach" I told the doctor. "Guys we need the crash cart here fast" I yelled out the hall to my pod mates. The physician intuitively placed his right hand beneath his left elbow making a 90 degree angle, placing his left hand on his chin. "Doctor the Bicarbonate is 9, do you think we should do two amps of bicarbonate? I've actively titrated the levophed for the past hour, and I believe it is starting to fail in the presence of this acidosis" I suggested. ---No response--- "Doc....!?" with a higher sense of urgency I questioned. Breaking him from his pensive state he uttered through his thick accent, "ah yes yes, let us do two amps of bicarb" It was then when I turned my back to find an army of ICU nurses, ECMO nurses, a crash cart, a group respiratory therapists, junior doctors, and even my nurse manager all behind me. In the most figurative and most literal way possible. "Two amps of bicarb my dear" my charge said as she handed me the medication. She winked with a smile of assurance. It was a rather rainy and gloomy day. Large windows in the patients room reveled the dreary and wet, yet shiny, modern, majestic architecture of the adjacent buildings that are also part of the same hospital. "Two amps of bicarb in at 1722" The monitor began to display a MAP of 57, 42, and 34 all too rapidly falling, the ECMO machine began to alarm as well. Quickly without much hesitation, or regret I opened the roller clamp on my blood tubing as to free flow it in. I squeezed the emergent squeeze chamber. My interventions displaying an effect before my eyes. The MAP rising to a steady 65 after about what seemed to be an hour but was in reality about 2 minutes. Tapping me on my shoulder was my former preceptor "Here's 1 gram of calcium chloride, next time the pressure drops suggest to the doc to push this" "Hey I'm writing all this down for you dude" another nurse called out from the corner. Through the course of the next hour a series of events occurred. Lethal cardiac arrhythmias, lab results close to being incompatible with life, the addition of 5 vasoactive drips, and medication push after medication push. Painful discussions with family. Sobbing and crying from family. The whole sequelae of events we all know too well. But through this entire experience I had the guidance of centuries of combined ICU experience. Yes as the primary RN I was at the forefront by the patients side with the cardiology fellow, but it was all a team effort. I want to emphasize to ALL new nurses, but especially NEW ICU nurses that you are never ever ALONE. You have centuries of combined ICU experience at your disposal. Use it. Embrace it. Absorb it. This is what I love about the ICU. The collegiality, the teamwork, the fresh ideas of the baby doctors, the wisdom of the older more experienced doctors and nurses. I truly believe that the most dangerous nurse is a nurse that believes he or she knows it all. When in doubt, ask! When you need help, speak up, ask for help. Don't be ashamed. This is the ICU, sometimes it takes a whole army. Coming from the floor, I had to learn to be OK with asking for help. As floor nurses, we usually keep to ourselves and since we seldom have emergencies there's oddly a need to have more than 3 people in the room at once. This kind of teamwork further convinces me more that I want to become a CRNA. I will absorb all this knowledge. All these lessons about teamwork and apply them to the OR one day. When I'm asked, "Why do you want to become a CRNA?" I will say, one of the reasons is because I want to be part of a team.
  16. The Liverpool Care Pathway (LCP) is widely used, and recognised as best practice when caring for patients who are end of life. It aim is to guide the multi-disciplinary team in areas such as discontinuation of fluids, medicines and the pathway gives guidence around comfort measures during the last days and hours of life. Organsised into sections, it has provided consistency, support and guidence for those who make use of it to promote and ensure a comfortable, dignified death. The Marie Curie Palliative Care Institute Liverpool In recent months there has been a great deal of scrutiny around the use of the pathway, orginanating from a Daily Mail article by Melanie Phillips who suggested that the pathway has been used to expidite death and without the full knowledge of relatives of dying patients. (I must warn the reader, the Daily Mail is a tabloid paper reknown for it's condemnation of the National Health Service and the UK healthcare workers) The medical profession's lethal arrogance over the Liverpool Care Pathway | Daily Mail Online The original article has caused great anxiety within the healthcare world, not because the information provided is correct but because the scaremongering tactics of this tabloid could potentially lead to end of life patients being denied best practice and subjected to painful, prolonged deaths. There have been concerns voiced on medical forums, in the British Medical Journal and via facebook fictional characters such as the "Medical Registrar", "the Palliative Care registrar" and "the Consultant Vascular Surgeon" I have used the pathway on many occasions, and in fact have on a number of occasions initiated it's use with discussions with the medical teams. I have only once had the experience of a patient who survived after being put on the pathway, it was discontinued when she showed signs of improvment (she was an elderly lady who had fallen, fractured her ribs, had a splenic bleed and had a multitude of chronic illness' ) It was felt she was unlikely to survive. She stopped bleeding and woke up a week after the pathway had been commenced, the comfort drugs were tailed off when she asked for a cup of tea. News analysis: What is the Liverpool Care Pathway? - NHS Liverpool Care Pathway: Relatives 'must be informed' - BBC News In response to the Daily Mail's article the government has responded, demanding that investigations be carried out in areas that have been named as having poor practice, there is a suggestion that healthcare organisations receive money for putting patients on the pathway, there has been an overwhelming response from medics stating that the care pathway is used after full clinical assessment and where the patient is felt to be in the last days of life. News analysis: What is the Liverpool Care Pathway? - NHS There are now genuine concerns that if healthcare professionals suggest the care pathway to families of patients who are felt to be end of life, there will be fear, misunderstanding and there is the real risk that patients will suffer as a result. Descriptions such as the "death Pathway", claims that it is used to expidite death only contribute to add to the misconceptions and further undermine the general public's trust in healthcare professionals. I have been truly saddened to see the assassination of such a helpful, clinically driven and patient focused pathway by a tabloid paper be taken by the government, and rather than getting facts and looking at the evidence behind the pathway, politicians jump on the bandwagon to condemn and give credibility to the scaremongering.
  17. jadelpn


    Confidence is an integral part of being a successful nurse. Confidence and ego are 2 entirely seperate things. So lets focus for a minute on the confidence you need to be successful. Nursing students by and large are smart cookies. They love(or learn to embrace) the science of nursing. They can tell you how the blood flows through the heart in 4 seconds flat. And this is a good thing. If you ace A&P and can identify various bacteria, then you are confident that you have the physical part down flat. What is difficult to master could be the theory part of your nursing classes. It is much like algebra.....WHY is there an "x"? Can't their just be numbers? It is all so, well, subjective! If you look at a patient as a whole person, inside and out, and the goal being that the patient gets to the highest functioning level as possible, it is a start on the confidence that you are aiming for success for your patients. So how does this relate to the actual care of patients? When you are doing your clinical rotations, remember--highest functional level. So really observe. How does the nurse you are observing do what they do? Pull out everything your parents ever taught you about effective communication, appropriate behaviors, manners. You will see patients at their worst. Do not internalize this. This is not about you personally. "You sound frustrated. I do not know the answer, but let me see if I can find you one" will be your best friend. Have confidence in the fact that even if you have not a clue how to answer a question from a patient, that you know where to look to get it. So familiarize yourself with your resources. No matter how many vents, nursing really is a team sport. There are people higher on the food chain than yourself. (until you become the DON, then there still are higher ups, but not so many!). Use them and their experience. Do not be afraid to ask questions, even if you have to ask your clinical instructor--write questions down! Don't forget to thank the nurse who shared their day with you. If you believe the nurse to rock, tell them so! Even the grumpiest nurse on the worst day can do one thing that you find fascinating. For me it was how a nurse put in an NG tube. All of a sudden the lightbulb went on. I never, ever forgot it, and thanked him for his time and letting me observe. Don't ever shy away from a learning experience. Don't ever shy away from getting involved in making your patients as comfortable as you can. Don't ever shy away from asking the tough questions. At appropriate times, to the appropriate people, but don't NOT ask a question because you feel it is "dumb" or "unimportant". Know your references. Look at them, use them, become one with the drug book, become one with the nursing diagnosis book. Go forward with confidence. And best of luck in all of your endevours!! You can do this!
  18. jadelpn

    Dirty Deeds, Done Dirt Cheap

    I have noticed more than one thread on the "laziness" attitude between members of a health care team. General statements such as "CNA's are lazy". "Nurses are lazy they make us do all the dirty work". Seems like everyone sits around on phones and the internet all shift. If this was happening in the record numbers it seems to be told here, I am not sure who is taking care of the patients. Then it morphs into who gets paid the most for the assumed least amount of work. If we take a moment to look at overall responsibility, then workers get paid what a starting wage is, climb up a ladder of raises--which no matter nurse or CNA, some facilities are just not giving raises--and nurses are being paid a starting wage that can sometimes be less than a multiple year CNA in the same facility. Rate of pay is based on a number of things--however, it should never be used as an excuse to get out of care and compassion for a patient. We all do what one could consider typically gross stuff. Some days more than others. Patients are in a facility because either they are acutely ill, or they require assistance not available to them elsewhere. We all deal with bodily fluids. If one is not getting a patient dressed and washed, one is undressing, assessing and yes, that sometimes includes ambulating and ROM exercises. We all do it. But the difference becomes as nurses we then have to document it to a "T" or we lose our jobs. We all have to turn, reposition--again, we have to document same--and yes, even peri care as sometimes a patient requires medicated lotions, powders..so in any given shift, we are "up in patient's business" just as much as the CNA. Call bells---ahhhh the infamous "who answers what when, it is your turn" debate. Sometimes, we can go into a patients room more times in a hour than a CNA will in a shift. Sometimes it is the other way around. Regualtions are often such that a nurse needs to round hourly. Sometimes more than that. We are there for patients. We are all looking to the same goal. In acute care it is seemingly to get a patient our ASAP. If it is something that only a nurse can do--like medicating, educating, or some sort of bowel protocol, then that is what we have to do. We are all bowel obsessed, and nurses are queens of the enemas. It never means that dependent on title, one is any less a caregiver than someone else. We all go home on some days with the smell of poop that just doesn't seem to go away. We all know what CDIFF smells like. What urine smells like that is infected. What yeast looks like. Nurses have taken enough puss-laden wound/abcess cultures to be able to do it with one hand tied behind our backs. But alas, it is not just that we have to complete the task at hand, it is yet again with the documenting, and the processing, and the medicating. Oh, and lets add the catchy new "key phrases" that we now have to be sure to include in the most basic communications. CNA's are worth their weight in gold. What's most important is to have a team approach to how a patient is going to be cared for, and still have their dignity intact at the end of it. How they are going to function effectively--whether that means going to a full assist to a stand-by assist, being able to wash their own face, or that we can educate to the point of knowing that a patient is going to take their medications at home correctly. We are in the people business. Like millions of other workers--lets be sure thate everyone is safe, everyone is alive, and that everyone feels like they are at the function that they should be, and we appreciate each other more for it. As I mentioned in another forum, at the end of the day we all sweat, we all need a good shower, we all need to decompress to be able to enjoy the rest of our lives...whether that we are nurses, CNA's, serving food, or cleaning toilets. Everyone has a purpose. You say "whining" and I say "venting"--it is what it is--good, bad or indifferent.
  19. Mully

    We Are ALL On The Same Team

    I'm talking about the constant complaints about everyone else in the hospital. Now granted, I've only ever worked at one hospital, but having talked to both my mom and my sister who both work at separate hospitals, it seems that it's the same no matter where you go. It goes something like this ... Are we getting the point? And this isn't even scratching the surface. I could go on for hours. It seems like lately, absolutely everyone has an attitude with absolutely everyone else! Over everything! I'm here to say I'M SICK OF IT. It makes for a hostile, unpleasant work environment that causes people to have more stress than is good for them, and is the main cause for massive burnout. So what can we do to help it? Well for one, we can stop getting mad at everyone around us. The next time someone's giving report and they don't know something that you ask, instead of sighing or rolling your eyes, how about giving them a little grace? Maybe they had a really rough day. The next time you're getting a patient from another unit, maybe try giving them the benefit of the doubt. Maybe they're getting another patient just like you are. Maybe we could assume that we all got into health care for similar reasons. Maybe we could value each others opinions, even if we don't like them. Maybe we could stop judging other units until we work a day or two on them. We're all on the same team. We all want what's best for the patient. We need to start acting like it.
  20. Ruby Vee

    How To Be A Great ICU Colleague

    Welcome to the ICU. We're happy to have you here, and we know you want to be a great ICU nurse. That's going to take a long time, but you can be a great colleague in the mean time. When you encounter someone new - or anyone, really - smile, say hello and introduce yourself Do this as many times as it takes. Some of your new colleagues will remember you the first time. Others aren't so blessed with name/face memory. Some will remember your name or face but not what you're doing in the ICU. Introduce yourself to the secretary, the tech, the housekeeper, the pharmacists, the providers and the consulting services. Those who are shy or find it difficult to introduce themselves will be grateful to you for making the first move. Be up front with what you know and what you don't If you're transferring in from Med/Surg, you already know how to put in an IV, NG and Foley but may not know how to set up the monitor. If you're transferring from the SICU across town, you already know how to take care of a patient but may not know how to document in this hospital's clunky computerized chart. If you're brand new, you may not know anything, and that's OK too. What isn't OK, is for you to pretend you know something you don't, or not to know something you do know and could help out a colleague by doing. Watch the monitors If someone else's patient has a systolic blood pressure of 42 or a heart rate approaching 300, DO something. Grab the nurse, alert your preceptor, tell the provider. Don't just hope that someone else will notice so you won't have to. If someone else's patient is coding, help out Even if you're new, you can run specimens to the lab, pick up blood from the blood bank, corral the visitors in the area, answer call lights for the nurses in the room, jump on the chest to do CPR (the best place to be to see everything!) or watch the monitors on the rest of the unit. In fact, a study done when I was a brand new ICU nurse concluded that other patients in the unit are at risk of dying or complications while their nurses are helping out in the code. So you can help out by just watching the other patients. (IF it's your patient, remember Samuel Shem's rules from "House of God": The first pulse to take in a code is your own.) If a patient is being admitted, help out Even if the only thing you can do is plug in the bed and the IV pumps, take a set of vitals and I & O on the admitting nurse's other patient or update the visitors. Manage your alarms No one likes to listen to someone's patient alarm over and over because they're in A Fib with RVR and the upper ECG limit has been set at 80. If your patient's heart rate is usually 120, set your limit 20% higher. (Or whatever your unit protocol may be.) If his systolic blood pressure typically runs around 80, set the lower limit accordingly. Silence your art line alarms BEFORE you draw blood. Change the ECG patches, leads, cables -- whatever you need to do to get a clear picture and no extraneous alarms. Manage your pumps Learning how to titrate drips is a skill. But most ICU patients have multiple IV pumps, and managing them is a different skill. They can all fit on one pole rather than having three poles at the bedside. Label your channels and your tubing in the unit-appropriate manner. Set your volume to be infused to a reasonable amount -- you don't want the IV to run dry, but you don't want the pumps alarming constantly either. Before you go on break or sign out to another nurse, make sure there's plenty of fluid in your bags. Order the new bags in plenty of time. Make sure your pumps are plugged in -- a battery that dies takes up to 24 hours to recharge, and some of the pumps cannot be silenced except by Biomed. (If that happens to you, get the pump off the unit or bury it under blankets and pillows until it's inaudible from more than 20 feet or so. Then call Biomed.) Manage your own visitors Don't let them wander up and down the hall peering into other patient's rooms. When you ask them to step out, direct them to the family waiting area and tell them how approximately how long it will be until they can come back. Don't just leave them standing in the hall even though it's only going to be "a minute". It's far too easy for them to see or hear something that is HIPAA protected if they're just standing there. Visitors standing in the hall create obstacles to be negotiated and can get themselves into trouble. I once watched (from my patient's bedside, where I was holding pressure on an arterial squirter) a group of visitors pull the tops off every lab tube on the supply cart and switch them around. Another group discovered an unlocked computer at a charting station and were navigating through a patient chart when I happened upon them. And one group amused themselves by staring at other patients in the unit. So don't let them hang out in the hall, the nurses charting stations or near another patient's bed. Ensure that visitors know and follow the rules Most ICUs have some sort of rules for visitors -- things like only 2 at a time, no eating or drinking in the room, no cell phone use -- whatever. They're written down somewhere (and if they aren't that would be a great project!). Know what they are and follow them. When you don't manage your visitors and ensure that they follow the rules, you're setting up a bad situation for the next nurse. If you've let the visitors do whatever they want and the next nurse wants them to follow the rules, you've made her a bad nurse in the family's eyes. Yes, it's easier to get through your shift if you don't insist upon follow the rules, but it's going to make your colleague's shift worse. Don't do it. You don't have to LIKE or AGREE with the rules; just follow them. Follow the rules for nurses Follow the dress code, even if you don't like it. Be on time. If you're not supposed to carry your own private cell phone, don't. If you're only supposed to eat in the break room, don't eat at the nurse's station. Hide your beverage. Whatever the rules are, follow them. That especially goes for self scheduling if you're allowed the privilege. A new employee who tries to slide an extra weekend off past the scheduling committee or slough off on their night shift requirement may not get counseled the first or second time it happens, but someone has noticed and is not impressed. That person may be quicker to jump on other minor offenses, and is less willing to like you or give you a break when you need one. Be accountable If you say you'll watch someone's patient while they go on break, watch that patient. If you say you'll clean the balloon pump that has just been removed, clean it. If you're supposed to be hand washing monitor, be hand washing monitor. Pay attention to your skills checklist and be alert for opportunities to learn new skills or practice older ones. Fit into the unit culture Talk to people. ICUs are stressful environments, and ICU nurses are often possessed of a very dark sense of humor. There may be a list in the break room of 47 ways to say "the patient is about to die". Circling the drain, waiting for the Jesus Bus, high Vulture index -- and many, many more. You're not going to make friends by being offended, even if you ARE offended. Add your favorite saying to the bottom of the list, and be prepared to think of a dozen new ways to say your patient lost consciousness. Or threw up. We joke about things that aren't really funny because often times things are so serious that if you don't laugh, you'll cry. Understatement is the hallmark of a true ICU nurse. The patient that just ripped off all his ECG leads, pulled out his central line and is running down the hall naked and screaming for the police may be described as "a tad lively" and the one with a blood pressure south of 60 and a heart rate north of 160 may be described as "a touch unstable." Sinus rhythm with PACs, PJCs and PVCs is "cardiac salad" and a loud murmer may be called "the Maytag sound." I am sure I've forgotten dozens of things, and hopefully someone will remind me.
  21. Anna Flaxis

    Teamwork...in an Imperfect World.

    I recently took a new job where I was just amazed by the teamwork displayed by the entire staff. I was just in awe. But now, the honeymoon is over. I'm starting to see the chinks in the armor. Like Neo in "The Matrix", catching glimpses of the true reality, I am beginning to "wake up". Don't get me wrong- the teamwork really is outstanding. Nobody ever utters the words "That's not my patient.", or when a physician asks who is taking care of Patient X, we might respond "Joe has been, but what can I help you with?". If there are orders to be transcribed, IVs to be started, meds to be given, EKG/Radiology/CT techs to be paged, whoever is not doing something at the moment just does it. Well, mostly..... I work with one particular nurse who has....habits, shall we say...that I struggle with. It has made me see the value of zone nursing, where each nurse is assigned a set of rooms, or primary nursing, where each nurse has a set of patients, and those are their patients that they are responsible for. This is the background I come from, where I cut my teeth in ED nursing, and I have really enjoyed the team nursing approach in comparison. But, I've been seeing the value in zone or primary nursing lately. What are these habits, you may ask? Well, disappearing for one. Not just for a few minutes to go to the bathroom or something, but anywhere from 15 to 30 minutes, where I do not know where my partner in nursing is. I tell my partners where I'm going, even if I'm just going to the bathroom. That way they know, if something happens and they need me, where I am. Not this nurse. This nurse seems to feel it's okay to be gone without saying anything. To be fair, sometimes this nurse does tell me where they're going- for instance they will clock in and then tell me they need to go deliver a book they're lending to another nurse over in OB- and of course, they're gone for no less than 30 minutes. Another thing is cherry picking. This is where the other nurse picks the patients they really want, sometimes even taking a patient right out from under me, and is conveniently busy when patients they don't want show up, leaving the other nurses to take them. This nurse tends to cherry pick the traumas and critically ill one on one patients, leaving the other nurses to manage the rest of the department. Lastly, the "going the extra mile" thing. This is where the nurse will spend a good 30 to 45 minutes on the phone with a patient that was seen in our ED last week but still has some questions. This wonderful, caring nurse will spend as much time on the phone with the poor hapless soul as it takes to solve all their problems, while we're getting hammered with real patients who need real care in our ED right now. I won't mention the personal phone calls. Oh, well I guess I just did. So, what is my plan to address this, you may ask? Well, I considered talking to my supervisor. But this nurse has been around for a long time and has pretty close bonds with my supervisor. I don't want to have to watch my back. I was happy when I found this job and thought those days were over, and I want to maintain that illusion as long as possible. So then I thought maybe whenever I work with this nurse, I'll just take care of my own patients and spend as much time in my patients' rooms as possible, sticking to a more primary or zone nursing model. But, this can be really inefficient, and not helpful to the patients. Ah, I know what I must do. I must address these habits as they happen in the moment. I have to actually communicate with this other nurse about these habits. I'm not sure exactly how to do this- interpersonal communication is not my strong point, especially where conflict might be involved. It's something I work on regularly. Maybe that's what I'm supposed to gain from all of this- more practice in this area of weakness of mine. It's not really what I want. I'd rather practice difficult IV starts or hone my respiratory assessment skills. Sometimes, however, getting outside of one's comfort zone, outside of that bubble of safety, is how we grow....and so, I will look at this as another one of those unsolicited opportunities for growth. And maybe, just maybe, the teamwork will be enhanced as a result.

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