No for real. Warning, positivity ahead!
In some weird New Agey/karmic/life balances way, I think the Universe knows when we need a pick-me-up. To say I’ve been suffering at work is an exageration, but it hasn’t been a place I want to be. I find my co-workers annoying, the workplace politics suffocating and the patients unbearable at times, and it’s been worse more lately than it has been for some time. Maybe it is because it is time to move on, or that I’m just having a run of bad weeks. Worst of it is that it is not the acuity of the patients, it is the overall mind numbingness of the repetitve. I thrive on challenges, new situations and a chance impact my patients, but lately there hasn’t been that. Suffering from a case of “give a shit syndrome.” Which is quite toxic.
The last shift I worked did that. I wasn’t in charge, had a semi-challenging group of patients, but what’s more important, I actually felt like I made a difference. It wasn’t just one intervention, but that I was able to be present, be available and be involved and immersed with my patients. It was the connection that reminded me why I love nursing. There were the times I wanted to slam my head against a wall, actually wanted to bitch slap my co-workers for their stupidity (really, who tells an elderly post-op patient that their heart stopped when it didn’t? It just scares them to ask for any pain meds even though they are in agony.). But those annoyances were far outweighed by the positives.
It’s refreshing to hear a family member stick up for the nurse to the doctor, for the patient to effusively thank you for “being here when I call” and to know that my comatose patient is fluffed and buffed so that the oncoming shift won’t have to worry about it for awhile. When I got home, there was the feeling of being tired, but knowing it was from doing a job well, rather than the tired of boredom. It was a nice change.
Not all that long ago I was a fresh-faced new grad, eager to explore the great wide world of nursing. School was done, externship was over and I had passed the dreaded NCLEX on the first try. I was ready.
My first year was brutal. Trial by fire, eating of the young, stress migraines and an overwhelming urge to run screaming as fast as possible away from my job and go work at McDonalds, that encompassed the first 6-8 months. Then as if by magic, I realized I wasn’t struggling, I wasn’t hating work, I didn’t get sick on the way to work and people were asking ME for answers instead of the other way around. I couldn’t tell you when it happened, just that it did. Having been through it I know that it made me a better nurse. That hell I went through toughened me up, made me become organized as a survival technique, taught me how to juggle the needs of my patients with the duties I needed to perform whilst maintaining a sembalnce of sanity. And it worked. It was kind of like boot camp: break you down to build you up.
Since then I’ve precepted new grads, been a mentor of sorts to them and tried to make their first year a little less harrowing, but still instilling the fire they need to survive. I don’t practice eating of the young, it’s counter-productive and will drive promising new nurses right out of nursing, or at least off of your unit leaving you back where you started: short handed. But I do believe a little bit of “tough love” is needed. Our job is not easy and the sooner you accept that it isn’t all candy and rainbows the sooner we can build you into a competent nurse. Not saying that you’re crying on the way home everyday, but not shielding from the rough days either.
Our system just bought into the Versant Residency Solution, which is a systematic residency program intended to rapidly prepare new nurses. “After only 18 weeks, trained observers report that Versant RN Residency graduates achieve Nursing Skills Competency ratings that are slightly above new graduate comparison groups who have been in professional practice for nearly a year and a half (17.1 months).” Sounds awesome. Wish we had something like that when I was starting out. That would have made my first year a little bit better. Or is it just delaying the inevitable?
Our RN Resident is with us for 18 weeks. 18 weeks of being precepted before they are on their own. 2 days a week in classes, 2 days a week on the floor. It’s a tough schedule, worse for those that drew a night shift slot. But in our over-saturated market many new grads were willing to sign over their first and second born to get a nursing job. For 50 something slots, over 500 newly graduated nurses applied. It’s that desperate here. Truly these are the cream of the crop. But for 18 weeks they are coddled into nursing on the floor. I had 12 shifts with a preceptor, and was told straight out that by shift 9 or so I would be taking a full load with the preceptor merely supplying help when needed. Our poor resident is struggling still to take 2-3 patients a night and they are already past day 12 and those running the program have told the preceptors that the residents aren’t expected to take a full load until the final weeks of the residency, if even then. For 18 weeks we expect less, are allowed to expect less and not to push as hard as we might have before. We’re coddling.
Do I expect new nurses to go through the same shit I did? It sounds like it. But I truly believe that there comes a point where you can no longer hold their hands, no longer allow them to sit idly by, skimming along with help from their preceptor: it’s time to fly! The 18 weeks is doing a dis-service as it is not making them fly on their own. What made me a competent and efficient nurse? Stress. Pain. Being kicked out of the nest and having no choice but to fly. Did it suck? Yeah, but I know that I’m stronger for it. This coddling aspect is so ingrained in our culture, from the “everyone wins” school of thought in sports, to getting a 4.3 GPA on a 4.0 scale, to overprotective parents, that we can’t just let people go and see how they function on their own.
Since I started on my floor, it has changed drastically. The old battle axe nurses have moved on, now you’re more likely to get help when you ask rather than a dirty look or eye roll and generally it’s a better place. Being let fly here is far less daunting than it was when I started, there is support whereas previously you really were on your own. But, due to the rules of the program we can’t let our residents fly on their own.
I know that people will ask, “So, are you doing anything to help the resident?” Yes, the preceptors (there are three of them) and a couple of the charge nurses have talked about ways to help them. We don’t want them to fail, but we don’t want the end of the 18 weeks to be a huge issue either, where all of a sudden you’re flying free and haven’t developed the skills to keep aloft. Who knows, maybe this idea is great and it will produce incredible results – that’s at least what the program developers say. But I have one lingering question: how can you be as good as a 18 month nurse at 18 weeks when you’re only spent 12 of those weeks actually caring for patients? Book learning is great, but it means nothing until you get to use it. It is the actual act of caring for the patients that brings the book knowledge into focus as Ricky Gervais said, “Without application, knowledge is pointless.” We’ll see how it end in about 3 months.
The other night I was getting report from the say nurse on a post-pacemaker placement patient (try saying that 5 times fast!) who was all in a tizzy. Scattered and doing things that really didn’t make a whole lot of sense. It had been a busy day, but it seemed like she was making more work for herself than she needed. Almost like running in circles. Not productive at all.
When the excreted fecal matter hits the proverbial air oscillator, I make sure I take a moment to assess the situation. Following the and then begin to gather the situational information. It seems that the ability to do this was lost upon my colleague and she went from zero to “Holy Shit!” in about 30 milliseconds. Over what? A simple 5 beat run of V-Tach. , I check my pulse
Yes, V-Tach is bad. We all know V-Tach is bad. 5 beats though? Self-limiting in a patient who just come back from getting a pacemaker? With a slightly low potassium? Not all that surprising. But no, flew off the handle she did. Called for labs, called the doc and worked herself into the fore-mentioned tizzy, Through this the patient is fine. Happily chatting with his wife about this or that. He’s on the monitor, already has a K-rider infusing and is about as content as one can be in the hospital. Why the drama?
Because all to often people don’t think before they act. Had the nurse been thinking things through and not reacting several things should have gone through her mind. First, the ventricular ectopy in the form of multiple PVCs and a single run of VT was caused by two different things, the hypokalemia – the patient was 3.6 on the AM labs and the fact that the cardiologist has just been poking and prodding and electrified piece of wire inside this dude’s right ventricle. Or in other words they had been pissing it off. Second, she already was correcting the hypokalemia with the running rider and if she really wanted a magnesium level, a quick add to blood still in lab would have sufficed. Third, she needed to look at the patient. Vitals OK? Feeling OK? No chest pain or discomfort? Yes, yes and no were the answers. Simple isn’t it?
I think why this got under my skin so badly was that the nurses isn’t exactly new. She’s been a nurse far longer than I and has been in cardiology for nearly the entire time: she should know better. But it seems that my day shift has been functioning in the fight or flight mode for so long that any little issue, real or imagined, gets turned into a full-scale shit storm. It’s like when the LOLs with delirium are extra hyper-alert that the slightest thing sets them off. So it is with the day shift. They forget to think. Unfortunately many nurses are in the same boat, we’re running scared and rile ourselves up faster to make sure Bad Things© don’t happen. So stop, think, then act.
As for the pacer dude, well, things worked out just fine. All that drama for nothing.
hmmm…drama for nothing and chest pain free… h/t Dire Straits
my World post…
Years ago, before I became soft and sedentary I used to go hiking. Not just this go for a walk in the woods for an hour or two, but those multi-day, carry everything on your back, see really incredible sights and camp where few have camped prior type of hike. Deep back country. Even in those remote areas we were always worried about water. Part of the daily camp ritual was get up, filter a couple of quarts before hitting the trail. And this was in unspoiled national and state forests. Imagine if it was along some of the thousands of miles of polluted rivers and lakes in our country alone. Here are some sobering facts courtesy of Do Something.org:
- 40% of America’s rivers and 46% of America’s lakes are too polluted for fishing, swimming, or aquatic life.
- The Mississippi River – which drains the lands of nearly 40% of the continental United Sates – carries an estimated 1.5 million metric tons of nitrogen pollution into the Gulf of Mexico each year. The resulting dead zone in the Gulf each summer is about the size of Massachusetts.
- 1.2 trillion gallons of untreated sewage, storm water, and industrial waste are discharged into US waters annually.
- Polluted drinking waters are a problem for about half of the world’s population. Each year there are about 250 million cases of water-based diseases, resulting in roughly 5 to 10 million deaths.
Water is essential to life. To have inadequate access to water is a damn shame in our modern world. To have polluted rivers and lakes is ridiculous. That so many should die from water-borne diseases is an affront to our civilization. That’s why we need stronger laws and regulations that prevent polluters from destroying our water. We need technological evolution and invention to create less costly, more efficient and larger scale ways of providing clean drinking water across the world. Most of all we need to wake up to realize this is a problem. We need to wake up to realize we can do something about it!
I like podcasts, but it seems like I don’t have enough time to listen to them. Call it an inability to plan well, structure my time well, or more that I just like to listen to music when I exercise/commute. When I do sit down to catch up, I flagellate myself to “keep up” but that doesn’t last for long. The great thing about podcasts is the ability to learn whilst doing nothing. Yes kids, learn. Y’know, ingest, digest and evaluate new information to improve one’s knowledge thereby increasing our abilities. Now there are podcasts not of that sort and are pure entertainment, which are just as good, but I like the ones that impart new information.
Here’s a short list of what I’ve been trying listening to.
Mark Crislip, “because the world needs more Mark Crislip”. He’s an ID doc within my hospital system and is downright hysterical, but informative. He has 2 that I really recommend in his media empire.
First, Gobbet o’ Pus. Brief snippets about infectious diseases with a certain twisted sense of humor.
Second, Quackcast. Yup, a dissection of alternative medicine. He has no qualms about calling people dumbasses, especially here.
He’s my favorite right now.
Here are some other worthy contenders:
ICU Rounds. Dr. Jeffery Guy’s series about ICU patients and what ails them.
Nursing Show Online. by Jamie Davis the Podmedic. Nursing stuff, brief bites.
And I just found this one thanks to iTunes: Freakonomics Radio. Take the ideas from the book and make a podcast out of it. Brilliant.
That’s all for now. Happy listening!
Go, sign the petition. Maybe once in awhile this self-centered exercise we call blogging can help a good cause.
Post to come on Friday about water…
Feel free to poke through the archives, put a drink on the coffee table without a coaster, mi casa es su casa! Enjoy your stay!
No seriously, I’m not kidding, actually orient the charge nurse. It’s not throw them to the wolves and let ‘er rip? Odd way of thinking, right? It’s not however and it’s something that is rarely done.
It’s funny, for an organization that tries to be pro-active with their staff, give them opportunities for education and growth and support their leaders, mine does a piss poor job.
Orientation was three days, the last of which I was on my own while my “preceptor” watched tele due to a sick call. Mostly it was, “Here are the things you need to do. “ There was no talk about responsibility, choices, what the other nurses were going to ask of me. Nothing to truly prepare me for being a charge nurse.
And a preceptor past orientation? That is about as funny as leadership development. We talk a big talk. Have had several conferences that were really not much more than expensive opportunities to talk a big talk but not have any sort of follow up. Of ideas that were discussed in the last two events, not a single one has re-surfaced. Not one. Many were dismissed outright before we even left the conference.
In spite of the lack of support (mostly), I’ve learned. Learned to juggle being a mentor/resource to newer nurses (and even some more experienced nurses), being a hard-ass when needed, leading from the front rather than sitting at a desk, taking my own patient load and still managing to do the things my manager expects us charge nurses to do like the minutiae of paperwork, flexing staff when not needed and balancing the load as able.
It might have been easier had I been supported and given a structured training, but with typical fatalism, I say, “It is what it is.” I still get the feeling at times from my manager that I’m missing something, that there is something else I should be doing, but I can’t figure out what it is. But I get validation in the best way: from patients and my fellow nurses. When a nurse is glad that you’re in charge versus another, it feels good and tells me that I’m doing something right after all.
Potpourri. Funny word. Always reminds me of Jeopardy. But it’s a collection of things. Randomness in a bowl.
It’s fall, finally. The leaves are changing and soon I’ll be back to sliding on leaves as I ride to work. Rain + leaves + cement = road rash. Happens every year at least once. But it’s good. Fall is my favorite. I don’t mind cold and wet, makes me want to curl up with a book, cook soup, plus there are a lot of good memories from growing up that are from the Fall. I can tell it is coming because of the smell. It’s a fresh, almost funky wet smell. It smells like time to pull out the woolies, hoodies and hot toddies.
Insomnia sucks. Once again I fell asleep for a couple of hours then woke up. For no reason. Wide awake in the middle of the night. Tried to go back to sleep, but just lay there tossing and turning. Too late to take an Ambien, to early to get up. It’s frustrating at times. Before I used CPAP I would have times like this and for a good 6 months after CPAP I haven’t had to deal with this insomnia, but in the last month it has happened more often. Probably have too much on my mind, ate pizza too late or some other reason to mess up my sleep cycle. My doc thinks that it’s related to my shift and he has a point, but until I can not take a pay cut to do so, I’m not working days.
I watched a bit of Hoarders last night. Made me very self-conscious about our house. While we don’t have garbage laying about, we have too much stuff. I despair looking at it thinking that we’re going to be moving in the next year and I have no intention of moving so much again. It comes down to buckling down, sorting and deciding on stuff. Not the easiest thing in the world.
Halo: Reach. What can I say? It has consumed far too much of my time of late. And why not? It is an amazing game. I haven’t had this much fun with a game for a very long time. People give me shit about it though. Yeah, I’m in my thirties and probably shouldn’t be so into games anymore. But why not? It is something I enjoy, something that provides a little escape from the grind and it’s fun. Too many people are far to serious and take themselves far too seriously and want to project that onto everyone they come into contact with. Sorry, I’m a gamer. It is my hobby. Deal with it.
I wish that the hospital would supply scrubs and provide a decent place to change. When they remodeled our floor they got rid of the bathroom with a shower in it. It was a nice luxury when you got covered in blood/pee/sputum/blood/assorted nastiness to be able to change scrubs and shower. I liked it when I rode in the summer for a quick rinse when I stunk from sweating my brains out. Ixnay on the shower though. But scrubs, they’re expensive. Admittedly I like the ones with multiple pockets to carry all of the detritus of floor nursing and they cost more. If I had a house I could write them off, but I don’t so I eat it. Would be nice to not have to worry about them. Show up in street clothes, change and work, then repeat. Would be nice.
Middle-aged guy comes in complaining of chest pain.
He had been sitting down to a nice recuperative meal after running a leg in a relay race. ED work-up reveals elevated troponin and some signs of mild dehydration and thus is admitted for monitoring overnight.
When he gets to the floor he tells us that he actually started to have chest pain while he was running, but at the end of his leg, it went away. Usual suspects: male, age in 50′s, ex-smoker, overweight – check to all of them. Then he drops the bomb: he’s had a stent before. After he had “mild” heart attack 5 years ago across the country. And what was he doing then? Running a half-marathon!
Having flash-backs to Jim Fixx as we’re hanging Integrillin and heparin. He goes to the cath lab and we go home.
I just wish I could have shared a word of advice: maybe running isn’t your thing!