Step one

So…

I’ve done step one. I’ve applied to a nurse practitioner program.

I’m terrified!

Am I smart enough?

Can I handle this?

Can I afford this?

Is it worth it?

Will I be able to find clinical sites?

Is this the right decision?

This is a really big committment. A lot of my time and finances will be going into this and I wonder if I’m ready for it. I have been bouncing back and forth between career paths and decided that I can do what I would like to do with an advanced practice degree.

Patient education is my passion and I know that as an NP I will get the opportunity to try and make a difference. By working in the “clinic” setting I will be able to try and prevent admission to the hospital by providing care and education on their health. I want to stop patients from being observers in their health care. I want patients to be a participant in their care plans. An educated patient does better. I love when patients comes into my current job and tell me all about why they are getting their scan. It let’s me know they are involved in their health. Those patients area typically in better health than my patients that have no idea what’s going on.

I know I’m doing this for the right reasons. I just don’t know if this is the right time. Then again, when is the right time? I can always find a reason to not do something. Life is always throwing me curve balls. I might as well step up to the plate, swing with all my might, and hope to God I knock it out of the park!

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GFR

Now that I am in the radiology department I spend a lot of time focusing on GFR and kidney function. Why? Good question!

In MRI and CT we give contrast to a lot of patients. In CT the contrast is iodine based. In MRI the contrast is gadolinium (metal) based. Both types of contrasts are filtered out through the kidneys and thus the reason kidney function is so important in this department. The way we assess kidney function is by checking a patient’s creatinine level in their blood. Luckily for us we have machine called the i-Stat that can test the blood and give a result in two minutes. The result transfers into Cerner (our EMR) and the computer then uses that result to calculate the GFR. Great… except I didn’t really have an understanding of why we were checking the creatinine, what GFR really was, or why there is a GFR result for African Americans and non-African Americans. I decided to do a little reasearch and I figured, since this is a nursing blog and all, why don’t I share what I have learned?

What is “GFR”?

GFR stands for glomerular filtration rate. Basically, the GFR tells you the flow rate of fluids through the kidney. Your glomeruli are the capillaries in your nephrons inside the kidney. Blood is filtered across the capillary membranes helping to remove waste that can ultimately be excreted through the urine. Taking you back to anatomy and physiology in nursing school aren’t I? *shudders*

A simple google search will bring up lots of GFR calculators. Typically the GFR calculator takes into account serum creatinine, age, gender, and race (African American versus not) and then it will give you the estimated GFR. A GFR >60 indicates a generally healthy kidney. Less than 60 can indicate potential kidney disease. Less than 15 can indicate full on failure. Here is a little infographic that is patient centered.

Why creatinine?

Why does the GFR equation use creatinine? In the most basic terms, creatinine is a waste product of creatine. Creatine is used by the muscle cells for energy. Your kidneys help filter the creatinine out of the blood to be excreted in the urine. Low creatinine typically indicates good kidney function (which makes sense, healthy kidneys will filter out creatinine effectively). High creatinine indicates the opposite, kidney function is probably on the lower end because the kidneys are unable to filter out the waste product. Creatinine is primarily filtered out through the kidneys which is why it is a pretty good indicator of kidney function.

Why is the result different based on race?

Many, many times I have looked at my labs and wondered why the GFR had a result for African Americans and then essentially everyone else. It wasn’t until I started working here and paying attention to the GFR that I decided to look it up. Turns out studies show we have “higher than average” muscle mass so we generate higher levels of creatinine. Higher creatinine levels lead to higher filtration rates. The difference in results account for this.

Now I can actually explain to my patients why I am taking blood after I start an IV. I like to be able to asnwer my patient’s questions so of course I had to do a little learning on my end. Hopefully some of you will also find this information useful! (Also here is a great reference for frequently asked questions from the National Kidney Foundation because, why not!)

A moment of prayer

How does it make you feel when the family of a patient starts to pray with you in the room? I used to feel uncomfortable because for a long time my relationship with religion has been iffy at best.

See, I am a bisexual woman that was raised Baptist. Yeah, “gay people are not of God and are going to burn in Hell” Baptist. My mom was a pretty liberal woman but our religion was not. I only came out two years ago but was well aware of my sexuality as early as high school. Religion and I didn’t sit well since I was pretty much condemned to Hell. This personal struggle affected how I reacted whenever my patient began to speak about religion or whenever anyone wanted to pray in the room. Typically it turned into “let me page the chaplain” as I awkwardly slid out of the room. I was allowing my own issues to affect my patient care. NOT OK! I really had to get it together. It took a lot of introspection and acceptance of what religion  means to me, and understanding that religion is different for everyone, before I became comfortable with religion in the hospital.

Standing and bowing my head while a family member is praying shows respect. I don’t have to pray like they pray or pray to who they are praying to. I can bow my head and pray for my patient in my own way. I can now listen to my patient talk about their faith and have an engaging conversation with them. Instead of religion making me feel like I was condemned and judged, I now look at it differently. I had to realize my patient was speaking from their point of view. They are sharing aspects of what religion means to them. At no point was my patient judging me. I know it sounds strange but when you are in the LGBTQ community, you tend to feel judged a lot simply for being who you are. I had to understand my patient had no idea about my sexuality and honestly, with what they are going through at the moment, they probably could care less! They are looking for hope. They are clinging to faith to get through a difficult time. They are coping with whatever is going on and for a lot of people, religion is the best way for them to cope.

This wasn’t about me. To bring my own insecurities into this was selfish! I was being so egocentric. I am not normally like that so why be like that now? I really had to make some adjustments to how I thought about religion. I had to learn that at that moment my patient needed someone to listen to them, to give them hope, to have empathy instead of just sympathy. At that moment, my patient needed Fred the nurse to be there for them.

I had to learn that it’s not all about me.

Look at me when I’m talking to you!

I am going to vent for a moment so bare with me okay?

I ABSOLUTELY HATE WHEN MY PATIENT DOES NOT LOOK AT ME EVEN ONCE WHEN I AM SPEAKING TO THEM!

This has nothing to do with eye contact. I know for some people, eye contact is uncomfortable or unusual in their culture. I get that. However, when I call someone into my IV chair and they can’t bother to put their  phone down long enough to raise their head and answer my questions it burns me up! I just feel like it is so disrespectful! Is that how they converse with everyone? No, I highly doubt it. I think *that* is what bothers me the most. I am simply trying to provide care within my environment. I didn’t force them to come to this hospital, nor did I force them to make an appointment for whatever reason they are here. I feel like the least someone can do is acknowledge that a human being is standing in front of them providing care.

There have been times when I am trying to go over information with a patient and they are so engrossed in whatever is happening on their phone that they have a hard time answering my questions. Typically this statement will get me the acknowledgment I prefer: “Let me know when you are done on your phone and then I I’ll continue.” After that I take a step back and wait. Patients will typically put the phone down and pay attention.

In all honesty, I don’t need their undivided attention the entire time they are in my care. Since I am the radiology nurse, I am going to be the one to go over the contrast questionnaire with the patient and then I will obtain vascular access. This isn’t dramatic stuff here. I really only need the patient to pay attention when I am asking them questions, after that I actually prefer they occupy themselves because most often it means they’ll focus on their phone and not on the 20g I am about to stab them with.

I don’t know, maybe I’m just getting old or something but a little acknowledgment wouldn’t hurt.

Uniform… Acceptance…

The hospital I work for has a uniform policy. As nurses we wear ceil blue and/or white. I hated the idea of uniforms… At first.

Now, I kind of like the fact that each department in our hospital has a uniform.

Yeah, it surprised the hell out of me too!

It helps me know who I’m talking to or who just walked into my patient’s room. I’ve often had patients say, “the doctor said I can have something to eat!”, however I haven’t seen the docs come onto the unit. Now I’m trying to figure out who my patient was actually talking to so I can find out what was actually said. With everyone being in uniform I can ask my patients “what color uniform were they in?” I cannot tell you how many times I’ve asked that question and then find out it was xray technician that came in to do the morning portable chest xray that the patient talked to! For a lot of our patients, anyone in scrubs is a doctor.

The fact that I can identify a department just by their scrubs is a real help and as much as I hate to admit it, uniforms made things a lot easier. I only have one big complaint, THESE COLORS!!!!

I despise the ceil blue/white combo. I would really prefer a darker color. Something like a hunter green or a navy blue would work for me but it is what it is.

So tell me, what policy did you initially hate that you’ve learned to accept and perhaps even like?

Building rapport with our patients

Last week I attended a conference on leadership in nursing. As a nurse not currently in a leadership position, I felt a little out of place. The early part of the conference focused on things like engagement surveys and other data points that Press Gainey uses to come up with patient and nurse satisfaction, basically, a lot of things that sort of went over my head. I saw lots of the nurse managers nodding and discussing. I’ll pass. I am not really someone that is big into data points and graphs.

One of the speakers from the second half of the conference shared information that really stuck with me. His presentation focused on building rapport with people, especially our patients. He began by talking about active listening and why we suck at it. According to information he presented, the average person speaks 125 words a minute. That blew my mind! 125 words seems like so much! He presented another point: our minds think far faster than that, that is why we suck at active listening. Our brains are moving too fast and we get to a point where we are no longer listening to understand, we are listening to respond. Makes sense, right?

He instead told us to listen for three things from the patient you are speaking to:

  1. Values- what in this conversation is most important to the individual?
  2. Hopes- what does the individual hope to gain from this conversation?
  3. Fears- what, if anything, is the individual afraid of?

Being able to touch on those three things in a convo with a patient can make them feel much more at ease. This shows the patient you were actively listening to what they had to say and that you were actually engaged in the conversation. That is the feeling I strive to give to my patients. I want my patients to feel like I care when we are talking. Sometimes, all a “difficult” patient needs is someone to take the time to listen to their concerns. Whenever I can, I try to be that person.

My first nursing convention

By the time this blog posts I will have gone to my first nursing “convention”. It’s a one-day event sponsored by my hospital but it is a whole day of speakers and learning related to leadership in nursing.

It’s actually meant for nurses already in a leadership positions but being a leader is something that interests me and I would like all the help I can get. I want to become someone that other nurses can look up to. While I don’t really plan on managing a unit or anything like that, I do plan on obtaining an advanced practice degree and I want to be a leader in whatever field I decide to go into. I have worked with and under great leaders and I have worked with people in leadership that I wanted to stab in the eye with a pencil (I have been a mental serial killer quite a few times!) I don’t want to be the person that someone else wants to stab in the eye lol!

I don’t feel like leadership=management position. Leadership, in my opinion anyway, has more to do with the person and less to do with the position. Some of my coworkers have been amazing leaders. Whether we have two codes going on simultaneously, admissions and discharges back to back, a super sick patient that is trying their damnest to circle the drain, or my personal fave: the wife and girlfriend trying to visit the trauma patient, there have been nurses that I worked with that immediately jumped in. They took the lead in the situation and helped turn chaos into control. I will say that in my experience most of those in management would have floundered in those very same situations. If you think about it, it is far easier to manage people than it is to lead them. You can’t be a leader while simultaneously saying “do as I say, not as I do”. At that point, a bad precedent has been set. I feel like a leader is going to search for the right way to do things and if they don’t know the correct way, they have no problem asking others for help. Leaders can provide positive feedback but also know how to provide constructive criticisms. The managers I have typically come across seem to be able to do one or the other, rarely both. That’s not to say I haven’t worked with management that wasn’t super badass. I will never forget one manager, Ron. He seemed so intimidating until I actually had to escalate a situation up to him. Long story short, I was working under “leadership” that wanted to be on a friendly basis with the team instead of lead the team. A certain situation continued to occur that ended up slowing patient flow. The supervisor didn’t want to step in because they didn’t want to hurt feelings. Well, you know me, I escalated beyond them to management. I remember exactly what he said to me when I walked into his office to complain “Shaunelle, don’t come to me with a problem without a solution.” We spoke and surprisingly I had a solution in my head without even realizing it.

His words changed how I handle situations to this day.

To me, that’s leadership. I want to be like that one day. I want to be able to not only provide solutions for my team, I want to encourage others to find solutions for themselves. So, off to the nursing conference I go. Hopefully next week I can come back and share some of what I learned.

Decisions

I think I finally made my decision about going back to school. I completed my bachelor’s degree last year and have been on the fence about getting my master’s degree. Is it worth it? What path should I take? I just couldn’t make a decision.

I think I know what I am going to do. I’m going back to school.

At first, I planned on either following an education or leadership path. I think that is going to change. I’m going to try to get into a nurse practitioners program.

After talking to lots of other nurses that are currently in school, nurses with their master’s degree already, and lots of research, I realize my career path is far more flexible if I have my advance practice degree.

I think I stayed away from the idea of an NP program because I had a very narrow idea of what nurse practitioners can do.

My views are changing. Being around a lot of wonderful NP’S in my career had shown me they do a whole hell of a lot. NP’S make a difference. I want to make a difference. I think I’m going to really give this a shot…

Almost on time

We have all worked with that one nurse that is almost but not quite on time. You know the one, they come in about 5-10 minutes late, they still need to go put all their stuff away, they still need to get their coffee (or they come in with their Starbucks cup and now you know why they are late), they need to get their report sheet, they stop and talk to other people, and they need a moment to complain about their assignment. It’s like 7:15 before they get to you. Meanwhile, you just had the shift from Hell, missed lunch because your patient couldn’t decide if they were ready to die or not, and you just want to go home.

That nurse drives me nuts!

I hate being late to work (though I am late just about anywhere else) because I know someone is waiting for me to arrive. I just think it’s rude. I do understand, however, that crap happens and sometimes being on time is just not on the menu that day. I get it, really I do. But that one nurse that can never seem to make it on time? Yeah, I don’t get that. I also don’t understand how they can walk in late and then still take their time getting report!

Yeah, no.

There are ways to deal with nurses like that.

When I knew I would be giving report to a certain nurse I would go ahead and write my report out. I mean, I would write a report that my nursing instructor would be proud of. As soon as they came rolling in (10 minutes late of course) I would catch them. “Hey I wrote out my report, I will be in the break room getting my stuff if you have any questions.” This was typically met with a blank stare but I really didn’t care. Now, I didn’t do this with every nurse that was running late, just the one(s) that I know are like the one I described above. I dont have time for the foolishness!

If I didn’t write out report I still caught them as soon as they made it onto the floor. No they aren’t stopping and talking to another nurse. No they aren’t going to stand and complain about their assignment. No I don’t want to hear about why they were late (yet again) this time. Not today buddy! When they hit that floor they are ready to go in my eyes and I am walking up, cutting right into whatever nonsense conversation they are having, and letting them know I am ready to give report. Glare, stare, I don’t care. I am done with my shift and it’s time for me to go.

If you are that nurse, the one that strolls in late and then takes your time coming to get report, I hope you finally get written up. I hope one of your tires is flat when you get off work. I hope Starbucks runs out of every flavor of coffee that you like. I hope that your patient has to has every scan possible and you have to travel from procedure to procedure all day. I hope your new admision is a hot mess.

Oh, and I am not back so you are going to have to give report to a whole new person…

Yep, I’m petty like that.

I’m a nurse, and the worst patient

I am a nurse. I am very proud of that, I mean, I have a whole blog dedicated to being a nurse!

However, I am the worst patient.

Lately I have had to be a patient far more than I want to be. (Here is a link to my blog post on why I have had to be a patient frequently.)

I don’t know how to stop being a nurse and sit back and be the patient. I don’t know how to shut up and listen. I want to talk. I want to tell the doctor what I know. I want to be in charge of my care. I want to be the nurse.

I don’t like not running the show when it comes to my own care. However, this situation is aggravated by the fact that I don’t even know what is going on with my health. I feel completely helpless… and humble. I now understand the fear my patients have when they are coming to get scanned. As you all know, I work in radiology and a majority of the patients I work up are there to get scans to either see if they have cancer or to see if their cancer has spread. They are coming in dealing with the unknown. The fear, the anger, the tears, the blank stares, I understand why my patients exhibit so many emotions. It’s the unknown. I am going through it now and I am pretty sure I have gone through a lot of those emotions. I am blessed to not have cancer but having to go from seeing a family doctor, to a pain specialist, and now to neurologist, all because I have spreading neuropathy is scary. I don’t know what is wrong with me and as a nurse that drives me nuts.

I am a nurse, I help people get as healthy as they can. My job is to literally fix people and yet here I sit unable to fix myself because I don’t even know what’s wrong. I feel so helpless. I want someone to say “This is what is wrong and this is how we fix it”. I want to fix myself like I fix everyone else. I want to nurse myself back to health.

I don’t even know where to begin so friends I ask: do you have any suggestions for not going crazy as I work through this?