April 1st

It’s coming.

April 1st.

No, I am not worried about April Fools Day.

I start graduate school. I make that first step towards my Master’s degree. I take that big leap back into school.

I. Am. Terrified. I don’t know why. I feel like I’m not ready. I feel like I have gotten myself in over my head. I feel like I am not good enough for this. I know this is my anxiety talking. This isn’t my first time dealing with the panic and self doubt that comes with anxiety. Anxiety stopped me from going back to school before now. Anxiety almost stopped me from taking the job I have now. Anxiety has awoken me from my sleep with my heart racing for absolutely no reason. True anxiety is no joke. It’s not easy for me to admit that I deal with depression and anxiety. I am the nurse that has it all together. I am the nurse that other nurses vent to. I am the nurse running a blog giving advise to other nurses. I am the nurse that has mental health issues.

I am not going to let anxiety win though. Yeah, I am scared sh*tless, I won’t lie. I feel like I might have made a mistake. However, I am still going to log into my student portal on April 1st and begin looking over my first assignment. I am the nurse that is going to have her Master’s in two years because I am the nurse that refuses to give up.

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Unnecessary

I almost lost my temper.

One of the anesthesiologist does NOT know how to talk to people.

It feels like she is being condescending at all times. I get it, you’re a doctor. I respect that. However, it’s totally unnecessary to speak to people in that manner. I am a nurse. If you talk to me instead of at me you would know I have plenty of nursing experience. I know quite a bit more than you give me credit for. I am fully capable of the tasks that are required of me during this anesthesia case. I can do whatever you need if you just ask. Contrary to popular belief, nurses don’t read minds.

I’ll say this, she has one more time to speak in her condescending tone. One more. While I am going to be professional and respectful, I’m going to put her in her place. I’ve had to do it with plenty of residents and a few attendings. This isn’t new for me, I know how to get my point across. She needs to be knocked off the pedestal she placed herself on… I’m just the one to do it.

Appreciated

A while ago my nurse manager came down to the department I was in to check on me.

My nurse manager came to check on me.

The day was turning into a hot mess and I had to get help from our sister nursing department to help get things back on track and help me put out the flames. After things started to calm down, my nurse manager came down to where I was to check on me and do you know what she said? “Fred, I am so glad I hired you.”

Say. What?

Did… Did she just show appreciation for how hard I was working?

HOLY HELL MANAGERS DO THAT?!?

Turns out, good management does. I cannot even count how many times either my nurse clinician or nurse manager has popped up in the department giving us updates or just checking in.

I have never really had that happen before. In fact, I was so unused to it that the first time my nurse clinician came down to the department checking in I thought I was in trouble! I really thought I had gotten reported for something and was about to be written up! That is how little I was used to seeing management (unless they were asking if we updated our whiteboards).

I was talking to another floor nurse, in fact, the one from the last blog, and telling her about management coming and checking in and she was also flabbergasted. She, too, was only used to seeing management whenever there was an issue.

That’s sad.

I don’t place 100% of the blame on management, though. I know they are encountering the same problem. Their higher-ups only want to discuss what they are doing wrong, give them unrealistic expectations, and unrealistic time-frames to complete the unrealistic expectations. Meeting after meeting they get bombarded with complaints. It’s a miserable existence and I can totally understand why so many nurse managers leave the job.

This is a bigger problem with how hospitals are a business focused more on numbers than patients. It trickles down. Miserable management creates miserable staff, and that leads to the high turnover rates in the nursing field.

No one feels appreciated and that needs to change.

I am lucky enough to work in a department where I actually feel appreciated. Yes, we have our foolishness just like every other area in the hospital. However, I find myself far less stressed in this position. I want more nurses to be able to feel this way. I want it to get to a point where seeing management becomes a positive thing. I wonder how we, as a group, can change this?

That’s… unfortunate

A majority of my patients cannot read and know nothing about their medical care.

That’s… unfortunate.

In fact, it’s scary.

My patients have to fill out a checklist before having their MRI or CT scan. It asks numerous questions about prior procedures and certain health issues.

So many of my patients can’t fill out the questionnaire. In fact, a lot of my patients don’t even know why they are having the scans! They are here because they have an appointment. They don’t know which doctor ordered the scan, what is getting scanned, or what the particular doctor even does for them. It’s sort of the mindset that “if the doctor ordered it then I should do it”, no questions asked.

That is frightening. Those of you that have been following me know I am big on patient education. With how fast paced my department is, I don’t have the time I would like to have to educate patients. And let’s be real, at this point I can’t teach someone to read. I guess what is so disappointing to me is the fact that it’s just glossed over. It’s accepted. The lack of patient education, understanding, and participation has become the new norm. I can’t stand it. I want patients to understand what is going on. I want patients to be a part of their plan of care. I want patients to be set up for success.

Apparently, I want to live in the NCLEX world where everything is perfect and everything runs smoothly.

I want my patients to be happy and healthy. Sometimes I feel like I am being unrealistic.

 

Burn out

I had a nurse shadowing me that was applying for a position in radiology. She seemed very nice and very knowledgeable. She is currently working at the bedside and decided it was time for a change. We began conversing about the job I currently do and how different it was from bedside nursing. Let’s be honest, my job can have chaotic moments but for the most part it is chill. I wanted to hear more about what made her want to transfer into our department.

Surprise, surprise… She was burned out. She started sharing why she was burned out. She felt unappreciated. She felt mentally exhausted. She was frustrated. I knew exactly how she felt. We swapped stories of our nights of hell. She was curious as to what made me leave the ICU and transfer to radiology. I was honest… I was burned the hell out at the bedside! I worked bedside for eight years. Eight years of endlessly cleaning poop, call bells ringing simultaneously, angry family members, unsafe staffing ratios, little to no lunch break, and management asking “did you update you white boards?”. I realized I was just over it. Now I will say this: I loved working in the STICU. It was hell on wheels some nights but I learned so much.

And that’s the thing, I feel like walking through the nursing “flames” made me a better and more rounded nurse. At this point I can handle just about anything you can throw at me. Being a beside nurse is what really made me a good nurse. While it was stressful, I don’t think I would change anything if I could go back in time and do so. However, I realized I was done and exited bedside nursing stage left.

I recognized I was burned out. I felt it. I could see the change in my patient and family interactions. I literally drove to work with anxiety because I just KNEW the night was going to be a sh*t show. I had to take benadryl just to sleep. Things were not okay. So I made a change. It looks like she is ready to make a change. I commend her for recognizing that. In fact, I commend any nurse that recognizes they have reached the burn out stage. More than that I deeply respect nurses that not only recognize they are burned out, they start making the necessary changes to beat burn out. Know when you feel burned out, it is okay. It is just fine to leave the situation you’re in. You are not running. You are not “abandoning” anyone. You are doing what is best for you.

Have any of you (nurse or not) ever had to leave your job because you knew it was making you miserable?

Disconnect

Have you ever had one of those shifts that you take home with you?

You know the one… Maybe a patient died despite you giving your everything yet you still feel like you could have done more. Maybe you stood up for what was right and got belittled by the doctor anyway. It’s one of those shifts that just doesn’t go away when you clock out and leave. How do you disconnect from those shifts?

What do you do to not let shifts like that drag you under? How do you keep it together and stay sane?

Being in the department I am in now, I haven’t had one of those shifts in a while. I can still remember having those shifts while I worked in the ICU though. In fact, I still can’t listen to “Fight Song” by Rachel Platten. I can still see the mother of the patient holding the phone to her 16 year old daughter’s ear. I can hear the song playing from the room. I can remember how heavy my heart felt knowing how hard her mother wanted her to fight. I remember how much it hurt to know her child’s injury was so severe that she would not survive.

Things like that stick with you.

Over the years there have been many shifts that I have taken home. There were shifts that almost broke me. It wasn’t until years into my nursing career that I learned how to disconnect… And not feel guilty about it. That was the other thing, I felt guilty about turning “it” off. I felt like when I tried to leave work at work I was not being a “caring” nurse. I felt like I was being cold and heartless. I had to learn that in order to continue to be a caring nurse, I had to mentally and emotionally take care of myself first. I couldn’t give from an empty vessel. I had to really practice some self care.

So now, I read. I write. I go jogging. I cook. And for the love of all things good, I use my PTO! I’m taking time off dammit! I may not go on vacation but I am a full believer in the “staycation”.

What do you do to keep yourself sane?

The future

What do you think we will see in the future with medicine? We seem to be making advances everyday. To me, that is a great thing. The further we advance, the better we can treat.

I have been a nurse now for eight years and just in this amount of time I have seen medications be introduced and then recalled for some side effect they weren’t anticipating. We now have a cure, a cure for hepatitis C! How wonderful is that? I have seen advances in procedures. I have been trained on new medical equipment because what we were using was considered obsolete. I can only imagine the changes nurses that have been working for decades have witnessed. I would love to just sit and listen to some of those stories!

Of all the advances there is one that I am waiting for most of all: a cure for cancer. I lost my mother and my grand-mother to cancer. I talk to patients all day that are here to get scans to check if their cancer has come back or spread. It is personal to me. I want cancer gone. I don’t want to see another child with a brain tumor. I don’t want to see another woman with breast cancer. I don’t want to see another man with prostate cancer. I wish cancer could get cancer and die.

I have this naïve little hope that in the next ten years or so someone, somewhere, is going to be the one to achieve that break through. I have this hope that I will turn on the news and hear the broadcaster say “scientists have finally found a cure for cancer!”. I keep hoping that the cure will happen in my lifetime.  I am only 35, I hopefully have plenty of years left in me. Come on scientist, do this favor for me ok?!

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.