Pacemakers?

My hospital is one of the few in our area that will perform an MRI on patients with pacemakers.

It makes me nervous.

I KNOW it’s supposed to be considered “safe” now. The newer pacers and defibrillators are being made to be compatible with MRI scanners.

It still makes me nervous.

I just don’t feel I should be throwing a person, with a magnet sensitive device, into a giant magnet. I feel like it’s a risk everytime I do it. Is an MRI of the wrist really necessary on this 79 year old man with a pacemaker/defibrillator combo? Like, is this life or death? Are you going to do surgery?

No?

Then why are we taking this risk?

I just don’t like it.

Do any of your facilities perform MRI’s on patients with pacemakers or defibrillators?

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“Exceeds expectations”

So, it’s evaluation season. Doing my own eval is uncomfortable for me. It feels like I am tooting my own horn, so to speak. I don’t like talking about myself. I don’t want to sit down and tell you about the great things I’ve done over the past year.

So, I sit down for my eval with my manager… As we start going over each section she tells me the ratings she has given me.

They were all “exceeds expectations”!

What?

I have been a nurse nine years. Every eval I have gotten was rated “fully meets”. I was always content with that. However, for the first time I exceed. My manager started mentioning all the things I’ve done that’s she’s noticed. She gave me compliment after complement for the care I deliver. I honestly didn’t know she paid that much attention. She manages over 100 nurses, she’s always on the move. However, she makes it a point to stop by our department and check in on us. She is always available. To be honest, she’s the best manager I have worked for. To know that with all she is doing, she still noticed my hard work, it felt great.

My actions are not so that I can be noticed. I just do what’s right for the patient. Ultimately, that who we are here for. I never thought I was going “above and beyond”.

It was a great feeling.

I’m in the right place. I’m definitely in the right place…

Does nursing education need an update?

I am going to share my thought on nursing education:

The way nursing teaches feels like it’s 20 years behind.

There, I said it.

What we are teaching our students and how we are teaching them is outdated.

I graduated with my Associates in nursing almost 10 years ago. Why in God’s name did I have to calculate drip rates? Not once in my almost decade of being a nurse have I EVER had to calculate a drip rate! In fact, most hospitals prefer meds to be given through the IV pump to help avoid mistakes in how fast an IV medication is given. Another thing I learned in school that is absolutely obsolete is how to give the “perfect” nursing bath. Let me just tell you that the bath you are taught and the bath you will be given are not the same. No one has the time to give this elaborate bath and many facilities are moving away from basin baths and moving towards the chlorohexidine wipes. However, those are mminor things that need to be updated.

What I really am appalled by is how nursing school made me feel like I would be all on my own. I spent so long trying to memorize every medication my poor brain could store because I was made to feel like I had to know them all. I tried to memorize all the side effects. I wanted to know contraindications, interactions, dosages…

I needed to know it all because I alone am responsible.

Yeah, no.

I have always had a wonderful relationship with pharmacy. I have no problem with calling pharmacy and asking about a dosage, an interaction, how often it can be given, etc. As a nurse you are actually not alone. If all else fails, there are several apps that can be downloaded to your phone that can provide a wealth of medication information (think Epocrates, Medscape, and so on).

And that is my next gripe, technology.

Why are nursing programs not incorporating the wealth of technology into their nursing programs? Just about eveyone has a phone now with access to Google. This idea that we have to memorize everything because we have no one to turn to is very obsolete. There is literally a wealth of information at our fingertips. We are in the information age and it’s time nursing realizes that.

But nothing, and I mean nothing, is probably more obsolete than those damn careplans! Hours and hours spent writing thorough nursing plans, while thumbing through the nursing diagnosis books and for what? Most careplans are now documented in the online charting systems (Epic, Cerner and such). Furthermore, NO ONE looks at them but the TJC when they come to visit!

Something is wrong with nursing education. Many Associates prepared nurses are coming out of school with plenty of knowledge on how to complete tasks. A lot of ADN programs teach tasks with no real time spent going over critical thinking. There are Bachelors prepared nurses have all the knowledge of theory and delegation but no real idea on how to apply that knowledge in the real world.

This is a problem. We are hammering nurses with knowledge and theory but not showing nurses how to apply what they have learned with REAL patients. Don’t get me wrong, as individuals providing health care we need the knowledge we are given. However, we need to learn how to teach nurses to apply what they have learned. We need to learn how to teach nurses how to reflect and resolve when problems do arise. This idea that nurses have to do it all and be perfect needs to die. Quickly.

Our future nurses deserve better.

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.

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?!