Arch nemesis

Classes have started for me. In fact, I’ve already completed one class. I’m liking the program so far but my fight with my old arch nemesis has reignited:

APA formatting 😒😐

I despise APA. I don’t even understand its point. Margins of this size, very particular page headers, citations that are done *just* so, reference pages with indentions done differently than the actual paper, references sited differently depending on what they are…

Why can’t I just write this damn paper and send it in?!

I get that APA formatting is to help maintain consistancy with how research is published and readability. What I don’t understand is why make it so damn complicated? It almost feels like the creators made it complicated because it made them feel smart.

I hate it.

APA has always been a thorn in my side. I’ve never been very good at it. I find the rules convoluted.

As you can see, I’m already over it…

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Set up… To fail

So, the higher ups have decided to implement new changes in our department to make us more “efficient”.

😒🙄

Are the changes going to work?

No.

I say no, not because I am against change. I embrace change and fully believe medicine is an ever changing field.

I say no because the changes are rigid.

Our department is very fluid. We may not have a single patient one minute, and the next minute 6 outpatients are here and there is an vented ICU patient on the way down and a patient waiting to go back to their room. Our patient flow changes throughout the day and unfortunately the decision makers don’t recognize that. They see numbers. They see productivity. Pie charts and bar graphs.

Patient care just doesn’t work like that.

However, we are going to implement the changes. We will go along with what management wants. We will grumble and groan as we see how poorly the changes work. We aren’t afraid to speak up. The speaking has been done. At this point, we are going along so we can watch the changes fail and create more problems. We are doing this so that they can see how inefficient their decisions are.

Sometimes the only way to get through to someone is to stop talking.

Drug dealers

Sometimes I feel like the health care industry are some of the biggest drug dealers around.

Case in point, the largest drug bust involving medical providers happened just this month. I first heard about it on the news while at work. Of course I had to look into it because I didn’t want to believe professionals in the very field I work in would stoop this low.

I was wrong.

This NPR article gave some numbers that were astonishing. There were almost 60 individuals caught in this bust. The Appalachia region of the US has been hard hit by the opioid epidemic. It was discovered that over 32 MILLION opioid pills had been prescribed in this region. If you don’t know, that’s more pills than there are people in most of the states in the Appalachian area! Doctors, NP’s, pharmacists, even a damn dentist was part of the drug problem. The Washington Post article tells a little bit more about how absolutely unbelievable these “professionals” were. Some traded opiates for sex. One doctor operated a pharmacy in his waiting room. The dentist apparently unnecessarily pulled teeth to justify writing prescriptions! However, the article goes even further with all kinds of things these people were doing in exchange for writing prescriptions. It’s shameful. So many people are dying of overdoses. So many are in our emergency rooms getting narcan to try and save their lives. So many people are on our units going through horrible withdrawal symptoms. Why would anyone in the medical field want to contribute to opioid epidemic?

It seems like the DEA (Drug Enforcement Administration) is starting to crack down on medical field when it comes to opioids. The New York branch of the DEA just charged a pharmaceutical distributor with unlawful distribution. This case is one of the first of its kind in the country. If this works out as planned, I feel like we may start to see more companies held responsible as well as individuals.

It needs to happen. There needs to be some sort of accountability for the medical field. Some of us are a part of the problem, they need to be removed. We are here to save lives, not destroy them!

Stress

I am about to start school. Another one of my coworkers is about to start clinicals for her NP. Another coworker is about to start her NP program. Needless to say, we are all stressed. At least I’m not alone, right?

I decided, however, I’m not going to let myself break under the stress of school and work. I am going to make sure I have some kind of kind outlet.

The first time I went to nursing school my friends and I would go out as a way to celebrate completing a semester. We would dance and let loose. It helped, it gave us a little something to look forward to. When I went back for my BSN my brother would notice I was stressed and drag me to Starbucks or Barnes and Noble (two of my favorite places) to have a moment of of the house. He would also make me do my studying there where there were no distractions (like the TV 😐) to steal my attention. It worked.

So now I’m trying to figure out what my de-stress plan will be for this go round. I know I’ll be doing the “out of house” studying. I think it may be time to bring back the end of semester party night as well! I just know I can’t let myself break under pressure. I’ve got to figure out what my self care will be for this experience…

A new thing

So I’m trying something new for health reasons.

Actually, I’m closing out my fifth week of it.

I removed meat from my diet.

My blood pressure the last few times has been borderline hypertensive. My weight is higher than it really needs to be. I always felt sluggish after eating a meal with a lot of meat. I also felt like it took so long for me to digest.

I know I wasn’t eating the right proportions of meat to vegetables. My meals were always meat-heavy. So I made a conscious decision to just cut it out all together and leafn how to eat the veggies I so often avoided.

My pressure is down closer to normal the last time it was checked. I lost about 3 pounds. One thing I wasn’t prepared for was how often I’m in the bathroom! Fiber, man, fiber! But I can honestly say I do feel better. I have no idea how long I’m going to keep this up. So far I’m not missing meat. I do wish veggie bacon tasted better though. Either way, let’s see how long this lasts…

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.

CIDP

In nursing, we are always learning something new. Sometimes we learn about a new med. Sometimes we learn about a new use for a med. Sometimes it’s a new side effect. Sometimes it’s a disease you weren’t aware of.

As I’m writing this, I just came across a disease I never knew existed: chronic inflammatory demyelinating polyneuropathy.

Say that five times fast!

I had a patient that had an MRI of the brain and complete spine ordered (that’s at least two hours) and the reason was “CIDP”. I have never come across this abbreviation before so I had to hit up good ol’ Google to find out what it is.

Turned out to be very interesting, at least to me.

What is it?

CIDP is rare. It’s a disorder where there is inflammation in the nerve roots and peripheral nerves. It also destroys the myelin sheath over the nerves. This inflammation and destruction interfere with signal transmission. Patients notice muscle weakness, impaired motor function, and it’s typically noticed on both sides of the body.

How is it diagnosed?

According to the rare disease database put together by NORD (National Organization for Rare Diseases), the symptoms of CIDP progress slowly. Patients notice “symmetric weakness of both muscles around the hip and shoulder as well as of the hands and feet”. These symptoms must continue for at least eight weeks without improvement to be considered CIDP. Patients may also undergo EMG’S, nerve conduction studies, lumbar punctures, and MRI’S to help lead physicians to the diagnosis.

Why do symptoms have to persist for so long, you ask? Great question.

Turns out, Guillain-Barré syndrome is kind of an acute form of inflammatory demyelinating polyneuropathy. With GBS there’s typically a preceding virus or illness. GBS progresses over three or four weeks. The symptoms plateau, get better, and don’t re-occur.

The extended period of time is to differentiate CIDP from the acute forms. With CIDP, the symptoms don’t get better without treatment. GBS is usually related to an illness while CIDP doesn’t really have a known cause yet.

How is it treated?

Corticosteroids and immunosuppresants are the standard treatments. According to the NORD article I linked to, IVIG has also been proven effective. It seems that plasma exchange has also been an effective form of treatment. However, both forms of therapy only last a few weeks and the patient may need intermittent treatments.

I spent about an hour reading about this disease because it was so new to me. That’s something I’m trying to make sure I do, read up and learn about the new things I come in contact with here in the hospital. I know I can’t learn everything. That isn’t going to stop me from trying though!

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?

Resolutions

I want to start 2019 off with some nursing resolutions to help me guide my year. I am normally not a person that believes in the whole “new years resolutions” thing because I make the same ones every year and never stick to them lol! This is a little different. These resolutions aren’t about me losing weight or magically getting out of debt. This is me making myself a better nurse. So, here are my “resolutions” (I almost don’t even want to call them that):

  • I am going to make a conscious effort to stop complaining so much at work. I mean, I honestly work with awesome people and my job isn’t that hard.
  • I am going to join some sort of national nursing organization. I want to keep up with standards of practice that are being discussed.
  • I am going to start an NP program. I applied but I keep finding reasons that maybe I shouldn’t do it. I am going to do it dammit!
  • I am going to join and actually participate in one of our nursing committees. I always say I am going to join but I never really do.
  • I am going to start back riding my bike to work so I can get that first bit of exercise in. I actually used to feel invigorated when I got to work but I stopped because of an ankle injury. I have been using it as an excuse ever since.
  • I am going to try and get either my PCCN or my CCRN. I have done 5 years of critical care and I am currently having to do ECCO for progressive care so I might as well get some kind of certification.
  • I am going to try and make sure I provide more positive feedback to my coworkers. Everyone needs to be told they are doing a good job every now and then.

It’s not a long list but these are things I am going to try and carry with me throughout all of the year instead of giving up by the end of January.

I am curious to hear if any of you have some “nursing resolutions ” you plan on trying to carry out?