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…

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Decision made…

So…

If you remember some blogs ago, I posted about applying for NP school.

I didn’t get in.

sad failure

I felt like sh*t. I felt small. I felt insignificant. I felt like a failure. I was super bummed about it.

Was…

You know how you make a plan and then allow the opinions of others to make you veer from your plan? Yeah, that happened. Let’s go back a little, shall we?

If you have been with me for a while then you know I have been wanting to go back for a Master’s degree for quite some time. I have bounced between where in the nursing field I wanted to specialize. I have had people tell me I would make a great teacher. I love teaching people about things I know. Teaching is something I have grown to really, dare I say, love. Months ago I was talking to one of my coworkers that has been a nurse forever. I told him about wanting to get my DNP ultimately. His response? “Great! Get your MSN in education and then come back here (the academic hospital where we work) and get your DNP! You’ll make a good teacher”. Prior to even talking to him, the “education” path had been floating around in my mind. I kept pushing it away because according to everyone else, that’s not the “money making” field. As far as most people are concerned, there’s no reason to go back to school unless it’s to get a degree that is going to make you way more money. Forget doing what I like to do. Forget wanting to make a difference in the medical field. Forget wanting to help others. Will it make me more money?

I got sucked into that mindset.  A DNP will make me more money and I need to get it now. Forget getting an MSN and then a DNP, that’ll take too long. Nope, I’m going BSN-DNP STAT!

I was introduced to a program that had the BSN-DNP option. Great! I expressed interest and quickly found out I did not have the GPA currently to do the DNP program.

denied

I could do one of the NP tracks though. Oh… Okay, I guess. I mean, I wasn’t really looking to be an NP but according to everyone else, it was the way to go. So I applied for the NP option. I filled out the application (3 times because the system kept losing it which was probably my first red flag), updated and sent in my resume, completed the essay, and got glowing references (which I ended up having to scan to my email to send to the advisor because the reference link wouldn’t link back to my application because of a glitch, second red flag), and I waited…

And waited…

And waited…

For four weeks.

And then the rejection email and the pity party.

So after all of that, I had to really sit down and think all of this through.

What do I enjoy doing? Where do see my career going? How do feel I can be the best benefit to others? What do really want to do?

I. Like. Educating.

DAMMIT SHAUNELLE, YOU’RE AN EDUCATOR!!!!

I am planning to start school in April. I got accepted into an MSN in education program at the same university that I obtained my BSN from. I should have my degree in about 1.5-2 years if I can buckle down and do this full time. I am not doing what everyone else wants me to do. I am not going for the big bucks (if I wanted big bucks nursing is probably not where I should have headed anyway). I am going to do what I feel is going to make me happy in the long run. It may take an extra step or two but I am going to do things my way.

 

 

 

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!

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?

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.

Preceptor behavior (how not to be an asshole)

I have been the orientee and I have even done a little precepting. I lucked out so far and had wonderful preceptors (except for one but anyway…) but I have seen some TERRIBLE preceptors.

One thing that I noticed from a few of the preceptors that I would definitely label as “assholes”, is that they take pride in being intimidating to their orientee. I have witnessed this behavior and have had other nurse confide in me about their preceptors after they were out of orientation. Some of the things I heard were appalling.

It is NEVER okay to make your orientee feel “dumb” or “stupid”. You were a new nurse at one time and you didn’t know everything when you started, you had to be taught as well. You know what else is not okay? It’s not okay to just leave your orientee to fend for themselves. You are not on vacation, you are responsible for teaching this new employee the ways of your unit. Get up and check on them, make sure that they are actually alright. STOP USING THE AMBUSH TECHNIQUE!!! For those of you that don’t know what the ambush technique is, let me fill you in on this bs. Basically what happens is the preceptor ambushes the orientee when they aren’t prepared for it and starts hammering them with questions of “things they should already know” in the eyes of the preceptor. Do I know the normal range for a CVP? Yes, I do. Do I know the normal range for a CVP when you show up out of nowhere, while I am catching up on charting on a patient that I just had to start on norepinephrine and give two units of blood? No, absolutely f*****g not! This does not mean I am less intelligent than you, it means I was focused on my charting and not expecting a nursing ambush! The ambush technique neither proves nor disproves someone knowledge, it just makes you look like a douche. While we are at it, stop making your orientee feel like they are bothering you when they ask you questions. They don’t know. You do. Spread the wealth of knowledge. Learn how to give constructive criticism and praise. A lot of preceptors seem to miss that last part. Your orientee is already paranoid and trying to be a close to perfect as possible. Let them know you notice the good things they do along with the things they may need to work on. Your orientee will be much more receptive of your criticism, trust me.

Look, i’m not asking for a lot. I am simply asking you to remember what it was like when you were orienting. Remember how stressed you felt. Remember how confused you were. Remember how intimidating it was. Remember that you aren’t perfect.

n00b

So you’re the newest person on the unit. You may not be new to nursing but you are new to this place. Don’t let that freak you out.

As the newbie I was always really quiet and reserved. What I didn’t realize was how off-putting that was to others. It never failed, once I got to know my coworkers they would all say the same thing “I thought you were so mean when I first met you!” For the longest time I didn’t understand why that seemed to be the case. You know me though, if I don’t know then I’m going to ask. That is when I found out that I sort of appeared unapproachable because of how I tended to distance myself from my new coworkers. I changed that once I started the new position I am currently in. This time I made a conscious effort to get to know my coworkers.

Here are a few steps to transition into your new work environment:

  • Introduce yourself to your new coworkers. If you know of a good ice breaker then use it (having the name Shaunelle but being called Fred is one hell of an ice breaker, everyone loves the story of how I got my nickname.)
  • If you are an experienced nurse understand this: your experience is much appreciated but you are the new nurse on the unit. Don’t walk around like you already know everything there is to know. You may know cardiac ICU but you don’t know how they run their cardiac ICU. Have a little humility (ran into this with a new coworker, she didn’t last long).
  • Don’t be afraid to ask questions. It is safer to ask than to assume you know what you are doing and then do it wrong. Your new coworkers will remember that screw up, trust me.
  • If you are a super proactive person, join one of the committees. You are bound to meet your coworkers that way.
  • Become familiar with your physicians and introduce yourself to them. Let them know you are new to the unit, I mean you will be working with them too.
  • Know that not everyone is going to warm up to you immediately and that’s okay. They may still be “feeling you out” so to speak. That is not your problem, that is theirs. They’ll either come around or they won’t. It’s not the end of your world. However, DO NOT allow bullying behavior towards you. You may be the newbie but you deserve respect and if they want it from you then they should earn it. Forget that “nurses eat their young crap”!

Those first few weeks, hell even first few months, are a weird time. You’re trying to adjust to a whole new setting. Things may feel off and that is normal. You may feel a little out of place at first, and that’s normal too. Give yourself time to get acclimated to your new surroundings, you are going to do great!

Teach back

Get your patients to “teach back” what you have taught them. Get them to repeat what you have taught them. You may be surprised at how little information your patient has absorbed from the education you have given. Using the “teach back” or “repeat back” method can help you gauge just how much information your patient is retaining.

With the “teach back” method, it’s exactly as it sounds. You get your patient to teach you what you taught them. This method is really effective for education that involves hands on training. Things like changing a colostomy bag at home, changing a wound dressing, giving tube feeds, doing peritoneal dialysis, etc all require a lot of teaching. These are thing you want to make sure your patient understands before they return home. When you get them to teach it back to you then you know that they have an understanding of the information they have received. As they are teaching it back, you can correct them if necessary and give them little hints to help them with the process.

“Repeat back” works well with information that may not require as much hands-on work. I found that it works well with my patients that are being sent home with multiple prescriptions, especially different inhalers. I had a patient with COPD and asthma (and yes, she still smoked, how did you know?) that had both Symbicort and an albuterol inhaler. She ended up on our unit from a bad asthma attack. When she started to get wheezy I took her the albuterol inhaler to help open her up and she refused. I couldn’t understand why. She said “that’s not the one I need for my asthma, I need the other one”. Confused, I asked her if she was referring to her Symbicort. She said yes, that’s the one she takes when her asthma flares up. She took her Symbicort whenever she felt tight or wheezy and took her albuterol twice a day. OH, nooooooow I know why you’re in here. I tried explaining to her that the Symbicort is for her COPD, not asthma. She argued with me for a good 10 minutes that I was wrong. I had to not only print out information on Symbicort but also have the doctor talk to her before she accepted that she has been using her meds wrong this whole time and that is why she was in the hospital. Upon discharge I made her repeat the education I had given her and show me which inhaler was her twice daily inhaler for COPD and which inhaler was for her asthma. I felt comfortable that she understood her meds upon discharge.

I think this teaching our patients about their health is where the medical system is lacking. Often, we are in such a rush to get people out so we can get people in that we just assume the patient understands because they didn’t ask any questions. Often, it’s the opposite. Some are embarrassed to say they don’t understand. Some can tell we are in a rush and don’t want to bother us by asking us to repeat what we have told them. It is up to us to make sure our patients are leaving with a full understanding of their health and their medications.

Constantly learning

A little while back, while I was still a STICU nurse, I decided to start a little notebook where I would right down new diseases/diagnoses/medications I came across during my shifts so I could look them up and learn about them. I was afraid when I transitioned into an imaging nurse I was not going to really be “learning” anything new. I’m just going to start IV’s and monitor for contrast reactions.

I was wrong.

People get MRI’s for all kinds of reasons. I have probably come across more diseases that I have never heard of in this position than I had the whole time I was in the ICU.

It’s been a constant learning experience. I start looking up the disease the patient is diagnosed with (which is the reason they are coming to MRI in the first place), and that leads me to another related disease, which leads to a new study, which leads to a med I have never heard of, and so on.

I’d never heard of MGUS, plastic bronchitis, or a syrinx. Came across all of those in MRI. I assumed that I need to be bedside to learn anything new in nursing. That’s not the case at all. As long as you are providing patient care you never really stop learning…

On my own

This was my last week of orientation in MRI nursing. Starting Monday I’ll be on my own.

I’m nervous.

It’s not that I don’t think I can do the job. Compared to getting my ass handed to me in the STICU, this is going to be somewhat less stressful. It’s the fact that procedural nursing is new for me. I’ve been bedside for 8 years now. I’ve always been in charge of the patient because they were “mine”. Now I’m dealing mostly with outpatients. I also deal with kids. As you all know, I don’t do kids, they make me uncomfortable. I will still have inpatient contact but while I am responsible for their safety while in MRI, they aren’t mine. I have to remember that my contact with them is as a MRI nurse and not as their primary nurse.

That’s a little weird for me.

It’s also kind of nice. Patient being a douche? I can send them on their way. Patient too confused to hold still for the MRI? Back to the unit for you buddy.

Not going to lie, it’s fabulous not going home with back pain everyday.

I think I’m going to like finally being on my own, you know, once I get over the initial shock of it.