Team

You need a team.

If you’re a nurse, you need a good team. There is no way to survive on any unit without team work.

When you interview for a position, ask about the team work. How well do the nurses work together? How is bullying handled?

You’ll want to know these things. A unit that isn’t a team is a unit headed to hell in a hand basket. It can’t function effectively. Trust me, I’ve worked on units where it was every nurse for themselves. It was horrible. There were nurses that wouldn’t help with the new admission. It took an act of congress to get someone to help clean up a patient. Gossip spread like wild fire. Nurses ate their young for fun. It was two years of nursing that I never want to experience again. From that point on I decided I would not waste time on units like that.

That’s why finding about the team mentality is so important. You want to work somewhere with nurses that work together. You want to work in an environment that is not toxic. Regardless of how the shift is going, you want to know your coworkers have your back.

Nursing isn’t a solo job. We aren’t super heroes that can handle everything on our own. We have to depend on each other to get through the day. When the shift is nuts, you want someone you can vent to. When you aren’t able to save the patient, you want someone that understands the pain. You’ll want someone you can ask questions to that won’t make you feel like you’re stupid. You’ll want a team.

Do yourself a favor, find a good place to work.

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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!

Pause and plan

All hell is breaking loose.

It looks like it’s not going to get better any time soon.

You are really close to the point of tears.

Pause. Breathe. Let’s plan this out.

It’s time to break out those critical thinking skills and use that time management you have been developing.

Look at the situation as a whole, is it as complicated as it seems? Can things be broken down into multiple manageable tasks instead of one giant ball of “what the actual hell”?

Start thinking. Which patient is the most critical? Can someone check on your other patient while you attend to the patient circling the drain? (You know what, the cup of ice is going to have to wait.) Which tasks are the most important? What tasks can be delegated? Do we really need to go to CT right now or can we see if we can push it to a later time when things are a bit more calm? So there are 5 patients in the waiting room, they all came at the same time. All of them are here for their scan. That’s great but you only have two scanners so let’s take each patient one by one.

The point is this: you are one nurse. One. Singular. Nurse. You CANNOT do everything at the same time and that does not make you a failure. Don’t panic. Take a moment. Pause and plan. Use your resources. Who can help you? Align your tasks from most important to least important. Tackle what is most important first.

More importantly understand this: there are only so many hours in your shift. There is only so much you can do. If you have to pass on a task or two, don’t feel like you failed for the day. Nursing is a 24-hour job. You are not super-human. Sometimes you can’t do it all. Understand that’s okay.

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?

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?

 

 

 

 

Real nurse?

In a conversation I had someone ask me if I was a “real nurse”.

Yeah, let that sink in for a moment.

Here’s what happened:

I was having a conversation with an individual and they asked me what I do, I told them I’m a nurse. Their response: “so are you a real nurse?”

This was my exact face:

I had to ask what they meant by “real nurse”. Their answer? “You know, a real nurse like ones that work in a hospital and not in a nursing home or doc in the box.”

Of course you know this means war…

I ask why those nurses aren’t real nurses. Apparently (according to this person) those nurses don’t really do anything but take vitals and give meds.

Oh really?

OH REALLY?

To people who think like this I have a question, CAN YOU DO IT? Can you be responsible for the safety and welfare of multiple patients, often at the same damn time? It was a real nurse that took care of you at Patient First when you caught the flu. It was a real nurse that got punched in the face by your demented Nana. It was a real nurse that handled your kid’s GI bug that you brought him to the doc in the box for. It was a real nurse that has been the only person some of these elderly assisted living patients get to talk to since you haven’t visited Grandpa in 3 years.

WE ARE ALL REAL NURSES.

Needless to say, I am an advocate for my nurses.