Guilt

I’m on school break and restart October 1st.

I didn’t have to take a break because of life events or anything like that. I am on term break until classes restart. I finished my 4 classes for the first term and had 5 weeks left until next term starts. If I had finished my last class a little earlier I would have had 6 weeks left which would have been enough time to add in another class. Since there, technically wasn’t enough time left, my advisor told me to take a break until the next term starts.

OK, cool, I earned a break…

Yet I feel guilty… Anxious. I feel like I should be doing something school related right now. I feel like I should be logging in to see if I can get the requirements for the next class. Not doing something school related makes me feel guilty.

I shouldn’t feel like this. I know that. However, I’ve been a full-time nurse and full-time student for so long that I don’t know what to do with free time. I’ve been playing Final Fantasy, enjoying friends, I even picked back up on learning how to knit. Yet I still feel this anxiety about school. My mind keeps telling me I am wasting my time and should be doing something, anything related to school… EVEN THOUGH THERE IS NOTHING I CAN ACTUALLY DO!

I hate that I have used school and work to occupy my time for so long that I feel guilt about free time. That’s not fair to me… And now you see why I’m in therapy…

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One down

So, term one is done.

One down, three terms to go to finally get my master’s.

I’m proud of myself. When I started school I really thought I might have been making a mistake. I didn’t think I was ready. I thought I was in over my head. My first paper got sent back and recommended for the writing center because it was so bad.

I had forgotten everything about APA formatting! I felt like an idiot. I took the recommendation and used the writing center for help. My papers are much better now. I feel more like a student, like I kind of know what I’m doing.

I still second guess myself. That’s just me. However, I feel more at ease. It’s tough, papers suck, I’m tired all the time, but I see that I can do it.

I know that it will get harder from here. More 14 page papers, projects to do, and soon, clinicals. I’m going to gripe, moan, groan, curse, and complain. I’m also going to get sh*t done.

I can do this. I’m ready…

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.

No days off

Have you ever encountered this particular situation,

Them: “Hey, when are you off again?

You: “Well I am off tomorrow but I…”

Them: “Oh good because I need you to…”

Or my other personal favorite,

Them:How are you doing?”

You: “Whew, I am worn out! It’s been a long week!”

Them: “How are you always tired, you only work three days a week!!!” 

Seriously? SERIOUSLY?!?!?!?!

Let’s start with the fact that nurses work with people every day we are at work. PEOPLE. Like, human beings… HAVE YOU SEEN OUR SPECIES??? We deal with emotional outbursts, insults, violence, unrealistic expectations, death, etc. ON A DAILY BASIS! It’s not just 3 days, or 4 days, or 5 days, or whatever schedule that we work. It’s the emotional baggage we deal with on days off. It’s wondering if you could have saved that patient if you had done one thing differently. It’s trying to figure out why this one nurse hates you. It’s sitting at home thinking about the child abuse victim that you know will be given back to their parents. It’s thinking about the insults the doctor hurled at you because you weren’t moving fast enough. It’s class assignments due at midnight. It’s the kids having soccer, baseball, and basketball practice the couple of days you have off. It’s 3 weeks of laundry that still needs to be done. It’s a house that desperately needs cleaning because you haven’t had time. It’s never having an inkling of downtime.

It’s constantly feeling like you are walking on a razor-thin edge between success and insanity.

It’s stressful.

The last thing we need is to be made to feel guilty because we are too tired to hang out or because we don’t have time to be someone’s personal errand-runner.

Your days off belong to you. Every single one of them. You deserve to power down. You deserve to do NOTHING if that is what you want to do. You aren’t being “lazy”. You are trying to maintain your sanity. You are not wrong for turning down a night out on the town. You are not wrong for telling someone “no” when they start to come up with your schedule for your day(s) off for you. You are not wrong for shutting out the world temporarily if you need to. You take care of so many people, you deserve to take care of yourself. Nurse yourself back to health. Take your days off and do whatever the hell you want with them.

A nurse that doesn’t take care of themselves can’t effectively take care of others.

 

 

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?

“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…

July…

It’s July. For some of you that’s no big deal. However, if you work in a teaching hospital July means something deeper… Darker…

The “brand new” residents begin their rotations…

Chaos ensues.

If you have had the pleasure of avoiding the July rush, you’re lucky. For the rest of us, there’s a sense of impending doom.

So many orders. Most make no sense.

-pediatric doses ordered for adults.

-level one head CT for “AMS” on your 98 year old patient with known dementia.

-12.5 mcg of fentanyl q3hrs for your chronic pain patient.

-one unit of blood for an hgb of 5.

-MRI of the ankle to look for osteomyolitis of the toe.

Many, many more orders from an alternate reality…

In this moment, it is your time to shine! You are the only barrier between your patient and a doctor that is still getting their bearings. You’re going to have to speak up, a lot. You’re going to have to advocate. You may even have to knock a new doc off their self-appointed pedestal (when they tell you you’re “just a nurse” please refrain from punching them in the throat).

You can do this. Take a deep breath and remember: you’ve made it through many July’s and you’ll make it through many more…

Keep calm

So that one coworker has managed to get under your skin.

Again.

The non-constructive criticism. The passive aggressive behaviors. The gossiping. The outright rudeness.

You have had it. You’re ready to blow a fuse.

Don’t.

As hard as it may seem, take a deep breath and keep calm. Easier said than done, I know. This one individual has made it their mission to drag you, and probably others, down to their level of misery. That’s exactly what it is. Misery. Perhaps their home life is falling apart. Perhaps they are struggling in school. Maybe someone they know is extremely sick.

Or maybe they are just an asshole.

Either way, they bring their misery to work and try to project it on others. It’s not your job to deal with their poor coping mechanisms.

I am not saying you need to ignore their behavior. I am saying don’t let them get you so worked up that you snap. When you snap you look like the aggressor and they get to play the victim. That’s why I want you to stop and take that deep breath. Walk away if you need to. Go take a break in the bathroom. Once you feel you are ready you need to pull them aside, if you’re comfortable, and speak your mind. Let them know you do not appreciate their behavior. Stand up for yourself. Calmly. Respectfully.

Then continue on about your day.

Two things will come from your conversation:

  1. They realize they need to change their behavior.
  2. They take no accountability and try to play the victim.

At this point, you have done what you need to do to handle the situation. If the behavior continues, take it to management. It is their turn to address this person. If you have a good manager they will step in and handle it. Conflict resolution is a part of their job. If your manager sucks, they’ll try to place it back in your hands and make you feel like you need to handle it. If your manager is the latter, take it higher. Make sure you communicate with management (through email so you have proof of escalation) that you are not comfortable with the way the situation was handled. Most places of employment have an HR department. Report the toxic behavior. You aren’t being a “snitch”. You are standing up against a toxic individual creating a toxic atmosphere. You are bringing attention to the fact that the behavior has been allowed to continue. You are taking a stand against lateral violence. You are taking the opportunity to fix a situation that has probably gone on for FAR too long. You are doing what is appropriate to create a positive work environment. You are doing what needs to be done. Take pride in that.

If you need to distance yourself from the individual(s) do so. If you can schedule yourself on the days or shifts they don’t work, do so. If you need to find a better place to work, DO SO. You became a nurse to help people, not deal with coworkers crappy attitudes for 8-12 hours. Self-care can mean removing yourself completely from a bad situation if need be. If you are treating those you work with respectfully, you deserve respect in return.

Keep calm and make moves.

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.

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…