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…

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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…

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…

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.

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.