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?

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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?

 

 

 

 

Story time no. 9

So I need to vent just a hint, ok? Ok.

Tuesday I worked in MRI. There was an ICU patient that needed an MRI of a few areas, after a trauma. No big deal, we do ICU patients all the time.

I do what I normally do, I first look through the chart and then I call and speak to the nurse to see if it is safe to bring the patient down.

The patient is freshly extubated, off sedation, agitated, already pulling out lines, and non-English speaking.

Let us take a moment to remember: this is MRI. You have to be able to hold still for 20 minutes or more so the images are readable. MRI’s typically take a long time. The scans they have ordered for this patient add up to about an hour… An hour that the patient will need to hold still…

Nah, this one shouldn’t be coming down here. Nurse knows this. I know this. Doctors don’t seem to understand this. They want to “give it a try”.

So, this poor nurse packs up the patient, gets all the way down to us and as we make eye contact we both know this is a complete waste of time. The patient is in restraints and quite unhappy about this trip.

I don’t see this going well.

We decide we are going to give it the old college try and attempt to move him to the MRI table.

Oh, this ain’t happening!

The patient starts kicking and trying to remove everything as we attempt to move them over. Needless to say, the MRI tech decided it wasn’t safe.

All of this… The nurse and MRI had to go through all of this because the doctors just don’t seem to be able to wrap their heads around the fact that the nurse knows her patient well enough to know what will and won’t work.

Irritating to say the least… Why waste the time of the nurse and the radiology department when we all know damn well this wasn’t going to work?!

 

 

GFR

Now that I am in the radiology department I spend a lot of time focusing on GFR and kidney function. Why? Good question!

In MRI and CT we give contrast to a lot of patients. In CT the contrast is iodine based. In MRI the contrast is gadolinium (metal) based. Both types of contrasts are filtered out through the kidneys and thus the reason kidney function is so important in this department. The way we assess kidney function is by checking a patient’s creatinine level in their blood. Luckily for us we have machine called the i-Stat that can test the blood and give a result in two minutes. The result transfers into Cerner (our EMR) and the computer then uses that result to calculate the GFR. Great… except I didn’t really have an understanding of why we were checking the creatinine, what GFR really was, or why there is a GFR result for African Americans and non-African Americans. I decided to do a little reasearch and I figured, since this is a nursing blog and all, why don’t I share what I have learned?

What is “GFR”?

GFR stands for glomerular filtration rate. Basically, the GFR tells you the flow rate of fluids through the kidney. Your glomeruli are the capillaries in your nephrons inside the kidney. Blood is filtered across the capillary membranes helping to remove waste that can ultimately be excreted through the urine. Taking you back to anatomy and physiology in nursing school aren’t I? *shudders*

A simple google search will bring up lots of GFR calculators. Typically the GFR calculator takes into account serum creatinine, age, gender, and race (African American versus not) and then it will give you the estimated GFR. A GFR >60 indicates a generally healthy kidney. Less than 60 can indicate potential kidney disease. Less than 15 can indicate full on failure. Here is a little infographic that is patient centered.

Why creatinine?

Why does the GFR equation use creatinine? In the most basic terms, creatinine is a waste product of creatine. Creatine is used by the muscle cells for energy. Your kidneys help filter the creatinine out of the blood to be excreted in the urine. Low creatinine typically indicates good kidney function (which makes sense, healthy kidneys will filter out creatinine effectively). High creatinine indicates the opposite, kidney function is probably on the lower end because the kidneys are unable to filter out the waste product. Creatinine is primarily filtered out through the kidneys which is why it is a pretty good indicator of kidney function.

Why is the result different based on race?

Many, many times I have looked at my labs and wondered why the GFR had a result for African Americans and then essentially everyone else. It wasn’t until I started working here and paying attention to the GFR that I decided to look it up. Turns out studies show we have “higher than average” muscle mass so we generate higher levels of creatinine. Higher creatinine levels lead to higher filtration rates. The difference in results account for this.

Now I can actually explain to my patients why I am taking blood after I start an IV. I like to be able to asnwer my patient’s questions so of course I had to do a little learning on my end. Hopefully some of you will also find this information useful! (Also here is a great reference for frequently asked questions from the National Kidney Foundation because, why not!)

Look at me when I’m talking to you!

I am going to vent for a moment so bare with me okay?

I ABSOLUTELY HATE WHEN MY PATIENT DOES NOT LOOK AT ME EVEN ONCE WHEN I AM SPEAKING TO THEM!

This has nothing to do with eye contact. I know for some people, eye contact is uncomfortable or unusual in their culture. I get that. However, when I call someone into my IV chair and they can’t bother to put their  phone down long enough to raise their head and answer my questions it burns me up! I just feel like it is so disrespectful! Is that how they converse with everyone? No, I highly doubt it. I think *that* is what bothers me the most. I am simply trying to provide care within my environment. I didn’t force them to come to this hospital, nor did I force them to make an appointment for whatever reason they are here. I feel like the least someone can do is acknowledge that a human being is standing in front of them providing care.

There have been times when I am trying to go over information with a patient and they are so engrossed in whatever is happening on their phone that they have a hard time answering my questions. Typically this statement will get me the acknowledgment I prefer: “Let me know when you are done on your phone and then I I’ll continue.” After that I take a step back and wait. Patients will typically put the phone down and pay attention.

In all honesty, I don’t need their undivided attention the entire time they are in my care. Since I am the radiology nurse, I am going to be the one to go over the contrast questionnaire with the patient and then I will obtain vascular access. This isn’t dramatic stuff here. I really only need the patient to pay attention when I am asking them questions, after that I actually prefer they occupy themselves because most often it means they’ll focus on their phone and not on the 20g I am about to stab them with.

I don’t know, maybe I’m just getting old or something but a little acknowledgment wouldn’t hurt.

Uniform… Acceptance…

The hospital I work for has a uniform policy. As nurses we wear ceil blue and/or white. I hated the idea of uniforms… At first.

Now, I kind of like the fact that each department in our hospital has a uniform.

Yeah, it surprised the hell out of me too!

It helps me know who I’m talking to or who just walked into my patient’s room. I’ve often had patients say, “the doctor said I can have something to eat!”, however I haven’t seen the docs come onto the unit. Now I’m trying to figure out who my patient was actually talking to so I can find out what was actually said. With everyone being in uniform I can ask my patients “what color uniform were they in?” I cannot tell you how many times I’ve asked that question and then find out it was xray technician that came in to do the morning portable chest xray that the patient talked to! For a lot of our patients, anyone in scrubs is a doctor.

The fact that I can identify a department just by their scrubs is a real help and as much as I hate to admit it, uniforms made things a lot easier. I only have one big complaint, THESE COLORS!!!!

I despise the ceil blue/white combo. I would really prefer a darker color. Something like a hunter green or a navy blue would work for me but it is what it is.

So tell me, what policy did you initially hate that you’ve learned to accept and perhaps even like?

Decisions

I think I finally made my decision about going back to school. I completed my bachelor’s degree last year and have been on the fence about getting my master’s degree. Is it worth it? What path should I take? I just couldn’t make a decision.

I think I know what I am going to do. I’m going back to school.

At first, I planned on either following an education or leadership path. I think that is going to change. I’m going to try to get into a nurse practitioners program.

After talking to lots of other nurses that are currently in school, nurses with their master’s degree already, and lots of research, I realize my career path is far more flexible if I have my advance practice degree.

I think I stayed away from the idea of an NP program because I had a very narrow idea of what nurse practitioners can do.

My views are changing. Being around a lot of wonderful NP’S in my career had shown me they do a whole hell of a lot. NP’S make a difference. I want to make a difference. I think I’m going to really give this a shot…

The kids are alright

This is my last week of shadowing in the PACU. I’m ending my week in pediatric pre and post op.

😒

I have been a grown up nurse my whole career. Med surg, small ICU, STICU, that’s what I know. I know how you fix an adult. I know nothing about children.

I am not good with kids. I’m uncomfortable around them. I’m not used to kids. I am out of my element.

I feel so freaking awkward!

I am so useless in here. It’s not because the nurses aren’t teaching me. The PACU nurses have been amazing. I just don’t know how to handle kids. I have none of my own. I don’t want any. I have no maternal instinct. I have little patience for crying. I’m just not good with kids and I’m well aware of that.

So here I sit, on my phone, typing up this blog while on lunch, hoping I survive a few more hours so I can go back to my adults in radiology on Monday…

OR 4

I’ve been shadowing in the pre and post op unit for the last week. I am still a radiology nurse but I’m up here learning a few things. In MRI we give some of our patients propofol to sedate them so they can tolerate the scan and then we recover them afterwards. My department has me floating in PACU to evaluate how PACU recovers patients to see if there are things we need to bring back to our department. I’ve been enjoying myself so far. Today I am following the sedation nurse. We are in OR 4.

OR 4 is where they are doing all the abortions today.

I wasn’t prepared.

I have no children and have never been pregnant. I have no desire to have kids. Honestly I’m not fond of them. I am pro-choice. I consider myself pretty liberal. I don’t judge women who choose to have an abortion.

I was still not prepared.

I’ve read about abortion. I know people that have had them. However, I have never actually seen an abortion and after today I don’t need to see anymore.

It’s emotional.

One was because of fetal deformity. Most were not. The reason didn’t matter. You could see the anguish in some of the faces of the patients. Some were stone faced and I couldn’t really tell how they were feeling. A 16 year old seemed not to really have a full grasp of what was really happening. One lady cried and expressed her feelings of guilt the whole procedure.

It’s was a lot to deal with.

The procedure itself was different than I expected. Mentally I has to steady my nerves to watch how the fetus was removed. Typically I stayed at the head of the table with the patient for their comfort… And my own. I tried to focus on the patient and not the procedure so I could keep my emotions out of it.

This is definitely something I could not do on a regular basis, if I could ever do it at all. This experience is something I definitely won’t forget.

I still remain pro-choice even after today. Now I understand what women go through not just physically but emotionally when having to make this choice. It’s so much deeper than what I understood.