I'm learning more and more that a big part of my personal happiness comes from taking care of myself first. In the past few weeks, I've had 2 unexpected days off from work. One EA (excused absence) and one on-call shift. These days are the result of the hospital trying to balance the patient census with the number of nurses scheduled to work. It saves the hospital money while offering time off for people who would like it, but not mandating people to stay home (although that still happens occassionally). It's funny because I've always worked myself so hard because I'm always trying to make ends meet. So time off needed to be paid time off. Now I take an occassional day to myself without pay (scary) and it's still ok. I feel conflicted about taking time for myself (afterall, I've always worked 40+ hr weeks), but I'm learning that I really need it to stay grounded and healthy. Not only do I give better patient care when I return to work, but I am more patient and happy in my daily life.
My last few days off were so great, last night especially. It was a beautiful evening so I went for a 5.5 mile run, which was amazing. I felt energized and refreshed and hit a good stride, which resulted in a faster pace! Sweet! After my run, I stopped at the gym to swipe my card (I need those 12 visits for insurance reimbursement) and do some stretching. On my way in I ran into some friends that I haven't seen in a few months since I started to work evenings. I joined them for a bite to eat and caught up on girl time. Short and sweet, but necessary. It was really nice!
Moral of the story: take time to take care of yourself. Daily, weekly. The little things add up and can make a huge difference in the long run. For me, it's taking a night to go for a run or go to the gym. Or maybe a night to veg on the couch and read or watch a favorite movie. Whatever the little things are for you, make time to do them. I promise, you won't regret it.
Thursday, March 29, 2012
Sunday, March 18, 2012
Car antics
My husband and I were running late to work on Friday afternoon. He's gracious enough to mentor a student this semester (something I hope to do when I know what the heck I'm doing first) and thus we were extra hurried to get there early so he could prepare for the student as well. We pulled into the parking ramp at work and found a spot pretty quickly (sweet we're not on the 6th floor!). The hubs went to turn the car off and the key wouldn't turn. Huh...that's strange. Jiggle the key around, nothing. Take it out of park into a different gear a few times, still nothing. Uh oh. Slight look of panic comes over the hubby's face. We spend about 10 mins trying to get the car to turn off and get nowhere. "You go inside and get ready for your student, I'll keep trying to figure this out", I say. "What's our back-up plan if I can't turn it off though??" Luckily (or unluckily), the key came out of the ignition, but with the car still running. So we could lock the car and leave it running without any keys in it. We quickly decide that if it won't turn off I would park the car on the roof of the parking ramp, take the key out and lock the door. Then go to work. And that's just what I did. For 9 hours.
As I walked away from the car, I thought "there's no way it'll still be here when we get done with work!". Surely someone's going to report a suspicious car running with no keys in it on the top of the parking ramp. Luckily my shift was chaotic and it was easy not to worry about it! About half way through my shift, the hubby called me to see if the car was still running or if it had turned off. Ha. Ha. Guess we'll find out, I said. At midnight, we headed up to the 7th floor of the parking ramp and sure as heck the car was still there and running. A bit hot, but running. We drove it home, picked up the second car and some tools, then drove it to the mechanic shop where we disabled some fuses to finally turn the stinkin thing off. Left a note for the shop and hope they find it on Monday. Oiy. Cars....ha!
As I walked away from the car, I thought "there's no way it'll still be here when we get done with work!". Surely someone's going to report a suspicious car running with no keys in it on the top of the parking ramp. Luckily my shift was chaotic and it was easy not to worry about it! About half way through my shift, the hubby called me to see if the car was still running or if it had turned off. Ha. Ha. Guess we'll find out, I said. At midnight, we headed up to the 7th floor of the parking ramp and sure as heck the car was still there and running. A bit hot, but running. We drove it home, picked up the second car and some tools, then drove it to the mechanic shop where we disabled some fuses to finally turn the stinkin thing off. Left a note for the shop and hope they find it on Monday. Oiy. Cars....ha!
Monday, March 5, 2012
The dreaded float
Today is my day off and I'm spending it on the couch sick with a nasty cold. I felt it coming on a few days ago and I awoke yesterday to a full on cold. I'm sure that participating in the Polar Bear Plunge on Saturday did not help my cold much, although it was fun! Sunday morning, I slept in until noon, hoping that I'd let my body rest as much as possible. I loaded up on cold medicine and headed into work with the hubby. I really felt awful, which pretty much sucks to try and be someone's nurse when you feel like crap yourself. Plus, I knew I'd have to wear a mask because I was coughing and snotting at times. My neutropenic patients (those with little to no immune system or WBC {white blood cells}) can't be exposed to any type of illness, even if it's just a cold. My regular little cold could cause a serious infection that could be life threatening to them. I know that sounds like I'm exaggerating, but I'm not. I'll explain that later. Back to my story first.
So right at the start of the shift, the charge nurse informed me that I'm floating to another unit, 7B, for the first 4 hours of my shift. I grabbed my drink and clipboard and headed over. The unit was in chaos at change of shift, so I waited until someone made eye contact and introduced myself. Then the whirlwind of a shift began. I looked up my patients' information and try to get organized for my shift. Then I got report for 3 of my 4 patients, but one of the nurses had to float to another unit so she had left already. Go figure, that was the patient that I had the most questions about. Oh well..,improvise.
Floating to another floor is par for the course in nursing. We learn to be flexible and to expect the unexpected. For a new grad nurse, floating can be quite scary and frustrating. There are lots of things (diagnoses and medical interventions) that I do not see on my unit because while we're a medical unit, we specialize in cancer and blood diseases. We see the occassional chest tube and G tube, but generally not a lot. Last night, 3 out of my 4 patients had a G tube (gastrostomy tube, which by passes a person's esophagus and instills food, water or medicine directily into the stomach) and were therefore very busy. Once I was able to get organized and prioritize, the running started. Except I was slower than usual for several reasons.
1. I coudn't find anything on this unit [Note: not all nursing units are created equally].
2. I only knew one person on the unit, so my resources were more difficult to determine. I introduced myself to people and asked questions, but it was a struggle to get help.
3. My cold kept interrupting. I had several coughing fits and had to excuse myself from a patient's room. Luckily I had loaded up on cough drops, which helped prevent the coughing fits. That's just what you want your nurse to do is start coughing and snotting all over your room!
Four hours is not a lot of time. Especially when you're running a race to complete 4 assessments (on very complicated patients), administer all medications, feedings and flushes, and help the patients with the few things that are important to them. So....it took me 5 hours. Lucklily the 7D (my home unit) charge nurse knew that I was feeling crappy. She called me on my ASCOM phone about 3 hours in and asked if I'd like to go home for the last 4 hours of my shift. We were up-staffed (too many nurses for patient census) and they were granting and EA (excused absence). I was the lucky winner who got to go home and sleep! I gave report to the on-coming nurse, then sat down and charted for an hour. Finally went home at 8:30p and curled up on the couch with a movie. I woke up about 11:15p when my hubby called to get a ride home.
Not a bad end to a tough day. Sleep, fluids, and cold medicines await me today.
So right at the start of the shift, the charge nurse informed me that I'm floating to another unit, 7B, for the first 4 hours of my shift. I grabbed my drink and clipboard and headed over. The unit was in chaos at change of shift, so I waited until someone made eye contact and introduced myself. Then the whirlwind of a shift began. I looked up my patients' information and try to get organized for my shift. Then I got report for 3 of my 4 patients, but one of the nurses had to float to another unit so she had left already. Go figure, that was the patient that I had the most questions about. Oh well..,improvise.
Floating to another floor is par for the course in nursing. We learn to be flexible and to expect the unexpected. For a new grad nurse, floating can be quite scary and frustrating. There are lots of things (diagnoses and medical interventions) that I do not see on my unit because while we're a medical unit, we specialize in cancer and blood diseases. We see the occassional chest tube and G tube, but generally not a lot. Last night, 3 out of my 4 patients had a G tube (gastrostomy tube, which by passes a person's esophagus and instills food, water or medicine directily into the stomach) and were therefore very busy. Once I was able to get organized and prioritize, the running started. Except I was slower than usual for several reasons.
1. I coudn't find anything on this unit [Note: not all nursing units are created equally].
2. I only knew one person on the unit, so my resources were more difficult to determine. I introduced myself to people and asked questions, but it was a struggle to get help.
3. My cold kept interrupting. I had several coughing fits and had to excuse myself from a patient's room. Luckily I had loaded up on cough drops, which helped prevent the coughing fits. That's just what you want your nurse to do is start coughing and snotting all over your room!
Four hours is not a lot of time. Especially when you're running a race to complete 4 assessments (on very complicated patients), administer all medications, feedings and flushes, and help the patients with the few things that are important to them. So....it took me 5 hours. Lucklily the 7D (my home unit) charge nurse knew that I was feeling crappy. She called me on my ASCOM phone about 3 hours in and asked if I'd like to go home for the last 4 hours of my shift. We were up-staffed (too many nurses for patient census) and they were granting and EA (excused absence). I was the lucky winner who got to go home and sleep! I gave report to the on-coming nurse, then sat down and charted for an hour. Finally went home at 8:30p and curled up on the couch with a movie. I woke up about 11:15p when my hubby called to get a ride home.
Not a bad end to a tough day. Sleep, fluids, and cold medicines await me today.
Thursday, March 1, 2012
Putting out fires
So tonight was an interesting night! Many of my shifts are spent "putting out fires" if you will, meaning I spend most of my night running around being the middle man just to accomplish one task. Tonight was a night of literally putting out fires, though not for me or my patients luckily! Our floor had a fire just down the hall in the occupational therapist office. It made for a crazy start to the shift! I was in a patient room when the fire alarms started going off and the lights started flashing in the hallway. 'Well I've never been here for a fire drill' I thought to myself. I wondered if I'd know what to do! One of the nursing aids was in the room and she said, "Oh someone probably just burned some popcorn. We're in no real danger." I found myself agreeing, as I'd heard plenty of stories of burnt toast or popcorn setting off the fire alarm. Then the patient's mom asked me what happens if there is an actual fire. I froze for a moment, but then my brain popped into auto pilot and answered for me! I heard myself rattling off the RACE accronym and explaining our plan in the event of fire. 'Good job Theresa!', I thought to myself. 'Good thing it's just a fire drill. Wait...is that smoke I see on the other side of that door to our unit? Wow! There was a real fire and it was on our floor. Awesome.' Needless to say, there was some action to put it out and some explaining to patients and their visitors, but the excitement was short lived. It just made me re-think using my expression of "putting out fires" everyday. :)
Sunday, February 26, 2012
Making time
This week has been a very busy one between work, chemotherapy classes, and helping family and friends. I find myself rushing from one place to another with very little time to spare. Yesterday I spent three hours out at a previous employers house helping the couple troubleshoot some catheter issues. As the trouble shooting took about 30 minutes, I realized they really just needed a friend in the healthcare field to listen to their struggles.
This couple has been married for 48 years and I find them very interesting. They have very opposite approaches to life, as she is very go go go, type A personality, and he is a very laid back, take your time sort of guy. But somehow that seems to work for them. They are both very intelligent and have been active in many interesting capacities over their lifetime. This past summer, the husband had a hemmorragic stroke and it has been life changing for the both of them. He was hospitalized for 84 days and is now in a wheelchair, as the left side of his body is paralyzed. He is finally home but needs help with everything he does. As I spent the afternoon with this couple, I observed true love and devotion between them. I found myself wondering how the wife stays so strong in this situation. The couple used to have somewhat opposite schedules that worked for them. She was an early bird who went to the gym and then to work, while he was a night owl, staying up late and sleeping in. This schedule gave them time apart and time together, which seemed to balance their marriage. After the stroke, the wife spent all of her time at the hospital advocating for her husband's care. After 84 days of chaos, they finally were able to return home together but with major changes in their routines. They have brought in lots of help and adaptive equiptment and have adjusted the first floor of the home to meet their needs. She provides total care for him and is the constant in his life of continuous changes. As we talked, I couldn't help but wonder how they are adjusting so well. They have had such a different routine for so long and now they spend all their time together, doing their best to fumble through it with love. It was truly an eye opening visit, as I myself have been struggling to find balance as a newlywed with a new career. This week, I felt so frustrated that I had no time for myself. No time to do the few things that help keep me grounded and balanced. Yet my frustrations are nothing compared to what this couple is going through! I tried to imagine the difference between spending all your time caring for strangers, versus spending all of your time and energy caring for your spouse of 48 years. I'm emotionally drained after work and my clients are strangers...I can't imagine the emotional repercussions of all of this for the wife.
The encounter has put much of my current struggles in perspective, as I realize they are nothing compared to others struggles. I still have the ability to make changes in my schedule and to find time for myself if I try hard enough. My husband and I still have our health and our independence. As a new week approaches, I resign to take a step back when I'm feeling frustrated or overwhelmed my life and just take note of all that I have. And be thankful.
This couple has been married for 48 years and I find them very interesting. They have very opposite approaches to life, as she is very go go go, type A personality, and he is a very laid back, take your time sort of guy. But somehow that seems to work for them. They are both very intelligent and have been active in many interesting capacities over their lifetime. This past summer, the husband had a hemmorragic stroke and it has been life changing for the both of them. He was hospitalized for 84 days and is now in a wheelchair, as the left side of his body is paralyzed. He is finally home but needs help with everything he does. As I spent the afternoon with this couple, I observed true love and devotion between them. I found myself wondering how the wife stays so strong in this situation. The couple used to have somewhat opposite schedules that worked for them. She was an early bird who went to the gym and then to work, while he was a night owl, staying up late and sleeping in. This schedule gave them time apart and time together, which seemed to balance their marriage. After the stroke, the wife spent all of her time at the hospital advocating for her husband's care. After 84 days of chaos, they finally were able to return home together but with major changes in their routines. They have brought in lots of help and adaptive equiptment and have adjusted the first floor of the home to meet their needs. She provides total care for him and is the constant in his life of continuous changes. As we talked, I couldn't help but wonder how they are adjusting so well. They have had such a different routine for so long and now they spend all their time together, doing their best to fumble through it with love. It was truly an eye opening visit, as I myself have been struggling to find balance as a newlywed with a new career. This week, I felt so frustrated that I had no time for myself. No time to do the few things that help keep me grounded and balanced. Yet my frustrations are nothing compared to what this couple is going through! I tried to imagine the difference between spending all your time caring for strangers, versus spending all of your time and energy caring for your spouse of 48 years. I'm emotionally drained after work and my clients are strangers...I can't imagine the emotional repercussions of all of this for the wife.
The encounter has put much of my current struggles in perspective, as I realize they are nothing compared to others struggles. I still have the ability to make changes in my schedule and to find time for myself if I try hard enough. My husband and I still have our health and our independence. As a new week approaches, I resign to take a step back when I'm feeling frustrated or overwhelmed my life and just take note of all that I have. And be thankful.
Tuesday, February 21, 2012
Learning in stages
Ugh. This week has been a tough week for me. Right now I'm so exhausted and really don't want to go back to work tomorrow. Several factors are contributing to my feelings of dread. First, I'm on a long stretch of work days, which means at this point in the week, I'm pretty much tired of work. Second, the patient load this week has been overwhelming for me. My hospital treats some really sick patients, which in nursing lingo is "high acuity patients". Providing nursing care for medically complex patients is exhausting. I think it's double fold for a new grad nurse because we generally know enough to keep patients safe, but lack the expertise that comes with experience. There is a lot of literature published about the journey from new grad nurse to experienced/expert nurse. Patricia Benner is a nurse theorist who has researched and published a lot of information about the topic. It's funny because in nursing school I remember thinking to myself, yeah yeah yeah...nursing theory....blah blah blah. :) But there's truly something to Benner's theory. I'm at my 5 month mark of being a nurse and I feel like I know less now than I did when I started! (Which is apparently right on track according to Benner's theory). This week really highlighted this for me.
Monday admitted a patient who presented with shortness of breath (SOB...which still makes me giggle when I see it in charts). His SOB of was secondary to metastisis of cancer to the lungs. Usually when we see a patient admitted with an acute problem, such as shortness of breath, constipation or urinary retention, etc, we are immediately concerned with cancer metastisis (mets). So, my patient was sitting in the classic SOB position, tripod position, to maximize his ability to breath. The doctor had evaluated him, put in orders and was on his merry way. Leaving me to get the pt comfortable. Long story short, the patient couldn't do any type of activity without his oxygen saturation dropping into the low 80's (90-100% is normal and necessary for tissue perfusion). He was sitting in a chair next to the bed but could not lay in bed because he felt like he couldn't breathe. I tried to assess the situation as best I could and discovered that he truly couldn't take a deep breath and thus planned to spend the night in the chair. I paged the oncall doctor to communicate my concerns and ask if there was anything more that we could do for the patient. The MD proceeded to speak to me in a somewhat condescending tone saying that the team was doing all the appropriate measures and there was nothing more he would order for him. I truly felt helpless! This patient feels he can't breathe and after talking to the MD, I was suppose to tell him 'tough luck...there's nothing else we can do for you'. I wouldn't accept that answer so I called respiratory therapy (RT) and asked them to come and evaluate him. Sure enough, they had the same assessment that I did. They recommended a nebulizer treatment, which eventually provided some relief for the pt.
My point in this story is that I knew that there was something wrong with my patient and that we weren't doing enough to help him breathe, but I didn't know what suggestions to make to the MD in order to address my concerns. It turns out that many times, it is the nurse who makes suggestions to the MD about what might help in certain situations. As a new grad nurse, I don't have all the knowledge that I need to do that. But each day, I learn something new and try to store that knowledge somehwere for safe keeping until I need it at a later date. Over time, I'll move through Benner's stages and become an expert nurse who listens to her intutions and applies knowledge from other situations to help improve patient outcomes.
Monday admitted a patient who presented with shortness of breath (SOB...which still makes me giggle when I see it in charts). His SOB of was secondary to metastisis of cancer to the lungs. Usually when we see a patient admitted with an acute problem, such as shortness of breath, constipation or urinary retention, etc, we are immediately concerned with cancer metastisis (mets). So, my patient was sitting in the classic SOB position, tripod position, to maximize his ability to breath. The doctor had evaluated him, put in orders and was on his merry way. Leaving me to get the pt comfortable. Long story short, the patient couldn't do any type of activity without his oxygen saturation dropping into the low 80's (90-100% is normal and necessary for tissue perfusion). He was sitting in a chair next to the bed but could not lay in bed because he felt like he couldn't breathe. I tried to assess the situation as best I could and discovered that he truly couldn't take a deep breath and thus planned to spend the night in the chair. I paged the oncall doctor to communicate my concerns and ask if there was anything more that we could do for the patient. The MD proceeded to speak to me in a somewhat condescending tone saying that the team was doing all the appropriate measures and there was nothing more he would order for him. I truly felt helpless! This patient feels he can't breathe and after talking to the MD, I was suppose to tell him 'tough luck...there's nothing else we can do for you'. I wouldn't accept that answer so I called respiratory therapy (RT) and asked them to come and evaluate him. Sure enough, they had the same assessment that I did. They recommended a nebulizer treatment, which eventually provided some relief for the pt.
My point in this story is that I knew that there was something wrong with my patient and that we weren't doing enough to help him breathe, but I didn't know what suggestions to make to the MD in order to address my concerns. It turns out that many times, it is the nurse who makes suggestions to the MD about what might help in certain situations. As a new grad nurse, I don't have all the knowledge that I need to do that. But each day, I learn something new and try to store that knowledge somehwere for safe keeping until I need it at a later date. Over time, I'll move through Benner's stages and become an expert nurse who listens to her intutions and applies knowledge from other situations to help improve patient outcomes.
Thursday, February 16, 2012
The blurry truth
This week has been especially challenging, thus my vivid dreams continue. Last night I woke up to use the bathroom and thought to myself, "I need to empty my Foley bag"! It's a blurry line between reality and dreams these nights! So as you might imagine, I've been emptying a lot of Foley bags, ostomy bags and rectal tube drains this week. It seems like our unit goes through waves of certain cancer types or complications. Last week, we had many gyn/onc (gynecology cancers) patients, which included ovarian and endometrial cancer. This week is rectal and prostate cancers. The past two weeks have been interesting because I have seen several fistulas. I hadn't seen a fistula in my first 5 months of nursing (as well as my 2 yrs of nursing school), but over the past two weeks I've seen four. What's a fistula you ask? A fistula is an abnormal connection between two parts of the body, such as the colon and the skin, or the colon and the bladder (both of which I saw last week). They are pretty bizarre! Sometimes the fistula is on the inside of the body and we only see the result by abnormal outcomes. Sometimes the fistula is a visible hole on the skin where it shouldn't be. Thus the vivid dreams and blurry truth.
I continue to find ways to process my emotions and frustrations from work. This week started out pretty rocky with a frustrating shift on Monday that ended at 12:45 am after no break! By Wed, things on the unit had calmed down and my coworkers decided we should get a drink after work to decompress. I was so glad I went because I haven't slept so well in weeks! We talked about work, our frustrations and emotions, the changes that are happening in the hospital, etc etc etc. There's something about getting together with others who share your frustrations and validate your concerns and emotions. It was a wonderful 2 hrs of support and I have a feeling that we'll do it again soon.
For now I'll leave you with a tip of the day from the book "Your 1st Year as a Nurse" by Donna Wilk Cardillo. In order to effectively deal with adversity, a new nurse must focus on the positive. Tip of the day: Think of one positive thing you accomplished today and write it down on paper. Look at it, think about it, and fall asleep on that thought.
Here's to sweet dreams and clarity.
I continue to find ways to process my emotions and frustrations from work. This week started out pretty rocky with a frustrating shift on Monday that ended at 12:45 am after no break! By Wed, things on the unit had calmed down and my coworkers decided we should get a drink after work to decompress. I was so glad I went because I haven't slept so well in weeks! We talked about work, our frustrations and emotions, the changes that are happening in the hospital, etc etc etc. There's something about getting together with others who share your frustrations and validate your concerns and emotions. It was a wonderful 2 hrs of support and I have a feeling that we'll do it again soon.
For now I'll leave you with a tip of the day from the book "Your 1st Year as a Nurse" by Donna Wilk Cardillo. In order to effectively deal with adversity, a new nurse must focus on the positive. Tip of the day: Think of one positive thing you accomplished today and write it down on paper. Look at it, think about it, and fall asleep on that thought.
Here's to sweet dreams and clarity.
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