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. 

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. 

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.

Balance

Getting into a routine should be pretty easy to do, especially since my husband and I both work straight evenings at the same hospital. Right?  Not so much. I've come to have a love-hate relationship with sleep.  I desperately need a night of 8 hrs of uninterrupted sleep (even 7 hrs would be great).  BUT, apparently one side effect of being a nurse (for me anyway) is dreaming about work.  Not just the occassional work dream either, but night after night of chasing around patients and trying to accomplish one task that never seems to get accomplished.  

Most nights unfold like so: I work at the hospital until 11:30pm or 12am (sometimes later on a tough shift), come home and chat with the hubby about our evenings (we usually car pool and have similar schedules), eat a snack, then climb into bed exhaused.  If I'm lucky enough to fall asleep right away, I tend to fall right into a dream about work.  Those nights I awake even more exhausted, feeling like I just worked a double.  Most nights, it's hard to unwind and turn off my brain so I can sleep.  It'l like my brain just keeps processing my shift, regardless of what I do to stop it.  In my head thoughts swirl of my patients and their families, their good news and bad news, their diagnosis, their medical challenges, their demands, their praise, their thanks.  All of it swirls in my head until eventually I sleep for a bit, wake up and repeat the cycle all over again.

Boundaries have been my newest area to examine.  Professional boundaries are talked about in nursing quite a bit and they seem straight forward on paper and in text books.  Boundaries seem pretty easy until you're caring for patients day in and day out who are fighting for their lives.  Patients who are going through hell; who have pain that the strongest narcotics won't touch; nausea that refuses to retract for just a moment so they can eat; constipation, diarrhea, skin problems like 'Hand and Foot syndrome'.  Pure hell for a slim chance at curing their cancer, though usually they're buying more time.  Time with family and friends.  Time to enjoy life a little longer, even though their quality of life is not what it use to be.  These are the thoughts that keep me awake at night.

The tough part about boundaries with patients and their families is that some patients are on our unit for weeks to months.  The hospital becomes like a second home to them and the staff like family. Emotional boundaries become challenging when you care for a patient for months at a time.  When you help them suffer through their treatments and then through the complications of their treatments. 

So my question is: How do I continue to care for my patients and their families while separating myself enough to leave my work at work? I've asked some of my experienced co-workers this very question , but still haven't seemed to find an answer that works for me.  My problem is that I don't want nursing to be a job that I just go to and from. One that I just make my check list each shift and leave the caring at home.  I want to feel like I'm impacting lives each day, that I'm making a difference. I want to help patients live with dignity, die with dignity and accept that life is not fair.  Yet I need sleep so I can continue to give and to care.  So how do I balance that?  How do I make a difference each day and impact patients' lives, while not letting it keep me up each night??

I'm hoping that I will discover the answer to my question in time.  In the meantime, it is my weekend off and I am awake at 1:30 am.  Hoping that blogging about my insomnia might help eventually take it away.  :)

Starting fresh...

In my opininon, starting out on an oncology unit of a hospital is a big challenge for a new graduate nurse. Of course that's just my opinion.  :)  The patient population is complicated to say the least.  Cancer patients face many challenges and deal with complicated issues on all fronts: medically, psychologically, financially, spiritually, socially.  Cancer affects every aspect of a person's life.  As nurses, we don't just address the medical needs of patients, but instead look at the whole person, the big picture.  I've been an oncology nurse for roughly 5 months now.  I have decided it's time to blog about the journey in an effort to process the vast emotions that accompany the job of caring for cancer patients. Hopefully in time, I will look back through my posts and see my growth as a professional nurse.  I guess I kind of see myself as a newbie nurse who is learning to fly...and I'm excited about what I will see as I learn to soar.