When I drop the ball

The idea of failure, I think, is pretty well universally feared. For a nurse, failure can have some truly devastating implications.  A nurse’s failures can cause pain to others. It can cause death. I believe it took most of the first year to rise above the complete paralyzing grip that the fear of failure had on me as a brand new nurse. It never went completely away, and I pray it doesn’t.
I remember this ritual I had, sitting in my vehicle in front of the small hospital where I worked. I’d pull up around dawn every morning before my shift, kill the engine, and pause. I’d hone in on the song the birds were chiming in the trees, I’d breathe in the smell of bacon as it wafted from the lower level kitchen. I envied whoever was down there. If they should fail their job today, we get burnt bacon. If I should fail, it could end in manslaughter. I really had to just give it to the Big Man, because I knew that I failed daily, and still do. I pray he guides my hands and feet, I pray that He graces me with wisdom and good judgement. I pray for His forgiveness and for the forgiveness of my patients and their loved ones when I fall short. And I have fallen short often. I’ve botched dressing changes and torn skin. I’ve forgotten pain medication and given wrong medication. I’ve over medicated. I’ve missed more IV sticks than I’ve gotten. I’ve let arms swell to twice their size before finding that the IV had infiltrated. I’ve neglected to turn patients and to pull down their stockings, resulting in skin breakdown. I’ve spoken when I shouldn’t and I’ve stayed silent when I should have blown the whistle. I have been the nurse you’ve cursed for leaving your Grandmother’s arms bruised and bleeding. I very nearly once hung the wrong antibiotic on a patient that was severely allergic to that antibiotic. These are the faces that haunt you when the day is done and your head hits the pillow. These failures are hard to live with, but in each there is a lesson. Don’t make the same mistake twice and ask forgiveness when you get the chance.  Forgive each other, and most importantly,  try to forgive yourself. You do good work. Give it to God. He will see you through.
It is also important not to hide your mistakes.  It takes courage to admit them and diligence to correct them. Several times, I’ve recieved the brunt of a particular surgeon’s “wrath” over various mistakes I made. The last time, he gained a great deal of respect from me when he said “You know, I’ve made my share of mistakes, severed ureters, caused bleeds, among other things, but is imperative that we pay attention. We are dealing with people’s lives.” Suddenly, I no longer a surgeon with a “God complex,” but a man who was there” as we all are, striving for excellent patient care. Through the decades he has been practicing medicine, learning from his mistakes. He is proud, but not too proud to be accountable for his errors. I think that is an excellent example for anyone to follow. Seek opportunity for growth and never let fear of failure cripple you.

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Baptism by fire

I daresay the cleanest, most heavily staffed and compliant nursing homes in existence aren’t able to completely conceal the unsavory, yet natural goings on of the human body.
We were standing attention at twilight in front of our first clinical site receiving our assignments.  Half on bath duty and half on vitals. We were to switch the next day. Our whites were ironed and our hair neatly pinned back per dresscode. Stethescope: check. Clipboard: check. Unwavering confidence: uh… hardly.
It has been said that if one knew what they were getting into before hand, they might opt out of marriage. The same may be said of entering nursing school. The majority of us had never laid hands on a human stranger for the purpose of delivering care. I think that we all had a feeling, however that we were about to crawl through the trenches that day.
I was partnered with, of course, one of the same girls I was so intimidated by in the classroom.  I’m ashamed to say, it felt a little good to see the tiny glint of defeat in her eye as we were tossed what looked like a mile long list of names. I swear it was at least two columns and no margins. Supposedly it was one hall’s worth of residents’ names and we had until noon to collect and document blood pressures, heart rate, respiration rate, and oxygen saturation on each of them. Luckily we had prepared by taking each other’s vital signs for an hour in the lab the day prior, so we were basically experts with unparalleled efficiency when it came to vitals. Not. Additionally,  we didn’t know these names and faces from Adam. Also, who’d a thunk? Nursing home residents DO NOT just hang out in their assigned beds all day waiting to get their vital signs taken! They are eating, playing bingo, smoking Virginia Slims, and gossiping in the dang flower garden! We were running all through the place trying to track these folks down with little to nothing to go by.
A couple of hours in, my partner and I were pretty proud of the dent we had made in our list. We actually got a system down pretty quickly and were feeling like Batman and Robin. Then we are handed another full sheet of names. Everyone except the two of us had been pulled to the showers or bed baths and the pair of us were to finish out basically the entire facility with the vital signs. It was really a blur. I know there was some wailing, some wondering, and some wollering. At our noon rendezvous my peers were stained, sweated out, winded and drenched up to the knee. We were all painted with the stuff you might expect from that sort of work. My partner and I turned in the two crumpled and smeared sheets with vitals scribbled beside three quarters of the names.
We were later told it may be a good idea not to work with each other because we were an inefficient team and your company could make or break your performance in this program.
Three years later she was the backbone of the Emergency Department in the facility where I worked med/surg. We always had each other’s back and worked together like cogs in a clock. We have since shared many laughs about that day in the nursing home. I think we learned more than anticipated and I value every moment of it.

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Changes Ahead

   

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     Today, I broke my strict “no ironing” policy after retrieving a few peices of my ragtag assortment of “business clothes” from what had to be close to the land of Narnia. As I struggled with tangled cords, scalding steam, and learning a bit about what rayon is, I couldn’t help but be excited about the new job I’ll be transitioning into in the next week. The past month has been rather emotional for me as I have decided to try something completely new professionally. As with all change, I have a healthy amount of fear going on, but the good kind, like before you jump off the tall-ass rock into the lake. I have spent my first nearly three years as a nurse on a med surg floor in a small hospital. I know, in nurse years, that is hardly enough time to get your feet wet. I have learned so much in my short time there and I have met some of the kindest, most compassionate, and sharpest witted people you could come across. That is what makes the move hardest. The people. I’ve formed bonds during my time here that I will carry with me always. Each of the friends I’ve made has given something to improve me either professionally or spiritually. For that, I am ever thankful.
    This new venture is in some ways, a homecoming.  I’m going back to the organization that I worked for all through college. They were so good to me, even then, and wanted to see me succeed as a nurse. It’s going to be so exciting to maybe give back. Of course now, I’m returning in a completely new, nurse role. I’ll be serving adults with developmental disabilities and I couldn’t be more excited to use the skills I have acquired the past few years to meet the needs of this group. They say do what you love, and you’ll never work a day in your life. Certainly, I’m not afraid of work or challenge and I’m sure there will be plenty of both. But to be a nurse and exclusively with disable adults? It’s really a dream come true.

“I’m not a waitress” and other lies.

I have read roughly seventeen bazillion articles/blogs that discuss how underrated, and mistreated the bedside caregiver is. Most of these are beautifully and tactfully composed. I love reading them because universally, they give the public a glimpse into our day, they give accounts of why we are proud of what we do, they value our calling, and it’s just plain nice to see that others walk through the same fire that I do. We are not alone in our struggle.
I do have to say, however, that oftentimes I come across comments from other nurses that trouble me. These comments make our community seem composed of haughty,  jaded brats. Just as “entitled” as the family member they are complaining about asking for a diet coke, I’d like to challenge my fellow caregiver to hold yourself a little more accountable than that. Let me remind you that our profession is a higher calling. We are, and should be held to a higher standard. When we are feeling “abused” at the bedside, who are we helping by “fighting back?” I daresay no one, including yourself. When we see the media discussing our work with anything but the highest reverence, how could it help anything by lighting torches and tying nooses? Let us remember that our work is no longer strictly volunteer. We get payed to do our work, and the currency is not gratitude. You need to find another fuel for your afirmation fire. It makes me uncomfortable when the unsung hero’s of healthcare suddenly demand songs of praise. That is simply not why we are here. It makes me sad when I see my fellow nurses infuriated when retail workers ask for holidays off when “we can’t do that.” Have we forgotten that our purpose is a little more important than black Friday shopping? If we want to be respected for the work we do, we have to respect it for what it is. If you aren’t willing to be a bit of a martyr, a bit of a servant, a bit of a whipping boy sometimes, perhaps you should reevaluate your career choice. Please, don’t think that I don’t get upset when my colleagues aren’t treated with the respect that I know they deserve. I recognize that there is a perception problem in our society of healthcare workers. It is my opinion, however, that a portion of this issue rises from our perception of our own profession. It has drifted away from what it should be. I believe that we could improve the public outlook towards us if we first redirect our attitude as a community. The fact is that we shouldn’t be offended when we serve as someone’s waitress, their maid, or their masseuse.  All of those things can contribute to healing or to comfort and that is why we are here. So chin up, smile, you’re doing a great job. You are helping people. Just don’t expect to be told that all the time.

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The Apes at Work

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     Sometimes, it’s easy to feel a little worn down at work. After a hard day of giving it all I’ve got and then some, I’m no stranger to the feeling of trudging home in a lead suit whilst a rusty dagger plunges through my feet with every weary stride. To reap big reward, I suppose,  one must offer up big sacrifice. This is especially true in the health care arena.
     The layperson may not know this, and I hate to ruin our public image, but hospitals are full of apes that love nothing more than to ride on the backs of health care workers.  These animals are of all shapes and sizes and are sometimes, very dangerous. They climb and cling and scratch and howl at us every single day. The trick is to find a way to relieve yourself of this belligerent band of baboons before you return to your own beloved brood at home. In case you don’t get my dilemma, allow me to illustrate a typical day in my shoes. (Can be adapted to most any health care worker’s day, these are just my personal regular monkeys.)

0500
Call the floor to do staffing. We are a nurse short with a full census due to illness. A monkey runs up my leg and snuggles into my flannel pajama pocket.

0630
Arrive to work. Two CNAs today. YAY! They hate each other and can’t get along. Sigh. Here comes another monkey. He’s a screamer.

0700
Call other departments to see how many beds will be needed for admits. Admits > empty beds. Monkey.

0730
My “walkie talkie” patient can’t keep a decent oxygen level. Call respiratory. Throw them a monkey. “You’re welcome”

0900
My patients home meds were entered wrong. I hear chittering.
I have to confirm with their pharmacy because they shouldn’t be taking “extended release” three times a day. Call our pharmacy to correct it. Call doc. Get attacked by a signing chimp. He angrily signs at me a sign I most often see while in traffic.

1000
“Walkie talkie” is breathing regularly,  but didn’t get breakfast. Call kitchen. The order isn’t in. Put in order for “regular frickin, diet.” Deliver it personally. Patient still pissed. A monkey sits on my head and shits.

1200
Forgot to do my blood sugars and surgery is on hold needing to give report. Trays are here. I’m hungry. I have to pee. Two people want pain meds. One patient got the wrong tray. One got no tray. Every other nurse is in the same shape I’m in. Also, administration, looking well-groomed and collected in their fancy suits, is doing a drive-by. “We’re doing great boss, never mind this silver back mountain gorilla happily perched on my left shoulder. It’s totes cool.”

1300
“Walkie talkie” is found in the floor. They just wanted to go to the bathroom alone. They now have a bruised butt and a respiratory rate of 44. Pick them up along with a couple of wrestling howler monkeys. I then go get the paperwork.

1500
Notice the next shift is desperately short staffed on the schedule. Try to call in help for them. However, I didn’t try to call the other monkey that leaped onto me like I’d like to do to a bacon cheeseburger right about now.

1630
Next shift calls to do staffing. Holds me personally responsible for their lack of help tonight. “But did you call the president and see if he could help?”
Judging by what one of the monkeys are doing to the gorilla, he must be into hefty ladies.

1900
Report off my patients,  heard about what all I should have gotten done, but didn’t. Time to get out of here.

The animals are climbing over one another to get on top of my head. It’s like the discovery channel is airing a WWE match. The screeching is ringing from inside my skull and echoing up the dismal walls of the stairwell as I desend. I begin to reflect on my day. I focus first on the face of the man I spent maybe too much time listening to about his now grown children. My foot lightens as a primate releases his death grip on my ankle. I envision my surgery patient finally resting when we got her pain managed. The poo thrower scampers away. I remember how respiratory had my back when my patient couldn’t breathe, how the aide and I worked together as we delicately washed the body of the recently deceased, and how my fellow nurse made me laugh in the middle of the storm of multiplying demands. Hairy bodies fly out of my car windows as I speed down winding roads. By the time I get home, I still reek of the simian circus. I’m still strewn with hair and feces and fleas. My ears still ring and my back still aches. But, I can tickle my son and embrace my husband without fear that the apes at work will latch onto them and damage my home.

Yea, I’m JUST a Floor Nurse.

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Reflecting on my “student nurse self,” I vividly remember two regretable ideas I had of the profession I was about to embark on. The first being that I would not be able to maximize my ability or skills working at a small town hospital. The second being that I WOULD NOT be a nurse on a medical surgical floor. If I absolutely had to “do my time” on med/surg so that I could specialize in something “better,” so be it. But, it WILL only be a steeping stone.
My perception of the typical “floor nurse” was that they were run-of-the-mill, mediocre in skill, often jaded or burned out, having a basic knowledge base, not up for a challenge, and definitely not what I was aiming for in my career. I recall my eyes glazing over every time a med/surg nurse recruiter came to school to speak. I had plans of really making a difference. Perhaps on the front line in the ER, or juggling the delicate balance of life and death in some fancy ICU, yea, that sounded so cool.
The Good Lord does have a sense of humor, people. When I took my first job as a new grad in a tiny, local hospital on the med/surg floor, I was ready to get my feet wet, but it was still just going to be a brief stent until I could get good enough to move on and be a “real nurse.”
It didn’t take long for me to find out that one must be one hell of a badass nurse to thrive on a floor like that. One by one, the little ideas I had about what floor nursing was obliterated and crapped on by my actual experience. On a given day, I will likely have a ped, a geriatric rehab patient, a fresh ortho surgery, a postpartum,  and CHFer. I work with some of the most caring people I have ever met. And, while our patient population isn’t typically very critical, when they take a quick turn for the worse, WE ARE IT. Everyone on our team wears multiple hats because we just don’t have the resources that are available at larger facilities.  In that way, we have to be MORE capable, MORE self reliant, and MORE flexible. I have truly worked with some stone cold beasts of nurses and I am glad I have had them to show me the way. Our problem solving is top notch, our time management is fine-tuned, our work is our calling. It just has to be. I am so glad that I was so wrong. I have learned so much. It can be a real riptide out there working under a lot of pressure and time contraints, but if you and your team are up to the challenge, it is more rewarding than I could have ever imagined.

Kori Reeves, Registered Nerd