My Strong Medicine

The adventures of a male nurse navigating through life, staying fit, surviving the journey.

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Behind the doors of a nurses’ mind

Posted by Sean on September 17, 2011

Here was a post over at Scrubs Magazine taking a comical look at how my mind as a nurse works sometimes. Am I alone?

A nurse’s subconscious mind

There are just some things non-nursing folks will never understand. It’s not a ‘knock’ against those who are not a nurse, really it’s not. What I’m talking about is how your brain gets ‘re-wired’ once you become a nurse. I don’t know if it happened over night? Maybe it happened gradually over the past half a decade? What I do know is my mind thinks and processes things SO differently than it did prior to being a nurse. I wonder… am I brain-washed??

Here’s what being a nurse can do to the mind:

  • At the restaurant, we silently hope that the person choking at the table next to us doesn’t need assistance – yet if they do we’ll be the first to run to their side.
  • Walking through the fog of a public ‘smokers break area’ – we all want to reach out and smack you. Do you want to die breathing through a tube?
  • While phlegm doesn’t normally bother (most) us at work – the sight or sound of you hacking up a ‘lung’ in public really does bother us. Especially when you don’t cover your mouth!!!
  • Public restrooms. Yes – there is nothing sanitary about them most of the time. What we can’t stand is witnessing someone use these facilities and then walk out without washing their hands!!! (How am I supposed to pull the door open and exit the bathroom without contaminating my hand??)
  • For some strange reason – we can never look at another persons arms the same ever again. Every time we see a good vein – yep, you guessed it, we think to ourselves, “wow! I could start an #16 gauge needle there!” Sorry.
  • We continue to micro-analyze anything on TV or in the theater that has a shred of health care related activities. “Oh yeah, THAT would happen” has echoed through our minds one too many times.
  • To this very day, I think we all have been cursed with measurements. We subconsciously measure how much we have urinated, how many CC’s of fluid we have drank and of course how many carbs were in our meals.
  • While on vacation – no matter the geographic location. We somehow ‘notate’ and remember where the closest emergency room and hospital are located.
  • I’m not sure if it’s just a nursing thing, I think paramedics share this curse. We still to this day have a spare set of scrubs stored in our vehicles, along with old ‘not in use’ equipment like stethoscopes, pen lights and scissors.
  • We still shake our heads at those wonderful ‘blood pressure screening stations’ located throughout the supermarkets and discount stores. I think we are more troubled by the fact that the public believe these measurements to be accurate.
  • We still (often) forget that it’s not common practice to talk about blood, bodily functions, and bodily fluids as a discussion topic during a meal. Again, sorry.
  • Yes, we find humor in the most disgusting and disturbing things sometimes (OK, all the time). I’d like to think it’s our defense mechanism for making sure we don’t drive ourselves crazy and burn out.

This just scrapes the surface of what goes on behind the doors of our minds. I continue to convince myself that I’m not brain washed, but that I have been trained and educated to always ‘be prepared’, but sometimes you have to wonder.

(That was a joke folks)

A nurse’s subconscious mind | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

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The real reason we nurses get bitter

Posted by Sean on September 17, 2011

Shrtstormtrooper shares a story over at New Nurse Insanity (link below) that encapsulates why we nurses develop short fuses. Fuses that lead to burnout, angst, anger and all kinds of negativity. Sometimes (some) nurses really need to check themselves before ‘reporting’ a fellow ‘fighter’ to their supervisor. Walk just a few steps in another co-workers shoes.. you might think twice about reporting someone for something you yourself probably forget or miss just as much, if not more than most nurses!

A high five to Shrtstormtrooper.

Priorities, seriously

So I got called into the Boss Man’s office this morning, because the floor wrote me up and he wanted to address the issue.
At this point, my feet hurt, I haven’t peed yet tonight, I didn’t get to eat anything, I have blood on my scrub pants…..

I have poop on my scrub pants…

I haven’t finished charting on that last arterial bleeder that came in….

and my coffee from 7pm is still sitting full on the counter next to my computer. It’s been a rough night.

 

I got written up because, in all the madness, I missed a skin tear on this patient. One skin tear, out of many. And actually, it wasn’t my patient to begin with,

New Nurse Insanity: The Adolescent Years | Priorities, seriously

Follow the link above to read the whole story. Be sure to leave a comment for her, let her know she’s not alone!

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Wading in the job fair ‘pool’

Posted by Sean on September 5, 2011

Over at Scrubs I share my experience at my first job fair as an ACNP student! Exciting times lie ahead!

My first job fair

In all my years of professional employment, I’ve never attended a job fair. Not that I wasn’t interested, I’ve just been lucky enough to have a job lined up each time they were appropriate. I already had a job in an ICU 2 months prior to graduating nursing school. I was into my 4th year as an employee when I graduated with my BSN. So up until now they really didn’t make much sense for me.

Fast forward to the present. I’m just completing my first year in my ACNP program with 4 more semesters to go (yes, there is a faint light at the end of the tunnel). While I’m a little bit ahead of slope, I thought I’d attend the job fair that was offered recently just to see what to make of it. I must say, prior to making my way there, I was actually quite nervous?? Not sure why, since I’m not even close to that stage in my new role!

In my current ACNP program we had the unique opportunity to attend a job fair geared for physicians. It seems to be the new trend in health care since the allied health care professionals, sometimes called physician extenders are being utilized more and more in a wide variety of settings (PA’s & NP’s)

It was surreal to be walking amongst the ranks of physicians. Once again I’m still getting used to this new advanced role (not that I’ve even got my hands dirty yet!).

This particular fair you could pre-register and upload your CV and/or resume via their website. They also had the option of bringing them with you.

The fair was a smörgåsbord of gifts, sales pitches, shoulder rubbing and networking! Everything and anything was on the plate. It was a pleasant surprise to see so many recruiters excited and interested in potential Nurse Practitioner hirees! I was overwhelmed by the positive feedback and encouragement all the recruiters showed, not to mention all the cool gadgets and free pens (you know how we nurses like our pens)!

The purpose of me attending a job fair an entire 18 months too early was just to learn what to expect from one of these shindigs, get a sense of what employers are looking for, get my name out there, and ultimately start the career ball rolling as soon as possible.

Mission accomplished.

I learned a couple things about job fairs:

  • Come prepared with a sense of what you are looking for. ( I honestly wasn’t)
  • Ask and answer as many questions as possible. (ask specifically about the job and all it entails)
  • Sign up for any and all lists that are offered – can you say networking?
  • Don’t be shy – enjoy the free stuff while it lasts!
  • Be careful – some recruiters can be like used-car salesmen/saleswomen (need I explain that one?)

I must say, after this experience I am even more excited to get my hands dirty and jump head first into my advanced practice career. The sky being the limit isn’t just a saying anymore!

My first job fair | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

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Advancing your nursing career

Posted by Sean on August 24, 2011

An article I posted over at Scrubs Magazine. While the choices may seem endless and confusing, which path you choose can be a very simple decision.

So you want to advance your career?

I think I’ve said this before. One of the greatest things about our career is the unlimited supply of choices and opportunity. The path our career takes is only limited by ourselves and our desire to move forward.

So would you be the least bit surprised by the unlimited number of choices a nurse has when it comes to picking a direction for an advanced degree? No, of course not. Advancing your nursing education is not as simple as “I’m going on to get my Masters degree in Nursing.” You have to pick a path as an advanced degree nurse.

Here are just a few of those options:

  • Advanced Practice Nursing
    • Nurse Practitioner (Adult, Acute Care, Neonatal, Family)
    • Nurse Midwife
    • Nurse Anesthetist
  • Nurse Educator
  • Clinical Nurse Specialist
  • Nurse Manager (Nurse Leader)
  • Nursing Informatics
  • Masters in Nursing specialty in:
    • Acute care
    • Adult
    • Family
    • Geriatric
    • Neonatal
    • Palliative care
    • Pediatric
    • Psychiatric
    • Obstetrics and Gynecological

Now throw all that into a bowl and add a dash of PhD and/ or DNP (Doctorate of Nursing Practice) and you got yourself a confusing swirl of opportunities just waiting for the picking!

Yes. It seems overwhelming enough to cause a slight headache, but when you break it down into it’s most simple forms, you can see the light at the end of the tunnel.

When I finished my BSN (I did an RN -to-BSN program) I knew I wanted to continue on and advance my degree. I just wasn’t quite sure which direction to choose? What if I choose wrong? What if I change my mind? What’s the best decision? What’s the most profitable? Which path takes the longest amount of time? Which path takes the shortest amount of time?

These questions and many others all have their relevance. They really do. The problem is, none of them are as important as this question:

Where do you see yourself practicing (in 5 years), where it would NOT be considered a job?

…

That’s really what ultimately guides you onto your next adventure. Of all those choices, which one could you do on a daily basis and not consider it your ‘job’? Where do you feel you make the most impact?

Let’s put it another way. In your current practice as a nurse – where are you most happy? And does that happiness elicit the most ‘effect’ to the patient’s you care for? For me, it’s always been Critical Care. I’ve felt the care I give at the bedside makes the most impact on my patients. I’m not meant to work in an office. I’m not meant to care for the ‘not well’. I’m meant to care for the critically ill. It’s where I am most happy. I love making the difference we make. I want to take that feeling and extend it. I want to expand my skills and knowledge. I want to advance my care where I know I’ll be happy, and where I know I believe I’m needed.

One final thought on those myriad of choices you can make when considering an advanced degree. I would HIGHLY recommend you ‘shadow’ someone already doing the job. I remember shadowing a CRNA when I was trying to make my decision on advancing my career. I small part of me wondered if being a Nurse Anesthetist is something I want to do. After shadowing the CRNA I realized that it wasn’t something for me.

In the end, the choice to advance your career is all about you. Don’t let the naysayers or the recruiters try and sway your choices. As a nurse, we tend to deliver our care from our hearts. Let your heart help you make this decision.

So you want to advance your career? | Scrubs Magazine

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My former self (the new nurse)

Posted by Sean on August 17, 2011

Over at Scrubs Magazine, this was a hypothetical satirical letter I sent to myself as a new nurse some years ago.

A letter to my former self (the new nurse)

Dear Me:

I know it’s been a while since we’ve talked but I thought I’d check in on ya and see how you are doing? I see you’re head is still circling after finishing nursing school. Yeah, I know, it still seems like a dream… but guess what you did it! You graduated.

Now on to the NCLEX (boards).

While you’re busy studying for that I know you’ve started working as a Graduate Nurse at the bedside. Just when you thought you were done with that ‘learning’ stuff huh? Yeah, you thought nursing school was tough? Now you have to figure out how to survive and eventually thrive as an independent nurse!

Don’t worry, we have all shared the same feeling: Being sure that sooner or later someone was gonna notice that you had no clue what you were doing!

It’s OK. We’ve all been there.

I thought I’d pass on some tips and words of wisdom for you during those first few years, to help you through the tough spots. Yes, you read that right. I said the first few years. It takes, at the very least, a full year to just get comfortable in your new ‘nurse’ skin. It’s only after another year of feeling comfortable in that skin that you finally shake those jitters.

Sorry. I promise it does get better.

Here are some things to keep in mind:

  • It’s OK to be scared: We all were and still are to some degree. Remember, not everyone can do this job.
  • You are not expected to know everything: Some of us have been doing this for decades, and we still don’t know everything!
  • It’s OK to ask questions: the minute you stop asking questions is when we get worried.
  • Stop beating yourself up over every mistake : we all make mistakes, and we all continue to make more. The key is to learn from them.
  • Yes, things really do move that fast at the bedside: we all learned to walk first, then run. So will you.
  • Your first patient death will shake you up: trust me. And there is nothing wrong with that.
  • Your first code will scare the living daylights out of you : you’ll understand it better once you experience it first hand.
  • Every time you want to ‘run’ force yourself to walk: hurrying through a task will only increase your chances for making a mistake.
  • Take the time to learn everything by the numbers, before you decide to adopt a shortcut: just trust me on this one.
  • Learn the difference between confidence and arrogance: it will save lives.
  • Stop dwelling on how fast you do things: yes, we all did things that slow when we started! Efficiency comes after accuracy.
  • Never, ever, ever, ever apologize for calling a physician about your patient : even at 3AM.
  • Don’t expect respect until it is earned. You’ve earned the right to be here, now earn the respect to stay.
  • No matter where the job takes you, there will always be somebody wanting to break you down: don’t let them infect you.

And last, but surely not least. You have entered into one of the most awesome professions around. Be sure to pass on your knowledge, your skill and your passion to those who follow. It’s our job to erase the old urban legend of nurses eating their young.

Best of luck to you on your journey and your career. You are in for a wild ride!

A letter to my former self (the new nurse) | Scrubs Magazine

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Be the Patient

Posted by Sean on August 15, 2011

Over at Scrubs I ponder the thought of being on the other side of the bedside.

The BEST way to train nurses

What do you think is the best way to train nurses to be the very best caregiver? Have them be the patient.

I learned a very valuable lesson this week. Everyone that works in health care doesn’t know jack about being a patient, until they are one. If we did, we’d take better care of everyone. We really would.

I was on the other side of the ‘bedside’ this week. It was nothing emergent or life-threatening. But yet it still was important to me and my family.

We nurses (I only use nurses since that’s what I am) tend to trivialize and even minimize what the patient and their families are experiencing, regardless of what that may be at any given time. I think we do this subconsciously or subliminally or maybe even reflexively because it’s something we ‘deal’ with every day we (as nurses) come to work. Dare I say aspects of our job become repetitive in nature (to a varying degree)?

Being on the receiving end of that clockwork care sprung my eyes wide open. I realized how much I have failed my patients in recent months.

Something that seems so trivial and minimal for me can a be very big deal and could quite possibly be a life-altering event for someone else (our patients).

Yes, I’m being vague. It’s intentional.

Take for instance something as ‘repetitive’ as dressing changes. For us, we almost go on autopilot about all the varying aspects of a proper dressing change. Everything from the type of tape, type of gauze or drainage pad, the integrity of the skin, the healing process of the skin, the condition inside the wound, around the wound and outside the wound. The important aspects of wet versus dry. Proper cleaning techniques. Knowing when to dab, knowing when to wipe. What looks good? What looks bad? (the list is quite possibly endless). When we do a dressing change we sometimes fail to properly educate the patient and their family members. We sometimes fail to put ourselves in their shoes. The insurmountable amount of questions they may have. Their fear. Their intentions, etc., etc.

I guess being the patient reminded me of how delicately balanced our responsibilities are, and I’m glad I was reminded in a cooperative and kind way. Because the fact of the matter is, we deal in life and death every hour of our working day. I don’t want any part of my care becoming trivial.

The BEST way to train nurses | Scrubs Magazine

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The ‘nursing’ sandbox

Posted by Sean on August 13, 2011

We all have to learn to play well with others. Over at Scrubs Magazine I talk about the team concept.

Playing well in the sandbox

I don’t know if it’s just a nursing ‘thing’, or other career choices emphasize and utilize the team work concept repeatedly. I have encountered it and seen it at ever level of my training and nursing education. From my diploma program, through my BSN education and now currently in my Master’s Acute Care Nurse Practitioner program. Working well with others is a quality that educators require.

I guess it should be no surprise considering what we do on a daily basis. We are the coordinators of care, the wranglers, and the sieve where almost all of our patients’ care is poured and filtered. So if we can’t navigate the didactic of the team concept, our patients are in trouble.

As students we are put through the rigors of group projects. The majority of my projects have applied to research projects, but they sure haven’t been limited to just that subject.

Sometimes you get to pick and choose your group and group members, other times you get the luck of the draw and are assigned to a group. This equates to working conditions if you think about it. You sometimes get to choose whom you work with and where, while other times you can be ‘pulled’ to a foreign or neighboring unit.

The group didactic can be quite enjoyable and simple, or miserable and complex. I’ve experienced both during my time as a nurse in both the academic and professional setting. One thing is for sure, the only thing you ever have control over is your own thoughts and actions. No matter what you may want or need from someone else, in the end you have to figure out how to make it work so that it benefits everyone.

There will be personality conflicts, scheduling differences, work ethic challenges, deadline stressors, and of course the occasional ‘what the heck happened’ moments (I sometimes call that the curve-ball syndrome). Regardless of the situation, the only way things work out is when everyone knows their part, does their part, and communicates their part effectively, efficiently and equally.

I don’t know about you, but every time I work within a group a learn a little bit more about my self. More about my strengths, my weaknesses, and of course my habits. I have subconscious tendencies that are both a help and a hindrance to me and the group. And I’m still trying to sharpen my communication skills to this day!

I haven’t met a nurse that looks forward to group projects. I think we all approach group projects the same way we encounter ‘change’ – we’re not big fans of it, but we know it’s inevitable.

I also look at it this way. Remember how I gave the comparison of getting assigned to groups and getting to work where you want? Well that comparison is synonymous with our patient assignments aren’t they? We sometimes get to choose the assignment we want or know is going to be good, and other times we have to bite the bullet and take that assignment that we know is going to put us through the ringer. Does that mean we provide less care?

Not in my opinion.

Playing well in the sandbox | Scrubs Magazine

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The change of shift ‘dump’

Posted by Sean on August 12, 2011

So, anyone else ever feel that guilt after you give shift report. Thinking that you may have ‘dumped’ on your co-worker? Here’s a post on Scrubs talking about how I hope I’m not doing that.

End of shift guilt

As a per diem nurse my time management skills slip a bit. When you work on a regular basis, you of course create ‘rituals’ that I think we all can relate to. It’s the rituals and the ‘reflexive’ nature of our responsibilities that I sometimes lack.

This absence or lack-there-of always leads to what I call ‘shift spill-over’. I end up leaving tasks for the next shift inadvertently. I do my best to not ‘dump’ on anyone, so I make it a point to wrap up as much as I can before I officially clock out and leave.

The other day was one of those ‘off’ days for me. I just couldn’t stay in front of the 8-ball with my patients. Everything from ventilator weaning and extubation to med changes and of course the traditional admit and discharge right around the change of shift sure didn’t help.

On my way home, I began to wonder if I’m the only one that has that end of shift guilt? I mean it’s not something that was ‘taught’ during nursing school. And it surely wasn’t mentioned in ANY of my hospital orientations. Yet, every shift I work I’m circling through my head all the tasks that I didn’t get done and have to pass on to the next nurse.

I know, I know… nursing is a 24 hour-a-day job. (One of the many nursing pearls I teach and have been taught)

I guess I always remember what it feels like to get ‘dumped’ on. I’ve taken shift report from some pretty horrible nurses. Nurses who failed to chart meds from the beginning of their shift (8 or 12 hrs.). I’ve cleaned up messes in patients rooms that were made at the beginning of their shift or even a previous shift. I’ve gotten my rear-end chewed out by a distraught family member because they weren’t called and updated properly on something I wasn’t even present for! And yes, I’ve had many physicians question my integrity because a med error was made or a med was missed on a previous shift.

*sigh*

I know I’m not dumping on anyone (at least I don’t think I am), but I can’t shake the feeling of it. Call me crazy, but that end of shift guilt keeps me on my toes throughout my shift. The last thing I want to do is let down a fellow co-worker.

I can’t say I’ve been approached or accused of ‘dumping’ – but that doesn’t mean the oncoming shift nurse didn’t feel that way.

One thing is for sure, I’d like to think I’m a fairly decent bedside nurse. It’s the nurses who don’t have even a shred of this guilt that scare me.

End of shift guilt | Scrubs Magazine

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Nurses and interns

Posted by Sean on August 7, 2011

This was an eloquent but viciously accurate list of things for interns to ‘not’ do when interacting with the nursing staff. Kudos to “Albinoblackbear” (She is a nurse turned medical student who blogs at Asystole is the Most Stable Rhythm).

One of my readers astutely pointed out in the comments section of my blog that “nurses will make your life a living hell” if you treat them badly. Some will make your life a living hell, no matter what. As in every profession, there are nurses with a chip on the shoulder, as well as those who are simply counting down to retirement. But for the most part, nurses want to work with you not eat you.

Some of my suggestions probably appear ridiculously obvious, but I wouldn’t have been prompted to write these pieces if I hadn’t observed the examples below.

Here are some things to avoid:

1. “That is not my job” or ”I’ll get the nurse to do it” are two phrases that can be heard by a nurse ears even if she were standing next to a jet plane at take off.

….

2. If a nurse is asking you a question about something, don’t blow her off with a patronizing answer or assume that they are questioning your care.

….

3. Messy handwriting is dangerous. Stop it. Many places are switching to computerized orders which definitely have advantages, one being that RN’s no longer will have to add ‘expert handwriting decipherer’ to their list of skills.

…..

Improving the relationship between intern and nurse | KevinMD

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An open letter to hospital administration

Posted by Sean on August 6, 2011

Another blog I posted over at Scrubs concerning Hospital Admin.

It’s not always about the money

Here is an open letter to any and all hospital administration who cares to listen.

Dear Administration Team:

We nurses understand the importance of Press Ganey, HCAHPS, patient safety initiatives and fiscal responsibility. The business of health care has become more cut-throat than ever before. But, somewhere along the way the lines became blurred and you forgot that the business of taking care of others cannot be accomplished unless you take care of those whom take care of you.

I won’t insult your intelligence, so you are probably aware that a fine balance between recruitment and retention is paramount to the success of any company. We all know that it takes more resources and deeper purse pockets to hire and train employees, than it does to retain those whom already have shown some allegiance and loyalty. Anyone and everyone’s ‘system’ can be bled dry by a high turnover rate percentage.

I thought I might suggest ways to increase your retention and quite possibly eliminate this system exsanguination:

  • Learn how to give more positive feedback. We always hear negative.
  • Stop finding the time to point out what we are NOT doing, and find the time to thank us for the job we ARE doing – EVERYDAY.
  • While a pat on the back is fine and dandy, how about a lil more tangible feedback for your appreciation? We all love a free meal now and then.
  • Stop micromanaging – please.
  • Adopt and enforce ‘The No Asshole Rule‘. This includes ANYONE with a G.O.D complex (no matter what their credentials say).
  • All work and no play makes Jack and Jill very dull boys and girls. Ever heard the saying ” A family that plays together stays together?” – ‘Nuff said.
  • Just because it looks good on paper, does not mean it will work well at the bedside.
  • When an employee makes the extra effort, or goes the extra mile, – find a way to give them an extra-ordinary thank you.

There is no predicting why or when someone chooses to leave. I guess we all fall prey to the possibility of greener pastures. If any of the above suggestions are followed, we most certainly would already be standing on the correct side of the fence.

I don’t think anyone can find their true dream job, because quite honestly everyone’s dreams continue to evolve.

Please keep in mind, that while we often feel we never get paid enough – our choice to pursue this career was never about the money. It’s not just a job for many of us, it’s a lifestyle.

Sincerely,

A Nurse

It’s not always about the money | Scrubs Magazine

Posted in health | Tagged: , | 2 Comments »

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