Monthly Archives: April 2012

Don’t Break My Zen

What an interesting week this has been. While I continue to be a nexus of possibilities, having all kinds of amazing experiences, it is fascinating to see what kind of response this elicits in people. The majority have been fabulous and supportive. Some have been inspired to start their own journey of self discovery. While yet others seem to make it their personal mission in life to pluck my very last nerve. Yesterday at work I had a uniquely challenging day. I was charge nurse, working with a very “special” nurse. While I am able to get along with him on a personal level, professionally he could infuriate Mother Theresa. This nurse always has issues with me when I am charge and he is not. It is silly really, as I am not one of those charge nurses that subscribes to the belief that somehow I am really in charge of anything. The truth is, we all hold licenses, we all are accountable, we are all employed, and we all had to pass a drug test to be there. As far as I am concerned, manage your own crap. It is not my job to chase you, or be a hall monitor. It simply means I give bed assignments, and fill out the charge report sheet. I am always a resource and a team player, so nothing in that changes by me being “in charge”. I don’t particularly care how people do things, just get your job done and let’s have a good day.

This gentleman does not subscribe to my philosophy on anything. not on nursing, not on being charge, not on a thing. He started out the day cranky because he was not charge nurse, I was. It went downhill from there. no matter what I did, how I tried, he was impossible. and to make things worse, he wouldn’t even allow me to try to fix things, or resolve any issues we were having. he would just throw my words back in my face, literally. The truly funny thing, is all of the things he complains about in others, he manifests in himself to a tee. And he was not content until he pushed me to the point of tears. He literally broke my zen. It was as though he took upon himself a personal challenge to burst my happy bubble. The more I tried to breathe deep and seek peace, the more he pushed. Takes some talent, really. One could admire his determination to piss me off, if it wasn’t so annoying. By the end of the day, I was frazzled, frustrated, exhausted beyond all reason, and so DONE. If I could have packed my stuff and walked out never to return again, I would have. I have zero tolerance for unprofessional dramatics. it is an unbelievable waste of time and energy.

The odd thing was, this persons antics really have helped me. It has further cemented my belief that there is a path for me, and that path does not include being like him. I had become complacent to a certain extent- content in the job location, settled so to speak. it was easier to just keep renewing my contract, even if I am not being stimulated and challenged. This is not the person I wish to be. I never want to be complacent in my job or any aspect of my life. I needed a stick to remind me that there is more for me out there, new experiences and new people to meet. I never need to live in a state of fear or anxiety. I do not need to choose to remain in an intolerable work environment. While I genuinely and truly like and respect the majority of people I work with, I have some fundamental issues with my work place. Unfortunately the biggest one of them all, is the fact that status quo is maintained. I think Clara Barton, the founder of the American Red Cross said it best-  “I have an almost complete disregard of precedent, and a faith in the possibility of something better. It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past.”

I will have to work with this person tomorrow again. But I think I shall thank him. I will thank him for the gift of shaking things up for me, reminding me that I have a higher purpose in life, and motivating me that much more to achieve it. I am the captain of my own destiny, and no person shall deny me that right. As I said to him yesterday, and will say again tomorrow- you’re not the boss of me. I also think I will take some earphones and soothing music along..just to be on the safe side.


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Respect in Nursing

• No man, not even a doctor, ever gives any other definition of what a nurse should be than this — ‘devoted and obedient.’ This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman.  Florence Nightengale, [1859]

I just read an article entitled “How to get the credit you deserve during Nurses Week”. Once again, I am angered and feel that nurses are being taken advantage of. The article quotes a person (with multiple letters and credentials after her name of course) “A nurse is valued for her ability to coordinate care among the team, when working with other disciplines, what does it say to the group that the nurse is the least educated among them?” The article went on to conclude that the only way for nurses to attain more respect from administration, patients, their co workers and the almighty physician, was to advance her education. Anyone surprised that this article was promoted by an online education program? that within the body of the article itself was a commercial for a school?

That single quote above, made me angrier than I have been in a long time. Do we work in a place where we walk around with bar codes on our chests, that if you scan them tells us our content including our educational status and expiration date? Because I do not hold advanced degrees that somehow makes me less credible and less worthy? really? The best nurse I know, the nurse I respect and admire beyond everyone, is a diploma nurse from Scotland. She has been doing this since she is 16 years old. And god bless her, she is of an age that you do not ask her age. I adore this woman, I respect her tremendously, and I use her as a resource. She has retained compassion and care as the core of her health care delivery method. She is an amazing nurse, and the best asset to our unit that we have. Everyone is thrilled she has returned to the ICU from cath lab.

The supposition that critical thinking skills can only be achieved via an institute of higher learning pontificating at me to the tune of 40K is ludicrous. I have respect in my work environment because I create an atmosphere of competency, compassion, knowledge, and approachability. I have respect from my coworkers because I treat others with respect. I have respect from the members of the health care delivery team because I demonstrate the ability to participate in the system. I educate myself on the disease processes of my patients, I become in tune with what is needed to help them along the path and assist them in their recovery. I act as a resource and help those around me. they are ALL our patients.

The role of the nurse in the health care team as I see it, is to interpret the physician’s orders, implement them, observe and evaluate, report back to the physician the results, and make recommendations based on those observations. It is the ultimate scientist. The physician sets up the theory, we observe for results.  You need to be able to ask questions, both of your patients and the doctor, in order to uncover the information needed to help the patient progress. The amazing bonus to this job, is we get to do this with people, not in some cold sterile lab. We are working with humans, full of all their complexities and emotions. We get to hug people and love them. This is why I became a nurse, because it is a profession that demands the combined usage of my brain and heart. The human component cannot be denied.

I am respected in my profession today, because I conduct myself in such a way that it cannot be denied. I do not hold any advanced degrees. I have an Associates of Science in Nursing. I have worked across many aspects of nursing, from direct patient care to administration. The reason I am respected for what I do, is I manifest competent compassionate care. I am able to discern what needs to be done in order to accomplish the goals for the patient. Whether that is discovering that the patient has nightmares from a bad childhood, thus she does not sleep well and has anxiety problems interfering with her recovery, or anticipating what information the physician will need during rounds and having that readily available for them. Have I had times where I am disrespected? Of course. We all have encountered that doctor who is “special”. However the majority of the time, I have discovered that it is because the doctor does not know me, therefore lacks trust in me. If I continue to demonstrate a primary focus of care and concern for the patient, combined with the ability to observe and report, respect comes. It is really that simple. And I do not need an advanced practice degree for that.

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I have been experiencing some amazing things lately. I do not know if this is a midlife crisis, or what. I am approaching a big birthday though I am choosing to ignore that. I cannot help but feel that I am on the verge of some big changes. I have been reinvigorated in many aspects of my life. I have had some amazing aha moments- from listening to music to watching films- things that have reaffirmed my belief that we create our own reality. When I sit in negativity, whether that be in my personal or professional life, it affects me. It affects those around me. Yes, it seems terribly cliché – but it is true. I am practicing a new yet old philosophy. to be centered, here and now, in my present, full of all possibilities. I can choose which possibilities I wish to manifest in my life. I am the author of my existence, and can choose to experience myself in a new way. Do people change? Maybe no. But you can discover a new aspect of yourself, that you can be a different you. So far this week, since practicing this, I have been able to seek out new things that reaffirm that I am on the right path. I have lost 15 pounds according to my scale. I feel transcendent. not because of the weight loss, but because I FEEL different. I feel happy. from inside. content and free of obsession and addiction. I do not need to look to outside things to validate my existence. I am here, I am now, I am love. I do not need to worry about other’s perceptions of me. I can be free to let go of fear and anxiety and that which does not enrich my life. it is time to let go, and to just BE. I feel like I am the Jewel in the Lotus. I finally get it…its about loving and seeing that which is possible. those possibilities create reality, by my observation of it. I then will make choices that create that reality.

and no…I’m not high I swear 😛 I am just…utterly happy.

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ok, well oddly enough I have found myself in the same place for almost a year. this means I am approaching the need to make some decisions. I like where I am, but I also need to consider everything. The main issue, is that I have opted for the tax advantage program of pay- this allows me to work for less of an hourly rate, but receive a large stipend tax free in my check each week. this helps me when I do overtime, because I do get an overtime bonus- but I don’t get knocked into the next tax bracket. when I work for straight hourly pay, a large portion goes to uncle sam.
so that being said, you can only do this for 12 consecutive months in the same location, or you have to change to the straight hourly as “non traveler”.
now, there are pluses and minuses to both. I am comfortable where I am, its close to where we are living, I like the area and I like the people I work with. the down side is the financial. the hospital corporation has its own agency it uses, and their pay rate is significantly higher, but they only offer a 401K plan, no insurance of any kind. I don’t have insurance currently, but I was going to enroll with my agency this month for that. If I convert to hourly with my agency, I will end up with a significant pay cut, at least 400 per week. that is not a good thing at all. plus any overtime will be taxed at the higher rate, which frustrates me beyond all reason.
so…basically I can either take something with my agency for 13 weeks and add an hour+ commute everyday, go out of state for 13 weeks, or change to the hospital staffing agency. the other option is to take something for 3 days a week in McAllen, and go with the local agency for 1 day a week where I am. that at least should get me 4 days per week consistently. I don’t know though. lots of things to consider.

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Nursing is a Gift

“Compassion is a mental quality that can bring us true lasting inner peace and inner strength”.- the 14th Dalai Lama.

Nursing is a gift. it is a gift you give your patients, your patient’s families, your coworkers and yourself. No other profession allows for the level of compassion and human contact that nursing does. We see people at their most vulnerable. We help people when they are most desperate. We often are the link that keeps them hanging on, or the one that gives them the permission to let go. We are the soul of medicine. I believe that with all my heart.
I recently had two radically different experiences with a patient’s death. In the first, we had a patient who was all alone. His family wouldn’t stay with him. They would come, visit, and leave. This poor man had been through countless surgeries. He had wounds and machines and had suffered. His family had elected to make him no code status- to allow nature to take its course. We knew his time was limited, and we tried to encourage his family to stay with him. They decided not to. The night he died, he was all alone. Except for nurses. I looked up at the monitor, and saw that his heart and breathing was slowing. I went into his room, pulled up a chair and sat down. I held his hand and told him it was ok. I wasn’t his nurse, just a nurse working that night. His nurse was frantically busy trying to reach the family, but they wouldn’t answer the phone. I held his hand as he died, and saw his soul leave his body. I cried for him. It tore at my heart, but he did not die alone. I do not care what your religious beliefs are, but I maintain that you can tell when that “spark” is gone. Even when someone is not responsive anymore, when they are no longer conscious, you can still tell when they have passed away, machines or not. As a nurse, and as a human being, I cannot bear the thought of someone passing their last moments on this earth alone. Not if it is remotely in my power to prevent that. Eventually we were able to reach the family, they came and signed papers and left. It was hard on all of us to see that.

The next day that I worked, I had a vastly different experience. A patient that I had taken care of for many weeks was gravely ill. Multi system organ failure, no hope for recovery. No evident brain activity. I had become close to the family over the preceding weeks. His daughters came back to town in order to assist their mom and to say goodbye. I was not his nurse that day. but the family asked for me. My time was spent hugging the family, being a shoulder to cry on, and giving them permission to grieve. They were in limbo- not able to move forward because he had not yet passed away, but he was for all intents and purposes gone. They elected to withdraw care and let him pass. It was difficult and hard, and I cried with them. The funny thing was, my “nursing” was for the family. We had already done everything we could for the patient. We were there to ease any residual suffering- but he had family to be with him as he passed from this world. What the family needed was our support to tell them it was ok. That was the gift that I could give them that day. To acknowledge their pain, to validate their feelings, to support their decision and to tell them it was ok to feel exactly how they were feeling.

As I see the flurry over advanced education for nurses, I am struck by how little people seem to know. I realize that what people are struggling for is a way to quantify what nurses do. I don’t think that can be done by a piece of paper. There is no degree in compassion. There is no certificate for empathy. You can have the technical skills of a god, but if you lack the ability to connect with another human, you cannot be an effective nurse. You can memorize charts and drugs and machines and abnormal values. But if you cannot put yourself in the shoes of your patients and their families, you are doing everyone a disservice. Whether it is holding the hand of a nervous patient and telling her its ok, or bringing a sandwich to a worried husband, all of it is part of nursing. It is a gift, the gift of loving someone, even if only for that moment. And I am always enriched by that experience, no matter what form it takes.


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