Is this you?

Throughout the years, I have gained many skills as a nurse that have transferred over to the "outside world." I have become really proficient at multitasking, I can put a band-aid on any boo-boo my kids bring to me. And I can tell a good yarn about my days at the bedside...especially when I worked nights.

I wouldn't call it "ruining" a perfectly good conversation, though. It's more like giving a valuable life lesson to my friends. Like, "If you don't stop eating those candy bars, THIS is going to happen to your feet when you get type II diabetes," or "If you don't wash that cut off, you'll get MRSA, and your infections will look and smell like THIS."

Sometimes, I even get requests for stories. I can recall one night eating at a higher end chain restaurant with my at the time boyfriend and his co-workers. As they all worked in sales, they were fascinated by my work experiences. They asked what I had heard to be most unusual item someone had put into a body cavity that didn't belong (hint: it involved Christmas lights!). So I felt like I was enhancing the conversation, not ruining it. Of course, no patient identifiers were given, in case you are concerned.

Then there are those stories we tell that are almost urban legends. I have heard from OB nurses about things people have named their babies and think, "that could not POSSIBLY be real." But it probably was. Or maybe you've heard the one about the pharmacist who called the nursing unit because a patient had brought in a script that read "Mofin, 5 pounds" (apparently someone stole a prescription pad and was hoping to get five POUNDS of morphine from the pharmacy)

Most of the time, though, the people I am having the conversations with are also nurses, so the stories tend to get really colorful. And then maybe it does ruin the dinners of people who are sitting within earshot of our tables when we are enjoying a nurses' night out.

Maybe non-nurses don't understand. They think we shouldn't tell stories about outrageous things our patients (and sometimes their families) have done. But we're not making fun of them. We are just preserving history and illustrating the human condition. And sometimes, if we nurses don't get to laugh, we will cry. And we might not be able to stop.

What's the story you like to tell when people ask you about your job?

 

You have probably seen those memes on the internet with a series of pictures that say "My friends think I do this, My boss thinks I do this, etc." Most of them are pretty lame, but one of my friends posted one about nurses that was spot on.

 The image says "Registered Nurse" at the top, and the photo of "What my friends think I do" has a nurse wearing a surgical mask and holding up a big wad of cash. In all fairness, nurses do make decent money, but I think we all know that the work we put in to the job is greater than the money we get in return. But nevertheless, our friends outside of nursing think we are rolling in dough.

"What my boss thinks I do" shows a huge amount of cash being flushed down the toilet. How often are we told in staff meetings to let more nurses go home if our census is down, even if our patient acuity is through the roof? Or that we need to charge our patients more for the supplies that we use? Or that we need to use less supplies? Even though we are doing what is best for our patients in that moment.

"What Hollywood thinks I do" is an image of a flirtation between a handsome doctor and a nurse dressed very provocatively. I just saw a movie on TV yesterday where a nurse in a children's hospital was wearing a tight, white dress with a cap. Yeah, that's an accurate portrayal. And the part about the nurse/doctor relationship is all wrong. Each year, I get all these young female students on the lookout for cute interns or young physicians. Honey, it ain't happening! Hollywood tricked you!

"What society thinks I do" shows a nurse holding a food tray, smiling. I really don't think that the majority of people who have not been hospitalized realize that nurses do things like provide lifesaving interventions, and not just empty bedpans.

"What I think I do" shows a blurry image of a nurse running alongside a gurney, rushing a patient off to the OR, or the trauma suite. Not what I personally think I do, but lots of my nurse friends would agree with this portrayal.

"What I really do" shows a nurse looking frustrated and overwhelmed amidst a pile of paper charts stacked up to the roof. Although pretty much no place uses paper charting anymore, ain't that the truth, folks?

So kudos to the creator of this meme. It is seriously the best, most accurate one of these I've ever seen. Thanks for understanding me, and all nurses. And for making me laugh.

 

It's late May, and all over the country thousands of nurse graduates are preparing to take the NCLEX-RN. It's one of, if not THE, most important tests you'll ever take. A passing score is one big piece of the requirements in order to practice nursing. So how are you going to survive if you are scheduled to take it this summer?

First of all, remain calm and confident. You made it through your program, and that would indicate that you do know a little something about being a safe practitioner so it's not like you are starting from nowhere when you start to study.

Next, be sure to study. Nurses who have passed the NCLEX say that doing some practice questions every day was what helped them prepare. The key is, doing some every day... NOT doing five hundred questions the night before the big day.

Don't procrastinate. Schedule your NCLEX test date as soon as possible. The longer you wait, the less fresh your mind will be. You don't want to forget anything!

Invest some money into products to help you prepare. Buy a book with practice questions, or take a review course in person or online. Sure, it costs money, but so does re-taking the NCLEX. And if you don't pass on your first attempt, most employers will demote you to a lesser pay rate. For example, instead of being a Graduate Nurse, where you make the same rate as an RN, you may be paid as a Nurse Tech.

Be sure to get plenty of rest the night before the exam. It will be hard to sleep, but you have to be well rested. Also, be sure to eat breakfast and/or lunch before the test depending on what time of the day your test is scheduled. I can still remember eating lunch at the Cheesecake Factory minutes before my big test ten years ago! Your brain and body will need fuel to get you through what could potentially be five hours of testing!

Don't forget to bring everything you need to the testing center. Especially your photo ID. Make sure you know where everything is the night before so you aren't scrambling and getting stressed that morning.

Come up with a guided imagery strategy. If you start to get anxious during the test, just take a deep breath, close your eyes, and visualize yourself in your happy place for a few moments. It sounds cheesy, but it works.

And finally, if you don't pass on the first try, don't beat yourself up. I have had friends who are awesome nurses who did not pass on their first attempt. Test anxiety can really cause problems for people who actually know their stuff.

If you are one of the thousands who are taking the NCLEX this summer, best of luck to you and welcome to the profession!

 

 

Happy Nurses Week! All over the country this week, you are probably receiving a cupcake or a coffee mug from your employer to recognize you for all the hard work you do. Nurses are the backbone of the healthcare delivery system- the last checkpoint through which medications and interventions, prescribed by physicians and dispensed by pharmacists, pass before being provided to the patient. We prevent errors. We provide compassion. We help people get better, or we help comfort those who won't get better.

I heard a commencement speech last weekend about nurses being the most trusted profession according to the yearly Gallup pole we all know about. The speaker, a nurse who is also a lawyer, felt that although nurses are the most trusted, we are the least valued. I don't want to sound ungrateful for my cupcake or my coffee mug, but I tend to agree with that statement. I know that even though we save people's lives and make a profound difference to our communities, our employers can't afford to give us multi million dollar salaries, or huge trophies or championship rings like athletes...but they can afford to throw huge parties and take out full page newspaper ads during Doctors' Week! At least where I come from...

But I am a nurse. I didn't go into this profession for all the kudos and pats on the back, and recognition for a job well done. I did it because I wanted to help people, to make their time on this earth a little better and more comfortable. And that's why I have stayed in this profession year after year. The real reward is seeing smiles on my patients' faces or on my students' when they successfully perform a skill on a real person for the first time.

I hope that this week you will know how much you ARE valued...by your patients, your co-workers, and your families and friends. You do things for others that non-nurses don't. You make a difference. And that is something to celebrate.

Take some time for yourself this week. Get a massage, or a pedicure, or enjoy a nice walk by yourself. You deserve it.

 

 

If you've turned on a radio or television in the last few days, more than likely you have heard about the Supreme Court hearing arguments about whether or not the Patient Protection and Affordable Care Act is unconstitutional or not. I probably better not state on this forum if I am in favor of "Obamacare" or not, but I will say that it seems silly to me that the people who have no good idea about how the healthcare system truly operates are making all the decisions on the matter.

Unless you work in case management or hospice or home healthcare, you might not be completely savvy about all the ins and outs of health insurance. What you do know, probably, is that at least one of your patients has nightmare stories about dealing with health insurance, doctor bills, and prescriptions costs... and there's a good chance that he or she works very hard and still can't make ends meet. Probably at least once you've seen the healthcare system fail a patient... maybe someone thought they couldn't afford a treatment so they opted not to receive it, or maybe they didn't fill his or her prescription because he didn't have coverage and couldn't pay the out-of-pocket cost.

Seeing that we have firsthand knowledge of the system, don't you think we should be involved in the decision making process when it pertains to healthcare? Why not put your wisdom and experience to work and be an advocate for thousands of Americans? Yes, I think there should be more nurses in public office. Think about it, the most trusted of all professions being in a position that is generally the least trusted. Think of all the good that could be done to help others.

Several states do have nurses as legislators. Karen Clark, a nurse, is a State Representative for Minnesota. And I have had the pleasure of working with Peggy Welch, an oncology nurse and Indiana State Representative. A few years ago, I interviewed Rep. Welch for a newsmagazine, and she shared her story of why she chose a career in the government and all she had accomplished (you can read it here).

Even if you don't think a career in politics is for you, you can still make a difference by contacting your local, state, and national legislators to make your voice heard. As nurses, we are in a position where others take our opinions seriously. I have made calls and sent emails to senators and representatives before, and because many other nurses made calls as well, oftentimes the bills I cared about passed. Many nursing organizations make contacting legislators simple, where all you have to do is type in your name and address and they do all the work.

Whatever your opinion is on the recent healthcare reform, make it known to your legislators... and if you have been thinking about what it would be like to be on the city council or in the state senate, maybe now is the time to start considering it!

 

I read somewhere that 30 percent of nurses of nurses are over the age of 50. So that means 30 percent of you should pick up the phone and schedule your colonoscopy in honor of Colorectal Cancer Awareness Month. Nurses are notorious for helping others stay healthy and ignoring their own needs. Hey, we're too busy to worry about ourselves, right? But I would be remiss in my duty as an Oncology Certified Nurse if I did not encourage you to go out and have a simple screening performed that can SAVE YOUR LIFE.

According to the American Cancer Society, colorectal cancer is the second most common deadly cancer for men and women combined. Pretty scary, huh? But you know what's crazy? It's said to be 90 percent PREVENTABLE when precancerous colorectal polyps are identified and removed.

If you are over 50, it's recommended that you get a baseline colonoscopy. As a nurse, you should already know that they don't hurt. They give you some conscious sedation and some pain meds, and you won't remember a thing. My friends who've had them done will tell you that the worst part of the whole thing is the bowel prep, but one of them did mentioned that she caught up a lot on her reading during that bathroom time so it's not ALL bad. Then, if screening is normal, you won't have to have another one for 10 years! Not bad, huh?

We encourage our patients to have health screenings, and engage in preventive behaviors, but unless we practice what we preach, how can they take us seriously? I know several nurses personally who are colon cancer survivors, so nurses are not immune from developing such a disease.

The symptoms of colorectal cancer can vary and include things like abdominal pain, change in bowel habits, and blood in the stool. These symptoms can indicate a number of more benign conditions as well, so don't let fear keep you from going to the doctor if you have been experiencing such conditions. With any cancer, early detection leads to a better prognosis so the earlier you get checked out, the better.

It's like they tell you on the airplane safety lecture: be sure to attend to your own needs before helping others. To be at our best when our jobs get tough, we need to keep ourselves healthy in order to keep our patients healthy.

Happy Colorectal Cancer Awareness Month!

We are hard pressed to find nurses on TV shows who fulfill real nurses' expectations of how we should be portrayed on TV. Letter writing campaigns exist so that we can contact writers and producers of shows like House, Nurse Jackie, and Grey's Anatomy and tell them where they misrepresent the profession of nurses. To be honest, I try to avoid hospital shows at all costs, so I don't know what shows are good and what ones are bad, but I hear Nurse Jackie is particularly offensive to professional nurses. In rare occasions, I think nurse advocates take their campaigns a little too far. For example, one group even took aim at my favorite recording artist, Jack White about a White Stripes song called, "The Nurse" (NOT my fave White Stripes song!)

I'm glad these advocacy groups exist, I'm really happy that they are working hard to make sure the image of nursing is respected, and that the public is educated about what it is that we do. The Truth About Nursing, whose executive director was the same one who had a problem with Jack White, did put out a really cool video about nursing called "Nursing: Isn't That Sweet?" You should check it out.

But I feel like not ALL nurses on TV are a bad example to the public. I want to talk for a minute about my favorite TV nurse, Lady Sybil Crawley on PBS' Downton Abbey. (If you haven't seen the show, you seriously need to check it out). The show takes place in England during World War I. In Season 2 of the show, the young Sybil, a daughter born into a family of British aristocrats, sees the effects of the war and wants to do something to help. She trains as a nurse and cares for many wounded soldiers who come to stay in the village hospital and later in her home of Downton Abbey. The show is complete fiction, but watching Sybil in action really got me thinking about Florence Nightingale and the history of nursing. The plot does not heavily focus on nursing, but if you are a nurse, you should still watch it because it is a great stress reliever.

What do you think of nursing on TV and in the movies? Do you think it accurately represents us? What are your favorite nursing/hospital shows and why?

As you may know, February is American Heart Month. Why is this important? Because heart disease kills more men and women than any other cause, including cancer. Even breast cancer.

The thing is, we often overlook risk factors for heart disease and we do things that are not really nice to our hearts. As busy professionals, nurses often do things like eat foods that are not healthy but convenient. We don't always have the time to exercise, and sometimes we feel to exhausted to even think about it. Even though we know better, some of us smoke, or drink more alcohol than we should. And probably almost all of us are living with high stress levels that we are ignoring. I know I am no picture of health. Up until the last few months I ate fast food...a lot. About the only workout I get is when I go up and down the stairs in my house. And Lord knows I have a lot of stress eating away at me. And the thing that makes it even worse is that I have a family history of heart disease.

So what do we do to protect ourselves from this nasty killer of women and men? Eat right by getting at least 9 servings of fruits and veggies a day. Limit your red meat and unhealthy fats, choosing healthy mono- and polyunsaturated fats. Exercise at least 30 minutes a day on most days of the week. Quit smoking if you currently are doing so. Limit your alcohol intake to 1 drink per day or less...although red wine does seem to have some protective heart benefits. And this will be the hard one. Learn to de-stress. My doctor is on me all the time about that one. He's even recommended I try something called HeartMath-although I am sure there are similar programs that work just as well. Even a few minutes a day of meditation or guided imagery may help.

Secondly, arm yourself with knowledge of the symptoms of a heart attack, and know when to seek medical attention for any health concerns. Heart attack symptoms are different in women than men, you can check out this website at the American Heart Association to learn more about them.

So this February, don't forget to wear your red scrubs in honor of Heart Awareness month. Although the National Go Red For Women day has passed, that still doesn't mean we can't raise knowledge of the problem. And love your heart-it's the only one you've got!

 

 

Wikipedia defines ageism as "stereotyping of and discrimination against individuals or groups because of their age. It is a set of beliefs, attitudes, norms, and values used to justify age based prejudice, discrimination, and subordination." Commonly, we see ageism directed at people of an advanced age, although it can occur with any age group.

I don't know about you, but I perceive ageism about geriatric patients when I am working with nursing students. Not with ALL students, but enough to make me aware of a problem. Oftentimes, some students will, if given a choice, select a thirty year old patient who is about to be discharged for a lap choley, as opposed to an eighty year old with many interesting co-morbidities and interventions that could be excellent learning experiences. Occasionally I will hear grumbling from student nurses about having nursing home clinical experiences as opposed to hospital experiences. And then, it seems like when asked, everyone wants to be an OB nurse when they grow up. Sometimes, I will hear students say things like "I love old people. They're so cute, I just want to take them home," which sounds nicer, but isn't much more respectful than "Old people are grouchy and I have nothing in common with them."

As the baby boomer generation grows, the thought of ageism towards geriatric patients becomes scarier. The reality is, the majority of patients will be of a higher age. And what will it mean for nursing care when a common thought of people is that the older you are, the less productive and helpful to society.

I have tried to think of creative ideas to educate students and new nurses about geriatric patients. Even though the baby boomer generation is getting older, they are living longer and some are very active and vibrant. The percentage of seniors living in nursing homes is actually declining. So how do we convince younger folks that there is more that makes us similar than what makes us different than older people? How do we get younger healthcare professionals to respect the elderly, and view them as intelligent and autonomous individuals, and not someone lying in a bed whom we call "honey," or "sweetie."?

Has anyone tried anything innovative or effective when it comes to bridging the age gap between young caregiver and the elderly patient? I've had colleagues who had students interview their grandparents and write a reminiscence paper, I've read of educators having their students write a personal letter to their patient (that they do not send), and I've even thought of having students do a case study of Betty White to learn that seniors can be active, lucid, and downright hilarious.

Do you see the same issue that I have seen with ageism?

When I was about twenty-five years old, I had been a nurse for three years. During those three years I had picked up a pretty good amount of experiences working with very high acuity inpatients. So when a patient didn't want me to access his infusaport and wanted another, more mature looking nurse to do it, I was annoyed. I was annoyed because this nurse had been a nurse for a shorter amount of time than I had, even though she was probably old enough to be my mother. Stuff like that happened time to time when I was younger...but now that I have my fair share of premature gray hairs, not so much.

And in the meantime, I have truly come to appreciate second career nurses, like the one I was working with the day I just described.

Second career nurses are coming to us at a time when we really need them. We are facing this nursing shortage, and need people to help make sure patients receive safe care. And even though many hospitals are facing budget crises and hiring freezes, nursing is a somewhat safe career choice in an otherwise scary job market.

The nurses I know who once had other careers bring such unique skills to their present work. I have a friend who was a former music therapist. She has used her music therapy skills to help her patients deal with nausea and anxiety while giving them nursing care. Another friend of mine is a former machinist. During his time working in a machine shop, he developed a strong work ethic and good problem solving skills.

When I taught at a community college, I had a clinical group in which each of the students had previous degrees in things like engineering, social work, biology, massage therapy, and more. It was so enjoyable to be their instructor. Because of their previous work, they had developed a maturity and certain life experiences that really helped them in their pursuit of nursing. Even for my students who had never worked outside the home but raised several children, they sure knew how to multitask!

So what I'm saying is, we are going to meet more and more second career nurses as the economy changes and more and more jobs are eliminated. While a few of the folks are not entering nursing for the ideal reasons, many of them make fantastic nurses. So if you meet one of them on your unit, make them feel welcome. And don't be annoyed if your patients think they've been a nurse longer than you because they are older than you..

How many of you reading this post are second career nurses?

What is it about venipuncture that conjures up such deep feelings in both the nurse and the patient? I recall being a nursing student and having so much anxiety about the first time I would ever start an IV. I made it through nursing school, never even having attempted to start one and by the time I got a job, it took me probably ten attempts before I was able to successfully initiate an IV line.

Now that I work with nursing students, it seems like the general perception they have is that nursing as all about starting IV's, and having a successful IV start is the "end all and be all" of their academic career.

And let's not forget the patients...it's not like they are excited to have their physician order IV fluids or lots of serum lab tests!

Today I ran across this article in the news about a nurse who has been credited with a new approach to starting IV's that is reported to be much less painful that the traditional methods of tying a tight tourniquet, hitting, flicking, and putting a warm compress on patients' arms. I hope that there is a lot of evidence to support this method, and if it truly helps patients that it will be accepted into practice in healthcare settings far and wide.

But I'm wondering, because it is such a big deal to many nurses and nursing students, do you have any great tips? Are you a flicker? A tapper? Do you grab a blanket out of the blanket warmer and lay it over your patient's arm? What works best for you?

I have observed many nurses over the years, and sometimes I've learned really great tricks from them. A clinical nurse specialist once showed me a great tip to avoid forgetting the point where you were going to make the venipuncture after you take the tourniquet off and start to cleanse the skin: if you take a retractable pen (that is retracted) and place it on the skin at the point you wish to enter, push down on the skin with very light pressure, and then scrub with an alcohol wipe, it creates a local histamine reaction on the skin which makes almost a "bullseye" to serve as a landmark where you want to stick.  Now, of course, before you try that on your own patient, make sure that is consistent with your institution's policy.

Any other readers have any words of wisdom?

Happy holidays everyone! First of all, I would like to congratulate all of the December graduates out there. I was a December nursing school grad ten years ago, and it is a magical time to be finished with college. Best of luck to you all!

We're in the midst of the holiday season. Are you scheduled to work on a holiday that you celebrate? Kind of a bummer, huh? And it's not just a drag if you have kids, because single people have families they like to be with, too. I've had to work on holidays as a parent and non-parent, as a single person and as a married person, and it's not like it's better in any of those situations. But think about what it's like to be in the hospital or extended care facility for the holidays. It has to be much worse than what we are going through. At least we're making time and a half, and we have our health.

Just this morning I read a news story about a young girl in my state that is doing something for children with cancer who are in the hospital for Christmas and it made me realize, yet again, why I do what I do for a living, even if the hours aren't great and you have to spend a few holidays at work. What a blessing it is for me, and all nurses, to have the opportunity to make someone's holiday a little brighter when they are feeling down and experiencing poor health.

Here's a little info about her story:

A friend of mine from high school is facing some challenging times right now during this holiday season. She and her husband learned this past summer that their eight week old son had stage III liver cancer. Yes, that says eight weeks. He has endured many rounds of chemo followed by surgery and now more chemo and has been a fighter through the entire process. A 12 year old girl had learned of his story and decided to organize a toy drive to provide toys to all the children who were hospitalized with cancer over Christmas. When I read this I thought, how awful it was of me all those times to complain about having to work on holidays when I should have been thinking a little more about the patients and families I was taking care of.

I hope that if you find yourself working a holiday this winter that your shift goes by quickly, that you get lots of treats and goodies to eat during your day, and that you get the chance to bring holiday cheer to those under your care.

Blessings to all!
Erin

This weekend, we put up our holiday tree. Each year, I love taking all the ornaments out of the boxes and thinking about all the memories associated with each one. This year, there was a particular ornament that seemed very special-it was a gift from my former supervisor at the library at Ball State University. She had given me a Christmas ornament. It was a young looking brunette nurse wearing green scrubs with a clipboard in her hand. On the left pocket of the scrub top, she had written my last name in very small letters, and on the clipboard, it read "Merry Christmas 2001." She gave me this ornament as a gift for graduating nursing school, as I was a December grad. As I unwrapped more ornaments, I found even more nurse ornaments given to me by friends and family that I still treasure every year.

What other things make great gifts for nurses? Maybe you have co-workers or staff you are looking to buy for this season. Here are my suggestions:

• Unscented, but very moisturizing hand soap. Nurses wash their hands what seems like hundreds of times a day, and in the winter, their skin gets very dried out. What has worked for me are hand creams that contain hemp as an ingredient, it really seems to be the only thing to soften my hands and protect them.
• I have said how much I love these before, but a nice pair or two or support socks. Lydia's stocks the Nurse Mates compression stockings. I just bought myself two pairs on Cyber Monday and I just took them off after wearing them all day long. I wanted to even wear them to bed, but I decided to let my feet be free for a while.
• An extra pair of hemostats. There are so many times during they workday when I wish I had my own set. Whether it's to untwist some tight IV tubing or something else, they really come in handy and are sometimes hard to come by.
• A nice flashlight. Again, another tool that is hard to come by on the nursing unit but it is very handy. Especially when anchoring indwelling catheters or working night shift. Maybe splurge and get a metal one that can be engraved, so someone else doesn't run off with it.
• Massage gift certificates. Nurses are on their feet anywhere from 8-16 hours a day. When we come home, we're sore. And let's face it, nurses deserve it.

So sure, this is not an exhaustive list, but hopefully it will get you started. Do you have any great suggestions? Feel free to post, or post about the most thoughtful nurse gift you've ever received.

Recently I cared for a patient who was told by her doctor that she had a few days to live. A big part of the focus of our nursing care is to mutually set a goal or two with our patients that they would like to achieve that day. Usually we set goals like the patient's pain will be rated at a tolerable level for them or the patient will ambulate in the halls a specific number of times. When we asked the patient her goal for the day she replied, "What's the point? I'm going to die anyway." Our hearts went out to the patient. How could we, as healthcare professionals, make her last days enjoyable and meaningful?

One of the nurses had the idea of bringing in a licensed professional to give the patient "spa treatments" like a manicure and massage. I thought this was a great idea, if we could have the funding to do so, as it would promote patient dignity, as she could know she went out of this world looking her best and feeling relaxed. 

I had the thought that we might wheel her outside to the lovely garden at the hospital. It was a beautiful day outside that day, and probably the last really nice autumn day we have experienced. She could be amongst the flowers and hear the water gently running over the river rocks at the fountain in the middle of the garden. She could see the butterflies preparing to fly south for the winter and maybe even spot a hummingbird or two. Many years ago, as a new nurse, I had a terminally ill patient who we wheeled to the top of the parking garage to witness a huge rainbow after a storm in the days before she parted this earth, and I thought this lady might enjoy being out in nature for a bit of fresh air as well.

Have you ever found yourself in this situation? What things have you done to make your patients' passing from this life meaningful and dignified? Please feel free to leave a comment with things you have tried, or ideas that you would try given you had the time and resources. We can all learn from each other. 

So many of my students want so badly to be a labor and delivery nurse and see babies taking their first breaths, as it is such a special time in a family's life. But what about being with patients who pass away? Is any less special? Different, maybe, but every bit as important.

For those of you who will be celebrating Thanksgiving, I wish you a happy holiday. For those of you who will be away from your families and working, I wish you a happy shift that passes quickly.

Take good care.

Erin

There have been some pretty heavy things going on in my own little nursing world right now and, in addition to evaluating my coping strategies, I have to take some time out for a little lightheartedness.

I wanted to share some healthcare funnies with you that I've run into on the web recently, some are pretty hilarious. Like this one, for example. A group of med students made a parody of the "I'm on a Boat Video" called "I'm at a Code."

While I was looking at YouTube I ran into some other funny stuff. Like "Diagnosis Wenckebach",  a video made by some Canadian med students which is a parody of a Justin Timberlake song. How do these people come up with this stuff??

Another notable video I saw was "Footloose: Nursing School Style," which was timely not only because of the remake in theaters right now, but because of my work as a nursing faculty member.

Check these out, they will take 10 or so minutes out of your day, but it will make you smile. In healthcare, we see things on a daily basis that break our hearts. Remember how important it is to laugh.

Even though I am not presently employed in an oncology setting, I will always consider myself an oncology nurse. When we would deal with hard situations like terminal illness or death, family members and visitors would always ask me, "How do you deal with this every day?" and honestly, I think the secret is to have a wicked sense of humor. My oncology nurse friends that I worked with on night shift always prided themselves on their warped sense of humor. It's not that they were cold hearted. It was a defense mechanism.

Of course, I might caution you, don't be laughing hysterically at nursing jokes at the top of your lungs at the nurse's station with a patient dying down the hall. To outsiders, it does seem irreverent.

Here is another website filled with hundreds of nurse comics to make you chuckle.

What are your best nurse jokes? Please post them! But please try to keep it clean :)

After watching Monday night's GOP debate, I really wanted to talk about healthcare and national health insurance this week, especially because I think nurses are some of the only people who are actually qualified to make statements about health insurance in real life situations...but I was afraid of death threats, nasty comments, or worse.

Instead, I think I will talk about a serious issue among nurses and healthcare providers: substance abuse. Just the other day, I got a memo that my institution had decided require tramadol to be counted each shift, just like a narcotic would be. When I read the rationale behind it, I thought of all the nurses I know who have been dismissed from their jobs or have received treatment for stealing narcotics from their employers. Yes, nursing does have this sort of a seedy underbelly, and pocketing drugs is not really a cool thing to do even if Nurse Jackie does it.

Our first reaction when we hear of a nurse stealing narcotics is "What kind of a lowlife monster would do such a thing?" And yes, it is a terrible thing to do. Would I want my family member to be receiving care from someone who had just shot up the contents of someone's leftover hydromorphone PCA syringe in the bathroom? No way. It is completely illegal, and UNSAFE for our patients.

Why would someone do this, you ask? Well, nursing is stressful. Not a valid excuse, sure, but some people don't really know how to handle stress like you or me. Perhaps they had an injury in the past and developed a deep psychological dependence on pain medicine. Who knows? There could be a multitude of reasons. All I know is I have found out that nurses who I thought were nice people, good people, have turned out to have addiction problems. They aren't all evil, sinister characters.

So what should we do if we suspect our co-workers to be stealing drugs or be practicing nursing under the influence? Immediately notify your supervisor. It is your legal responsibility to ensure your patients are safe, and even though you might feel bad, you are taking the first step at getting help for your co-worker.

How do we know if our co-workers stealing drugs? We may notice behavior changes, suspicion, a change in handwriting and documentation, drowsiness or agitation, diaphoresis, pupil dilation or other observable physical changes. They may start wearing long sleeves, even in warm weather, to cover up IV drug use. They may even offer to help us more than before with wasting unused narcotics, setting up patient controlled analgesia pumps, or counting the narcotics at the end of the shift.

Drug abuse in healthcare workers is never an easy situation, but by being aware of the signs and knowing who to contact if you suspect it, you are taking steps to protect yourself, your patients, and your co-workers. If you are uncertain what to do at your institution, look up their policies and procedures on this subject.
 

After wanting a smartphone for years, and after trying to convince my husband why I just NEEDED one for just as long, I finally got one. Is it something that makes me wonder how I ever lived without one? No, but I do enjoy some of the fun apps you can download. Mainly because they help occupy my kids when I need a minute or two of silence or when we're stuck somewhere waiting for something.

Being a nurse, and a free app lover, you can imagine my delight when I saw a banner ad for a game called "Hospital Story." In the game, you are a doctor who provides treatments for all the sick and wounded patients who come into the emergency room. Within the game, you earn coins for each patient you successfully treat (magically, they are all able to pay cash at the time of service), and with those coins you may purchase additional technology, purchase additional "beds" or stations, and hire more doctors and nurses to assist you.

When the game started out, I was able to make sure all the patients got what they needed, each one did not have to wait in line for a bed, and they did not have to wait in line for the cashier when finished.  As the game progressed however, the patients came in faster and faster and there were not enough beds. If I didn't get to them in time, they would die (and become cute little ghosts) or they would get impatient and leave without paying.

I thought the answer would be to upgrade each one of the patients and add more beds with my coins. The patients kept coming and coming and were dying off right and left.  Finally, I realized that I was able to hire additional doctors and nurses. The number of unhappy patients was drastically cut. Which made me realize --- no matter how much technology we have at our fingertips, no matter how big our facility is, we cannot succeed as nurses unless we work together as a team.

Now this doesn't seem like a groundbreaking idea, does it? But I have worked in places where we all worked in our own little silo during our shift. If a call light went off and it wasn't "our" patient, we went about our own business...and just like in the game, the patients suffered. But I have also worked in a place where the staff all worked together as a team. Even though we were not assigned a particular patient, we cared for all the patients. If I was busy in a room, I knew my co-worker would escort my other patient to the restroom if he needed to go. I. Never. Felt. Alone. Someone always had my back. And I had hers. And I felt good about going to work each night.

When I worked on units that did not have the same team spirit, it was miserable. I would cry every time I thought about going in to work. And of course, I don't do that job anymore, either.

So think about your work environment. Do you have a sense of teamwork between you and your co-workers? Or is it every nurse for her/himself? If so, it might be time to talk with your nurse manager about it. There are lots of team building exercises, staff retreats, etc. that can be effective if everyone will buy into it. And if your boss isn't on board, think about organizing a "nurses night out" for the staff members who don't have to work...but schedule it more than once so everyone can get a chance to attend. Go to a movie. Go bowling. Whatever. Just get to know each other, be nice to each other, and develop friendships that will strengthen the team and make for a much more enjoyable job. I hope it can work out for you.



Here's where I give my shout out to my girls at Ball Memorial Hospital Inpatient Oncology Nurses! You are an amazing team, I love you, and I miss working with all of you so much!!

By now, you've probably heard of the tragedy last Saturday at the Indiana State Fair. Five people were killed and forty-five others were injured when one of the concert stages collapsed during a high wind in a storm. This tragedy struck me pretty close to home, not only because I reside in Indiana, because two days prior I had been there with my four year old daughter at a sold out Big Time Rush concert. Even though our seats were about as far away as you can possibly get from the stage, I would never have wanted her to witness such a sight first hand...but as healthcare workers, we know that these things do happen and no one is immune from experiencing such horrible events.

Maybe you've seen the footage of the stage going down, at least on our local news channels they've played it many times. As disturbing as the images of a huge structure falling down into a huge crowd of people was, the footage of what happened afterward is what really brings tears to my eyes.

Instead of running away in terror, nurses, doctors, paramedics, and many other emergency personnel rushed to the scene of the accident. Footage of nurses off the clock triaging the victims and firemen and policemen carrying off the wounded on makeshift stretchers also were posted on the internet. Stories of people with lacerations, compound fractures, and other injuries were told on the news. My mind was absolutely blown when I think about how these people jumped in and started caring for strangers, with virtually no supplies or equipment. In the middle of a severe storm.

It stories like these, although tragic, that make me proud to be a nurse. Although I've mostly worked with patients with DNR status, healthy moms and children, and most recently in academia, I still consider myself capable of these kind of actions. What a gift.

When this happened, one of my friends had asked if I'd ever been in emergency situation such as this, but outside of work. Thankfully, no. It's never come up. But do you have stories? Please share your experiences of jumping in and helping when tragedy struck. Let everyone know how nurses, EMTs, techs, paramedics, respiratory therapists and anyone else I may not be thinking of at this second are the real heroes in life- not overpaid athletes or bad boy or bad girl recording artists.

Thank you for all you do.  And also, my thoughts, prayers, and condolences for everyone who was at that Sugarland concert last week lost their loved ones in the accident.

Erin

I don't know if I am even allowed to write this column, because in some hospitals if you even whisper the "u" word, I think you are put through some sort of secret investigation by administrators, but I want to know more about nursing unions. Do you work in a union hospital? What is your experience?

The other day, I was engaging in a conversation about a former supervisor and an unpleasant interaction we had. The nurse I was talking to wondered if the behavior from the supervisor was a result of working in a hospital with a nurses' union.

It seems to me, that nurses who work in a non-union hospital have negative opinions about a hospital with an organized union. And I'm sure there have been problems, I remember a hospital in a town in Michigan that had the longest nursing strike in history shortly after the nurses became unionized. Maybe it's because I was raised in a blue state that relied mostly on automobile manufacturing and unions were the norm, but I am not sure why unions would be a bad thing. Aren't unions in place to ensure things like safe nurse to patient ratios and safe work environments?

What has your experience been working in a unionized hospital? Positive or negative? Do the nurses have higher levels of satisfaction? Or are they a bunch of greedy folks threatening to strike and walk out on patients if they don't bring home $70K a year? I want to know real stories of nurses in these institutions, because as with many things in the media (universal health care, for example) there is a lot of fear based on a lot of misinformation.

Today as I scoured the interwebs for news topics about nurses to possibly feature in my blog, I came across this piece about a daughter of an elderly woman who is also a nurse. She talks about the hostility she faced from her mother's healthcare team after they learned she is a nurse. It's a less than five minute read, if you want to check it out for yourself.

I am feeling that this must be a pretty common phenomenon. Once, when I was a young nurse I was in the exam room while my dad was getting ready to have a medical procedure done. The nurse had started an IV and had started pushed some medication or hung some sort of IV piggyback. A red streak began running all the way up his arm. I said to the nurse, "I think he's developing some IV phlebitis, look at his arm."

"Phlebitis?" she said, and looked at me, aghast.

She sighed at the inconvenience of having to stop the infusion, and later when the anesthesiologist came in she told him what I said.

"You thought he had phlebitis?" said the anesthesiologist. The two of them had a laugh together like I was some idiot who had no idea what I was talking about.

If I hadn't been hearing about IV phlebitis rates every three seconds at my hospital, or if I wasn't a chemotherapy nurse who dealt with people's veins all the time maybe I would not have been so offended.

Has anything like this ever happened to you? When your family member is hospitalized (or when you are hospitalized) do you tell the staff that you are a nurse? I have decided over the years to not tell people I am a nurse. I don't want doctors and nurses to assume I know everything and leave out important details. I also don't want people to know how much I don't know, when I am calling the pediatrician's office about some weird rash on my kid's face (who remembers all that dermatological stuff from nursing school, anyway?)

I think part of the hostility problem could be due to the whole, "Nurses eat their young" (and each other) issue. I've discussed lateral violence before, and I still don't know why there is so much jealousy, rivalry, and animosity towards each other.

There are many other factors that could be contributing to this problem. For example, this particular nurse decided to hold her mother's blood pressure medicine (which was probably not a bad idea, but I don't know the whole story). It can make you feel powerless as a nurse when you are not the one in charge of a loved one's care. We want to heal everyone, and when a doctor prescribes a treatment that we do not agree with based on our experiences, it makes it very hard for us.

That's all for this week, I hope everyone is beating the heat and using their sunscreen. Take care!

-Erin