Nurse Sean (dot) com

I was just over at emergiblog reading about the classes Kim is just finishing up. I too am struggling to finish the critical care course that I’m taking. My last test in my advanced physiology course is this afternoon and I’m working hard to cram my brain full of information.

This last unit is on the body’s defense systems, including: mediators, inflammation process, the immune response, and stress. Sure, it sounds simple enough, but as I quickly realized, this is by far the most intensely complex system in the body.

Everything has pathways and activators and mediators, and nothing has an easy name to remember. It’s things like C3a and IL-1. I’ve read the 150 page unit three times now and I feel as though I have learned nothing at all.

So, I sit here writing instead of studying. After all, would a fourth read really make a difference? It probably would. Actually, if I just slowed down and worked through the unit without rushing and skimming (this is the sixth unit, I’m getting a little restless) I’d probably easily figure everything out.

But it fascinates me that nurses are so inclined to continue their education. I think that nurses have an innate sense of wonder and curiosity that guides them through their lives. Like a two-year-old, they go through the day wondering “why?” over and over again.

Why is my patient’s urine output low? Why did the doctor order a c-reactive protein level in the blood-work? Why is my patient having shoulder pain after gallbladder surgery? Why has my patient all of a sudden started acting confused? Why do illnesses happen to some people and not others? Why is administration starting another committee to look at why we may need more committees?

Nurses are the type of people that run home and hit the books (or google) with that burning question that came up during the day. There’s that rush of happiness when you find the reason–and a bigger rush when you can explain the complicated answer the next day when someone else is equally puzzled.

I think I must declare: If you aren’t innately curious, dislike continually learning new things, hate to ask why, and simply just accept everything at face value, you may struggle as a nurse.

So, get out there, take a course, learn something new, and by all means, do it with pride and excitement!

Would someone please Please PLEASE come up for a cure for post-op delirium? It would put an end to crappy shifts like last night. There’s nothing like being told you’re an alien that has kidnapped all the patients from the hospital…and you must be killed at all cost! This while desperately trying to keep a foley and central line from being pulled out. Oh, the blood splatters that would have caused! Then came the swinging fists. Ugh!

It’s 00:43 and I’m between night shifts, and I’m having a happy dreamy night. It’s been a great weekend, and today was particularly great! It included: taking my dog to get his picture taken with Santa, drinking some of the world’s best coffee, and putting up our Christmas tree.

So, right now I’m continuing with the dreamy times (Grey’s Anatomy would be proud of all this dreaminess). I’m sitting in front of my dreamy tree:

And drinking some dreamy coffee that was ground in my new grinder and made in a press:

From one of the bestest dreamiest coffee roasters in the world!

I really can’t wax poetic enough about 49th Parallel coffee. While the Ethiopian Yergacheffe shown above is amazing, their “sleeping woman” is quite honestly the greatest cup of coffee I have ever had in my life. And on order are two more coffees from them that are considered even MORE incredible. I feel like I’ve truly discovered a treasure…and I’m trying to decided whether I should share it or keep it all to myself!

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So, I wanted to catch up on a few things that I’ve been meaning to post about! First of all, I was tagged by Peter over at St. Vincent’s Hospital Darlinghurst. He asked about my proudest moment.

It won’t be a long answer because it is short and simple. My proudest moment was when I received the letter in the mail telling me I passed the RN exam. The size of the accomplishment crashed down on me at that very moment and I bawled. My last day of school, my professor saying she’d recommend me for grad school, and even receiving my diploma didn’t feel as good as that simple scrap of paper stamped “pass.”

And I’m not just saying that because it’s a nursing blog. It was a culmination of so many struggles. I’m still proud of me. Yay!

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Kim over at Emergiblog has been talking about clinical vs. theoretical experience. She put out a call for opinions on the subject. Disappearing John RN has already put in his opinion on the subject.

As for my education, I feel that there was a strong balance between clinical and theoretical nursing. We spent hundreds of hours in the clinical setting putting our lab skills to practice. In fact, I think the only way they could improve our clinical experience would be to go back to hospital training programs.

The issue I had with my education and clinical training is that it offered a Pollyannic and unrealistic. They taught us how to holistically care for patients physically, spiritually, and emotionally. The reality is that the hospital system only supports caring for the physical. If you have time to sit down and talk emotions with your patient, then you have time for more patients!

We work in a system that rewards technical skill over holistic care.

The other issue with the education we received is that they preach a style of nursing that doesn’t exist, and to be honest may never exist. That is, they teach us to be leaders of a team of people. They teach us to delegate tasks to those around us so that we may orchestrate a complete and effective care that (sorry, I’m sounding like a broken record here) cares for the patient holistically.

I think that nursing NEEDS to go to this style of care because as the numbers of RNs wane, we will be replaced with technicians that require strong leadership and supervision. However, I believe that this will take decades to occur because nurses push away the idea more strongly than they fight for nurse/patient ratios.

I, personally, went into nursing thinking I would be exactly what I described: a leader of a team of folks working to care for patients. I truly didn’t know nursing would be as it is–oops! So, for me, the idea of transforming what nursing looks like is an exciting prospect. However, many nurses went into nursing because they loved the idea of caring for patients: washing them, changing them, walking them (I often think we describe caring for patients as we would caring for a dog). To them, the idea of stepping up our focus and moving slightly away from the bedside is a slap in the face to the profession of nursing.

I think nursing will transform, but we won’t allow it to, so it will have to happen out of necessity rather than will.

So, to answer Kim’s question point-blank: I feel that my nursing degree prepared me very well, but it prepared me for the wrong thing!

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Beth over at PixelRN posted some ideas for blogging topics. This one stood out for me:

3. Advice for fellow nurses. Everyone loves to give advice, lets face it. As a nurse blogger, you have the ultimate soapbox!

OK, I don’t have an entire post devoted to the topic, but I did want to answer with my advice. And it’s simple! My advice is to RELAX sometimes. Yes, it’s a stressful, busy, scary, sometimes hopeless job. But please, don’t forget, it’s OK to be yourself, have some fun, laugh occasionally, look for the positive, and as I said:

RELAX!

It’s cold here! Last time I checked it was -18C (I’m not good at fahrenheit conversions for ll the American folks out there), which is even cold for a person like me who hates heat. However, it gives me a chance to bundle up in my 2006 Canadian Winter Olympics gear which I adore.

I have a couple days off before switching back to nights. I have been working 12 hour days for a months now, and I’m ready to be a night person again! I am tired of hearing that alarm go off at 05:00am. It will be nice to be back to where I feel more comfortable.

I was working in our unit’s high observation room for the last few days. I adore working in there! For starters, we have a 2:1 nurse/patient ratio (the room fits four patients). This means that while working together, we get an incredibly good amount of stuff done for our patients. I wish it was always so good.

The other thing I like about the high obs room is the high acuity of the patients. Some nurses can’t stand unstable patients, but I’ll be honest: the more unstable the patient, the more interesting they are to me! This is the reason I fully plan on moving to the ICU and working toward being on the hospital’s code team.

Speaking of the ICU, I wrote another of my critical care nursing course tests yesterday. This one was brutal. It was renal physiology, which I generally find fairly straight forward, logical, and easy to learn. However, I just didn’t have a lot of time I could devote to studying for the test. I don’t have my results back, but I don’t think I will see a mark above 90% like the other tests; and frankly, I don’t deserve a high mark.

Yesterday, we had a large staff meeting. We’re tired of being chronically understaffed; we’re tired of having patients lining the hallways because administration forces us to take many patients over our unit’s capacity; we’re tired of our incompetent manager; we’re tired of so many things.

We compiled a list of our complaints about our manager and the hospital. Then, we backed up all our complaints with research and numerous personal experiences. We also cited our nursing association’s practice standards. Then, one of us (thank God for her!) stood up in front of about thirty unit staff, our manager, and two of her managers, and listed our complaints and demands.

We called for serious action!

We really didn’t get any. The answer we received was basically, “We here what you say, we believe what you say, we understand what you say, but we have no solution…so sorry. You still need to work understaffed and over capacity.”

The only step forward was the creation of a “unit council” that will meet with the goal of coming up with solutions to our problem. The administrators are pushing us to reform our nursing model. They want to use a much more multidisciplinary approach to nursing.

In this model, nurses would be “case managers” as they described it, and would manage a team of multidisciplinary individuals. Instead of providing direct nursing care, the RN would direct a team of individuals to provide care of patients.

They even suggested adding extra staff to the unit, such as: pharm techs, physio techs, Recreation therapists, and whatever else we could imagine. Their thinking is that we could utilize the appropriate resources to provide well-rounded care to our patients.

I personally a very strong advocate of this style of nursing. When I went into nursing, this is actually what I thought being an RN. That is, I thought RNs were the supervisors on the unit that gave orders to LPN’s and NA’s to provide care to patients. I thought they were the case managers that I just described.

I am always embarrassed to admit that when I started nursing school, I didn’t think RN’s did bed baths, or changed diapers, or toileted patients. Even after the first year of nursing school I was under the impression that we were just learning those skills because we would have to supervise others while they performed them. So, it was a bit of a shock in the second year of nursing school when I came to the realization that these tasks WERE a part of my job.

The major opposition to this approach is nurses who went into this profession because they wanted to do the bed baths, toileting, attends changes. They refuse to let go of these items simply because it’s the part of the job they think IS nursing.

As I’m a recently trained nurse, I was taught that being a RN means working at a much higher level. Nursing, the way I was trained, is about being a leader of a multidisciplinary team focused on implementing a holistic plan of care that cares for the patient both physically, spiritually, and mentally.

I truly believe that a lot of nurse’s skills are wasted! We only use a small fraction of our scope of practice. And the fraction we use is stuff that other professionals can perform. It’s stuff that, were it to be let go of, would allow us to work at a higher, more intellectual level, and (God forbed!) be seen as professionals, rather than blue collar workers.

We deserve a step forward in our profession!

Sorry, that was longer than I intended….

After our meeting, we went out to dinner. It was so much fun hanging out with the folks from work and gossiping. I don’t get invited to a lot of events (every event seems to be a bridal shower or baby shower…no men allowed!), so it felt good to be chummy with my friends from work.

Today, I’m looking forward to getting a small amount of Christmas shopping done. But, I’m not too stressed out about it. I typically enjoy doing my shopping closer to Christmas day. Seriously, it just FEELS more like Christmas when you actually buy your presents around Christmas. Buying everything in August just isn’t the same.

Well, as expected, my first shift back after being off for a week (most of it sick) was absolutely horrible. Isn’t that always the way? You feel rested, relaxed, recharged, energized and newly excited about your profession. Then you walk in and within ten minutes you are reminded of exactly why you keep getting burnt out. 

Some of you are thinking, “what? You haven’t even been out of school a year and you’re using the ‘B’ word?” However, for me, burnout isn’t an end of the road situation for me. Instead, I find that it is a cycle that ebbs and flows over time. 

Last night I had fresh post-op patients, new ICU admits, a psychotic patient, a total care patient, a patient that needed excessive toileting (ARG! I hate walking little old ladies/men to the bathroom several times a night when they are sloooooow!), two others that kept me busy by frequently asking for menial tasks. Yes, there’s nothing like that desperate call from a patient because they need their perfectly fine leg moved two inches to the left! We had one of these conversations:

“Nurse Sean, can you move my leg two inches to the left?”

“Why don’t you try adjusting it yourself?”

“Oh! OK, is that allowed?”

I had two patients on tubefeeds, almost all the patients were on q6h sliding scale insulin, one had a heparin drip that needed to be titrated, three were having low blood pressure issues, two others had low urine outputs, one needed discharge paperwork started, another needed to be prepped for a CT scan. On top of all this, administration insisted that we start lining our halls with new patients even though we were short staffed.

I think if I could choose one factor that contributes most to my burnout, it would be a complete lack of control over my environment at work. I have no say in my patient assignment (I can request a change, but it isn’t likely), so if I feel I have too many patients and feel unsafe I have no recourse. If five nurses call in sick but they still insist on filling up our unit far past capacity, we don’t have the ability to stop admissions because we just can’t handle more. I can’t tell doctors that certain procedures will have to wait until morning because I have too much on my plate. In situations like these, I am simply told, “too bad, deal with it.” And usually very rudely.

So, last night my mind was filled with the question of how can nurses  regain control of their own work environment. The only resolution I could come up with was regarding our union contract. I firmly made the decision that I will never say yes to a contract unless it includes some way for nurses to refuse dangerous workloads. Until nurses have the ability to say “no,” I will not be agreeing to anything.

Sure, this may mean that I never vote yes on a contract again, but I believe nurses have massive pools of power that they never use! Instead, they sit around the break room and complain about their jobs without taking action. Imagine if every nurse decided they would never sign a contract or work in a job unless it gave the nurse more power over the safety of their environment! 

Come on nurses, use your power! If you don’t like something, find a way to fight it! Even if the only recourse is to withdraw your yes vote. 

I need to get this off my chest. I am very interested in the debate in the US between private health care and public health care. I am a Canadian and have lived under a socialized system for my entire life. I am tired of reading blogs and forum posts that continue to perpetuate complete myths about socialized health care. These are the main ones I hear that I would like to dispel: 

1. You will no longer have any choice over your doctor or what hospital you can go to. The government assigns doctors to you! 

Ok, I honestly don’t know where this comes from! Doctors are never assigned to people in this country!

Here’s how you get a doctor in my city: first, you go onto the website for my city and click on the link entitled, “Doctors that are accepting patients,” secondly, you choose the area of the city you live or work in…or whatever part of the city you want to travel to to see a doctor. Thirdly, you look at the list of doctors and choose one. In order to help you choose the doctor you can look at comments provided by patients of these doctors on how they rate their services. This process of choice is the same whether you are homeless or a millionaire.

As for choosing a hospital, well, they are all run by the same executives and follow the same policies. Choosing different hospitals won’t get you better care. In fact, each hospital strives to give equally great care. Choice is based on location and availability of beds. 

2. The government controls what the doctor can and cannot do!

Please! The government wishes they were this powerful!

Plain and simply, doctors do not work for the government. They are self employed. The only difference is that they send the bill for their services (as do the hospitals) to the government as opposed to the patient or their insurance company.

Doctors answer only to their licensing body, as do nurses and all health care professionals.

In fact, I think there’s much more freedom for doctors. They don’t need approval from insurance companies for procedures. The doctor is in control of what is necessary and it is more likely to be based on the patient’s needs than profit margins. 

3. You have to wait months to get into the hospital or go for procedures!  

Sometimes this is true! But only for minor surgeries that are being done for comfort reasons. For example, if someone needs a knee or hip replacement because it’s painful to walk they may have to wait a little while (but not the exaggerated amounts of time that you hear).

And no, patients don’t walk around with broken hips. If you are in trouble and you need help right away, you get it right away! I’m tired of hearing ridiculous stories of patients who have to wait months for emergency bypass surgery, or years to get their ruptured appendix dealt with. 

Sure, you hear about people going to the states for procedures. However, this is for the extremely wealthy. If someone said to me, “you can pay $20,000 and have your knee replaced tomorrow, or wait a couple months and have it done for free,” well, I’ll wait! Going to the US for procedures is absolutely NOT as common as people think

4. The US has the absolute best health care in the world! People flock from all over the world to have procedures done here.

I hate to break it to everyone, but (brace yourself) all that technology that you have is miraculously available in the rest of the world as well!!!   

*gasp!*

Don’t flatter yourself. All the things you can do in the US can be done everywhere else. In fact, on my particular unit, the doctors specialize in a particular cutting edge procedure. Patients flock here from the US and all over the world to have it done. 

5. If the government runs the health care system, the bureaucracy will run the hospitals into the ground!

Are you kidding? The government is the only place billed. There’s no paperwork to fill out, just a healthcare number to keep on the chart. There’s no billing department to send out itemized bills to patients, insurance companies, etc. The administrative side of public healthcare is incredibly streamlined.

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OK, that’s all I can think of for now. I’m sorry if I offend. I simply am tired of people telling me all about this crappy system I work in when really they are completely misinformed about how this system works. 

How could I not love the fact that I showed up for work, sniffling, coughing, dripping from my cold, only to discover I made a mistake and didn’t have to work. And by some miracle, we weren’t short-staffed. So, here I am, back at home to enjoy another night watching movies and reading blogs! Sweet!

I really like the picture I put on this blog. I’m referring to the picture of the nurse on the right that seems to be watching over everything I write. She is hard as stone but appears soft; she is young but is definitely mature; she looks warm-hearted but ready to dispense tough love at a moment’s notice. She has many dichotomies as most nurses do.

It’s as though she is my own personal goddess or Saint that watches over everything I do as a nurse. She follows my evolving practice. She is ready to pick me up off the floor when I’ve had a horrible day. She is ready to pat me on the back when I feel as though I’m really coming along.

Is it strange that I contemplate what a picture on my blog is doing or thinking? I think I’m just imaginative. Any opinions from the mental health nurses out there?

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They say the first year out of school is the hardest. After you’ve finished that year, you’re golden, right? You automatically become a perfect nurse, right?

 I find it hard to believe that in a couple months, my initial year out of school will be done. Some days it feels as though I’m barely ready to pass my very first nursing clinical, let alone be done school and out there working on my own!

I’m in limbo though. Some days I’m treated as the new kid on the block who doesn’t know a thing. Other days, I’m plunged into leadership positions with new staff, graduates and students lined up to ask my opinion. I’m always amazed at how much I know! I really am learning!

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Illness sometimes happens right when you need it to. For the past couple weeks I have felt dopey. My head has been foggy, and some would even say it has been “up my ass.” I have been missing details, moving slowly and struggling to put forth my best effort. And nurses always have to be at their best, right?

So, a few days ago, I came down with a nasty cold. It has forced me to lie on the couch, surrounded by pillows and a quilt, sipping tea, and watching TV. I may still be a bit sick, but my mind feels rested and much MUCH clearer. I feel ready to go!

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I have a confession. I’m supposed to be working on my critical care course right now. I have a test in a few days on the pulmonary system. Right now, I’m learning about perfusion versus ventilation, and what the different ratios between them indicate. I must say, I adore the detail of knowledge that I am gaining. This detailed anatomy/physiology that focuses the main acute care systems is much more appropriate right now than the broad scope of nursing school anatomy.

Let’s face it, it’s nice to know the anatomy of a taste bud, the structure of the eye, and how earwax is produced, but that’s really not what gets me through a shift! This course focuses on the lungs, heart, kidneys, brain, cells, and defense. This is the stuff that I work with on a daily basis—it’s my bread and butter.

I still can’t believe that here in Canada, critical care is so lacking in Universities. Many (like me) spend their entire four-year degree without stepping into or even discussing the ICU or ER. If you want to work there, you need to train for it following your Bachelor’s degree.

Edit: After actually doing the studying, I am feeling completely defeated by pulmonary physiology. This is complex stuff! 

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I have a sinking feeling that this will be ER’s last season on TV. I feel it in my gut. What will I do without ER? I even credit it with sparking my interest in nursing. I highly doubt that Gray’s Anatomy or House could ever do that!

I’m terrified about having that void in my life!

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I hate having to write an entire post twice! Yes, I did indeed type this post twice…ARG!

You know how it is… 

You have a busy week, and there’s just no time to blog. Then, before you know it, it’s been three months! And since it has been so long, it starts to get harder and harder to blog at all. We’ve all been there, right?

I have to admit, this summer was not overly exciting for me on the nursing front. It was as though life was on fast-forward. That part of the show that just feels like filler, so you zip through it with no regrets.

Fall is proving to be exceptionally busy. I have started my critical care nursing certification. The first course is physiology, which I am absolutely loving! It skips over the parts of physiology that acute care nurses rarely use (anatomy of the eye or the physiology of the tongue for example) and focuses on the critical systems for survival: lungs, heart, kidneys, and brain. There’s also a unit on defense systems. I love learning the intricate details of life. 

A coworker and I were discussing the ICU. She stated that she wasn’t overly interested in working there because she had heard it described as, “nursing dead bodies” and that she would miss the human interaction. I’m sure sometimes it feels as though you’re nursing dead bodies, but I highly doubt that it is a constant.

Regardless of the level of consciousness of ICU patients, I realized more at that moment than ever before that it isn’t the human interaction that drew me to nursing, but rather my fascination with anatomy/physiology. I also realized that what is great about nursing is that no matter what brought you to the career, you can find a place that matches your desires perfectly. 

I am VERY seriously contemplating heading up north to do some short-term stints in the North West Territories. There a town I’d like to work in called Inuvik with about 3000 people. It’s just above the arctic circle; the kind of place with 24 hour dark in winter and 24 hour light in summer. The town is up near the arctic ocean, surrounded by tundra, in the middle of nowhere. The hospital there serves all the little aboriginal towns in the area (A BIG area). It’s rural nursing at its best! There is a lot of flight nursing in an outpost like that, which excites me even more! So, I’m going to try and contact the management there to see what I can do. They’ll pay for your travel expenses, and they have residences for hospital staff. I’m becoming obsessed with the idea!

The biggest problem I have always had with nursing is that there are just too many things I want to do with my degree!   

Hi everyone,

I wanted to write a quick update considering it has been several days since my last post. I am on a long stretch of eight hour night shifts, so I’m feeling a little beat up. Last night was a particularly tough night! One of my patients unfortunately went downhill and passed away. I’m looking forward to writing about the experience.

I also have a post in the wings about lateral violence in nursing (AKA: Nurses Eat Their Young). It is a controversial topic and I look forward to putting my “spin” on it. Especially in light of all the “blog wars” that seem to be occurring in the nursing blogosphere.

Thanks everyone for keeping me entertained with your awesome writing! Keep those posts coming! And don’t forget, if you have a blog or link that you would like me to add to my roll, please don’t hesitate to ask.

Bye for now!

Sincerely,

Nurse Sean