Nurse Sean (dot) com

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!

******

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!

******

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!

******

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.

Jen over at Keep Insite Open has posted an important event that will be occurring in Ottawa, Canada! Jen and I are both supporters of Harm Reduction Theory; however, she has the passion to get out and DO something about this important issue.

Harm reduction is one of the most controversial theories that is debated by nurses–even though we use it every day! Yes, many people are adamant that safe injection sites such as Insite are detrimental, but the evidence to the complete opposite is extremely convincing.

Even if safe injection sites, needle exchanges, or condoms for teens is outside of what you consider appropriate, Ask yourself how you feel about other harm reduction strategies: do nicotine patches work? Methadone? Giving food to the homeless? Designated drivers?

Fascinating stuff! For your fill of debate, head over to Keep Insite Open!

This article is based on a final project I wrote for my Bachelor’s of Nursing degree. I expect to be updating it over time. I have placed this at the top as a permanent tab, but I thought it would be nice to include it here as well. 

During my final practicum of my career as a nursing student, my philosophy of nursing has begun to develop. Until this semester, I was more focused on the skills of nursing and did not pay particular attention to how I practiced. This final practicum has lent itself to the development of my personal philosophy of nursing and a resulting framework. This framework looks at the shared reality between patients and nurses, and expands it to suggest that this reality should be shared between an entire team of professionals and the patient. It also imagines healthcare professionals as acting together to create a barrier between patients and illness.

During a night shift at the beginning of the semester I had the opportunity to discuss a patient’s perception of his condition. I realized that he was speaking of his condition in emotions and relationships. He told me how he felt when he was originally diagnosed with prostate cancer and how this had affected his wife. Unlike a healthcare professional’s view of illness, which is very scientific and objective, his was subjective and fluid. In other words, he was creating a reality for his illness that was his own.

As a nurse, I realized that it was my duty to explore these realities so that I can understand a patient’s needs better. Because every patient’s reality will differ, no two will need the same care. All to often, as nurses, we get stuck in the routines of our jobs, acting as slaves to the clock, racing to complete tasks. I realized in this moment of epiphany what the true art of nursing is. To be an artistic nurse, you must work within the subjective realities of your patients, acting creatively to find a place in his or her story.

However, I realized that nurses also bring a certain subjective reality to their practice. Each of us has values and beliefs that are created throughout our lives and cannot be compared to anyone else’s. We also bring the concrete knowledge of nursing to our practice. Finally, nurses bring stories of patients who have been in similar situations and are able to discuss the similarities and differences with the patient. As a result, when we take care of a patient, we are not only on the receiving end of our patient’s information; we are also sending our own information.

In the end, the nurse and patient create a shared reality that is a combination of the patient’s own view of his or her illness and experience in the health care system, and the nurse’s knowledge, values, and beliefs. Together, they must negotiate the best way to improve the patient’s health. It is my belief that this relationship is created nearly subconsciously. However, if a nurse specifically focuses on this aspect of care, they could work toward creating a better experience for the patient.           

Nurses are not the only people that interact with patients. Physicians, family members, and all other members of the health care team also individually talk with patients, bringing their own knowledge, values, and beliefs into the situation. Unfortunately, the shared realities between these persons and the patient may conflict with every other person’s. This creates a chaotic and confusing experience for the patient, making it difficult for everyone involved to create goals for the patient.

I decided to build my framework around this concept of “shared realities.” However, I also wanted to use a simplified version of Neuman’s (2002) model. Neuman’s model contains multiple layers of complex barriers between the patient and stressors that cause illness. In my simplified version, I simply see nurses as part of a health care team that, when properly used, creates a solid barrier around a patient. This barrier needs to follow the patient through primary, secondary, and tertiary care.

In figure 1 is a view of a model in which each health care professional is utilized to either a great extent, or not enough. The larger the circle, the better their skills were utilized. The lines show that most of the communication travels from the professionals to the nurse and then to the patient. In this model, it is the nurse who bears the majority of the stress of coordinating the team of professionals. It also makes it difficult for the professionals to work together as they do not understand each other’s subjective reality.

In Figure 2 is a view of what I believe a nursing framework (or more accurately, an interprofessional framework) should look like. It shows the members of a health care team working together to create a shared reality between the entire team and the patient. By creating this reality between the entire team rather than just each professional and the patient, it creates a unanimously agreed upon goal for the care of the patient. Having a shared goal would make it easier to share ideas and creative ideas on reaching this goal. The key to making this work is communication. Each member of the interdisciplinary team must feel comfortable talking with every other member of the team, and in turn must be approachable at all times for discussions regarding their patient.

I spent a lot of time trying to create a complex framework for nursing that would show the intricacies of our professions. However, in the end, I realized that by simplifying the model, it made it realistic and easy to follow. It simply states that a nurse must respect the differences between patients, and tailor his or her care to adequately care for their patients. On a bigger scale, a nurse must work, through communication, to create goals with the entire health care team. By working together, we create a stronger barrier around the patient that works to strengthen the barrier between health and illness.

 References

Neuman, B., Fawcett, J. (2002). The Neuman Systems Model (4th ed.). Upper Saddle River, NJ: Pearson Education Inc.