Nurses and Secondary Trauma

Nurses and Secondary Trauma

I had the opportunity to speak with Jessica Shaw, PhD about secondary trauma and nursing. Learn what it is and how to deal with secondary trauma.

I had the opportunity to speak with Jessica Shaw, PhD about secondary trauma and nursing. Learn what it is and how to deal with secondary trauma.

When I started nursing school, I had a fascination with being in the thick of the really intense medical situations that frequently accompany working in an acute care facility. The more intricate and gory the story or predicament, the better.  I wanted to be in the middle of the action, part of the team. I wanted to fill the role as the smart, dependable nurse. The one who the doctor trusted, and the one with whom the family felt safe.  I still desire this to some degree, but after working in cardiac stepdown and neurocritical care, my mentality has shifted quite a bit.

While we say it’s really cool to see those kinds of things and be on the front lines, the actual reality of it is… well, not. It’s not cool or interesting to remove the breathing tube from a young father of three and watch him take his last breath, or perform CPR on 30 year-old nurse, or pronounce an elderly woman deceased, when she was the only person her daughter had left in this world.  It wasn’t interesting to see a man who was already struggling  with severe depression suffer a devastating stroke, nor was fascinating to care for the man who tried to kill himself with Tylenol.

At first, I was excited to jump into that role as the nurse caring for these patients as they walked through arguably the worst moments of their lives.  What I didn’t realize at the time was the empathy I provided in those situations was at a great cost to myself.

What is secondary trauma?

I had the opportunity to speak with Jessica Shaw, PhD who is a community psychologist and is faculty at Boston College about vicarious trauma and nursing.  She states that, “vicarious trauma, also known as secondary trauma or indirect trauma, can result from being indirectly exposed to trauma through the firsthand accounts of others’ traumatic experiences.”

Dr. Shaw goes on to mention that, “as individuals are exposed to story after story of others’ traumatic experiences, and those individuals are tasked with being a witness to each, they build up and accumulate. These individuals then carry the accumulated, collective weight of these traumatic experiences.”

Sound familiar, anyone?

How do you know you’ve experienced it?

Dr. Shaw discusses how important it is to differentiate between burnout and vicarious trauma.  Burnout is quite the buzzword in our profession as we struggle with higher nurse to patient ratios, increasing demands at work, constantly evolving technology, all accompanied by sicker and sicker patients. Here is a great article that really dives deeper into a definition of burnout, which essentially outlines burnout by three components; extreme exhaustion, alienation from work activities, and reduced performance.

“Vicarious trauma is different [from burnout] in that it persists even when we shift to new contexts. We continue to be in a state of high arousal, thinking of the worst case scenario in every context we find ourselves in, feeling irritable or defensive, as though we can’t do enough or aren’t doing enough, and so on. These thoughts and feelings are intrusive and persistent,” mentions Dr. Shaw.

I don’t know about any of you out there, but what she said really hit home for me.  After working in critical care, with my every day as someone else’s worst-case scenario, that mentality started spilling into my personal life. (I talk about this a bit more in depth in the FreshRN Podcast, Dealing With Patient Deaths.)  Every joyful moment seemed to be overshadowed by a worry that my husband would suffer a major stroke, my daughter would get cancer, my father would be diagnosed with a brain tumor… and since I am a nurse, I can paint a pretty accurate picture in my mind of what that would look like.  Those worst-case scenarios were very, very real to me.  I was having a tough time really being mentally present because I was constantly holding back fear.

What do you do?

Now that we’ve defined vicarious trauma and differentiated it from burnout, let’s chat about what someone who feels that they may be experiencing this should do.

Dr. Shaw outlines some steps below. (A self-care care plan, perhaps?  No?  Not so much? I’ll show myself out…)

I’ll let her take it from here…

Context

“Before discussing what an individual should do, it is important to remember that the individual is embedded in a larger context–the organization for which they work and the broader systems in which that organization is embedded. It is this broader context that engenders vicarious trauma. Thus, if we want to prevent or treat vicarious trauma, it is this broader context that will need to undergo some changes. The Vicarious Trauma Toolkit from the Office of Victims of Crime discusses what organizational changes may need to be made to create and foster a supportive environment for its members.

Of course, though, when we are dealing with vicarious trauma, we cannot sit back and wait for organizational change. So, while reminding ourselves that change is needed at levels beyond our direct control, we can take steps to take care of ourselves right now.

Practice self-awareness

When you feel some kind of way, don’t just ignore it, but take time to reflect on what you are feeling and why you are feeling that way. What underlying values in your life contribute to such feelings (e.g., compassion, integrity, justice, healing), and why are those values important? Center yourself by giving yourself deliberate space to reflect in how you’re feeling, the values that contribute to those emotions, and reminding yourself that such values should inform all aspects of your life–including how you take care of yourself.

Find supporters

Find others, perhaps at work, perhaps elsewhere, with whom you can process how you are feeling and why you might be feeling that way. Validate one another’s experiences to let one another know that each person is not alone in this work and that you each do not need to carry this load alone.

Set boundaries

Create physical spaces or set times in which work, and your cumulative trauma exposure, does not enter. Use these spaces to engage in activities and with others that bring you joy. If you find work or other intrusive thoughts creep in, acknowledge them, perhaps even out loud. Then tell yourself that you do not need to think of that now as you will set aside time to attend to such feelings later. By acknowledging the thought briefly, you are better equipped to set it aside.”

Use your resources

Dr. Shaw highly recommended the the Trauma Stewardship Institute and Laura’s book, Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others

Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for OthersTrauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others

Dr. Shaw also recommends the Vicarious Trauma Toolkit from the U.S. Department of Justice, Office for Victims of Crime for organizational change strategies.

Also, many healthcare facilities have Employee Assistance Programs available with trained counselors at no cost to the employee. Ask your manager if your facility has this benefit.

Hospital chaplains are also a great resource. They aren’t there just for the patient; they are also are there to also care for the employees, and many are trained to support people through these experiences.

Here is Laura’s TED Talk… and guys, it’s wonderful. She outlines this in much more depth than I have here.  One of the the things she said in how you can identify one of the various way  if you’re experiencing this is, “when the best part of the work day is when you don’t have to do your job.”

Anyone out there watching the clock? Counting down the minutes until the next break? Can’t wait for 5 days off in a row, but can’t really enjoy that last day because you know you have to back?

Please, watch this video. It is incredibly powerful and applicable to our profession.

Self-compassion is a key aspect of providing empathy and compassion in a sustainable way.  I highly encourage you to check out Dr. Kristin Neff and her plethora of resources on self-compassion.

Self-Compassion: The Proven Power of Being Kind to YourselfSelf-Compassion: The Proven Power of Being Kind to Yourself

I also have experienced profound personal emotional benefit from Dr. Brene Brown and her books on empathy and imperfection.

Braving the Wilderness: The Quest for True Belonging and the Courage to Stand AloneBraving the Wilderness: The Quest for True Belonging and the Courage to Stand AloneRising Strong: How the Ability to Reset Transforms the Way We Live, Love, Parent, and LeadRising Strong: How the Ability to Reset Transforms the Way We Live, Love, Parent, and LeadDaring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and LeadDaring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and LeadThe Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You AreThe Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You AreI Thought It Was Just Me (but it isn't): Making the Journey fromI Thought It Was Just Me (but it isn’t): Making the Journey from

Remember, “this is not simply the cost of caring, and that exhaustion and sacrifice should not be worn as a badge of honor. We cannot take care of others if we do not take care of ourselves,” stated Dr. Shaw.

Even more resources

A great nurse burnout resource is Elizabeth Scala’s blog and books.

Nursing from Within: A Fresh Alternative to Putting Out Fires and Self-Care WorkaroundsNursing from Within: A Fresh Alternative to Putting Out Fires and Self-Care WorkaroundsStop Nurse Burnout: What to Do When Working Harder Isn't WorkingStop Nurse Burnout: What to Do When Working Harder Isn’t Working

I hosted a webinar with Nurse.com entitled Empathy 101 For Nurses: How to Care for Yourself While Emotionally Supporting Others

Dr. Brene Brown – she has a great website with lots of information about empathy

Dr. Kristin Neff – resources related to self-compassion

I had the opportunity to speak with Jessica Shaw, PhD about secondary trauma and nursing. Learn what it is and how to deal with secondary trauma. Trauma Stewardship Institute

Jessica Shaw, Ph.D., is a community psychologist and is currently faculty at Boston College. Her work focuses on examining and improving community and system responses to sexual assault. She partners with a range of stakeholders in her work, including sexual assault nurse examiners.

Tips for New Grads in the ICU, Be Your Own Advocate

Tips for New Grads in the ICU, Be Your Own Advocate

This is a guest post.

The purpose of this episode is to offer tips and advice to new graduate RNs starting in an ICU.

All opinions in this post are that of the guest author and not those of their employer.

As a new grad in the ICU there is a learning curve. Learning to be your own advocate will help you learn things the way that is best for you.

 

This is part three in a 3 part series. Be sure to check out part one, New Grads in the ICU, Nurse Characteristics, and part 2, Tips for an ICU Nurse, Showing Initiative.

Melissa Stafford, BSN RN CCRN SCRN is the author, and will also be our featured guest nurse in Season 2 of the FreshRN Podcasts.

 Advice #4: Know yourself and be your own advocate

  • Learning style vs. teaching style: If I’m going to teach you how to knit me a scarf, how do you learn best? Can I just talk you through it? Do you want me to give you an article to read? Do you want to watch me do it? Or, do you need to hold the needles and do the stitches? Or… do you learn best with a combination of those things? Your learning style and my teaching style may be very different, so we should talk about that at the beginning. Or, best way you learn knitting may not be the best way to learn figure skating. Talk to your preceptor about things that are or are not working, that’s how you’ll learn to adapt to each other.
    • Know your limitations. Recognize what you don’t know. Nothing will kill your credibility quite like being the ‘know-it-all’. As a new grad, it will make you look dangerous. I would recommend you have regular conversations with your preceptor.
      • Example: Your post-op patient is becoming increasingly tachycardic.
        You: “My pt is tachycardic. I’m concerned they might have internal bleeding”.
        Preceptor: “Why do you think that? The patient has a fever.”
    • This would be your opportunity to show your critical thinking skills by reviewing the patient’s other vital signs (say a low BP), or your preceptor may direct you to check the patient’s lab work, or most recent dose of pain medication.
    • It takes time for your preceptor to validate your knowledge and technical skills. By allowing this natural progression, you will only improve your credibility among your peers, which will help demonstrate your independence.
  • Ask for help. This coincides with knowing your limitations. Asking for help is not always a weakness. Sometimes it can be a key strength in safe patient care. If you aren’t sure how to titrate your vasoactive drips on the new IV pump, or, if you need a refresher on how to perform trach care, ask. Your preceptor may want you to demonstrate what you do know, but this will help identify learning opportunities.
  • Find a mentor. This will likely NOT be your preceptor during orientation (but they will often become one after you are on your own). This person does not have to be the most experienced person. But, it should be someone who has experience in the unit who can offer a sounding board after a rough day, suggestions for your performance, or how to interact with your preceptor. This would be someone who is not grading your knowledge/technical skills, but someone focused more on personal and interpersonal development.
  • Own your orientation. Orientation is an extension of nursing school, without the formal grading. Use resources like textbooks, professional nursing organization references, or reputable internet sites to look up unfamiliar things (like disease processes) on your own time. Your preceptor and manager will appreciate your self-motivation to learn! Bonus: These notes will give you something to go back to when it comes back up again in the distant future.

Advice #5: Keep your orientation organized

There will be a lot of paperwork during orientation. You will be (or should be) exposed to many types of patients during orientation. The same goes for types of equipment (IVs, vents, monitors, pressure lines, etc.) You should keep notes on what you’ve experienced, what you’ve done well, and what you need help with. I hope you’ve got a preceptor helping with this one!

Advice #6: Organized routine is key

Whether it pertains to organizing orientation paperwork (as above) or to how you run your day, having an organized routine will help things run smoother. Below are some of my thoughts for starting out.

  • Assessments: Head to toe. Getting in a routing on what/how to assess your patients will help you master the patient assessment. Furthermore, good assessments are the foundation to success in critical care. This is how you will learn to recognize changes early. Technical skills are important, but your assessment skills are more so.
  • Report: Needs to be organized/streamlined whether giving or receiving. You should have a tool (whether self-developed or a borrowed) for report. It’ll help you organize your thoughts, ask questions, and plan your day. CAUTION: Do not regurgitate the report you received as the report you are giving someone else.
    • Receive report. I need to know why my patient is here and the most pressing issues. (WARNING: you will likely not receive every piece of information you need during report. For this reason, do not rely on word of mouth for your orders. Review the chart for active orders and current MD notes)
    • Assess the patient: Your eyes should go to the patient first, NOT the monitor. Seeing your patient is dusky and short of breath will tell you way more than an SpO2 of 94%. Same goes for an awake, chatty, pink healthy patient whose SpO2 is reading 52%.
    • Assess the monitor: Are the vitals normal? Anything I need to address urgently. (WARNING: check to be sure your alarms are set appropriately, both numeric values as well as sounds)
    • Assess IV meds: Look at what is actually hanging vs. what is programmed into the pump. Also, you should have enough fluids to get through the first couple of hours. If not, address promptly. The last thing you want to do is run out of Levophed while in the midst of starting your day.
    • Go from there. You decide when charting assessments, scheduled med administrations and the dozens of other nurse tasks will get done over the next 8-12hr shift.
    • Practical application: I start my day like this:
      • Receive report. I need to know why my patient is here and the most pressing issues. (WARNING: you will likely not receive every piece of information you need during report. For this reason, do not rely on word of mouth for your orders. Review the chart for active orders and current MD notes)
      • Assess the patient: Your eyes should go to the patient first, NOT the monitor. Seeing your patient is dusky and short of breath will tell you way more than an SpO2 of 94%. Same goes for an awake, chatty, pink healthy patient whose SpO2 is reading 52%.
      • Assess the monitor: Are the vitals normal? Anything I need to address urgently. (WARNING: check to be sure your alarms are set appropriately, both numeric values as well as sounds)
      • Assess IV meds: Look at what is actually hanging vs. what is programmed into the pump (my IV insulin story). Also, you should have enough fluids to get through the first couple of hours. If not, address promptly. The last thing you want to do is run out of Levophed while in the midst of starting your day.
      • Go from there. You decide when charting assessments, scheduled med administrations and the dozens of other nurse tasks will get done over the next 8-12hr shift.

Advice #7. Learn your alarms and use them to your advantage

There is a reason for every alarm. All alarms have to be answered promptly. Still, in an ICU there are often many alarms occurring simultaneously. It’s important that you learn to prioritize. For example, a V-fib alarm needs to be addressed before an occluded IV. Each alarm has a different sound, and therefore it is imperative that you to recognize the sounds.

Even better, use these alarms to your advantage. My favorite 2 alarms to utilize in this way are IV pump alarms and tube feeding pump alarms. On an IV pump, you can program the VTBI so that you know when one antibiotic is done and it’s time to hang another one. Or, use it to remind yourself half way through to make sure you have another bag of Levophed with plenty of time before it’s empty. Titrating your tube feeding rate to goal? Use the volume to trigger an alarm on the pump as a reminder when to turn up the rate.

Advice #8: You need downtime

Becoming a nurse is an exciting, but stressful time. Becoming a critical care nurse right out of school adds another layer to that stress. Learn to separate from the physical, mental, and emotional stress of work. You will have good days and bad days, both to varying extremes. Sometimes things don’t go your way, and sometimes is very hard to accept that. But, you cannot (and should not) be in orientation 24/7. Identify stress relievers, whether that’s exercising, bowling, painting, hanging out with friends, or shooting targets at a range. Do something fun! Home-work balance is important to your long-term success.

Bottom line: you will likely have some (or many) days where you think, “I can’t do this.. or what have I gotten myself into?” But rest assured that you can. It takes time, trial and error, and confidence in yourself to become a safe and competent ICU nurse.

Welcome to Critical Care Nursing!

  • Tips for New Grads in the ICUMelissa Stafford, BSN RN CCRN SCRN graduated from nursing school in 2000, and after a short time on a medical surgical floor transitioned to neuro critical care. During her career, she has precepted multiple nurses, taught classes ranging from neurological/neurosurgical specific subjects to general critical care medicine, been involved in shared governance and resides as chair for nursing peer review. She has received various recognition’s, including the Great 100 Nurses of North Carolina and DAISY Award. Melissa enjoys spending time with family, painting, watching sports, visiting the beach whenever possible, and vacationing at Disney World

ICU Skills Conference

Learn both hard and soft skills about ICU nursing care. From vasopressors to emotional support, this comprehensive ICU skills workshop covers topics applicable to every nurse working in critical care, as well as those sending patients to, or receiving patients from, intensive care.

Use code ICUskills for $20 off!

Tips for New Grads in the ICU, Showing Initiative

Tips for New Grads in the ICU, Showing Initiative

This is a guest post.

The purpose of this post is to offer tips and advice to new graduate RNs starting in an ICU.

All opinions in this post are that of the guest author and not those of their employer.

This three part series gives helpful tips for an ICU nurse. As a new graduate, the ICU can seem overwhelming, these tips will help you find your way.

Tips for an ICU Nurse
 

Advice #3: Show initiative

It develops rapport. Every single interaction with every single patient, family, nurse, doctor and other health care partner will be a learning opportunity. Seeking out learning opportunities shows your co-workers that you are engaged. There’s a patient getting a bedside trach or ICP bolt? Ask to be in the room and tell them you’ve never seen it before. Ask questions. Most doctors appreciate the new nurse who demonstrates the desire to learn.

RT can teach you about blood gases or lung sounds, or modes of the ventilator. PT can teach you the best way(s) to mobilize patients (a huge AACN initiative). OT can show you adaptive maneuvers to help the patient learn new ways for ADLs (like feeding themselves after a stroke). ST is not just about safe swallowing (though important)… they can teach you about other cognitive deficits and how to recognize them and help patients adapt. BE A SPONGE and soak up the opportunities. That being said, be careful not to over-extend yourself in any given shift.

Advice #4: Know yourself and be your own advocate. An important point in many ways.

  • Learning style vs. teaching style If I’m going to teach you how to knit me a scarf, how do you learn best? Can I just talk you through it? Do you want me to give you an article to read? Do you want to watch me do it? Or, do you need to hold the needles and do the stitches? Or… do you learn best with a combination of those things? Your learning style and my teaching style may be very different, so we should talk about that at the beginning. Or, best way you learn knitting may not be the best way to learn figure skating. Talk to your preceptor about things that are or are not working, that’s how you’ll learn to adapt to each other.
  • Know your limitations. Recognize what you don’t know. Nothing will kill your credibility quite like being the ‘know-it-all’. As a new grad, it will make you look dangerous. I would recommend you have regular conversations with your preceptor.
    • Example: Your post-op patient is becoming increasingly tachycardic.
    • You: “My patient is tachycardic. I’m concerned they might have internal bleeding”.
    • Preceptor: “Why do you think that? The patient has a fever.”
      • This would be your opportunity to show your critical thinking skills by reviewing the patient’s other vital signs (say a low BP), or your preceptor may direct you to check the patient’s lab work, or most recent dose of pain medication.
      • It takes time for your preceptor to validate your knowledge and technical skills. By allowing this natural progression, you will only improve your credibility among your peers, which will help demonstrate your independence.
  • Ask for help. This coincides with knowing your limitations. Asking for help is not always a weakness. Sometimes it can be a key strength in safe patient care. If you aren’t sure how to titrate your vasoactive drips on the new IV pump, or, if you need a refresher on how to perform trach care, ask. Your preceptor may want you to demonstrate what you do know, but this will help identify learning opportunities.
  • Find a mentor. This will likely NOT be your preceptor during orientation (but they will often become one after you are on your own). This person does not have to be the most experienced person. But, it should be someone who has experience in the unit who can offer a sounding board after a rough day, suggestions for your performance, or how to interact with your preceptor. This would be someone who is not grading your knowledge/technical skills, but someone focused more on personal and interpersonal development.
  • Own your orientation. Orientation is an extension of nursing school, without the formal grading. Use resources like textbooks, professional nursing organization references, or reputable internet sites to look up unfamiliar things (like disease processes) on your own time. Your preceptor and manager will appreciate your self-motivation to learn! Bonus: These notes will give you something to go back to when it comes back up again in the distant future.

You will more than likely come across many chances to use these tips; some will be easier to master than others. The ICU can be very intimidating, but remember that you are not any less valuable to the team. Everyone has something to bring to the table, and that includes you!

This is part two in a 3 part series. You can read part one, New Grads in the ICU, Nurse Characteristics and part 3, Be Your Own Advocate.

Melissa will also be our featured guest nurse in Season 2 of the FreshRN Podcasts.

Tips for New Grads in the ICUMelissa Stafford, BSN RN CCRN SCRN graduated from nursing school in 2000, and after a short time on a medical surgical floor transitioned to neuro critical care. During her career, she has precepted multiple nurses, taught classes ranging from neurological/neurosurgical specific subjects to general critical care medicine, been involved in shared governance and resides as chair for nursing peer review. She has received various recognition’s, including the Great 100 Nurses of North Carolina and DAISY Award. Melissa enjoys spending time with family, painting, watching sports, visiting the beach whenever possible, and vacationing at Disney World

ICU Skills Conference

Learn both hard and soft skills about ICU nursing care. From vasopressors to emotional support, this comprehensive ICU skills workshop covers topics applicable to every nurse working in critical care, as well as those sending patients to, or receiving patients from, intensive care.

Use code ICUskills for $20 off!

How Nurses Can Transform Health Care

How Nurses Can Transform Health Care

This post is sponsored by Capella University.

Please see my disclaimer page for more information on our partnership. 

Nurses Can Transform Healthcare
The theme for the 2016 Magnet Conference in Orlando, is Empowering Nurses to Transform Health Care.  I was trying to think about what that means to me… how can nurses truly transform how health care is delivered in this country? And then I thought about two scenarios…

Hospital 1

At hospital 1, the nurses clock in and out on time. Their meds are passed, call lights are answered. Patients get admitted and eventually discharged. The nurses answer questions when asked, but relatively frequently, things get lost in translation. Policies and procedures are reviewed, but not routinely. A nurse does not sit in on the process of completing policies and procedures. Because of this, they are written in a way that does not make sense to the practicing bedside nurse, and are therefore rarely utilized. The nurses on the floor learn how to do most procedures by just doing what their preceptor told them to do. Their preceptors were never properly trained to precept, and many were trained to do this 10+ years ago and therefore the policies that they were trained with are out of date anyway.

Health care is delivered…but it’s not really care. It is sterile. It’s mechanical. It’s transactional.

Hospital 2

At hospital 2, nurses clock in and out on time. Meds are given on time, call lights are answered. Interdisciplinary rounds happen routinely and nurses lead them. Nursing care plans are discussed in rounds. Nurses have a care plan established for their patient at the beginning of their shift and work with members of the health care team to assure these goals are realistic and that they are progressing towards them. The committees that review policies and procedures have appropriate representation from each service line, including nurses. When asked to have input on policy and procedural updates, these nurses take it seriously. They utilize resources from professional organizations and databases, and consult their shared governance to balance what is the latest evidence based practice along with what’s practical and cost effective.

Preceptors have gone through a formal training. Utilizing policies and procedures is a regular occurrence and they are based on the latest evidence because it’s engrained into their culture. “We’ve always done it that way,” is considered a 4-letter word.

Patients get discharged sooner because nurses are aggressive with the care plan implementation and progression. Patients have better outcomes. Patients are more satisfied because the nurses educate them at every step of the way so that they can play a more active role in their recovery.

This hospital network also regularly meets with members of the community to see how they can play a part in better patient care and meet the needs of the community best.

The entire community is cared for by this hospital, whether or not they’re a patient.

Which would you choose?

Now, tell me which hospital will transform health care? Which hospital will have a better impact? Which hospital would you rather work for? And most importantly, which hospital would you rather have your loved ones receive care from?

Nurses have the power to create these cultures. Nurses have the power to drive policy change. Nurses have the ability to create patient-centered care plans to progress patients to discharge sooner and ensure better outcomes.

Nurses can transform health care.

Magnet 2016 Conference

Are you going to Magnet in Orlando? Be sure to check out booth 1323 where you can learn about Capella University’s 8785_magnet2016_ppt_final-shirtnursing programs! Also, Capella is sponsoring the Magnet Lounge where they are doing something pretty cool to help impact the local community. Within the lounge, you will have an opportunity to assemble a hygiene kit that will be donated to a local women’s shelter.  Each participant will receive a t-shirt as a thank you from Capella.  They are hoping to assemble 900 kits over the 3 days.

See graduation rates, median student debt, and other information at www.capellaresults.com/outcomes.asp.

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What Do You Think of When You Hear the Word “Nurse”?

What Do You Think of When You Hear the Word “Nurse”?

This post is sponsored by Capella University.

Please see my disclaimer page for more information on our partnership.

When you hear the word  nurse . .. what do you think?  More importantly, what do you feel?  Healthcare is constantly changing, but the nurse remains.

When you hear the word “nurse” .. what do you think? What do you see? More importantly, what do you feel?

I see a person, standing there in the middle of chaos – with a subtle grin.   Someone that can not only handle the world flying by them a million times a minute, but they kind of enjoy it.

Technology is constantly changing. Residents are in and out. New process, procedures and policies come out so fast you barely had time to learn about that last change. Every few years there are new faces in administration.

But the nurse remains.

The nurse stays steady at the helm.

Because even though things are constantly changing, at the end of the day, there is still a person who craves caring for and being with people – and that’s all that matters.

They crave the one-on-one, “I’m right here for you,” “don’t give up,” moments. The “I know you’re really scared – I’m not going to leave you” moments. The “I don’t care if I make this doctor, administrator, or coworker mad because I am standing up for my patient because they deserve better than that” moments.

They’ll deal with working overtime. They’ll deal with confusing charting systems. They’ll deal with practically humanly impossible requirements for charting and tasks to make sure all of the bases are covered legally for the hospital. They’ll come in early. They’ll stay late. They’ll miss time with their loved ones to go to work and care for people.   They’ll push themselves. They’ll do the things they hate doing (you know…making others mad, disappointing people, frustrating people, annoying people) just to advocate for their patients. And would do so in a heartbeat. A PQRS.

When I hear nurse – I see that confident person in the middle of a crowded room, while the world races by them…sitting there quietly.

They are connecting with a patient, and completely oblivious to the madness around them.

And the patient feels connected.

The patient feels safe.

Capella asked three artists to paint what the word nurse meant to them. Check out this video to see their interpretation.

Aren’t they beautiful?

Capella is partnering with Scrubs Magazine in a contest to giveaway each of these pieces of art. The link to the video contains instructions for how to enter.

A Nurse Practitioner’s Medical Mission to Africa

A Nurse Practitioner’s Medical Mission to Africa

This week I am featuring an interview with my sister in-law, Elizabeth Fields.  She recently went to Bora, Ethiopia with the medical mission group Health Gives Hope.  Last week, I interviewed their founders, one of whom is actually a Nurse Practitioner!  Click here to check out the previous post.

To give you a little background about Bruce and Elizabeth Fields, they are quite the athletes and world travelers.  Bruce played professional basketball in Europe for 9 years and now works at State Farm in the Chicagoland area.  Elizabeth played volleyball at Parkland College (where I played basketball for a short time!) in Champaign, IL and then completed her BSN at Indiana Wesleyan University while continuing to play volleyball.  She has worked at Northwestern Memorial Hospital for the last ten years as a registered nurse, working the last two years as a Nurse Practitioner.  She obtained her FNP from Walden University.

These two crazy kids.  They met in Austria some odd years ago and have traveled to the following countries either together or separately:  Turkey, Switzerland, Austria, Thailand, Ethiopia, France, Italy, Belgium, Norway, Spain, England, Philippines, South Korea, China, Russia, Ukraine, Poland, Germany, Mexico, Japan, Denmark, Canary Islands, Romania, and Canada.  Oh, and Bruce has lived in a handful of them as well!  Clearly they know a bit about traveling!  Me, I’m more of anxious traveler (think Monica Gellar going to London).

I decided to interview them to give people a look into the practical side of what going on a medical mission looks like.  As you read, Bruce is not medical.  However, what he lacks in nurse-ness, he makes up with hard work and height.  (He’s 6’5″.)

Please note, answers given below are from Elizabeth, unless otherwise indicated.

Why did you decide to go on a mission?

I went to Bora, Ethiopia because they don’t have access to health care, and this was something I could not only make a difference doing, but I knew it would grow my knowledge and stretch me professionally. I also went on a mission trip to live out something I was taught and believe in deeply: you should use any talent you are given to bless others.  Nursing is a talent that was given to me and I am passionate about sharing it.  

What was the travel there like? 

This is from the HGH website: The team flies from the US to Addis Ababa, and then drives south through the lower rift valley into the Guge Mountains of southern Ethiopia.  The team will then hike 6 miles, ascending nearly 2,000 feet, from where the road ends in Chencha to the village of Bora.

Travel in Africa is entertaining and challenging. We were on planes, boats, buses, and on foot – our baggage traveled up the mountain by donkeys and our road was often congested with cattle, camels, and people.

Tell me what was going through your mind the first time you saw their set up for medical care?

The clinic set-up is smart, efficient, and well planned – their resources are growing – but the first thing you think is – “WOW – they have access to SO LITTLE compared to what we are used to; how am I going to make it work?”. But then, you make it work, and realize how MUCH we have in the States and how profound your assessment skills are!

What are some of the biggest differences between the care you provided there versus in the USA?

We had no access to running water, internet, or specialty consults. We had no diagnostic testing. I had to be excellent in my history and physical taking, and in my assessments so that I could determine differentials and treat appropriately. The creativity needed to get medications into infants, translate reasons, times, importance and information to patients was profound. The translators were amazing, but I have to hand it to the nurses – they had so many amazing ideas to help make these challenges ones we could overcome.

What were your meals like?

AWESOME and different! It was a mix of American food and authentic Ethiopian foods. The people there are extremely hospitable and loved cooking for us. We got to observe and help them cook in a “cooking hut”, and experienced what is like to cook without any modern conveniences. Some of the meals they made for us I have tried to recreate here, and have been moderately successful in accuracy.

What were the sleeping conditions?

We slept in mud huts, on straw, in our own sleeping bags. At first I struggled with the conditions – it is exactly like you would see it in the National Geographic! But looking back, I wouldn’t have wanted to sleep anywhere else; I lived and experience it in the most authentic way possible.

Tell me the bathroom situation, STAT.

Bathroom? You mean tell you what it was like to squat on a gorgeous mountain side and hope no animals or humans saw my southern regions? Two words: wet. wipes.

Tell me about some practical cultural differences.

One of the things that hit us hardest was the reverence and respect for elders that everyone had.  Here in the states the elderly population is often viewed as a burden, while in Ethiopia they are  cherished and consulted for their wisdom. Another shocking difference was how hard the women worked.  The Ethiopian people often refer to women as “provider”. You will see in our pictures that women do the heavy lifting there.

Elizabeth, walk me through one day as an NP there.

I had two interpreters assigned to me. Each patient would come in my exam room, tell me their complaints/history, and symptoms.  I would do an examination, diagnose their problem, and prescribe medications (pending availability). When I had a patient that “stumped” me, I called upon the other practitioners and nurses for their expertise. Because we had no diagnostic testing available (labs, X-ray machines) collaborating was our lifeline; we all needed each other to make each day in clinic work and it was an incredible experience!

Bruce, walk me through one of your days there.

 Every morning we wake up and walk from our hut down the mountain to a place we called “the cliff”. It was an incredible time to enjoy a beautiful view and reflect on our days there. We then returned to our compound to have breakfast that was made for us by the locals.  It consisted of grains, potatoes, sauces, and amazing Ethiopian coffee (FYI, Ethiopia is the birthplace of coffee). We hiked up the mountain a mile to the clinic every morning, with the village children holding our hands the entire way — this experience melted my heart.

My time in the clinic consisted of building shelves, setting up a privacy tent for the bathroom over a hole dug by a previous team, working in the pharmacy dispensing the medication prescribed by the practitioners, and helping teach patients how and when to use them. I often made lunches for the entire team with another group member and did what was necessary to ensure a good flow at the clinic. I was concerned that because I’m not medical I wouldn’t be very useful, but when I got there I found the opposite to be true. We each had a role and without each other it would’ve been impossible for the clinic to be successful.

How much did it cost?

About $2500 a person, and this included flight, ground transportation, lodgings, food/water, two days of sight-seeing. It was the cheapest 2 weeks abroad!

How do you feel this impacted your marriage?  Do you recommend married couples going together?

YES! GO TOGETHER! My husband isn’t medical, but the need is so great and watching him use his gifts in service by building shelves, working in the pharmacy, making team lunches, setting up privacy tents, and playing with the kids was  – well, SWOON. I can’t exactly bring him to work with me to see patients here in the States; watching each other in our own elements was amazing. It gave us greater respect for one another, and made me want to encourage him more in what he excels in.

I know these experiences are hard to predict how they will affect you.  What did you anticipate versus what did you experience?

I didn’t expect to want to stay there longer – but I was so sad to leave. There are days at work when I find myself in the grind of the day, burnt out and discouraged; to feel so needed and impactful in Bora, Ethiopia was priceless, and it took me off guard. I didn’t know I would fall in love with medicine again – I didn’t know that I needed to be there for my own benefit, just as they needed me there.

What did you learn that has changed your practice as an NP in the US?

Because I had to rely so heavily on my assessment skills and collaboration with the team when I was faced with a questionable diagnosis, I have worked much harder to perfect those areas since I’ve been back.  Those areas include knowledge and differentiation of various heart and lung sounds, alternative treatments, and preventative medicine. My desire to be a better provider has substantially increased since going to Ethiopia.

Would you do it again? 

We would go back tomorrow. Without blinking. It was professionally and personally something that humbled us, empowered us, and revitalized my passion for medicine and nursing.

Health Gives Hope: An Interview with a Nurse Practitioner Who Co-Founded a Medical Mission Organization

Health Gives Hope: An Interview with a Nurse Practitioner Who Co-Founded a Medical Mission Organization

Last month, my nurse practitioner sister in-law went on a medical mission to Ethiopia with her husband.  She had an unbelievable time!  I have been asked about medical missions before so I thought I would do an interview with the founders of the organization and my sister in-law.

An Interview with a Nurse Practitioner Who Co-Founded a Medical Mission Organization

This post is my interview with the founders, Amber and Jerry Kaufman.

All answers below are from Amber, unless otherwise noted.

(Also, please note Jerry’s solid beard.)

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Amber and Jerry!

Amber, I know you are a nurse practitioner.  Where did you get your nursing degree and your NP?  Do you still work in the USA as an NP, if so, where?

I got my nursing degree from Purdue University. I initially became a Pediatric NP from the University of Central Florida. I later got a Post-Master’s Certificate for adult NP from University of Massachusetts – Boston. I currently work as an NP with One Medical Group.

Jerry, what is your professional background?

I am a Ph.D. student at the University of Chicago. My areas of interest are health, globalization, race and ethnicity, and organizations.

Why did you both start going on medical missions?

Amber: When I was in high school I heard a woman speak about doing medical mission work in Papua New Guinea – from then on, I knew that I wanted to do it. As soon as I had my first clinic day in India, my first medical trip, I knew I was hooked. Little did I know that I would be where I am today in 8 years!

Jerry: I’ve been involved with international nonprofits for over a decade, so I’ve been interested in international work for a long time. I got into medical mission because, well, my wife!

Where was both of your first medical missions?

Amber: My first medical mission trip was to India.

Jerry: My first medical trip was to Ethiopia.

Why that particular region of Africa?

Honestly, it just fell into place. We were set to go to another country with a medical team and the trip fell through due to political unrest. The other co-founder, Dan, happen to know someone from college that was teaching in Ethiopia. We asked if we could bring a medical team in 5 weeks to Ethiopia and she said yes. She introduced us to Israel, who is now the Health Gives Hope Program Director in Ethiopia (4 of his siblings also work with us). Israel was our leader for the trip. Amber knew right away that Ethiopia was were we were suppose to work. And here we are 7 years later with a health center and teams going twice a year. Amazing!

What are some practical differences in the way you provide medical care in Ethiopia versus the US?

You have to make due with less. We have solar powered lights but that’s it for modern conveniences. No running water and limited supply of medications. We don’t have access to labs and diagnostic testing. In emergencies or for critically ill patients, we will transport them to the nearest hospital. But for the most part you use the patient history and exam to make your diagnosis and treatment plan. It is a challenge, but rewarding.

What do the villagers do day-to-day for medical cares/concerns when you do not have a group there?

We have a nurse that travels from a nearby town, Chencha, and works at the health center we run in Bora (Hidota Health Center). She works 3 days/week to provide care. If she is not there, the people either have to walk 6 miles to Chencha or they don’t go, which is usually the case.

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Hidota Health Center

 Every nurse also has a patient experience that they can look back upon and say “I am a better nurse because of this person” or “I am a better nurse because of this particular patient experience”.  What specific patient experience from Ethiopia has made you a better nurse?

On the 2nd trip to Ethiopia, we had our clinic set up in a local church and we were seeing patients there (the Hidota Health Center was still a few years away!). A father came frantically to the clinic and asked if I would come see his wife who had just given birth during the night. He just kept saying she was sick. I packed my backpack full of medical supplies – trying to think of every possible scenario I might encounter. We hiked down the mountain about a mile to their hut. A woman was lying there and clearly not doing well. After a quick assessment and history, I determined that she was severely dehydrated (she hadn’t had any water in about 36 hours – and delivered a baby in that time!) and she had a possible early infection. I gave her IV fluids and IV antibiotics. We stayed with her much of the afternoon until she turned the corner and started feeling better. I assessed the baby who was happy and healthy! By the time we left, the mom was able to sit up and drink water on her own. The family then told me that they decided to name their baby “Amber.” It was an incredible moment. I was so thankful we were there – otherwise, I am not sure that mom would have made it.

In nursing, we learn tricks of the trade in our day to day practice.  I have a feeling that tricks of the trade in providing nursing care are a bit different in Ethiopia are different than in the US!  What are some tricks of the trade or pro tips for nurses providing care with HCH in Africa?

Your face and tone says a thousand words! Since you are using 1 or 2 translators (sometimes you need translation from the local dialect to the national language to English), the people are really looking at your expressions. It really does make a huge difference. Also flexibility is a must – in all things, all the time.

Tell me some common rookie mistakes that nurses make during their first medical mission?

Honestly, there aren’t too many. It’s not a mistake but it’s common for nurses to feel bad about the times where we can’t provide the care that is needed (for example, medications or treatments that we don’t have). It can take time to realize that this is just part of working in a rural setting.

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Providing patient care!

Tell me your biggest reality shock as a nurse when you first started serving missions?

I don’t know if I would call it a shock…but maybe an area of growth.. For me, learning to slow down and have patience. Things just don’t happen as quickly as I am used to or that I want them to. I have finally arrived at patience, for the most part.  

Do nurses need to have a certain amount of experience to serve?  

No – new nurses and seasoned nurses are welcome. As long as they are willing to serve, they can join!

My sister in-law (Elizabeth Fields) is second on the left. She's an NP, the other three young ladies are nurses with about 1 year of experience!

My sister in-law (Elizabeth Fields) is second on the left. She’s an NP and the other three are nurses with about 1 year of experience!

Can nursing students serve?

Absolutely. I have also had NP students and I was able to serve as their preceptor for clinical hours. 

What is the average cost?

The cost is $1500 for your land package (everything except souvenirs and vaccines) plus airfare. Airfare tends to run between $1300-1600 depending on your departure city.

When many people hear medical mission, they may connect it with a faith-based organization. Do you need to be of a certain faith to serve with your group? Our organization usually calls our trips “medical service trips.” No, you don’t need to be a certain faith.

I noted that you are based out of Chicago.  Do people interested in serving need to be from that area? No – we have travelers from all over the country join us!

If I decide I want to serve or learn more, what are my next steps?

Email Amber at amber@healthgiveshope.org The next trip is November 9-20, 2016 (then in April, 2017).

Next week, I’ll post an interview with my sister in-law (Elizabeth Kleber, MSN NP about her trip!

For those of you that may be interested in learning more, check out their website!  Please note that while these trips are extremely rewarding, the travel can be very challenging physically.  Upon arrival to Addis Abada, Ethiopia, you take a 10-12 hour bus ride, followed by another half day drive, then hike for half a day at an altitude of 10,000 feet above sea level up mountains.  If you have specific questions/concerns about the travel and if it would be a good fit for you, shoot Amber an email!  You’ll hear more about my sister in-law’s experience, both with the travel and her entire time, next week!

Have you ever been on a medical mission?  If so, please comment below with where you went and which organization you worked with!

When Your Patient Starts Crying

When Your Patient Starts Crying

YOU ARE SIMPLY THE

Everyone has their own forte’, and for some, providing emotional support to people in crisis can be an OMG WHAT DO I DO moment. It can be uncomfortable. It can be weird. It can be scary. It can be one of those situations you avoid at all costs.

But it doesn’t have to be! Some of the best nursing care you can provide can be in these moments. I learned some things that are very valuable when I started to find myself in this typical situation more frequently that I want to share with you.

Whenever people used to get emotional in front of me, my natural response was to try to make it better. I wanted them to stop being upset. I wanted to fix it, STAT. I felt inadequate if I could not say the perfect thing to them to remedy the situation. This left me feeling like a bad nurse and desperately avoiding emotional patients and family members. However, after I learned some things I realized how wrong that thought process was.

It is really important for you to know this: even if you have the most perfect response to them, you’re not going fix it. You’re not going to make it go away. You’re not going to take the pain away from their terminal cancer diagnosis. You’re not going to heal the anger in a family’s heart for their father not taking care of his blood pressure and ending up with a massive stroke and who is now dying.  You can’t fix that with words. That pain is there and you cannot remove it. But you can comfort it.

It’s also important to know that they don’t expect you to fix this massive tragedy with words. They’re not sitting there, crying and waiting for their nurse to have the perfect verbal response to put them at ease. What they are yearning for is support. They are in desperate need of someone to just feel with them.

So, how does this look practically?

The first step is to let go of that natural urge to fix the situation. Take a deep breath and let that go – you cannot fix this.

Allow silence.

I know it can be awkward, but being okay with silence and just being with someone who is hurting and not rushing them or yourself means a lot to someone. Many times, these patients or family members don’t want to burden others with their emotions. But they need to experience them. They need to feel them. You just being there, allowing silence and providing support that’s not rushing out of the room lets them know that their emotions are valid. They are important. They deserve time. And you are an awesome and supporting nurse, so you will provide that.

Acknowledge the situation.

Sometimes, people just need to hear that what they’re going through is tough. Hearing a nurse acknowledge how tough a situation is, that they’re going through a lot, can really validate someone. It can let them know that it is okay to be upset, sad, angry, or whatever emotions they’re going through because this is a hard situation. And we see and recognize it.

“I’m really sorry this happened,” with a hug or hand on the shoulder is much more supportive and powerful than people realize.

“I’m so sorry this is happening but I’m really glad you told me. I’m here to support you and your family. I’m here for you.”

Or even just grabbing a box of tissues, patting them on the back, and saying you’re sorry and allowing silence and support can be enough.

 Take really good care of them or their loved one.

If they really trust you to do a good job with their loved one, that will put them at ease and support them by taking one big stressor off their plate. I don’t mean all of the technical stuff like getting all of your charting perfect, interpreting lab values, giving all of your meds precisely on time, or consulting with the interdisciplinary team. I mean the more basic stuff. Things like taking extra time to comb their hair, getting their favorite flavor of Jello, or trying to connect with them and make a joke to get them to laugh…that can really mean the world to someone. If they trust that they or their loved ones are safe and cared for in your hands, that itself provides emotional support.

I have taken care of patients where I did the above things. It didn’t feel like much to me because I wasn’t fixing anything, I wasn’t physically making anything better. I couldn’t actually see the impact I was having. However, when I did these things, I received the most emotional responses later in the shift or the next day. Tearfully, patients and family members have told me thank you for my love and care. Once I let go of fixing and started supporting, somehow my patients and their loved ones felt even more cared for.

My next post will be an example of how I went through these steps. Stay tuned!

What kind of small, seemingly insignificant things have you done for a patient or their loved ones that you later found out meant the world to them?

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Nurses:  Thankful Every Shift

Nurses: Thankful Every Shift

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It’s that time of year where everyone starts to think of things they’re thankful for and talks about them on social media. Nurses however… we are a different bunch. Every time we go into work, we are thankful. It doesn’t take the month of November to inspire this.

We are not thankful for our massive salaries or bonuses. We are not thankful for predictable jobs where we are guaranteed to finish an entire cup of coffee or get at least two bathroom breaks. We are not thankful for having every holiday off with our families. When nurses think about what they are thankful for, our list looks very different than most peoples’…

We are thankful that we are able to walk, talk, and breathe on our own

We have seen exactly what it looks like when someone suddenly loses those abilities. We have seen the tears stream down patient’s faces, as they are unable to verbalize their feelings. They let their tears fall for their nurses because they don’t want their families to see them struggling.

We are thankful we have jobs with sick time

We see patient after patient come in jobless that has waited until the very last second to come in to have their ailment treated because they cannot afford to pay anything or take time away from work. They wait and pray at home for things to just go away as they become exponentially worse. The man with the pain in his foot three months ago is now having it amputated. The woman with untreated diabetes whose vision was getting blurry earlier this year is now blind. The young mother of four with a respiratory infection that she hoped would go away on its own because she couldn’t take any time off… who is now intubated and sedated in the ICU, in acute respiratory distress syndrome… whose fingers and toes are starting to turn blue and purple from all of the medications she’s getting just to keep her blood pressure up… who is now a DNR.

We are thankful for and constantly in awe of medical advancements

The concert pianist who came in with a stroke and was unable to speak at all – received tPA; and after a few hours of being distraught and unable to communicate all of a sudden can speak as clear as a bell and cannot stop crying out of joy. The 55-year old dad and construction worker who went down at work, but because of his coworkers immediately starting CPR, a hypothermia protocol, and a quick acting medical team and nursing staff in the emergency department/cardiac intensive care unit, he will be able to see his daughter graduate from college. The man who is severely depressed because he has been unable to stop hiccupping for seven years has an operation and sleeps through the night for the first time because they’re finally gone. A few nurses have walked in on him crying with a smile on his face.

We are thankful for our friends, families, and support systems

We see patients come in with no loved ones, no friends, or wards of the state. Shift after shift goes by and no one comes to see them. It breaks our hearts. We spend extra time in their rooms. Give them extra care. We try not to think about their loneliness at home because it hurts too much.

We are thankful for justice and righteousness

We are thankful when we see a physician have a tough but necessary conversation with a family who never sees their loved one and insists on keeping them alive and putting them through painful procedure after painful procedure, even though the medical team has extensively explained that they will not survive or have a meaningful life; or the doctor who stands up to the patient who has been belittling the nurse for the last nine hours; or when abuse is identified and the patient is finally removed from the environment and feels safe at last; or when the nurse practitioner explains to the emotionally absent family of the patient with mental illness exactly what is going on in their loved one’s brain and it finally makes sense to them – and they stop treating them like they need to “just get over it”.

We are thankful for silence

With phones constantly ringing, patients calling out with needs, doctors rounding, pumps beeping, and alarms going off, we are filled with joy when that car door closes and we hear absolutely nothing. It is the sweetest sound.

We are thankful for life

When a normal day at work consists of walking through someone’s worst nightmare, you hug your loved ones a little tighter that night. You cuddle your pets a little longer. You aren’t as quick to be angry. You are keenly aware that it was not your life that just permanently and radically changed – it was the people that you just spent the last 12 hours with, trying to emotionally support them through.

A day in the life of a nurse is a constant and humbling reality check. Sometimes you have to try really hard not to think about how thankful you are in that moment because the sheer emotion from it can take over and you are unable to function. But that is the life we chose, and I wouldn’t change it for anything.

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Nursing Time Management for When You’re Totally Overwhelmed

Nursing Time Management for When You’re Totally Overwhelmed

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It never fails. You start your day with the best nursing time management intentions.  You started your assessments and meds on time (woo hoo!), and then all of a sudden three doctors round at once and expect you to implement their orders immediately. One patient needs to pee, one needs pain meds, lab is on the phone with an alert lab value, a family member is on the phone waiting for an update, and the STAT med you called for an hour ago hasn’t shown up yet.

Good. Lord. What do you do now?

While this may seem extreme, it’s kind of not because all day you will be prioritizing and re-prioritizing. When you think you have your next two hours figured out, something inevitably comes up. The key is being able to re-prioritize in an instant.  Learning nursing time management is essential to being a successful nurse.

I will tell you what I do when I find myself suddenly so overwhelmed that I don’t even know what to do next…

Learning nursing time management is a process

You may want to be perfect right away, but that is an unrealistic expectation.  Stephan Curray didn’t become a lights-out point guard overnight, Harry Potter didn’t learn a Patronous charm in one session with Lupin, and Adele didn’t learn how to sing like an friggin angel with her first note.  You will do things inefficiently.  You will learn some things quickly, and some will require multiple explanations and attempts to sink in. You’ll think you have something figured out, then a new doctor comes on the scene and changes things up… please, have patience with yourself and don’t beat yourself up when it takes time to become efficient. Remember, you’re not only learning what to do, you’re also learning how, where, and when.

Stop and take a deep breath

Calm yourself down first and get in control. Don’t just go run and complete whatever task is fastest first… you need a plan to maximize your time.

The first pulse you take is your own.

Think about which patient is the LEAST stable and address them first

Please keep in mind; this is not always the one complaining the loudest. While one patient may be extremely upset that it’s taken 45 minutes to get them their 4 mg IV morphine, your other patient who just had a graft placed with a blood pressure of 192/91 is your priority.

What can you delegate?

If a patient needs to pee and a CNA is available – delegate. If a patient needs pain medication and you know another nurse is caught up, ask if they can give the med for you. Nursing is a TEAM sport. We all are taking care of the entire unit together. That means when you’re caught up, you’re helping others who are behind. Trying to do everything on your own when others are caught up is a disservice to yourself and your patients. You will be running ragged and your patients’ needs will take forever to get addressed. Working together as a team is an essential part of a well-functioning and safe nursing unit.  I know it can be hard to ask others to help you, but please do.  Most are more than willing to help.

What can you do simultaneously?

If a family member is on the phone wanting an update but you also need to see what meds you can give another patient, look that up while you’re on the phone.   Whenever I’m on the phone and anticipating being on hold, I always get by a computer and chart or look things up simultaneously. Consolidating tasks, trips, phone calls, etc. is essential. When you see a patient, always ask if there’s anything else they need before you leave. It’s incredibility inefficient to be with a patient and try to leave immediately without asking if they need anything first, because they will inevitably put on their call light 7 minutes later for something you could have addressed while you were in the room.

Remember that charting is now the last priority

If you do have a second, chart the random/difficult to remember thing, but this matters the least right now. Always chart your medications in real-time, but charting assessments can wait when you’re that far behind. Make notes if you need to, but if you’re running from an unstable patient to a new admit to a screaming discharge, charting is going to wait.

Apologize for being late with things to patients and families

Never respond with excuses – they don’t help the situation (and honestly they can make it worse). Sincerely provide a heart-felt apology even if it was not your fault. Knowing that you are truly sorry for taking so long to get their pain medication (even though you were hanging blood, rounding with an upset physician, and giving an antihypertensive med for a patient with an BP of 238/104) really means a lot to people. Additionally, apologizing immediately can smooth things over before they get rough. Having a grumpy patient or family can make the shift pretty tough.

  • Example of what not to say: “Sorry it’s taken so long for me to get here. We’re so short staffed today it’s not even funny!”
    • Why this is no bueno: Techincally you’re apologizing, but you’re also telling them there’s not enough staff there to quickly address call lights. While that may be true, it will make your patient and their family uneasy and nervous, which won’t help your situation…it will only make it worse.
  • Example of what to say: “I’m really sorry it took a while for me to get your medication. How have you been feeling? Is there anything I can get for you while I’m here?”
    • Why this is better: You apologize and acknowledge their concern/frustration immediately and quickly center everything on how they are feeling and their needs.

I know it’s really frustrating to be short-staffed and drowning all day. I’ve definitely been there and it’s pretty overwhelming, even for experienced nurses. However, it’s not the patient’s fault that 3 nurses called out and we couldn’t get the CNA’s we need, so just apologizing to them is the best approach. That frustration and need should be directed towards management, staffing, or whoever would be appropriate in your facility – not the patient, even if they’re really upset.

Remember: it’s a process

Even though I’ve been a nurse for seven years, I still have to remind myself of the above things. Sometimes I get overwhelmed and can’t figure out what to do next and have to remind myself to stop and go through the steps. Occasionally, I have to talk to a coworker… “Ok, I’m really overwhelmed and I’m not sure what to do next right now?” …just talking through it out loud to someone else helps me focus and figure out my priorities.

Looking for more nursing time management help written by nurses?

Check out:

 

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I’ll Never Forget Your Room Number or Your Pain

I’ll Never Forget Your Room Number or Your Pain

I don’t know what else to do.

Here you are, lying in that hospital bed that you’ve been sitting in for five days now, totally aware of what is going on but unable to tell anyone what you’re thinking.

You can’t move your right arm or leg. You can’t swallow so you cough on your spit all the time.

You’re only 69.

Your brother and sister-in-law died within the last 8 months.  They were your best friends.

Your wife of the last 35 years recently left you.

You were sinking deeper and deeper into a dark pit of depression, but put on a happy face for your few friends and what family you have left so they wouldn’t ask you questions. You just didn’t want to talk about it, because talking about it made it hurt. It hurt so, so bad. So you just pretended you were fine, but you really weren’t. It was like you were in a cold, dark room with no door, no window, no bed, no comfort, no escape. No one was there to pull you out because no one knew you were even there.

Even your dreams were drenched in sadness and somehow you were in an even deeper and darker room. There was no refuge.

And then you had a stroke that would change your life forever.

Not only can you not move the right side of your body; you can barely speak. You can only say 2-5 sentences at a time before you get tired and your speech becomes unintelligible.

You were once a proud, private man. Now you are completely dependent on this staff of 20 and 30 year-olds to clean up after you and turn you every two hours. You get frustrated because people can’t understand what you’re saying so you just don’t talk much. This was too much before it started.

The doctors breeze in and out, saying you’re doing well. What does “well” even mean at this point? Yes, your vital signs and labs are stable, you’re getting adequate nutrition and don’t have an infection. But they don’t stop to ask you how you’re doing. You couldn’t really tell them anyway even if they did…

You already told a nurse you wanted to die. You just want to give up.

You break my heart. I don’t know what to do to cheer you up, to ease the pain.   I know I can’t take it away, but I want to make it easier.

So I linger. I stay in your room as much as possible. I joke with you. I put the pictures of your family on the left side of your bed because you can no longer look right.

I ask you how you’re doing, and I wait for the answer.

I hold your hand when you reach for mine.

I wipe the tears away because you can’t reach your own face. I shed a few of my own because now I see a little glimpse of this terrible pain you’ve been walking through. And it hurts.

I tell you I’m sorry that you lost your family. I acknowledge how hard that must have been and continues to be. You mumble “thank you” through your slurred speech and quivering lip.   I have a feeling you’re one of those “never cry” guys and you hate that this 20-something nurse is going there. But secretly you appreciate it.

I try to encourage you. I try to tell you that I’m proud of your progress and that it’ll get easier. You squeeze my hand a little tighter.

You start to speak more, but it’s getting harder to understand because you’re getting tired. You get upset that I can’t understand you. Now you’re getting angry. You throw my hand away from you. You roll your eyes. You grit your teeth. You close your eyes to end the interaction.

I step away from you and walk out of the room. I try to curb my feelings of frustration and personal insult, after trying to connect with you and getting behind on the 900 other things I had to do, just for you to get mad at me. But I immediately swallow my pride and frustration, because I can’t even imagine going through what you’re experiencing.  I try to remind myself he’s not mad at me, he’s mad because he can’t talk.. he’s mad at the situation.  I hope.

I go to check your chart to make sure they restarted your antidepressant. I put in a consult for our chaplain to see you daily to offer support. I call your son to touch base and let him know that while you’re doing well physically, you could really use some face time with loved ones.

I’ve done all I can think to do. I don’t know what else to do.

I hope it’s enough. I hope I didn’t make it worse.  Although, I’ll probably never know because by the next time I work you’ll have transferred off of our unit.   It’ll take a few weeks for you to blend into the abyss of former patients in my mind. For me to forget your name, but remember your room number and your pain.

Another Open Letter to Nurse Nina

Another Open Letter to Nurse Nina

Today I read this article in the Dallas Morning News entitled Free of Ebola but not fear, Nurse Nina Pham to file lawsuit agains Presby paren, worries about continued health woes by Jennifer Emily (thank you Katie Duke, for sharing).  Nurses and nursing students, please read it.  

Hey Nurse Nina,

My name is Kati and I’m a fellow critical care nurse. I wrote a letter to you on my nursing blog back when all of the Ebola stuff was happening in the news. Today I’m reminded that when someone goes through something traumatic and painful, not only do they need support and encouragement in the midst of it, but also after the dust settles.

I read the interview you did with the Dallas Morning News. I read and reflected. I put myself in your nursing shoes (Danskos, right?) and tried to think about how I would feel. I, too, have cared for someone shift after shift, only to watch them die before my eyes. The images of patients in their final moments struggling to breathe, their hearts stopping, and their skin turning ghostly pale, will be burned in my mind for the rest of my life. Being a nurse comes with a heavy, heavy burden.

I can only imagine how difficult it was to watch Mr. Duncan die.   I know you formed a bond with him, cared for him, and were there for his most intimate and vulnerable moments. I’m sure he talked to you about death. I’m sure he cried. I’m sure you held his and hand reassured him. I’m sure your heart was ripped in half, left to lie on that dirty isolation room hospital floor.

Every day as a nurse, I try to disconnect the dots so I can be more emotionally available for my patients. I pretend that it’s not a possibility for me to contract or experience whatever it was that got my patient into intensive care. Being slightly detached from reality while I’m trying to critically think about all the things I need to do during a shift…making sure my medications are all appropriate, vital signs are stable and treating them appropriately as they become unstable, calling the physician when something is wrong, emotionally supporting the patient, coordinating care with an entire health care team, and basically making sure every single need of that patient is met…is a survival tactic used by many nurses. Doing so with Mr. Duncan was probably a challenge, however I cannot imagine how difficult it was to watch the patient you bonded with die before your eyes, only to find out that you were infected with the disease that killed him.

That’s absolutely terrifying. I watched the situation unfold like the rest of the world did; through the eyes of the news. From my perspective, you handled the entire situation with bravery and grace. I was, and still am, proud to share your profession.

I’m upset for you

However, when I read in your article that you specifically requested multiple times to remain anonymous, yet Gary Weinstein MD, your treating physician, filmed you without your consent and the hospital published the video, I got hypertensive. The second you went from nurse to patient – things should have changed completely. If your name was to be private, that should have been respected. Your role as employee and nurse ended, and at that moment you had become a patient of that hospital.

Sadly, at that point you were not a patient to them. You were an opportunity to make them just not look so bad. I wish they had used that opportunity to support and protect you, not exploit you, after you risked your life to care for Mr. Duncan.

I cringe – in anger and frustration. I am furious that this organization, together with your physician, created an instance to obtain a video of you despite your repeatedly expressed desire to remain private, as well as lied to you and used it to make themselves look better.

That seemingly private moment of you in your hospital gown in tears was obtained and mass distributed illegally. Every nurse and nursing student in this world understands how unethical and illegal that is.

You trusted that physician with your life and he exploited you to make the hospital look better. He should be fired. The group of hospital employees that facilitated the making and distribution of that video should face an investigation and they should all lose their jobs.

They kept identifying you as a nurse, but at that point, you were a patient. With a right to privacy. And that was horribly violated.

We live in a society in which a nurse can get fired in the middle of a shift for re-posting a picture that a physician posted online, but a physician can lie to a patient and film them without their consent, and mass distribute it to all major news networks, and still have a job.

I am appalled at Gary Weinstein’s lack of professional judgment and violation of the Hippocratic oath.

I am horrified at the complete disrespect of you and the violation of your privacy.

I am also upset that you were put in that situation – not being adequately prepared to safely care for Mr. Duncan. I respect and understand the duty you felt to do your job as a nurse and continue to care for him.  I would have done the same thing.

I want to publically say thank you for caring for Mr. Duncan. Reading that article about how emotionally difficult it was to care for him, how physically and mentally exhausting it was dealing with the isolation process and waste…I could see and understand it in a way that probably all of the nurses in the country could. We understand what all that entails and how difficult it must have been.

I want to encourage you

I also want to encourage you. There is a nation of nurses out here, standing with you. We support you. We are thankful for you. We are happy that you have physically recovered, and are praying for mental and emotional healing. I know court proceedings are a tough process, and I pray that it will go as smoothly and as quickly as possible.

I know your life may not feel like your own at this point. You worked your butt off in nursing school, became a nurse, and suddenly you have this traumatic experience and you’re left to figure out what’s next.

There is an amazing and supportive community of nurses on social media. Twitter, Facebook, Tumblr, and blogs all contain so many amazing nurses that understand what you went through. I want to encourage you to get involved and see this world of supportive nurses online. We want to stand with you against this injustice because you are one of our own. And you did not deserve to be exploited so a hospital could attempt to save face.

You will overcome this. You will do, and have done, great things. “He who is faithful with little will be faithful with much,” and you were faithful and diligent with Mr. Duncan and his care.

Do not despise the day of small beginnings, because through this you will rebuild and do even greater things. Rejoice in life, health, and Bentley.   You are so awesome and brave to me.   I don’t know you personally, but I am proud of you. Proud of the example you have provided as a nurse. You’ve handled everything with dignity and grace.

I know you publically mentioned relying on God to get you through this. I read a verse today that I thought might encourage you.

“.. we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not disappoint us, because God has poured out his love into our hearts by the Holy Spirit, whom he has given us.” Romans 5:3-5

If you’re ever in Charlotte, come hang out with me! I’ll take you to get some delicious Charlotte food and my dogs would love to snuggle you.

We support you

And now I want to address the rest of the nurses in the nation. I want us all to stand with Nina…throughout the trial she will face, as she recovers from this trauma, and as she fights this horrible injustice. We are constantly told how essential HIPAA is, that our patient’s privacy is of the utmost priority, that we will lose our jobs for exposing our patient’s private information – and this hospital and her physician, leaders of the institution, severely violated her basic right. I know you are as disgusted as I am. I want nurses all over the country, and world, to write notes of encouragement to Nina. I want our voice heard as a nation and world of nurses both in support of her hard work as a nurse, and as a patient who deserved her right to privacy. Just because she was a nurse employed at that facility didn’t make her any less of a patient. I want us to fight for her like she is our coworker and our patient.

I also want to acknowledge and support Amber, who also contracted Ebola. I can only imagine she is having a similar experience since the Ebola dust has settled in the United States. Know that we uplift and support you as well.

All the best,

Nurse Kati

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An Ode to My Steering Wheel

An Ode to My Steering Wheel

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Many things are synonymous with nursing… stethoscopes, nursing caps and pins, a solid pair of Danskos…but one of nursing’s unsung hero’s is our steering wheel.

A day at work that has me on the verge of tears all day has me yearning for that moment when I can stumble to my car, close the door, and sob all over my steering wheel. I cry out all of those tears that have been held at bay for the last 12 hours.

Those tears I couldn’t let fall on my face when we were coding that young woman and I couldn’t stop staring at her lifeless hand bouncing on the bed with each chest compression; or the tears I held back when the woman filled with cancer suddenly stopped breathing and her husband became belligerent with grief – so much so that any peace he could have with her death dissipated into that sterile hospital air; or the physical pain I felt when I was turning an emaciated man who was covered in painful weeping skin that was breaking down with every touch and turn; and when I just couldn’t win all day.. from chasing a high blood pressure, to patients in pain, to admission after admission, unstable patient to unstable patient, and frustrated physician to angry family member. No second could be spared for 12 hours, no moment could be wasted – every single thing I did for the entire shift was for everyone else to get what they needed… and I didn’t pee or eat the entire time. Even then I felt bad, because with each bite I was getting farther and farther behind. And somehow – somehow – it still wasn’t good enough. Something still wasn’t done, or done the right way. I throw up my hands and step away, just to hold it together; just to hang on a little bit longer until I see that steering wheel.

It’s always there. Always ready and waiting for me to decompress; to mourn; to reflect; to ugly cry; to let go.

Ask any nurse where they tend to let themselves break down. It is always at the wheel.

So, from nurses all over the world…thanks Mr. Steering Wheel. Thanks for letting us get that initial cry out of the way so that when we call our spouse, BFF, or mom on the way home and start to cry all over again, we’re already halfway cried out.

I Wish I Could Cry With You, But I Can’t

I Wish I Could Cry With You, But I Can’t

This post contains affiliate links

Author’s note: I believe many people misunderstood what I meant by I can’t cry with you. I think many assumed that I was trying to communicate that I am not allowed to cry, rather than I emotionally cannot handle your pain right now and therefore must distance myself.  Please check out my follow-up post, Why I Can’t Cry With You if you have a knee-jerk “did she just say she can’t cry with her patients!?” reaction. I have cried with many patients. This post discusses the emotional challenges of working with people in the midst of death and dying.

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I just saw the doctor walk out of the room…the room of your husband on a ventilator, who after 12 days of no improvements, has had set back after set back. I talked to the doctor before he walked into the room. I know what he told you.

Forgive me. I have to avoid you for a short time. I’m going to go do something else for a little while.

You see, I’ve seen that look before, that look on someone’s face where they are about to sob uncontrollably and throw up from the sheer emotional pain. People usually put on a strong face when the doctor delivers the news. And as soon as the physician has vacated the area, they allow themselves to break down.

But guess who is still in the room?

The nurse.

Through their tears, they ask us the questions they were either too shocked or too scared to ask the doctor. Somehow, what we say stings even more.

Shift after shift, we see lives permanently altered. We see people walk into the hospital with hope and we see them walk out with despair.

It never gets easier to do this. You just get used to it. You figure out how to do it.

So, I’m sorry. I’m sorry to the wife who needs me right now. I know you have questions you want to ask me. Questions you didn’t think to ask the doctor. Questions you didn’t want to ask him because you didn’t want him to think you were stupid. Things you want me to explain. I know you want my honest opinion.

I need to collect myself first before I walk into your husband’s hospital room. I need to put up my wall. I need to mentally prepare myself to not compare you and your husband to my mother and father. I need to disconnect the dots.

I have to do that because as soon as I’m done being there for you, I have to go see my other patient. My patient that will probably recover from the massive stroke he suffered, but is a little down today. I have to go in with a smile on my face and tell him that he’s doing great. I have to be happy for him. I have to motivate him. I have to inspire him.

So, please forgive me. I know that because I’m not emotionally upset with you right now, I may look cold and heartless. I promise I’m not. It is out of self-preservation that I am not going into that deep, dark pit of despair with you right now. I’m going to get as close as I can without losing it. I’m going to take a ladder down into that pit with you, but I’m going to stay on that last step. I’m going to stay on that step because I have to be able to quickly climb out on a moment’s notice for the man in the room next door.

You see, I’ve gotten pretty good at that. I’ve gotten really good at lowering myself into that pit and getting as close as I can to your pain, but not quite there. And I’ve got even better at running up that ladder and out as fast as I can.

I’ve gotten good at that because I’ve had to. If I take that last step, I cannot continue on. I cannot do my job. I cannot be there for any other patients. I cannot talk to physicians and coordinate your husband’s care or the care of any others. I cannot hold myself up. All I will think about is my husband dying. Or my father.  Or my mother.

So, I put up my wall. My boundary of empathy. I will get as close as I possibly can for you. I want to support you. I want to be there for you. I want you to feel cared for. So I will give you as much as I can bear. I pray that will do, for I have no more left.

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I am hosting a free 1-hr webinar with Nurse.com entitled Empathy 101 for Nurses: How to Care for Yourself While Emotionally Supporting Others. You can get a free CE for the 60 minute course. Sign up here. 

Here are a few great books that discuss empathy, compassion, death, and the human experience:

   

   

More posts on FreshRN about death and dying:

 

 

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From One Nurse to Another: An Open Letter to Nurse Nina

From One Nurse to Another: An Open Letter to Nurse Nina

Hey Nurse Nina,

My name is Kati and I’m a critical care nurse in Charlotte, NC. I hope you’re able to read this in your isolation room. I hope some thoughtful soul gave you a computer so that you can do something to pass the time. Let me know if you need some Netflix recommendations, as I am well versed.

My city is preparing like many others, getting isolation units ready and training staff. I can’t help but have your nursey heart on the forefront of my mind as we prepare.

I wanted to let you know that this nation of nurses stands behind you. We commend you for going to work, putting on your protective equipment, and putting your life at risk to stand at the bedside of a deathly ill and contagious patient for twelve hours at a time.

Thank you.

We know how tedious and difficult it is to put and take off on full protective gear over and over again. We know how hot, sweaty and unbearable it gets. We know what it’s like taking care of critically ill patients with constantly changing needs. We know what it’s like standing beside someone for hours at a time, knowing that life is slowly leaving his or her body. We know how much that hurts mentally, physically, and emotionally. We know all of the painful little details of what it’s like to be a critical care nurse. But, because we are nurses we are expected to deal with it with a smile on our face and carry on.

I hope you’re doing the best you possibly can be, kicking Ebola’s butt. I hope your nursey vitals are stable, your labs are improving, and that you’re playing pranks on all of the nurses caring for you. Try to resist the urge to interpret your own telemetry strip.

I’m sure those sequential compression devices are getting annoying and you’re super tired of that hospital bed. We are all praying for a quick and complete recovery.

Also, how awesome is that doctor that donated plasma to you? Major nursey respect, doc. Nurses everywhere love you.

I know that having one of our own nurses fighting this battle hits us all close to home. We all know and accept the risk of caring for people when they are ill. It saddens us when one of our own has been afflicted.

Thank you for caring Mr. Duncan. Thank you for putting your life on the line to provide care for another. I know it’s just part of our job, but it’s a job not everyone is willing to fill.

I also want to thank the nurses caring for you right now as well. You’re all on the same team, #TeamNina – and we’re all praying for the safety and health of the nurses at your bedside and as well as your complete and nursey recovery.

We salute you. We stand with you. We are praying for you all. And we are rallying behind you all.

And hey, #TeamNina – you’re so awesome to us.

From a nurse and her pup to another nurse and her pup, hang in there!  (I promise he’s enthusiastic – he’s just being a grump right now)

Stay nursey. Stay strong.

Signed,

a nation of nurses and their pups

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Becoming An Awesome Nursing Preceptor:  Phase Two

Becoming An Awesome Nursing Preceptor: Phase Two

Hello good friend!  Welcome to my second post in a series of three about how to become an awesome nursing preceptor.

Please keep in mind that this is aimed towards the orientation of a new graduate nurse on a general medical-surgical floor.  However, it’s pretty general so it can be adapted to fit the needs of speciality units.

In my last post, we discussed the first phase of orientation. Here is the link:  Becoming An Awesome Nursing Preceptor:  Phase One

I’m now going to discuss the ever-important second phase of the orientation process.

Phase Two:

During this phase, they’ll take a patient on their own. After seeing how you take care of a patient, they should be able to adequately care for one person while you’re nearby for questions.

They will take and give report on their patient. They will do everything for them, even call physicians and support staff, as needed. They will complete all of the documentation. They will talk to their loved ones. They will educate the them.

Again, if they don’t know how to do something, always direct them to the policy first. With one patient, they should have time to go look up the policies for everything.

Continue to give them homework. Print off information about your patient population and quiz them the next day.

During this time, I start to ask all of my why questions.  Depending on their progression and knowledge base, I try to challenge them with the questions.  I also try to think of questions that patients may ask about their care plan.

  • Why do you think they’re on subcutaneous heparin?
  • Why are they on Colace and Pepcid?
  • Why do we need to do a bladder scan if they didn’t void 6 hours after you removed the foley?
  • Why do you think you needed to put your patient with CHF on oxygen after he got two units of blood?
  • Why do you think we need a central line when initiating vasoactive medications?
  • Why is it imperative that you lay them completely flat when removing their PICC line?
  • Why are we still giving them IV pain medication when we have oral pain medication ordered?

Whenever they ask me a question, I just ask it back to them to see what they think. I want them to develop their critical thinking skills. We need to go from being task-oriented to being big-picture oriented. While developing these skills, it’s important to not give away the answers quickly.  Let them think.  Furthermore, if other members of the health care team (docs, MD’s/PA’s, CNA’s, etc.) ask them questions about the patient, don’t answer for them.  I’m terrible at this.  I have to try really, really hard not to answer for them.

You want to encourage them to ask questions, so don’t act like they’re stupid if they get one wrong or do something incorrectly. Handle those situations with grace. Please don’t use that opportunity to make someone feel bad about themselves.   That’s that terrible nurses eating their young thing.

It is really important that during all phases of orientation that you are treating everyone around you with the utmost respect.  If you are talking badly about other people in front of your orientee, they see and hear that. If you’re not being respectful of the CNA’s, you’re telling them it’s okay to do that. If you are nice to someone’s face and once they leave you talk about them, you’re not being a good role model to your orientee.  They are watching how you do everything, including how you interact with others.  If you want them to be a good nurse and supportive coworker, it is imperative that you model that yourself.

Amazing nursing preceptors out there – what is your routine with your newbies once they get their nursey feet under them?  What tips/tricks/advice do you have to share?  Please comment below!

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