October, 2005 Archive

October 10, 2005, 6:49 am

It All Comes Out in the End

That’s funny. I learned the importance of toilet tissue when I was about 2 years old. I don’t remember any toilet tissue unit in Maternal/Child Health class, nor do I remember doing a visual inspection of the roll prior to my patient’s use. What is she looking for?

Maybe she is counting the squares. That’s what my great-grandmother would do. She said you should never use more than three squares. Yeah, right….never mind that my sisters and I are personally responsible for a good portion of the planet’s deforestation. I just figured”Three-squares-per-wipe” must have been a Depression-era slogan. Did they ration toilet-paper in the Depression?

It has been my deepest belief from the time I entered the hallowed world of emergency nursing that assistance with elimination of solid waste from the body did not fall into the realm of the emergent assignation. In other words:

ENEMAS ARE NOT A FUNCTION OF THE EMERGENCY DEPARTMENT.

Ever. Period. End of discussion.

Say a patient comes in with abdominal pain. There is no obstruction; no appendicitis. The patient is acutely “FOS” or “full of stool” (feel free to vernacularize). There is no reason the patient cannot be given an oral preparation to initiate the free flow of flatulance. Or given a suppository to use at home. Or an enema preparation to use at home. And don’t get me started on soapsuds/tap water enemas. Water in, water out. They aren’t worth the H2O they are printed on and are a waste of emergency department time and resources.

Yes, I am passionate about this.

Now, what about the patient who presents with the chief complaint of “Constipation” ? They are literally sitting in triage because their regularity has been disrupted for, oh, what…TWO DAYS? Maybe three? Did they call their doctor. No. Did they try anything at home first? No.
And the ultimate response: I called my doctor and he/she said to come to the emergency room. (!!!!)

A pox upon that doctor’s house.

Emergency room doctors feel they must do something so they order enemas. Do they understand that anything other than a Fleets takes up valuable ER nursing time? The patients can do it themselves at home. It can be done at a nursing home. It can be done as an inpatient if that is where they are headed. While the nurse is working in the land where-the-sun-don’t-shine, their other patients are not getting EKGs, labs, meds or anything else. Or worse, because enemas are not a priority, the constipated patient waits and waits until all urgent/STAT/god knows what else is taken care of. And then they are miffed and beg to go home and then write to the head of the ER about how long they had to wait with their non-urgent problem. There goes the Patient Satisfaction rating….

I wonder how many enemas would be ordered if they had to be done by the ER doctors?

Of course, the patients never know this. They are “enema-ized” as ordered. I always tell them that I understand it is uncomfortable and not to be embarrassed, we deal with it all the time and they will feel better soon. Then at discharge we discuss how they can keep it from happening again.

But everything I do for them could have been done at home. For a lot less than $1000 plus dollars. For about the price of a Fleets, actually.

Give me a freakin’ break.

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October 7, 2005, 4:17 pm

Burning Down the House

What did YOU accomplish this morning? I managed a cup of coffee, my email and some blog reading, as a matter of fact! I don’t even read newspapers anymore. I sit with my cup of coffee, curled up on the couch with 2-3 cats and my laptop. When you write your blog, remember that someone may be reading it with their mouth full and don’t write anything that makes them spray it all over the monitor! Nothing like a “spit-take” to start your day….

I was thrilled to find a copy of this ad. If I could, I’d get a paper copy and have it matted and framed. I first saw it while suffering from an overpowering case of burnout many years ago. It helped me refocus on why I was a nurse; it gave me a sense that what I did with my life was important.

I knew I had crossed the line into severe, pathological burnout when I was standing at my kitchen sink and heard an ambulance in the distance. I put down the dish towel, turned around with my hands on my hips, surveyed my house and thought, “…now where am I going to put them?” It sounds comical to me now, but at the time it was the final straw in a deep downslide into the world of the burnt-out nurse…….

The term “burnout” gets tossed around very lightly but it can be a serious, depressive state. Your soul is a black hole. You have absolutely nothing left to give anyone, you’re hollow. It takes every ounce of your strength to move your 5000 pound arms. You’re an emotional zombie giving an eight-hour “performance” five times a week during which you smile and “act” like a nurse. When the curtain comes down you leave the stage of your unit, numb. You’re on the verge of tears, but they never come. Your chest is heavy and breathing almost too much trouble. There is no enjoyment of time off because you dread the next shift – even if it is two days away. You feel trapped, without options. The world is siphoning off your will to function. I hated nursing.

That was me in 1987. I had it bad.

Here are a few suggestions based on my experience.

  • Don’t overwork.
    • Double shifts, double backs, extra shifts and long stretches will take a cumulative toll on your body and your psyche. It’s one thing to help out occasionally but there are hospitals out there that will want you every single day for one hole in the schedule or another.
    • Learn to say no. Practice it. It’s hard to say no to “The Call” when you have nothing planned but relaxation for the day, but you can’t be all things to all people all the time. The sooner you realize that the better.
      • Mark yourself as “unavailable” or “N/A” on the schedule to decrease the chance you will get a call.
      • If you can’t say no, get a message machine and screen your calls. If you are not available, don’t answer it.
    • The extra pay is nice, but it isn’t worth your mental health. And you know what? After awhile it’s the law of “diminishing returns” – meaning that most of that pay goes to taxes anyway!
    • If you do work extra or do a double shift, try to negotiate comp time, i.e. another day off if you pick up the extra.
  • Take advantage of flexible schedules and creative uses of holidays and paid-time-off to give yourself “mini-vacations” on a regular basis, short stretches of time off that you can look forward to.
  • Realize that you have options.
    • The flexibility of nursing is its best asset. Take advantage of it. Feeling restless, bored, empty, depressed?
    • Change your hours, your shift. Look at what other facilities are offering. Better hours? Better pay? Weekends only? No weekends? Less commute? More challenge? Less stress?
    • Realize that one position may not fit your needs, or your lifestyle for your entire career. Don’t be afraid to explore, to step out and try new areas/specialties.
      • We are being actively recruited. New graduates are being accepted into specialty preceptorships and experienced nurses are highly sought after.
      • A wide variety of experiences makes you even more desirable to nursing employers.
  • Take care of yourself. It’s not a cliche. If you are sleep deprived and eating poorly your ability to cope with the stress of nursing will be greatly diminished. If you aren’t physically healthy your mental health will suffer.

Burnt? I was crispy fried, folks.

Without making it too simplistic, I was able to work my way out of the pit of my burnout-that-lead-to-depression by following the points above, working with a counselor and in my case, using a brief period on antidepressants. It worked. I regained my passion for nursing and more importantly I was able to feel compassion for my patients. I could care again.

My advice? If you start to feel the twinges of burnout, take steps to stop it STAT.

It is much easier to avoid burnout than it is to cure it.

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October 6, 2005, 12:17 am

The Call of the Nurse

Having worked as a psychiatric nurse, I’m very interested in the field of mental health. Dr. Deborah Serani , a psychologist (and blogger) specializing in trauma and depression, reminds us that this week is Mental Health Awareness Week. Check out her blog at the link above for information on the National Depression Screening Day scheduled for October 6, 2005 (today!) in locations in both the United States and Canada.

hhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

Well that was interesting! I hit the “h” key in the “Webdings” font and it was an ambulance! How appropo!

In my search for nursing ephemera I’ve found many images and slogans. Some are funny, some are serious. Some are just plain corny. I was attracted to this poster because it speaks of finding self through service to others; a rather profound philosophy to sum up in one sentence.

I have always felt that nursing was a “calling”, that the urge to care for the sick and the ability to do so was a gift from God. Everything I did, every class I took from the age of nine onward was geared to accomplish the goal of being a registered nurse. Without deviation. How many nine-year-olds are that focused? I was writing to diploma programs for catalogs by the time I was ten. I could not believe I was accepted to the first program I applied to, nearly just out of high school. As I entered the field and worked as a nurse there were times I fought it, times I hated it, times I wished I could do anything else, but instinctively I always knew that it was what I was supposed to be doing with my life.

So it was illuminating to find out that this was not the standard experience of other nurses!
Interestingly, some men I know, who chose nursing as a second or third career, were attracted to the pay, the job security and the flexibility of hours. No sense of a “calling” there at all. Hmmm. What about the women? Well, one says she can’t remember a time that she didn’t want to be a nurse but never felt it was any kind of a spiritual calling. Another had such a wretched experience watching incompetent nurses deal with the death of a relative that as a teenager she thought, “I can do better”. And she does! She is a great nurse, loves her job, but never thought of it as a “calling” per se. My last “interviewee” said she made the decision at the age of 18 but it was a rational decision to focus on that area of study. No “calling” involved.

So gee, is it just me? These old posters and vintage photos depict nursing as a “noble” profession; maybe I was just born 20 years too late or never got over my “CherryAmesItis”. I know it was never addressed in my training. No classes on the history of nursing or the contributions of nurses to society. The more modern recruitment campaigns (“If caring were enough, anyone could be a nurse.” ) surely don’t focus on it. And compare this ad to the one above. “Because I’m A Nurse”? What, I can stand there with my arms crossed looking like a
bad-ass-don’t-mess-with-me chick? This poster was up in our ER and I was trying to understand what the message was.

It certainly wasn’t about finding yourself through caring for others.

Someone who is into nursing only for the money, the benefits, the hours and the flexibility won’t last a year in this profession. They had better be into nursing for the patients because that is where the entire heart of the profession resides. I would like to see this fact mirrored in the recruitment drives because while there are wonderful, tangible benefits to the job, it’s the ability to care and to translate that care into action that makes the profession a vocation. Because it isn’t true that if caring were enough, anyone could be a nurse.

It takes a unique person to “care” the way a nurse cares.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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