November, 2006 Archive

November 27, 2006, 2:14 am

Running Into the Arms of God

patI would love to tell you that the title of this post is an inspiring story about a patient or a nurse.

It isn’t.

A classic story of redemption set in an emergency department and written by yours truly.

In my dreams.

Instead it is a book of many stories. Stories that will have you howling with laughter and heaving with sobs.

In the same paragraph.

My copy isn’t autographed, but that’s okay. The author is invited to my house for Christmas dinner.

You see, Running Into the Arms of God was written by my brother-in-law.


Don’t tell Pat, but I read this book for the first time tonight.

Through hilarious stories of growing up in a family of nine kids (my hubby makes more than one appearance) and poignant stories of people whose lives he has crossed, Pat makes the case for “stories of prayer/prayer as story” but you will come away with so much more.

We pray without uttering a single sound or a word.

Prayer is in a father’s kiss, a glazed donut and the San Francisco skyline.

Prayer is in a tough kid’s smile, a baseball championship and the mysteriously decreasing height of a bench in India!


Although not a book about nursing, after you read it you will never practice nursing the same again.

You’ll care for the homeless and underneath the stench and grime you will see God.

You will never sit with a dying patient without noting that “…the line that seemingly separates life from death, despair from hope, suffering from joy” disappears before your very eyes.

You’ll find a prayer in every hand you hold, every brow you wipe, every pain you ease and every cup of coffee you hand to a waiting family member.

I’ve been praying for the last 28 years every time I crossed over the threshold of my hospital. I knew my calling to nursing had a purpose. I didn’t realize it was prayer.

I realize it now.

Do yourself a favor and buy yourself this book for Christmas. You deserve it.

You can find the icon for Running Into the Arms of God in the “middle” sidebar just below Blog Carnival.


As a last note, I want you to know I can vouch for every single word of the family stories. I’ve been a member of the Hannon family for as long as I’ve been nursing and they are just as charmingly nuts as they sound in the book.

You’ll laugh. You’ll cry. You’ll laugh so hard you’ll cry! And then you’ll wonder how any of them got out alive!

And yes, my mother-in-law was a saint. She had to be!


Don’t forget!

Change of Shift goes live this Thursday with Mama Doc doing the hosting honors over at Fat Doctor!

You can send in submissions through Blog Carnival or to ( at gmail dot com).

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November 26, 2006, 9:59 pm

Torched and Scorched: Recognizing Burn Out Before You See the Ashes

operationHere we have a classic picture of a surgery in progress.

Normal people see that.

Nothing out of the ordinary.

But first thing I thought when I saw the picture was:

“Now this patient is saving money by having her annual pap smear and her surgery at the same time!”

Well it does look like that, you have to admit!

Now, I know that is the anesthesiologist up there.

I’d say a nurse anesthetist but this happens to be from the 1950s and I’m not sure they had nurses in that role then.

But it just shows how warped my sense of humor has gotten after reading ads for a year-and-a-half.


It’s insidious.

You find that you are more exhausted after your shifts.

(And you weren’t that busy).

You stop just being happy that you have the next day off.

(And you start praying that today will be over soon).


You find it harder to deal with challenging patients.

You find it very hard to deal with challenging doctors.

Your blood pressure rises just thinking of the last “incident” you had with a physician and you begin to get a headache.

(The “incident” was four months ago).

You are less able to tolerate the idiosyncrasies of your colleagues. Your first response is to snap at them, only to catch yourself at the last minute and respond appropriately.

(And all they did was ask for help).


Every memo from management feels like an insult.

It seems like you can never do enough..

Nothing that you do accomplish is ever good enough.

You find the game playing and politics of the job tiresome.

You start dreading having to go to work.

At first it starts an hour before. Then two. Then the night before.

And eventually you leave one shift dreading the time you have to return for the next one.


You feel you are “on stage” for eight solid hours playing the part of a nurse.

You smile so hard for so long your face hurts.

You resent everyone. The doctors. Your colleagues. Your manager. Your patients.

The point comes when you snap. You can’t play the role any longer.

(You don’t have a choice.)

Depression follows.

You have to take medication just to get to the point that you can put on those damn scrubs and put one foot in front of the other.

(A commercial for “ER” makes you physically sick).

You spend the majority of your time off sleeping. Your family suffers as apathy and anhedonia infuse every aspect of your life.

You can’t quit. You’re trapped. You need the money. You have to have the benefits. You desperately look for something outside of nursing to cling to, something else you can do for a living.

But… you aren’t educated to do anything else and besides, every other job you consider just pays minimum wage and you can’t support your family.

Soon you feel numb. The energy you no longer have is spent on lifting your five ton body out of bed.

You have nothing left to give. You have been sucked dry.

You are burned out.


Not a pretty picture, is it?

I’ve been there and I’m living proof that it is possible to bounce back from the depths of burn out.

But occasionally I find myself at the top of the downslope that leads to burn out only now it doesn’t result in a free-fall.


I know how it starts and I’ve learned from experience that the best way to keep yourself from burning out is to recognize it at the beginning and take steps to stop it.

So, from the horse’s mouth here’s some hard-earned advice.

  • Do not work one day more than you need to work to pay your bills and live the lifestyle you are willing to maintain.
    • Picking up the extra day here and there to help with a sick call is fine.
    • Scheduling yourself for 24 extra hours a pay period for the next three months is just plain stupid and you are asking for trouble. Trust me on this one. I know what I am talking about.
  • Take as much control over your schedule as you can.
    • If you can’t do twelve hours because you feel like a quarterback who has been sacked fifty times by the end of the shift, then don’t do twelve hours!
    • Do not schedule yourself for long stretches without a day off. Define for yourself what you consider a “long stretch”. LISTEN to your body. If you are doing five twelve-hour shifts in a row you are asking for the toaster.
    • To the best of your ability try and get on a regular schedule. Your body will be more resilient if you keep to a regular routine of work, exercise and nutrition.
  • If you can’t beat ’em, join ’em.
    • Management is not going to listen to you when you say, for example, that they are pushing you to the limit with paperwork. They don’t care. The more you understand that, the better off you will be. They are required to produce a flood of paperwork to prove that work is being done. You, the nurse, are the bucket at the end of the waterfall made up of “regulations”. You catch it all.
    • Get involved.
      • For example: you may not like the fact that you now have to write a written report on every patient you transfer but you sure as hell can have a say in what the transfer form looks like.
        • Don’t just gripe. Come up with an alternative.
        • Join the committee to formulate the document, or at least give constructive feedback to the committee members who are working on it. You will feel empowered and that helps keep burn out at bay.
  • Consider a change of scenery
    • You don’t have to stay at the same hospital or job from graduation to retirement and while that may be anathema to the older generation, I know for a fact working in a variety of institutions gives you broader experience.
    • Look at other areas of nursing that interest you. Always been interested in neonatal nursing, for example? Does a hospital in your area offer a preceptorship? Is your own facility willing to train you in another area?
    • Consider transfering to a different floor or a different unit if you no longer find your current position palatable. Take the ER, since that is what I am familiar with: one ER can be a fantastic place to work and another five miles down the road can be the personification of hell. Do your homework.

Once you realize that you are in the acute stages of burn out and you are pretty sure it has become a chronic problem:

  • Keep your mouth shut!
    • No body cares that you are burning out. Trust me again, no one cares!
      • Your manager will listen, but don’t expect any slack.
      • All that management cares about, and your co-workers too, for that matter is that you show up for work, do your job and do it well.
    • You are a professional. Your manager and your co-workers are your colleagues, NOT your therapists. Forget that and you will pay the price; anything you say can and will be used against you in the court of unit opinion.
  • If you have reached the point of no return and need to take a medical leave for a few weeks so that you can get yourself and your sanity together, do NOT discuss your reasons with your co-workers.
    • If you need to take time off to recover from the mental hell of burn out, to get some space, take it! Better to have you not working for six weeks than to lose you from the nursing profession. But understand that burn out is synonymous with depression and mental health is not looked upon with favor, even by your colleagues. So understand that:
    • You will be resented and they will assume you are just doing it to get some “free” time off. Break a bone and everyone supports you. Take time to repair your soul and you are a slacker.
    • At this point your manager needs to know. These days it can’t be discussed due to HIPAA regulations.

Someone once commented that I only presented the happy face of nursing, that I was, essentially a cheerleader.

I guess I am. I love my profession. I’m passionate about it.

But I’ve been to the “dark side” of nursing, where is sucks everything you have to give and leaves you a dessicated shell. Maybe that’s how you feel right now. You may be working side-by-side with someone going through it.

This is an important topic.

By sharing what it felt like to slide into nursing hell, what I experienced as I desperately grabbed onto anything and anyone for help, I hope to make the point that burn out is not an inevitable result of nursing and definitely not fatal to a career.

The key is to recognize and deal with the early warning signs.

I wanted to show that you can bounce back and have the passion for nursing return even stronger than before.

If anything, I’m a better nurse having lived through it.

You don’t have to live through it. Learn from my experiences.

Even one nurse lost to burnout is one too many.

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November 25, 2006, 9:03 pm

Confessions of a Fair-Weather Fan


I have a confession to make.

I turned off the game.


My options were to obliterate any evidence of the slaughter or go take ten milligrams of Valium for my nerves.

The other option was a few shots of Irish whiskey.

So I’m a horrible Irish fan and I should turn in my autographed Brady Quinn football and put my pom poms in storage.

But I have one thing to say to the offensive line of Notre Dame right now.


Your other job is to GET YOUR BIG O’ SELVES FREE from any and all spoiled brat rich kid defensive line JERKS trying to PREVENT you from exercising your PRIME DIRECTIVE.

Not that I’m bitter. Or anything.

And you! Yeah, you on the Notre Dame defensive line. Okay ALL of you on the Notre Dame defensive line! YOUR job is to STOP the spoiled brat rich kid OFFENSE of the OTHER team from exercising their Prime Directive.

John David Booty needed his bootie kicked and badly. While chivalrous of you to allow him unimpeded access to his receivers, it would have been much more appreciated if you had landed him flat on his back, oh, I don’t know, maybe…..once or twice a quarter!

Not that I’m upset. Or anything.

Irish, you blew it. When you win you play like the champions I know you are, but when you blow it you make Hurricane Katrina look like a puff of wind.

I do NOT want to be a fly on the wall when Charlie Weis gets ahold of this team after this abomination of a game.

Now my only consolation is the fact that the Irish will be in a Bowl game. I think.

And that I will be able to follow Brady Quinn and that hunk of a receiver Jeff Samardzjia in the NFL next year.

Well, let me paraphrase that deep philosopher named Scarlett O’Hara.

Tomorrow…is another season!

I’m so upset right now, I am not even going to post the Notre Dame fight song. How upset am I? My husband took my football out of my hands so that I would not throw it through the television set.

In conclusion, I am a bad, bad fan.

And I hate usc with a passion never before seen in human history.

So! How was YOUR day?

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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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