June 2, 2009, 8:20 am

Sweeping Away the Ashes

kendallpreschoolMeet my son, Kendall.

As far back as I can remember, he was always graduating/accomplishing something.

At the age of seven, he announced his candidacy for the office of President of the United States.

As a Democrat, no less.

us-at-graduationThis photo was taken just a couple of weeks ago at Notre Dame following the law school graduation.

The transformation from the first photo to this photo seemed to occur overnight. Hug your babies, folks, because they grow-up faster than you can ever imagine.

We managed to get 4/5 of the family together that weekend. That’s me, Kendall, hubby John and daughter Lillian.

Next graduation: me in 2010 with a BSN, followed by daughter Rebecca in 2012 with her BSN. Yep, I am living with the future of the nursing profession.

Let’s hope she keeps her unit cleaner than her room.

********************

You walk into the unit, put down your backpack, fill your pocket with pen, scissors, and tape, sling the stethoscope over your neck, swipe your namebadge into the infernal timeclock and enter stage right.

It’s showtime!

Get the triage, hook up the monitor, grab the EKG, slam in the saline lock – grab the bloods in the process, hang a liter of normal saline, put up the side rails, hook the call bell to the side rail, throw on a warm blanket, medicate for fever and slam the chart in the “to-be-seen” rack.

Repeat x 30 over the next eight hours.

Feel like burnt toast, look like burnt toast, act like burnt toast.

*****

Where’s the patient?

You know, the person you just triaged, hooked, slammed, hydrated, side-railed, blanketed, medicated and lined up for evaluation?

Oh.

Did it ever occur to you that the reason you feel like burnt toast is because you are so focused on what you are doing you have lost sight of the “who” you are doing it to?

*****

Well, it occurred to me.

Because that is exactly what had happened.

Oh, my physical care was fine.

But I had stopped looking patients in the eye. I was spitting out standard responses instead of listening to what my patients were saying. I was expending the bare minimum of energy required to complete tasks.

I was doing; I wasn’t caring.

And I was burnt.

*****

But I discovered something.

And this is huge.

I was not focusing on tasks because I had burned out, I burned out because I had started focusing on tasks.

Let’s face it. The ER, while seemingly exciting to those outside the ambulance doors, can actually feel redundant to those of us who deal with the same issues every day. The same complaints. The same symptoms. Over and over and over.

So, what makes each case interesting? What makes each case unique?

The patient behind the story. The person under the symptoms.

Lose sight of the person and you lose sight of the profession. Lose sight of their humanity and you lose sight of your own. Lose sight of your own and you become a burnt shell.

*****

You would think that after three decades of this, I’d have figured this out by now.

I guess you never stop learning.

This time, my teachers were an elderly man with a DVT who talked to me about his time on the LAPD, back in the day.

And the young woman who described, quite vividly, how it felt to go from the pinnacle of health to the devastation of a cancer diagnosis, overnight.

Or the 18-month old who tucked their head under my chin and fell asleep as Mom described  the terror of witnessing a first-time febrile seizure.

*****

Who would have guessed that sometimes patients are the cure for burn out and not the cause of burn out.

The patients didn’t change, they were always willing to talk.

All I had to do was stop and listen.

That simple.

Go figure.

22 Comments

  • Walt Trachim
    Walt Trachim

    June 2, 2009 at 9:04 am

    Yup.

    I couldn’t have put it any more succinctly than this, Kim.

    Having been on the other side of the bed cured me of whatever burnout may have been lurking and ready to pounce on me. So I can well and truly appreciate what you’re saying, albeit from perhaps a slightly altered perspective, of course.

    A great post. And congratulations to your son as well as to your daughter a bit early….


  • Mike Briddon
    Mike Briddon

    June 2, 2009 at 9:05 am

    Moving post. Thanks for sharing!


  • Black Cloud ER Tech
    Black Cloud ER Tech

    June 2, 2009 at 9:06 am

    Trust me… as an ER Tech, redundancy can sometimes be the name of the game… EKG in Room 1, Room 10 needs more guaze, Room 3 needs a short-leg posterior splint… the list goes on. I, too, have found that talking with the patient really does help prevent (and cure) burnout. Giving a story to each of the faces helps! Keep going, Kim!

    B/C ER Tech


  • Walt Trachim
    Walt Trachim

    June 2, 2009 at 9:07 am

    And to you also – I have no doubt you’ll be glad to have it all done.

    We should talk – I’m considering going to nursing school myself. Being married to an RN, of course, is a positive, I think. You and she could have been classmates as you both graduated from nursing school at about the same time (but on opposite coasts :).


  • Kathy Emde
    Kathy Emde

    June 2, 2009 at 2:32 pm

    You said it, sister. The stories and the people are what keep us going back day after day. I loved talking to the elderly lady who shared that her family were the first in Washington state to own an motorcar. She described the exhilaration of that first ride and I could almost feel the breeze! People are fascinating, unique and so worthy of our best care. PS I have a daughter who enters a post-baccalaureate gerontology nurse practitioner program in the fall. We have replaced ourselves, why can’t we retire? Don’t they have a special grant for “parents of future nurses”??


  • Andy
    Andy

    June 2, 2009 at 6:46 pm

    Aha, The Kim McAllister Model of Nursing Theory! 🙂

    Kim, why aren’t you teaching? You’d be a great preceptor.


  • maha
    maha

    June 2, 2009 at 8:21 pm

    A friend of mine had to go to the ER for horrible back pain and listening to her talk about being ignored in an uncomfortable gurney for almost 9 hours really made me let go of my ‘nurse face’. Her story and your post are just what I needed after some not so stellar shifts. And I agree with the poster above – you would make a great preceptor 🙂


  • Reality Rounds
    Reality Rounds

    June 3, 2009 at 6:46 am

    So sad, and so true. Nurses value tasks to much. “Oh she is a great IV start” “She can get the foley in fast” etc, etc. It seems to me that patients don’t remember that stuff, but they always remember the nurse who took the time to listen and talk to them. Patient’s can be very entertaining if ya take the time to listen.


  • Maureen at IslandRoar
    Maureen at IslandRoar

    June 3, 2009 at 8:06 am

    Oh, man I love your blog. Thank God you are the future of nursing, AND your daughter. Everyone burns out; not everyone deals effectively.
    Congrats on your son. They DO grow up fast.


  • Frosty
    Frosty

    June 3, 2009 at 10:49 pm

    Great perspective. I am so glad that I read it.


  • RehabRN
    RehabRN

    June 4, 2009 at 5:52 am

    I always get sh*T for talking to people, because it takes “so long”.

    Why not just talk while you’re doing stuff? I do. I don’t do anything without telling someone what I’m doing.

    Sometimes they talk back, sometimes they don’t, but I always try to give them the option.

    Yes, they think I’m a greenhorn, but that’s just tough. My people like me because of it.

    The air of burnt toast is quite heavy on my unit somedays…


  • Healthcare Today
    Healthcare Today

    June 4, 2009 at 6:47 am

    Sweeping Away the Ashes…

    Who would have guessed that sometimes patients are the cure for burn out and not the cause of burn out?…


  • Annemiek
    Annemiek

    June 4, 2009 at 1:47 pm

    I find myself going between being close to burn out and feeling better. Sometimes you need a reminder like you write of why you are doing this, but sometimes you also need to protect yourself.


  • Reality Rounds
    Reality Rounds

    June 4, 2009 at 5:39 pm

    Kim, have you read this story that is floating around the internet:
    http://realityrounds.com/2009/06/04/listen/

    I did not write the story, I just copied it to my blog. It is amazing.


  • Candy
    Candy

    June 5, 2009 at 8:14 am

    This needs to be required reading for every nursing student — NEVER, NEVER take your eyes off the patient!

    Bless you and your amazing ability to make it real.


  • Sean
    Sean

    June 7, 2009 at 5:59 pm

    An old nursing school instructor once told us ‘never get caught up in the do-ey things’ focus on the patient.
    Thanks for sharing those words of wisdom


  • TC
    TC

    June 9, 2009 at 5:04 am

    I know just where you’re coming from. Part of why I left the ER was because I could feel myself getting hardened and I never wanted to be like one of “those nurses.”

    What you’re talking about is actually pretty Zen-it’s about paying attention and being in the moment with whatever you’re doing. Now I see the same patients over again in clinic every week. It’s nice because you get to see the same people and it’s not nice, well, because you see the same people every week. Thanks for that post, though. Sometimes the seemingly simple is the hardest to figure out and I’ll be remembering it when I’m feeling burned out.


  • AlisonH
    AlisonH

    June 13, 2009 at 10:41 am

    This patient thanks you.


  • AlisonH
    AlisonH

    June 13, 2009 at 10:41 am

    (Hit submit too fast) and congratulations on your son’s graduation!


  • […] Check out the rest of the post here. […]


  • Monica
    Monica

    June 16, 2009 at 10:38 am

    I am looking forward to this show tonight, however I was a bit disappointed with the character description of “Ray”. He may be one of the best nurses, but he has always dreamed of going to medical school….

    Nurse Jackie and Hawthorne are both TV shows and will not always depict reality, but it is a good thing that (finally) nurses are a central character in a show and esp. having an african american nurse and in a leadership position.


  • Burned out and used up | HealthBeat
    Burned out and used up | HealthBeat

    February 2, 2011 at 2:46 pm

    […] a post titled, appropriately enough, “Sweeping Away the Ashes, she writes: “Lose sight of the person and you lose sight of the profession. Lose sight of their humanity […]


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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