Oct
18

Juggling

I have been fully immersed in my new role(s) for over a month now. I’m surely still in the honeymoon period, so take this with a grain of salt, but I am soooooo much happier in general. I even went back to my old hospital to visit a friend who had been admitted, and one of my former co-workers commented that I seemed like I was in a better place. Boy am I.

Hospice nursing is as rewarding as I expected it to be. It is also a place that seems to attract staff with an unbelievable work ethic and team-oriented spirit, which means that management comes in to work the floor when needed, our supervisors and attending physicians often “stop by” on weekends to check in with patients, families and staff, and most of us stay at least 1-2 hours past our shift time to finish our documentation or simply help the oncoming staff with patient care. Although we could be criticized for lack of boundaries, for now I am (mostly) refreshed by the dedication I see on a regular basis. The people who work in hospice – from the nurses to the volunteers – consider it a privilege and a calling, and the sense of commitment is inspiring.

My new hem/onc floor is also going well. I’ll finish my orientation next week, but for the most part I am operating independently. Unlike my former floor, they give chemo all the time so they are fairly relaxed about the process and not nearly as anxious. These are helpful qualities for a nurse who loves oncology but is terrified about giving chemo. The laid-back environment pervades the unit, although ironically is it also a floor with a disproportionate share of rapid responses and codes. The nurses are still remarkably vigilant. It’s hard to explain. It’s also a nice counter-balance to the emotional intensity of hospice. And the staffing, oh the staffing. The MAXIMUM number of patients any nurse can have is four. Yes, four. We always have three nursing assistants. Charge nurses do not take patients, period. Coming from a place where I can easily have six patients, where more than once I worked as charge nurse with three patients (two of whom were getting chemo), and where we are often short one, even two, NAs, it’s almost a vacation.

Almost. ;-)

And then there is teaching. I love teaching. After a bad shift or an emotional encounter, I go to my clinical site and spend time with students who are bursting at the seams about everything they get to learn. It reminds me why I love this profession. It’s an opportunity to adopt the roles of mentor and support system that have always sustained me. Granted, I have an incredible group of students this semester, and next spring I may be eating my words. But somehow I doubt it.

I love it so much that I’m considering a fourth potential position (yes, I know I’m crazy). Another nursing school in the area, where I applied for a full-time teaching position last summer, contacted me about a possible clinical instructor job for the spring. The details have yet to be worked out and no official offer has been made, but it’s a distinct option. Bonus: It pays $5/hour more than any of my current jobs.

The beauty of working per diem is that I can work when I am available. The challenge is piecing together multiple schedules and not over-promising my availability to one job, to the detriment of work options with another. Not to mention balancing these schedules with school and my own clinical rotations.

Sigh…I suppose I wouldn’t be me if I wasn’t busy. ;-)


Sep
25

Ch-Ch-Ch-Changes

It’s been three weeks since I worked my last shift in the hospital. My departure was rather anticlimactic. Whereas most staff who leave get a send-off potluck or at least a card, I arrived on my last day with most people not even aware that I had resigned. I got individual well-wishes and hugs from co-workers I loved, which mattered more to me anyway The . But it still stung a little that my manager didn’t even try.

Not that it surprised me. When I went to the ER the night before my second-to-last shift, I emailed him an update and told him I would do my damndest to be at work in the morning. And I did show up and worked my tail off. He was there all day and couldn’t be bothered to check in and make sure I was okay. Sigh. And so it goes.

Enough complaining though… Although it was a bit sadistic of me to start three new jobs in the same month, I have to say it’s been a refreshing process. Here is how September has gone.

  • Hospice – My transfer between departments (from hospital to hospice) has been a little messy. But damn, do I love hospice nursing. It is physically, mentally, and emotionally hard as hell. But rewarding as hell too. What a privilege to be part of such an intimate part of people’s lives. To be trusted and counted on to give comfort. It’s why I became a nurse, all rolled into one incredible job.
  • Hem/Onc – I have yet to start orienting on the floor but general orientation has gone quite well. I feel welcomed already. The whole health system seems to be built on a foundation of gratitude, which is really encouraging. When I mentioned to the manager that I was hoping to travel over part of the holidays to see my family, she had our scheduler email me so that we could work out my holiday shifts. In September. Before I had even officially started working. I think I will learn a lot here. Plus, they’re going to cross-train me to the bone marrow transplant unit so I can float both places. The nerd in me is delighted.
  • Teaching – I adore this job. I adore watching nurses-to-be grow and push themselves. I am refreshed by their energy and their positive outlook. I am inspired by our post-conference discussions. I feel like I get to relive The Makings of a Nurse  every day I am with them. What an incredible journey.

I’ve been reminded again and again this month why I chose this profession…or why this profession chose me. Through all of the frustrations and health setbacks, I get to go to bed every night thankful for what I do.


Sep
05

Ready for Fall

Last time I lived in North Carolina, back in my college days, migraines were not a part of my life. No, those little bastards didn’t show up until nursing school.

I have been able to identify a number of migraine triggers over the years: red wine (sob), dark liquor (sniffle), sleep/wake cycle issues, fatigue, menstrual cycles. But as I’ve started to document and track my attacks this summer, I’ve noticed a disturbing trend, considering where I live and will continue to live for the next few years:

Humidity is a bitch for migraines.

This really sucks, because if you’ve ever been to the southeastern U.S., you know that between late May and early September, stepping outside is akin to stepping into a sauna. It can be enough to land me in bed for the rest of the day. A friend of mine who has a neurological disorder of her own likens it to wearing an iron jumpsuit while treading water. Yep.

This past week, I got a little desperate. Despite switching to day shift for the last month of my current job, I’ve been extremely uncomfortable. After living with pain on an almost-daily basis for three weeks and being unable to get in to my neurologist for a nerve block “tune up” (they’re as fun as they sound), I gave in and did something I said I’d never do again. I got my butt to an emergency room.

Three hours and $250 dollars later, I was feeling drowsy but much, much better. The ED I live near has a standard migraine cocktail of IV medications that doesn’t involve opioids, hallelujah. My own hospital could learn a thing or two about this practice. Unfortunately a fluffy dehydrated woman in pain does not make for easy intravenous access, and I ended up with an IV in the most uncomfortable spot ever:

*Shudder*

*Shudder*

(Source)

Despite the discomfort, I took a deep breath and tried to snooze for a bit. After a fluid bolus and pushes of Toradol, Reglan and Benadryl, I felt like a new person. I was even able to wake up at five o’clock the next morning and go to work with zero pain, for the first time in months.

I know it was a quick fix and I’m already starting to feel worn down again. Which means it was a very expensive short-term solution. But when you’re chronically hurting, a day without pain is a gift.

I have a follow-up with my neurologist in a few weeks. I’ve taken some personal and professional steps toward a better-balanced life. I’ve utilized complementary medicine and researched evidence-based naturopathic options. But I think I need to get serious. My home has turned into a pharmacy and I’m at the end of my rope.  This summer we started discussing a couple of chronic management options: Botox injections or a new treatment called a SphenoCath. It may be time.

But in the meantime, I can’t wait for the air to get crisper and the leaves to start falling. Maybe then I’ll get a little relief. Another reason to love my favorite season!

P.S. Steve gets husband of the year award! He drove me there and sat in a dark room with me (meaning he couldn’t read) while I got pumped full of fluids. What a keeper. :-)


Aug
28

Crowdsourcing: “The Change”

Hello friends! I have a favor to ask if any of y’all are interested…

For my reproductive health seminar, one of our assignments is to interview a woman who is going through menopause. If you read this blog and would like to share some of your experiences (or if you know someone who might be interested), please use the Contact NurseTeeny link to send me a message.

The commitment is pretty minimal – I would just send you an email with some questions and you can respond. The assignment is not due for several weeks, so you would have plenty of time. And of course your privacy and confidentiality will be respected, with no identifying information included in the final assignment. The only person who will see the final write-up are myself, my professor, and you (if you would like a copy).

If you are interested or you know someone who might be, please pass this along and let me know. Thank you in advance for your help!


Aug
27

Response Team

Like many hospitals, mine has a Rapid Response team (RRT). Although they go by different names, they have a similar purpose: To provide complex and rapid medical support to a patient who is acutely decompensating but does not require resuscitation (yet). The goal of RRTs is to stabilize these patients and prevent the need for calling a Code Blue. At my workplace, patients and families can actually call for the RRT directly. I tell them at admission that it is akin to calling 911 from home – if there is a change in the patient’s condition, it is appropriate to call for help without having to wait for the nurse. Sometimes we are able to stabilize the patients with support from respiratory therapy and ICU staff. Sometimes Often we have to transfer the patients to a higher level of care. Sometimes we are forced to call RRTs because we are concerned about a patient but their attending doesn’t seem to be all that worried, and we want more eyes on the situation.

I’ve been lucky (or unlucky) enough not to have participated in many RRTs in my career. The good news is, I haven’t needed to. The bad news is, RRTs make me nervous because they can be very chaotic and unsettling to patients and families. Plus, as I’ve said before, critical care situations just aren’t for me.

When I have encountered patients requiring rapid response, I’ve often struggled with a decreased confidence in my own clinical judgment. I ask the typical questions: Could I have prevented this by doing XYZ? What did I miss? Is this my fault?

It’s hard not to beat up on ourselves when our patients need a level of care that we can’t provide. I have to stop and remind myself that whatever the cause, my patient will do better on a unit where his/her nurse does not have five other patients. I’m as vigilant as I can be, but sometimes it’s a question of patient safety.

Which makes me wonder… At a time when efficiency and cost-cutting are prioritized, are we compromising safety for the sake of dollars and cents? Or because it’s convenient? For example, we’ve had patients admitted to our unit because we are the oncology floor, even if they are not appropriate and should really be in the ICU. The oncologists have justified it by saying the patients will do better being cared for by oncology nurses. But these oncology nurses are also medical nurses with 5-6 patients on a typical shift, and we don’t have the staffing to provide the intensive level of care that some of our patients require. And just because a patient has cancer doesn’t mean we are the right caregivers – if they just had major surgery, or are critically ill, or have a fresh trach, they need (and deserve) more support than we can possibly provide.

As helpful as RRTs can be in preventing code situations, I worry that we rely on them too much. When I’ve tried to advocate for a patient transfer to step-down or ICU, I have been told by supervisors, physicians, and fellow nurses that it’s not possible now but I can “always call a rapid”! I understand that we work as a team and it’s okay to call for help, but shouldn’t we be trying to prevent these situations from happening in the first place? With staffing the way it is, will response teams become our new normal because patients are not receiving the care they need?

Falling back on mantra that we can always call a rapid feels a bit lackadaisical to me.


Aug
24

Review: The Emperor of All Maladies

Well, I finally finished it.

emperor_maladies_cover

I figured I would take a while to get through The Emperor of All Maladies. I didn’t count on it taking a year, but what can you do? ;-)

But please, don’t let this tardy recap deter you from diving in. I would have swallowed this book whole, had I the mental energy. If you have any interest whatsoever in oncology (or even if you don’t), do yourself a favor and buy this book. It reads like a novel, tracing the history of cancer, from thousands of years B.C. to present day. It explores not only the medical and scientific breakthroughs that made cancer treatment what it is today, but it also reviews the social and political forces that shaped the “war on cancer” as we know it. It truly did feel as if I was reading a complex and captivating biography. This story will remain on my bookshelves, among the oncology textbooks, as a reminder of the impact cancer has had on us all.

Most importantly, it made cancer accessible. For an incredibly complex disease, it can be equally complex to describe what you mean when you say someone “has cancer”. Siddhartha Mukherjee helped me find ways to better explain the disease process and treatment options to my own patients. I found myself constantly gasping with wonder as Mukherjee unpacked and unraveled topics that I thought I understood already, but with this book gained a whole new level of comprehension. My family can attest that I would repeatedly place the book down in front of me, announce that I had just figured out “Why XYZ” and attempt to share my fascination. I didn’t always succeed because I’m not nearly as eloquent as the author. But the Eureka! moments arrived frequently, and I relished every one.

One of the most poignant sections of the book were its final pages, when Mukherjee attempted to reframe how he thought the war on cancer could successfully be waged. I remember being 11 years old and believing that I would find a cure for cancer someday. Once I became an oncology nurse, I realized just how impossible that seemed. But this book gave me hope again. Rather than boldly proclaim that the cure for cancer was right around the corner, Mukherjee acknowledged that the complexity and inherent “us-ness” of cancer may make it an impossible disease to cure. It may just be a genetic end-point that we cannot escape as a human race. But the scientific breakthroughs that have come about have helped transformed many cancers from death sentences to chronic illnesses. It has given us months and years to reclaim and treasure.

We are mortal beings. But we are mortal beings with an incredible capacity for knowledge and thirst for discovery. Perhaps that is why cancer has fascinated me so much, all these years. I have attained just enough knowledge to realize how little I actually know.

What a gift that is.


Aug
22

Another Chapter

I mentioned the other day that I had some new opportunities in the works after resigning from my job.

Now that they have come to fruition, I can share the exciting news!

I have accepted two per diem positions, one in inpatient hospice and one on a hem/onc floor across town. Since both are PRN, the pay is significantly better than my current wages, which means working fewer hours with more variety, and continuing to do what I love. At the hospice, I’ll be providing direct care and conducting admissions. On the hem/onc floor, I’ll get a lot more exposure to heme malignancies, which have captivated my imagination since my bone marrow transplant rotation over the summer. I am excited to learn new skills and continue working with the patients I love. [Bonus: I can get health insurance for Steve and myself through school. So the whole "no benefits" thing isn't as big a deal.]

I’ll also still be teaching on a very part-time basis. If that goes well, perhaps I will have more opportunities to work with students in the coming semesters.

Due to orientation activities for my new jobs and various other registration complexities, I did have to slightly adjust my fall semester plans:

  • Oncology Residency in inpatient palliative care remains the same. I’m excited but a little disheartened. My first day was supposed to be this past Tuesday, but my preceptor no-showed. Hope that was a fluke and not a sign of things to come.
  • Reproductive Health – A requirement for my certificate. I was waffling between taking it on-campus this fall or online next spring. I thought I had settled on spring until I realized I’d have to miss 4 out of my first 5 Genomics classes for job orientation [I couldn't take both classes on-campus since they fell on different days, which would do a number on my availability for clinical and work]. That didn’t seem fair to the class or the professor and just didn’t sit right with me. So I pulled a switcheroo, dropped Genomics, and will take reproductive health on-campus, with a bunch of my oncology girls (a HUGE plus in my book).
  • Electives in HIV advanced practice (one in pathogenesis and one about psychosocial dimensions) – They’re both only one credit and offered online and I couldn’t help myself. The science geek in me wants to grasp HIV as a disease but the anthropologist and community health nurse in me want to explore the legal, social, and ethical issues related to the disease.
  • Due to some registration headaches, I had to drop my first nursing education class. Long story. Trust me, it’s boring and convoluted.

I’ll push genomics and nursing education to spring 2015, to take with a DNP course, which I will slowly be building back into my courseload over the next year. I’ll also start my primary care residency in the spring, completing 200 of 300 total required hours. I’ll do the final 100 in the summer, with two more nursing education classes online. Since I won’t pick up my DNP in earnest again until Fall 2015, there’s no absolute rush. And in the spirit of slowing down, I decided to do myself a favor and actually walk the walk this time.

So there you have it. Musical jobs and musical classes. Story of my life. The new term starts next week.

Six more shifts at my current job and I am counting the hours…


Aug
16

Scrubs Galore

Several months ago, I was contacted by the folks at Medical Discount Scrubs with a request to try out and review some of their items. I was invited to identify the scrub top and bottom of my choice, and soon afterward, received a box of goodies in the mail.

At the time, I was still expecting to stay in my current job, so I went with colors that complied with my hospital’s uniform policy. I ultimately mixed things up a bit by going with a white top from Dickies and blue bottoms from Cherokee.

*Note: The exact items are no longer available, but the top was part of the Professional Whites collection and the bottoms came from the Cherokee Workwear Stretch line.

I immediately took the top out for a spin by wearing it on my next shift as charge nurse. Why then? I was less likely to get blood or other bodily fluids on my pretty new scrubs. I got several compliments at work, and the top had a flattering cut and fit just right. I’m not one for selfies, but here is a shot of the top itself.

2014-04-29 17.12.04

I also loved the little details that made me feel very feminine (and made the top feel quite lightweight):

2014-04-29 17.12.12

My only caveat overall is that a square neck is not super compatible with sports bras (which is my undergarment of choice on the job). But that was really my fault in ordering the neckline I did. I’d also advise that if you go with white, wear a tank top or camisole underneath.

Unfortunately, I didn’t account for my short stature in placing my order, and the scrub pants arrived about six inches too long (in nursing terms, that would make me a fall risk ;-) ). Despite my best intentions, they are still hanging over my washer/dryer, awaiting a trip to the tailor to be hemmed. Other than the length, however, the pants fit extremely well and were true-to-size. I have always been a fan of the elastic waistbands available on some Cherokee scrub pants, and these were snug enough not to fall down but loose enough to be comfortable. I’m not teeny tiny by any means, so the elastic works well for me.

If I had it do over, would I have ordered white? Probably not, just because I won’t wear it as often due to the potential stain factor. But the clothes themselves fit well and were comfortable. And getting brand name scrubs at a discount? Yes please. :-)

My apologies to the folks at Medical Discount Scrubs for the delay in posting this review. You have been more than patient with me while I plodded through the last semester, and I appreciate that so much!


Aug
15

Exploring My Options

So I quit my job. What’s next?

First, I plan to exhale. I’ve felt so suffocated the past several months, and submitting my resignation was like a breath of fresh air. As scary as it was, I knew it was the right decision. Rather than feel constantly frustrated and discouraged, I’ve decided to write my own ticket.

My goal is to assemble a mish-mash of PRN/part-time opportunities that will offer me the opportunity to learn new skills, as well as the flexibility to focus on my studies when I need to. For kicks and giggles I applied to a few full-time jobs, but after a lot of thought, per diem really is the way to go. S and I can get health insurance through school, which was really the only thing holding me back. Per diem pays better per hour and I now have the experience to make me qualified for these types of jobs. I’ve interviewed for two in particular that I am really excited about (don’t want to jinx it by sharing more details…yet). If I got offers from both, there’s no reason I couldn’t accept both. PRN jobs tend to have very loose time requirements, and I think it would be fun to mix things up a little bit.

I’ll also be diving into nursing education. My DNP is being funded by a federal program that covers my tuition in exchange for my willingness to teach full-time after completing my doctorate. As someone who has always loved the opportunity to mentor and teach, I am okay with this arrangement. So to test the waters, I’ll be a clinical instructor for the BSN students at my nursing school. I’ll start off with a very part-time CI gig once a week, and possibly pick up additional courses for the spring. I’m excited and terrified. Mostly excited terrified.

In some ways, my new options will make things more complicated. Balancing 2-3 jobs instead of one will not be easy. On the other hand, I’m also simplifying my life by saying “Yes” to the opportunities that make me love being a nurse and “no” to drama and BS.

Time to take some big leaps forward…

 


Aug
10

New Directions Indeed

I resigned from my job last week.

It was a long time coming, really. If this summer was about learning to say “No,” this decision was about saying no to drama. Since I crashed and burned last fall, I like I have been in an emotional tug of war with my manager and clinical lead. I’ve continually felt as if I had a target on my back, as if they were sitting back and waiting for me to screw up so they could fire me for performance. Unfortunately for them, I’ve done everything by the book and they haven’t been able to fire me. So instead they’ve reached out to make me as miserable as possible (or so it felt). And I finally said enough was enough.

I’ve been going back and forth about leaving for months, now. The only factor keeping me there was my night shift team. My wonderful, supportive team. But I was unhappy and they knew it. When I told them I was thinking about leaving they said “Good for you. We’ll miss you, but you deserve better.” Nothing like true friends.

Between my first PCU job and this experience, I’ve learned some important lessons…

  1. Enough with the night shift already. I thought I might do better in a job I loved, with people I loved. Turns out my body didn’t agree and I’m just not cut out for working all night. It was taking me longer and longer to recover. My neurologist finally sat me down and said my body needed a normal sleep schedule or I was never going to get better.
  2. Overcommunicating isn’t always wise. Throughout the past year, I made an effort to be completely transparent with management about my situation. I volunteered information about my health that I didn’t have to offer, because I didn’t want there to be any questions or doubts or gossip. Turns out the questions and doubts and gossip persisted anyway. And I ended up feeling vulnerable. One of my classmates said I just needed to keep my mouth shut and go to work and not let on what I was thinking or feeling, because it would be used against me. Turns out she was right.
  3. Nurses suck at taking care of nurses. I should have realized this the first time around. But when it comes to chronic illness, we judge each other as harshly as we judge our patients. I can’t tell you how many migraine patients I’ve admitted over the past two years and when I got report from the emergency department, it always started out with “These migraine patients…” As one of “those” patients, the complaints I heard from fellow nurses made me feel like a malingerer and a drug-seeker. I felt like the weakest link. I felt like whenever I called out (the reason for which was protected under federal law), no one believed me. My manager called me on days I was scheduled “just to make sure” I was coming to work. Is that even legal? When my reason for calling out wasn’t documented by the charge nurse I spoke with (even though I always gave the reason), he marked it as an unexcused absence rather than an FMLA absence, and gave me a verbal warning for having too many of those – you better believe I fought that tooth and nail).

Needless to say, I’ve become a little gunshy about trusting the people I work for and the people I work with. And that makes me sad because I’m a flipping nurse. And we’re supposedly the most trustworthy profession in America.

How come we don’t take care of each other?

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