Dec
11

Another One for the Books

Gah, someday I will recapture the art of blogging whilst studying, but apparently it’s not today…

Tuesday I submitted my final paper/project of the fall semester. Today I saw that my final grades were posted.

Stick a fork in me.

That’s a wrap.

Another one bites the dust. … Can you tell I’m a bit punchy? :-P

For being my “lightest” semester credit-wise, there was nothing really light about this fall. I worked my tail off, while learning three new jobs. No, I wasn’t stressed at all. In the midst of everything, I also had another crash/burn cycle of migraines, and had to take an incomplete in my oncology residency, which I will wrap up next spring with a new preceptor. I will apparently never learn how to truly slow down.

So what’s next on the docket for Nurse Teeny?

  • Finish up my oncology residency. Just have 50 hours to go. All of my assignments were completed this semester, so it’s a matter of getting in the clinical time.
  • Start my primary care residency in … wait for it … PALLIATIVE CARE! Double bonus – it’s with the medical director at my current workplace, who already knows me well. I was literally sitting next to her at a retreat when I got my clinical assignment via email and almost fell out of my chair. I don’t exactly know how I swung that (I certainly didn’t request it), but I have a sneaking suspicion that someone is trying to tell me something.
  • Resume my DNP coursework with a finance class. *Shudder*
  • Take my first official nursing education class. Woop woop!

I’ll be taking on more responsibility at hospice, which equals fewer shifts in hem/onc. Which is okay because I officially hate giving chemo (another story for another day…). And, I get to continue teaching, which is my newfound love. I’ll be continuing as a clinical instructor in the same class I was teaching this fall, and I’ll also be a lab CI for the students’ health assessment teaching time.

But first I pick up some extra shifts to make some much-needed $$$ and then S and I head to Antigua for five days! Couldn’t be better timing … we both need a break from reality!


Nov
06

Thoughts on Brittany’s Choice

Chances are, you’ve heard the name “Brittany Maynard” uttered frequently over the past several weeks. Chances are, your social media feeds have been full of videos, articles and opinions posted about the decision the 29-year old made to publicly share her decisions related to her terminal glioblastoma diagnosis.

Chances are, you have strong feelings about the choice she made to end her life over the weekend, utilizing Oregon’s “Death with Dignity” act.

As much as I’m sure Brittany valued her privacy, I appreciate her giving a voice to this debate, for coming out and sharing her story, in the face of strong criticism. In many instances, her experiences have sparked a healthy and important debate, from the philosophy and ethics behind the death with dignity concept, to whether there should be a distinction between how Brittany died and other forms of suicide, to whether we have over-idealized death. It has certainly led to conversation about whether death with dignity legislation will reach beyond Oregon, Washington, and Vermont. It has also raised awareness about the important and thought-provoking work of Compassion & Choices, the organization that advocates on behalf of and directly supports terminally ill patients throughout the country.

I’ve also been disappointed (but not necessarily surprised) about the vitriol and judgment that has come across my computer screen..I won’t dignify this hatefulness by linking to it, but you wouldn’t have to look hard. I was shocked to hear a hospice physician declare that she didn’t understand why Brittany wanted to “off herself just because she had a terminal diagnosis”. I feel compassion for the patients with their own terminal illnesses who came forward and begged Brittany not to end her life. I was amused by the comments on Facebook and Twitter that we live in a death-obsessed society, when in my experience, it’s been exactly the opposite.

The reason we struggled with Brittany’s public (and in my opinion, courageous) choice was exactly because we don’t know how to talk about death.

In an era of medical technology that far surpasses the imagination, accompanied by a religious movement that believes that cures for cancer come from prayer, we don’t like to acknowledge that we will all be there someday. We use terminology like “battles” and “courage” to describe those who pursue aggressive treatment, sometimes at all costs. Then we turn around and call people like Brittany Maynard a coward for acknowledging the inevitable and going out on her own terms, after she crossed off the last item on her bucket list (a trip to the Grand Canyon) and after she celebrated her husband’s October birthday.

Working in palliative care and hospice (and with a background as an oncology nurse), I’ve seen “good deaths” and “bad deaths”. But the important lesson I have come to understand is that I don’t get to decide what makes them “good” or “bad”. I may have emotions or opinions, but it isn’t my death to face. And when the time comes for it to be mine, I can only hope that I live in a state that gives me the freedom to face death on my own terms, in my own home, surrounded by my own family.

Death comes to us all, whether we like it or not. I’ve often heard fellow hospice nurses refer themselves as “end of life midwives”. I think this is quite poignant. Just as coming into this beautiful world need not be medicalized to the hilt, neither does leaving. We can love our lives, we can cherish our loved ones, we can grieve for ourselves and for what we might miss when we finally say goodbye. But the truth is, we will all be saying goodbye at some point. How (and with whom) we choose to say it is our last chance to make a choice.

And what a profound choice that can be.


Oct
31

Product Review: Tafford Plus Size Scrubs

I am constantly in the market for scrubs that are comfortable, fit well and will effectively cover me when I’m on my feet for 12 hours.

This is not an easy task when most scrubs retailers feature models who wear a size 0 and make it appear as if you could run a marathon in their trendy low-rise, cargo pants. Here’s a hint: Trendy low-rise cargo pants may look cute but they’re not so helpful when you’re in the midst of a code, doing chest compressions on a patient who fell out on the floor. Trust me, I’ve been there.

It’s fun to look nice, but nurses need scrubs that will stand the tests of time and rigor (and hopefully look nice as a bonus). Add a few extra pounds to the equation and it gets even more challenging.

So when Tafford Uniforms contacted me about trying out a pair of their new plus size scrubs, I jumped at the opportunity. On the Plus Size line’s website, I read that they emphasized slimming lines through color blocking and strategic seam placement, elastic smooth waistbands, full coverage sleeves, and longer length tops.

I was not disappointed. I went with the comfort waist flare leg scrub pants in black (to potentially go with other scrub tops in my closet), and the color block V neck scrub top in “Coastal Surf”. Here is a nice video (with Tafford’s permission), highlighting the features of this particular duo:

My only concern about the top I chose was whether it would be too low cut – a common issue for busty girls everywhere (amiright, ladies?). I need not have worried – apparently whoever designed this line knows our plight, and I felt covered.

I was told that the scrubs intentionally ran big in order to accommodate variations in size and shape. That wasn’t my experience, however. I found that the sizes I ordered (which were my typical sizes these days) fit me just right, except the pants were too long. This is not a new issue for me, as I have had to hem almost every pair of scrub pants I’ve ever bought. I really must learn to sew…

What I really loved about these scrubs:

  1. The full coverage. Not only were “the girls” well concealed, but the top was the perfect length to prevent riding up from the back or the side.
  2. How the top felt breathable yet sturdy. I could wear this in the middle of a North Carolina summer and not feel stifled to death. But it also neither felt nor looked like it was going to fall apart at the seams.
  3. The color. “Coastal Surf” turned out to be a beautifully rich aqua green. Even my husband commented that he really liked the color when it came out of the box.
  4. How the pants did not feel like they would drop the minute I bent over or sat down. I trust that in the aforementioned code scenario, I would remain appropriately dressed.
  5. The flattering cut. The first day I wore these scrubs, I can’t tell you how many people complimented me and told me how flattering they looked.

My only (minor) complaint was that they didn’t offer varying pant lengths. Again, my fault for being a shorty, but I think it would be helpful to acknowledge that plus-size girls can sometimes be petite as well.

The final test…would I buy another pair for myself? And that answer is a resounding YES! I was pleased beyond belief with these scrubs, and delighted that someone has finally gotten a clue and designed a line that is both flattering and appropriate for busy nurses of all shapes and sizes.

*Note: All product reviews are my opinion and mine alone. I was not paid or perked for this review, except for receiving this product for my personal use, so that I could offer honest and informed feedback.


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. 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…

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