Making Mistakes

"Anyone who has never made a mistake has never tried anything new"  Albert Einstein

Making a mistake can be an awful blow to the ego.  Making a mistake in nursing can have life changing consequences.  Making a mistake in pediatric nursing can make you the most hated person for the rest of your life!!!  

Yesterday while teaching pediatric clinicals I made a mistake while supervising a student giving an IV antibiotic to a small child.  Yep, the earth stopped turning, my stomach did several somersaults and it kept me awake all night.  Thankfully it was not a huge mistake, I got the right drug, right patient right route (thank goodness) but I calculated the rate incorrectly resulting in IV was done and pump was still running end game.... in air in the line.  It was not me who discovered the mistake but an observant staff nurse.  However, she chose to take her wrath out on the student and when I stepped in and said its not her fault at all, totally me, I was supervising her.  I then encouraged the staff to make this a teachable moment and go step by step through how to calculate the rate so (me) and the students will hopefully not make that same mistake again.

The student was mortified but in post conference I reminded them that everyone makes mistakes.  Most nurses have made med errors and if they deny it they are lying.  I remember the first time I made a med error I did not sleep for 3 weeks!!  The point is we have to at all costs prevent mistakes through careful teaching and supervision but it's going to happen.  So let's create an environment of "no fail", where its only a failure if you don't learn from it.  I have made many mistakes as a novice and seasoned nurse and there is really no point hiding from it, or getting defensive.  You just have to swallow big, own the mistake and move on.  It still hurts though, spend the night asking myself how did I make such a simple mistake?  How arrogant!!!  It happens to us all, we all have an off day.  

If you see one of your colleagues making a mistake of any proportion say to yourself "there but for the grace of God....."  Embrace them, sympathize, empathize, learn and move on.

Have missed blogging for a couple of weeks, got totally caught up in that holiday called Thanksgiving.  Young adult college age children came home which also means their entourage arrived shortly thereafter.  I love having young adults in the house, spent my time making bacon everything, filling/emptying the dishwasher, folding laundry, picking up beer bottles....you get the idea.  It was heaven, I loved every minute of it. 

Now thankful for a day when I can sit in my office with my buddy (the puppy) and get stuff done as the snow falls heavily outside.......a perfect day.

So....know there is life after you make a mistake, it may even make you a better clinician.

Taking a Breath

Taking a breath sometimes..no often; is essential to create that balance in our lives.  It is something I always seems to be striving for but never quite attaining.  I recently was approached to act as a nurse consultant to a medical health care advertising company for a project they are working on for a major pharma company.   It would involve me stepping away from community health for a while.  All of a sudden that seemed like a very attractive proposition and I realized I needed a break more than I thought I did.  Like most women I think I am superwoman Mon-Fri, then your diet goes to hell in a hand basket because you have less time to organize the pantry, then the fitness regime you promised to follow starts to teeter, then the sleep pattern goes and well, then its all over, you may as well ask the men in white coats to come and take you away in straight jacket!!!  This epiphany came just in time, during a recent trip to see my college age children they informed me that when I am over committed (like all the time!) I range from nasty to an extreme micro manager......really.......and I thought I was handling everything so well!!!

So, I took the option not to renew my contract with the home health agency I have been working with for the past 3 years, put on my corporate clothes (dug them out from the back of the closet) and went off to my first meeting.  Intimidated?  Oh yes, these ad agency creative types are way above me in terms of creativity and dialogue, but during my first meeting I realized we were talking a similar language and our mutual link of health care gave us more in common than I thought.  I have really enjoyed working with this group, not sure where it will go as it is a contract position that could be short or long lived depending on the success of the project.  

I was also asked to pick up an extra clinical teaching day for a colleague who had to go out sick for the rest of the semester.  More students, mentoring and coaching the next generation of nurses, bring it on.  So far they have proved to be a promising and lovely group, I am enjoying them a great deal.  So even though I am still working several jobs, apart from 2 days of teaching I am at home telecommuting and I love it!!  I love the flexibility, I love the fact that I do not quite know what I will be doing after Christmas.  I love the ability to breath a little and recover from that burnout that we all experience every now and again.

Only a week until the kids come home for Thanksgiving, it has to be my favorite week in the whole year, hanging out in our pj's, eating bad food and lots of it and crazy hours of the day and night.  And then packing everyone off back to school with all the leftovers.  Cannot wait!!!  All I need now is a huge snowstorm and I will be extremely happy.

Nursing is like a Hurricane

We have just survived hurricane Sandy.  Compared to our neighbors in New Jersey our experience was the inconvenience of being without power for 48 hours and some minor cosmetic damage to the front of the house.  We are lucky to live in a community where we have close friends with power so at least we could get a hot shower and local coffee shops where we could plug in and stay connected.  But still it disrupted the week.  From a work point of view not much got done, although I did get a 1000 page novel read that I had been meaning to do all year!!  Sleep was not great as it was sooo cold, even with the dog in bed as a foot warmer!  And there was a general feeling of not being in control, of wishing, hoping the power would come on NOW!, and even a rumbling panic of what if the power does not come back for days and days.

When patients become a patient they must feel like this.  A loss of control, someone else is in charge of their destiny for the course of their treatment.  A patient is at the mercy of the medical team and their decisions of what/when care will be administered.  At pediatric clinicals yesterday this was highlighted for me.  A parent had been visited by her medical team at 6.30am (usual time for rounds!  really... busy days of clinic surgery mean an early start).  The team decided her child was well enough to go home.  Well, by 11am the discharge process had not even begun as the doc had not written the order.  Mom was going nuts, as she had other kids at home to care for and was being told if she just walked out ( I could see she was tempted) she would be leaving against medical advice, therefore risking the wrath of the medical team and social work (more aggro than she was willing to take on).  I could see the medical teams point, on a priority list this was low on the totem pole, especially on a week where staffing members were down due to inability to get to the hospital (I have lost count of the number of fallen trees on power lines around here).  But also I had great sympathy/empathy for this parent, we are here to serve her family, not just her child and I am not sure we were doing a great job of keeping her in the loop of communication and hustling the discharge process along better.

When a nurse joins a team she/he may feel like the power went out in the hurricane too.  So many unknowns, what is the culture of the team/organization.  Will people like me?  Will I be competent?  Will there be someone who will show me what to do (for weeks or months if needed)? Will there be that safe person I can ask all my stupid questions to?  Then there is the lack of control over work schedule and assignments, coming to work early, staying late to do paperwork, dealing with the difficult patient, family member, staff member!!  Dealing with the truth that we do not always make it all better and some patients get worse and die, and dealing with our own emotional grief and physical exhaustion throughout that.

Wow, I just reread that last paragraph and wondered if this is truth why would anyone want to be a nurse! However, many have had an incredibly rewarding life in this profession, myself included.  But it is OK to admit the rough stuff, to get it out of the closet of perfectionism.  Over the years you build resilience as a nurse, I am not sure if resilience can be taught but it certainly comes with experience. 

On the 48th hour exactly without power the lights came back on in my house, very very happy.  It was an rough week even though all we really experienced was some minor discomfort but it gave me a greater perspective to not dwell on the small things, I mean really, does it really matter if I cannot log onto Facebook?!!  And to dwell and prioritize the important stuff, family, great friends and work that I love and despite all the thorny points cannot imagine myself doing anything else but staying in Health Care.

Burn Out and Bullying

Did you know the term burnout was first used to describe exhausted an disillusioned health care workers in the 60's, it certainly was a very relevant term.  As nurses it is not uncommon for us to suffer from burn out at some point, this condition is especially prevalent in high acuity areas such as the ER, ICU and Oncology but I think you can suffer it in every speciality, certainly more so if you have one of more bullies in your team!  At a time in nursing when nursing informatics is changing the face of clinical care so much (really when I walk on the floor now often nurses are glued to computer monitors and smart phones and not walking the halls and talking to each other!), and we are being asked to do more with less, who would not get burned out.

For me it is cyclical, I can have peace and harmony for a while then juggling all the different roles I have, clinician, nurse educator, consultant suddenly tumbles like a good game of Jenga and I have to step back and breath a little.  For me that means slowing down, making sure I get to that kickboxing and yoga class (really, it helps sooo much), get a good nights sleep and take care of my diet.  Small changes somehow make me feel a little more in control of the chaos that surrounds me, let's face it, it surrounds us all.  My family always knows when I am super stressed as I am in the kitchen making a dinner that Julia Child would be proud of.  Somehow creating something nutritious centers me, not surprisingly the family are not too upset when I get stressed......they know they are going to get fed.

Taking a step back and taking care of myself also helps me put those bullies and the control I am allowing them to have in my life into some perspective.  As I hinted in my last post a bully usually lashes out because they are operating from a place of pain, insecurity, surely someone who is that nasty must be in personal pain of some kind.  It allows me to think compassionately about that toxic person in my life without condoning their behavior and reestablish good boundaries, so I do not let the bully bother me so much and let them know how little they may get away with at my emotional expense.

The last couple of weeks have been that crazy for me and this week even though I perceived I had no time I walked the dog around the reservoir and just took in the colors and the great weather, went that extra mile at kickboxing (boy does it make me sleep better) and determined to make that yoga class tonight before my 4.30am start tomorrow for pediatric clinicals, which is going really well.  Heck I love students.

I promise this is the last post on bullying for a while but probably not the last word on taking care of ourselves as nurses.  We have to give ourselves permission to put ourselves first for at least 5 minutes a day and have/be a great day!!!!

Bullying In Nursing Culture Part 2

There is a point when you get way into your 40's (like me!) that you hope all the bullying and passive aggressive remarks in nursing will 1. Disappear or 2. Float off your back without sustaining the sting they intended.  Sadly I have more luck of the sun not rising in the morning.  Let's face it, we are a female dominated, dysfunction relationship, sad example of girlfriends gone toxic.   

My husband who is very successful in business can have a heated discussion with a co-worker and then go out with him for a beer.  I can interpret the most innocent of remarks as an attack on my performance, intentions, work ethic and character and not sleep for a week!!  This is because men are able to compartmentalize professional and personal and women cannot and therein lies part of the issue.

I was once a part of such a dysfunctional team that management forced us to do group therapy....yep that was about as much fun as cleaning up an over full exploding colostomy bag!!  But I do remember one this the therapist told us.

"Think the best of me and I will think the best of you!"

I have tried (not always successful) to apply that to my work relationships.  Maybe if that colleague called out she really is sick, maybe when your co-worker gave you the stink eye she was thinking about other things like troubles at home, maybe when your team mate snapped your head off it was because her to-do list is so long and she has not slept in 2 nights as she was up with her baby who is teething.  Who knows what the reason is, but the point is peoples bad moods and reactions to us is not always about us and so we should try and take the high road and focus on what we are doing right and not on that one thing we may have done wrong or that one thing that your co-worker wants the whole team to know you did wrong!!

We cannot change the psychosis of bullying within our profession over night but we can start with us.  Chose to be kind, chose not to participate in the gossip, in fact flee from it and make it known you will not participate.  Set an example for the novice nurse and the nurse who is unable to defend herself.  Be a champion of kindness and let's start caring for each other the way we care for our patients.

Bullying Within Nursing Culture Part 1

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Nurses are often called “Angels”.  This term has made me feel uncomfortable when directed at me.  If that patient and their family only knew all my foibles and judgmental thoughts that go through my head in the course of a day.  However, sometimes we are not very angelic towards our colleagues.   

This phenomenon has many terms these days, nurses eating their young, nurse bullying, horizontal violence.  The good thing is, it is being documented and written about more and more in nurse literature, but is it decreasing the incidence of horizontal violence.

I am sure every nurse reading this can remember a time when they were the victim of bullying in the workplace.  The discomfort of being victimized by this never leaves us.  It can be especially bad for new nurses; at a time when they need to be mentored and supported they are wondering if they made the biggest mistake of their lives by joining this angelic vocation called Nursing?!

I once left a job when the bullying got so bad.  I loved the job, but a few burned out cynical nurses who decided to put a target on my back made life at work so toxic I did something I am not proud of.  I handed in my notice and walked out the same day!  This is not something I would recommend, but the situation had become so bad and once I handed in my notice I actually was in fear of the consequences so I just left and never went back.  Not cool, really not cool but I also have to say it was a vote for my emotional safety and I do not entirely regret it. 

The job started well enough, it was a new area for me but I was eager to learn.  The team were supportive, wanted to get to know me but it was obvious that a few nurses who had been there several years were burned out in the high stress area of pediatric oncology and had become victims to their situation, claiming their victim hood as a source of self-soothing for the daily grind.  It started with the usual gossip of other team members; with things as trivial as a perceived bad hair style to accusations of work ethic (really sometimes junior high never ends for some people).  I tried hard not to participate in these conversations; maybe that was my first mistake and the beginning of the target on my back.  I soon was avoiding coffee and lunch with certain nurses because then the trash talking would get really bad.  It set me apart; maybe they thought I was better than them.  Nothing could be further from the truth, not a novice nurse, but one in a new area, I felt I was drowning in information I did not completely understand and had nowhere to turn.  Physicians were too busy to entertain my frequent questions and certain nurses looked at me as if I was asking yet another stupid question.

Then started the withholding information, a power play that made me feel even more isolated.  Sometimes it was just that almost insignificant team stuff that makes you feel a part of the team, so and so if pregnant, isn’t that great?  Drinks after work, would you like to come?  Then this escalated to the team emails, highlighting that one small error I had made in a very public way. Often they came on a Friday afternoon so I would be in agony about the issue all weekend and dreading going back to work by Monday morning.  

Reasonable conversation helped in the short term but then the abusive behavior would start again.  When I took it to my supervisor I was told I needed to deal with this myself, it was the best way.  I had always prided myself as having good communication skills and not lacking in personal confidence in the workplace and a team player.  But I recognized I too was turning into a victim.  I seconded guessed what I was doing.  Once after I addressed the passive aggressive behavior face to face no one talked to me for two weeks!!! Well, clearly that did not work.  Soon I was crying every day on the way home from work and then I was waking at 2am dreading going to work.  My husband begged me to find a solution. I left but for a long time felt like I had failed in that position, when in reality the organization failed me.  It can be a silent lonely experience to be victimized in the workplace.  Bullies have a perceived power that is hard to come up against, it takes a fair amount of courage and emotional energy to make the daily attack that will enable long term change.

This was my story, everyone has one, and sadly I know this is true.  As I start this series on nurse on nurse conflict I would love to hear your story.  Please email me at angiemiller1966@yahoo.com and I will publish your story, anonymously if you prefer.

·        
        What is your experience?

·       How would you have handled it differently?

·       What tools and support do you think would have made the situation better

·       How can we finally stop this happening to novice and expert nurses alike

Nursing Informatics - Curse or Crucial

As the title of this post may suggest I am having a love hate relationship with technology this week.  However, I learned long ago I better get with the program or I would be left far far behind in every aspect of nursing.  Technology is a fast growing, rapidly essential part of everyone's nursing practice.  From learning to take a blood pressure with the touchscreen monitor at the bedside (first you have to set the right profile, know the right buttons to press, being able to trouble shoot - you get the idea!) to the ipad applications that are just there for those in the health care profession.  Yes, yes I know these tools are there to make my job easier and promote high quality of nursing care, but instead of getting a BSN there are some days I wish I had a degree in computer science!

The online class I teach has just changed it learning environment from EPIC to Blackboard.  Now I had just come to terms with EPIC, me and EPIC had recently become friends, I was able to join the discussion board, use the grade book, send and receive emails all without too much stress.  Now my new love is Blackboard but we are like a dysfunctional couple from the "Bachelor", we desperately want to make it work but we do not really know each other yet, and we are in love with the thought of being together but the reality.....well it leaves me wanting.  Learning a whole new system has seriously slowed down my productivity and increased my stress this week.

The University I am a clinical instructor for recently changed their email server from Outlook to Google.....What!!!!  What was wrong with Outlook, it was an old friend, like sleeping in your favorite t-shirt.  This Google thing is for the millennials, how do I populate my address book,why am I now getting emails from the whole university not just the nursing department.  I am not really interested in who is running for freshman student government (although I am sure it is extremely valid), but now I am getting daily emails from Tiffany, Justin and Dave trying to persuade me why they need my vote!!!

Now don't get me wrong, I am a lover of technology.  In our house we have more computers than TVs, sad fact is you will often find my husband and myself in the evening working on our laptops and ipads spontaneously.  I pride myself on being a multi tasker, I can cook dinner and text my kids with one hand behind my back.  But sometimes technology goes so fast I feel stressed, marooned with nowhere to go.  Thank goodness I have very techy children who are also nocturnal so I can call them at anytime of the night.  Goodness knows how I would have got through grad school without Elliot showing me how to use PowerPoint.

And it got me thinking, nursing is one of those multi generational professions.  We have nurses in their 60's and their 20's who must both coexist with peace in the clinical environment.  And technology can make it hard for those who have not been exposed to it all their lives and fear looking stupid if they ask for help too many times.  In the converse, the older more mastered nurses often do not tolerate the millenials with the insane ability of opposable thumbs and the ability to listen to you while playing on their smart phone!  There must be tolerance both ways because I am afraid my friends that accelerated technology is here to stay.  

All I can say is HELP!!!!!