Knowing Better.....Being Better

 

8 Ways to Become a Better Nurse

Have struggled this week to come up with some ideas for my blog and was kind of down on myself that because I am not doing active bedside nursing right now really I am not a real nurse and have no right to blog about the subject.   Nothing could be further from the truth.  Nurses are more than clinicians in the practical sense and we use nursing in all of our life skills be that teaching, family, executive function, friendships.  Anyways on doing some research I came across this blog entry by Phil Baumann who validated my point that even those of us who are not currently bedside nurses still have a voice and an opinion to put forth.  I know that at the end of every class I teach, every semester, every patient case that is closed I ask myself what did I do well but what could I do better.  In the business of our lives its important to reflect every now and again.



Guest Phil Baumann shares some great advice on how to be nurses can improve their care.

This is a guest post written by Phil Baumann originally posted on his website.

One of the benefits of being away from bedside nursing is that I’ve had time to reflect on my own performance. How could I have been better? What simple precepts would have helped? Being out of the “fog of war” has given me a clearer view of what’s right and what’s wrong in health care. Our culture doesn’t offer much positive encouragement for the nursing profession. That’s a costly shame, as many Baby Boomers soon will discover. To help out, I’ve come up with eight ways to become a better nurse.

1. Pay attention to how you perceive your patients
2. Intend nothing but the best for your patients
3. Speak the truth in a way that echoes your wisdom, not your darkness
4. Act on the facts but respect your intuition
5. Live your life as a connection to something greater than yourself
6. Work through your hardest times, not against them
7. Mind your mind: its power to destroy is its power to heal
8. Focus on the moment, not the past
9. Some of us are cut for bedside nursing, some of us aren’t. I think if you’re in bedside nursing and enjoy what you do then you’re a Jedi Knight who commands more respect than you probably receive.

For those of you who don’t quite enjoy what you do, think about your reasons for what you do. Consider the eight precepts (or make up your own) and see if anything changes for the better. You have more options than you realize.
Feel free to add your own suggestions for becoming a better nurse. If I get to 101, I’ll post your thoughts here and promote the living shit out of the list.
I hope the list I’m offering here helps you to become a better nurse, a better person, a better part of our quickly-changing world.

Thanks Phil........well said!

I'M BACK!!!!!!

So after a bit of a break in my posting due to a technical issues (was locked out of my Blog) I found a college kid (Sam Faulkner you rock!!) who is helping me with a new business website and got me back into Nurseology.  This makes me immensely happy, all I have to do is feed him (college kids love to eat) pay him a small hourly fee and he fixes all my IT issues.  Money well spent and he is available for hire locally or remotely so if you have a need, message me and I will give you his details.

Anywhoo, back to the plot.  Wow I have a whole year-to-date to talk about.  Where to start?  So I took a hiatus from Visiting Nursing this year as I have so many other projects on the go.  I miss the hands on clinical experience, I miss the one on one patient contact and the relationships that I made in the field.  I do not miss being a slave to the schedule, traffic jams, showing up at someones house when you have just told them (10 minutes ago) you are on your way and they have either gone out or will not let you in.  I do not miss being yelled at by family members because I cannot fix their loved one who is in the stage of end-of-life.  I do not miss working with a dysfunctional team (lets face it most teams are).  I love love love working from home, being my own boss and setting my own schedule.  My stress levels went from the height of the Empire State Building to ground level.....that is priceless. So this may not be a forever break from Community Nursing but it is for now.

I continue to teach face-to-face and online.  I taught two clinical sessions for the Philadelphia University I am employed by at a busy city children's hospital.  I had two awesome groups of students, I loved them all.  I have a formula I have developed the past couple of years that seems to work so I build on it.  First of all I think it helps that I really enjoy young adults, but I try to get to know them as people first, develop them as people as well as nurses.  That way I can see their strengths and what we have to work on.  Also, there is much published evidence out there that shows if a student believes the instructor cares about them they perform much better.  Think about the teacher in school you did best for, part of it may have been because you liked that teacher and thought they liked you.  We had our fare share of renal patients, lots of bronchiolitis, babies with GI issues etc.  The basics are great to teach, highlight how to work with the nursing process, document and most importantly build a relationship with the child and the family.  All my students passed their clinical and I hope it was a good experience for them

Online teaching continues.  For some mad reason I agreed to teach for yet another online school.  This was not a good idea as they were not organized, their communication was awful and their students poorly prepared.  It was the longest 8 weeks of my life but we got through it.  I quickly ditched them and told them I was not available to teach for another class.  However I continue with my original school (in Texas of all places) teaching community health, nurse leadership and care of the elderly and love it.  Was able to keep up all my grading and discussion on a recent trip to Rome.....aahhh the beauty of working online! 

So welcome back to my blog, now I am in look for weekly updates.  I missed you guys and I really missed blogging.  Got lots of ideas to rave about for the summer.

Schools Out.....Yeah

This semester was busy, chaotic, energizing, challenging, enriching, involved many 5am starts and a few late nights.  Faculty meetings, exams, student evals.......its all done and I am ready to take a breath.

I feel like a did a bit of everything this semester, I was teaching pediatrics, care of the elderly and nurse leadership, but the basic foundation was there.  I want to know who my students are first and then weed out their strengths and weakness and build on their competencies.  Its interesting to those who know me well because I am not an incredibly social person.  I do not seek out friends, parties and gatherings on my free time.  I hate, detest, abhor Christmas parties, small talk wears me down and I feel overwhelmed in a large group.  However, when it comes to students, I can't wait to get to know them.  Their stories are fascinating, how they operate as individuals and as a group in extremely interesting, and watching the generational changes is something I would like to publish on (if I get any spare time that is!!).  I have mainly millenials but I have also had several students who are second career nurses and their stories are rich and their experience of life seems to give them that extra edge.

One of my pediatric clinical groups was like a meeting of the United Nations, I wondered how it would go.  To be honest it was challenging in places, not only if the student did not have English as a first language but also making sense of the cultural context.  However, I saw tremendous growth in all my students and felt privileged to be a part of their journey.  To celebrate a successful end to the semester all my students came to me for afternoon tea.  Everyone brought a dish to pass, what a feast.  We had cucumber sandwiches, Vietnamese shrimp, Peruvian Chicken, Albanian Baklava and good old American Pizza.  Its so hard at the beginning, its exhausting in the middle when you realise you still have a great deal of semester to go, but the feeling of accomplishment at the end is like no other and motivates me to sign on for another semester.

My online teaching classes also finished up this weekend.  The Care of the Elderly class has a final assignment on grief and the student must reflect on a personal experience they have had with the death of a loved one.  I am found grading this assignment with the dog on one side and the cat on the other, howling my eyes out.  There is something about this assignment that is so raw, so beautiful it gets me every time.  Leadership class was excellent, one day I am going to design a class called Leadership and Professionalism, where the curriculum focuses on how to be a good kind and fair leader who nurtures and develops their staff and works hard at eradicating all that in fighting that nursing teams are famous for (again, something I will do in my spare time!!!)

Next semester I will continue with all four classes but it works out that I am out of the house only 2 half days a week and the rest is completed on line.  Busy busy busy but in a good way.  I feel blessed, enriched by what I do and ready for a break!!!!  Spring semester starts middle of January.  Yeah!

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!!!!