Thanks for making my 12+ hour shift worth it by Linda Chu

It was a Saturday morning, I got called into work for the day due to some emergency surgeries that couldn't wait till after the holiday weekend. It was my second case of the day. 

You were anxiously waiting on your gurney for me and the rest of the operating team to arrive. This was your first surgery and you were quite nervous. So I took my time to understand your concerns and explained to you exactly what to expect in the operating room. I made small talk with you on the way to the room and talked to you until you went off to sleep.

Surgery went just as planned. We finished and took you over to the recovery room. You opened your eyes and right as soon as you saw me, the first thing you did was thank me. You said that surgery was exactly how I described it and that I was the best. And then went on to repeat this about five more times in the next two minutes. 

I laughed it off at first, but soon came to realize how the couple of extra minutes I had taken had made such a positive impact on you. Looking back on it now, I am the grateful one. Thank you for making my 12+ hour day worth it today and everyday.

 

About Author : OR Nurse, @lalalinddaaa

Bullying: The Culture of Nursing

Bullying: The Culture of Nursing

Katie Duke MSN, ACNP-BC

  

Bullying is an everyday occurrence in nursing and health care. Nurses bully each other. Physicians bully each other. Supervisors bully employees. This often leaves us wondering how is it that people in an industry centered on service, compassion, and patient care can be so awful toward each other. Are we burnt-out caregivers? Is this our way of “venting” the chaos and emotional strain that we endure on a daily basis? 

There is nothing that irks me more than bullying in nursing. Even after 10 years, I have occasional run-ins with bullying by nurses and providers that I work with. It’s a harsh reality of our profession. Bullying is something that we together can work to stop. It starts with developing and encouraging a culture of no tolerance. This must start with education. The solution starts with you. 

 
   

If someone is bullying you—gossiping about you, grumbling about your work, or giving you attitude—it’s up to you to have the courage and professionalism to not tolerate it. You should confront them in a professional and appropriate manner. If you don’t make the effort to stick up for yourself, who will? The only way that we can start this new culture of a bully-free environment is by standing up for ourselves. However, there are effective and not-so-effective ways to go at it. 

Here’s what I recommend… 

  • COOL OFF. Don’t react in the moment. Wait until you can look at the incident or behavior objectively, without being angry or emotional. 
  • ASK TO CHAT. Respectfully request a meet-up with your bully at the end of the shift or another convenient time, and set a place where there won’t be an audience. Do this outside of the patient-care area—perhaps in a manager’s office or a neutral space. 
  • ACKNOWLEDGE EXPERTISE. Everybody brings something to the table. Flattery won’t get you anywhere, but be clear that you recognize the bully’s professional qualifications and experience—of whatever length, especially if the nurse is senior to you. 
  • POINT OUT ALIGNMENT. Include something like this: “We both chose this profession because we believe we can care for patients and we can improve well-being. That’s why I’m here. I’m sure that’s what motivates you too.” 
  • FLAG THE BEHAVIOR. Be specific and brief about the incident, point out what happened, how it made you feel, and why it was unhelpful. 
  • BE CLEAR ABOUT R-E-S-P-E-C-T. Be clear that you don’t mind feedback from coworkers, but you expect professionalism. “I’ll be more likely to meet your expectations and be more helpful if I don’t have to separate the message from all the negativity. I expect respect.” 

  

Again, confronting a bully is never easy. Make sure you document the moment too, by writing down what happened or having a conversation with HR or your supervisor (assuming that person’s not the bully.) But most important is connecting directly with the bully and being clear that you have too much respect for yourself to let them get away with the bullying behavior and that you both should focus on delivering the best care to patients by promoting a positive and well-flowing work environment. You don’t have to be friends, but nobody should be walking on eggshells every shift. 

 

 

 

 

 

It Could Have Been You

It could have been you. It could have been your shift. It could have been your department. It could have been your license on the line. And if it were you…what would you do? Would you stand firm in your convictions? Would you hold your ground? Would you support the patient on the stretcher who – in that very moment – is at the mercy of whatever you might allow? 

 

It could have been you. And not just a Caucasian female version of you: but each and every race and religion and gender and color and creed. It could have been you in a rural community hospital. It could have been you in a level-one trauma center. It could have been you on a slow Sunday morning or amid the heat of a busy weekend streak. It could have been you caught up in a moment, dealing with a scenario that forced you to remain cool. It could have been you with the backup of your colleagues. Or it could have been you – somehow – all alone. What would you do when your ethics are questioned? How would you react when your patient is on the line? Because Alex Wubbels is all of us: and admittedly, she composed herself better than many of us could or would or, arguably, should. Alex Wubbels used policy and professionalism to protect her patient and her practice, and was granted handcuffs in return. As nurses, we go hand-in-hand with our brothers and sisters in blue: yet the law enforcement officer chose cuff-to-wrist instead. I will not speak of that officer’s name, the one who is currently enjoying a paid vacation while a “formal investigation” is conducted: but he, who wielded his authority in the form of abuse – he respects not us in white, nor represents those in blue. 

 

Justice for Nurse Wubbels is justice for all of us: for a profession that bends to the breaking point day after day; for a cohort who flexes on issues shift after shift; yet somehow manages to come away unscathed. Not anymore. Now we are wounded. Now we are burnt. And the excuse here is not psychological illness or progressive disease or an altered mental state: rather, it’s a sense of entitlement from a position of power that shifted advocacy into assault. 

 

We feel the sharp sting of cold metal on our own wrists. We hear the voice berating us despite calm and controlled attempts to explain our position. We smell the breath of a law enforcement official too close for comfort in a place that is intended to provide nothing but care. But who cared for Alex Wubbels? Who stood up for the nurse? Every single day – every single shift – we bend and we flex and we damn near crack – but who is there to help us back in place? It could have been any of us: any goddamn one of us…and for some, it may have ended worse than others. It’s time for our cohort of nursing professionals to stand together. It’s time for policy to protect those who care for others to be put in place. It’s time for everyone else to care for the nurses.

By Sonja M. Schwartzbach
Find her on instagram @nursesonja

 

Do I really have to go back to school?

When I went to nursing school, back in the dark ages, I had all I could do to earn my Associates Degree. I took three years of pre-requisite courses, and two years of full time nursing courses, which included two to three lecture days a week, and bi weekly clinical rotations, along with whatever other ridiculous shenanigans they drummed up for us, like taking blood pressures at the mall or giving flu shots on the campus green to whomever was foolish enough to accept, this in the name of community nursing. While this was all going down, I was also working full time, since I am fortunate enough to be an independent woman, and unfortunate enough to not have ever won the lottery or inherited a swimming pool full of money. One of my most painful memories in life is waking up at 0330 in the dead of winter to bundle up my two tiny kids, and drive them an hour to my sisters house, so she could watch them (hey! it was free!) while I went to clinical and work. I’d drop them off, and then drive the hour to the hospital, where I’d park down the street (student parking was offsite, and the shuttle didn’t start til long after we were expected to show up), and trundle up to the front doors in my squeaky white shoes and painfully thin student nurse scrubs, eyes burning from the cold and exhaustion, to arrive on the floor at 0645, ready for huddle with my fellow students/sufferers, under the meticulous and unforgiving eye of our instructor, whom I believe learned all she knew from the devil himself. After a full shift of screwing up and trying not to cry about it, I’d hustle out of the hospital, using the long walk back to my car to contemplate the sweet peace of death, and then race over to my own LNA job, for a solid eight hours of the most brutal kind of work imaginable in this field (if you’ve never been an LNA, you’ve missed out on this right of passage). Then, finally, it was home to throw together updates for my care plan due the next morning at 0645. This shizzam was no joke. It went on like this, in one way or another, for years, so when it finally, blissfully ended, and I tasted the sweet freedom of not wanting to throw myself in the ocean every day, I was in no kind of hurry to go back.

I knew, because I had heard from my veteran nurse mentors, that I should start working on my bachelors degree right away. What I didn’t understand at first, that I do now, is that earning your BSN is essentially the difference between nursing as a profession and nursing on a technical level. This, in my opinion, is a really grey area, since I would consider my scope and understanding at this point to be developed on a much more usable, realistic level than that of a freshly minted BSN grad straight off the commencement line. On paper, they have earned substantially more credits and credentials than I have, but, if shit were going down, like a code or a belligerent detoxer looking for trouble, expecting them to handle it based on a degree alone would be unfair and unsafe, a real set up for disaster. When push comes to shove, and lets face it, as floor or staff nurses on the front lines in the hospital, push is doing much more than its fair share of shoving, I want the AD nurse with ten years of experience in my corner before I would expect the one year BSN grad to take charge. Give them five years, ten years, and yes, there’s a more comparable level of understanding. Most of the stuff we need to do to really, really run the show, you can’t learn in school, no matter how long you go or how intensive your training, or how high your degree. No one in school tells you how to phrase your request for an order to get exactly what’s safest for the patient, i.e., exactly what you want. No class is going to teach you that if a patient really, really needs a foley, its better to ask for forgiveness than permission. And certainly no where, no how, is anyone ever going to tell you about the “nurse dose”. No degree of any kind is a better teacher than experience.


So the question though still remains, why am I going to go back to school now, after all this time, when I am happily employed and doing a damn good job without it? The National Advisory Council on Nurse Education and Practice recommends that, because of the increasingly complex demands and ever changing landscape of todays healthcare environment, at least two thirds of the nursing workforce be educated with a BSN or higher. I couldn’t tell you what difference that higher education would make, since I don’t have it. But the demand for specialized nursing, such as clinical nurse leaders, nurse practitioners, and advanced practice specialty nurses, is growing at a rate that far outpaces the available talent, so someone has to go get that BSN. The US Bureau of Labor Statistics indicate that nursing, specifically registered nursing, is the field set to have the largest job growth between 2008 and 2018 (a fact you can verify on their website just like I did, if you are so inclined), and also to experience the largest shortage, by just over 250,000 able bodies shy of the number needed to meet the healthcare demands of our increasingly sick population. With this in mind, does it matter if I have my ADN or my BSN, so long as I can recognize a patient who is on the verge of physical crisis and act accordingly, as well as provide quality care for a variety of conditions in a fast paced environment? Is it ok to be happy right where I am? Am I not fulfilling a social obligation unlikely to see an end? In other words, is my role as a less educated but more experienced nurse not equally valuable?


I could solve this problem like I solve most of the ones in my life, and ignore it til it goes away. But if I really give it some thought, the best reason for me to continue my education would be to set an example. For the younger nurses, the newer nurses. The LNA’s and the techs considering nursing. To show them that continuing to learn and grow and develop as a professional is just as important as showing up every day and doing the job you already are good at. To validate the importance of what they have done, rather than trivializing it with the attitude that it doesn’t make a difference. The field is ever changing, and the requirements, the protocol, all of it will be different, and we can either go with it, or risk being “that nurse”, the one on the unit who’s been there since they poured the cement for the foundation, who has a bunch of dusty stories about the “old days”, (“when I was a new nurse, we didn’t have real needles, we had to whittle our own! We had glass bottles for everything, and when they broke you saved the glass to cut things because we didn’t have scissors either! We calculated our drip rate on an abacus!”). I actually like these stories, but I also know that we do ourselves a disservice by refusing to adapt, because its our own research and innovations that create the change we see. The autonomous nature of nursing means that we drive our own scope, we shape what it is now and what it will be in the future. We owe it to ourselves, and those who follow after us, to be as equipped as possible to handle what lies ahead. Now make no mistake, I don’t want to go back to school. Not even for a second. Nothing would please me less than that. But will I do it? In all likelihood,yes. Because I appreciate the greater good of what I do enough to tough it out. Because being a nurse means doing what needs to be done, regardless of whether or not its pleasant, or fun, or even a little bit easy.


If you really think about it, the individual pieces of our job can downright blow. I mean, does anyone look forward to an enema? “Oh boy, I hope I get to take a bath in poop water tonight!” Or putting in a catheter? “You know what would make this day brighter? A trip into a cavernous vagina!” Or placing an IV in a patient with no veins? “Well, since I’m not doing anything else, I guess I’ll poke this guy with a needle to see how long it takes him to get pissed off and punch me!” Nope. It’s a no to all of that. It’s the reasoning behind these agonizing little tasks that makes them worth doing though. And the same is true of earning the BSN. In no way will it be enjoyable. But in the end, its worth the doing, isn’t it?

About Author : @rn_mfkrs_

Day shift vs Night shift by RJ Austin

Why I'm qualified - I'm a mobile pool nurse. For those of you that don't know what that means, please allow me to explain. I work for a hospital system that owns several hospitals. So I give the staffing coordinators my schedule for the week and every morning or evening, depending on what shift I work, they call me around five thirty and tell me which lucky hospital and what floor I'm going to be saving from being short staffed that day or night. And yes I do work both shifts, depending on the needs of the hospitals that day. So I guess you can say I'm bi. Bi-shifter, get your heads out of the gutter. I know what you're thinking; I do have a girlfriend and she is a nurse as well. Okay, maybe that's not what your thinking but whatever. You can't blame a motherfucker for trying. Enough about that though. Let's get down to business. 

My whole point to this is that, since I am privileged enough to work both day and night shift, I can give you my most fairest and honest opinion on which shift is better, and why. So here goes nothing. I really hope this helps everyone. And if it doesn't then leave a comment or question so I can directly address your bitching.

Day shift - Ok so let me put it to you this way. When I go home, after working a 12 hour day shift, I have to have my feet rubbed because I haven't had a chance to sit the fuck down the whole time. Unless you count charting in the bathroom. Dropping a deuce while I chart Mrs. Smiths rushed and half assed head to toe physical assessment isn't the most ideal way to chart but I've learned to improvise. Just like I've learned to tell the charge nurse I have to go on smoke break because somehow they understand I have an addiction problem and this kind of break is excusable even though I don't actually smoke. All this being said, at least I have the option on day shift to go out after work and have dinner with family and friends like a normal human being. That is, if I wasn't so fucking tired from getting shit on for 12 hours on the day shift. All the accu checks, procedures, families, PT, RT, doctors, clergy and that fucking therapy dog, Romeo, that ate the Xanax I accidentally dropped on the floor when it popped out of its, next to impossible to open with gloves on, packaging. And why the hell is management ignoring my suggestion to give all day nurses Segways? But whatevs. Let's move on to that other shift.

Night shift - This shift starts sucking cock as soon as you get in your car to go to work. Mid day traffic has me wanting to ram my car into the car in front of me. But since I'm in stopped traffic I can't gain enough speed to do any real kind of damage because the car in front of me is only 5 inches away, so I just sit there and cry instead. Oh, and morning traffic can suck my cock to. All I want to do is go home in a timely manner so I can avoid the full intensity of the sun before it reaches the top and hurts my night shift eyes. Opposite of day shift, when I go home from a night shift I have to have my ass rubbed because I was fortunate enough to sit on it for eight out of the twelve hours. And I know you're thinking, that doesn't sound too bad but fuck yeah it is. Have you ever tried to fight the sand man from about three in the morning to the time you lay your head down in bed at home? Snug as a bug in a rug? Okay then, shut the fuck up. Not to mention the fact that I just shaved 5 years off my life for picking this shift but whatever, that shift differential is fucking worth it. And there's nothing like hanging out in Walmart at three in the morning on your days off because that's the only thing that's opened and all your friends did the right thing and picked the day shift. 

So in closing win the lottery. I guess both shifts have their advantages and disadvantages. I hope that I've made your decision, at least a little bit easier. If not, you can just be bi like me and really mind fuck your Kardashian rhythm. 

Thank you. 
Peace be where you want it to be.

About Author : My name is RJ Austin. I'm an RN for over 10 years now and an author for 2. I just published my third book and still continue to work in hospitals as well. Ig @rj_austin_

Can't forget that white dress by Liz Zimmerman

I was a younger and naive ER Nurse in the U.S. before I decided to take a LOA to be a missionary nurse at a small charity hospital in the Kathmandu Valley of Nepal on the eve of my 24th birthday. Thought I knew everything with 4 years under my belt in critical care/emergency nursing...I was so wrong. During 2014-2016, civil war had broken out in the kingdom of Nepal between the monarchy and Maoists. In and around our tiny village of Banepa, suspected Maoists would disappear from their homes in the middle of the night or worst yet, their lives cut short and their bodies discovered on the trails during early morning runs in the hills. Bombing and curfews were common occurrences during my year there. It was a scary time. I complained so much about what we didn't have at our charity hospital and the frustration grew, until one beautiful spring day, we had a massive MVC happen close to our hospital campus : commuter bus vs. a taxi cab carrying a family. Having practically nothing, the entire ex-pat and local medical teams within our inky-dinky hospital pulled together everything and everyone we had to care for the injured and dying. I'll never forget my patient, a 6-year-old girl, who was found unresponsive and listless in her blood stained white party dress. She and her parents and siblings were all in the taxi cab heading to a picnic before they were hit by the bus. I was 1:1 with her, trying to maintain her faint pulse and treating her open CHI. There weren't enough doctors and none who had trained specifically for trauma. It was my day off and dressed in sari (I was at church when I got the call), I tried to "Macgyver" a make shift backboard made of plank wood, rolls of hand towels and masking tape to stabilize her. Working as fast as we could, the medical assistant, pediatrician and I worked on this little girl until she could be stable enough for the bumpy ambulance 1 hr ride to the city hospital in Kathmandu. It felt like moments but we worked on her for at least an hr before transfer, her mother screaming in Nepali above all the noise and chaos of our makeshift ER. To this day, I can still hear her mother's screams. After we had either stabilized, admitted, transferred or put in body bags the rest of the patients from the MVC, I remembered to consciously breathe. I had a tear in my sari and sweat dripping from my face. I looked over at one of the tables and I saw my 6-year-old patient's blood stained dress we had taken trauma shears to. During those hours we treated trauma patients, I had not felt anything until I saw that torn dress. I looked around the entire team with worry, exhaustion and sweat on their faces, who had pulled together through the lack of resources to do the best we could with what we had. And for the first time that day, I cried until I had no more left in me.

It's been 12 years since that day. I'm an ER Nurse manager now. I still remember that awful day in Nepal because it will always keep me humble and grateful for what I have. I'll never forget that little girl in her white party dress.

 

Liz Zimmerman, MPH, BSN, RN, NE-BC

On Burnout by Catherine Rutherford

Heads up, this story is pretty negative. I recently moved back to my hometown. I have yet to start looking for a job here, because my first job as a nurse was so terrible that I hate even the idea of being a nurse right now. I am so burned out from the 2.5 years I spent on a Transplant unit in southwest Ohio that I am afraid to even interview for another nursing job, even at hospitals that I know and love, ones that shaped me in clinicals as a student nurse. When people like ZDogg, MD bring to light how absolutely horrible it is to be a nurse right now, they aren't being whiny or negative. They are speaking the uncomfortable truth. Why do you think so many people want to work in clinics and other outpatient settings? Bedside. Nursing. Sucks. I stepped out of my orientation onto a floor that had been, and still is, woefully and chronically understaffed. In my two and a half years I saw 42 nurses come and go. I'm not kidding. Some there 10 years before they couldn't take it any longer, some there 10 weeks. My normal shift was at least 5 patients to every nurse. Most of them surgical. Most of them too stable for ICU, but too acute for the floor. Imagine a stepdown full of nurses who don't know they work on a stepdown. It's a miracle we didn't have more codes. If we were lucky we would have 1 tech for 24 patients. They'd take 12 patients so you'd only have to worry about doing absolutely every part of your patient's care for 2-3 of your patients. Many nights we had no techs. Many nights we lacked 2 or more nurses. Many nights we would fly by the seat of our pants and give our patients adequate care, at best. Many nights we would put our licenses in jeopardy. Our manager was a hot ass mess, to put it mildly. Known for calling at night while drunk "to check on us" she would rattle off excuse after excuse when we begged, pleaded for her to find us more staff. The nurses' union we belonged to was equally a mess, taking money from our checks and offering nothing in return when it came to advocating on our behalf. New grads who had been on the floor 5 months were forced to be charge. There was no training provided. Imagine your loved one trying to recover from a transplant on a unit with 4 nurses for 24 patients, where the charge is a 23 year old who's been a nurse for less than half a year and is still the most senior on the unit. Complaint after complaint after complaint fell on deaf ears. What had started as a rewarding and educational experience quickly turned into a contest to see how fast you could pass your meds and how much of your charting you could guesstimate once you sat down at 9 am. The patients did little to help my quickly darkening outlook. I will never forget the man who showed up drunk for his liver transplant. Or the woman who took her new kidney for a test drive by refusing to take her anti-rejection meds. Or the frequent fliers, good lord, the frequent fliers. There was the HIV/HCV + patient with severe bipolar who enjoyed skipping dialysis and throwing blood soaked tissues at the staff. The angry old fart who raised his cane to hit me while I stood by his bed, 9 months pregnant, explaining that he was a fall risk and the bed alarm was a necessity. Don't get me wrong, there were good patients. The kind who laugh with you, thank you, nominate you for Daisy's and reaffirm your feeling of self worth as a nurse. But those were few and far between. I could go on and on. I share this to say, burnout is real. And it is harmful. Dangerous. It chips away steadily at the life force that makes a nurse, a nurse. The compassion, the will to help and understand others. The caring. The commitment. 
For starters, every state needs legislature regarding mandatory safe staffing ratios. Every. State. And I think we can all agree Press-Ganey
needs to get the hell out. These issues are just the tip of a very, very big iceberg. 
So much in our healthcare system is burning us out. Killing our dreams. Preventing nurses from being nurses. And it's a damn shame.

Catherine Rutherford