RE:Connect

Working With the Interdisciplinary Team

One thing that I have found to be very difficult through my orientation period in the PICU is conversing with different members of our team, the residents, fellows, attendings and nurse practitioners. It has been hard because when they do talk with me over matters concerning patients, I don't always know the correct answer and I don't want them to think I am an incompetent nurse. I have found that other members of the team will only talk to nurses that they know, even though I am technically the patients nurse for the day. It sort of feels like a slap in the face when they call for patients nurse and I answer the phone and they proceed to ask to speak with someone else. I understand it is hard for someone to take you seriously when you are still learning so much on a day to day basis. But, it has been frustrating because I am wondering when I will ever be taken seriously as the patients nurse. I know my anxieties and fears of feeling stupid will only get better with time.

When you all first started working on different units, how did you overcome these feelings of inadequacy when talking with members of the interdisciplinary team? I know time and experience are the major answers to my question, but does anyone have any advice?

Teetering Work-Life Balance

Anyone else glad May is almost over? Whew! Between graduations, conference season, and proposal deadlines, I'm beat. I very rarely travel for work, but I traveled three weeks in May covering San Antonio, Amarillo, and Houston. Needless to say, all the "other" work didn't stop. When I was in the office, I found myself singing out loud in our building foyer every morning and evening because I was the only one there (and our foyer has some pretty nice acoustics I had never noticed). While I was keeping up with everything work related, I found my family suffering. My two small kids, 4 and 2, were often asleep when I came home, and my husband was beat from chasing after them. As I continue to grow in my nursing career, I'm getting more and more requests to do this and that. Not to mention, thoughts of a PhD are pressing in my mind. And these are only the professional concerns. I had dinner recently with a former nursing professor and mentor of mine, and she reminded me - just say no. She challenged me to take a serious look at my priorities. I did, and my stress level has decreased tremendously. I just love the nursing faculty and mentors in my life! With a new focus, I'm determined to keep my work-life balance in check. Any suggestions for a growing nurse and young mom to keep my sanity? What helps you?

When the Nurse Becomes the Patient

Warning - this is not a post about any new evidence-based protocol or networking possibilities.  I would like to open a discussion about our role as oncology nurses and to what extent, if any, our perspective is influenced by that role in certain situations.

I recently had a close family member with some unusual radiology results.  A CT and MRI both reported a 3cm solid mass involving the head of the pancreas and the duodenum.  It was inconclusive as to the "organ" of origin.  An EGD was clear and he was told that whatever it was did not penetrate the intestinal wall.  Next up was a transesophageal US with needle biopsy (done extremely promptly thanks to a great GI doc).  Funny thing happened - upon US examination, no mass was found.  As an oncology nurse, are you already diagnosing what is happening?  If you did not specialize in oncology, would your opinion be different?

How about this one:  A 38 year old woman with a personal history of fibrocystic breasts and family history of breast cancer finds a new lump on BSE.  The lump is firm, fixed, and non-tender - feeling much different than the cysts she has felt for years.  The mammogram shows something - not sure what as the breasts are dense.  The US reports a 3.2cm questionable mass in the area of the palpable lump.  The breast MRI reports "no areas of enhancement to suggest malignancy" but makes no reference to the suspicious area (ROI - region of interest analysis).  Does your oncology radar go off? 

As specialized nurses, we know the facts.  We know the percentages.  We know what characteristics can be missed and by which tests (i.e. calcifications do not show up on MRI and often mask ductal carcinoma). We advise our patients and navigate them through the process.  But, if you were the patient in either of the situations above, do you think you would be able to separate the patient from the nursing knowledge?  Does our knowledge serve us well or make it difficult to remain objective?  Or both?

Have any of you found yourselves in this situation?  Would you be willing to talk about it? 

Social Networking

Social networking sites such as Facebook, MySpace, Twitter, and blogging have quickly established themselves as acceptable means of communication in our current society. Technology is advancing at an alarming pace and for new nurses and those part of the Generation Y, life as they know it has always included technology and computers. A fellow blogger commented on the benefits of blogging and instant communication/social networking at the recent ONS Congress and while I agree wholeheartedly, as the devil's advocate I must raise the question of how much is too much? I am a thirty something nurse who is technologically capable who can navigate the internet, send a text message, and blog but even I admit that the whole Twitter experience boggles my mind. So much so that I choose not to try to understand it all. Perhaps my close mindedness will also close opportunities for me but that is the risk I will have to take.

I read with interest the "Ask a Practice Consultant" column in my professional nursing journal last month where a staff nurse voiced concerns over a colleagues posting on Facebook about comments and frustrations about their unit manager and some patients on the unit. She asked whether or not this posting posed a professional problem? I really related to this question because it is such a timely and topical issue. The information in the response letter serves as a reminder for all nurses and included a reminder that information posted on the web while often considered private is not. Identiying information may breach an individual's right to privacy. It is important to bear in mind that while some may feel 'safe' to post information on their 'private profiles', once posted it is part of the public forum and network security settings may not stop others from viewing it. The article gave a general rule of thumb that when posting: do not post anything on the Web that you wouldn't feel comfortable posting in the lunch room at work.

As I sit here at my desk and blog, I can't discount or devalue the benefits and importance of social networking sites, cell phones, and technology but I post this article as some food for thought.

Vanilla Ice: Organizational Behavior Expert?

I just finished reading Lara Gaston's, RN, BSN, BSEd, May ONS Connect article, "How Can Generations of Nurses Learn From Each Other?" (I know I'm a bit behind. Humor me.) As a young oncology nurse myself, I loved reading her experiences with nurses in other generations. I couldn't help but laugh out loud in regards to the differing communication styles and her solution: "In the words of Vanilla Ice, we needed to 'stop: collaborate and listen.'" So true - in practically every setting.

It's definitely not easy working with three and four generations in the workplace. I've had my share of challenges - like the first time I was the night shift charge nurse alongside nurses who had been in nursing longer than I had been alive. Yeah, that was special. Actually, I loved nursing alongside them. We taught each other a lot. As a young manager, I still encounter these kind of moments...I'll save those stories for another day. The positive experiences far outweigh and outnumber the not-so-great experiences, though. Next time you're working with several generations, organizations, or really anyone, think Vanilla Ice. Stop. Collaborate. Listen. I know I will.

I know I'm not the only one, so let's hear it. What are some of your most memorable and educational moments working with other generations?

Oncology Nursing Month

Hello all,

So, what are you and/or your institution doing for Oncology Nursing Month?  Has the economy effected the celebration?  If you have been busy (like that could ever happen!!) and let time slip away, you still have the opportunity to recognize oncology nurses in May 2009.

If you aren't certain what can be done at this point, check out the Oncology Nursing Month Facebook page.  Your colleagues are talking.....talking about how they are celebrating.  I'm certain that, because imitation is the sincerest form of flattery, they would be thrilled if you borrowed their ideas!

Just follow the link and start celebrating!

http://www.facebook.com/pages/Oncology-Nursing-Month/50832022917?sid=b51137b53b18a224b9d5b395dd537351&ref=search

Socially Networked Congress

Hello, Everyone! I'm brand new to the RE:Connect blog, and I couldn't be more excited to contribute. The time since Congress has been super busy, but I'm still thrilled about all I learned at Congress and all the new people I met. I always look forward to networking at Congress, but this year was different. Better. Thanks to social media. Congress was everywhere in social media - YouTube, Twitter, Crowdvine, Facebook and more. My Congress experience was definitely enriched through the use of these tools.

Crowdvine really served as a central location for all social networking activities, as it aggregated all the YouTube and Twitter streams. If you missed Congress, you can still get a glimpse of the fun by viewing several Congress videos on Crowdvine or YouTube. Yep, YouTube. It's not just for skateboarding dog videos anymore. Through Crowdvine, I was able to reconnect with friends and colleagues before traveling to San Antonio and even set up times to meet other nurses that I had never met before. That's how I met Brenda Nevidjon, current ONS President, the very first day of Congress. Who knows - I may have never introduced myself to her otherwise. 

During Congress, I was able to upload mobile pictures to my Facebook page for friends and family to see, and I even received instant emotional support from my Facebook network right before I spoke at my podium presentation. It was a tremendous source of encouragement for me. I also happen to use Twitter a lot, and I was able to view other Congress attendees' Twitter feeds on Crowdvine. I subsequently followed many of them and even meet a few of them in person at Congress (@guiniga & @sandyrn) and got insights into their Congress experiences when they used the #ONS_Congress hashtag. (A hashtag is a keyword that allows searches of the information.) There were just as many Congress exhibitors using Twitter as there were attendees. I was able to meet and have Twitter conversations - real conversations - throughout Congress with ONS, Cancer and Careers, Planet Cancer, CURE Magazine, Imerman Angels, Fertile Hope, the Leukemia and Lymphoma Society, the American Cancer Society and numerous cancer survivors across the nation. Several Congress tweets were retweeted (which is like a forwarded email) to literally thousands of others around the world. How cool is that? Seriously, when do you get to talk to so many amazing organizations and people in such a short amount of time? That's the power of Congress. That's the power of social media.  

More and more nurses are joining social networks everyday. Are you a part of one? If so, which ones do you like best? If not, what's keeping you from joining? I look forward to connecting with you all here on Re:Connect and who knows where else in the social media world!

Happy Nurses Week!

Happy Nurses Week to everyone. This year was extra special for me, since it is my first official Nurses Week! Usually the institution where I work gives out gifts to all their nurses. However, this year is a little different since the status of the economy. It is kind of sad that it was my first nurses week and the budget cuts have taken away the nurses gifts. I rather have a secure job though, so I'm okay with missing out on a few gifts. Each floor in the Children's Hospital celebrates Nurses week differently. In the PICU, we had different events everyday. The first morning, our doctors made us breakfast in our tiny break-rooms, filled with waffles, fruit, donuts, bagels and more. The next day was a Hawaiian punch party, where we were served cake and punch at midnight. Some of the other days included cookie bake offs between the staff and drawings for the staff for a free holiday pass where you could choose a holiday to get off this year.

What events or special things did your institutions do for Nurses Week in spite of the economic status?

Staying Up All Night Long

I have been learning to deal with night-shift over the last week and a half. It is definitely a lot different than I thought it would be. I have had no problem sleeping during the day. I can apparently sleep at any time, just give me a pair of ear plugs. My dog is a little confused why I am sleeping during the day, but the only part about night-shift that I am not enjoying is that it feels like I do not have 4 whole days off, since you have to prepare the day before and recover from the shifts afterward; it is as if your wasting a whole day. I am also missing my friends and family. I know that everyone must pay their dues and work night-shift for some allotted amount of time, I just hope my time is not too long! So far, I will be on orientation until June 28th. During this time I will be rotating between days and nights for 3 weeks at a time. Then I will go to straight nights in mid September. I do enjoy the pace of night-shift better. I feel like I have more control over the situation and I can take my time to really care for and learn about my patients. I am enjoying the ICU setting and the constant business of the shifts. Being on night-shift makes me believe that I can possibly handle being a critical care nurse, but then I will go to day-shift in a couple of weeks and that thought will go out the window!

Chemo in the Non-Oncology Setting

Among the many valuable sessions at Congress last week was one that asked whether or not nurses in non-oncology settings should be trained to administer chemotherapy agents.  This is a sensitive subject that illicits very strong opinions on both sides.  The session was very informative and attendees offered many positive comments at the session conclusion. 

The bottom line is this: Oncology nurses are considered the "chemo experts" who are oftentimes summoned to non-oncology areas to administer "chemo" to patients with rheumatoid arthritis, lupus, ectopic pregnancy, etc.  Although we are "chemo experts", we are not RA, lupus, or ectopic pregnancy experts.  So, do we train oncology nurses to be RA, lupus, etc. experts or do we train those who are RA, lupus, etc. experts how to safely administer select chemo agents to their patients. 

I will step out there and offer my humble opinion with which you are welcome to disagree.  I love point - counterpoint, so please feel free to post your thoughts!  Frankly, I am an oncology nurse and don't have the desire to be an RA, lupus, etc. expert.  My plate is quite full already!  These medications are already being given by untrained nurses in many settings.  As oncology nurses, we have the opportunity to lead the educational efforts for our nursing colleagues, ensuring that they receive appropriate information.  The need for education regarding safe chemo administration in non-oncology settings is one that is not going to decrease in the future.  As a leader in the oncology nursing community, ONS has developed a course for this purpose.  The course was offered at Congress for the first time as was the trainer course.  I was fortunate to have the opportunity to attend both and, as usual, ONS has developed a high quality course that should help many nurses.

Keep your eyes open for this course to be offered over the next several months.  Recommend it to your organizations for their non-oncology nurses.  This 4 hour course is appropriate for those who give chemo agents for reasons other than cancer.  ONS recommends the 16 hour Chemotherapy/Biotherapy Guidelines for Administration course for those nurses who will administer chemo agents for cancer diagnoses.

Please post your opinion on this highly-debated topic:  Pros and cons?  For or against?