RE:Connect

TV vs. Nursing

Erin previously posted about Nurse Jackie, and I must say "I agree!"  I have not seen the show as I do not subscribe to that channel, BUT, I don't think I would enjoy it after reading the description.

Several non-nurse friends of mine are divided on the topic as well.  Some say that nursing is a highly-respected profession and that TV shows like this leave a bad impression of real nursing.  Another friend said we shouldn't take it personally; that people know it is fiction and is intended only to pull-in viewers. 

I have spent many years of my nursing career explaining what exactly a nurse is.  This has been especially true since becoming a CNS.  It takes years to earn the respect of our co-workers, physicians, administrators, and, most importantly, out patients.  So does a TV show like this one damage nursings reputation?  Do you take it personally?

Another new TV show focuses on nursing as well.  Have you seen HawthoRNe?  Like Erin, I think highly of the actress playing the lead nursing character, Jada Pinkett-Smith.  My question for those of you who have seen this show:  Have you ever seen a CNO do these things?  No offense to CNOs, but no CNO can be in so many places at one time, performing tasks meant for other disciplines all the while knowing every detail of all of the staff members personal lives. Hmmmmm.  Lesser of 2 evils.  At least she is a patient advocate and not a druggie who hides her next fix in the ER nurses prosthetic leg.

But I digress.........

From Orientation to Resourcing

I recently have completed part of my orientation process and have begun resourcing. In the PICU, resourcing is where I have my very own patient assignment but I have a "back-up" RN who sits at the medical receptionists desk area and is there to answer any questions I have or help me if I am too overwhelmed. Everyone that I had talked to said that the Charge Nurses were really great about easing the new orientees into our role as the official RN of the patient. So, I guess I had this idea that my first couple of nights on my own would be easy. Well boy was I wrong! My very first night on my own, I had a two patient assignment and one of my patients coded! My first thought was that I had 15 weeks of orientation to experience a code situation with a preceptor right beside me. Of course it didn't work out like that though. I was so scared, my adrenaline was through the roof and I remember saying to one of my friends, "I don't want to go in that room." My friend, a fellow RN, told me that I had to go in the room and said that she would get the emergency drugs and that I had to go be the nurse. At that moment, I was thinking "ok, ok I can do this." Even though I was scared out of my mind, I was not alone, which was incredibly comforting.

Looking back on that night, I learned a really valuable lesson. I learned that I should never for one second think that I will have an easy night. I need to be on my game every time I step in that hospital, because even though I will not be caring for the most critical patients right out of orientation, a patient at any time during their stay in the hospital can take a turn for the worst, and if I as the patient's nurse am not always on my game, I could potentially harm the patient. In the end, the patient survived. We had to intubate the patient and do compressions for about 10 seconds, but the patient survived. Throughout nursing school and starting my job, I have practiced mock code situations countless times. But I think until you truly experience a real life code situation, you are never really prepared. That was one of the scariest situations I have experienced so far in my career and I am sure there will be many more situations like that. However, I feel like I will be better prepared from here on out and I know I will not be alone.

How do you measure nursing workload in your practice?

Every quarter I send an e-mail to my staff informing them that we will be conducting 2 weeks of "Intenstiy Study".  At my institution the term Intensity Study is used to describe the period of time that the chemo nurses collect data on the various types of care provided to the patients and calculate the actual nursing time spent with them.  Every chemotherapy drug, regimine, supportive medication, injection, blood draw, and follow-up phone call is assigned an Intensity Level of 1-5 based on the nursing time required by the nurse to provide the care required for the treatment/intervention to the patient. The process of collecting the data is quite labor intensive and it's probably one of the least favorite tasks for the nurses, however the information that the Intensity Study provides once the data is collected is very important.  Results from the Intensity Study compare the amount of "actual" nurses to the "proposed" amount of nurses that are actually need to care for the patient load based on the intensity levels collected.  We use this tool to monitor the "real" intensity of the workload as opposed to using the nurses anecdotal feedback of "we're so busy".  The results justify the need for new postions and help us to plan appropriately for future staffing needs. 

How do you measure nursing workload in your own practice? 

Portrayal of Nurses on TV

I was recently alerted about a new television show premiering this month on ShowTime with a nurse as the lead character. I'm usually 'in-the-know' about new shows especially medical ones but with the arrival of summer I have to admit that this one took me by surprise. By the time the snow melts, I've usually had enough of being a winter couch potato and am ready to engage in hobbies that include more than the mind-numbing tedium that winter on the prairies brings with it.

So I googled "Nurse Jackie" and learned that it is a new medical comedy starring Edie Falco. This intrigued me more. She is a respected and skilled actor, just the person to accurately show the world just how great it is to be a nurse. My opinion of this show in no way is a criticism of the actress. In fact, I haven't even seen it yet. Nurse Jackie is described as "a wife, mother, and highly competent ER nurse who knows more than the doctors. She talks tough, is quiet and mean but when no one is looking she's good with kids and the elderly. She's a rule breaker." Sounds good doesn't it? BUT she's also a highly functioning drug addict who gets her supply from her lover, a co-worker, a pharmacist in the hospital. Ugh! You just lost me. Maybe to non-nurses this sounds great but why oh why can't being an ER nurse, mother, and wife be enough of a storyline? We does the image of nursing have to be tarnished? I don't know about you but none of my friends and coworkers are addicted to drugs or having affairs with co-workers. Granted you hear rumors of 'hospital hookups' but they are the exception not the rule. TV portrayal of nurses and health care professionals sways the general public. If you think it doesn't then you are being naive. My best friend thinks thaT I work at "Grey's Anatomy" despite ongoing reassurance that I actually get my work done without a quickie in the clean supply closet!

Nurses are viewed as sex objects, or cold and heartless. Nursing may not be that glamorous, that is, sex, infidelity and drugs but most days I can go home and tell my boyfriend a good story or two about an interesting case, making a difference and helping someone or a ridiculous mishap that had us in stitches (pun intended). If the people who decide what to put on TV can put 10 'famous for simply being pretty celebrities' on a desert island for the summer so we can watch them do nothing, why can't Nurse Jackie just be Nurse Jackie? I know nurses and I'd tune in. What do you think?

Lessons from a Nurse Living with Cancer

The June issue of ONS Connect is cover-to-cover with survivorship. It's so exciting to see this topic come into its own and develop into a new area of study and knowledge. With nearly 12 million and 28 million survivors alive today in the US and around the world, respectively, it's about time (National Cancer Institute, 2008; Lance Armstrong Foundation, 2009). As I reflected over all the cancer survivors in my own life, I didn't have to look very far - just right across the hallway - to a nurse colleague. Mary (not her real name) is a thyroid and melanoma cancer survivor. Her husband has been living with "terminal" lung cancer for the past four years. That's right - "terminal" and "four years" - it's a recurring theme in cancer survivorship thanks to advances in knowledge and medicine.

She went in for a routine exam, her doctor palpated a thyroid nodule, the biopsy was negative, but they decided to remove it anyway. The postsurgical pathology report showed the nodule was malignant. When Mary found out she had cancer and it was removed, she thought nonchalantly, "So, I have cancer." She credits her attitude to her own cancer to living through her husband's diagnosis when he was told he had three to six months to live; they subsequently made some "stupid mistakes," selling their home and waiting. Waiting. Waiting. Until they "threw out the book with the statistics" and started living their lives.

Mary continues to watch her husband live with cancer and she knew she could live with it, too. "Cancer is not synonymous with death. Life is synonymous with death," she chirps. Six months after her thyroid cancer excision, Mary found a questionable spot on her ear - melanoma. She had it removed on an outpatient basis, and says the hardest part of having cancer was telling her children. Neither her nor her husband have a family history of cancer, but "now my children do."

It's no different as stage I or stage IV, Mary says her life has changed greatly as a cancer survivor - physically, emotionally, and mentally. She confidently says it's better because cancer made her straighten her priorities. She now does yoga, prioritizes concerns, does "everything within reason to give [herself] the best shot [at health], and enjoys the day. Boy, does she. I love working and being around her. She and her husband also now have a "bucket list," and they are whittling it down - buying their dream home last fall and taking a first-class, week-long cruise with college friends this summer. I took away a great lesson from her - start living today. "Don't wait until you have cancer." Wait. What? Me? Cancer? Oh, yeah...As I start to see statistics in my mind my bucket list is forming and growing.

As survivorship continuous to grow into its own unique area, I'm curious to learn from other nurses living with cancer. There were several nurse cancer survivors that spoke at ONS Congress. If you attended any of their sessions, what did you learn? How are nurse cancer survivors impacting survivorship in your own practice and lives?

Finding a Balance

I wanted to comment on Joni Watson's previous blog about balancing work and life. I too have struggled with balancing my work life and even having a personal life. For the last couple of years, my entire focus has been on getting through school and now my focus is still career related where I am trying to figure out how to be a PICU nurse. Sometimes I feel as if my nursing friends are the only ones who understand me and what I go through on a daily basis. My non-nursing friends simply don't understand what I see and have to go through on a daily basis. A lot of times they are grossed out by the things I deal with at work and don't really want to hear about it. The nursing profession is set up very different than most other careers. It's not the 9 am to 5 pm, Monday through Friday job. It is very long hours, working holidays and it is working when the rest of the world is sleeping. 

I've had to make myself really work at making more of an effort to see my friends and family. That has been incredibly hard to do since starting night shift because I never quite seem to catch up on my sleep. I hope that I will soon find a balance between everything. Commenting on Joni's post, I tend not to make too many commitments, because I never know just how tired I am going to be. Which, I don't think that is working out in my favor because then I feel like I am missing out on life. I know that my career is not what completes me. It is the friends and family and all sorts of relationships that are there for you in the end. At the end of the day, its not very fun to be successful if you have no one to share it with.

Extracurricular Activities

Well it is almost that time again.  Our local Relay for Life is this Friday night at 7:00.  Well, actually, it has been happening since last year at this time.  We have Relay-related activities and last minute items each night this week.  It is such an incredible event!  I truly love participating and have been involved with Relay for many years.  One of the difficult aspects is juggling the schedules.  With a husband, two kids (in MANY sports, activities, etc.), a full-time job that very rarely consumes less than 50-60 hours a week, and a part-time adjunct professor job, I have had to miss a few meetings this year. 

How many activities such as Relay are you involved with?  Does your employer support the activities?  Are you given time off from work to participate in the actual event and/or to serve as a volunteer on Steering Committees? 

Graduation Season

Well, it happened last week.  My 17 year old daughter, and youngest of my children, graduated from high school.  I was surprised at the ceremony that I remembered so many of the kids from their days in preschool.  They all have such bright futures.  They can become a doctor, lawyer, or indian chief. . . but why not a nurse?  As the mother of 3, i am dismayed that none of my children had even a fleeting desire to pretend to be a nurse.  My oldest, at 26 is aspiring to be a teacher.  I had always hoped that she would be interested in nursing.  She told me once that she would never consider nursing because of the awful hours, and "poor working conditions"  My son still has a sexist point of view, and the new graduate tells me that she "doesn't want to spend her life taking care of other people."  So I guess the generational line of nursing in the family will end with me.  I take pause that perhaps I didn't accurately portray nursing as it is, my one and only career, that I find something new and challenging in everyday.  Maybe too much behind the scenes moaning and complaining. At any rate, I'm sure there are plenty other kids out there who will be at my heels soon enough, eager to move into my position.  Only wish that one of them was mine.

Being a Leader

In the May 2009 edition of ONS Connect Sean Pieszak write an article on Learning to Become a Strong Nurse Leader. I was particularly interested in this article because I have recently changed jobs from a staff nurse to a position of leadership in the same organization. This new position is a "one of" job in our facility. By that I mean there is only one of us in that role. Having worked in the facility for the past 6 years and now making the change has been a struggle for me. It requires a change in thinking for myself and my colleagues who for many years have related to me as an equal rather than someone in an active leadership role. The tips provided seem so simple and basic but so true:

Carry yourself well- be confident and dress professionally.

Choose your words carefully-the more you say the less people will listen.

Work harder-lead by example.

No clowning around.

Honesty counts.

Show respect.

Stay cool, calm, and collected.

These tips remind me of those posters that remind us that "everything we needed to know in life we learned in kindergarten." Basically, how to play well in the sandbox! These behaviors are the building blocks or foundation from which leadership, professional conduct, and good working relationships grow.This article reminds me that when in doubt go back to the basics. It is also why one of the value statements for Canada's national professional organization, CANO, is that "every nurse is a leader." You don't necessarily need to be in a formal leadership position to practice and execute leadership. If each of us strives to be a leader, our profession will continue to move forward, stay optimistic, and progress. So no matter what position you are in, be a leader. Or...remember to play nicely in the sandbox.