Nurses are clinical experts and expert listeners; researchers, inventors and compassionate caregivers; protectors of patients and promoters of healthy living. They are teachers, but they’re learners, too.
When Nurse.com launched the program “The Next Shift: Nurturing Tomorrow’s Nurses” in partnership with the Johnson & Johnson Campaign for Nursing’s Future during National Nurses Week 2014, our goal was to provide a positive platform for seasoned RNs to impart the wisdom they had gained through years of experience to nurses who are in the early phases of their careers.
Since then, nurses answered our call by sharing their stories and advice and encouraging their colleagues. They’ve passed along their passion, told us how they’ve overcome obstacles — some having skinned their knees on their first hurdles, and showcased their exceptional pride in their profession.
To celebrate this year’s National Nurses Week, Nurse.com and the Campaign are pleased to present a series of stories from The Next Shift. The stories are as varied as the nurses who wrote them, but each in its own way showcases above all else that nurses heal others and, perhaps, each other.
Everybody has a story
By Joi Canton, MSN, RN
Before becoming a nurse, I completed six years in the military and a little more than five years as a police officer. I thought I did it all. That is, until I became an RN in 2000. I have to say, nursing has been the one career that made me who I am and influenced how I live.
I began my nursing career as an ED nurse in a very busy hospital in Miami. I thought being from New York gave me an edge or some swagger, but I was wrong. I was introduced to a world of poverty, uncontrolled diseases like HIV and true despair. I found it easier to shut out the deep stuff and focus on the surface. The surface being the illness, alcoholism, noncompliance and other issues by which I judged patients. We all do it. It is our defense mechanism. It is what helps us not to cry and gives us an edge. I kept being a surface nurse until I met my first storyteller.
Diagnosed with cancer, he dodged the bullet several times, but this time there were no more chances. Death was coming soon. He was a father, grandfather, husband, ex-teacher — and he was dying. I asked him a question that, to many, seemed intrusive. “Are you afraid?” This was the beginning of my journey as a nurse who went to the heart of the people she cared for. I looked for the story. I let the stories lead my care plan. I allowed the stories to give me courage and strength. I took the stories and stowed them in my heart. Stories became, and continue to be, my guide to quality patient-centered care. Everybody has one and it is up to you to discover it.
Alcoholics don’t want to be alcoholics. I met one who began drinking after he was involved in a motor vehicle accident that killed the other driver. He could not deal with the picture of that person’s mangled body in his head, so the brown liquor helped it go away for just a little while.
Most suicidal patients aren’t looking for attention. I met one who lost everything in the market crash, including his wife. He invested heavily in the market because he wanted them to retire early and spend every moment together. He considered death as the only way to stop the pain and the loneliness.
Not all elderly nursing home patients are there because they want to be. I met one who wished she had children so she could have someone to visit her, talk to her and hold her hand. She never married, but she was in love once. He fought in a war and never returned. No one ever made her feel like he did.
Everybody has a story. You just have to listen for it. It does not always come out easily; it sometimes has to be coaxed out. It may come out as you hold a hand, place a warm blanket, give a smile or just be in a patient’s space. Everybody has a story; you just have to be that person the storyteller wants to trust with it.
Joi Canton, MSN, RN, is a nurse manager in telemetry at Lake Worth (Fla.) Medical Center.
Leaving it at the door
By Rachelle Psaris, BS, RN
In nursing school, we were taught our primary focus at the bedside was the patient, and nothing from our private lives, including our own health concerns, should get in the way of the care we deliver. As a result, we will have succeeded in being the true professionals that we set out to be.
In 2013, my physician informed me that because my white blood cell count was below the norm, I should see a hematologist. I made the appointment and Googled “causes for low WBC counts.”
Some of the causes, such as leukemia, were alarming. Others, such as vitamin deficiency, were not. I prayed for vitamin deficiency. Then I turned my mind off to the whole thing — or thought I did.
I came to work one day and began admitting 83-year-old Oscar for implantation of an intravenous access device. His diagnosis was leukemia. I immediately checked his WBC. It was normal — much higher than mine. I began to feel uneasy.
Oscar’s daughter-in-law Susan came with him and provided support and made him laugh now and then. She was attentive and eager to see to his comfort, and she helped him answer questions he had difficulty with because of memory issues. She clearly cared about Oscar and was not just a visitor sitting in the chair next to him. Susan was wonderful.
As I proceeded with the admission, I could feel the tension building. Here sat this wonderful man, who had such an awful diagnosis, and here I was thinking I might end up with that diagnosis or something equally as awful.
Healthcare workers need to leave it at the door and not allow personal issues to interfere with work. Our ability to be compassionate and thorough in our assessments can be compromised if our thoughts are muddled by our own issues. So many of us have known situations in which a healthcare professional was not there emotionally and psychologically for his or her patient; there clearly was something missing, whether in the dialogue or actual physical care. Some of us may have even experienced this as a patient ourselves.
With Oscar, however, the pressure was mounting, and although I treated him with compassion, I felt I was leaving something out of the mix. But what?
Oscar returned from the OR, and I was there to care for him before his discharge. I discontinued his IV, discussed his discharge instructions with his daughter-in-law present and wished him well. But, again, something was missing. Finally, it clicked. I admired Susan so much, but because I was so wound up with my own worries, I did not tell her how much I admired her devotion to her father-in-law. Was that a requirement for good nursing care? No, but it certainly is part of the equation.
It’s a delicate balance, leaving one’s own problems at the door and being there for the patient 100%, but there is no other option.
Rachelle Psaris, BS, RN, retired after 42 years as a staff nurse in perioperative nursing at Brookhaven Memorial Hospital, Patchogue, N.Y.
We’re stronger as a team
By Carol Gaido-Schmidt, BSN, MBA, RN, CSN
Last night I dreamed about a hospital at which I once worked. In my dream the hospital was closing down. It sounds like an odd dream, except that two of the four hospitals I have worked at have indeed closed.
I think about it now — the people I worked with, the relationships that we built — and I think that the closure of a hospital is one of the saddest things that any nurse can go through in his or her work life.
I know change is constant in healthcare. But closure, well, that’s permanent. This particular hospital was a great place to work.
What makes the difference between greatness and a nightmare? After all, we do the same tasks wherever we go. I have thought a lot about it, and I believe it’s the team.
There is something about a great team. Chalk it up to good leadership, careful hiring or simply coincidence, but every now and then a group of people come together who click. Like a championship football team, they learn to work together, playing off one another’s strengths and weaknesses, supporting each other, caring about each other. They become almost like family.
Sure there is friction, as in any family. But on a very deep level there is a strength that comes from interpersonal bonding that makes a great team unstoppable. No individual is the star. The team is the star. Patients feel it, and they benefit from it. Quality improves and patient satisfaction improves.
Patient care is always our primary focus. We strive to provide good care wherever we go. But a great team will provide great care.
When nurses are unhappy, care will suffer. Unhappy nurses leave quickly, care becomes fragmented and a vicious cycle of unhappiness, poor care, high turnover and general decline will turn the workplace into a place of misery. Members of a great team feel a sense of belonging that leads to improved morale and performance.
To create great teams we need to recognize that nurses do not exist in a vacuum. A nurse is not just a body to fill a shift. We are all people with strengths and weaknesses, who need each other’s support. We need to foster interpersonal relationships in the workplace.
It is important for staff to have opportunities to connect and get to know one another. Meetings, classes, luncheons, even activities outside of work hours can bring people together. New staff should be included and not left to flounder alone.
We deal with some of the most profound human suffering that anyone can witness. At work we must remain calm and professional in the midst of chaos. We must appear to be in control at all times, when we know that complete control is an illusion. This takes a toll on nurses, whether we acknowledge it or not. It wears on the spirit. The only thing that keeps us going is each other. We know we care about the patients. Sometimes we forget to care about each other. Together we are stronger. Take time to know each other, take time to care, be part of a team.
Carol Gaido-Schmidt, BSN, MBA, RN, CSN, works at the Beaver County (Pa.) Career & Technology Center.
By Cynthia Stock, MSN, RN, CCRN, CVICU
I didn’t become a nurse ever expecting to feel like a rock star. But one day it happened. John, a 40-something-year-old man, arrived in our unit after coronary artery bypass surgery. On the second day after surgery, his wife approached me. She cried and told me the man in the bed was not the one she brought to the hospital. She had never seen her husband so petulant, angry and vulnerable. I reassured her that patients often act out the most with the people they trust. I also suggested that perhaps her husband might be struggling with the thought of someone opening his chest and handling his heart, which some people believed housed the soul.
Back then heart surgery patients stayed in ICU for several days. The woman’s husband continued to waver between active participation in care and regression into a state of passive dependence, and I continued to provide reassurance and support to him and his wife.
The day he transferred to the telemetry unit, I discussed the well-documented depression some patients experience after heart surgery. I told his wife to expect mood swings triggered by the unexpected. Period. End of report. Or so I thought.
Months later I was grocery shopping, bent over a carton of eggs looking for cracks. A voice broke my concentration. “Excuse me,” she said. “I doubt if you remember me.”
I looked around and faced a woman slightly older than I, her cart full and her face aglow with a genuine smile. My face gave me away, a blank stare caused by lack of recognition. “It’s OK,” she said. “You must meet a lot of people doing what you do.”
“Do you know me?” I asked.
“I have wanted to say ‘thank you’ for so long,” she said. “You cared for my husband after his heart surgery. If it hadn’t been for you and what you taught me, I could never have coped.”
Then she explained. “After we got home, John lost a 39-cent Bic razor,” she said. “He sat down and sobbed over a cheap, plastic, replaceable razor. But I remembered what you said about little things becoming important. You reassured us both that things would fall into place and be all right.”
She described how she comforted John, held him, just let him cry. “All the time I thought about what you said and how right you had been.”
I am not skilled at accepting praise. My cheeks burned. I could have said, “I was just doing my job,” but that would have been a lie. Forty-two years later I still awaken in the middle of the night and wonder if I could have done something more for my patient.
I still invest myself in those for whom I care. Nursing has never been just a job; it defines the person I am — the person I want to be.
I remember that day and the way it made me feel. Recognized. Affirmed. Thanked. And although it happened in the refrigerated section of the grocery store, in that moment, I was a rock star.
I have been a bedside nurse for 42 years. Sometimes it seemed my education lagged behind my experience, and other times, just the opposite. But what I know for sure is this: Always be open to learning. A unique, precious individual accompanies every disease, surgery or trauma. Sometimes a little thing makes a big difference. Enjoy the successes. Savor the rock star moments.
With all the changes in healthcare, what has sustained my enthusiasm and love for the profession are moments like that one.
Cynthia Stock, MSN, RN, CCRN, CVICU, is a critical care nurse at Medical City Hospital, Dallas.
A special friendship
By Vanessa Easterday, MSN, RN
Nursing has been one of the most difficult and challenging, yet fulfilling, ventures of my life. It has been a journey of relationships and experiences. Touching lives when they are lonely, ill, hopeless or dying is a privilege that few other professions offer. Offering compassion to patients during times of personal loss or tragedy has its own rewards, but helping to protect and maintain human dignity is invaluable. One of the most fulfilling and moving experiences of my life came from caring for a quiet, elderly gentleman who had nobody in the world to care for him. I met him in the ED one night after he was rescued from his home. He had been trapped on the floor of his home for weeks before he was rescued.
When I first cared for him, I offered him a meal from the cafeteria, and he smiled and said he would love to have something to eat. He told me that this was the first full meal he had eaten since the passing of his wife four years ago. He explained that he had always eaten his meals with her in the nursing home where she lived. Something occurred that evening that bound us in a friendship that doesn’t happen every day.
The patient was admitted to the hospital and, because he had no family nearby to care for him, he was placed in a local long-term care facility after his hospital stay. I was able to locate and check in on him one day. His experience was haunting to me. He had been so isolated and found in such an undignified situation. He had been removed from his home of nearly 70 years. It was a difficult transition for him to lose his dignity and his independence.
I asked permission to visit him at the long-term care facility from time to time, and he was excited about having company. I visited him for two years.
One day, a nurse friend of mine happened to be working at the facility where my new friend was staying. She called to tell me he would soon be passing and she had found my name and number in the front of his chart listed as “friend.” She recognized my name and wanted him to have someone he knew with him when he passed.
The last trip to visit him was one I will never forget. He asked me to talk to him. “I am tired and it would be comforting for me if you would just talk to me and stay with me,” he explained. He passed quietly shortly after that.
This relationship motivates me to continue to care for those who are in need of a compassionate touch and a listening ear. It also inspires me to teach nursing students about the importance of treating every patient with dignity and compassion. Encounters like this can inspire and renew our passion for our unique profession.
Vanessa Easterday, MSN, RN, is an assistant professor of the Chamberlain College of Nursing Indianapolis Campus.
Don’t be afraid to be creative
By Patricia Cicerone, BSN, RN, HNB-BC
When I became a nurse, I never realized how important finding original solutions could be when taking care of patients. After 20 years of caring for mothers and babies in a hospital setting, I took this philosophy and started my own business helping new parents in their homes. I attended a postpartum doula class given by the Childbirth and Postpartum Professional Association, whose mission statement includes “to give families the tools needed to move forward confidently into parenthood.”
A postpartum doula offers support and education to the new family, which may include newborn care, breast-feeding support, care of the mother, family support and even light housework. Having taught childbirth and breast-feeding classes for the past 10 years, I also could offer those skills. Through education and support, I help new parents prepare for their child, the birth, breast-feeding and the popular question, “Am I doing this right?”
One of my first clients was partially deaf. Angela could read lips, and her husband, Mike, knew some sign language.
After years of infertility, Angela became pregnant. It was not the easiest pregnancy. Angela’s gallbladder became inflamed. An ultrasound revealed that it had many stones and would need to be removed. The surgeon felt the procedure could wait until a month after delivery.
During the time prior to the baby’s birth, we met for childbirth, newborn care and breast-feeding classes at Angela’s home. We realized that with Angela having a scheduled cesarean section, she would not be able to read lips because everyone would be wearing masks. She was terrified.
The Americans with Disabilities Act of 1990 requires healthcare settings to provide effective communication for those who are deaf or hard of hearing. A sign language interpreter was offered to Angela, but she preferred to read lips.
Mike suggested a white board to write down answers to Angela’s questions. I cleared this with her physician and the nursing staff. It seems that some physicians are more open to discussing a potential problem when a solution is offered. We all want the patient to experience as little stress as possible.
The Monmouth Medical Center L&D staff and I came up with phrases — such as time out, name and date of birth, lie down, lots of pressure and here comes the baby — that a patient might hear during a C-section, so I could familiarize Angela and Mike with them. I printed them out on a clipboard for the circulating nurse. The circulating nurse would point to a phrase, and Angela would respond when appropriate.
I also received permission to be a support person for Angela in the OR. I was at her side from the moment she walked into labor and delivery until she was comfortably settled in her postpartum room.
Logan was born with no difficulties and bonded skin to skin with Mike in the recovery room while Angela’s operation continued. Due to some complications, the procedure lasted longer than planned, but with the white board I could easily answer Angela’s questions and pass on updates from her physician.
The white board followed Angela to postpartum and became a valuable tool for all her caretakers. And she used it again during her cholecystectomy two weeks later.
What I learned from this experience is that every patient has his or her own needs. It’s up to us to figure out the best way to make a scary procedure less frightening and assist the patient in meeting those needs. And it is absolutely OK to be creative.
Pat Cicerone, BSN, RN, HNB-BC, opened Pat the Darling Doula in June 2014. She is pursuing a master’s degree so she can teach nursing education.
Nursing: So many possibilities
By Marion Johnson, BSN, RN
I was called to my profession when I was about 7 or 8 years old while reading books about Cherry Ames, a mystery-solving nurse. By the time I was 18, I was managing a floor in a nursing home. Later, I attended night school to further my education and earned my BSN when I was 43.
Looking back, I realize the beauty of nursing, aside from the personal rewards you will receive from caring for patients and their families, is that you will never be bored. You don’t need to remain in the same old job and you can always learn new things by taking courses and earning certifications.
As a nurse you have the opportunity to experience so many different types of positions. Over the years, I’ve worked in geriatrics, home care, hospice, bereavement and physical rehabilitation emphasizing cognitive retraining. Today I’m a school nurse at Amityville Memorial High School in New York, where I graduated.
Each time I went into a new field, I said, “Oh, this is where I belong!” I would take courses, get my certification in that specialty and soak in the new knowledge. Every field is a specialty, and it’s so exciting to learn new information.
With nursing, there are no limits as to where you can go and what you can experience. Don’t be afraid to try something new. Work hard and continue your education, remembering you have the opportunity to change people’s lives, which is a powerful feeling.
I wish you much happiness.
Marion Johnson, BSN, RN, is a school nurse at Amityville Memorial High School, Amityville, N.Y.
By Sandra Chica, MSN, RN
I began my nursing career when I was a 19-year-old single mother. I started out as a home health aide, which helped me make sure I didn’t invest too much time in a career I did not like. I then took a CNA class. I loved it and decided to apply to LPN school. Twenty years later, I still love what I do and have grown in a field that allows you to branch out into so many areas. The main component is to have heart.
Without the heart and love for it, you will be burned out, depressed and miserable. Money is never enough for what you do, the lives you touch, change and influence. The sacrifices you make to tend to other people’s families only are understood by your family, who has supported you throughout your growth, and by those who share the same vision.
Sandra Chica, MSN, RN, is a patient care manager and house supervisor at West Kendall Baptist Hospital, Miami.
The call bell is patients’ lifeline
By Sharon Nam Dobbs, MN, RN
At the University Health Network in Toronto where I work, we pride ourselves on providing patient and family-focused care. Two years after becoming a nurse, I had to have an MRI at St Michael’s Hospital in Toronto.
As a nurse, I have often sent patients off for tests — whether they are X-rays, ultrasounds, MRIs or CT scans. I have explained to the patients about what these tests do, the types of findings that could occur and have provided assurances that “it will be OK,” yet, I didn’t want to give patients a false sense of assurance. Often, patients are looking for different information than I provided to them. They wanted to know things such as, “Will it hurt?” or “Does doing this test mean I am very ill?”
Now it was my turn to experience what my patients experience.
During an MRI, the patient lies very still on a table that moves into the MRI scanner in an enclosed space. The scanner spins, and generates loud noises. Because I was very nervous about both the enclosed space and the noises from the machine, my doctor prescribed an anti-anxiety medication, which I took before going into the room for my examination. However, the medication didn’t calm my nerves as I lay on the table.
The technician handed me a call bell and told me that if I needed him, I should push the button. When I asked him, “If I push the button, will you come immediately?” he answered, “Yes.”
That one word reassured me like nothing else did. And although my anxiety level remained high as I was moved into the enclosed area of the large, noisy, spinning machine, I did not push the call bell. I was able to relax sufficiently to have the test completed without me trying to jump off the table. But in those moments, I experienced an “aha” moment — an understanding of the connection between the patient and the call bell.
For many patients, hospitals can be scary places. They don’t understand much of the medical or nursing jargon and may misinterpret their treatment plan. For instance, the care plan might be to maintain the patient’s current health status, while the patient might expect their health to be restored.
But one of the constants for patients is the hope that healthcare workers will treat the call bell as a priority. The call bell is not an interruption to nurses’ workloads — it is the lifeline that connects the patient to the nurse. It is the device that the patient uses to say, “I need you.”
The call bell speaks for patients who can’t talk. It connects the immobile or disabled patient to the nursing station. It is the difference between life and death for some patients, and it is the source of relief to a vulnerable person that a nurse is coming to help.
After my MRI, I could no longer tolerate hearing unanswered call bells, nor could I watch others dismiss the bell, without going to see why the patient was calling. My nursing practice has improved, with quicker responses to the call bells, because my patients feel more assured in my confidence, care and level of empathy. I understand what it is to be the patient and I understand the need that motivates the patient to activate the call bell system.
Rapid response to the call bell decreases anxiety levels, eliminates misunderstandings, improves patient and family satisfaction levels and hopefully improves the patient’s outcome. Answer the call bell!
Sharon Nam Dobbs, MN, RN, works in the bariatric clinic at Toronto Western Hospital.
What to do before you retire
By Nancy Berger, MS, RN, NE-BC, LFACHE
In my role as director of perioperative services at New York University Langone Medical Center Hospital for Joint Diseases, I averaged five scheduled and four-to-five unscheduled daily meetings, collaborated with medical staff, and partnered with managers and nursing administration on Magnet-required projects amid a major transition to a new electronic documentation system and two major constructions.
The days were long and demanding, and I enjoyed every one of them.
But after developing severe chronic lymphotic leukemia, I became exhausted just commuting daily to downtown Manhattan. So the issue arose — was I financially prepared to retire and could I live comfortably for the remainder of my life?
The sickness and complications prevailed and I retired. It was a very sad day for me to leave what I loved the most. But my experiences, I believe, can help young nurses who are just beginning their journeys.
Take a step back every so often and think of the lives you care for, the unforgettable experiences you have and the friendships you make while practicing in a most rewarding profession.
Also, find a way to work with academic medical centers, which often provide unique and complicated challenges and opportunities. In the AMC environment, you can collaborate with multidisciplinary teams and participate in research. One of my best experiences in this environment was gaining Magnet certification. Nearly all the perioperative nursing staff had BSNs and almost 40% were certified. We had three published nursing research projects and five quality-improvement projects, two of which were published in nursing journals.
Today, I am in total remission, thanks to my oncologist and primary physician. The decisions I make are simple compared with those I made as an RN. They involve shopping, babysitting grandchildren and planning trips. I am enjoying every day as it comes and have adopted the philosophy of living one day at a time.
God bless each one of you, and pray for the strength and the conviction to move on with your career and face your retirement, when that time comes, happily, knowing you have worked in one of the greatest professions.
Nancy Berger, MS, RN, NE-BC, LFACHE, is the former director of perioperative services for the NYU Hospital for Joint Diseases. She retired in January 2013 and lives in Easton, Pa.
5 tenets for 21st-century nursing
By Leslie Wright-Brown, MS, RN, NEA-BC
The following are my notes on nursing for my 21st century colleagues:
Tenet 1: Accept challenges as learning opportunities in disguise.
Six months after I obtained my RN license, my head nurse told me, “Lt. Wright, you are going to be the staff development officer for the floor.” I responded, “But Maj. Ward, I don’t know how to start an IV or insert a Foley.” He said, “Lt. Wright you will learn it and you will teach it.”
I discovered I liked critical care and teaching. I adopted Michael Jordan’s attitude — “I can accept failure. What I cannot accept is not trying.”
Tenet 2: Listen to your patients.
One night in the ICU/CCU I admitted a 45-year-old man with a heart attack. While obtaining his health history, he asked, “Do you have a red cart here?” I responded, “Do you mean the code cart?” “Yes,” he responded. “Is it close? You are going to need it.”
Then the cardiac monitor alarmed. I looked up and saw ventricular fibrillation on the monitor. This was his third heart attack in one year. I learned first-hand what the “feeling of impending doom” meant.
Tenet 3: Trust your gut.
Ten years later while caring for a 63-year-old quadriplegic patient in her home, I noticed strange facial twitching while she slept. She woke up agitated and disoriented. She insisted I call her husband to come home from work. Her behavior reminded me of someone suffering from hypoxia or an electrolyte imbalance. I called an ambulance to take her to an ED, even though her private physician thought I was incompetent. I knew I was looking “impending doom” in the eyes. Once there, her anxiety continued.
The next morning I called the private duty agency to check on my patient. She had died of a massive heart attack at 3 a.m. I am glad I trusted my gut.
Tenet 4: Embrace silence.
Fifty-year-old Mr. Nicholson was seven hours post-op when I noticed he was not following commands, nor moving one side of his body. After neurological testing ensued, his family was informed. I wanted to find the right words to comfort them. I remember saying it was good he made it through surgery, to which his wife replied, “Yes, but he had a stroke.” I learned sometimes family members are not looking for profound answers. Being a good listener speaks louder and is sometimes more sincere than any spoken word.
Tenet 5: Be supportive and take care of each other.
If at 7 a.m. I walked into a disaster zone, I would immediately ask the night shift nurse, “What can I do to help you?” My colleague felt comfortable enough to accept help without guilt. When many patients required complete care, we huddled to discuss how we would work together to get the patients bathed and repositioned.
We also enjoyed each other’s company when we weren’t at work. When we worked together, we worked hard. And when we “played” together, we played hard.
The focus of the profession is the patient. Getting out of one’s comfort zone can facilitate professional growth, advocacy, critical thinking and teamwork. In order to ensure the profession not only survives but excels, never lose focus.
Leslie Wright-Brown, MS, RN, NEA-BC, is nursing education manager at Saint Barnabas Medical Center, Livingston, N.J.
Fears fade, lessons continue
By Michele Fusco Serino, MSN, RN, RDH, CNOR
One of my first assignments in the OR as a new nurse was to take care of a patient with a gunshot wound. Many thoughts raced through my mind. “I don’t know anything about them,” I said to myself. “What am I going to do?”
After the initial panic subsided, I took a deep breath and started to realize I must be ready or they would not have assigned me to this patient. I know how to care for patients undergoing surgery, I told myself. Why would this case be different?
I inventoried the steps I would take to handle the situation, starting with assessment, planning, intervention and evaluation. I thought back to experiences I had with Nancy, my preceptor. “What would Nancy do in this situation?” I wondered.
All the foundational knowledge I acquired during my nursing education and orientation came rushing back. “I can do this!” I thought. Now was the time to start building my credibility as a nurse. Now was the time to spread my wings.
My education and training did not let me down. The case went surprisingly well, or perhaps not so surprisingly. The lesson I learned was to trust your knowledge. Use what you have learned and apply it to the situation at hand whether you are familiar with the type of situation or not.
Nurses also should take the time to learn about and know their environments. Remember your tour of the hospital on the first day? It’s probably a dim memory. Or maybe you received too much information all at once. Revisit that tour. Acquaint yourself with the location of as many departments as you can. Identify departments with which you will interact — that you need to interact with to do your job. Stop by and say hello. Don’t be shy.
Another lesson is to know yourself. Be truthful when you ask yourself, “Why am I here?” The answer will be the catalyst to motivate you as you navigate through your new career. The efforts you put forth must satisfy not only the needs of your patients but you as well. Satisfaction with a job well done validates your efforts to yourself and others.
Balance your work and life. Your career is only a part of your life picture. Prioritize creating a balance between work and lifestyle; pleasure, leisure, spirituality, health and family.
Become self-directed and motivated and draw on your experiences. Identify your learning needs, and seek out knowledge to fill the gaps. Find yourself a nurse mentor, an experienced nurse who learns the same way you learn, and develop a relationship. Share. Share. Share.
Err on the side of caution. If it doesn’t sound right or feel right, go with your gut. Ask yourself, “Would this be a safe intervention for my mother, father, brother, sister, spouse or partner?” If not investigate, research, seek out the information you need to provide the appropriate care.
Do not rush your clinical decisions. The knowledge you acquired during your nursing education should provide you with the foundation you need to make educated decisions. You also can solicit answers from experienced RNs whose practice you respect. Mentors are a resource you must tap into. Experiences seasoned nurses can share with you are invaluable.
Nursing is a journey. Healthcare is a dynamic entity. School is never out of session. Knowledge is your power. You worked hard to get here. You belong here. Now is your time to soar.
Michele Fusco Serino, MSN, RN, RDH, CNOR, is interim director of surgical services at Leaders for Today, Wellesley, Mass.
Get all the experience you can
By Celinda Lovett, BSN, RN
The nursing profession offers innumerable options for professional and personal growth. In this field, it isn’t all about making money, but having the money to make it in life. Most of us want to experience a work life that meshes with our personality and our lifestyle desires and needs. Nursing is a perfect profession to make that happen.
Years ago, I found myself changing jobs. My nursing path included long-term care, assisted living, hospice care, ICU, respiratory care and home care. I found myself feeling apprehensive because I didn’t have that “sticktuativeness” (made up word but you get the picture) that I’d seen in many career nurses.
My reasons for changing jobs every two years ranged from family adjustments, schedule demands and curiosity. I enjoyed all the jobs I took on, but after a couple of years, I’d get an itch for something different and challenging.
My resume was getting quite crowded, and I began to wonder if I was doing myself a disservice by not staying in one area of nursing for longer periods of time. The majority of my nursing career was in long-term care, and I did have one five-year period working in a healthcare organization that focused on the needs of the elderly.
Well, 20 years later I found myself in a perfect-for-me nursing position, and the experience from all of my prior nursing positions came into play. I felt I had gone full circle and finally arrived exactly where I was designed to be. I am not planning on changing jobs in the near future.
My position as a medical facilities inspector allows me to continue to learn and use that knowledge in my work. It also appreciates my past experiences. The focus of my job is rooted in teamwork, investigative skills and critical thinking measures all to ensure patients, individuals and residents are getting the best treatment and service possible.
I could go on and on talking about my current line of work, but my point is to encourage nurses to not be afraid to change for the sake of experience and growth. The nursing profession’s plentiful options and opportunities can encapsulate your personality and lifestyle choices. Nursing is a joyous profession, especially once you discover your perfect fit.
Celinda Lovett, BSN, RN, is a medical facilities inspector for the department of health in Richmond, Va.
Work hard, learn harder
By Ann Worley, RN
I often tell people that I didn’t know what I wanted to be when I grew up until I was 30. That was when I returned to college to become a nurse — a decision that changed my life. I have been an RN for more than 30 years and recently earned an MSN with a specialization in nursing education. I cherish the opportunities I’ve had to mentor students in their fourth year practicums on my unit. I tell them nursing is a career that requires your heart, your head and your hands.
If your passion is caring for people at their most vulnerable moments, ministering to their physical and emotional needs, then nursing is the career for you. You are called upon to give from the depths of your very being — your skill, your knowledge and even your spiritual foundation. Your role is a privileged one, as patients view you as trustworthy of their innermost concerns. Challenges confront nurses every shift that demand problem-solving and stretch the limits of one’s creativity. Yet a nursing career can bring the utmost satisfaction. As a nurse you are often the person on the healthcare team whose assessment and advocacy skills can change the quality of care your patient receives.
Regardless of how advanced your nursing education, if you do not have curiosity, ask questions or seek opportunities to learn, you will find little success. Keep asking questions. Seize opportunities to become a leader in your field. Find an area in your field that sparks your interest and become consumed with it. Learn from your patients and families, as many of them demonstrate courage in the face of stress and illness.
Perhaps the most powerful learning tool is mistakes — we all make them, and their impressions can be lasting. Always ask for help when you need it. Your colleagues will inevitably ask you to do the same.
Develop effective communication skills, and never make assumptions. Never be afraid to speak up in the face of opposition when you are advocating for the safety or welfare of your patient. A spiritual faith can help carry you through a tough shift when you think you have no more to give. And a sense of humor can lighten the load for you, your patients and colleagues in seemingly hopeless situations. As a pediatric nurse, I have found that children are particularly amenable to humor. The time I drew a smiley face on my isolation mask and referred to my isolation gown as the “latest costume fashion in hospital attire” produced a smile from a fearful child and a chuckle from an anxious mother.
You have the power to influence the future of the profession. Embrace change. By way of electronic medical records, you contribute to the development of data which empirically demonstrates the value of your work. Get involved in research — this is the way nursing-specific knowledge is generated.
You came to the start of your career with a sense of expectation. You joined the ranks of the most trusted profession. Never violate this trust, and always do what is right for your patient. When others learn you are a nurse, you may be the one who family and friends seek first for personal healthcare advice. Be proud of what you do. Never get caught calling yourself “just a nurse.”
Ann Worley, MSN, RN, CPN, CNRN is a pediatric nurse at Children’s National Medical Center, Washington, D.C.
The importance of self-care
By Olivia Cummings, RN
As a nurse for the past 20 years, I’ve gone through many transitions from a fast-paced life in busy trauma center ORs on the East Coast and in cold northern states to serving as an open heart surgery nurse, a hospital private scrub nurse and an office nurse in OB/GYN and family medicine.
The orders, emails, documentation, bells, alarms and cell phone calls barrage you all day, keeping you in constant motion. At the end of your work day, you often are emotionally drained. Away from work, you go through many life changes — getting married, raising children and caring for aging parents.
When you are away from your job, my advice is to turn all of it off and listen to the world around you. Give those who mean the most to you your undivided attention without the diversion of workplace bells and demands. Make sure to take time for yourself by finding a hobby and doing something physically beneficial every day.
Whether it is a craft or athletic adventure, a hobby can give you something worthwhile to pursue and enjoy besides your job. I took piano lessons as a child and also learned to play the violin. Recently, my husband purchased a fantastic violin for me and I have challenged myself to improve my playing. The connection with the strings and the sounds I produce take me to a place all my own.
I also love walking with my dogs down a river walkway near my home. It’s peaceful. My mind focuses on the sound of the water and the rustling tree leaves. Perhaps you can take a day trip or a weekend vacation and lose yourself in your surroundings. Whether you walk, run, swim, play with your dog or take the stairs instead of the elevator — these are great ways to experience mental and physical release.
Find something that you can do every day and you will strengthen your heart and mind, ready to return to work to face the next challenge.
Olivia Cummings, RN, works at Southwest Medical Clinic, Roanoke, Va.
Facing anxieties in the classroom
By Dawn Hydes, MSN, RN, CNOR, ENB
Time passed quickly between the first semester of my MSN program and graduation in spring 2011. This educational journey, full of articles, discussion groups and journaling, took me beyond the clinical side of nursing. Writing journals and scholarly papers was foreign to me — I had to overcome my fears and develop my academic skills, just as I had developed my clinical expertise over 28 years as a perioperative nurse.
My first class was a tough one. The brutally cold night, unfamiliar place and my late arrival did nothing to alleviate my anxiety. When I had to analyze my challenges and visualize what I wanted out of this experience, I had a difficult time expressing my thoughts.
The weeks began rolling together. My new job as a clinical educator was still evolving and I was juggling too many dichotomous pieces of my life. In addition, working on my first scholarly paper, presentations and final journals almost overwhelmed me. I wanted to escape, but I knew I could only overcome my anxieties or, as I called them, “demons,” by meeting the demands placed upon me.
I have always found that when life becomes too demanding, I feel more in control if I concentrate on one thing at a time. My yoga practice and meditation helped subdue my self-doubt and allowed me to focus. This practice also has assisted me in becoming more focused at work, and I continue to incorporate these practices into my daily life.
Researching articles by Strackbein and Tillman describing the “triangulation approach” enabled me to understand what journal writing required and bring together the three requisite elements — interpretation, classroom debate and individual fundamentals — to produce insightful papers throughout the semester.
As I wrote my journals, I was flooded with wonderful memories of life as a nurse in Europe and the Middle East and the many sites I visited during my tenure there. I relished translating thoughts and ideas into the written word.
The classroom discussions were insightful. Certain articles appealed to the group as we discussed our jobs and feelings of exhaustion. My light bulb moment came as I researched articles dealing with burnout; an article by Karen Espeland, MSN, RN, resonated with me as she described the symptoms of burnout, and how to energize careers to prevent it from occurring. This article helped me work toward goals in my job and not feel responsible for everything and everyone.
Snow was still on the ground as I approached class with my scholarly paper. After days of reading, rereading, editing and receiving critiques from supportive work colleagues, I felt that I had produced an interesting and insightful paper. I felt a great sense of relief as I turned in my paper.
I am unsure if it was the change of weather as winter passed to spring or the fact that our semester was concluding that caused a change in me, but I started completing assignments with less trepidation. As I moved into those final weeks and evaluated my transformation from novice student to confident individual entering a new learning phase in my life, I recognized that I now have the ability to integrate the knowledge of scholarship I gained into my professional and personal life.
Advancing your education allows you to grow in your career and as a person. It provides you the opportunity to choose where you go and what you become. I knew there would be obstacles along the way, but I persevered through the months and years, embracing my continuing education as a gift that I continue to share with students and patients I encounter along my journey.
Dawn Hydes, MSN, RN, CNOR, ENB, is a nurse educator for the main OR, cardiovascular, Connecticut Joint Replacement Institute and the Spinal Institute at Saint Francis Hospital and Medical Center in Hartford, Conn.
The more you know
By Meredith Willis, RN
Nursing school was tough. Although I had always been a straight A student, the rote memorization which served me well in the skills lab was my downfall in theory. Somehow I managed to keep my grades up and pass the NCLEX. Even 17 years later I still can’t believe I did it.
My instructors were amazing, but I learned so much more on the job. I remember looking up to my mentors and thinking I would be so confident and have all the answers within five years. Five years later, I laughed at the memory of my naiveté. Over time, I have learned so much and I’d like to share a few things new nurses should know.
First, know your limits. It’s only natural for your orienting nurse to try to encourage you out of your comfort zone. There will be many tasks you may be doing for the first time. For instance, we were not allowed to hang blood as students. If a skill is new to you, speak up. Do not pretend to have the answers.
Ask for a demonstration. I always thought I should know the answer and that kept me from asking certain questions. Even when I did ask, I sometimes met with resistance. I’ll never forget being told to draw blood at a client’s home the first week of being a home health nurse. When I said I hadn’t done it before I was assured that it was just like starting an IV, but in reverse. I did it, but as a seasoned nurse I would now say, “Show me.” There is no shame in not knowing, and there can be grave danger in not asking.
Also, know your role. Television nurses always seem to have it all figured out. They bark orders and constantly defy the rules. Familiarize yourself with your state’s Nurse Practice Act. Follow your chain of command. Advocate for your patients in a professional manner. This is real life, not a set. Be careful when you are advising patients on what they should do. I once told a patient to eat one more bite in the nicest way I could muster and ended up covered head to toe with tomato soup. Did I mention I was wearing white scrubs at the time?
Know you will find your way. My goal in becoming a nurse was simple — I wanted to help people. I imagined myself swooping in to save the day, but it turned out that was not the brand of nursing for me. The ED kept me on edge and not in a good way. Labor and delivery was not my thing either, although some of my best friends work in the maternal child area.
After two years of hospital nursing I finally stumbled into home health, hospice and eventually public health/community nursing. It turns out I have a knack for teaching and, more importantly, listening. I am organized and independent. I enjoy building a trusting relationship while maintaining professional boundaries.
Finally, know your impact. A smile, a kind word or the right medicine in the right amount at the right time, can make all the difference. You will be tired. You will have bad days. You will cry, you will rant, you will laugh and through it all you will care. Caring counts. That’s all you really need to know.
Meredith Willis, RN, is a former Children First public health nurse for the Kay County Health Department, Ponca City, Okla.
Discovering a new side of patient care
By Janet Howard-Ducsay, BSN, RN, CDE
As an RN for 29 years in critical care and ED, I have welcomed every opportunity to educate patients and family members. In 2006, I expanded my role and became a certified diabetes educator.
Initially, I felt like quite the novice, but over the past few years, I have been able to exercise my passion for patient care, while at the same time, providing them with crucial information. I am proud to say that most of my encounters with diabetes patients result in their being open to something I have shared with them about self-management.
I take time to read my patients’ histories and physicals so I don’t have to ask the same questions they have been asked so many times. I approach them openly, without judgment, asking “What obstacles are you having with your diabetes?” It isn’t always about food. Perhaps they have lost their insurance or are recently divorced or have not had their condition explained to them. I ask open-ended questions to find out where they are at the moment.
Many times I talk with patients about accepting that they have diabetes. In any given week I can meet with a young adult who chose to just stop taking his or her medication. I can have multiple sessions with a dialysis nurse who had severe complications from diabetes because she felt, as a caretaker, she needed to care for others and not herself. Then there’s the patient who, at 87, developed diabetes and questioned “Why now?”
Another patient was a 30-something man whose tough exterior melted in the quiet solitude of his hospital room. His tears spoke simply, “I’m scared.” In our third meeting, he revealed his concerns — a fear of needles because of all the drug-related issues in his immediate family, feeling sad that his children don’t want to trick or treat with him and not knowing how to stop his binge drinking. As he spoke about these issues, it might have been the first big breath he took in a long time.
I take my patients on a journey starting from wherever they are and teaching them the basics that will fit into their daily lives without disruption. I help them lean into the process, showing them that it’s not about deprivation but, rather, it’s about doing things differently. They learn that self-management allows them to make decisions and plans they can see themselves doing now and five years down the road.
I miss caring for patients in the ICU and ED, but my new role as a diabetes educator has fulfilled my purpose and passion beyond my expectations. As you follow your career paths, always keep an eye open for an unexpected opportunity to follow a new road that may be a wonderful, fulfilling chapter in your career.
Janet Howard-Ducsay, BSN, RN, CDE, is a diabetes educator at Redlands Community Hospital, Redlands, Calif.
Mother knows best
By Melinda Diaz, RN, BS, CHPN, LHRM, CHPCA
As you step into the next phase of your life and begin your career as a registered nurse, I want to share some of the things I have learned during my 33 years as an RN.
Always follow policy. Policies are there for your protection and the protection of your patients.
Never stop learning. There are new drugs, new procedures and new equipment emerging every day. You are a lifelong learner now that you are a nurse.
Always treat your license like gold. You worked hard for it, and there are rules you must follow to keep your license clear and active.
Always be accurate in your documentation. Write what you did and when you did it. If that medical record is brought into question by internal auditors or a court of law, you can rest easy knowing your documentation is valid.
If you are ever uncertain, stop and ask. Better to ask than to make a mistake that could have been avoided.
If you do make a mistake (and you will), always be truthful and learn from it.
Always help out colleagues. You work best as a team and you never know when your day will be crazy and you will need their help.
Always listen to your patients and families. If they tell you that grandma takes two yellow pills in the morning, check it out. After all, they have been caring for her for longer than you have.
Don’t leave tasks undone at the end of your shift. Your colleagues will appreciate
Try to see the humor in life every day. Sadness, illness and death are all around us, but keep a smile on your face. It may be the only smile the patient and family see all day.
Be grateful for the “thank yous” from your patients and families, and don’t take their complaints personally.
Patients will yell at you. Families will yell at you. Patients are scared and they have this big ball of fear that they don’t know what to do with, so they throw it at you. Try to deal with it with grace and remember that they are trying their best. Families are scared too, and tired and hungry. Be kind. You have a moral, ethical and spiritual obligation to care for them to the best of your ability.
There will be days that you are tired, upset and understaffed. That is not your patient’s fault. Over the years, I have been physically assaulted by patients and their family members. But every day of my career, I remember that they are scared and hurting, and that I am duty bound to assist in any way I can.
Through it all, I tried to never forget my purpose, and I challenge you to do the same. I am so proud of you and I am excited to watch where your career will take you.
May God bless and guide your hands as you care for the patients entrusted to you.
Melinda Diaz, RN, BS, CHPN, LHRM, CHPCA, is senior director of operations for Catholic Hospice and Catholic Palliative Care Services, Miami Lakes, Fla.
Good practice habits
By Diane Meagher, BSN, RN, CCRN
I have been a nurse for 30 years, 28 of those in critical care, and have been a preceptor to new critical care nurses for more than 20 years. I love direct patient care and teaching, so in my role as preceptor I have the opportunity to combine both of my passions in my work.
I feel I make a difference with my patients, their families and my preceptees every day — some big, some small. I have a handful of memories in which I know I alone made the difference between life and death for patients, but those are not the stories I wish to share now. Instead I would like to share a little wisdom and advice.
I want to encourage you, tomorrow’s nurses, to develop good nursing practice habits. I encourage you to be thorough in your assessments, cautious in your documentation and diligent when reviewing and reporting patient information and processing physicians’ orders. The electronic medical record has been developed to improve safety, but if not used properly and carefully, it can actually contribute to errors and omissions. We are surrounded by advanced equipment and technology, especially in critical care, but be sure to focus on patient care and safety. Always employ safety measures, which include basics such as verifying two patient identifiers before labeling a specimen, administering a medication, or performing a procedure. Use the safety measure we call STAR – Stop, Think, Act and Review. I find this tool especially helpful when I am very busy. When I titrate a vasoactive infusion, I stop and think about the change in dose I want to make, I make the change, then I review by waiting to watch the dose display on the infusion pump screen to verify that I made the change correctly.
Don’t hesitate to speak up whenever you have a question in any given situation, whether you question the appropriateness of an order or a provider’s technique during a procedure. Optimize patient care based on physician orders and your facility’s policies and procedures, but be sure to also incorporate best practices to prevent complications, such as pressure ulcers and healthcare-associated infections. Always employ proper isolation precautions to prevent the spread of multiple drug-resistant organisms and infections. Use skilled, effective and respectful communication techniques with all members of the healthcare team, including patients and families, to ensure the exchange of all pertinent information throughout your shift and at handoff, and to effectively advocate for your patients.
You can make the difference between life and death for patients by developing good practice habits and providing patient care that is cautious and deliberate.
And don’t forget the basic care activities that provide comfort to your patients, like repositioning and back rubs. Be sure to take the time to talk with your patients and their families; keep them updated on their condition and plan of care and allow them the time to express themselves. Little things mean a lot, and patients and families always will remember the little things you did to help comfort them during a difficult time in their lives.
Diane Meagher, BSN, RN, CCRN, is a staff nurse in the ICU at Winchester Hospital, Winchester, Mass.
Creating a sisterhood and brotherhood
By Stacey Northcutt, BSN, RN, PHN, CCHP
In my very early days in nursing school I heard a fellow nursing student ask a nursing instructor, “Is it true that nurses eat their young?” I wondered what the profession had in store for me. I quickly learned that, yes, nursing students are often ignored, not acknowledged, not included and not nurtured or embraced by experienced nurses. At best, a large majority of nurses in the clinical setting were not helpful to me and went out of their way to make mine and many other students’ learning experience as anxiety producing as possible. Because of these experiences early on, I decided as a new nurse I would be kind and set an example, far different from the ones I had.
Fast forward 25 years. I am now a program manager — a leader. When I ask students how their other clinical experiences have been at previous clinical sites, I learned they all have had at least one negative encounter. I show them empathy and reassure them that we value students having a positive clinical experience. My advice to them is to remember times they may not have been treated well and to help break the cycle of being unkind; to be a positive example of how to treat students.
I make sure all students are greeted, given a tour of the units, introduced to all staff, encouraged to ask questions and told in front of staff “we welcome students here.” I openly discuss my experience as a student those many years ago and clearly set the expectation with staff that nursing students on our unit will be provided with an environment that is supportive, encourages and engages them in learning, and provides a positive experience.
During the events of 9/11 and following, the news frequently showed police and firefighters talking about their “brothers and sisters” within their professions. It made me think, “Why aren’t nurses united, and why don’t we refer to one another as brothers and sisters? After all, we are a huge workforce. Why are we not, as a profession, more empathetic to students who are the future of nursing? Why have we allowed unkindness to exist as part of the profession’s rite of passage?” My goal is to do my part to make our profession more united, and you can do the same.
You can start by greeting new students, making eye contact, shaking their hands and introducing yourself. Introduce the students to other staff members, tell students you are glad to have them and pair them up with a staff member. Nurses also can offer to be a resource during their rotation and check in with them from time to time to see if they have questions. They also would appreciate if you include them in unit activities and share your own student experiences, both positive and negative.
It is my hope the students I encounter will carry on the kindness they have received, be leaders, question the status quo and help create a much needed brotherhood and sisterhood within our profession.
Stacey Northcutt, BSN, RN, PHN, CCHP, is a program manager for Juvenile Health Services at OC Health Care Agency, Orange, Calif.
My nursing journey
By Diane Sincavage, RN, OCN, CCRN
They call us older nurses “seasoned.” During my 35 years in the profession, I have worked in staff and clinical coordinator roles in medical, surgical and neuro adult critical care and have served on various nursing committees. When the hospital where I was working was heading toward closure, I moved to Philadelphia, where my children lived and where there were many hospitals from which I could choose.
Who wouldn’t want me with all of my experience? Within six months, I had applied for every job that appeared online and didn’t hear back from anyone. It felt like no one wanted me.
A position at the Cancer Treatment Centers of America appeared online, and after phone conversations and interviews, I was offered a night position on a med/surg unit. I knew I needed to begin learning about oncology. I passed the chemo-biology course and offered to give chemotherapy whenever I could. I kept studying and realized that no two patients with cancer are the same. They might have the same treatment protocols but each reacts quite differently. I also realized I needed to take one patient and family at a time.
In about a year I transferred to the ICU. That’s where I met Stephanie, one of the smartest people I know. She suggested we take the Oncology Nursing Certification exam. Back to studying again. I took every online Oncology Nursing Society class including the OCN review course, and I passed the OCN exam. It felt good — no, it felt great!
Soon after, our educator informed me the facility was opening a stem cell transplant unit. When she asked if I would be interested in being part of the staff training program, I jumped at the opportunity. I participated in the facility’s series of classes, visited the CTCA Chicago transplant unit for a few days and took an online bone marrow transplant course. I began working on the unit as soon as it opened.
I’ve been there for 1 1/2 years now. I am amazed at the chemotherapy we give our patients, and how they are so sick one day and then able to walk a mile a day around the unit soon after. We love our patients and they love us. There always is something new to learn and it’s fun. I am proud to say I teach a class on the caring for oncology patients that we offer to our new nurses.
So today I am an oncology nurse. Often our professional journeys are long ones — mine has been more than 40 years. And I’ve never regretted any of the decisions I made to change roles, positions or facilities.
There are so many opportunities if you look for them. It may mean starting over in a new specialty and being that “new nurse” again. But please realize you always learn so much more and become a better nurse for it. I’m not afraid to ask younger nurses I work with for help and I’m always willing to share what I know. And that’s what our journey is all about, whether you’re fresh out of school or a seasoned nurse.
Diane Sincavage, RN, OCN, CCRN, is a staff nurse on the stem cell transplant unit at the Cancer Treatment Centers of America, Philadelphia.
The blame game
By Elizabeth M. Riffle, BSN, RN, RNC-OB, CCBE, MSN-Ed(c)
I don’t think of nursing as a job; it’s part of who I am. I love being a nurse — the difference I can make and the lives I can empower — and I want others to enjoy being a part of the profession as much as I do. But the responsibility can be overwhelming at times. Nurses are expected to be perfect because lives are at stake, but mistakes do happen because “to err is human.” A mistake actually presents an opportunity for growth. But when errors occur, there can be a human tendency toward blame and shame and a rush to judgment.
Unfortunately, assigning blame is not new to nursing. Since the Joint Commission’s Sentinel Event Policy was implemented in 1996, nurses have been presented with monthly incident reports that regularly remind them of the mistakes they’ve made. All echelons of nursing can be found belittling one another for making an error, and that’s disappointing. As an educator and a leader, I have made it my duty to quell this type of behavior when I see or hear it, but I cannot make the difference alone.
Even asking for help can cause shame if the nurse you are asking chooses to criticize you before providing assistance. All it takes is one exasperated expression or snide remark to cause shame, and from my personal experience, it takes three times as much praise to overcome this type of experience. More experienced nurses should recognize situations in which new nurses might need assistance before they even realize the need to ask. We should be cultivating the next generation instead of alienating them.
In addition, instead of pointing the finger, nurses should offer assistance in figuring out why an error occurred and how it could be prevented next time; this way we all learn together.
Leadership should be setting their employees up for success by implementing recommendations regarding nurse-to-patient ratios. But every nurse should be upholding the first provision within the Code of Ethics for Nurses — to practice with “compassion and respect for the inherent dignity, worth and unique attributes of every person.”
I urge you to not be the nurse who belittles others. Instead be the nurse who helps and supports your colleagues as much as you would your patients. After all, we are all in this together. There is no such thing as a perfect nurse, and we cannot provide healthcare alone. We need to respect and be able to rely on each other as stepping stones toward the common goal of health and wellness for all.
Elizabeth M. Riffle, BSN, RN, RNC-OB, CCBE, MSN-Ed(c), is a staff nurse at Naval Hospital Bremerton (Wash.), U.S. Navy Nurse Corps.
Keeping the faith
By Margaret A. Persaud, MSN, RN
During a brief return to bedside nursing in summer 2014 after two years away from direct patient care, I had the opportunity to care for an obstetrical/postpartum patient in need of help. This experience reminds me that, as healthcare professionals, I not only need my knowledge and experience at the bedside, but also the strength of and spiritual connection with God.
I was a maternal/child and gynecological nurse for more than 10 years and a med/surg nurse for a few years. But all of my experience in OB/maternal/child nursing did not prepare me to deliver the best care possible in this particular case. My patient was a one-day, post-vaginal delivery, first pregnancy and birth, who suffered more than a fourth-degree laceration. Her perineum was severely edematous, red, dark blue in color.
In nursing, we are sometimes faced with the unexpected and variances that deviate from our plans of care. What do we do? What helps us to creatively think and deliver the safe and effective care we are expected to give?
We depend on our knowledge and experience, each other and the critical thinking we learn in nursing school and over the years through our daily observations, tasks and interventions. Personally, I also need that spiritual component that supports me with what I do for patients and everyone around me.
On this day, I did all I could to make this patient comfortable. But she was in a lot of pain and discomfort related to her full bladder and perineal status. “Think quickly, nurse!” I thought to myself.
I knew she would be unable to void because of all the swelling and trauma of the delivery that affected her bladder tone. I had to relieve some of the pain. I needed to insert an indwelling foley catheter to straight drainage. Utilizing my nursing process, I was prepared to do this.
I gathered all supplies and the patient and family members were informed of my actions, and so was the physician. With the help of the charge nurse, I was able to insert that foley on one try.
Truthfully, I went in with uncertainty because the urinary meatus was deviated, and I was not sure of the location. The extreme swelling, as well as the fluid and blood accumulation at the perineum area, obscured everything, despite the spreading of the labia.
Initially, as I was inserting the catheter, I paused for a few seconds to pray and experience that feeling of faith that all will be well. I felt that sense of peace and gratitude knowing God is working through me to take care of the most vulnerable population — the sick, the elderly, the children.
Our goal is to deliver safe and effective nursing care, and in the end we get a sense of joy and peace that we have done our best, and our patients feel less pain or discomfort. They feel safe and secure that they are being taken care of, and their needs have been met.
After the patient was discharged the next day, the physician asked me, “Margaret, how did you insert that foley?” I said, “Not only with my experience, but I did it with God’s grace.”
Margaret A. Persaud, MSN, RN, is retention coordinator at Washington Adventist University, in Takoma Park, Md.
My primary goal: Relieve the pain and fear
By Patricia O’Rourke, BSN, MBA, RN (retired)
As far as nursing skills are concerned, the single most important one is compassion. The nurse must have compassion for all patients. Not empathy, because God knows you do not want to feel their pain and anxiety. Not sympathy, because you cannot stay in the profession very long if you feel sorry for the patient. Compassion is the human emotion that allows us to respond to and mitigate the pain and anxiety of others.
Observation also is a key nursing skill. The nurse must observe and evaluate the patient during all interactions. Talk and then listen. While listening, observe for signs of restlessness, pain, stress, anxiety, anger and fear — not to mention observing color, circulation, skin integrity and mentation. Mentation is a critical component when assessing the patient’s condition. I have read accident reports that have said: “The patient suddenly bit me,” “… suddenly scratched me,” or “… suddenly struck me.” The patient did not do anything “suddenly.” He was anxious, hypoxic, in fear or in pain. Go see your patient, talk to him, relieve his pain and fear. Do not sit at the desk waiting for an alarm.
Remote patient monitoring has its advantages, but also its disadvantages. We can sit at a desk and see the EKG, heart rate, oxygen saturation, and then respond to an alarm. But the patient’s status is also in his face, in the feel of his skin, in the words he utters. Early recognition and treatment or intervention will help prevent the patient from becoming angry or violent. Anger and fear use up valuable oxygen in the blood, emitting adrenaline for autonomic self-protection, the flight-or-fight syndrome.
Helping patients to rest and relax is an important part of nursing care. When I worked in coronary care patients would say, “I’m in here because I am going to die, right?” I would say, “No, you are here because you are going to live; this is a coronary care unit, after all.”
While placing the monitor electrodes, I would explain to the patient what I was doing, but I’d add, “So now you’re wired for sound like an astronaut. This monitor picks up everything, so watch your language; even evil thoughts are picked up.” The patient would laugh. Great. Laughing causes a release of endorphins, which makes the patient feel good.
My primary goal was to reduce pain, fear and anxiety because negative emotions release adrenaline, and adrenaline puts strain on the heart and raises the blood pressure. It was to everyone’s benefit that I provided reassurance as well as medication as needed and a calming and soothing atmosphere.
I have sat next to patients to chat with them and help them relax. I recommend this; it’s good for both of you. I’d dim the lights and partially pull the curtain after 8 p.m. or so. Critical care units can be so bright and so loud 24 hours a day. This adds to the patients’ anxiety, and decreases the chance they’ll get a good night’s sleep. Dim the lights and the noise.
Yes, the single most important nursing skill is compassion, and it is that human emotion that allows us to respond to and mitigate the pain and anxiety of others.
Patricia O’Rourke, BSN, MBA, RN (retired), worked for 10 years in critical care nursing at Miami Heart Institute and Kaiser Foundation Hospital in San Francisco and worked for 36 years in occupational safety. She retired in 2012. She also has attained Six Sigma Black Belt Certification.
Realizing a vision
By Anna Liza D. Fernandez, MSN, RN, CHTS
I have been a nurse for more than 20 years, working in the perioperative unit. Looking back, I know I have made a difference in the lives of my patients and families. Even though there have been many challenging moments, I have been enriched and inspired by my patients and my colleagues. Every nurse could share so many inspiring stories. When we choose nursing, we choose a path that blends science and compassion. Every minute with a patient or a colleague is an opportunity to learn, to grow and to empower ourselves and others. Nursing gives us the chance to be of service to others and provides us with priceless moments. As a nurse, even our simplest action can touch someone’s life; by doing so, we become a better person personally and professionally.
I attend the Association of periOperative Registered Nurses’ conferences because they’re an optimal setting for learning, growing and developing oneself. I’ve contributed by volunteering as a moderator, a session assistant and as the AORN chapter delegate chairwoman. I also facilitate the educational sessions and act as a guide for attendees, particularly the first-time participants — novice nurses, seasoned nurses, aspiring students and international nurses.
Having spent most of my career working in the Philippines, I thrive on the opportunities like the AORN conferences to exchange information and knowledge about nursing concepts, cultural beliefs, diversity and nursing practices. I am inspired by and take great pride in the fact that as a profession we can share with one another to improve our nursing care.
As a nurse leader, I provide care based on a simple doctrine that includes:
We can help patients, even by the smallest of gestures — by listening and making an effort to uplift someone from loneliness or from the anxiety he or she may feel while waiting for surgery.
We should always be attentive and present when interacting with other staff. Always being in a hurry in the hallways or lacking eye contact when talking to a colleague would give the impression that you don’t care. Don’t we complain when our supervisor fails to listen to us? To be an effective leader and change agent, learn to communicate sincerely. Have an open door policy and initiate a five-minute time out rule when someone wants your attention.
Everyone, no matters his or her standing in life, is important. Caring transcends any status or position in life. We should treat every patient like a VIP. Age, color, gender or cultural affiliation is not a basis for the level of caring, but a guide to provide appropriate nursing care.
Every moment is an occasion to care. All of our actions should be carried out to alleviate a person’s suffering, to promote health and prevent afflictions based on the core concept of caring.
A nurse’s passion for caring should never burn out, and this extends to colleagues. Surrounded by frustrating imperfections in healthcare systems, there are days where a pat on the back, a smile or a kind word is all we need to bounce back and appreciate the fact that we are caring nurses, and we’re here to make a difference. Let’s do this for each other.
Anna Liza D. Fernandez, MSN, RN, CHTS, is nurse manager, OR, at the Veterans Affairs West Palm Beach (Fla.) Medical Center.
Cultural awareness is crucial in nursing
By Oligens Sulo, MSN, RN
My inspiration to become a nurse began in 1998 when I volunteered to work with Kosovo refugees who sought shelter in Albania during the Kosovo War.
Joining a Norwegian association that built temporary shelters for refugees, I assumed the role of translator. Although I did not have a healthcare-related background at the time, working closely with the medical team made me realize the desire I had to care for people. I learned how to be compassionate and empowering to the sick. I also learned how to remain strong, calm and ready to serve at any moment. I connected with the refugees, and being able to translate helped me learn about medicine. While working with the physicians and nurses, I witnessed the caring and compassion they demonstrated in their roles as healthcare providers.
Seeing the people on trucks with kids, elderly and everyone else was simply heartbreaking. I did not mind waking up in the middle of the night to translate. That’s the least I could have done.
When my family and I came to the U.S. in 2000 from Durres, Albania, I entered the nursing program at Henry Ford Community College in Dearborn, Mich., earning my associate degree in nursing in 2005.
Being a nurse is the embodiment of having compassion for other cultures, as well as loving yourself and others. It means being culturally aware and having an understanding of how human caring is an essential part of nursing knowledge, the healing environment and the nurse’s own cutural and moral beliefs.
To me, cultural awareness is a journey that involves letting go of personal presumptions and assumptions about another person, regardless of race, ethnicity or color. Once we reach that awareness, we can then start the process of becoming culturally competent — an important element in the nursing profession.
Nurses also must consider the role morality plays in various cultures. Like culture shapes the way people derive meaning from illness, suffering and dying, morality shapes the way individuals or groups derive meaning from character development, behaviors, values and duties.
Being culturally competent and aware will increase our skills in providing care to our patients. Recognizing and acting upon our nursing assessments among diverse cultures as well as vulnerable ones is key to saving someone’s life. As healthcare providers, we must connect spiritually and holistically with our senses to embrace immense diversity in the melting pot of humanity at this pivotal time in history.
The power of cultural awareness and understanding the needs of everyone, no matter their background, allows us to bring wisdom from the past and gain knowledge for the future to help us learn to respect one another.
Oligens Sulo, MSN, RN, is assistant professor/skills lab coordinator at Roseman University, Henderson, Nev.
It’s about more than saving lives
By Mariam Wisnewski, MSN, RN
As nurses, we are taught the value of saving the lives of our patients, young and old. I do not dispute that, but I am here to tell you that after more than 25 years of nursing the critically ill, saving lives is not all there is. Nurses have a unique view on life and death, one others often cannot and do not understand. My first rule, and one I insist will be on my own epitaph, is: Just because something can be done, doesn’t mean it should.
As a nurse, you are trained in assessment, diagnosis, evaluation and treatment. You focus on making your patients well, because that is what you are taught. But the reality is, even with the technological advances available to us in healthcare, we can’t save everyone. And death does not discriminate for age, economic status or religious affiliation.
Handling the loss of a patient is as individual an experience as the death itself, and one that most nurses will face many times during their careers. That’s why I believe nurses should be given the opportunity to learn about end-of-life care — a topic not traditionally covered in nursing school curricula — during their training.
End-of-life care will mostly come from experience over time, and it can be difficult to learn. But if you start your career as a nurse understanding that death is part of life, that it can be as peaceful an experience as it is allowed to be, and that it is sometimes the right and most compassionate thing you can advocate for a patient, you will be a blessing to your patients at the end of their lives, and to their families.
End-of-life care, and not just of patients but often moreso of their families, takes a special kind of nurse. You can teach yourself to be one of those special nurses by seeking information about who your patients were before they became patients. What was their quality of life? What was most important to them? Will they ever be able to return to their activities or lives they lived before? If not, consider helping them transition from focusing on treating to cure, to being made comfortable and freed from aggressive medical interventions.
Nurses mourn the loss of their patients and deal with that loss in their own way. I have always allowed myself to retreat to the break room and cry if necessary. The day I stop crying over the loss of a patient is the day I need to find another line of work. I also find comfort in being able to honor patients and their families after death. I facilitate their mourning, often attend viewings, and make sure the family’s needs are met before they leave the hospital after a loss.
I have lost count of the patients whom I have had to keep alive because they had not made their end-of-life wishes known or because family members disregarded those wishes, unable to accept the impending loss. We have an obligation as human beings, not just as nurses, to facilitate the honorable deaths of those patients whose chances for recovery have diminished to random miracle, or whose quality of life will never be the same.
Don’t be discouraged when you lose a patient for whom you have tried your best, or for whom no interventions have succeeded. It is not a personal failure for you nor the physician, who will often be more reluctant to stop offering aggressive treatment measures than you will. It is a necessary transition, and wherever you believe your patients go after death, helping them get there peacefully is a true honor of the nursing profession.
Mariam Wisnewski, MSN, RN, is a nursing practice specialist at Lee Memorial Health System in Ft. Myers, Fla.
From nursing to administration
By Paul Balcom, MHA, RN, FACHE
In 1952 when I was a young aspiring student of hospital administration, my mentor, a physician and administrator, advised that both business and clinical grounding would best serve as preparation for my career. That advice started my long journey into nursing and influenced me to later serve as a mentor myself.
I am confident that my nursing background added greatly to my success over my administrative career, including my involvement in nursing organizations. My nursing background enhanced my self-confidence and contributed to my maturity, as I dealt with the diversified fabric of the ever-changing hospital and public health scenes. I feel the respect I gained from my peers was due in part to my nursing background. I had a sense that I was perceived as able to mix with the troops versus being perceived as the man in the suit in the front office, since I understood their environment.
Although I supported other disciplines, I was a staunch supporter of nurses. Insights gained from a nursing education and practice added greatly to my sense of purpose. Medical staff relationships were favorably bridged as we spoke a common language. As I built my executive staff, I required that each of my senior executives had previously functioned in some capacity related to direct, hands-on patient care.
In 2002 and 2003, I volunteered for three tours as an OR circulating nurse with Medical Ministry International surgical operating teams in the Dominican Republic, and I recruited nurses to volunteer with MMI, as well. A few years after retirement, at age 72, I was invited to volunteer with MMI, as an OR circulating RN. Doubting my very rusty OR skills, I suggested that I could better serve as a truck driver or in an alternate role. The physician project leader assured me that with focused on-the-job retraining I could do the job. Reluctantly I agreed to serve in the OR and took the necessary refresher and training courses for my first of three missions to the Dominican Republic.
In retirement I had been serving as resident of a nonprofit foundation. This foundation later supported my recruitment of volunteer nurses and other healthcare personnel for MMI missions by providing generous scholarship support for future mission participants.
Over the years young folks have been referred to me for employment and career counseling, just as I benefited from mentoring at the beginning of my career. As I received, so I gave, enjoying the fulfillment of beneficially touching the lives of others. Mentorships, whether you’re on the giving or receiving end, are meaningful, significant relationships that enrich everyone involved and improve our profession. And whether your goal is to become a healthcare administrator, manager or team leader, your nursing background will serve you well.
Paul C. Balcom, MHA, RN (retired), FACHE, lives in Lorain, Ohio. He practiced at several Minnesota hospitals and, as a lieutenant in the U.S. Army Reserve, 92nd Field Hospital, he trained medics in patient care and later served as a medical detachment commander for an infantry battalion. He served as a senior executive/CEO at several hospitals and was inducted into the Sigma Theta Tau Honor Society of Nursing in 1995.
Challenges and choices
By Carol Montiel, MS, RN
I am proud to say I have been a practicing nurse for more than 45 years. My career has been challenging, yet so rewarding, and it has led me in many different directions from the hospital, home care and air ambulance to education and long-term care. My experiences have taught me to be self-sufficient and always have a plan B. Nursing, like life, is never perfect. However, the profession has taught me, as I hope it will teach you, to have a passion for the work you do and seek opportunities that provide you with meaningful experiences.
Nursing is more than just the 4 C’s you study in nursing school. Certainly, compassion, concern, commitment and care are what brought you into the profession. However, once you enter the workforce, you need two more C’s to follow you — challenges and choices.
When we challenge ourselves, we have the ability and confidence to share our knowledge with physicians and other healthcare professionals. We are different but equal in the relationship paradigm.
Nurses demonstrate commitment to patient care by doing all they can with all of the available resources, in the most caring way imaginable. Nurses joining the profession possess that commitment and use critical thinking skills in all they do. We are graduating a new generation of men and women who are capable of making decisions for themselves, and many are seeking to further their education. They are no longer handmaidens of physicians.
With all of the changes, patient care still is primordial; being on a computer 75% of the time is unacceptable. Nurses who find themselves spending more and more time with information technology and less time with patient care will leave the profession at an alarming rate.
Certainly there will be challenges. Every day will bring new experiences and new knowledge. But always remember why you became a nurse. Nursing is not just a job, but rather a career and a vocation that gives you innumerable opportunities to make a difference, to advocate, to counsel, to comfort and to teach.
We all have choices, and don’t let anyone tell you otherwise. Some of you may find excitement in the hustle of the ICU, ED, trauma or air transport. Others will find a special spot in their hearts for caring for the smallest of patients and choose to pursue neonatal or pediatric nursing. I am sure many of you will find a propensity for caring for our aging population and geriatric nursing will be your calling. Some of you will choose to further your education and will pursue academia, research or informatics.
I have had the opportunity to become the director of Golden Glades’ “Baby House,” a home for medically fragile and profoundly disabled children and young adults. Schools of nursing come to our facility during students’ pediatric rotations. Our students learn how to care for special needs patients and receive hands-on experience with those who are on ventilators and have tracheostomies. My patients do not speak or eat by themselves; they do not move and cannot shake your hand to say hello or goodbye. Every night when I leave the facility, I know I have helped my patients feel happier, healthier and safer.
Being a nurse is a privilege. To be entrusted with the care of sick and aging patients is an honor. To be a nurse means being a loving, compassionate, dependable, competent, responsible, comforting and caring person. It also means having a burning passion to make a difference in the lives of others.
Be proud you have chosen nursing as your profession!
Carol Montiel, MS, RN, is director of Golden Glades, Miami.
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