Image: Thinkstock | Stockbyte

How many nurses feel like they must carry the weight of the world on their shoulders?

We have all been guilty of this, but the key is knowing when to let go. I love the following story for that reason:

A young lady confidently walked around the room with a raised glass of water while explaining stress management to an audience. Everyone knew she was going to ask *that* question:

“Half empty or half full?”

She fooled them all. ”How heavy is this glass of water?”

Answers called out ranged from 8 oz. to 20 oz.

She replied, “The absolute weight doesn’t matter. It depends on how long I hold it. If I hold it for a minute, that’s not a problem. If I hold it for an hour, I’ll have an ache in my right arm. If I hold it for a day, you’ll have to call an ambulance. In each case it’s the same weight, but the longer I hold it, the heavier it becomes.”

She continued, “And that’s the way it is with stress. If we carry our burdens all the time, sooner or later, as the burden becomes increasingly heavy, we won’t be able to carry on.

As with the glass of water, you have to put it down for a while and rest before holding it again. When we’re refreshed, we can carry on with the burden–holding stress longer and better each time practiced.”

So, as early in the evening as you can, put all your burdens down. Don’t carry them through the evening and into the night…pick them up again tomorrow.

These 18 life lessons are some of my favorite reminders to de-stress:

1. Accept the fact that some days you’re the pigeon and some days you’re the statue!
2. Always keep your words soft and sweet, just in case you have to eat them.
3. Always read stuff that will make you look good if you die in the middle of it.
4. Drive carefully…it’s not only cars that can be recalled by their maker.
5. If you can’t be kind, at least have the decency to be vague.
6. If you lend someone $20 and never see that person again, it was probably worth it.
7. It may be that your sole purpose in life is simply to serve as a warning to others.
8. Never buy a car you can’t push.
9. Never put both feet in your mouth at the same time, because then you won’t have a leg to stand on.
10. Nobody cares if you can’t dance well. Just get up and dance.
11. Since it’s the early worm that gets eaten by the bird, sleep late.
12. The second mouse gets the cheese.
13. When everything’s coming your way, you’re in the wrong lane.
14. Birthdays are good for you. The more you have, the longer you live.
15. We could learn a lot from crayons. Some are sharp, some are pretty and some are dull. Some have weird names and all are different colors, but they all have to live in the same box.
16. A truly happy person is one who can enjoy the scenery on a detour.
17. Have an awesome day and know that someone has thought about you today.
18. AND MOST IMPORTANTLY — Save the earth…it’s the only planet with chocolate!

It’s not so important who starts the game, but who finishes it (John Wooden).

Comstock | Thinkstock

Are you facing your LAST clinical rotation before graduation? Here are a few tips for excelling as a preceptee!

• Arrive 10 minutes before the official report time–appropriately dressed, well-fed and ENTHUSIASTIC!
• Leave the extra jewelry (diamond rings, bracelets, necklaces and dangling earrings) at home. These items are not safe and are a source of infection. Most are against school and hospital policy in patient care areas.
• Short nails (NO artificial!) with no chipped polish are expected. This is a CDC standard. Lots of “nasties” have been cultured from nurses’ nails!
• You will have, of course, already been to the bathroom and done a “mirror check” to be sure that no underwear or tattoos are showing and that your hair is out of the way. We prefer “above the collar.”
• Introduce yourself to your assigned preceptor and present to him/her your list of learning objectives–this person is your instructor and will evaluate you during your time together.
• Remember that you are there to watch, listen and learn! It is YOUR responsibility to let your preceptor know what you are or are not allowed to DO.
• Your preceptor will look for learning opportunities, which may involve: observing surgery, going with a patient to CT scan or MRI, or even assisting another nurse with a procedure.
• As you get comfortable working together, your preceptor will welcome your input. You will find a lot of things which do not fit the mold you were taught in school.
• One day you will be given the chance to fly solo–with supervision, of course. On that day you will get report, quickly assess your patient(s) and gather up all lab and X-ray results so they’re there when the MD arrives. You know exactly how much intake and output/bowel movements the patient has had as well as any other information. The Goal is to make the doctor’s rounds go as smoothly as possible and to let them learn to trust YOU.
• NEVER tell a doctor “I don’t know.” Say instead: “Let me double-check that for you.”(Because of course you know ALL things, but you need to be sure.) This keeps the doctor from becoming anxious about your abilities as a nurse. Remember The Goal.
• Doctors LOVE to “teach” (i.e. show off what they know); your preceptor often will ask the doctors to describe/show/explain what they are doing in a procedure.
• Remember that the only stupid question is the one that you do not ASK!

I never teach my pupils; I only attempt to provide the conditions in which they can learn (Albert Einstein).

Image: Thinkstock | Comstock

Ever since I was a young girl, I’ve been pretty certain of my calling to be a nurse. In high school, I made sure to take all of the right science courses as electives so I could apply to nursing school at the local college.

And, in order to be absolutely certain that nursing was for me, I enrolled in a 6-week nursing assistant course at the local vo-tech school that summer. We were instructed by a veteran RN and most of us were hired by the local hospital. Having already been accepted into the 2-year RN program at the local college gave me a leg up.

Like all nursing assistants of the time, my job was to be wherever I was needed in the hospital on my 8-hour shifts. The uniform was a pink dress, beige stockings and white Clinic shoes! The only jewelry allowed was a watch and a plain wedding band if you were married.

We got report along with the nurses and were given patient assignments, as well as general floor tasks such as filling water pitchers, serving and clearing meal trays, etc.

But the best part was learning from the nurses. On every unit, there is usually at least one RN who is approachable.  These were my first mentors. They were the ones who knew stuff and shared it with others. They were trusted by the docs and respected by management. Over the course of my career, I’ve tried to be that person for students and others.

Today, the nurse’s aide has transitioned to more technical skills, and their certifications and titles have changed to reflect this. In my day, the portable blood sugar and ACT testing machines didn’t exist and blood was drawn only by a lab tech or RN. Today’s nursing assistants are a vital part of a unit’s strength in its staffing. Many times I have made the decision to keep my regular nursing assistant, rather than to give her up for an RN who doesn’t know the unit.

Having started at the bottom of the ladder, I’ve pretty much done it all. I believe very strongly that no one should ever ask or expect another person to do what they themselves are not willing to do.

I believe it’s always important to keep learning new skills and the principles that go with them, and to be the kind of person who’s willing to share hard-earned knowledge with others. I believe in helping others overcome their fears and anxieties about trying something new, and always reminding yourself AND others that the only stupid question is the one you do NOT ask!

The truth is that the best way to get good help is to teach them how to be all they can be!

Some of the best lessons are learned from past mistakes. The error of the past is the wisdom of the future (Dale Turner).

Image: Thinkstock | Pixland

How many times have you felt the frustration of patients’ family members who camp out in the waiting room for days on end?

They get someone to bring their meals to the waiting room unless there is a “no food” policy and someone to enforce it. They live and sleep in the same clothes and do not bathe, they compare notes with other family members (so much for privacy and HIPPA rules!) and they bring in expensive treats for the staff. I once had a patient whose son brought in three boxes of Godiva chocolates for each shift (this is part of the “bargaining” stage of coping).

There was a family member who had a cooler with her in the “camping area,” which we later discovered contained a half-gallon bottle of gin. In the middle of the night she got VERY drunk and a “cat fight” ensued with security finally removing the woman. For some reason they brought the bottle of hooch back to me in the unit. As if any of us could drink on duty! (Kind of like the family who brought in the jars of moonshine–but that is another story.)

What you notice after a few days or even weeks is that these family members have begun to exhibit signs of deterioration mentally, physically and spiritually. They are already going through the stages of grief as defined by E. Kubler-Ross, which most of us learned about in school.

In their most vulnerable moments, they’ll begin to nit-pick about small details and practically stalk the doctors. The blame game will ensue among family members, an acute phenomenon in the first few hours or days.

So what do you do to help yourself AND your patient’s family?

I used to tell my patients’ families: “Now is the time for you to take care of yourself and let us do the work. Do something that is part of a regular lifestyle. Sleep at home, go and get your hair done, eat a real dinner at a nice restaurant, etc. Because you will need your strength when Mama gets out of ICU. If something should happen while you are not here, know that there is nothing you could have done if you were here. In an emergency, no one is allowed to come in and we will do everything possible to take care of the problem.”

Be certain you have all of the correct cell and home phone numbers for the family and be sure to call them, as you have promised to do, with any new changes or developments.

Sometimes a patient will pass away when his or her family leaves. When that happens, you will have to explain the unexplainable as best as you can.

Sometimes nothing that you do or say will change a situation like this. In the end, you must respect that the family members have the right to stay or go as long as they are not being disruptive or violating the rights of others.

There is no doubt that it is around the family and the home that all the greatest virtues, the most dominating virtues of human society, are created, strengthened and maintained (Winston Churchill).

Image by: Thinkstock | Stockbyte

Not long ago, Nurse Jo wrote an article about the installation of RFID tracking devices on ID badges in her facility. This is highly disturbing, as is the discussion supporting the use of smartphones at the bedside.

I would like to elaborate further on my comments as posted under Nurse Jo’s article:

I see lots of problems with all of this. RFID signals are also used to transmit information on things such as your credit cards to allow a thief to steal your identity. Also, since any and all computer systems can and have been ”hacked,” the same problems arise with HIPPA protected data which can be transmitted via smartphones.

RFID signals can be blocked with certain metals and can be completely disabled with a strong magnet, such as the type that is still used to test pacemakers or an MRI.

Electronic devices such as tracking badges also can be victims of “accidents”–dropped in the toilet, stepped on, lost in the elevator shafts, etc. Repair or replacement costs money. Those devices with access codes may be stolen by someone who wants to get into a restricted area, such as the nursery or pharmacy.

I would ask what this data set is to be used for, but I think that we all know the answer. What happens when you must eat lunch in the nurses’ lounge? Or if you must leave the facility to transport a patient to another hospital?

Also, tracking of personnel is a violation of personal privacy rights. Does everyone in the system wear a tracker? Administrators and doctors, too? And who sits and monitors the movements of personnel all day? Who gets the reports? What do “they” do with the information?

I think that we can all pretty well figure THAT out.

This also costs lots of money which should not be spent by facilities which receive federal tax dollars in the form of Medicare/Medicaid. It just SCREAMS “Big Brother.”

George Orwell is probably rolling over right about now.

Image by: Thinkstock | istockphoto

Nurses often leave from or arrive at work in the dark, in poorly lighted or under-patrolled parking lots and garages. Those who prey on women KNOW these things and consider such areas “target-rich” environments. So how can you avoid being a target?

Refresh your memory with these things to do in an emergency situation. It never hurts to be extra careful in this crazy world we live in.

If a thief demands your wallet and/or purse, do not hand it over. Toss it away from you. Chances are he or she is more interested in your wallet than you and will go for the wallet/purse. Then run like mad in the opposite direction!  (Another thought: it might be wise to keep your drivers’ license and other items which have your address/phone number in a separate wallet or even in your vehicle rather than carrying such items in your purse.)

A few notes about getting into your car in a parking lot or parking garage: Remember that the two most powerful weapons you have are your vehicle and your cell phone. Do not give up either if you can possibly avoid it! Make sure that the GPS tracking option is turned ON when you are setting up your cell phone.

When approaching and getting into your vehicle:

A.) Be aware. Look around you, look into your car, at the passenger side floor and in the back seat.

B.) If you are parked next to a big van, enter your car from the passenger door OR find an escort–preferably a police officer.

Many serial killers attack their victims by pulling them into their vans while they are attempting to get into their cars. Remember that Ted Bundy came across as a “nice guy” who often appeared to need help.  And what do nurses like to do? HELP people!

Look at what is parked on both sides of your vehicle. If someone is sitting in the seat nearest your car, you should walk back into the mall or workplace and get a guard/police officer to walk you back out.

Women have a tendency to get into their cars after shopping, eating or working and just sit doing their checkbook or making a list. Don’t do this! The predator will be watching you, and this is the perfect opportunity for him/her to get in, put a gun to your head and tell you where to go.

As soon as you get into your car, lock the doors and leave.

If someone is in the car with a gun to your head, do not drive off as instructed. Instead: GET RECKLESS! Gun the engine and speed into anything, preferably wrecking the car on the side of the intruder. Your air bag and seat belt will protect you and the “wreck” will draw attention to you and your situation. If the person is in the back seat, he/she will most likely get the worst of it.

As soon as the car crashes, bail out and run if you can.

If you are ever thrown into the trunk of a car which does not have a yellow “emergency open” handle, kick out the back tail lights and stick your arm out of the hole and start waving like crazy. The driver won’t see you, but others behind the car will. This has saved lives.

Remember: It is always better to be safe than sorry.

A woman must not depend upon the protection of man, but must be taught to protect herself (Susan B. Anthony).

Image by: Thinkstock | Zoonar

For as long as I have been a nurse, there has been a huge debate over educational requirements for basic RN licensure, AKA entry into practice.

Now we have this “eight-year initiative”–the latest program designed to mandate a BSN for RN licensure in the United States.

From the time I became a two-year degree RN in 1978 until I finally completed a BSN in 2010, I have been on “both sides of the bed” and have yet to see how a mandated BSN does anything more than give the hospital’s marketing people something to brag about.

BSN nurses do not typically make any more money than associate degree RNs but may be expected to do more administrative chores, often for even LESS money than a shift nurse can make. Also, higher education has evolved into a BIG business–if you look at who is driving the mandatory higher degree requirements, they nearly all live in academia and hold PhDs. Yet we still do not have an initiative for one U.S. RN license even though we have ALL taken the same exams for more than 40 years!

We already have an overabundance of “soft hands” in this country. Most of the recent BSN grads I see are already enrolling in master’s programs to “get away from cleaning poop.” Many are going the NP route for reasons such as: Monday-Friday schedules, weekends and holidays off, better pay, benefits and in some states the chance to practice independently.

Look closely at who and what is driving these agendas before you jump on board. Most of them have not actually WORKED in the real world in years. The world of academia is artificial at best: lots of theory and unproven pseudo-science. (At one point in the 1980s, the nursing school I attended embraced “humanistic existentialism,” complete with crystals, psychics and other unproven controversial stuff before nursing and medicine finally began to embrace scientific evidence as the basis for its practice.)

So what happens when EVERY nurse in the country has a master’s degree or even a doctorate (already required for Advanced Practice Nurses who are not grandfathered in)?

The answer is simple: There won’t be any RNs at the bedside because they will have been “educated” away from it!

Follow the money (William Goldman, All the President’s Men).

Image by: Thinkstock | istockphoto

We hear and read a lot about burnout in nursing. Most of us who have been around for a while have experienced it to some degree at some point. It even occurs when we have a job we like.

Generally, nurses who have reached “flashpoint” experience depression, exhaustion, mood swings and a general dread at the thought of going to work. There is usually no desire to take on the role of preceptor or to participate in other unit activities. As the burnout continues, some turn to drugs, alcohol and other unhealthy practices in an attempt to cope and keep going. Some seek professional help if they can recognize the symptoms.

There are as many reasons for burnout as there are nurses. Changes in management, staffing ratios, patient acuity levels and mandatory overtime all have been cited by various researchers who study the problem.

Personally, I have another theory for what could be a causative factor: BOREDOM. Even the coolest, sexiest specialty unit gets OLD after a while. After you have mastered the game and even the worst of the worst becomes routine, you may find yourself  just “going through the motions.” The thrill is gone.

So what can a nurse do when this happens? The most effective thing I have done is to make a change, at least for a little while. (Probably why I have such a diverse resume!) I have seen the same tactic work for other diehard ICU nurses.

Three ideas:

1. Go on vacation, even if just for a few days. Even a week at home doing simple things does wonders.

2. Change things up temporarily. A different unit or specialty area may be just be the thing to put the spring back in your step. Most managers understand the need for a change, especially if you plan to come back to them eventually.

3. Change things up for good. You just might decide you prefer the new unit. The docs and nurses who worked well with you will miss you and may even beg you to come back, but remember that you cannot be effective if your head is not there with you. Follow your own heart and be good to yourself. I know–this is hard for us to do, but we are no good to anyone if we are not happy to be where we are on a given day.

Be in touch with your inner self. Pay attention to your feelings. Do not feel that you must sacrifice yourself on the altar for any institution. The stress that goes with burnout is powerful. Remember, you cannot help anyone if you self-destruct and have to get out of the game.

 A sad soul can kill you quicker, far quicker, than a germ (John Steinbeck).

Image by: Thinkstock | Comstock

As nurses, we tend to steel ourselves against showing our emotions, especially with patients and their families. So what happens when the “worst possible scenario” comes home to our own family?

Some years ago, my mother-in-law, a long-term diabetic, poorly controlled and with frequent exacerbations of atrial fibrillation, experienced chest pain the day after Thanksgiving. A cardiac catheterization revealed several blockages which could only be repaired with cardiac bypass surgery.

My husband and his siblings didn’t know just how unstable their mother had been for quite some time. I, on the other hand, had been blessed with her phone calls. I knew about the high blood sugar levels and “racing” heartbeats, but she never complained to anyone else. She also refused to call the doctor to report any of these events, no matter how much I begged, pleaded or threatened.

So it was not a terribly big surprise to me when, on the day of surgery, her surgeon finally emerged from the OR after 5-6 hours and began to explain just how big a mess he found with all of her vessels. (The fact that she came out of surgery on the aortic-assist balloon pump was also a pretty strong indicator.) As I listened, I knew he was doing his best to “soften” the bad news.

My husband’s family was in extreme shock. They thought Mama was going to have the surgery and be “all better.” None of them had any idea how unstable she had been for so long. In that moment, being the critical care nurse in the family was not a good thing.

The next five weeks were filled with the absolute hell of “anything that can go wrong…” as we see all too often in the ICU. Amputation of one leg by the end of the first post-op week, a tracheostomy and feeding tube, MRSA pneumonia, isolation…

Her sons took turns sitting at the hospital 24/7. They were emotional wrecks, unable to eat, sleep or go to work. They constantly called each other to report any changes, however small. At the end of that month, each had a cell phone bill greater than $900. It was hard to watch as they turned in on themselves instead of leaning on the rest of us.

We tried to celebrate Christmas in the middle of it all, for the sake of the kids. But not many of us had our minds on the tree, gifts or services that year. The one shining light through that dim holiday season, though, were the doctors, nurses and all others who were so wonderful through it all.

Finally, the day after New Year’s, the remaining leg became gangrenous. We withdrew the ventilator and stopped all meds, tests and feedings except for the comfort measures and pain relief in accordance with what we all agreed would have been her wishes.

And here I am today.

It took years for me to get over as much of the ordeal (as is ever possible). It was truly the kind of experience I would not wish on anyone. The strain and stress took its toll on my relationships and the holiday season is never quite the same.

Still, life goes on and I try to continue the journey one day at a time, for tomorrow is promised to no one. I lend my love and support to my family. I try to raise the children and grandchildren into responsible and caring adults. I try my best to remember: I must use my gifts and abilities for the good of others.

Keeping my mother-in-law’s spirit alive is surprisingly contained even in the seemingly mundane things: Frying chicken and cooking rice and gravy her way, keeping the recipe for her lemonade cake alive, reading to the children and putting her collection of The Night Before Christmas books out on top of her piano at Christmas every year.

These acts, big and small, are the finest way I know how to honor a loved one.

I have found the paradox, that if you love until it hurts, there can be no more hurt, only more love (Mother Teresa).

Image by: Thinkstock | istockphoto

There is no shortage of “nurse gear” on the market to advertise who and what we are. ”Nurses Call the Shots,” “Proud to be a Nurse,” “RN on Board”–t-shirts, coffee mugs, bumper stickers, tote bags, the list goes on!

We are all proud to be nurses–especially when we finally graduate/pass the licensing exam/get our first “real” job. It is natural to want to shout it from the rooftops!

And our families are also very proud to have a nurse around. They will make a point of loading us up with all sorts of goodies advertising it and will often “rat us out” when we go with them for their own medical checkups (which can get weird when the doctor starts explaining things to US instead of THEM!).

Of course, later we will have to “translate” the Medspeak into English, and then whatever “my daughter/son, the NURSE said…” will be what gets shared with friends and the rest of the family.

So, is wearing the nurse badge a GOOD thing?

Depends on whether or not you want the world to know who you are at any given time.

Sometimes you would like to pass unnoticed in the world of nonmedical sentient beings, like at the grocery store after a particularly stressful 12-hour shift, or when YOU are the visitor in the hospital. (Of course, if you are still in uniform, it’s a done deal.)

But there are times when, for example, if you work in and out of people’s homes, you may find having a license plate frame and perhaps a windshield sticker helps your patients know who is driving up. This can also be a safety feature in dangerous areas or where law enforcement may need to allow you to pass. In my years of home health nursing, I have found that even the gang members and drug dealers tend NOT to mess with mama’s nurse.

Some nurses never get tired of being “made.” Others NEVER want to be recognized.

And sometimes we can’t quite skip past the patient who falls down right in our path…

It ain’t braggin’ if you can do it! (Rene Neville, RN)