The short answer is that nurses either make peace with the emotional demands of the job or find a different one. Mostly I have made my peace with it, but some days are harder than others, and those are the days when the “how” of coping really matters. I’ve had a few of those days lately, and they’ve made me think about what I do to keep the sadness of the floor, and the enervating work that regularly confronts death, from taking over my life.

A few months ago, a patient—a woman roughly my age, 44—was actively dying. When she was admitted with a diagnosis of leukemia a year before, she was energetic and bubbly. She had been a hairstylist, and once she started to lose her hair, she borrowed clippers to shave her head. When a rounding attending told her that being bald suited her, that she had a “nice-shaped head,” my patient thought this was hilarious, and her strong laugh was hard to resist.

Now, close to death and doped up on morphine, she could not chat with, listen to or even notice the people around her. Her husband and I talked, though. In the hallway outside her room, he looked at me, shaking his head. “I don’t know how you do it,” he said, imagining the toll the job took on me.

Two years ago, when I first started as an oncology nurse, I would pretend an emotional immunity in these conversations, a placid resilience, that I did not actually feel. Over time I admitted to myself that demurring was really only a way of lying about how the job taxes me. So this time I looked at my patient’s husband and thought about an honest response. “Well,” I said, “I have three kids, and they really do rejuvenate me.” The husband looked at me, surprised, and then nodded his head.

An explanation, however, is not an action—and to stay sane in this job, you have to act. As soon as I could, I called my husband. “Hey Arthur,” I said, “how about you pick me up when I get off work and we take the kids to Max & Erma’s?”

My son Conrad, who’s 13, and Miranda and Sophia, 10-year-old twins, really like the local Pittsburgh chain restaurant. But they know it’s not a place I would ordinarily choose, so they asked me, with that unselfconscious directness children have, why I suggested going. Once again, I thought about my answer. I often try to soften or even hide the hardest truths about my job. This time, though, the truth seemed like the best idea.

“A patient I like very much is dying from cancer and I was feeling sad about work,” I told them. “Seeing you guys makes me feel better, so I wanted us to go to a restaurant you really like.” All three of them sat silently for a few seconds, and then, like my patient’s husband, they all nodded.

The restaurant’s hum returned, along with the kids’ chatter. Miranda described the fifth grader who spent too long in the bathroom, Conrad bemoaned the librarian who could not control her class and Sophia complained about homework. The conversation was like a salve on my soul.

CONTINUE TO NEXT PAGE–>

Image by: Thinkstock

Communication is the foundation of everything we do. It’s how we implement our interventions, how we coordinate tertiary care and how we educate everyone involved. While the spoken word is the gold standard of communication, the unspoken word resonates at a higher volume and frequency. In other words, it’s not what you say but how you say it that matters the most.

This concept is most important when speaking to our patients and their families. Be sure you don’t make these mistakes the next time you are communicating:

Timing

• Be where you say you’ll be when you say you’ll be there. Nothing shakes a patient’s confidence in the care you are delivering more than when you tell them “I’ll be right back” and they don’t see or hear from you for hours. Be specific, be honest, and when all else fails, update them as often as possible.

Body language

• The way you stand, where you place your hands, how you look at them and your eye contact are just a few queues that can draw the line between your body saying “I’m listening” and your body saying “Are you talking?” Focus on what is being said when it is being said.

Every breath you take

• I was extremely guilty of this. I used to give that “sigh” before and after a sentence. Whether I did it out of exhaustion or disgust, all it says to your patients is “I’m annoyed.” Even worse, I used to give that big sigh whenever the patient was talking to me. Nothing sets someone off more than that. Even if you are annoyed, tired or disgusted, be sure to keep it to yourself.

Fiddling

• Stop tapping your finger, clicking your pen, watching your monitor, writing, typing or charting when having a conversation. Stop distracting your attention from the topic at hand–you’re probably missing something important. If you cannot stop what you are doing, be sure to explain to your patient why or what is requiring your attention.

Manners

• If a phone call, page or monitor alarm demands your attention, be sure to excuse yourself. Nothing says “You’re not really important” like walking away mid-sentence without some closure or an attentive attitude.

In the end, the lines of communication are like a hinged door: If you  ignore it, sooner or later you’ll get hit by it swinging back at you.

Image by: Thinkstock

I recently was doing a little research for school when I realized there are some common and popular nurse/nursing myths out there. It seems there are two trains of thought: There is the public’s view of the nursing profession, and then there are those who actually know about the nursing profession.

I’m not sure if it’s our own fault or if Hollywood has a stranglehold on the general population’s opinion. This particular top 10 list is intended for all those who are considering pursuing the profession of nursing–I’d like to call it the “Here’s what we are not and don’t do” list:

1. We don’t wear all-white uniforms.
2. No, we stopped wearing caps a long time ago.
3. We do more than pass medications.
4. We do more than just clean up “poo.”
5. This is not Grey’s Anatomy – we’re not secretly sleeping with all the doctors. Nor is this House – we do the blood draws.
6. No, not every “nurse” is the same. There is a profound difference between a Nurse Practitioner and a Nursing Assistant (about 6-8 years of education).
7. We actively collaborate in the decision-making process and don’t just take orders.
8. No, we are not all women.
9. No, we work in other places besides hospitals and physicians’ offices.
10. No, we didn’t fail at becoming doctors. We chose this profession.

I know, I know, we’ve beat this horse senseless, haven’t we? I have to admit, I am just scratching the surface here. I think we all could generate an endless list of nursing urban legends.

What would you add?

Image by: Thinkstock

Everyone needs to be able to confide in someone. Can you be trusted to keep another person’s information to yourself?

We hear so much these days about patient confidentiality, keeping medical records from being compromised, what constitutes “consent” to release information, and so forth. But can our own friends and associates count on us to keep their trusted information from becoming public knowledge?

To have earned the confidence of another person is a great honor indeed. It is difficult to find someone with whom one can share, and perhaps take counsel from, matters of a personal or professional nature. Most of us have experienced the fallout from gossip in the nurse’s station or at the lunch table. Information which has passed from one set of lips to several others is rarely the same as when it was first shared and can have very unpleasant consequences for the one who initially let slip whatever was given in confidence in the first place.

Previously I wrote an article on why nurses blog. In it I suggested one reason for blogging is the perceived anonymity which one hopes to achieve by using an avatar or user ID instead of one’s own name. As it is practically impossible to share “confidential” information on the Internet with anyone, it is more important to find someone with whom you can share your thoughts and problems without fear of exposure or betrayal.

There are times when being approachable is not only an honorable thing, it can also seriously impact another person’s life and limb. Particularly when one is dealing with teens and young adults who often desperately need to talk to someone outside of their own family or circle of friends.

Anyone who “accepts” the role of counselor, formally or informally, is subject to the same ethics as a priest, psychiatrist or therapist. There are only two occasions when a sacred trust can be broken: When there is knowledge of a crime or when there is a threat of danger to oneself or to others. In most cases, it is usually best to encourage the person to self-report the problem if no one else is in peril. Offer to go with them. Such honesty can go a long way toward someone keeping a job and getting whatever help is needed.

As nurses we have a professional responsibility to ensure patient safety. If we have knowledge that an error has been made which could potentially cause harm to someone, we have a duty to see that it is reported to the proper authority. This does NOT mean we go and gab about the person who made the error to the rest of the staff. He/she is probably upset enough from making a serious error in the first place. It is management’s job to address the problem with that person.

So, before you allow someone to confide in you, ask yourself if you can deal with whatever the secret is. If you can’t, encourage them to find someone else. Above all, do NOT use a person’s trust for any other reason than to help!

The human voice can never reach the distance that is covered by the still small voice of conscience (Mahatma Gandhi).

Image by: Thinkstock

Earlier in the current season of “Nurse Jackie,” we saw the difficulties that nurses returning to the floor after some time away face, illustrated through supervisor Gloria Akalitus’ not-so-smooth return to All Saints’ Hospital. And though Akalitus is a fictional character, we’ve all experienced the feeling that the more time you’re away from the floor, the harder it is to smoothly transition back into your normal routine.

Nurses who are coming back to the bedside after a long break are relying on nurse refresher courses, designed for those who have not practiced in a hospital setting for an extended period of time. Not only do these courses give nurses the opportunity to brush up on the latest standards and practices, they also provide an environment for nurses to sharpen skills and let their instincts kick back in.

Once such program is the Current Nursing Practice Update CE Certification Program at Harper College in Palatine, Ill. The program is designed to make returning nurses more “competitive” by allowing them to learn in an environment that allows them to function somewhere between a nursing student and member of a hospital nursing staff. Nurses gain practical, hands-on skills in a program that includes 68 classroom hours and 104 clinical hours.

Would you take a course like this?

Below: Gloria Akalitus return to All Saints’ Hospital:

Source:
Nurse.com

Image by: Fotosearch

Pens that don’t work? Socks that cut off your circulation? Cheap key chains? Yep, those sound like some Nurses Week gift failures to me!

I have some suggestions for gifts I think every nurse would appreciate for Nurses Week. Here are two major ones (you can thank me later!):

A real lunch break

• You know, the kind of lunch break that involves leaving the nursing unit, or even leaving the premises all together. The kind where you actually taste your meal instead of inhaling it on the go. Maybe even a full hour-long lunch so we could enjoy the food we eat and take our time getting back on shift.

IOU: A time out

• A certificate that allows you the ability to just call a time out. I’m talking stopping everything, putting your hands in the air and taking a “Calgon moment.” No explanation necessary, just produce the IOU. We should be able to use this IOU whenever the need arises. You could even put an expiration date on it, although I doubt it would take long to use this one up.

Here are a few more random ideas for gifts:

• A valet ticket for parking
• A free lunch (or more than one)
• IOU: One time you get to leave work early
• IOU: One time you get to come to work late
• IOU: One request for a new pot of coffee be made (when the pot is empty)
• IOU: One admission paperwork completion
• IOU: A free breakfast

Don’t get me wrong, I’m always appreciative of the recognition, but I think if we’re going to celebrate all things nursing, then the gifts should be worth the year-long wait!!

Any other suggestions? What would be a great gift for you this Nurses Week?

Image By: Jupiterimages

As National Nurses Week swings around yet again, one expects to feel appreciated in some way. For some of us, it means a free meal in the cafeteria, a gift with the hospital logo on it or a “Happy Nurses Week” ad in the paper. Administrators and management smiling at you for a change…

For most of us, the one week observance is quaint and expected, while at the same time feels a bit awkward given all of the “niceness” that seems to pop-up and, just as quickly, disappear when the week is over.

But what about the REST of the year?

Most hardcore clinicians, myself included, will tell you that the much-hyped appreciation of Nurses Week does little to make them feel valued. Let’s face it: We chose a very difficult career that’s hard on the body and the soul. Relationships suffer and we have anything BUT normal work schedules. How many times have we heard someone say: “I don’t know HOW you do it–I could NEVER be a nurse!”

Nurses can tell you true stories that are so amazing, wild, incredible and ridiculous that no one could possibly make them up. No fiction writer could imagine the things we see and do on a regular basis. No movie or TV show can come close to the reality of life nurses know.

We are the ones who are privileged to be present at all stages of the lifespan. To be there for families when they experience joy as well as tragedy. To be willing and able to break the rules for the sake of making our patients’ quality of life better, even if just for a few hours.

Nurses make a difference…for somebody, in some place, at some point in their life’s journey.

Whether it is in a modern hospital, on vacation, in a shack with no supplies or running water, in a desert aid station, on a ship, in a POW or concentration camp, on board a jetliner over the ocean, in a rural health clinic, or (fill in your own blank space) wherever there are human beings in need, there have been and always will be nurses.

Doing the work. Making it better. Every hour of every day. 52 weeks a year.

Knowing that we made a difference at the end of the shift just by being there for someone.

And THAT is why we do what we do!

The best and most beautiful things in the world cannot be seen or even touched–they must be felt with the heart (Helen Keller).

iStockphoto | Thinkstock

May 6-12 is when nurses are nationally recognized for their efforts during Nurses Week. It’s a celebration of all things nursing. During that week, you have National Nurses Day, Student Nurses Day, and School Nurses Day to recognize the individual efforts of these “types” of nurses. The week ends on May 12, the birthday of the founder and mother of the nursing profession, Florence Nightingale.

Everybody with me?

Until recently, I’ve always enjoyed Nurses Week. I usually got a cool trinket or gift from my employer, and my fellow nurses would joke about the one time of the year we nurses actually are noticed.

These days, it seems the only time of the year we DO get recognized is now being watered-down (and maybe even flushed away) next to another nationally recognized week–National Hospital Week, which is also May 6-12 this year. The only difference I see from year to year is that the actual dates for Hospital Week can differ slightly, while Nurses Week always starts and ends on the same dates!

I guess maybe that’s my problem. Why must another week-long national celebration trample on the toes of our celebration?? (I kept getting circling results, so I gave up searching for some relevant history on National Hospital Week and the coinciding date.) Obviously, the celebration dates for National Nurses Week bear significance with one of its founding mothers.

In my opinion, nurses are getting shortchanged simply because most nurses work in hospitals, so it’s more convenient and cost-effective to celebrate both weeks jointly than to have two separate celebrations (it’s always about the money, you know).

Also, the health care personnel who are being recognized are equally shortchanged, because now they share their “week” with a much larger group of fellow health care professionals (nurses).

It’s become so common and convenient to lump them together that I found numerous articles that meshed this celebration into one singular event (I refrained from naming names here).

Deep breath.

Maybe I’m being selfish. Maybe I’m being obtuse. But the last time I checked, we nurses rarely, if ever, ask for recognition. And the one and only time the nation recognizes our sacrifices they decide to divvy up the recognition with another holiday?

What am I missing here?

Polka Dot | Getty Images

Over the years, I’ve learned to deflect most of the work-related “drama” that can consume you. We nurses can be vindictive, catty, diabolical, cold, mean and down right unappreciative many of the hours we spend saving and improving the lives of others.

We do this to ourselves, our coworkers, our patients and their families. The worst type of offensive behavior is the kind where the nurse denies or is unaware of his or her evil ways. The stress of the job and the toughness of life can weigh a person down sometimes, and the repetitive brow beating we get from all aspects of our job can turn any positive person into a “Negative Norm” or “Negative Nancy.”

We forget how awesome our job is sometimes. We forget how blessed we are with the knowledge and skills we have. We forget how good we really have it.

Sure, we have stressors. There are “corporate suits” out there who do not make our job any easier. Or the patient or family member that treats you like the maid or butler. Yes, there are plenty of allied health care professionals who have no clue what kind of job we do, nor do they care how much they need nurses.

But through it all, we still have a pretty awesome job.

We have a relatively stable profession in an economy with a rickety foundation these days. Our job doesn’t require us to brave the elements for endless hours a day. Our pay scale is respectable compared to most. We have unlimited growth opportunities if we just put forth the effort and sacrifice. And quite honestly, people are living longer and getting sicker these days–that itself equates into some impressive job security (hint of sarcasm there).

I think we all are guilty of driving through life at the speed of sound, not stopping every so often to appreciate what is around us.

We all could follow the example from this fabled tale (I’m sure there are many versions of the story, but you’ll get the message):

Life Throws a Brick at You

A young and successful executive was traveling down a neighborhood street, going a bit too fast in his new Jaguar. He was watching for kids darting out from between parked cars and slowed down when he thought he saw something. As his car passed, no children appeared, instead, a brick smashed into the Jag’s side door. He slammed on the brakes and spun the Jag back to the spot from where the brick had been thrown.

He jumped out of the car, grabbed some kid and pushed him up against a parked car, shouting, ‘What was that all about and who are you? Just what the heck are you doing?’ Building up a head of steam, he went on. ‘That’s a new car and that brick you threw is gonna cost a lot of money. Why did you do it?’

‘Please, mister, please, I’m sorry. I didn’t know what else to do!’ pleaded the youngster. ‘I threw the brick because no one else would stop.’

Tears was dripping down the boy’s chin as he pointed around the parked car. ‘It’s my brother,’ he said. ‘He rolled off the curb and fell out of his wheelchair and I can’t lift him up.’ Sobbing, the boy asked the executive, ‘Would you please help me get him back into his wheelchair? He’s hurt and he’s too heavy for me.’

Moved beyond words, the driver tried to swallow the rapidly swelling lump in his throat. He lifted the young man back into the wheelchair and took out his handkerchief and wiped the scrapes and cuts, checking to see that everything was going to be okay.

‘Thank you, sir. And God bless you,’ the grateful child said to him. The man then watched the little boy push his brother to the sidewalk toward their home. It was a long walk back to his Jaguar… a long, slow walk. He never did repair the side door. He kept the dent to remind him not to go through life so fast that someone has to throw a brick at you to get your attention.

I would like to challenge all my fellow professionals out there to pick up that (imaginary) brick and throw it at your fellow nurses. Have them slow down and simply appreciate life. I know I’ve needed it thrown at me a few times.

Anton Prado | Veer + Scrubs

A little over a year ago, I wrote a brief FYI blog post about the future goals of advanced practice nursing and the role of the DNP according to the consensus model by the AACN. Questions have come up that I’d like to address.

Will there be a set of uniform guidelines that each state follows in transitioning the requirements from an MSN to a DNP for a current practitioner?

As most nurses have discovered, state requirements are very different from national requirements. While all states share the same minimum requirement of following national certification guidelines, each state’s specific requirements for licensure and employment is at its own discretion.

In my opinion, this means each state will choose how you may transition. If the current state protocols are a reflection of things to come, be sure to do your homework and contact your local state agencies to get the details. I would not assume the guidelines for one state will mirror another, no matter how close their geographic locations are.

I’m in the last year of my ACNP program and we quickly are learning that there are many hoops to jump through and red tape to follow when applying for licensure.

What incentives does acquiring a DNP have other than just being a requirement?

Many nurses are questioning the motives behind the impending changes and what incentives exist to motivate a current nurse to pursue the DNP. More specifically, are there pay rate changes to the DNP as opposed to the MSN? I mean, we’re technically being required to get another 12-24 months of advanced education–are we being compensated? More education should equal more pay, right?

It’s not a simple answer.

The NP profession sort of shot themselves in the foot with this one. For years, NPs fought for independence. Independence in the practice, and then independence as a practitioner. Granted, this fight was more for the general practitioners (Family Nurse Practitioners), but since the NP profession has become more specialized, it affects all specializations.

Now in some states, an FNP can open a clinic or office with the assistance of an MD. And in some states, the FNP can practice without the actual physical presence of the MD (just a phone call away).

Not to minimize the concept, but Uncle Ben from the Spiderman comics said it best: “With great power comes great responsibility.” If we as a profession want to have the power to work independently and function with that kind of “power,” it is our responsibility to be prepared. More responsibility equals more education, period.

Oh, and let’s not minimize the ever-expanding complexity of health care, our patients and their health challenges. The truth of the matter is, our patients are living longer and have more health challenges that did not exist a decade ago thanks to advancements in treatment. We as the practitioners need to “up our game” to meet these challenges. Upping our game means attaining a higher level of education.

So the “motivation” for attaining your DNP is simple. Do it to improve the care of our patients.

If you’re worried about not being compensated for your additional education, we might want to take a step back and look at our economy as a whole. Our profession is one of the few that is not being affected by the current economic strain. There are MANY health care professionals out there who have no job opportunities at all.

I, for one, predict that depending on the area you choose to work, the pay rate will change, but not because you simply got your DNP–rather, because your role as a practitioner has expanded and will continue to expand in the years to come. Yes, an MSN prepared NP functions just as a DNP prepared NP does currently, but I foresee that changing very soon.

In the end, if the impending educational requirement from an MSN to the DNP is affecting your decision to advanced your degree or swaying you towards not advancing your degree all together, then maybe it’s just not for you.

Links of interest:

• http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
• http://msntodnp.com/average-salary-msn-vs-dnp/
• http://community.advanceweb.com/blogs/np_7/archive/2010/05/04/will-employers-pay-for-a-dnp.aspx

Some additional articles:

• http://scrubsmag.com/5-perks-of-an-np-degree/
• http://scrubsmag.com/a-doctor-in-nursing-uniform/
• http://scrubsmag.com/doctoring-the-doctor-title/