Not Nurse Ratched

Balance? What is this balance of which you speak?

Not Nurse Ratched — Sat, 25 Sep 2010 19:32:56 +0000

I have another blog for my photos, but I’ve been trying to sneak up on these birds since May and finally got a good snap of them this afternoon. It was worth the wait. I love their little expressions (“whatcha doin’?”).

What am I doing? Not blogging. I’ve had a few nights off and now I have a few nights on, which is about how it tends to go. I have been crossing small distasteful postpone-able tasks off my lists because they stopped being postpone-able and spent a not-inconsiderable amount of time curled up in my recliner with the new Sophie Kinsella book.

It seems I’m crispy with work-related burnout. It’s not my profession itself that’s burning me out; I love healthcare, and I love being a nurse. The three big bad B’s, not so much. (Never heard of them? They are bickering, back-stabbing, and bullshit.) But these things are easily confused (am I burned out on my JOB or my CAREER?), and I needed to get them sorted. A big part of a successful nursing career is learning to cope with these situations, and I’m still learning. ER nurses seem to get burned out faster and worse than nurses in other specialties, and I knew that going in. It all boils down to I have a good job, I’m good at it, and I am confident that I will eventually come within a glancing blow of balance. I had fair success with chick lit and chocolate, if anyone else wants to experiment with that and report back!

Not a nightshifter forever

Not Nurse Ratched — Sun, 19 Sep 2010 21:17:07 +0000

I’m looking at a major lifestyle change and am extremely nervous about it. I’ve been a nightshifter for years and think of myself as “a night nurse.” Nurses know what I mean. The pros on paper outweigh the cons for me; I make quite a bit more money, I have some chance of some downtime (theoretically, but not generally in practice since we’re short-staffed constantly on nights), and I get to work with people who are even stranger than those who work days. You have to admit that nightshifters have a slightly off sense of humor. You have to be more creative on nights because the ancillary services just aren’t there. I could go on, but my point is that I have pretty much said to myself and everyone else “I’m just a nightshifter at heart. Get over it.” Now I hope that’s not the case because I’m moving off nights. I don’t know when or to which shift (we have midshifts in my department, so it could be 10-10 or 12-12), but I put my name on the list.

I have a critical mass of reasons for doing so balanced against “I’m a nightshifter.” Some are personal; some are professional; some are social/lifestyle-ish (notably, none of my current friends works nights, so I never see anyone except my boyfriend, and even HE is a dayshifter). Most I’ve attenuated by various means, but the one I can’t get away from is health. Longtime readers of this blog know that I have an industrial-strength anxiety/panic disorder problem. After the few years I’ve been working nights I’m now forced to consider that flipping my sleep schedule constantly is not helpful for regulating it. The people whom I see for help with this issue have been first gently, then not so gently telling me to knock off the nights, but I have a nearly flat learning curve; every major step I’ve taken that’s actually helped my panic attacks has taken me a few years to arrive at. Seriously. I’m a terrible nurse insofar as I tell patients constantly that psychological issues are just as important and legitimate as medical ones and they should treat them with the same attention and gravity, and I completely ignore that advice for myself. Until. I can’t take it anymore and have to try SOMETHING.

Sometimes you have to make big changes because “if nothing changes, nothing changes.” Nothing’s changing. I’ve researched the connection between increased anxiety and working nights, and evidence weighs pretty heavily against my “I’m different because I’m a NIGHTSHIFTER” determination. So. I had one false start a few months ago when a shift opened and I put in for it, but the actuality of it freaked me out and I withdrew. This time I’m going to stand behind myself with a cattle prod and do this thing. Few changes can’t be unchanged, after all. If I can’t handle the change or if it doesn’t help, they always need nightshifters, so I can probably go back. I’ll lose my seniority, but with change usually comes risk.

This morning I woke up early and experienced a cool foggy start to the day. I remember the years I spent getting up at 4AM to go for long runs. I wonder if I can do it (be a day person). I guess we’ll see. I felt pretty good about my ability to be awake in the morning and even went for a swim. Then I came home and slept for 3 hours. I just don’t know how well I’ll tolerate this whole “awake ALL day” thing.

One thing is certain: I will be anxious about the uncertainty until I discover my fate. Obviously.

Reblog: Bitten, shot, spat on: Violence in hospitals common for staff – CNN.com

Not Nurse Ratched — Sun, 19 Sep 2010 13:30:55 +0000

You would never go into the supermarket and say ‘the tomatoes aren’t good enough’ and punch the clerk and get away with it. That’s exactly that happens in the emergency departments all over the U.S.

via cnn.com

THANK you. The ENA just found that a disturbingly high percentage of ER nurses think violence is just part of the job. It is, but the acceptance shouldn’t be there. My department has a zero-tolerance policy and actually implements it, which means I still get hurt but they treat me if necessary and are taking giant strides to help us deescalate and anticipate violence. I just went to a fairly long class invented for our ER nurses on how we can protect ourselves while also protecting patients, and it was worth its weight in gold. I hope other ERs do the same. Our security staff is awesome and come at a gallop when called. So is our local PD.

But you can’t anticipate the out-of-the-blue whallop, kick, or arm-breaking grab. I still usually have bruises in various stages of healing, and I’ve had one doc visit and one x-ray just in a year for beyond-bruising injuries. I AM getting learned helplessness about it. I see where the acceptance comes from, but I. Must. Resist.

Reblog: The future of nursing……..food for thought

Not Nurse Ratched — Sat, 18 Sep 2010 23:30:59 +0000

It is WE, the workforce, who I blame. WE who do not stand up as a group and say we’ve had enough. We who do not advocate to the public we serve that we need more nurses at the bedside and not more UAPs. We do not tell the public that more nurses equals better, more appropriate care and fewer days in the hospital.

via emergencynursingtoday.com

I like pretty much everything on this blog, but this post is sobering and contains uncomfortable but compelling points. What can we do? There is so much inertia and missing the forest for the trees. Should we be writing letters to the editor? I am at a loss. Trying to fire nurses up is like setting concrete on fire with a match.

Elements text editor for iDevices review

Not Nurse Ratched — Thu, 16 Sep 2010 19:35:44 +0000

I was going to write up a review on Elements [iTunes link] this afternoon, but then I saw that MacWorld just posted one. They covered most of the things I was going to cover. One area they missed is a huge one: keyboard support.

I bought an Apple Bluetooth keyboard to use with my iPad after I sold my MacBook, and I set out to purchase a real productivity app with which to perform actual work on the iPad. I researched Docs to Go and the other major productivity suites (most of which sync with Office, Google Docs, or both), but I bought none of them because they don’t support arrow keys on external keyboards (a good point in favor of researching before you buy, because these apps are roughly $15 each). I’ll say that again because it seems vaguely frakking important: they don’t support arrow keys on external keyboards! What? I’m not a mouse fan and am all over my keyboard like white on rice. Hitting an arrow key and not having my word processor respond is so unacceptable that I’m not sure why they even released the software.

iWork wasn’t even on my research list because I’ve heard too many stories of issues dinking around with the syncing, and I’m so not interested in things I have to really mess around with to make work.

Anyway, just when I was about to seriously regret offloading my laptop, I found Elements, and I’ve been really happy with it. I’m a longtime Dropbox user, so the seamless sync appealed to me (and it IS seamless). It supports external keyboards fully, including not only basic arrowing but also shortcuts for skipping from word to word and paragraph to paragraph, thus allowing me to speed around a document on my iPad at the same lightning speed as on my iMac. It supports TextExpander. And it’s only $5.

Why so cheap? Probably because it’s all about plain text. Folks who need to toss documents back and forth between the iPad and desktop and retain formatting are not going to find Elements useful. It’s not a Word replacement. It makes an Elements folder in your Dropbox folder and populates it with plain text files. It does not sync with any other suite. I’m unperturbed by this because most of the stuff I write is destined for the Web anyway, so if I feel compelled to format something I just toss in some HTML. If I’ve just got my iPad and need to create a Word-ish document, I hammer it out in plain text and then just copy it into Google Docs or, if I have time to let it start up, Word. But I would find this unworkable if I had to do it very often.

Bottom line: Elements is an excellent solution for Dropbox users who want a lean, mean, painlessly syncing text editor for their iPads (technically it works on the iPhone as well, but I find working with text on the iPhone so painful that I haven’t tried it) and who need their dang keyboard shortcuts.

Spidey sense

Not Nurse Ratched — Wed, 15 Sep 2010 20:28:47 +0000

There are better terms for it (such as “nursing intuition”), but I call it spidey sense because I just like to inject a little levity into my work day. Has it been researched? Has it been validated? I know it absolutely exists, and I am happy to have a decent dose of it. Spidey sense, however, develops with experience, so I can’t yet scale buildings or cast webs. You can’t get complacent with spidey sense because patients will always surprise you. People aren’t predictable, and bodies all work differently, so there will always be garden-path patients (another term of mine, stolen from Noam Chomsky [Wikipedia entry], meaning patients whose assessments and histories lead you down the wrong path completely).

What is spidey sense? Your patient just looks wrong. Or DOESN’T look wrong, but you have a gut feeling that something is about to go seriously wrong. Generally, and this is really the point of my post, you’ve got nothing to hang your hat on as far as an assessment finding or anything from the patient’s history, and that makes spidey sense problematic: IF you are working with a physician who trusts spidey sense (some do, from some nurses, and with varying degrees of acceptance), you don’t have much time to make your case, and “err…she just doesn’t look quite right to me” never sounds exactly right to me. I say it. I take the “advocate for my patients” part of my profession extremely seriously, and if the patient doesn’t look quite right and that’s all I’ve got, I use it. I feel a little silly, but I do. Sometimes spidey sense is wrong and the patient is fine, which is actually just peachy with me. I want all my patients to be fine and don’t mind looking a little stupid sometimes. (Nursing offers unparalleled opportunities to look stupid multiple times per shift, so I’m used to it by now, maybe.)

It takes some cajones to go with your gut as a newish nurse—especially if you’ve got nothing to go on and no track record. However, it takes guts to be a nurse to begin with, and the only way to get a track record is to run with things, so I advocate the pursuit of spidey sense. Most docs will at least agree with putting a line in a patient you think is about to go downhill, and for pure time savings in an emergency nothing, nothing, nothing beats ready IV access. If you don’t believe me, watch how quickly everyone’s interest is captured if a patient WITHOUT IV access suddenly goes into a life-threatening arrhythmia or pukes up a liter of blood or has a drastic change in level of consciousness. Have I put lines in patients who didn’t need them? Unfortunately yes. But patients also get a ton of radiological and lab tests that ultimately don’t show anything wrong either, and we still do those, so I lump unnecessary IVs in with that stuff.

Nurses, what do you have to say about spidey sense? Can it be taught? Honed?

Love this word: presenteeism (coming to work when you’re sick)

Not Nurse Ratched — Wed, 15 Sep 2010 16:27:09 +0000

via pagingdrgupta.blogs.cnn.com

We ALL do this in the medical field. Everyone. All the nurses and docs I know stay home if we’re puking sick, have a crazy fever, or are otherwise actually incapacitated. Otherwise we down Tylenol and suck it up. Good idea? No. Why do we do it? Lots of reasons. We don’t want our colleagues to have to work short or come in extra, we believe our patients just can’t stagger along without us, and/or we work for facilities that, like the last one I worked at, FIRE you if you’re sick more than three days in 6 months (that’s not much if you get a good knockout flu). People in all fields probably do this, but I always thought it was a bad idea to do it in, eg, the ICU (fever around fresh postop patients? not that good…).

Happy-TNCC flowers

Not Nurse Ratched — Wed, 15 Sep 2010 05:02:53 +0000

The BF rocks. I passed TNCC (Trauma Nursing Core Course) today, thus completing my ER nursing trifecta (PALS, ACLS, and TNCC). He withheld the brutality of the course from me beforehand (imagine calculus—or, for those who LIKE calculus and find it easy, substitute some subject that is fairly complicated for you—for a day and a half followed by a tricky test and a practical exam) lest I become discouraged. I’m a perfectionist with a good memory so I read most of the book (!) and did fine, but I was a little worse for the wear, especially after getting up when I’m normally getting off work and going to bed. So he brought me flowers and chocolate. And told me I’m a good nurse and people like me.

Old post reposted: Disruptive behavior at work

Not Nurse Ratched — Thu, 09 Sep 2010 11:47:40 +0000

This issue (a post I wrote 2 years ago) is still salient and needs to be revisited often.

I wonder how many excellent nurses get fed up with childish, hateful behavior among their associates and leave this profession. It’s probably a large number and a terrible loss to our ranks. For a caring profession, we nurses can be unbelievably and randomly cruel to our associates, and it needs to stop. Zero tolerance for lateral violence!

Kindle app beats iBooks for reading on iPad

Not Nurse Ratched — Sun, 05 Sep 2010 21:07:05 +0000

I’ve been reading books on my iPad for a while now and want to write a little about what I’ve found regarding the iBooks vs Kindle apps on the iPad. This isn’t a new topic (in fact, it may have been beaten to death), but I’m a fairly avid reader and a fairly avid iPad user, and it’s my blog, and I can write about whatever I want. Today, I’m in a book mood.

When iBooks was first announced, I was pretty excited because (a) I thought it was high time Amazon had some pricing competition and (b) the eBooks format was reputed to be more open than the locked-down Kindle format. It’s been a few months and I haven’t seen any price reduction, and although the format is still more open, it’s still got DRM. I’m not seeing the DRM as a vote for or against either the Kindle or iBooks route because they both have it, and it’s a serious drawback. I’ve already written about the case for e-books in general, so I won’t rehash it.

I’ll come to my point and state that I use the Kindle app far and away more than iBooks. The Amazon selection is far better, there are more options for buying books (iBooks limits you to going through the iBooks app, whereas on Amazon you can use the Web from anywhere and specify where you want the book sent), the most recent updates include the popup dictionary function I sorely missed in the early versions, and my notes and highlights are available from the Amazon Kindle Web portal. I can read my books from any of my devices (true for iBooks only if you have all Apple stuff, which I do, but not everyone does, yet). I also like the Kindle app setting that shows popular highlights; it’s occasionally interesting to see what the general populace has seen fit to emphasize or remember.

I do use iBooks for PDFs and free books, of which there are a metric ton on Google Books and Project Gutenberg. It’s possible but not as easy to get this stuff on a Kindle or into the Kindle app on an iPad. With iBooks, you just drag the thing you want to read onto iTunes and sync, and it looks good on the iPad when you’re done. I can’t remember the Kindle process, but it seemed more painful than that. iBooks has a little more eye candy, but it’s not useful. You can, for example, choose what color your highlights should be, but you can get to them only through the app on your device. What good is that? With my Kindle-format books I have them all available online through Amazon, complete with my notes, highlights, and ratings.

Those are my thoughts du jour on the state of e-readery on the iPad. Here are some links and resources as a parting shot:

-Project Gutenberg
-Amazon portal: this is where you access highlights and notes
-How to save PDFs to iBooks (through print menu on Macs or through iTunes)
-Kindlerama daily cheap/free Amazon deals
-Amazon’s Free Kindle Books page

Update, 9/6/10: I just found this timely article on Salon.com espousing an opposite view, and it’s a pretty good read.