Back in Shape

My wife isn't the only one who became out of shape with this baby. I have decided to challenge myself to lose some weight and get back in shape. I started running a week ago. Something I haven't done since 2004. That's right. It's been 9 years. My short term goal will be to run a 5k. With my longer goal being a sub 24min 5k or running a 10k if speed isn't achievable at this point.

I also need some muscle improvements and I have enlisted the fittest person I know to help me in that area. I've begun taking supplements for my creaky/gravelly knees that the Army left me with. I will not be taking any performance enhancing supplements, so please, if you want to suggest one... Don't. 

I'm ready to take control and get my ass in gear. I will be using the Nike+ running app too. I haven't decided if I want to go public with a profile to compete against ppl or not. I'll see. Well, it's off to bed. Running at 0530. 

Over my Dad body!!

Some of my more astute followers may have noticed... aww who am I kidding? All of my followers are astute! So, all of you may have noticed that I have been missing from twitter lately. I tried to sneak a tweet in now and then but mostly I've been absent. The reason for my absence is that my wife has gone back to work after a little over a year off, most of which was with our baby girl. Here she is being choked by an RT.

So, in the classic role of Father/Provider I continued to work as much as possible to allow my wife to stay at home. My wife has never really worked as a nurse. She did some part time med passing at a NH as an LPN during school. So, naturally she was nervous about stepping out into nursing for the first time. I, on the other hand, was petrified about the idea of being alone to care for our infant daughter without anyone else around to help. So, lately, (If you can excuse my country colloquialism) I've been busier than a one-legged cat trying to bury a turd on a frozen pond. I don't mean to ignore twitter, but most of the time spent between witty posts/rejoinders before was spent at work which is my best Muse. Now that my wife is back to work I'm down to 3 days a week instead of 5-6. In addition to the new responsibility, it seems that more and more there is an ever increasing number of Nursing Anon accounts out there and they aren't coming up with much that is original. They may think they are, but they aren't.  I've started to have some of my older tweets stolen and my account copied and now my Avi is being used. I'm ready to evolve into something greater andI  have that in the works.  

It is no secret that I am a founding member of the @MurseMafia. We, as an organization, are planning to help change (or at the very least improve) nursing. Especially for men.  We are in the early stages of development now and are trying to earn enough capital to take off. We have a website, and we are selling merchandise for which we earn very little profit but each T-shirt or coffee mug we sell is advertising gold.  So, please make your way over to our store and take a gander at our inventory. I know the shirts are expensive but there are stickers and buttons that are pretty cheap. I'm networking right now with a freelance artist who creates designs and I'm hoping to get him on board for some new tshirts that we can ship ourselves 

We have big plans in store for our little project and I am excited about its future. If any of you have an over abundance of money and feel the need to donate email me and I'll let you know how. Otherwise, go buy some Murse mafia merch and we can all benefit. 

-@MurseWisdom

Does Nursing make me a better father?

Seven months ago, give or take a few days, my wife and I became members of a not-so-exclusive club referred to as Parenthood.  We did so willingly and, contrary to common practice for our area, we did it after we were married instead of getting married because we were pregnant. This is a meaningful distinction for us and it speaks volumes.  It says that we made this decision as two adults and were prepared for the consequences.

CONSEQUENCES shown below:

 
 

 

 Not bad for my first try. Wait until I get some more practice.

{Quick background on my wife because I'm pretty sure I've never really mentioned much about her. We met while taking pre-reqs for Nursing school but we had both went to high school together. I started Nursing school a semester ahead of her at the same school. Which led to a very rocky first few years of our relationship. However, we saved a bundle on books, or at least she did. We married in nursing school and she spent her last semester pregnant. Now back to the story.}

I started thinking soon after we found out we were expecting our little bundle of joy (see above) and aided in this thinking by current parents who relish the opportunity to tell you the hardships. Some of the more common things were as follows:

1. You would no longer sleep-in and possibly may never sleep more than a few hours at a time.
2. The amount of stress you will encounter is unlike anything you have ever felt before.
3. All the crying.
4. All the pooping.
5. All the diaper changes.

But then after the horror stories they would a the caveat... but it is SO worth it!

I made the correlation immediately!  I flashed back to my first year or maybe even first week in nursing school. When all of the seniors would see us and tell us of the horrors that awaited. Such as:

1. You would no longer sleep-in and possibly may never sleep more than a few hours at a time.
2. The amount of stress you will encounter is unlike anything you have ever felt before.
3. All the crying.
4. All the pooping.
5. All the diaper changes.

  Look familiar? My wife and I agreed that if we could both survive nursing school, at the same time no less, that this baby business would be a breeze. So, we went in to the final stages with very little stress about the imminent changes.

We discovered that raising a child is more difficult than nursing school in many ways, but it is also easier in many ways. 

Here is what I know, I know that my ability to function on 3 hours of sleep is legendary, and a newborn sleeps approx 20 hours a day. Unfortunately, my newborn did this sleeping 15 min at a time for the first 2 months. 

Baby: 1 Nurse Parents: 0

Despite a near disaster in the sleep department, I had developed the ability to perform everyday tasks without sleep. This is where performance enhancing drugs came into play. I'm not talking about anything illegal like cocaine, hell, I'm not even talking about Adderall these youngsters depend on to tie their damn shoelaces now-a-days. I'm talking about Caffeine. The real Vitamin C... I'm talking Monster, Coffee, Espresso,  Red Bull... you get the picture. I drank so much coffee the first week I gave myself an ulcer.  

Baby: 1 Nurse Parents: 1

Diapers? Seriously? I can change these little things with just my non-dominant hand while peering out of one bloodshot eye! I don't even need to go into the diaper thing.

Baby: 1 Nurse Parents: 2

Poop goes hand in hand with the diapers thing but I felt I should address it separately.  My baby didn't poop much the first month and a half. While at first this seems like a blessing, to a nurse is spells certain ileus! There was about 50 hours of research done in my household before finally asking a Dr. about this "Condition". We were given specific orders and followed them precisely. Every 5 days we produced a BM. It was nerve racking. 

Both sides get a point. Baby: 2 Nurse Parents: 3

Crying. I didn't cry in Nursing school because I am a Man and we have rules. Don't roll your eyes at me and say "Real men do cry" Because I will tell you that I am not imaginary and am very real, and I DO NOT CRY. However, my baby does, frequently, and I am told she gets it from me. I consider that to be a great injustice and resent even the slightest of comparisons. Regardless, crying is noise, and I can tune out noise.

Baby: 2 Nurse Parents: 4  

This brings me to stress.  There is no comparing the two events and the stress each one creates on its own massive level.  I will say this. When you leave Nursing school and go home, even if you have homework, you are still away from Nursing school. With babies, you are stressed all the time and coming home provides no refuge from the stress. Not even mentioning that Nursing school even if taken to its most extreme wouldn't even make it to puberty in the lifespan of a child.

Baby 3...  You know what, I'm sick of keeping score.  Nursing school is hard. Raising children is hard. Doing both is unimaginable, and yet I was in school with new mothers, old mothers, and single mothers.  My hat is off to you, ladies. I am in no way equipped to take that on. 

This Parenting thing is just starting and I'm sure will evolve from here as will my perspective on this whole thing.  Am I a better father because I'm a Nurse? Absolutely! Is the inverse true? Am I a better Nurse because I'm a father? I'd like to think that it adds a level of empathy. So, yes I am.

Well, I hear my little one starting to cry now. 

Thanks for reading,

MurseWisdom

Check out

www.MurseMafia.com
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www.NurseStrong.org

Who are you callin' a Burnout?

We've all seen it. It starts in their eyes. They begin to have that "1,000 yard stare", then they begin to stare holes through their co-workers, maybe even their patients. Next they start to grumble under their breath, or start letting a few bad words slip at the Nurse's station. Then they start showing up to work late and their quality of work begins to degrade. Eventually they start calling in sick or in extreme cases they no-call no-show.  It's not long after this point that they call it quits. They will leave that job for another or some may leave the field of nursing forever.

You might say to yourself, "Burnouts are people who got in to this field for the wrong reasons, I won't burn out because this is my life's work, my calling." If you say or think this your are not only wrong you are at risk. "The individuals who are most vulnerable to occupational burnout are ones who are strongly motivated, dedicated, and involved in the work in which they partake." [1]  Add to that that we are in high risk career for occupational burnout and the odds are not in your favor. 

We call them "Burn outs" or say they have "Compassion Fatigue" and consider this the diagnosis. Well, I see it as the signs and symptoms of a bigger problem. A more systemic problem in nursing as well as many other health care professions. One reason is an epidemic of Nurse Managers, losing their identity as Nurses and focusing more on the management aspect. The only problem is that they are piss-poor managers and don't realize it. Case in point, my manager recently went back to school to get her Master's degree... In business administration!! I suppose she really needed that degree as it most likely helps her when she sits in her office and listens in on conference calls or attends meetings. In gaining this degree, however, she lost touch with her people, her brothers and sisters, her fellow Nurses. Now she can't see that all of the good Nurses that were the back bone of their respective units transfer out from under her grasp or leave the hospital completely. Leaving fewer and fewer of these, smart, experienced nurses trying to keep it all afloat. 

So, how do we prevent/treat "Burnout"? First you must perform a Root Cause Analysis to determine the cause of the Burnout. Some major causes of Burnout include: [2]

• critical boss

• perfectionism

• lack of recognition

• inadequate pay

• under-employment

• tasks with no end (This one ring any bells... or call lights?)

• impossible tasks / nearly impossible problems for solving

• difficult clients (Patients)

• incompatible demands (many demands that may not be achieved together)

• bureaucracy (This is a big one in hospitals)

• conflicting roles (home, family)

• value conflicts (personal / workplace values)

• meaninglessness of achieved goals (the success type of burnout)

• social and emotional skills deficit

Prevention is probably easier than treatment. You need to understand your limitations and set realistic goals. If you are a baby Nurse then you need to take baby steps. You will not be in charge of the unit/floor/hospital in your first year. At least you shouldn't be. So, set a goal you can achieve. Many hospitals track statistics such as bar code scanning compliance or pain reassessment times. These are great goals that have a quantifiable and measurable outcome. My favorite is total number of medications administered, I lead the entire hospital for three months in a row this winter in this category and maintained a 97-98% scanning compliance. That one felt good. Like I was getting recognition for always having the patients with the most medications.  Remember that you too need days off and that other people can work instead of you. When they call you in, you can say no. If it wasn't a choice they wouldn't ask the question. My hospital gives 3 weeks of paid vacation after a couple of years and no one uses them. Its like a damn contest to see who has more PTO. 

New Nurses, as you start in your new role/job as an RN at times you will feel like you are the fresh soldiers coming in to reinforce the shell shocked and war hardened troops on the front line.  A lot of times that is exactly what is happening, budget demands may have put a hiring freeze on certain units or the entire hospital for an amount of time and they had to fight with what they had. Some of them may look down on you because you weren't there when times were hard because they are looking for someone to blame. Some older Nurses have developed that "Eat their young" mentality and see you as a threat to them. You have to have the strength and the perseverance to withstand all of that and press on. 

No one started Nursing with years of experience under their belt.

Accept the fact that successful outcomes are not always achievable.

Repeat after me... This is NOT my emergency.

Find an escape or a hobby that is not Nursing related.

And practice saying NO to your boss.

Please feel free to criticize, share, or comment. Subscribing would be great too, but only the cool people do that. 

Follow me on twitter @MurseWisdom 

and follow my friends @MurseMafia @That1Murse and @JustSomeMurse and watch as we change nursing from within.

   

1. van Dierendonck, D., Garssen, B., & Visser, A. (2005, February). Burnout Prevention Through Personal Growth. International Journal of Stress Management, 12(1), 62-77.
2. Beverly A. Potter, Overcoming Job Burnout: How to Renew Enthusiasm for Work, Ronin Publishing, 2005

Flu Season

Damn I hate flu season. I swear! You should be able to slap anyone in the hospital for the flu or some complication arising from the flu if they refused to get a flu shot. #1 most cited reason for not getting the flu shot... it always makes me sick. < face-palm >  Just what do you call this?
Whatever... Any way, that's the reason I've been unable to blog for the last few months. These 60-72 hr shifts are good for the paycheck but bad for the... well, everything else. My sanity, my family, my back, my compassion, my ability to interact calmly with other humans... all strained to the breaking point. But, knock on wood, it seems to be dwindling down now.

Right now my biggest life challenge is transitioning from an Android to my new  iPhone 5. It's strange how much difference there can be. Right now I find myself installing and syncing iTunes on my PC so I can have some music on my new phone before I end up cussing Siri's ass out. I'm not completely sold on the iPhone yet.

I just experienced a major cramp in my hamstrings. Holy shit... That provides me an interesting segue into my next topic "Getting Back into Shape" but first i'm going to walk around a bit.

I think it's safe to say that 90% of us are not in the "shape" we would like to be. I fall safely into that 90%. I have fallen into a rut filled with malaise, depression, and complacency. Not to mention a severe lack of motivation. But there is hope. I recently quit smoking which I've been doing since high school. I'm going cold turkey for those of you wondering. So, I have that major victory that I can use to slingshot myself into becoming more fit. Or fit again I should say.  The plan is in motion, my wife has watched every food documentary on Netflix and has begun to change our diet for the better. Believe it or not that's the easy part. Now I must find time to work out. I'm hoping to start soon. I plan to run 3x a wk and lift 2x a week with one day of cardio cross training consisting of a heavy bag and a pair of boxing gloves. By the way, a heavy bag is an excellent way to decompress after a bad day. Just be sure to use proper form so you don't injure yourself.

Tomorrow is my last day off and I plan on enjoying some relaxation before this all gets in  full swing. I hope to include updates in future blogs.

Until next time,

Keep Calm and Murse On!

Night and Day

 You've heard that old colloquialism "as different as night and day". Recently I began to believe that this may not be referring to presence or absence of the sun and more appropriately, at least for nurses, as the differences between our counterparts on the opposite shifts.  This has always been an issue I would assume. I have noticed long ago that a certain animosity exists between most shift workers. I feel like I'm just stating the obvious here and that you guys will read this and roll your eyes as if I've been naive up until now. The truth is I'm just now reaching the point where I want to vent about it in a public way.

Let me put a little disclaimer on this. I will be speaking in generalities about hospitals and RNs/CNAs of opposite shifts. It goes without saying that this is about my situation at my hospital and does not reflect the work and professionalism of all nurses at my hospital or in the profession at large.

I work day shift now. I have worked night shift, so you can't pull the wool over my eyes about how "Hard" night shift is. I'm going to be blunt... Night shift is easier in general. Night shift is where we start our new nurses and it's where we keep the ones that are a little bit off. Sometimes a nurse will stay on nights because it's all they've ever done and their sanity surely depends on keeping their circadian rhythm on track. On night shift you have the luxury of not having admin looming around. You don't have to deal with meals, and you have a lot less family hanging around. For the most part, your patients sleep at night. Of course there are exceptions, sun downers being the most obvious. The bulk of medications are given during the day too. At my hospital, which is not a teaching hospital, we do not have doctors around after 5ish with the exception of the OB if delivering, the ER and emergency surgeries. Rounds are done (primarily) between 7 and 9am the exception being new admits who come up after rounds. So, night shift will hardly ever have to interact with a doc in person. Some of our night nurses admit to not even knowing what some of our docs look like. We don't have a unit secretary, at least not the conventional kind. We have a CNA who sits and goes over IV charting and charges for half a shift. We, as day nurses, are responsible for all the orders the providers spew out during rounds. With all of the discharges occurring between the hours of 8 and 5 there are only a couple of night nurses that can even complete a discharge, including house supervisors.

Now for the venting.

On an almost daily basis, I walk in to find night shift sitting and shopping online or watching TV on their phones or some other kind of shenanigans, with food and drinks scattered about. I am then privileged with a half-ass, substandard report on Pts that, if I had worked the day before, sounds almost exactly like the report I gave them, as if they were reading mine back to me. After they leave, I must scour the patients charts to determine what was left out of report. What meds were left not given or were due at shift change and were not given. And I have to do it fast because the Dr is rounding and will no doubt catch these mistakes and I will be the target of his ire and the face he/she associates with utter incompetence. My shift and I have each other's backs. I will take the heat if my aid forgot to chart or even recheck a temp on a febrile pt. I'm always down to turn/reposition the heavies. And we will answer any call light. That's how we operate, that's our mentality. It is OUR shift and OUR patients. This sense of fellowship or camaraderie was not present when I worked night shift. It was more of an "Us against the world" attitude. Most of them carry some form of chip on their shoulder for the day shift. One reason for this may be because we are generally staffed with more people, but this is only due to the increased work load. Also, recently they implemented a new policy that made night shift responsible for pulling day shifts AM meds (0730-0900) with the exception of any controlled or refrigerated meds and place them in a locked alcove outside of the patients room. This was met with great resistance from both shifts. Nights, obviously, didn't want to have to do it, but the day shift didn't trust night shift to do it correctly and would rather have the extra workload. Admin countered by adding that Day shift must pull night's meds as well from the same time frame. That was met with more resistance. It now stands, at least in policy, not necessarily in practice, that nights pulls AM meds and Days doesn't pull Night's meds. As either a subconscious or passive aggressive form of rebellion it seems that our meds in the AM are almost always wrong. A few nurses absolutely protest doing this.

Most recently, yesterday in fact, I came in for report on 4 repeat patients from the day before and 2 new patients. I noticed in report that one of the repeat patients IV fluids had been stopped and saline locked. Knowing damn good and well that they didn't call the Dr to DC the fluids I asked why the patient was saline locked. I was told that while turning the patient another nurse told her that she thought the patient was saline locked on a previous shift she had worked. So, without checking orders, they simply saline locked the patient and left. WITHOUT CHECKING THE ORDER! Who does that? This is a hospital! This is a new day! Things change, orders are made, treatments are adjusted! This and the STATUS QUO dept! PAY ATTENTION! I know it is a small thing. Hey, it was only running maintenance fluids at 40/hr. But what if it were something else? What if it were vitally important. What if we were running 1/2 NS with 40meq of KCL at 125/hr to correct a low potassium level and they had shut it off and the next shift didn't catch it, then they reported that the patient was saline locked and lack luster noc shift accepted it without question. That's 36 hours at 125ml/hr which is 4500 mls with 40 meq per liter that's 180meq of KCL that the patient didn't get. One day they said, I don't know if the Pt is A/O they've been asleep all night. Turns out they weren't asleep they were unresponsive. THERE IS A FUCKING DIFFERENCE BETWEEN ASLEEP AND UNRESPONSIVE!

Last night after giving report to an eye-rolling, teeth-sucking, sighing, sarcastic, bitter nurse, I began to report off to another and I overheard the other saying that she "wasn't even going to go in a room tonight." ARE YOU SHITTING ME! It's like my whole shift of hard work is negated by their shift of laziness.

Again, I am venting, this is about my hospital, and even within my hospital it is primarily only a few nurses that are responsible for all of this rant.

But it can't be just me that is noticing something like this. I'm not just being negative, right? I feel better already having gotten that off my chest.

Thanks for reading,

As always follow me on twitter @MurseWisdom
Also follow @MurseMafia @That1Murse @JustSomeMurse

I'm back, Jack!

It's been a long time since I've posted a blog. It's been too long. So, I'm going to attempt to catch up.

I don't know if Ive mentioned it here before but my wife is also an RN. She graduated last May. Just before she graduated and at her behest, we moved out of our 100 year old apartment to a house in a very small town about 45 min away. She continued to commute to her last few days of classes and clinicals and I commuted to work while looking for a job some place closer to our new home. Wait, back up... I forgot to mention that she was 5 months pregnant when she graduated. So, she quit her job when we moved and being 5 months pregnant couldn't find work anywhere. Although they don't discriminate against pregnant women, she never seemed to get interviews. So, I took on all the bills and expenses of moving on my own. To make that worse we found out we were pregnant 1 week after I bought my new truck.

 So, naturally, cuts had to be made. I couldn't get rid of the truck or the gas needed to drive 45 min one way to work. I had to cut the internet and the cable. Well, I didn't cut it so much as I never started it at the new house. How exciting for my pregnant wife to sit at home with no cable and no internet in a town smaller than Mayberry with nothing to do. Thank God for Smartphones and 3G signal in the boonies. So, having no access to the internet on my computer, I couldn't write the blog anymore. I certainly wasn't going to try to type it out on my Droid.

My job search went well, interviews left and right, I finally landed on a small hospital about 30 mins away. Didn't improve my commute much, did I? But they really liked me and the CEO was so positive and energetic and likeable, the new Nurse Manager (who has an MBA to go with her BSN) was awesome too, and she told me all about the new ideas and plans she and the hospital had in store. I'll be honest, it sounded like I was getting in the door at the right time. I took that job but didn't quit my other job, figuring I'd have to make up for my wife's missed salary. Then I got a call from my former DoN asking me to come help her out as she had recently been hired as a regional director for a home health company that worked with Peds. She had been doing all the infusions herself on top of her administrative duties and wanted me to jump in and do some infusions. I said "Ok", and then I had 3 jobs! I really didn't have time for blogging then. I worked my tail off all summer until late August. I stopped scheduling myself at my original job and became extremely PRN. The infusions slowed to a crawl because eventually you worked yourself out of a job because your Pt's got better from the infusions, or they died. I know, that's a downer but it's true.

Sept 27th, my wife gave birth to my daughter

 

 A few days prior to that I had finally gotten cable and Internet and was all ready to get back in to blogging. Then I stopped sleeping! My God! Do people know how needy these babies can be? This has been a whirlwind of emotions and a physical strain. I will tell you that I have served in an active combat zone, I have stayed awake (my longest stretch) for 55hrs and finished it off with a convoy through a heavily populated area, and of course I have graduated Nursing school. NONE OF THESE THINGS PREPARED ME FOR FATHERHOOD!

That should catch y'all up for a while. I really enjoy my Twitter Anon shenanigans and I enjoy giving out advice and guidance. There is someone on twitter now that is almost a blatant copy of my account and I don't know whether to feel flattered or angry or threatened. I now that it's pissing me off so far and I'm refusing to follow him because if I see him tweet something that I've tweeted before I will lose my shit and probably hundreds of followers in the process.

I'm debating doing one of these Google Hangouts with the other Anons, I just recently bought a web cam so I can talk to my parents over Skype and they can see the baby. It would just be really awkward to jump on there and recognize someone.

Ok, I'm sorry that wasn't a comedic post. I'll be funny next time.

Until next time...

Follow me and my Murse buddies on Twitter

@MurseWisdom

@That1Murse

@JustSomeMurse

@MurseMafia

And leave a comment so I know you guys are reading this!