July, 2007 Archive

“how can a new nurse avoid burn out?”

this is a question emailed to me by a new nurse who said she is “at the point of quitting nursing” after less than a year of being one. i am not an expert in giving advises, but these ideas saw me through when i was new:

you will be overwhelmed. do not expect otherwise.
     there are a lot of legitimate reasons why you can get overwhelmed. first of all, you are dealing with lives. one major mistake can lead to someone’s death. unlike paperworks that can be revised and redone, a patient’s life is a one time only deal. needless to say, that responsibility weighs heavily on your shoulders as you give meds, carry out orders, and deal with a very sick patient.
     the people around you are dealing with all kinds of stressful situations. the patients are either devastated by a new illness or frustrated with a chronic medical condition. their families are either weary, or scared, or weary and scared. the doctors are either worn out, or bullied by other doctors. the charge nurses are being pulled into two opposing directions. your fellow nurses are just as stressed as you, as they try to make it to their 12 hour shift without doing any harm.
     when you are new to all these, there is no way you can handle it like a pro. learn from your day to day experience and be very observant. prioritize and focus on your tasks. when you feel that the sense of being overwhelmed is getting out of hand, have a moment of silence, tune out others’ demands and suggestions, and start with a clearer mind. 

reconsider your options. 
     even though you are bombarded by ideas coming from all sources that only ICU and ER nurses really matter in the heirarchy of nursing status, do not embrace this idea. while it maybe true that ICU and ER nurses are smarter and quicker, it is not only them that can make a difference in a patient’s life.
     if you cannot cope with the demands of a fast paced, pressure filled nursing, maybe you will function more effectively in a slightly laid back unit. one great thing about nursing is that you have a lot of choices. try other things and find your niche. believe me, it all boils down to being your best in a place that brings out the best nurse in you.

do not be embarassed to seek help. 
      even when you were the very first person to respond to a dying patient’s plea, and he eventually survived, you still cannot own the recognition of saving that patient’s life by YOURSELF. you are a part of a team and a lot of the members of the team are happy to help you. while it is true everywhere that there are people who enjoy “eating their young”, as time goes by, you will have an eye for spotting them in a snap. all you have to do is leave them alone, and  stick to those who understand teamwork. learn from them, stick with them. then, pay their kindness forward and break the ugly cycle started by those whose idea of maturity is “i suffered when i was new, it is but proper that you suffer too.”

know your resources and use them.
     if there are particular things that stress you out because you lack knowledge, find out where you can get your needed informations and read. or ask. “fear of the unknown” is not just a statement. it is true in nursing. if you are expected to do something you don’t know, you will be terrified. you need confidence when you show up at work, people are depending on you. one certain thing that can boost your confidence is knowledge.

be honest. do not be ashamed to admit you don’t know everything.
    it takes courage to step forward and say “i have not done this before, i will appreciate it if somebody can show me how to do it, and watch me do it on my own next time.” sure you will feel like you are the world’s stupidest nurse, but that is okay. it is better that you appear and feel that way for a moment than commit a grievous mistake that you will regret for the rest of your life.

do not ever compare yourself with the seasoned/veteran nurses.
     when you see other nurses breezing through their shift like everything is smooth and easy, remember they were in your shoes once. the experiences and knowledge they have did not happen overnight. don’t be too hard on yourself and expect that you gain in one year what others gained through years or even decades of experience. that is unfair. the experienced nurses are not your competition, they are supposed to be your ally. respect and acknowledge them. do not feel superior over them because of your degree. know that the things you learn in school are not enough. the real world is more complicated than what you’ve read.

connect with others who are in the same boat.
     you will be surprised to find out that you are not alone. when you hear fellow new nurses express their concerns of feeling so tired and overwhelmed, you can all discuss your fears and frustrations and learn from each other. you can exchange tips on how to cope. you can share informations and take advantage of the nurses who know what you are going through, from the same point of view. 
     
take a moment.
     in the middle of complete chaos and endless lists of expectations, it will not hurt to go to the restroom for a minute or two to take a moment. you can use that moment to either take some deep breaths, or cry, if that makes things lighter for you. there is nothing wrong with that. when your mind has rested, even for a minute, it will be a lot easier to prioritize and then accomplish things.
     get away for a couple of days. if the past week or so have been unbelievably tiring and stressful, you will be surprised at how a day or two in a place away from your home and work can make a refreshing difference. usually, an encounter with nature does the trick. it will put things in the proper perspective. you will be reminded why you are doing what you are doing.     
     when you realize the higher purpose of being a nurse, you will be motivated to continue to do it. when you remember that you are here not only to be able to pay the bills but to make a difference, you will keep on caring. you will keep on serving.

____________________

there must be a hundred of other ways to avoid burn out. those of you who have been in your job for a while, please feel free to offer your suggestions. we cannot afford to lose another nurse. we need to encourage and support each other, because if we don’t, who will do it for us?    

whose fault is it?
why are patients being held up in the ER?

patients who crowd the ER for real concerns of unknown or scary but non emergent cases. can you blame them?

diagnostic tests techs who are squeezing in non emergent cases while waiting for emergent ones and are in the middle of something when the emergency test is being ordered. is it their fault if some of the machines either play up or just all of a sudden stopped working? can you blame them?

housekeepers who have been paged to clean three isolation rooms before they get the call to clean a room stat, for an admit, and can’t make it because they are in the middle of their 30 minute lunch break which was supposed to be hours ago, but they never had the chance to take? can you blame them?

patients who are supposed to go home, their family on the freeway, but there was an accident so they were late in picking up. can you blame them?

doctors who are forced to deal with a number of patients more than humanly possible to handle. those who get weary and forget to write or ask a few things and end up eating more of the very small time the ER nurses have. can you blame them?

floor nurses who are sitting on their chairs, doing nothing, who have no idea they’re supposed to go up the ladder and take off the old curtains so the isolation room can be ready ASAP. those who, after four straight hours of assessment, cleaning, repositioning, suctioning, changing linens, changing dressings, calling docotrs, following up lab draws, giving meds, changing diapers, following up with pharmacy, feeding, reassuring families, have the audacity to sit down and catch their breath just because. can you blame us?

well, maybe you can blame some of us. but you can’t blame ALL of us.

there maybe patients, techs, doctors, or nurses who delight in nothing but delay. they find it very amusing that ER nurses are up to their necks with things to do, and a place so chaotic, they end up very edgy. some people probably wake up each day, thinking of things they can do to create a sense of imbalance in ER, and to annoy the ER nurses.

there is a possiblity that some people are like that…but not ALL people are like that.

when i receive a patient from ER whose bottoms are covered with hardened stool, (the kind of stool that even a ten year old will know have been in there since who knows when) i gather the things i need, and clean the patient. i won’t lie and say i was happy i get to clean the patient when he should have been cleaned a decade ago, but i don’t go around telling everyone that ALL ER nurses don’t have the heart to care enough to clean a patient.  i reason out that there must have been some emergency trauma cases that poured in one after the other, and seriously, nobody really died from an unclean ass. saving lives is more important than cleaning poop. i get that.

when i see ER nurses sitting, doing nothing, then i get an admit from the ER,whose urine leaked under the sheets and was soaking wet, it is NOT automatic for me to think that “ER nurses are lazy and superior, they don’t think keeping a patient clean matters”.

is it then too much to ask, that ER nurses NOT automatically think that floor nurses who are sitting, doing nothing are lazy asses causing the delay in patient admission?

some things are just unavoidable. it is not a sin to see a messed up system and believe no one is to blame. sometimes, it is just a series of unforeseen, unfixable events. sometimes, despite heroic efforts to make things move faster, there are still instances when delays happen. sometimes, there is absolutely no one to blame, and it is absolutely no one’s fault, and things can still be okay.

at the end of the day, blaming anyone doesn’t REALLY help the patient. we are all in this together, and we are better off as a team rather than competitors.

sorry for the rant. i just chimed in because geena asked. not just me specifically, but i’m one of the med-surg nurses.

i was a little too late. i stopped blaming myself when i realized it can’t change what already happened. both his hands were covered with feces, and with the looks of it, there was a huge possibility he was able to put some inside his mouth too. 

i literally felt like crying when i saw him. especially when he started to cry, and kept saying “please, please, please.”

he’s in his early 80s and didn’t know his name. when asked something, he would start talking insensibly, in sentences that dragged on and on and on, in a whisper like monotone that made him sound like a scared little boy. i assumed he was a good a doctor in his younger days. he used to teach and it was no surprise that his former students took time to actually be there when he had his surgery. they treated him like a complete VIP by actually wheeling him from our unit to the OR. all five of them!

he lived in an alzheimer’s facility. he fell and broke his hip because one of the residents pushed him for no reason other than the fact that like everyone else there, he didn’t know what he was doing.

unlike the AM nurse i gave report to, who sarcastically questioned his family’s attitude by placing him in a facility, i totally get the whole idea. i understand the negative implication of placing a demented loved one in a facility, but i won’t lie and say i won’t do it for a loved one. honestly, if i was his daughter, i wouldn’t mind the caregiving part, but i don’t know how long i will be able to emotionally stand watching him slowly losing it all. i don’t think i am that strong, that’s why i salute those who have what it takes to do it with compassion and efficiency.

while i was cleaning his fingers, his nails filled with poop, he was crying. i kept telling him “it’s okay doctor M, it’s okay.” i hated the way that statement sounded, but what else was there to say? it sounded like a lie, and i felt like a complete fraud. still, i said it over and over, almost believing that repeating it will make it real.

but seriously, how can it be okay?

he was a dignified man who used to help people. he was respected by his family, colleagues and friends. now, he’s in bed not knowing who and where he was, not knowing what he placed in his mouth.

how can THAT be okay?

the whole scene was so sad i felt like embracing him. although alzheimer’s and its effects are not new to me, there is no way i will ever be immuned to the heartbreaking sense of helplessness that i feel everytime i encounter people suffering from this nasty disease. i hate to be melodramatic about it, but only the heartless can look at someone eat his poop and not get somehow emotional about it. it is a scene that will tug at anybody’s heart. it is a scene that stirs the strongest feeling of helplessness.

i know it makes no sense but i can’t stop from asking all these stupid questions that obviously do not have answers. i get exhausted, and i end up praying that i just die rather than live like that…physically existent but mentally out.

devoid of dignity and humanity, it is almost worse than dying.

the patient’s wife asked for the nurse manager because she wants to complain. apparently, she believes that her husband is being sexually molested/harassed by the nurses.

the patient is a guy with endotracheal tube. the nurses routinely suction secretions from this tube to keep the patient’s airway clear and to ensure good oxygenation. water or saline is used to flush the suction catheter to prevent from clogging the tube. the secretions often form into whitish/foamy lumps or gunks that settle either on top or side of the saline/water that is collected in the suction canister. the suctioning occcasionally happens when the wife is visiting.

almost verbatim, here’s the wife’s concern: “the nurses are molesting my husband. they put a tube down his throat, and suck all his sperm out. i don’t know what they want, but i see them collect his sperm in that little container on the wall.”

the nurse amanager felt it necessary to share the wife’s concern to the staff, one of them is my sister who works in a county hospital ICU.

true story. because really, you think i am THAT imaginative to make this thing up?

kidding aside, i cannot even make up an appropriate reaction to this story. is this suppposed to be funny or sad? let me know what you think.