Well Being

The American Journal of Nursing asks whether we are well beings. They skitter around the topic of nursing burnout, brownout or flat out as a consequence of being an unwell being. Or is it the trigger of being unwell?

Nursing has always been a hard job. It is not for the faint of heart, not for the drama queens (of either gender), not for the delicate souls wounded by the world’s pain. Yet we see them there, at the bedside. The coping mechanisms nurses employ to distance themselves from the pain, deaths and fear they encounter continuously are often seen as skills.

There is technology – it has become embedded into the work of nurses to such a degree that it can, and does, offer a multitude of opportunities to divert your focus away from the patient and on to the machines, numbers and data. A ‘good nurse’ in the profession, is seen as one who can balance the machines competently and skillfully, taking off a bit here, adding a bit there, continuously adjusting and balancing the multitude of variables that get the patient through the shift. A facinating array of machines to take the place of clinical observation leading to looking at the numbers rather than the patient.

There is bitchiness, also defined as a ‘vocal nurse’ and mis-defined as a patient advocate. These are the ones that create the image that we eat our young. They also eat other professions’ young, families, other nurses, physicians and patients themselves. They make life a living hell for managers and have the union grievance process memorized and on speed dial. They take patient safety guidelines and use them to create an excuse to act in a way that should get them a time out in the corner. They bully their way through the day and have been doing it for so long that everyone one else refers to their bad behaviour as ” oh, that’s just X”. We all know who they are and they are on every unit. Worst of all they think they are the expert nurses on the unit and have a divine obligation to tell everyone else exactly what they are doing wrong. They are trolls.

There are the overtimers. They will take any and all extra shifts, at overtime only of course. I saw one nurse’s OT payout for the year. It was $120,000. For one year. Does this make the nurse a dedicated nurse, a better nurse? Hell no! Truckers, pilots, train engineers and other professions have requirements of how much extra hours they can work and still be safe. Nursing has no such professional limits set. Your nurse could be functioning on her 6th 12 hour shift this week. He could have switched from days shift to night shift with 8 hours in between. This person is mixing and administering poisons to you and titrating them to a specific effect that is desired. This nurse is expected to attend to hundreds of alarms, subtle clinical changes, new information and mix it all together and make rapid decisions about what you need now. They need to be able to communicate clearly and effectively with other health care workers about what they are seeing, smelling, hearing and feeling yet they probably have no idea what day it is or where they gave you your medication on time or at all. They are sick, forgetful and hazardous to themselves and others.

There are thousands of good, skilled competent nurses who know when enough is enough. They don’t work more than is safe, they have families and outside interests to balance them into human beings first and nurses second. They understand that the art of nursing is more important than the science of nursing. They value the young and believe in succession planning. They are not threatened when you ask what they are doing, what that medication is, and you never have to ask who they are because they tell you first thing. They are the quiet professional of nursing and we thank the nursing gods for them. They are well beings.

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WWFD?

 A blog from Legal Nurses of Canada caught my eye.

Nurses do make a difference in outcomes. Florence knew this and every year research validates this as current and continuing to be true. The cost of a senior nurse so far does not equal 2 junior nurses, however some local health care organizations are pushing to increase the number of full-time positions and encouraging departments to reduce part-time positions. Senior nurses, some who are very close to being considered actual seniors, need modifications to the work environment to continue working. Many love the work they do but are finding 12 hour shifts, 40+ hours a week tiring and often exhausting. Part-time positions allow their knowledge and expertise to remain in the clinical area while granting them the chance to balance their work-life ration to meet their own needs too. Because the nursing workforce has primarily been female who excel at subjugating their own needs over those of others, health care organizations have done little to improve the work-life balance. When the contract negotiations come out it seems to always be about the dollars, when in reality, it is much more complex than that. Yes, if you throw enough money at people they will come to work anyway, but really, is all we need at the bedside a warm body? Or are we truly committed to providing the highest level of care?

One step in the fog

I’ve just come from a funeral for a woman I didn’t know. I’m not one of those who generally attends funerals unless it is someone close to me, but this was the wife of one of the managers on our leadership team and it was assumed that you would be there. It would not hurt me to show up.

It’s been a weird week. On Monday came the news that this woman had been found dead, by her husband when he returned home from running some errands. She had been sitting at the computer, much like I am now, working on her dissertation as she did every evening. She was to convocate in April with her PhD in nursing.

One of the other managers has been off most of the week attending – I can only assume – legal offices as she is undergoing a sudden divorce. I assume he is a cheatin’ heart as he sent her an email a few months ago saying that she seemed to do better without him and that he was willing to let her go. A cheatin’ heart and an asshole – who breaks up their 20 year old marriage by email?

Another manager had to deal with a nurse who just simply walked off the unit abandoning patient, co-workers and presumably, career.

There were nurses crying in the back hallways when a man recited the wedding vows he and his wife exchanged 14 years ago as she lay, critically ill in one of the beds and families trooping in members by the tour groups to look upon the frail, wasting body of daddy who cries every time he is touched yet is seen by his children as full of life and desire to do everything. And everything is, so very much.

Then out in the world a physician MLA is hell bent on self-destruction all in the name of improving patient care – or furthering his own agenda – the jury is still out on which is his primary goal. Mysterious claims of pay offs in the millions to physicians to keep patient on waiting lists and hundreds dying while languishing on the list instead of getting supposed life saving surgery. It seems a little far fetched as every surgeon I know will give up his first born in order to operate, any day on anything. You can’t pay them to NOT operate – they are not farmers.

Then a casual conversation in the stairwell – where, I should know by now, all really important conversations take place – to an ex-coworker from my previous job resulted in her running back to her unit and spreading the information that I was saying nasty things about someone who worked there. Wow. Whereupon the alleged injured party stormed into my unit, demanded to talk with me and then proceeded to rip me a new one while demanding that I never, ever talk about her again – to anyone. Well, shock and sideswiped I was.

See, perception of an event creates a reality for the individual even if that is not the way it happened, and now, in her mind, I have been judged and found guilty of spreading tales of incompetence and and laziness. In reality I acknowledge I know nothing about what she does and I am grateful that I don’t have her job.

But I see from this experience and from reading of the head of thoracics who claims to have been run out of the province, how very easy it would be for innocent remarks to become fodder for the anger of others and very easily lead to a life changing event.

The mob mentality is simmering, always, just below the surface presentation of civility. Just a simple comments, a look, a murmured innuendo and the frenzy of self-righteous lynch mob spills forth through FB, titter and the like to decide your fate. We live believing our reality is stable, but it sits on the edge of a precipice.

And from how fragile that tenuous hold we have on our own reality I connect how easily our lives change forever through one event – the sudden death of a loved one, the sudden loss of love, the mysterious anger of a previous friend, acquaintance or even sibling. We balance so close to being lost in the fog around communication, so easily do we become lost, and alone in what we perceive. In a blink our communal reality is dissipated, as if it never existed. In a heart beat we are separated from others, and in a halt of a heart beat we are lost to the fog.

Migraine Diaries continued

I used to get a nice warning of an oncoming migraine. It looked much like the picture above. However, if nothing else the migraines are ever changing in aura. Gone now is my scintillating scotoma, but not the visual experience. Now I get what is refered to as coronal phenomenon, with scotoma, headache, abdominal pain and as an added bonus, mental confusion. Have I mentioned mental confusion?

This week when I got to work a startled co-worker asked with horror what was wrong with my eye. Apparently I had a small bleed  and looked ghoulish. Shortly after I got the coronal phenomenon, with a few black lines across the visual field. It looks like everything is extra sharp, or in relief – standing out away from the background. Then the headache, which was, interestingly on the same side as the eye bleed. When I went to fax a document I stood looking at the machine and couldn’t remember how to do it. I remembered another time when I couldn’t remember how to photocopy and had to get the secretary to show me – I suspect she thought I was just being a bitch, or had lost my mind. The loss of how to do something seems to be related to technological equipment, but what happens when I suddenly forget how to drive while I am driving?

I did get the document faxed with some help from a different secretary, but had some word loss for a few hours. Oh, not complete aphasia, but just a few words here and there – sure it makes you look like an idiot, but at least most of the surrounding words make sense.

Losing a word here and there certainly is better than developing a case of extreme stink-eye and ripping out someone’s carotid because they seemed to be breathing too loud.

In the cold, staging or finding a begining and end to a migraine is often confusing. Definately environmental triggers but is it just one long migraine from October to June?

Oh Bother!

Just to let you know I have quit shovelling my walks. It is March and after a nasty winter, broken wrist and heavy snowfall, I quit. The city doesn’t have to clear the roads, so I don’t have to clear the walks. Minus 23 has come to feel like minus 43. My glasses have frozen to my face and my brain is exhausted trying to maintain blood flow to all important limbs.

Honestly, how much can one person be expected to contend with?

Maybe I should call in for a snow week?