In New Shoes

As nurses we see, feel, think, hear, and smell things the average person does not in his or her daily work. The crazy thing is that after a while it doesn’t phase us. Thus, why we can discuss bodily fluids at the dinner table without realizing that it may not be quite so appealing to the rest of the normal world. That being said, I think perspective of circumstances changes as life changes. Cases that made me feel one way now may be different three months from now based on life events.

Now that I am expecting a child, I see cases surrounding miscarriage, pregnant patients, and children in a whole different light. For kids I want to soak in every ounce of knowledge so I can assess my own sick child in the year to come and know when I should be concerned as a nurse verses just being a mom. Will there be a difference?

I triaged a woman with the same due date as myself and sent her back to a room to see a doctor for abdominal discomfort. Immediately I felt connected to her. Something about the solidarity between pregnant women...that understanding of discomfort, change, and vulnerability that comes in the first few months that makes your heart feel for that other woman no matter who she is or where she comes from. I didn’t reveal this commonality to her, nor did my baggy jacket, but worried simply because any new or uncomfortable symptoms in a pregnancy are scary. After she went back to a room I checked my baby app as I do daily to learn what fruit my baby was comparable to that week. A small peach. Wow, I thought. We were both carrying human life the size of a peach!

Later that shift I reached out to help a coworker with an IV and ended up in this same woman’s room, where she was indeed miscarrying. The sadness and pain in her eyes and the father’s eyes struck me. Why her? I thought. Why is that fair that her baby couldn’t make it? Why do they have to feel this pain? Why isn’t it me in her shoes? I looked down to see the beautiful baby, too young to be saved, curled up and attached to the umbilical cord, the size of a small peach.

I have seen miscarriages before and cried silently for the baby and family, but this one pulled my heart strings in a different way. I silently prayed for this baby and mom and dad and held back my tears. The first miscarriage I witnessed I cried out of pure shock and sadness for the family, trying to process the sight in front of me. This time I knew what to expect, but I was struck by the beauty of the baby, how in his developing state, he looked so perfect and human. I was confused with feelings of sadness and wonder as I realized that was what was inside of me. That is what my baby looked like.

A selfish part of me wanted to be a part of her care, to help however I could simply to feel like I could do something...because what can you do or say at a time like this? I simply could not imagine being in her shoes...and I felt vulnerable knowing her shoes were walking my same path only hours before.

I am continually grateful for what I have and where I am, particularly in a job that sees tragedy most every day. I pray for the grace to be present to others and humility to be grateful for each day I am not in the shoes of patients I treat.

A New Baseline

I stopped, took a deep breath, and thought to myself You’re being ridiculous. You can do this. It will all get done. I felt overwhelmed and quite honestly just wanted to sit down and cry, yet at the same time realized this was irrational and I was overreacting. Conversing in my head I realized I was flat out exhausted. I called for help and was granted extra hands, yet I still just wanted to throw in the towel and cry.

Yes, I work 12 hours shifts and run around on my feet all day, but usually the exhaustion hits at the end of day 3. When fatigue takes hold before day 1/3 even begins it can be a rough day. The last three months have been rough and recently took a turn for the better (thus my lack of posting). It is hard to find a positive spin to life when it takes every aspect of your being just to get out of bed in the morning. This is not me, this is not who I am. What is worse is when your coworkers notice. I looked tired, my energy was low, and faking it days on in addition to days off was flat out exhausting! Turns out I am pregnant, which explained the utter exhaustion, constant nausea, and irrational mood swings. A beautiful thing, yet really hard if you’re keeping it a secret through the first trimester and visibly not yourself. It’s hard to just “be sick” for 2 months.

In this time, I reflected a lot about what it meant to be out of my element. No, I wasn’t myself and no, I couldn’t run around the ER with my same gusto. What is more, my patients often annoyed me and I found myself thinking What happened to my compassion? Why is it so hard to fake it and not get annoyed?

Trying to come to work and fake my normal level 10 energy needed to end. It was too much. The first step was accepting this. I acknowledged that I had a new baseline. I didn’t need to skip everywhere, I could slow down my pace and still get everything done well. I hoped it would end soon, but in the meantime, took lots of deep breaths, and gave whatever my best was for that day.

Life throws us waves and we must learn to roll with the tide. As nurses we’re good at that. Flexibility is key. But we’re the ones caring and don’t do well being cared for. This was humbling as I was forced to slow down and let my coworkers help me and my husband care for me and take stress away at home. It reminded me what it is like to be the patient…So the patients who were annoying were simply annoyed because they had to be in the care of others, not because they wanted to be rude. I could at least relate to this.

It’s critical to leave personal problems at the door. My physical symptoms were still present, but my mental strength could acknowledge I was not doing well, leave “me” at the door, and move through my day one step at a time. 

Gratitude

It’s the most wonderful time of the year, right? I like to think so. The excitement, giving, and spirit of the holiday season typically fills my life with joy. There is nothing like Amy Grant’s Christmas album playing with a kitchen full of baking goods and friends and family. I think in a way I have always taken this for granted. I thoroughly enjoy holidays with my family where we spend countless hours laughing and competing in board games, treasuring the time we have together. That time is precious and I wouldn’t trade it for the world.

This week at work made me grateful for my reality. For many it’s the most stressful time of the year. Finances are tight, family problems arise, deadlines get harder, and as Thanksgiving and Christmas loom closer the stress builds. For others, it’s the loneliest time of the year. My suicidal patient this week told me I (as in the hospital system) was only making her life worse by locking her away on a holiday away from family and friends. I felt for her as this was a difficult time and the fact of the matter was that she was safer in a facility than at home. Yet she made a valid claim…aren’t we all better when we feel surrounded by those we love?

Then there was my stroke patient who was no longer capable of ambulating independently and was admitted the day before Thanksgiving. He was grumpy and I stopped myself before saying “Happy Thanksgiving” and changed my language, recognizing that this Thanksgiving for him was not going to be so happy, rather potentially life changing. He had made it very clear that he was not happy about the situation. I held his hand and wished him well.

No one comes to the ER because they think it will be a fun experience for the day. They come seeking help, and on the holidays, most often because the matter is urgent. It is always hard to see a family member in the hospital, but that weight is felt more around holidays.

I recognized yesterday that many whom I treated were in for a rough Thanksgiving with their families. One family so relieved to have help for their dad, yet sitting by his intubated side in critical condition on this Thanksgiving, and another who buried their mother the morning of only to have their father pass suddenly that very evening. As time of death was called shortly after arrival I began the process of the death paperwork and stopped. The patient was dead on arrival and we only did CPR for a few short minutes. Typically, these cases have little emotion attached simply because we know there was nothing that could be done; however, when everyone left the room I paused and reflected over this man’s case and felt a pain in my heart. This family lost not one but two people in a short span, and their joyful holiday was clouded by the sadness of loss. This man was celebrating the life of his wife just hours before…it would be a Thanksgiving without her…did he die of a broken heart? Usually this case wouldn’t strike a chord, but sadness and tribulation feels greater in this most wonderful time.

Life brings its ups and downs and it is amazing to witness and an honor to be a part of many people’s holiday experience. It is times like these you almost feel more needed than ever as a looming holiday adds more stress and sadness to a situation. I hugged a daughter before leaving last night who said “You really love your job. We need more people like you”… a small reminder of why I do what I do. I love caring for others. While holidays are tough they present a beautiful opportunity as a nurse to make a huge impact in someone’s life. It is an honor to be in a position to bring stability and peace to the chaos. For that I am grateful.

To my nurses working today, thank you for working and remember you have the ability to make an extra special difference for someone today. Happy Thanksgiving.

I'm Your Advocate

Recently I've been educating about distracted driving in the high schools to fulfill hours for my practicum course. One of the classes I was fortunate to speak in was focused on careers and future aspirations. The teacher asked me to speak a bit at the end about nursing and what it is like to be a nurse. As I started to speak I became excited. I was so proud to talk about my job that I love so much and kept coming back to the idea of being an advocate for others. I find this to be one of the most beautiful pieces of the nursing profession. 

Advocacy in nursing comes in so many different forms. On someone's worst day I have the ability to be their voice and advocate for best practice and excellent care. As an educator I have the ability to advocate for my students and support their growth and development. As a relief charge I get to advocate for my nurses in the craziness of our daily work.

When I first began to transition into a relief charge position I was curious as to if I would like not having my own load of patients. Would I miss that patient connection? Would I lose a par of that patient advocacy? Surprisingly I found quite the opposite.

Every shift as leadership we are asked to round on patients in the department. How has your care been? How have we made you feel cared for as person? I was running around trying to check tasks off my daily list when I found myself rounding on a tearful young woman. She was the daughter of a patient who had been living with her for an extended period of time. She had become his caregiver. I sat down to ask my questions starting with “how has your care been today?” This sweet woman broke in to tears as she explained the disease process that took over her father and her fear that she could no longer handle his medical needs. She voiced her internal struggle and how she swore she would never put him in a nursing home, but was realizing right now things were just too much. She wept and I had the honor of listening and allowing her to express the pent up frustration and sadness she had been harboring. I was struck by her honestly and her devotion to family. She was such a strong, kind, and selfless woman, and her father, too weak to speak much for himself, simply looked towards her and smiled. He loved her and the connection these two shared was just beautiful. As he went off for a scan I discussed options with the daughter. I applauded her dedication and the love she possessed and reminded her that she was only one person. She was only one person and her superhuman strength and love could only take her so far. I connected her with our case manager and wished her luck. By the time I walked out of the room we had spent a solid 20 minutes together.
On a busy day as a nurse there is no way I would have been able to sit for that long without being called away to another room. This was a type of patient and family interaction I had not anticipated being in leadership. This was the ability to advocate for the awesome care my nurses provide in addition to giving someone who needs it the space to talk during a life changing event. This advocacy is my favorite part of nursing. Advocating for my staff, for my patients, and for their families. While a charge shift poses different challenges and responsibilities throughout the day, it still provides fulfilling interactions that help reach and care for people in a way I didn’t anticipate. Perspective change is always valuable and this new leadership opportunity has allowed me to open my eyes and see emergency care through a different lens that ultimately broadens my perspective.

Thank You

The last couple of weeks have been rough. I struggled with fatigue in college and it has taken me 7 years to feel like I have a grasp of what I can and can't eat and what fuels verses what fatigues me. For the most part I have a great handle on this, but every once in a while it creeps up on me and robs me of my enthusiasm for life. This is frustrating and when you work 12 hour shifts it tests your patience and ability to hold compassion for others when you can barely hold it together yourself! For someone naturally bubbly and energetic a blow to my stamina feels like a blow to my identity. The struggle feels real. 

One of these days was busy. I had psyched myself up to working with the emergent patients in the ER with my light at the end of the day being that I was only working an 8 hour shift. I was able to smile and work my way through the morning which was fairly slow and steady and tried not to acknowledge the heaviness in my limbs. 

I had the honor of caring for a very sick septic patient that day who required mostly 1:1 attention for the first few hours of her arrival. She was sick, unstable, and her condition unexpected to her sweet husband who sat by her side the whole time. We were holding ICU patients and so her typical period of stabilization to transfer to CCU was prolonged by the capacity of the hospital. My patient was unable to communicate with me effectively, so I tried my best to explain to her husband what was going on and what to expect. He was calm and open to everything I had to say. Part of me wondered if he fully understood the extent of her condition. 

In and out, in and out of her room, small talk with the husband, and simply counting down the hours til I could go home. She was stable when I left that evening and I didn't think much of it. I had just hoped I had been able to give enough that day. 

Two days later I was down at the coffee cart when I felt a tap on my shoulder. That same husband approached me and said, "I just wanted to say thank you for everything you did the other day, with my wife. I really appreciated it. Thank you." 

I was so appreciative of his words. Every day in this profession we try and try and try, and many days go home not knowing if we did enough. It's these little moments that help remind me why I do what I do. I don't do it for the recognition or the thanks, but when someone takes the time to say they appreciate you, it sure goes a long way. 

I think we forget to thank a lot of people in our lives. Remember to appreciate those around you and verbalize it. Sometimes those two little words go a lot further than you would imagine. They did for me.

Humbled

The things we encounter in a day as a nurse...

I was reflecting on what I could blog about and threw up a prayer asking God to help me articulate something meaningful. I think God chuckled a bit as I was working this day of my request and He placed me in a scenario that I believe I will hold on to for a long time, if not forever. 

That's the thing about nursing, and particularly in the ER, that you get so used to seeing emergent, traumatic patients, they often blend together by the end of the days, weeks, and months. A minor story you tell at the dinner table (most definitely retained by those non-medical people at the table who are usually horrified) is forgotten days later as it is replaced by new cases and people. We only vividly remember a few.

This was one to remember. This patient had family in critical condition and was brought in to help regain control of his breathing, which was triggered by grief and panic. The beloved family member did not have much time, and after the first few minutes of medication and deep breathing we were asked if the patient was stable enough to say goodbye in the last minutes of the loved-one's parting. I threw some oxygen on the man, grabbed a wheelchair, and took him down the hall as quickly as I could, knowing only minutes were remaining. 

When we wheeled in the door I positioned him next to the bed of his love one, who had just passed. Doctor came in and delivered the news, and the sound of my patient's grief echoed down the halls of the CCU. For 45 minutes I witnessed the strength of the family supporting each other and helping calm down my patient in the midst of their sadness and disbelief. 

I stood bracing my patient to ensure he didn't fall out of the wheelchair, and wiped his tears as I held back my own. My heart ached for this man. Not only was his world flipped upside down that day, but he was so overcome with grief that he could hardly catch his breath. I imagined myself in his shoes and quickly jumped out of that thought as such a thought was terrifying and brought immediate, strong emotion. 

I could not imagine what this man was feeling, but I can still hear his cries to God asking "why?". I still can see his tear-stricken face and glassy eyes, and I can feel the tug on my heart that inside cried with this man.

I was completely humbled. The pain and the grief that no words could touch at the time. The humanness of the situation. The reality of life and death. The truth of the brother who simply stated that we all have a time that will come. The reality that I work in a profession where I get to be present to people on their very worst days. 

I was humbled to witness such a vulnerable time with this family. It's so easy to forget the terror and tragedy that can accompany a visit to the ER because we see it every day. It is humbling to step inside someone's world and view things through a new lens and feel with those involved. I pray this man finds peace in the darkness of this time, and I pray that his story remains in the back of my heart as a reminder to hold close the ones I love and to remember what it is like to be on the other side of the curtain.

Fake It to Make It

There was one day where I was flat out exhausted. I've dealt with energy issues for seven years and over the last three months finally felt like I had control until this particular week. For whatever reason I woke up tired and wanted nothing more than to sleep for four more hours as opposed to starting off day one of three twelve hour shifts. The negative energy was frustrating because it is not a feeling I like to harbor or possess...ever. I reverted to my motto of "Fake it to make it". I offer up the day and pray God gives me the strength to hold it together.



The trouble with not having energy to begin with in a day, is that is takes twice as much energy to be present and pretend that you're okay. Talk about exhaustion by hour 13! I rolled in to work mentally cheer-leading in my head to shake the fatigue and anxiety where I was greeted with the eyes of an eager student who had been placed with me for the day. Bless my coworkers as they had only good intentions of placing her with me, as I teach students regularly throughout the year and thoroughly enjoy educating (on most days), but was not feeling it today.



Oh boy I thought as I took a deep breath in and breathed out with a welcoming smile. If I thought faking it for myself was gonna be hard today, faking it while maintaining patience to teach quadrupled the faking energy at that point. But I know there is nothing worse than a nurse showing frustration or disappointment at the opportunity to teach a student, so I smiled and prayed it would be a good day.



It was a good day. Thankfully it was slow enough in the morning where I could dictate my care and walk her through some basic IV skills before the volume picked up. She was positive, eager, and asked excellent questions. I found the teaching piece almost gave me more energy throughout the day as it is something that naturally energizes my soul. She was a great student and the day went by quickly. I had tried really hard to help her, but still felt like I didn't give her the experience I could have had I been feeling 100% that day. I felt guilty as I reflected on this while she was at lunch.



She came back from lunch and finished up her last few hours with me, and presented me with a card. "I don't normally do this, but I really appreciate how you've made my experience so great today," she handed me a card from the gift shop.



I was speechless. All day I had been trying so hard and felt like I had failed her, while she felt what I had to offer was more than she expected in a shift. Her gesture made my whole day.



Some days we have things on our minds, we're sick, or we just don't have our normal 100%. I've always been told to bring with me 100% of whatever I do have in a given day. Maybe it's far from my normal, but it's the best I can offer at that time. That day my 100% wasn't my usual, but it was appreciated and my effort did not go without successfully impacting someone around me.

Sometimes you have to fake it to make it through or just to simply find your energy and groove for the day, but no one will ever fault you for putting your best forward, whatever your best may be in that given time or day.

Rekindling the Fire

Every once in a while I will wake up in the morning and wonder 

Why do I do this? Why do I work 12 hour shifts? 

Why do I pick up extra hours? Why do I find myself at work even on my days off? 

I do it not because I have to, but because I want to. I want to wake up every day and make a difference in my work and at the end of the day  I love what I do...

And, as with most things, this fire waxes and wanes if I am not careful to balance life and take care of myself. I've always been great at spreading myself as thin as possible to fulfill a subconscious desire to do everything. Time has taught me that doing a lot is not nearly as effective as doing a few things well. 

I envision commitment like pizza dough. The thinner I spread it, the easier it is for a hole to break through. Similarly, the more I add on my plate, eventually things fall through the cracks, including my sanity. This overwhelming feeling comes with anxiety and robs me of the joy I innately possess without the stress. 

I preach a lot about self care and resiliency, something I am even more passionate about after two months of not taking care of myself and feeling the burnout this summer. There's nothing worse than seeing something you love to do not give you the same energy it had in the past, but feels like someone robbed you of your passion. I failed to post a blog over the last few weeks simply because I felt overwhelmed, even though writing is something that helps me process and decompress.

So what revives that passion? For me, it's a refocus. It's humbling myself to place my energy in fewer places so as to create a larger impact. It's vacation and taking a break for my mind to be free and refuel. It helps to talk about what I love about what I do and to remind myself why I do it. 

Every time I teach a new group of nursing students I am reminded why I do what I do. I have the pleasure in such a role to teach the art of nursing. I love a student's excitement after a successful IV or foley placement, but what touches me most is the impact of attitude, spirit, and joy that is so moldable in a student. No mater the age, these intelligent, passionate individuals come to clinical to learn how to nurse, most (as I was at the stage) with absolutely no idea what that means. Their excitement and eagerness is either molded and expanded, or squashed and destroyed by nurses who have lost their passion and forgotten why they nurse in the first place. 

I get to discuss what makes a great nurse. What are the qualities a patient hopes their nurse possesses? In speaking these words I myself am  inspired to be better and reminded of why I do what I do. There is always room to grow, and teaching them reminds me to refocus and rediscover what gets me out of bed in the morning.

This inspiration puts a literal spring in my step. (I got caught this week skipping by a doc). It helps me see the person in each patient. It also gives me the passion to work towards a culture of self care so that others don't feel that burn out I felt over the last month. How do we find ways to remember our passion for what we do? Each person is different. What part of what you do makes you get up every morning? Maybe you've forgotten? I've been doing this for three years and catch myself in slumps when I don't take the time to connect back to the beginning. 

What did it mean when I said I wanted to be a nurse? What does it mean now? How do I preserve that fire for my work to fulfill my own passion and in return inspire the lives of those I care for and those whom I work with? 

Today I Will Choose Joy

"Today I will choose joy". 

This is what I told myself driving to work. I was tired and a little apprehensive after a few days off. I needed to kick myself back in to "work" mode as many of us in nursing do after too many days of free time or a vacation. I have struggled with my energy levels for years, 7 to be exact. It is managed with diet but something that creeps up on me every once and a while with stress, lack of sleep, or too much sugar. It is this fatigue fog I was attempting to push through that particular morning which plagued my normal, baseline happy spirit. It's like when you go to work when you're sick and it takes twice as much energy as a normal day to just put a smile on your face. Add that to the beginning of a 12 hour shift and you are in for one heck of a day!

Trying to shake the exhaustion and slight anxiety of these thoughts, in addition to the frustration that naturally couples them, I decided to focus on this pursuit of joy. 

Happiness and joy are different, and I believe that true happiness stems from joy. I can be happy about an outcome, happy that the sun is out and it's summer, and happy when I look at the blessings in my life. But think about it...how many people have you met in your life who you envied as happy? Their social media profile is scattered with incredibly "happy" looking photos and they always have a smile on their face. How many of these people did you find out later actually weren't as happy as they made themselves out to be? Aren't we all guilty of this in one way or another? I know I'm not going to broadcast my bad hair day on Facebook as my profile picture. 

Now think of someone who is not just happy, but joyful. Maybe they possess both, but when I think of joy I think of not an emotion, but a spirit. A spirit that is contagious and celebrates the good in others. A spirit that does not impose, but is open to being present in whatever moment life throws at them. A person who finds beauty and hope in all things around them. This person appears genuinely happy,  but it is rooted in their contagious joy. 

So my goal for the day was to strive for joy. This is a huge aspiration on a daily base, and particularly on a hard day. When a patient frustrated me or I became annoyed with the world, I took a breath and consciously attempted to find joy. 

How can I bring I spirit of joy into the room with me?

It started with a clean slate when I walked in the patient room, a smile, and a heart open and ready to listen. I engaged in the story of my patient sincerely and found ways to make them smile and make them comfortable. When I left the room I had a new energy that carried me to my next patients, as my rooms filled up and things got busy. It was the craziest thing because this new mindset kept me cool. It kept things in perspective, allowed for intentional interactions, and kept me smiling, even when chaos ensued. In each interaction I attempted to find joy, and this joy seemed to fill me twice over. 

I went home that day feeling filled, energized, and could only think "I love my job". Any other day with the patient trajectory this one had would have ended with physical, metal, and emotional exhaustion leading to apprehension towards the next day. 

So now every day I strive for joy. The joy I hope someone can give me if I'm sick, the joy I feel in the most special events off life, and the joy that fills me with love and passion for what I do every day. 

Find joy in your life and strive to show it in whatever you do. You might be surprised to see what it does in your heart and to your perspective. 

"Joy is the proof of the presence of God". (Kathleen Nicholas). 

He is everywhere, you just have to find Him.

The Language of Compassion

 Every time I care for a patient who does not speak fluent English, I wonder what it would be like to be in their shoes. I imagine I would be terrified and struggle feeling out of control in such an unfamiliar environment. Past the initial fear would have to be a surrendering and allowance of a certain amount of trust. I would trust the nurses and doctors had my best intention in mind and I would trust that they were competent practitioners. I would have to trust because at a certain point, what other choice would I have? There is something so special about our nursing profession that people do trust us. It is in the name of being a nurse that people automatically assume (in a good way) that one is compassionate, caring, intuitive, respectful, hard-working, and kind. People expect us to care and be their advocate in their most vulnerable times. They absolutely want us to be competent in what we do, but security in their care rests in the fact that we are nurses, and all that encompasses being a nurse. Thus, nursing named as the most trusted profession.

If you asked someone who has been hospitalized to describe a nurse you would most likely hear things about constant presence at the bedside, an advocate to the provider, someone who took the time to listen, understand, and care, a compassionate individual, an educator, and in charge of the plan of care. While IV skills may be praised as patients hate being pin cushions, nursing is less known as a profession of pill-passing, IV-starting, foley-placing, wound-dressing, and computer charting. Sure, all aspects in our day to day work, but skills that are apart of nursing. I would describe this as the “doing” of nursing, while the former description is the “being” of nursing. If trained, most anyone can do nursing, but not everyone can be a nurse. To integrate compassion into aspects of caring and communication is a special gift nurses possess. Everyone has their own style and pace, but at the bottom of good, patient-centered nursing care is the ability of a patient to feel like someone cares.

I walked in to assess a young patient this week and gave my typical overview of an ER stay trying to give her and her family a realistic picture of ordered tests, plan of care, and time of stay. I turned to write my name on the whiteboard in the room while saying, “My name is Christy, and I will be your nurse while you’re here…” when she stopped me and asked, “Do they make you say that or something?” I stopped and laughed. 

“In a sense, yes. Why do you ask?”

She replied, “Because you’ve told me your name three times”.

I laughed and told her she better not forget it then.

Maybe you don’t frequent the hospital, but the culture of healthcare is shifting with a large emphasis on patient satisfaction. Were you comfortable? Were you cared for? Was care efficient? Did you know who your nurse was? Did he/she round with you frequently? Sometimes these questions feel inappropriate when a patient is angry about wait time because you were doing chest compressions for 45 minutes to keep the patient next door alive, but generally, in taking a step back, it takes some of the anxiety away from a patient when they at least know what is going on and who is taking care of them. Everyone wants to know the plan. Maybe a little on autopilot and maybe a little overkill on the explanation, but I knew that family felt informed and knew who was advocating for them during their stay. This was validated when the patient’s friend poked her head out of the door and flagged me down by name to get some help as oppose to saying “hey nurse”.

It’s the little things. Those little things can bog you down or you can use them as tools in practice to make your patient’s life and ultimately yours a little easier. Sometimes it is hard to see until you are on the other side in the bed or with a family member wondering what the plan is and who cares about what is going on. I hope those little things show you that I care. 

It is in our nature that we all want to feel cared for and want to feel compassion. What does it mean to give compassion? I don’t think I can answer that with an easy answer, but I think it is being present in the little things, chatting through the mundane tasks, getting to know one thing about your patient. Sometimes it is just being present to listen. How do you feel compassion from another? I don’t typically have time to sit and have a long conversation with a patient in the ER, but I have time to look them in the eye and validate their symptoms and concerns, keep them informed, and advocate for their needs.

You may not understand a word of the diagnosis I just explained to you and you zoned out when I explained how long you would be here and additional tests we needed to run. You can’t remember my name and can’t see it on the whiteboard, but you know I’ve been in the room and you recognize that I care. Maybe I can’t speak your language or maybe you are too overwhelmed to understand the education, but, as your nurse, I hope that my words, actions, and body speak the language of compassion.

Keep Calm and Nurse On

In light of nurse's week I was reflecting on being a nurse. I came home last night to my husband and a friend who asked me how my day was, to which I dove into general events that included: multiple critical patients, never ending ambulances, traumas decompensating at the same time, one patient who needed an immediate work up at the same time two conscious sedation procedures needed to be performed, while in another room a specialist yelled about supplies not being ready for the fourth procedure. This was soon followed by a patient in active cardiac arrest, multiple discharges and three ambulances to fill the beds immediately upon patient departure. Seven pm could not come soon enough! 

They looked at me with eyes wide, laughed, and my husband said, "This is why I work with rocks" (He's a geologist). While the events of the day were fast-paced, overwhelming at times, and with very high acuity, I wouldn't have it any other way. I smiled and reveled in the thought that I absolutely love my job. I love that I get to be apart of this chaos and love that I get to partake in the care of the sick and bring a spirit of hope and comfort to those who come through the doors. 

Let's face it, as nurses in the ER we thrive on the adrenaline, the high acuity, and a world of fast thinking and chaos. If an alert is paged out for emergent help in a room, you have not one, but every nurse on staff rushing to jump in and help. It's just who we are.

I recently heard a ted talk about stress and how society's problem is not how much stress we have in our lives, rather how we perceive the stress. The speaker's opinion, based on research, was that if we view stressful times positively, it positively impacts our body as opposed to wearing it down. Signs of stress such as elevated heart rate, maybe some sweating, anxiety, etc. should be seen as preparing us to take on a challenge, not wearing us down and leading to a sense of dread about what lies ahead. 

I think as an ER nurse this is one of the keys to not burning out. I could see what lies ahead of me as completely overwhelming and stressful, or I can perceive this "stress" as a challenge to overcome. What is my priority this moment? How can I delegate? Is anyone going to crash if I am not there in the next five minutes? Who is dying? 

Extreme? Maybe, but this is often an ER nurse's reality. You might be monitoring a post-TPA stroke patient in one room, trauma in another, and sepsis down the hall...in addition to the intoxicated patient who in the meantime decided to pick a fight with their neighbor across the hall and now needs to be restrained. Sometimes you have to take a deep breath, laugh, and acknowledge that it's crazy. Not everything can be done this second, but I mentally prepare myself to take on what lies ahead and get it done one thing at a time. "This is stressful" becomes "This is what I love to do. I love emergency care and I get to work hard and fast to make this happen". Get this mentality in your teammates and an overwhelming day becomes a true team sport. 

Don't get me wrong, some days are hard, and when I'm tired and hangry it's hard to keep life in perspective. But work is most fun when I remember that I love it. I remember that timing is never perfect and neither am I. I am one person, and if I give 100% of what I have, then I can clock out every day, go home, and laugh about a crazy day. Here's to all the nurses out there, but especially my ER nurses who help me keep perspective and still love my job after those draining days. 

Nursing

Is it hard? Yes

Exhausting? Absolutely

Draining? Typically 

Worth it? Every day

Rewarding? No doubt 

Profession? Yes, but I'd call it a vocation because when you love what you do you never work a day in your life.  

Retreating to Redefine

Sometimes you just need to retreat. Retreat from the stress, retreat from the due dates, retreat from the daily grind. My idea of retreating this weekend was a two hour drive up in to the mountains of Estes Park where I helped lead 100+ teenagers on their confirmation retreat. Some might consider this the farthest thing from a relaxing weekend, but I found it nothing but peaceful. 

There is something about being surrounded by the gorgeous Rocky Mountains, tall, green trees, and clear skies that puts my heart at rest. No cell service, no schedule, no time...basically Hakuna Matata. Not only was I surrounded by gorgeous scenery, I was blessed with the company of fellow  adult leaders who brought me nothing but laughter, joy, affirmation, and love. In a 48 hour stent on this mountain I felt no stress, no insecurity, and no doubts. I felt only love.

The first talk given to the teens Friday night asked Who are you? The speaker spoke of her journey through high school and described the activities that, at that time, defined her. She then said something that stuck with me. She described how all these activities became boring over time because there was no meaning behind them. Because she was only defined by what she did, which was never connected with who she was.

I marveled at this and thought back to my high school and college days. Who was I? Yes, I was an athlete, the oldest child, a youth group leader, a good student...these things described me, yet they did not define me. Thus the difficult transition when health issues ended my collegiate athletic career. I had defined myself as the athlete, yet had to nurse my bruised ego as I evaluated who I really was when the court, the cheers, and the adrenaline faded. Sports made up a huge part of my life, but what defined me wasn't my reputation as an athlete. What defined me as a person was (and still is) my competitive spirit, my passion and drive, my desire to love, the joy I find in living, my compassion for others, and my love for my faith. It was recognizing who I really was that allowed me to enter in to the next chapter of my life with a fresh perspective.

Being a nurse describes me, but it is these other characteristics that define me and make me the nurse I am. If I defined myself as a nurse, what would that mean? What would that look like? Without knowing who I am first, I would likely burn out and look for something else after becoming bored over time in a profession backed with no passion. Because I identified who I am, I understand why I chose the profession I did and am able to find consistent purpose and joy in my work.

How do you define yourself? How does that influence your daily work? Let your passion shine through what you do and you will rediscover meaning in your daily life and daily work and you will come to understand and love yourself. 

Processing via Prayer

The past two weeks I have attended two sessions on  how to process and debrief difficult events. One of my processing strategies comes through prayer and learning how to let go of what I cannot control.

There are always those patients you remember and the ones you carry on your heart. For some, these are patients who passed in your care, for others, maybe the patient had a memorable story.  Then there are those who for no apparent reason just touch a special place in your heart. Recently for me my heart has been touched by several youth I have encountered. 

When I started in emergency nursing pediatrics terrified me, so I decided to join the peds team to overcome this fear. After several difficult cases and learning how to work with kids, that fear melted into joy and a better understanding of pediatric care.

There is something special about a child. Their openness to life, resilience, and their ability to see and tell the truth. Their personality shines through their words without fear of judgement for what they say because they only know how to be their genuine selves.

As a nurse I have a place to advocate for all patients, but especially those in the pediatric population who cannot advocate for themselves. Our education to the parents impacts the child and how they are cared for beyond the hospital doors. When treating sick adults with chronic diseases we often wonder:

Where was the fall out? Why didn't this person take care of themselves?  

Maybe from a young age they weren't taught how. It's not usually the kid's fault. Now this isn't to automatically blame the parents,  (I am not a parent and have no place to judge), but it is a realization that has helped me to recognize the importance of educating parents in addition to the kids we see every day. That much is in my control, while many times the situation back home is not. Those are the cases that pull on my heart...

It's the pre-teen boy who has the maturity level of an adult because he is the father role in the house and protects his siblings. He doesn't realize that the things he knows and the responsibility he holds on a daily basis is nothing he should have to do at his age. The genuine care and concern he holds for his siblings and his willingness to talk to the police and CPS reveals the heart of gold this boy holds. I go home and pray for him from time to time knowing he knows no other life but one of responsibilities. He does not get to be a kid, and I pray that one day he is able to have someone love and care for him like he cares for others.

Then there is the beautiful, intelligent young teen who had the courage to call for help after finding mom down and unresponsive. She hovers at the bedside with concern and care, and I wonder if she has  any knowledge that her mother tested positive for amphetamines. This strong, young girl has incredible potential and is mature for her age.  She watches over her younger sibling and carries herself with a humble confidence. My heart breaks for her and I pray that she finds a mentor who can be an example of a strong, driven, and inspiring woman to keep her from losing the potential she has to the same path she watches her mother walk each day. 

Then there was the young man so wrought with mental illness, anger, and sadness that he banged his head against the wall while crying out, "Just let me die, I'd be better off". It breaks my heart that his support system over time vanished and he has lost direction and purpose. My heart hurts for him because he is no longer in control.

There is so much brokenness in our world and as healthcare providers we see our fair share of the hard stuff, abuse, neglect, and brokenness in the streets just beyond the hospital doors. If I held on to every case I would lose my mind. I focus on how I can advocate and serve those patients in the time I have. I educate parents, I call CPS, and I offer compassion and kindness. At the end of the day I say a prayer and offer up those cases, because they are no longer in my hands. Some stick in my head, and when I acknowledge them I pray for each of these people and place them in Gods hands, praying they encounter special circumstances to overcome the odds life handed to them. 

I pray they find a way to move past survival and learn to thrive.

Privileged

I am privileged in many ways. I have a roof over my head,  a wonderful husband, a career I love, amazing family and friends...I really couldn't ask for more. These are things I try hard not to take for granted as it is so easy to do so. Last week I had the honor of reconnecting with a person I helped resuscitate at the gym in 2015 (see Dec. 2015 blog "How Faith Saved a Life").  We were asked to speak together at an educational event focused on cardiac arrest. The outline for my talk asked to share my story and to also address the following:

1. Why did you become a nurse?

2. How does nursing define you?

3. How does this story relate to your passion about nursing?

I gained a lot by taking a step back to ask myself these questions. Too often I fall in to the motions of life and forget that what I do for a living is something I love. I love people. Why did I become a nurse? ...that is another story for a future week...but, in short,  I was looking for a profession of service. I wanted my work to be meaningful to someone else. I wanted to leave my job every day knowing I made a difference in someone's life. My education path turned into nursing which has since revealed itself to me as a profession of caring in addition to teaching.

2. How does nursing define you? I don't think nursing defines me, rather who I am defines my practice. How I choose to interact with people impacts their experience. I strive to see the good in each person and treat them as if they were my family because I have a responsibility to provide the best care. I want to make a difference, I want to make someone comfortable and feel better, and I want to be a light on those dark days. Quite often there is a lot of darkness when someone is in the ER. It is not the place people plan to be when they wake up in the morning.

3. How does this story relate to your passion about nursing? My passion is for people. As I wrote my talk I realized that what I have is a gift. The knowledge, skills, and brain power necessary to practice as a nurse are gifts. But even more than being a gift, it is an absolute privilege. It is a privilege to have someone put their trust and confidence in me to care for their loved one. It is a privilege to have the skills to resuscitate or stabilize a patient. It is a privilege to be the hands and feet of Christ in my daily work. Yes, I am trained to resuscitate people and help bring them back to life. It's what I get to do on a daily basis, but it's not something that everyone is capable of doing or has the training to do. To not use my skills and to not practice to my full potential would be a rejection of the gifts I have. I have to remember that I don't "have" to go to work, but I am fortunate and have the privilege of serving my community.

Try viewing what you do as a calling and see how it changes your perspective.

I am privileged and honored to be in the profession I am. Thank you for letting me care for you.

How am I Supposed to Feel?

Our Father, who art in heaven, hallowed by Thy name. Thy kingdom come, Thy will be done, on earth as it is in heaven. Give us this day our daily bread...

This was the prayer my coworker whispered into my ear as she embraced me in my tears. I thought I had it together. I thought it didn't bother me. I thought I could just swallow it and move on. As I exited the room after time of death was called, all I could hear was the loud sobs of the family members present. I thought that patient wasn't supposed to die...the tears began to fall and I was overcome by the emotion I thought for sure I wasn't burying deep inside. 

I felt emotionally numb. There was nothing more than could have been done, yet I wanted nothing more than to see that patient breathe or cry out. The team was excellent, the interventions on point, and yet we still couldn't change the outcome. We still couldn't mend the grief of the family. What more can you do than be present, and ask if they need anything, or say, I'm so sorry...? 

After some chocolate, a long run and bike ride, venting to my best friend, and some writing, I developed some perspective on the event. I know some days will hurt and I know my job is emotionally, physically, and spiritually challenging. I know there are days when I'll feel like I want to cry and days I can't save people. There will be days I fail, and days I exceed expectations. Every day is different. I wake up and come to work every day because I have the privilege to be the hands and feet of Christ and touch people in a way many cannot. I have the ability to help save someone's life. I have the ability to educate those in the community about how to care for themselves. I have the ability to intervene, assess, and make a difference. 

In the ER we fight over the big cases, we live for the traumas and the high acuity patients, and we rejoice when we help them pull through and stabilize to continue their care as an inpatient...and then we are struck hard by the ones that don't make it. Those cases we try not to think about because they hit home and rock us to the core. Those cases humble us, are difficult to process, and leave us asking how am I supposed to feel? I have come to the conclusion that no matter what I do feel, it is important to feel it. Am I allowed to smile and move on? It is disrespectful to not mourn the loss I just witnessed? 

The charge nurse commended the teamwork and commented on how lucky the family was to have me as their nurse. I shook my head thinking, I don't know how to help them. I feel like I didn't do much for them. She smiled back reassuringly and said but they know that you did your very best and their family member had the absolute best care.

I honor that patient by feeling whatever feelings are aroused within me. I honor that patient by leaving everything I have in that room and knowing I gave my whole heart and soul. I honor that patient by saying a prayer for them and their family and processing the event the night after it happened. I honor that patient by putting my scrubs back on the next day, showing up with a smile, and once again giving 100% to every patient that walks through my ER doors. 

To my patient, 

I pray for you and I pray for those you left behind. I pray for all involved in your care and I pray your presence lives on in my heart as a reminder to always give my best. In your honor I will hold my head high, smile, and I will remember you. I pray that God is holding you tight tonight in a place better than the imagination can fathom. Thank you for letting me care for you today.