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.