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.