christmas cray

...because it's not christmas until we're wrestling with a hallucinating amputee who's trying to run from the guy who's trying to kill him in his room.

restraints and haldol to all and to all a good night.

these are a few of my favorite things

lately i've been trying to find joy and satisfaction in whatever i can at work.  typically this comes in the form of things patient say and gross medical procedures.  so without further ado...

• patient diagnosis overheard in report "got shanked at the library".  dangerous places, those libraries

• awesome coworker's patient was vomiting non-stop and needed an NG.  i was her second set of hands and watched her put in a beautiful NG that pulled 2,125 ccs of bile out of the patient's stomach.  picture a 2 liter bottle of soda...yeah, that much.  it was a magical experience.  

•  new terminology: "chronic GSW".  you know, for when we take care of you after you get shot on more than one occasion.  you'd be surprised by how many repeat customers we get...they are the ones that i like to target with my "make good choices" speeches.  

• the patient satisfaction surveys... full of gems such as "you don't have MSNBC on the tv" and "the vending machine took my money".  my personal favorite were the responses from two different patients, one of which said "don't bring me water unless i ask for it" and the other "i shouldn't have to ask for water to be brought to me".  yes, these are the things that our patient scores depend on.  

• our developmentally delayed pt who wanted to go "take a tour" of some newly constructed rooms so he could request one for his next surgery, all while decked out in christmas gear with stuffed elves hanging from his IV pole.  cute.  

• we have had such good residents lately!!  attentive, smart, wanting to collaborate...a holiday miracle, for sure.  

• my wonderful coworkers.  they get me, and they remind me who i really am and the kind of nurse i want to be.  

the last few months have been hard for me, that's for sure.  but i DO have things that i love about my job and i DO have so much to be thankful for. 

on criticism

i had a painful meeting this week with management on the topic of "expectations and opportunities".  this is apparently a euphemism for 'everything that is wrong with you'.  it did not go well.

they were quick to tell me that i'm a great nurse and that i provide excellent patient care.  which, if i'm not mistaken, is my job.  take care of patients.  be nice to them.  work well with others.  follow policies.

did someone forget to tell me the part where i agreed to think only happy thoughts all day despite bleak morale, impossible expectations, and understaffing?  or the part where i said i would be only rainbows and smiles 24/7, on all the time with no trace of frustration or feeling overwhelmed?

THAT IS NOT MY JOB.

i have apparently become some sort of "leader on the floor", which is another management euphemism for "fall in line before others mutiny".  keep in mind this is not something i asked for, nor something i have been payed for.  no, this honor has been give to me because i'm one of the only people who has been able to survive 5.5 years on the floor, through 5 different managers, 3 directors, countless threats of physical violence, verbal abuse by patient and doctors, unsafe staffing/patient assignments, and little to no credit or thanks most of the time.

so you're probably wondering what i did that's so awful, right?  did i have a screaming fit at the nurse's station?  did i rant to a patient?  did i tell off my manager?

no.

i said that staffing was "not ideal" (which it wasn't).  and i said it to my coworkers (who are my friends and should get to know why their assignments suck).  while making up the day's assignments (which i am not payed extra to do).  which i actually have to do before i punch in for the shift, so i am doing them on my own time for free.

i for one thought that i was being pretty tactful, given what i would have liked to say, but i guess i should be ashamed of myself.

so anyways, something silly like daring to voice an unapproved thought led to almost an hour meeting about how i am in charge of my shift's morale.  i must be positive.  i must not say negative things about staffing to my coworkers.  if i must say these things, i should find my manager, go to her office and close the door (this was emphasized) and then i am allowed to speak with "candor".  otherwise, i must take time to "collect myself" before returning to work...apparently with a 100 watt smile and my pom poms, cheering the team on.

as i have previously mentioned, i'm at the end of my rope with this job.  i'm giving everything i have left to my patients, which doesn't leave a whole lot of energy to be fake around my coworkers.  i'm tired, and i'm sure it shows.  but i am TRYING.  and i don't understand why i'm being held to a different standard than anyone else.  i don't want more responsibility, or more pressure.  i basically want to be anonymous and to be left alone.

so to recap: i'm expected to take on additional responsibilities like being the charge nurse, precepting, and being a resource, which can be inconvenient, annoying, and stressful.  and this somehow makes me a "leader".  but instead of getting more of a say on the unit, or getting the right to voice an opinion and bring about change, i'm being stifled.

so which is it, management?  do you want me to lead or not?  do you want me to advocate for my people, to be their voice?  or do you just want me to do all the work, toe the party line, and shut up?

i think the answer is obvious.

at the end of the day, i need to answer to myself.  can i be proud of myself?  did i stand up for what i believe?  am i saying things that need to be said, or just whining?  there's a fine line between advocating for myself and my coworkers and being divisive.  but there's also a fine line between being a "leader" and being a drone.   

 

nursing in an urban war zone.

as i walked into work yesterday i noticed a police car heading pretty fast towards my side of the hospital.  then another as i got closer.  and another.  and another.  by the time i walked into the building, there was a gathering of dozens of squads outside.  there were employees huddled in the doorway murmuring something about bomb threats, and i got the general sense that i did not want to be walking in to whatever this was.  but as with most things, when normal people are running away, nurses are going in.  so i went about my day, only to get on the unit and learn of a man with a gun in a neighboring building.  and it felt a lot like this day.  the news was rabid outside the window of the unit, and on tv they were airing whatever "tips" that random people were calling in from inside the building, almost all of which weren't true.  the police ran crime scene tape around the trees outside our charting room window, and we watched from the inside as people gathered for a press conference.

it made me angry.

you shouldn't have to feel unsafe at work.  you shouldn't have to wonder if an angry family member with a gun is coming for you.  you shouldn't have to feel obligated to put your own personal safety at risk like some sort of martyr's sacrifice to take care of other people.  i signed up to be a nurse.  in the midwest, not some sort of combat zone.  and yet in the past 6 years i have watched the police push up ceiling tiles in a patient's room on the hunt for a weapon.  i've been handed a grainy picture of an attempted murderer who tried to kill one of my patients and have been told to "be on the lookout".  a little over a year ago i hid in a room with a patient, listening to news broadcasts saying there was a mass shooter with a gun in the hospital cafeteria, and waiting for him to come up to my unit looking to finish the job.  i've had veteran trauma nurses tell me the story of when US marshals came to arrest a patient's most-wanted family member with guns drawn and made all the nurses lay down on the nurse's station floor.

these are the things that are happening, and these things are not ok.  i NEVER thought that i would have to deal with anything like this when i became a nurse, and i still don't think that i should have to.  i care about my patients, and i want to keep them safe.  but at what cost?  and am i obligated to put myself in harm's way to protect people i barely know?

the man with a gun was shot by police.  then he ended up in the trauma bay, and we all were afraid that he would get admitted to the floor and we'd be forced to take care of this man who no one could muster up much compassion for.  but he didn't, and then it was done.  the news went away, and the helicopter stopped hovering overhead.  the crime scene tape came down and the squad cars left one by one.  and we were just supposed to go on with our day, like it didn't matter that we had another example of just how easy it is to waltz into a hospital with a gun down your pants.

it matters.  and it is NOT OK.  

fatigue & compassion

there is a thing called compassion fatigue, and that basically means that you are tired of caring for other people.

yes.  that.  

i am exhausted.  i have nothing left to give.  i sat down after my shift today not having charted anything.  ANYTHING AT ALL.  i felt like i gave my patients everything that i had to offer, and didn't even come close to meeting their needs.  

my brain injured patient has an ever-growing left arm that no one will address.  he won't eat and hasn't gotten out of bed.  he barely gets turned because he's a huge guy and just doesn't roll.  he sleeps all day, except for when he's screaming out in pain.  and i know he's brain injured, but it still makes me feel like a horrible person when he's yelling at me all the time that i don't understand his pain.  

my admit has a room full of nurses and is herself "medical".  she looked at me with accusatory eyes from the first moment i stepped foot in her room and right away i felt the need to prove my competence and live up to unrealistic expectations.  when she said "that medicine isn't doing anything for my pain", it was obvious that she meant that it was ME who wasn't doing anything for her pain.  and despite my ice packs and moving pillows all about and switching around pain meds and adding muscle relaxers and splinting her fracture, the pain got no better and i achieved nothing.

my sweet GSW to the chest has a necrotic liver, and just feels like crap all the time.  there is basically nothing that i can do for her, and that feels like failing too.

so i sat down at a computer to do 10 hours worth of charting, and started to cry.  the exhausted, frustrated, i'm crying about one thing but it has become everything kind of tears that don't stop.  and as i sat charting and sobbing and blowing my nose and creating a mountain of used kleenex next to me, the door to the charting room opened and one of the oral surgeons walked in.  and he sat with me and awesome coworker for almost an hour as i continued to cry and chart and try to cover my feelings with cheese bread and vent all my nursing guilt and inadequacies.  he told me that it's ok to care, and that i am making a difference, and that i'm not a failure.

a surgeon.  who has feelings.  who is not scared by my ugly crying, but as i found out later heard that i was having a rough day and sought me out just to talk.  there are no words for that.

when you live the kind life where you pour everything you have into other people and typically go home having been given nothing in return, receiving compassion and kindness for yourself is a shocking and wonderful thing.

my coworkers know and love me, and they are incredibly supportive.  we take care of each other, and they are the only things keeping me at this incredibly challenging and frustrating job.  but this doctor doesn't know me particularly well, and he doesn't owe me anything.  yet for some reason he took it upon himself to offer me support and reassurance when i needed it.

and because of that, i have lived to nurse another day.

enough.

i've never been very good at accepting less than perfect.  five years of nursing has taught me that there is a limit to how much i can give, that sometimes doing 'the best i can' is all i've got.  but lately that hasn't been enough.  you'd think that i'd get used to being so frustrated, seeing as how i've spent the better part of my career feeling that way.  unfortunately not.

this week, which sadly has only been 3 days, has made me realize a lot of things.  i'm not happy in my job at all anymore.  the compassion that used to come so naturally to me just doesn't anymore.  i've started to view almost everyone that i come in contact with as an inconvenience to me and an obstacle to me making it through one more day at this miserable job.  i don't remember the last time i loved my work or the last time i thought something at work was fun or exciting or interesting, in fact i'm so unhappy that i can't even remember what made me want to do this in the first place.  i've lost all joy and wonder; the reality of nursing and working on a toxic, thankless floor has killed that for me.

because the truth is, nothing i do is enough.

i work in a place where all we hear is "good job with that, BUT...".  management nags us constantly.  now i realize that this is their job, but it's excessive.  we can't just be piloting one new project that no one wants to participate in, it has to be three.  there isn't one new required form of duplicate charting, there's two.  it doesn't matter if patient acuities are through the roof and nurses with 10 years of experience are literally crying, half the floor WILL go to a mandatory meeting to discuss what we can do to make the floor better...oh the irony.

but it's more that that, really.  it's the feeling that my patients deserve more than what i can offer them, not because i'm incapable but because i'm so stressed and spread so thin.  it's the feeling that i've never had to work so hard to be such a failure in all my life.  i'm tired of sucking at my job all the time.  i'm tired of trying my very hardest to barely keep up, and to fall short of the 'expectations' that i'm being held to.

every ounce of care that i used to have for this job and this floor has been sucked out of me.  i have become the 'things will never change' nurse, and i'm sure it shows.  you can only give more than you have to other people with nothing in return for so long.  after that you apparently become bitter and washed up and sad and old.  well who knew?

i feel like a caged animal.  i am desperate to escape, and i'm willing to claw anything that keeps me from my goal of making it through another day.

i used to be kind and now i'm calloused.  i used to be optimistic and now i'm a downer.  i don't have compassion and i don't have patience and i probably have no business working with people at all when i feel this way, but i have bills to pay and no other choice.  i've begun to desperately search for another job.  i've sent applications, i've emailed managers.  at this point i will do ANYTHING to escape...leave my friends, work nights, lose my seniority...ANYTHING.

i  can't work like this anymore.  i can't live like this anymore.  i've just had enough.

favorite things.

fav new RN on working with the 'laid back' nurse: "my back is killing me...from carrying the team"

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new work motto:

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awesome coworker on the elevator music we're forced to listen to: "seriously, this music sucks"
me: "um, that's your patient's chair check"
(awesome coworker sprints off)

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two new forms, new IV pumps, and mandatory triple charting on patient med teaching this week.  as favorite float pool nurse says "they should just tell me when to show up to get the chip put in my head".

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brain injured patient to my fab pregnant nursing assistant: "you know what you gonna name that little gangsta boy?"

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and this:

"i tried carrying the weight of the world, but i only had two hands".  yes, that exactly.