Then and Now...

I grew up in a small town in Maine.  My mother was a stay at home mom…my father worked full time and many times, over time, in the local paper mill.  We were not poor but we were not rich.  My brother and I had all the material things that were necessary and a few fun things for birthdays or Christmas.  We did not eat out in restaurants, my mother cooked all of our meals, and if we were sick we stayed home from school and my mother took care of us.  There wasn’t anything that bag balm, duct tape and Vicks couldn’t fix!! 

Thinking back on several childhood illnesses, what I remember, is laying on the couch in my pj’s, comforter and pillow situated so I could see the TV and the famous orange bowl (puke bowl) on the floor by the couch.  I would sleep, puke, run to the bathroom, sip flat cola and nibble on toast until feeling better.  If we had a fever my mother would give us Tylenol and Vicks hot packs.  Sometimes our illness lasted several days and we would remain on that couch until the symptoms passed. I say all of that because it is very troubling for me to see a culture today that is unable to think through how to care for the typical illnesses that run through our communities.

Our healthcare system is out of control with its spending, as is our government with its spending.  I hear from nurses all over the country (ENA) who are concerned for this very thing as well. The abuse of the healthcare system is a hot button topic (one that every ER nurse in the country to go on for hours about!) The ER’s are overcrowded and in that mix is the person who has had a sore throat for 1 day, a child who has been nauseous for 2 hours, a child with a fever for 4 hours and has not had any Tylenol…People do not either know how to care for these basic illnesses or are unwilling to or don’t have the ability to be the stay at home mom with the time to do so.  Quick fixes are what people want. 

As a nurse I am saddened that my role as educator has been removed!  The patient is the consumer now and they do not want to be taught anything…they want us to fix it…give them a magic pill and send them home.  I am sad that we in healthcare have stopped being the patient advocate and the patient has stopped wanting that …teaching them how to help themselves…teaching them how to use natural cures for simple health issues…teaching them that by losing weight and eating healthy foods to help with inflammation that is causing so many of their health crisis…encouraging them to stop smoking, and on and on it goes. 

The patient of this day gets down right angry if the healthcare team tries to encourage healthy behaviors for better health.  Our healthcare employers are concerned about customer satisfaction and thus discourage making the patient uncomfortable in any way…so NO patient education for healthy living, it tends to offend. 

We are not helping our patients by giving into their every demand (like they know more than the doctor what will help their problems), or by handing out prescription pain medication by the handfuls for every possible ailment.  Sadly, as I listen to nurses in every possible nursing field, we are not helping our communities by dumbing down our health care system…by NOT educating our patients with practical and alternative therapies to promote better health.    

Times they have changed, and not for the better in healthcare.  I wonder…if our economy continues to do a nosedive, will healthcare be forced to go back to times of old? 

A little prayer goes a long way!

Driving into work this morning I was admiring the last of the leaves remaining on the trees, realizing that the storm that was headed our way would most likely end the leaf peeping season. My high beams caught shining orange, yellow and red leafs that lined the road way and dangled loosely from outstretched branches.   I thanked God for the beauty that I was able to see on my way to and from work every day…every season.  Right now my commute begins in the dark and ends in the dark!  The amazing part is right now my commute takes me 30 min and at this time of year I get to see the glorious pink and orange sunrise as it peeks up over the trees and water…it is amazing!!  I thanked God numerous times for the beauty that he allowed me to see this morning~ and I felt such a peace and comfort knowing that he heard me!

I do not want to climb on a religious soap box here but I do want to talk about the power of prayer and the effect it has on our patients.  As a Christian I know first -hand the power of prayer in my own life.  I have prayed for miracles and seen them done.  I have prayed for peace and it was delivered.  I have prayed for wisdom, knowledge and guidance and seen the answers. I could go on and on about how prayer has blessed my life.  God uses prayer as a communication tool to him.  We can use prayer as a tool in our arsenal of patient care.

In my nursing research class last semester I did a paper on the healing aspects of prayer in patient care.  The research was qualitative in nature of course but there was also some very quantitative findings as well.  There were several studies that I looked at 1. The patient being prayed for by another, either out loud or silently and 2. the patient doing the praying.  Patient’s vital signs, visual signs of stress/pain were noted and a pre and post prayer session pain scale was used to monitor the effects.

The findings were that if the patients believed in prayer it didn’t matter if they were praying or if another person was praying for them, they felt less anxious, had less pain and vitals decreased….both during and after the prayer. If the person didn’t believe in the power of prayer but accepted the prayers of another there vitals showed a decrease and they also stated less pain but not less anxiety.

Doctors and nurses alike who took part in these studies were profoundly effected as they realized the spiritual nature of each patient and that there are times when prayer works better than the pain meds we so readily push!

I bring this up to just get you thinking…what tools are at your disposal for better patient care. You may not want to pray with someone yourself but you can always ask if they want it and find a clergy or another nurse who would be willing.  I pray for my patients as I care for them all the time, usually in my head as I’m doing my tasks but I have had the amazing privilege of praying for them physically as well.

Prayer is free, it doesn’t take a lot of time, it gets you to focus on the need of your patient in a way that you might not otherwise see, it benefits you just as much as it benefits your patient, the patient feels cared for and cared about as a whole person BODY MIND and SPIRIT… isn’t that what we all want?

Trip down memory lane

I had the awesome privilege of being able to speak to an Associate RN class on my experience with nursing, burn out, self- care and Reiki the other day.  As I stood in front of the class and reflected on my 21 years of experience it struck me how easy it had been to just go along with the motions of every- day life and let the memories fade away. 

As I drove home from that day I thought back to nursing school~  I made a couple of really long lasting friendships from those long study days…shout out to Robin and Kim!!  I also still have close contact with 2 amazing instructors who touched my life in many ways…shout out to Terry and Lynn… I recalled the excitement of imagining being a “real nurse” and the fear of not knowing all I needed to know. In fact I was sooooo green that on my first day of clinical I walked into a male patients room and the side rails of his bed were up, and his urinal was hanging off the side rail….now I was green…very green…. I picked up the urinal and asked him if he would like me to fill his water jug!!  Yup..I thought the urinal was a water jug~~~ for real…  that man laughed so hard and I didn’t know why…after his hysterical laughter he says, “oh my you really are a brand new student nurse aren’t you…honey, I piss in this jug!”  lol.  I have learned a lot since then!!  lol

 I remember the pride of the pinning ceremony and of graduation…wearing my professional nurse uniform (white dress with white hose and white shoes and yes a white cap) to my first day of work J.  I have very fond memories of my nursing preceptor Laverne~ who treated me so kindly and taught me so much about being a professional, caring nurse. 

I have had the privilege of working in many different settings and with many different patient populations,  medsurg, post op ortho, homecare/hospice, emergency room….I can say the ER is my favorite as it gives you the variety of cases that are different every day and the rush of a trauma or an MI…being able to intervene and really save someone’s life is amazing!! 

What I shared with that class the other day again cemented for me that patient care is not just about all the technical things we know how to do and love to do….it’s about touching someone’s life in a positive way…I often times forget that and that is when burnout hits me the hardest…The patient does not give 2 hoots that you can read their EKG and intervene, or that you can start their IV, draw their blood, hang their medications, dress their wounds or collect evidence from every orifice known to man!!!  They only care that you, the nurse, gives 2 hoots that they are there…that your eyes and face convey to them that you are listening to them, caring that they are in pain, offer them a warm blanket and a hand to hold…now I’m not saying our nursing skills are not important, because we all know if we do not perform those skills well the patient will notice!  But we could mess up every skill we have and if we have sat with that patient for 10 min, held their hand or given them a warm blanket and a warm smile…they think we are the best nurse on the planet!!  I don’t know about you but my thank you cards from patients NEVER mention my awesome skills…but they always mention the warm blanket and the caring smile. 

Here’s to remembering your early years as a student…a new nurse…and why you love nursing…take some time to think back to those early days…it’s a fun recall J

Apparently I always wanted to be a nurse

     So I got home from work last night and on my counter was a book "all about me" that my mother had sent in the mail~  it was one of those kindergarden through 12th grade books...including pictures! and comments about friends and aspirations, grades and boyfriends... you know the kind...
      My husband was dying to flip through it with me (he already had looked at it!!) and laugh at my ongoing short bobbed hair cut that had a few layering variations...and comment on the outfits I chose to wear for the first day back to school...I had to laugh as well as we looked at them~~~I always thought I looked so cute! 
I will never make fun of the photo's of him wearing his orange tough skins again!!  (ok so I probably will :) )
       I enjoyed looking at the book and remembering some old times, and some outfits I really thought were awesome!!  but what I noticed most was the running theme of, what do you want to be when you grow up, my career choice~  Since Kindergarden I either wanted to be a nurse or a teacher...one year I said  I wanted to work with children...how, Im not sure...But nurse won out with the most votes of 7. 
       At this stage in my life I want to be an educated nurse!..hahhhahaha..
       Looking back at the school girl book has been a gift in a few ways...one, it brings me back to some very fun times in my life...two, it shows me NEVER to wear my hair that short again...three, it has given me a kick in the pants to get exercising again ...as my weight has dramatically increased since graduation!!  four, it has given me the gift of showing me that I have always wanted to be a nurse...and that being burnt out in the every day grind is different than being burnt out with nursing. 
       The gift of being a nurse is so multi layered ...besides the patient care aspect of touching people's lives physically and emotionally, we get the gift of having a profession that takes us anywhere we want to go...the ER, the OR, ICU, NICU, Med-Surg, School nursing, Clinic nursing, home health, hospice, Nurse Educator, Flight nurse, Interventional Radiology, Psych nursing, travel nursing, Clinical nurse specialist in many fields, NP....and on and on it goes~ 
        Where are you in nursing now??? Where do you want to go????
        

Just venting a frustration today

Soooo how long is it humane to keep a human being in a behavioral health room that is 10x10, with no windows and no fresh air????

 Let me set the stage for you… Our Hospital is a small rural, critical care access site and our ER is a 22 bed~ highly functioning machine that can take care of every person and every diagnosis that walks through our doors, (or comes in via ambulance.)  except for the psych patient that has real psych interventions…. Now, I don’t mean that our ER cannot take care of that person…by keeping them safe, giving them shelter, meals, a hot shower, meds and interaction….what I mean is the “system” cannot take care of them.  This person comes to us for help…they are suicidal or psychotic…or manic…whatever the situation, we get them to a place that they are unable to harm themselves or others…they are watched and cared for as we and our “crisis” team search for a hospital bed in a psych facility that can properly house and treat them accordingly.  It sounds like this should be so easy…so cut and dry.  It is not.  This system, our mental health system, is broken!! 

We have had many behavioral / psych patients that have been “housed” in our ER for up to a week at a time as we have worked daily, for many hours, searching for a hospital bed that could meet their needs. There are only 4 hospitals in our state that take these types of patients and it seems they are always full…or they cannot take our patient because “they are too high risk for the rest of our patient population”   What this means is…the patient can stay in the ER where they get their physical needs met (except sunshine and fresh air because we cannot risk elopement) BUT not their mental health needs!!  Most ER's, including ours, does not have a psychiatrist or mental health trained nurses to tend to the needs of this population. We try to follow their med regimes but typically they need med adjustments and therapy...both of which ER docs are not trained to do.  The ER docs, nurses and mental health patient end up being frustrated as we search for the trained professionals in mental health hospitals that have the ability to properly care for these patients AND are willing to accept them.

 Now call me stupid but I cannot understand why the psych hospitals can reject a patient when they have open beds because the patient does not meet their criteria….BUT we take every patient that walks through our doors…NO matter if we are down staff, if our patient population is at full capacity or if this new patient doesn’t fit well with others…. These patients can stay in our ER for days…a week…like a caged animal...or a prisoner…waiting for the care they need!!  It is very frustrating as a provider… and I cannot even imagine what it is like to be that patient.

I wish there was an easy solution to this problem… it is a huge problem…seems so overwhelming…

The one thing for us all to keep in mind is that this patient is a human being.  They need care and concern, a healing touch and an open mind. I admit that this patient population isn’t the one that usually gets my mothering juices flowing but yesterday I had a moment with just such a patient that made me remember just how human they are…. Something that we all could use a reminder in.

I went into the behavioral health area to answer this patient’s call bell and the patient told me her back hurt and that she wanted an ice bag.  I filled an ice bag and went back to her… she was crying and lying on her bed.  I placed the ice bag onto her low back and asked her if I could help her in any other way (I feel so useless in this area when I have no mental health training…and I just don’t want to say the wrong thing!) She asked me to rub her back.  I did.  She began to sob…and said, “that feels so good… no one has touched me or rubbed my back in so long.”   This touched my heart so deeply.  As I rubbed her back and listened to her cry I was so thankful that I could fill this one need for her and maybe help calm her. 

Sadly this patient is still with us…in our small area…with no windows and no fresh air because none of the mental health facilities in our state can “take her level of care.”