PixelRN

May 1

Why I Stopped Blogging

I recently read this on the AJN blog regarding old blogs that don’t get updated anymore and it really made me chuckle:

“. . . maybe blogs should go to a blog graveyard at some point, or be given a proper burial, or demolished like old buildings in a great controlled cinematic whoosh of collapsing pixels and pixel-dust.”

And of course I thought of this nursing blog. It’s a good a point. So many blogs out there, frozen in time. It would be nice if there was a way for all of this content to degrade gracefully.

So why did I stop?

On one level it’s because I stopped being a nurse. The reason I started this blog was to tell some stories about what it was like to be a nurse, and to process some of the frustration and anxiety of the first year in nursing. As I became more comfortable in my role, the blog evolved into more of a nurse’s perspective on health care, rather than just storytelling. Then I took a hiatus from nursing and this blog kind of stalled.

Life got difficult.

I had a child. Then two more. Possible flirtations with postpartum depression. And then my brother’s suicide, which basically sent me reeling. As I gradually began to piece my life back together, it occurred to me that it had been more than three years since I’d even worked a nursing shift. I’ve been ambivalent about a return to nursing. I wish I had made more progress in my career before I started having children. But when you start a nursing career in your mid-thirties and haven’t started a family yet, let’s just say that time is not on your side.

I haven’t exactly missed bedside nursing. On the contrary, I often have anxiety dreams that I’m back in the ICU and am clueless. I have aspirations of doing something else. Something I’m better suited for. But I’ve missed the community of nurses that exist online. I’ve gone in and out of following people, reading their blogs. This was mostly out of frustration that my own nursing career had stalled, and so I didn’t feel like reading about other nurses.

So that’s all. Just wanted to stick my head out there and announce that PixelRN isn’t ready to collapse in a whoosh of pixel dust. Not yet anyway. And I’ve been feverishly working on a new project, a nurse blog aggregator (sneak preview!) that I hope will revive some interest in nurse blogging. More on that, soon!

Oct 3

Nurse Ratched: Movie Villian

“Nurse Ratched is ranked fifth among the greatest movie villains of all-time by the American Film Institute, behind Dr. Hannibal Lecter, Norman Bates, Darth Vader and the Wicked Witch of the West.”

via Nurse Ratched returns to Salem | Statesman Journal | statesmanjournal.com.

Sep 13

Nurses and Creativity

Are nurses creative? Of course it varies from nurse to nurse. Perhaps the better question is: Do nurses get to use creativity on the job? When I was a new nurse I didn’t think so. As a creative type, and a sometimes artist, I was happy to have finally settled on a career that had nothing to do with art. Now I was free to work on my artistic pursuits, apart from any worries about making money from them.

When I was a new nurse, I thought you couldn’t find a less creative job. At times I felt like a robot – churning out tasks, adhering to schedules, following orders. Where was there room for creativity? But the more I practiced nursing, the more I realized that of course nurses use creativity. Give a nurse a towel and some surgical tape and she becomes a sculptor. Give a nurse a tiny scrap of paper and an encyclopedic amount of data to write on it and he will become a graphic designer.

Give a nurse a patient care problem and they will solve it. There are numerous products invented by nurses like the bili bonnet and the Wee Thumbie. Both products were invented by NICU nurses to solve particular problems that they came across in their practice.

Opportunities for creative problem solving are everywhere in patient care. How to get a chemo patient to eat. How to help one sleep in a noisy ICU. How to teach them how to do wound care when they leave. How to teach a newly diagnosed diabetic what to eat. These things take creative problem solving skills to a new level. And nurses do it on the fly.

Do you get to use creativity in your job as a nurse?

For more thoughts on creativity in nursing, I recommend following Creative RN on twitter.

Aug 7

Can a Nurse be Introverted?

I recently read the book “Quiet” by Susan Cain. If you haven’t read the book but are interested in the whole introversion vs. extroversion personality type, I highly recommend it. I’m an introvert and I wish I could have read it 20 years ago, if only to make me feel more comfortable inside my introverted skin.

The book dispels the myth that introverts are these shy, meek people. Rather, they are simply people that thrive in situations that are quiet, solitary, and interruption free. On the other hand, extroverts tend to thrive in group settings, and are adept at handling the many types of interruptions and stimulation that are thrust upon them.

Interruptions? Group settings? Sounds like an extrovert would thrive at nursing. So where does that leave us introverts?

I came across this interesting thread on the topic. I found it interesting because although it predated the Cain book, a few of the nurses were very aware that introversion does not mean shyness, or a lack of confidence; rather it involves levels of social stimulation. Some suggested that ICU, OR, or even school nursing would be tolerable for introverts.

But all of these suggestions don’t take into account that just about any nurse job involves being around people most of the time, and constantly fielding interruptions. Both factors that make an introvert want to pull her hair out.

My advice to the nurse introvert? Go eat lunch by yourself. Find a quite corner somewhere. The chapel, perhaps. Or go outside if the weather permits. An hour of solitude can go along way in re-energizing you for the rest of the shift. But be prepared. Nurses tend to be act in a tribal way, so you may find yourself gingerly explaining that you want to be alone, and you don’t mean to be antisocial.

Also consider the night shift. I used to dread bouncing back and forth from AM to PM shifts, but sometimes the night shifts could be really quite peaceful, without all the interruptions that occur during the day.

In a perfect world we could all find careers that suit our every personality need. In this imperfect world, I believe an introverted nurse can be a happy nurse if he just takes the time to respect his introversion and give it the occasional solitude that it requires.

May 8

Nurses: Do you have an exit strategy?

A slightly disturbing thing that I noticed this summer was the amount of nurses who have an exit strategy for leaving the bedside. It seemed like the majority of nurses I worked with were planning their exodus from bedside nursing in the form of CRNA school, NP school, or perhaps even just getting a MSN in order to obtain a more administrative role.

It certainly doesn’t leave one with much hope for the profession. I wonder if other professions experience this phenomenom (i.e. how is the best way to put in my 2 years of drudgery and then advance?)

On the other hand, one thing I noticed was the advantages of raising a family when one parent is a nurse, because there is such a variety of shifts you can work. Here are some examples – these are all people I know:

A nurse who does home health care during the day so she can be home when her kids come home from school.

A nurse who works 4 weekend ICU shifts a month and spends the rest of her time staying home with her young children.

A nurse manager who works M-F, 9-5 and has her kids in day care.

A male nurse who works nights and weekends so his wife (also a nurse) can stay home with the kids

A female nurse who works agency so her husband can stay home with the kids

A nurse who mostly stays at home with her child but picks up contracts here and there when the family finances call for it (guess who that one is!)

And I know a plethora of nurses who do the conventional ICU schedule (every other weekend, rotating days and nights) while raising a family with a spouse who quite often works an opposite schedule.

This last option is hard. Extremely hard. But if planned right, it can work to maximize the time that your family spends together.

I remember reading in one of my nursing theory textbooks that these types of nurses who fall in and out of the profession and will only work full time when it’s convenient for them and their family are very bad for nursing. They don’t contribute at all to advancing the cause of obtaining more power and respect for the profession.

And yet where would nursing be without them? For the most part they are the ones who aren’t working on an exit strategy, because it all works out so well for them.

Jul 17

A Nurse Without a Licence

No license, no job: Why many have put their lives on hold – TwinCities.com.

Can you imagine going all the way through nursing school and then not being able to work because a state government shutdown has prevented you from getting a license? Or for that matter, what if you are an experienced nurse and can’t renew your license because the state board of nursing is closed? That’s what Minnesota nurses are facing. Government shutdowns have unintended consequences.

Feb 28

3 Comments

I Lost my Brother

It’s been a long time since I’ve posted anything meaningful here. A lot has been going on that I’ve wanted to post about. But. One thing overshadows everything else.

In August, I lost my younger brother to suicide.

It’s been a shattering experience. It’s almost kind of ridiculous to try and write about it. The most accurate thing I’ve heard describing the experience of dealing with the suicide of a loved one is that there are no words to describe it.

But I feel paralyzed in this blog until I address it.

So here’s the thing. When you find out. Immediately there’s a violent gash that separates your life. The Before and the After. You desperately want to return to the Before but you know there’s only the After.

Chaos. Pain. Insomnia. Anger. Confusion. Anxiety. Guilt. That’s how the After starts.

In September I found an incredible art therapy support group called the Rita Project. I started going and my recovery began. Now it’s February and I’m almost feeling normal. I can never get back to the Before. The pain is still there, hard as a rock and confounding, but the chaos, anxiety and confusion have thankfully subsided.

Anger is still there. I’m working on that. And no anger for my brother, like I always assumed is what happens after a suicide. Just generalized anger at the world.

But onto my brother…
He’s almost reached saintly proportions in my mind, even though he was so misunderstood in this life. He suffered from a cruel form of treatment resistant depression. I think many with this type of depression don’t make it past the age of 25.
He made it to 36. Today would have been his 37th birthday.

He wasn’t the easiest person to get along with but he was a good person with an awesome sense of humor. He was a total movie buff and the last conversation we had I was telling him I can’t watch Tarantino anymore because I can’t stand all the gore. He said but wait – you have to watch Inglorious Basterds. He said I would like it despite the violence. And damned if I didn’t love that fucking movie.

Goodbye, Mikey. You didn’t deserve to die.

Sep 14

Gen X Nurse

I’m a Gen X nurse.

What does that mean?

In the most obvious sense it just means that I was born in 1970 and I’m a registered nurse. I try not to put too much stock in all of the generational stereotypes, but I have always felt like I was Generation X to the core. Gen Xers tend to be cynical. We’re hard on ourselves and others. We have this reputation for being slackers, not because we’re lazy, but because our standards are too high to just grab whatever old McJob comes our way.

When I graduated from college in 1992, I had a liberal arts degree and no clue what to do with it. I wasn’t interested in graduate school. At that point I was ready for the next step. I wanted to play the game. I wanted to get a paycheck.

The conventional wisdom at the time was to pick a company. (How? Based on what?) Get an entry level position (doing what?) Establish yourself and move up the ranks (to become what, exactly?) It was all so nebulous.

So I got a job in a bakery. I have always loved working with food. It was extremely low-paying but that was okay. I was happy.

I knew it was a dead end job though, so I started taking community college courses. First in psychology (I thought I wanted to be an art therapist) and then in graphic design. Meanwhile I “moved up the ranks” and became a waitress. I started to make a lot more money and it was a job I rather enjoyed.

I did this for 10 years. I travelled a lot. Bought a house. Always in the back of my mind was, “You have a college degree! You should be doing something else!” But that voice was never quite convincing enough.

Then in August of 2001, I attended the funeral of a close friend’s brother. He was a young, wonderful, hard working person who was ruthlessly killed by a drunk driver. Nothing like a funeral for a young person to send you into an existential tailspin.

I fell into a temporary despair. I desperately tried to come up with ideas for what I should be doing different, how to change my life.

And then September 11th happened. Despair turned into anger, followed by numbness. My existential tailspin was curtailed by the need to just go on living. To try and make sense of day to day things without being overcome by rage. I thought about joining the military.

8 months later I made the decision to start nursing school.

Sometimes it takes a tragedy to make you see what’s really important. And the important thing for me was to do something that I could define, something that had meaning, and something I could take pride in. Sure I could pay my dues and work for a company, sell things, market things, design things, manage things, get promoted. But nursing is different. It’s so much more simpler:

What does a nurse do?

She takes care of people when they are sick. And gets paid for it.

And that’s why despite all the bitching and moaning I like to do about cleaning up poop, I’ll probably always be a nurse.

Mar 6

The White House Health Care Summit: A Nurse’s Perspective

On Thursday, President Obama held a summit to discuss our current state of health care. It was attended by representatives of various health care organizations as well as a sampling of senators and representatives. I also had the pleasure of attending. (Okay, I didn’t really attend but I watched the live stream and tweeted about it, so that’s kind of like attending, right?) At any rate, I think our health care woes can be summed up rather succinctly: We want better health care, for more people, and we want it to cost less. If only the answers were that simple. As you would expect at an event with plenty ‘o congressmen in attendance there was lots of complaining and pontificating. Despite that, I managed to suss out some interesting ideas for you ; ) Nurses were well-represented by Rebecca Patton, president of the ANA. As a nurse, I’m proud to say that she was one of the few people bringing actual ideas to the table, rather than just complaining about the situation. She presented the idea that nurses should be allowed to use the full extent of their clinical skills. I took this to mean nurse practitioners should be allowed to practice, and RNs should be utilized more for their clinical skills rather than just doing endless rote tasks and paperwork. She also suggested that more public reporting of outcomes and staff ratios should be required. I think this is a great idea, although it doesn’t address the issue of lowering health care costs. A facility that has a low nurse-patient ratio is certainly going to have higher costs, unless they choose to cut corners somewhere else. Daniel Smith, president of the American Cancer Society discussed raising the tobacco tax. The argument against this is if you raise the tax on cigarettes, you will disincentivize people to smoke, hence you will not raise more revenue in tobacco tax. But if the tax hike is significant enough (say by 75%) and the amount of smokers reduces by only 15%, you’re going to have a net increase in tobacco tax revenue. Bonus points: This could facilitate a reduction in lung cancer and COPD; thus saving more money down the road. The idea was also presented that we utilize more home care services for chronic illnesses and end of life care. I couldn’t agree more. First of all, it cuts down on nosocomial infections, and secondly, I think people would rather receive treatment in their own homes, particularly if we can show that this improves outcomes. Also, what a great way to utilize your nursing workforce. We still have a long way to go towards improving our health care system. There was also a lot of talk of “we’re all going to have to pay our share, and sacrifice a little bit,” (Wait – wasn’t the the whole point to NOT sacrifice better care, and to NOT have to pay more?) Really this just means that some of us will be required to pay higher taxes to fund all of this. One group that was conspicuously missing from the health care summit was doctors. That’s unfortunate. After all, doctors are the one group that really spend their time at the intersection between reimbursement and patient care. Shouldn’t we be listening to some of their ideas and solutions?

Mar 3

Meet me at HealthCamp Philly!

First off, what is HealthCamp Philadelphia? It’s a free mini-conference that gives health care providers and technically minded people the chance to come together and discuss their ideas. So why am I going? First of all, I’m looking forward to meeting some of my favorite tweeps like @holaolah, @LizScherer, and @PhilBaumann in person. Secondly, I’m hoping to have a discussion about the way patient information is exchanged between health care providers. In nursing we like to refer to this as “report.” Technology should theoretically allow our reports to be exchanged in away that is timely, accurate, and efficient. We have computerized nearly all the aspects of our health care delivery from ordering, to charting, to health records. Yet our nursing reports still consist of handwritten notes and rushed phone conversations! Why is this? To explain my frustration, I offer you a typical MICU scenario: A doctor goes to the computer and places an order for your patient to go to radiology for a procedure. You haven’t seen the order yet because you are in your other patient’s room, doing an assessment. You get a phone call. It’s the procedural nurse. “Your patient is coming to radiology, right? We haven’t gotten your transport sheet yet.” “I haven’t even seen the order yet.” “Well, try to hurry up and send us the transport sheet.” (The transport sheet is basically a patient report sheet that you fill out by hand and fax to the appropriate people.) So you finish the assessment while thinking about what meds you will need to give before your patient can leave the floor. You get another phone call. This time it’s the transport team. “Your patient is going to radiology, right? We haven’t gotten the transport sheet yet. We’ll have a team ready in 15 minutes but you have to fax us the transport sheet.” “Just got the order. I’ll get it to you as soon as I can.” As an ICU nurse, you have to grab this piece of paper from the nurses station, open up your electronic chart, and start writing down the information on a piece of paper so it can be faxed to 2 different parts of the hospital. Do you see the folly in this? (I guess you could say the transport sheets are kind of like my TPS Reports.) The flow of patient care has just been interrupted not once, but twice, by people telling you to “Hurry up and fax us the transport sheet!” You’re already working with electronic charting. Why do you have to transcribe something with pen and paper? Isn’t the whole point of making things ELECTRONIC so that you don’t have to do it that way? If another health care provider needs access to this information a patient report should be automatically generated and sent to the appropriate areas of the hospital. Then, if anyone has any questions about the patient, they can call you to get clarification, hopefully without too much interruption. So what’s the answer? There are many different ways to solve this problem. I’ll focus on one: I believe that twitter could serve as a model for relaying patient information efficiently, timely, and accurately. (And obviously you would address the issue of patient privacy as well.) Bonus points? The 140 character limit forces you to enter the most relevant and concise facts about your patient, so you’re not flooded with information that you don’t need at that particular point in time. And that’s just one use for twitter in the health care arena. Check out Phil Baumann’s slideshare presentation of 140 more! Is twitter an oversimplified way of solving this complicated problem? Perhaps. But the point is that we have to start discussing this. The technology exists to make hospitals so much more efficient, and yet I can tell you from a nurse’s perspective, we aren’t seeing much in the way of innovation. Hopefully in the near future we will be seeing more of these Healthcamp-like events where people can get together and start the discussion.

Everything you've always wanted to know about being a nurse, wrapped up in a blog.