It's Not Easy Being Green

I'm here to tell you, starting a new job is no fun.  You don't know anyone, or where to put your purse, or where the hiding places are for drinks at the nurse's station, or who is really in charge, or which docs are which, or how people actually chart, or which computer each nurse likes to use, or who to ask, or who sits where, etc.

And, of course, the most important question...where is the closest Diet Coke machine???

Since I've been a nurse for almost 30 years, I'm not really "green".  Just situationally green at the moment.

Did I mention that I really don't like being new?

The Union Question

The hospital I just started working for has a nursing union.  It seems weird and somewhat impossible, but I truly had no idea.  I don't know the rules, but apparently it is not okay for the manager who interviewed me to bring this up.  I found out when I saw "union presentation" on the classroom orientation schedule.

Honestly, I would not have applied to this hospital had I known about the union.  Florida is a right-to-work state, so I'm not required to join the union or to pay dues to the union.  Personally, I'm against unions for nurses.  I know that many nurses are strongly pro unions for nurses.  I have many reasons and I feel I can look at the issue objectively, as I have been a member of a nursing union in one hospital for whom I worked and I have worked in a hospital that has a union to which I did not belong because I was a travel nurse.  I'll talk about my reasons in another post.

My main concern here is that I wonder if I will feel pressured to join or will be ostracized as a new person for not joining the union.  I've already done a week of orientation and really want to get in the CVICU and see what it's like.  I thought about pulling the plug, as my husband says, but feel obligated to at least give it a try after the hospital has invested the cost of the classroom orientation in me.

The presentation by the union representatives was disappointing.  They gave historical information to the nurses, a couple of who have very little nursing experience, that was incorrect.  I didn't say anything, but I felt very uncomfortable with what was said.

How will this work out?  Time will tell.

The Black Hole of Orientation

*courtesy yahoo.com

I've been a little absent on this blog - I apologize.  I started a job and I've been in the classroom at my new hospital all week listening to the endless speakers and videos that go with starting a new job.  The non-nurses only have one day of classroom orientation, nurses have a whole week in the classroom.

I completely get why we have to do it, hospitals have to prove to accrediting bodies that they provided this information.  The information has, for the most part, been good and the people have been very friendly and nice, but it still sucks. 

You know that stamp you get on your hand that lets you back into the fair, a club, a kid's sporting event, etc.?  Why can't we do that for some of the new employee stuff?  Honestly, I think I'd be willing to get an actual tattoo that says I completed a class about the MSDS sheets, corporate compliance, and restraint documentation and am good for the rest of my career. 

Should You Never Ask a CNA To....?

I became a nurse because of the nurses I worked with when I was a nursing assistant at a small rural hospital during my high school years.  I was not certified - I got on-the-job training from some spectacular nursing assistants and nurses.  I needed a job because the hours at my after-school pharmacy job no longer worked for my life so I applied and got hired at the local hospital.  I had never even considered nursing, but working with and watching the nurses at that hospital convinced me that nursing was the career for me.

I have nothing but the highest amount of respect for Certified Nursing Assistants.  My only complaint about CNAs in general is that I do not think they realize their worth or importance.  Nurses cannot get their work done without the CNAs on their team and patients appreciate CNAs so much.  The influence of a CNA on a patient's experience is profound.

This week on Facebook, an article has been floating around which discusses the fact that nurses should never ask a CNA to do something out of sheer personal convenience for the nurse.  You can read the article here.

While I agree to a major extent with this idea, I also think that it's not a simple issue.  There is a significant amount of work that a nurse does that cannot be readily identified except by another nurse.  I have heard nursing assistants complain about a nurse who is asking the CNA to do something while the nurse "sits at the desk".  What a CNA might not realize is how very involved some of the paperwork is that needs to get done and "sitting at the desk" might be what the nurse needs to do at the moment to complete a discharge plan, medication reconciliation, or coordination of care.  And, frankly, the paperwork needs to be right.  Patients lives depend on it.

I remember when I was a new nurse that my manager's job looked pretty easy.  She spent a lot of time walking around and talking to the staff, or so it seemed to me.  Then I became a manager and realized that it is an incredibly hard job without much reward.  It is never a good idea, I realized, to make judgements about a job which I do not have the credentials or experience to perform.

The example given in the article does make the nurse sound as if she is avoiding work that is unpleasant or difficult and, of course, that is never good.  When it comes to providing care to challenging patients, physically and/or mentally, it's best to employ the team approach.  Nurses and CNAs should work together, we are all on the same team. 

Snow Nurses

 The Polar Vortex caused a lot of problems for most of the country over the past few days and many schools and businesses were closed because of the cold and snow.  You know what businesses didn't close?  Hospitals.  You know who didn't get to stay home because of the cold and snow?  Nurses. 

Here's a big THANK YOU for all of the nurses who had to brave the cold and snow (and who had to take their kids out in the cold and snow to get them to daycare even though it was cold and snowy)!

In The Line Of Duty

Nurse.com celebrated the life of Gail Sandidge, RN, yesterday; Gail was killed while performing her job in an ambulatory surgery center in Longview, Texas, last month. 

Gail was stabbed by the son of a patient who was having surgery that morning.  In all, this man stabbed five people and two of them died.  The other fatal casualty was a man waiting to take his son home.

You can read the full story here.

When I think about nurses being in danger of violence at work, I don't think of ambulatory surgery centers as being a place of risk.  This is a good reminder that anything can happen any time.

My heart goes out to the family of this nurse, Gail Sandidge, who I know are still trying to recovery from this tragedy.

When It's Not Physical Illness...

On New Year's Day, I found out that my neighbor's 29-year-old son overdosed on his own prescription medications and died on December 26th. He suffered from bipolar disorder and schizophrenia.  My heart breaks for our neighbors, they were devoted to helping their son handle these horrible diseases and I'm so sorry they have to go through this. 

I found out about our neighbor's tragedy while standing in the street talking to another neighbor.  All three of us parent children with mental illness. 

Did you know that mental illness is actually sometimes called the "no casserole illness"?  That's because when there's a physical illness in the family, family and friends come out of the woodwork and bring food.  When there's mental illness, nobody shows up at the door with a casserole or a cake. 

For my neighbors who lost their son, this is particularly profound.  Their adult daughter (mother of their grandchildren) has cystic fibrosis. What a contrast in responses from others she had between the two. When her daughter has been hospitalized with exacerbations from CF, she can count on the kindness and support of family and friends.  When her son was hospitalized for exacerbations of bipolar disorder and schizophrenia, nobody wanted to hear about it or talk about it, much less offer support or relief of any kind. 

I hope that as nurses, we always recognize that mental illness is illness.  Period.

Silkwood Shower

You know when you have one of those REALLY icky days at work?  When you've been cleaning poop, barf, pee, or doing dressing changes on yucky wounds, or had a patient in isolation?  Those days when you leave work thinking about burning your scrubs and knowing that a regular shower won't cut it?

I call those my Silkwood Days.

The movie Silkwood came out in 1983 and was the story of Karen Silkwood, who died in a suspicious car accident after investigating and planning to expose the questionable safety practices of the nuclear plant at which she worked.

In one scene of the movie, Karen Silkwood, played by Meryl Streep in the movie, is exposed to radiation and has to be scrubbed in the shower with a wire brush - presumably to get the radiation off of her skin. 

I think we've all had Silkwood Days.

Resolution: More Naps

Medscape Nurses reported this week on a study published in the American Journal of Critical Care about safety issues when nurses are sleep deprived.  You can read it here.

One of the suggestions is that nurses be allowed to nap.  To that I say : "duh". 

Way back in my early years, I did a travel assignment for a hospital that encouraged nurses to nap on their breaks, especially night nurses.  Nurses who worked 12 hours were given an hour break (instead of the usual half-hour break in a 12-hour shift) and were encouraged to leave the unit during this time. They used the buddy system - buddy assignments were made at the beginning of the shift and buddies worked out their break times between them.  Night shift nurses were expected to take a pillow and a blanket and find a place to sleep, there were staff lounges on another floor of the hospital and designated places on each unit.  This was before cell phones (yes, I'm that old) and usually the nurse's buddy woke them at the agreed upon time.  I only did half of my contract at that hospital on nights, but let me tell you that the naps saved me (and my patients, I'm sure).

Why are we not encouraging this practice?  If it's safer for our patients to have nurses who are well-rested, shouldn't we be providing a longer than 30-minute break for nurses to relax and recharge?  I personally am not a "power napper", but many people are.  I have so many nurse friends who say that they can sleep for 15 minutes and be completely rested. How about a place, instead of the frantic cafeteria, that nurses can use to close their eyes and nap or meditate?

Kindergarteners don't need naps (though the teacher might); nurses need naps.