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What makes a good day?

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A good day in the hospital is not like a good day on a day off. It is not a lack of patients, more free time to browse social media, or even a full 30 minute, uninterrupted lunch break (although, that would be nice).

A good day in the hospital is a day when each patient can be cared for individually, rather than quickly checking off the Cerner checklist. It’s a day with a 5 patient load and the chance to focus on the physical and emotional needs and wants of each patient.

It’s a good day when a patient wants to show me their family or a hobby they enjoy and I actual have time to sit down and listen.

It’s a good day when a patient who wants a bath is able to get one when they want it and even get a nice hairdo.

It’s a good day when a doctor appreciates the work that you do and the thought behind any questions.

It’s a good day when even when everything is going wrong, you know you couldn’t have done anything else.

It’s a good day when you have time to read progress notes.

It’s a good day when 0800 charting is done by 1100 when rounding began at 0730.

It’s a good day when there is time to walk a patient in the hallway or go outside in a wheelchair.

Its a good day when you find that one patient of the day that validates why you chose nursing.

It’s a good day when the power of prayer becomes evident.

It’s a good day when cancer has been ruled out.

It’s a good day when nurses work as a team.

What makes a good day?

There is good in every day, you decide how you see it.

Until next shift,

Shania

Speak Life: The Power of Words

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“The tongue has the power of life and death, and those who love it will eat its fruit.” Proverbs 18:21 (NIV)

“Words kill, words give life; they’re either poison or fruit- you choose.” Proverbs 18:21 (MSG)

Choose Joy. Those two words I wear on my badge every day at the hospital. The most common compliment that I receive is that I am always smiling. The hospital is full of emotional highs and emotional lows. Being a caregiver at the bedside, it is my job to at least look like I am having a good day. A smile can brighten the room, and hospital rooms can be quite dark- both literally and figuratively. From new terminal diagnoses to upcoming procedures, the patient and family are not at their highlights of life. The least I can do is smile, and show genuine compassion.

I choose joy everyday because my patients cannot afford much less. In the midst of low blood sugars, falling blood pressures, calls for pain medications, family phone calls, each patient has the right to be treated individually with kindness, autonomy, and respect.

Whether speaking to yourself or to someone else, the words spoken have either the power to heal or the power to kill. There is a time to be sad and a time to be happy, however words must be carefully thought before they are spoken. Here are a few examples:

  • A doctor rushes into the room to share the plan without asking for any clarification, questions, or concerns. – Speaks death
  • A doctor shares unwanted test results at the bedside at an appropriate time. – Speaks life
  • A prayer before a procedure. – Speaks life
  • A word of encouragement and hope at discharge as a patient transitions to rehab after experiencing deficits from a stroke. – Speaks life
  • A dying patient breathes their last breath after a loved one says that it is okay to go. – Speaks life
  • Nursing retention rates are low at places where bullying is prominent. – Speaks death
  • Powered by People is a service utilized to recognize caregivers by their coworkers for their hard work- Speaks life
  • The minute a person gives up, is the minute their body starts to decline; “I can’t…” – Speaks death
  • You would never speak to someone else like you speak about yourself/ your own abilities. – Speaks death

Are you speaking with kindness today? Do your words speak life into a person or do they speak death? You decide.

Until next shift,

Shania

A day in the life of a nurse

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Here is a “typical” hour by hour breakdown of a 12-hour shift with 5-6 patients:

0645-0730: Huddle and report

0730-1000: Gather medications, pass medications, shift assessments, review MD orders, get everyone into chair for breakfast

1000-1200: Document assessments, care round, answer call lights, call family member, clarify orders, d/c patients

1200-1230: lunch?

1230-1400: d/c and admit patients, code?, care round

1400-1600: pass medications

1600-1800: update report cards, care round

1800-1845: Make sure pain medications are given, IVF are infusing, all orders are completed and reordered, MD responses documented, I/O, care plans updated

1845-1930: Night shift report

Inspirational Reads/Media

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Podcasts:

  • Elevation with Steven Furtick- Christian
  • Life Church with Craig Groeschel- Christian
  • Fresh Life with Levi Lusko- Christian
  • Like a Doss with Ronnie Doss- daily inspiration and leadership talk
  • The Joe Rogan experience- interviews with various popular people
  • The House of Pod- 2 GI doctors discussing various medical topics

Books:

  • The Emperor of all Maladies by Siddhartha Mukherjee- the origins of cancer biology and treatment to present day discoveries
  • Man’s Search for Meaning by Viktor Frankl- a psychologist’s personal Holocaust survival and the meaning of life
  • Being Mortal: Medicine and What Matters in the End by Atul Gawande- end of life care and hospice experiences
  • You Learn by Living by Eleanor Roosevelt- 11 keys to a fulfilling life
  • The Book of Joy by Dalai Lama and Desmond Tutu- a conversation between the Dalai Lama and archbishop Desmond Tutu on living in harmony and happiness.
  • When Breath Becomes Air by Paul Kalanithi- a doctor’s battle with lung cancer

Tips for new nurses

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  1. Nurse the patient, not the computer. New nurses are very task-oriented and focused on completing what needs to be done for the day. It is so easy to focus solely on the screen and not even make eye contact with the human being in the room. It is important to listen to the patient and family, as well as to establish rapport. “If it is not documented, it wasn’t done.” Save documenting until everyone is properly cared for. Do not leave a patient unattended because documenting is behind.. you can always back-time.
  2. You do not work for the doctor, you work for the hospital. This was the most helpful advice my preceptor gave me during orientation. I would get so upset if a doctor yelled at me, but they have no right to do that. We are employed by the hospital, not the physician. Be respectful and follow their orders, but do not be afraid to question orders or ask for clarification, especially if you are concerned about the patient.. They see the patient for roughly 30 minutes, we see them for 12 hours.
  3. Smile. There are many difficulties and frustrations with nursing, but complaining does not solve anything. No one wants to be admitted into the hospital, just smile. It brightens the environment, is proven to make you in a better mood, and people are less likely to yell at you.
  4. Take every opportunity. Learning comes with experience, so take every chance and opportunity to grow. Nursing is a profession, and treat it like one. Be enthusiastic for what you have worked so hard for. Act like you are confident, even when you are not.
  5. Care for yourself. Do something every day that is for you. Whether that being reading, taking a bubble bath, making your favorite food, or watching your favorite show. Make sure you have a healthy you-time to destress from the previous shift. Exercise, eat right, and be kind to yourself.
  6. Set goals. Getting a certification, moving to a new specialty, earning a higher education. Have something to aspire.
  7. Remember you are one person.
  8. Invest in compression socks.

Until next shift,

Shania

Death: You cannot doubt God

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“What matters is not the meaning of life in general, but rather the specific meaning of a person’s life at a given moment” – Man’s Search for Meaning by Viktor Frankl 

Working with many hospice families on the medical floor, there are so many stories that cannot be explained by science, alone. Each death is different, surprising, and often, beautiful. Supporting a grieving family as they wait and watch their loved one take their last breath brings me to the core of nursing care. No computer, no doctor, no book, and no prayer can comfort like the personal touch of the nurse.

I have seen oxygen saturations in the 70s jump to 100% as a family member walks in to say goodbye. I have seen patients who hang on until they find their last bit of closure whatever that may be before crossing over. I have seen obtunded patients open their eyes and use all of their remaining energy to say a few last words to their family members before closing their eyes for eternity. Death is and can be beautiful.

The first death I experienced was when I was still on orientation. It was a man who battled many years of cancer. He was literally skin on bones. His daughters and wife were at bedside, and it is the family that breaks your heart the most. They sat around his bed and talked about all of the memories that they shared together. They showed me a picture of him, a healthy 180lb man, now a 60lb man laying in the bed. Those are images you can’t forget.

Caring for Hospice patients and families is some of my favorite cases because of how real and genuine the emotions are. At the bedside, nothing else matters except the love and belonging the family has left.

Some families grieve with anger, some with prayer, some with thankfulness, and some with silence. Some patients wait for families to step out of the room before passing, some wait for a bath, some wait for a blessing, and some go suddenly.

It is crucial to maintain the compassion for each of these families. It is easy to appear too busy or even to become insensitive to these life events. The most important thing for palliative care and hospice is to simply be present. Sit down and listen to the family wishes and hopes. It is okay to cry with them, I often do. Cry, and then carry on. Focus on each patent encounter individually. One room at a time.

Death is a beautiful thing.

Until next shift,

Shania

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