2020. The Year of the Nurse. As if...

Thursday

A glimpse of the camaraderie, professionalism and science of Nursing
My inspiration for this post is not to praise my colleagues, although they deserve praise...
but rather to put the call out there for backup. 

I'm talking to the kind, organized, intelligent and compassionate people out there 
 to be the next generation of Nursing.

I'm talking to you.

So, here I am making masks for my friends who are on the front-lines of care. 
Nurses in the ER, ICU and Screening Centers. I think of them. And how cool they are. How smart they are. How 'science-based' they are. I've been retired for a few years now and anticipate that there may be a high probability I will get back into the fray - should it be necessary.
The 'calm before the storm' in Dallas has got my head back into 'Nursing Mode' and my training to never quit and to anticipate worst-case scenarios has been revived.
Hence, the masks

Now, don't get me wrong... I take good care of myself and although I still have a little life left in me. 
Recently, our current Lieutenant-Governor of Texas, Dan Patrick implied  I would gladly give up my life for the US Economy... but I say- hold up there, Dan - not so fast. 

Believing in science and knowing how expert Nurses, Doctors, Techs, Respiratory Therapists and all those in concert, encompassing a wide variety of healthcare disciplines, I'm confident that this virus will be managed safely and effectively with all hands on deck. 

That includes you, Dan. 
You are in a position that can help move mountains in this crisis. 
Be a Nurse, Dan. Don't be a Dick, Dan.
Don't be a quitter. 
Anticipate worst-case scenarios and work your ass off to prevent them.

Awright... back to Nurse Recruitment...

Who knew that Nurses were not all about bed-baths and pill passing?

Beginning my Nursing career in Toronto, Canada and I became a 'Dialysis Nurse' at age 19. To say that I was scared shit-less would be an understatement. That year in Dialysis was one of great introspection and self-assessment. Not counted amongst the best Nurses in my unit, in retrospect I realized that what I brought to the Nursing table was a passion for learning, and a profound degree of compassion and love for others.
Just a kid, really.
Nursing ...provided me an opportunity to travel. I made it to the USA from Canada and found myself  'Jones-ing' on 'Cardiac Medicine'. It was a 'Telemetry Unit' where I got a crash course in Organizational Skills, EKG Interpretation and Cardiac Resuscitation. Loved it!

Nursing provides those with a 'restless heart' - movement. I was young and had a restless heart. My ER career began at Baylor Downtown on the advice of a Doc I had met while working in Cardiac Medicine. "Go to th ER" he said, "It will be fun!" he said. He was right. And exhausting, and difficult, and life-saving, and taught me more than I can ever know about the fragility of life. The break-neck pace strangely soothed my restless heart. Hard to explain but there ya go.

Later in life, I anticipated (Hey, Dan) that the pace of ER Nursing might be a little much on my 50 year old body and decided to learn how to be an ICU Nurse. Literally having to run with a stretcher loaded with a sick patient, monitors, defibrillators, IV pumps etc, to CT was literally a 0.5 mile trip each way. One of many trips I would take each day. Good News... since then, I hear things have improved as most ER's have their own CT Scanner in the department now! Yay you!

Although ICU Nursing was no picnic, it was physically hard work as well but you generally had a chance to get a cup of coffee before you took report from the off-going Nurse.
In the ER - this was not always an option as many times CPR/Traumas/Hemmorhagic Emergencies/Crazy/Stoned/Drunk People (the list goes on) required that you immediately step up.
ICU Nurses, et al
ER vs. ICU:
It seemed to me that in ER you relied on your super-keen observation skills & spidey-sense to anticipate if a patient was going to 'crump'. In the ICU? Everybody looks like they are about to 'crump' to begin with - so you have to rely on the numbers to help you prevent 'crumping'. Numbers? That's where it gets really interesting. ICU Nurses use high tech monitors to identify specific values of pressure, rate, volume etc. simultaneously in real time while administering care to their patients. But that's yet another post. Oh, and I was surprised at how 'thankful' families were in the ICU - the 'emergency' was now over and they had time to process what had happened to their loved one. Gifts of cookies, flowers, pizza abounded ...Sorry ER.

In Nursing...you have an instant 'peer-group': The friendships are real and lasting and many times profound. So many memories of the fun (and not-so-fun) times with my Nurse-friends. I could write another post on Nursing-friendships alone...but you get the idea.

At one point, I gave Nurse Management a whirl - it was not well suited to my personality - but is definitely the way to go for some great Nurses out there - I'm talking to you, Susan Rossow RN, Jody Phillips RN, Jessica Wilson RN, Jane Norris RN & Lillie Crain, RN ...to name just a few. I wish I could name them all but after 42 years... it's a lengthy list.

And I kid you not... I was an 'underachiever' in Nursing.

Nurses that I have been honored to work along-side throughout the years, are now...
  • Infection Control Nurses
  • Cardiac Rehabilitation Nurses
  • Nurse Practitioners: Some of their specialties include Emergency, Pediatrics, Psychiatry, Trauma, Critical Care, Family Practice, Gerontology
  • CRNA's : Certified Registered Nurse Anesthetists 
  • Clinical Nurse Specialists: Critical Care, Pediatrics, Nursing Education
  • Professors of Nursing
  • Case Managers: They assist patients, families, and the Health Care Team with determining future needs of the patient, prevention of 'issues' and identifying potential barriers to their progress.
  • School Nurses
  • SANE Nurses: Sexual Assault Nurse Examiners
  • Flight Nurses
  • OR and Recovery Room Nurses
  • Day Surgery Nurses
  • Plastic Surgery Nurses
  • Home Health Nurses
  • Nursing Entrepreneurs
  • Neonatal Nurses
  • Hospice Nurses
  • Palliative Care Nurses
  • Oncology Nurses
     So I'm writing this in anticipation that one day soon, we will need you. I will need you. 
ER Nurses, et al
Granted, Nursing is not for everyone. 

A good attitude about dealing with shit that you really don't want to do is necessary for Nursing. But Nursing as a career choice was the best choice for me and I'm here to say... if you think you might have what it takes... do it. If you already have a degree, it will take you about 2 more years (give or take) but that would be 2 years well spent. At the risk of sounding crass, the pay is good - starting around $65,000 in Texas for a new grad. (depending on your area) with health care benefits for you and your family, flexibility in hours and shifts, tons of specialties, incredible job-security and a lifetime of unbelievable experiences.

Any Questions? I'm here for you. 

And for my Nurse-Colleagues, the Techs, RT's, Docs, Unit Clerks out there... I know this is a scary time for you and your families. Please know that I love you, miss you, pray for your safety and thank you. But I also know that you are all over this and will help see us through this difficult time. 

2020. The Year of the Nurse. As if Flo planned it this way.




The Women's Chorus of Dallas

Tuesday

Photo by Marius Masalar on Unsplash
This is a re-run of a post I wrote last year - I'm re-posting it because we have a concert coming up soon and I would love to see you there!

Thursday, March 5th at 730pm 
The Women's Chorus of Dallas will be singing at
The Moody Performance Hall
with The TWU Women's University Choir and The Dallas ISD Choral Students! 
Don't miss us!

Here's the link for tickets
 "Travelin' Voices - Voices of Women VI"

Let me know if you'll be there and I'll meet you in the lobby after the show!

➤ At the beginning of last year, I decided that it was time for me to sing in a choir.

     Because I love singing.

However, without any singing experience, nor any musical background or education I set the bar a little low and decided to look for (something along the lines of) your basic church choir - no mega church - just a Mom & Pop kind of church. That's what I was looking for. No pressure. Surely, church-people would be a forgiving bunch.

So I started looking around.

It soon became clear to me that church-choirs generally want their singers to be a part of their 'flock', so to speak. Fair enough. But evidently, I needed to give this church-choir thing some serious thought if I would be required to embrace a new religion. Maybe there was a non-secular choir out there?

Google popped up The Women's Chorus of Dallas and I got right on it. Contacted them, attended a rehearsal and info session. I heard the chorus sing "How Can I Keep From Singing" and I was hooked. That being said, I solidly braced myself for humiliation as the next step in becoming a choir member was by auditioning.

FYI: Don't search YouTube "Choir Audition" to prepare for a choir audition. I did. And heard a 9 year-old sing like Aretha Franklin. If it weren't for my husband encouraging me, I never would have auditioned.

The Women's Chorus of Dallas has been around for 30 years and is funded primarily by private donations. If you would can help support us so that we can continue making great music and representing Dallas...here a link to get you there... TWCD

Oh! And you have got to hear us! We don't suck!
 This clip is from Voices of Women Concert last year... 



A few photos of our performances from the past Spring Season...

Mother's Day - Texas Discovery Gardens, Dallas Tx

Carnegie Hall, New York City

Carnegie Hall, NYC

Hugh Jackman, American Airlines Center, Dallas Tx

The Women's Chorus of Dallas. It's been quite a ride!


Don't Look Away: How You Can Help

Wednesday

Recoleta Cemetery - Buenos Aires, Argentina
Photo Credit: Joan Spotswood
I can't bear to re-post 'that' photo.You know the one. A dad and toddler. Dead. Face-down in the murky water's edge of The Rio Grande. A failed attempt to cross the water in hopes of finding peace and prosperity in America.

"We hold these truths to be self evident, that all men are created equal, that they are endowed by their creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness". When my friend and colleague, Kory Caughie posted the aforementioned photo, these were the words she chose to caption it with.

And I cried.

I cried for the man and his child, for his wife - as she bore witness to their deaths, I cried for the struggle so many human beings endure to make it to our country. Their beacon of hope. And then, I cried for the country that I had proudly adopted as my own just a few years ago.
Photo Credit: Matt Hudgens-Haney

Kory lives in the Texas border town of El Paso and is founder of El Paso Cares  A non-profit established in November 2018 whose goal is to increase awareness and understanding of human trafficking, exploitative relationships, prostitution and trauma [National Trafficking Hotline 888-373-7889]. Needless to say, she literally has her 'boots on the ground' with first hand knowledge of what's happening in her city. I contacted her this morning as I needed to know what we can do to help. Here is what she said...

1. Annunciation House: "They have operated for years and money fully goes to help the refugees.  They distribute donations to all churches who help with feeding, transporting, etc.  I work with these churches and everyone in this city will tell you that Annunciation House (and Rubin Garcia who runs it) are operating in full integrity and 24/7 to help.  He is the voice of the voiceless here.  He is highly respected by our city council and anyone working in the issue." 

2. Compassion International: "Jimmy Mellado, CEO, said, 'Kory, none of our children are fleeing because they are in safe, healthy, villages...They are one of the highest ranked organizations on how much money goes to the child.'"

"The stories are true, Joan.  They are running from unlivable places. We can’t house everyone here, but they can’t live there right now. We need to help on both ends until a solid solution is in place. Every time I leave the bus station or airport and see a little kiddo walking toward a new safe healthy life with their momma or daddy, I thank God for one more life spared and for their opportunity and hope when their situation was hopeless AND for the people who helped me provide a good safe healthy life for my own kids when life was hard... but never one of life or death! Spread the Word!!!".

So this is my plan - I'm spreading the word and have chosen to donate. Will you join me?

#DontLookAway

What's So Bad About The NRA?

Monday



So, What’s so bad about The NRA?

Personally, I have friends and family who I admire and respect that have been and continue to be members of The NRA. They are responsible gun owners and gun enthusiasts. That being said, in the past few days there has been more mass shootings too close to home and it really seems that these incidents are becoming the new 'normal'...

Santa Fe, Texas -May 18th, 2018 - 8 Students & 2 educators killed - 10 others injured.  The 17 year old shooter had access to his parent's shotgun and handgun. Every 36 hours, a child unintentionally fires a gun and kills or injures himself or someone else. That doesn’t include the number of suicides and homicides that occur when kids have access to unsecured guns.

Ponder, Texas – May 17th, 2018 - A mother of three, shot. Her kids and boyfriend were killed. Her ex husband then killed himself. The judge who handled her divorce case, knew that her ex-husband had tried to commit suicide. She warned the judge that she considered him mentally unstable. Those warnings had gone unheeded.

What can you do?
Vote and learn what politicians have accepted money from The NRA.

What politicians have accepted money from The NRA in Texas?
President Donald Trump, Governor Gregg Abbott, Senators Ted Cruz, Dan Patrick & John Cornyn ... These politicians have a choice - they can choose to not accept NRA funds - a simple fix.

Why Should You Care?
Because The NRA includes a powerful lobbying group under their umbrella called The NRA/ILA (Institute for Legislative Action). It is supported by gun manufacturers and designed to promote sales of guns and gun accessories (silencers, armor piercing bullets, bump stocks).

The NRA/ILA has presented "The Hearing Protection Act" to congress. A law designed to allow silencers to be sold legally. Really?

The money that politicians accept from The NRA has strings attached and why so many politicians are complacent about enacting any kind of gun legislation. It has very little to do with anyone’s 2nd Amendment Rights and everything to do with needing and wanting NRA money, careful not to ‘bite the hand that feeds them’.

Gun Legislation that 'can't hurt and might help' include...
  • Background Checks for all gun purchases
  • Raising the age of gun purchases to 21
  • A 'Red Flag' Law - Allowing law enforcement to remove guns from a person who has been deemed a threat to himself or others.
  • Those convicted of domestic abuse denied firearm ownership.

As of today, in 2018 we have lost 5,436 Americans to gun violence. American women are 11 times more likely to be murdered with a firearm than in any other country and an American woman is fatally shot every 16 hours in the US. And as of today, America has eclipsed 1,000 teens (ages 12-17) shot or killed in 2018.

Something has got to give. It could be the life of your kid, next time. And there will be a next time.


Another Mass Shooting in the USA

Tuesday


Last week, 17 students and teachers were killed in Parkland, Florida by a mass shooter wielding an AR-15 and along with so many others, I am angry and I grieve.

The thought of any child staring down the barrel of an assault rifle was, at one time, inconceivable. Not any more. Children participate regularly in 'Active Shooter' drills at school, part of a necessary safety plan and my heart breaks for them and their parents.

We live in a country where the 2nd Amendment in our US Constitution reads: " A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed."

I sincerely doubt that banning all the guns in this country is the answer. We really do have a shitload of them. Personally, the gun owners that I know are responsible and safety-conscious people who enjoy target-practice and hunting. But do we really need weapons of war?  

The way I see it, is that a powerful and wealthy organization that once was devoted to marksmanship, safety, craftsmanship and education of firearms - The NRA - is our problem, as a nation.

The NRA is 'in bed' with gun manufacturers. 
According to Business Insider,  The NRA "made 20.9 million from selling advertising to industry companies marketing products in its many publications in 2010, according to the IRS Form 990. Crimson Trace (which makes laser sights) donates 10% of each sale to The NRA. Taurus buys NRA memberships for anyone who buys one of their guns. Rugar (Sturm Rugar) gives $1 to the NRA for each gun sold, which amounts to millions. The NRA's revenues are intrinsically linked to the success of the gun business."

Our US Elected officials are 'in bed' with The NRA.
When The NRA donates over $11 million to elect Trump (and $20 million to defeat his opponent), when US Senators and Congressmen receive up to $7 million from The NRA per candidate, I'm thinking it would be a safe bet to say that any gun legislation designed to change our current gun laws will not be enacted. Common-sense gun laws that would prevent someone from purchasing a firearm if they have a history of mental illness or domestic violence. Gun laws that would make "bump-stocks" illegal - thereby turning semi automatic assault weapons into fully automatic.

Really?

In 2013, after twenty 1st graders and six adults were shot and killed at Sandy Hook Elementary School, legislation was proposed to ban assault weapons. Assault Weapons Ban of 2013 (AWB 2013). It was defeated by the Senate 40-60. 

Think about it... the young man who brutally killed 17 in Florida last week would not have been able to purchase his very own AR-15 if AWB 2013 had passed. He was 14 years old in 2013. In Florida, the minimum age to purchase a gun is 16.

So,what can we do?
The politician who accepts "blood money" from The NRA is a problem. Being 'owned' by The NRA makes them complicit. Clearly a conflict of interest.

I am a new American Citizen (2/2015) and although this may sound naive to many of you, the only way I see out of this dilemma is by encouraging one another to look closely at your chosen candidates. Specifically...who contributes to their campaigns? If they take cash from the NRA...they will not support common-sense gun laws. That is all.

This November, Governor Greg Abbott (Rated A+ by the NRA) and Senator Ted Cruz (rated AQ and has received $36,000 from The NRA) of  my State of Texas are just two recipients of NRA funds that are up for re-election during the midterms in November.

As Maya Angelou once said,  "When you know better - you do better". They know better and so do we.
_________________________________________________________________________


How The NRA rates elected officials...

A+: A legislator with not only an excellent voting record on all critical NRA issues, but who has also made a vigorous effort to promote and defend the Second Amendment.
A: Solidly pro-gun candidate. A candidate who has supported NRA positions on key votes in elective office or a candidate with a demonstrated record of support on Second Amendment issues.
AQ: A pro-gun candidate whose rating is based solely on the candidate's responses to the NRA-PVF Candidate Questionnaire and who does not have a voting record on Second Amendment issues.
B: A generally pro-gun candidate. However, a "B" candidate may have opposed some pro-gun reform or supported some restrictive legislation in the past.
D: An anti-gun candidate who usually supports restrictive gun control legislation and opposes pro-gun reforms. Regardless of public statements, can usually be counted on to vote wrong on key issues.




My Latest Obsession...

Sunday

Little did I know that when I met this man...
Elliot Fallas
I would look forward to getting oil paint under my fingernails, use waxed paper as a palette, own a color-wheel, learn that 'GoJo' was my BFF and that odorless mineral spirits would be a close second.

Bob's Sea Turtle 2015
Far from being an expert, my latest obsession brings me joy.
Newfoundland, Canada 2015

Peggy's Cove, Nova Scotia, Canada 2015

Tobermory, Ontario Canada 2015

Red Flowers 2016

'Protector'' for Michaela's Nursery 2016

Puppy Portrait: Lexi-Lou 2016

Who knew that 'gray' was not just a mixture of black & white?  That 'depth' can be achieved by combining at least 3 shades of the same colors? That I would find myself inspired, guided and challenged by such a wonderful artist? 


Thank you Elliot.




Bullying, Health Care and Me

Saturday

Photo credit: NurseTogether.comNurseTogether.com
It's not just nurses who can be bullies. It's Doctors, PA's, Secretaries, Respiratory Therapists, Managers ... you name it. The health care environment is just teeming with 'em. Throughout my 40 (eek) year  nursing career, I have been witness to and the brunt of bullying. I'm writing this for you. 

A few weeks ago, I attended a lecture, "Understanding and Eliminating Workplace Bullying' given by two nurses from Indiana (Terri Townsend & Pamela Anderson). It made me sad. Bullying interferes with the well-being of our patients, families and of ourselves. Here are some facts that were presented...
Consequences to individuals. 

  • Bullying engenders distress and emotional pain, anxiety, feelings of isolation, helplessness, and dejection, physical illness, and increased use of sick time. 
Consequences in the workplace. 
  • Bullying can create and sustain a toxic work environment. 
  • Bullying can erode morale and job satisfaction, leading to loss of productivity, work absence, and nurse attrition. 
  • Bullying is also viewed as a risk to patient safety. Bullying interferes with teamwork, collaboration, and communication, the underpinnings of patient safety.  
  • Canada is presently reporting one out of seven adult suicides result from workplace bullying (Workplace Bullying Institute, 2003).
Bullying affects not only the victim; but also the witness (Patten, 2005). The witness begins to wonder if she or he is next. Subsequently, self-esteem decreases, erodes, and gives way to depression and anger for nurses who witness bullying. 

What exactly is Bullying?
  • Repeated, offensive, abusive, intimidating or insulting behaviours
  • Abuse of power
  • Unfair sanctions that make one feel humiliated, vulnerable or threatened.
_________________________________________________

As a new nurse in 1976, "bullying" was just part of the deal. An expectation. A rite of passage. I just sucked it up and kept my head down. 

My first bully was my Nurse Manager. She would regularly berate and belittle me, using my peers and patients as her audience. On one occasion she called me out of a patient's room in order to critique my nurses notes. Bombarding me with unrelenting interrogation and petty questions, I started to cry. It just added more fuel to her fire. A doctor stood up and said "Stop!" then asked me to join him in the dictating room so that I could collect myself. I did. And she was furious. I later received a written counsel for 'not supporting management'. I resigned after one year. Upon receipt of my resignation she said, "Oh Joan, I'm sorry you're leaving - you could have been one of 'my girls'".
Ick. No thanks.

_____________________________________________

Managers 'Bully' by...

  • Public Discipline
  • Threatening Consequences
  • Playing favorites
  • Withholding information
  • Setting one up to fail
  • Verbal Harassment
  • Unfair evaluation
 The Manager Bully - The main and the foremost purpose of bullying is to hide inadequacy, incompetence and inefficiency. Bullying has nothing to do with managing etc; good managers manage and bad managers’ bully. Management is managing; bullying is not managing. Therefore, anyone who chooses to bully is admitting their inadequacy and incompetency, and the extent to which a person bullies is a measure of their inadequacy.—Himachali
________________________________________________

Ten nursing-years later, improved coping skills were developed including befriending like-minded peers, partying like it was 1989 and 'blowing off' the bullies. In this case it was a very bright ER Nurse who was the Nurse Manager's 'go-to' girl. I was the new kid and she smelled blood. To me, she was consistently angry, flippant and sarcastic. To others, she was intelligent and all-business. Her bullying was directed towards my inexperience in ER Nursing. She would critically assess my nursing care - in front of the patient - and would find fault in anything from the way I might have secured an IV to how I would apply a sterile dressing. All inadequacies were reported to the Nurse Manager as well. I dealt with this by forming close bonds with other nurses and creating a social circle that collegial and fun. I blew her off. It was how I coped. One afternoon, I received a hemorrhaging patient - after working diligently to save this patient, I heard 'Miss Priss' grunting about how shitty my care was, her audience was the Nurse Manager and a couple of his minions. It was then that I spoke up and told my offender to... "Go Fuck yourself". She, in a fit of fury, stormed out of the department and went home. That same afternoon I was counselled for "unprofessional conduct".  It happens.
____________________________________________

The Queen Bee - According to Cheryl Dellasega, a psychologist and professor at Penn State University, Queen Bees are the top of the bullying food chain.  They tend to describe themselves as take charge, having ultra-high expectations of others. They appear on the outside to have it all together. They fail to consider the consequences of their verbal grenades or sabotages. They are really very insecure on the inside, and feel threatened by other women in the workplace.Queen Bees who end up in positions of authority tend to feel they must be in control at all times. They intimidate through belittling, display arrogance and see themselves as being above the rules. They may single out only one individual at a time, making it difficult for their superiors to see what is happening. They have an uncanny knack to look good to their superiors. They also tend to feel very threatened by competent subordinates.
____________________________________________

Twenty nursing-years later my improved self-confidence helped me discover the 'silver-bullet' for dealing with bullies. Simply confront the behaviour. Privately and professionally. Who knew? The days of... "Go Fuck Yourself" had been replaced by "I want you to know that the way to spoke to me a few minutes ago was offensive and disrespectful". That was it. Do it quick. Soon after the event. Then get over it. The bully expects never to be called on their behaviour, especially in an adult manner. They assume you are going to "stir the pot" and gossip about the event. Don't do it. Every bully I have had the opportunity to confront - backed off.

Doctors are tricky. It's tough confronting them. But I encourage you to do it. They are just like everyone else who has a self esteem problem except they have MD behind their names. If a private and professional confrontation doesn't feel comfortable to you, ask for a meeting with your nurse manager, the physician and his/her director. I did this on two occasions and found that communication improved dramatically.

Needless to say, I don't have all the answers. I'm hoping that bullying will be eradicated in the workplace one day but unless we have zero-tolerance to bullying behaviours, I doubt that will be the case. So for now...hang in there and good luck! I hope this helped to shed a little light on such a dark subject.

Have you been bullied? I'd like to hear your story...


PTSD and the Trauma Nurse: Now What?

Tuesday


[Love these Trauma 'Meerkats']
Despite spending 25 years of my life in Emergency Departments, it seems strange to me that I have trouble recalling the horrific injuries and events where I delivered care directly. And that is probably a good thing.

I do remember coming on shift one morning and learning that the night crew worked to save the lives of a mom and her two little boys following their vicious stabbing. The boys died.

I was met with incredulity when I asked ..."So why didn't anybody call us in?"

Part of what makes a good ER Nurse great is to "never letting them see you sweat" and being proud of it. Keeping your cool is extremely important and I totally support that - but after witnessing the violent deaths of a 5 year old and 7 year old, I'm thinking that maybe - just maybe - these nurses, techs and docs should have had every effort made to relieve them of having to care for the yeast infection or snotty nose down the hall.

Call me a bleeding heart but I have never forgotten the nurse who came to me that morning, recounting all three stabbing victims arriving simultaneously around 3 am. CPR in progress on the two boys, their Dad pacing the corridors of the ER, their mom, alive but seriously injured. The chaos that ensued and then wrapping it all up by reporting off on the other patients that remained in his care.

Police, Firefighters/Paramedics who responded to this event were all taken 'off service' following it.

No one was called in to relieve the ER staff.

I 'get' that in events such as these, the last thing on the minds of ER nurses is to have someone come in to take care of them. But I guess what I am suggesting here is that it might be a good idea to have a plan in place - in the event that your ER staff might really need to be cared for. Would you have a problem with coming in early or on a day off to relieve one of your peers after such a traumatic event? I didn't think so.

There is nothing like ER Nursing. But we could use some adjuncts for ourselves to stay healthy.

Therapy:

It helped me. No - I didn't talk about the blood and guts but I did learn techniques and strategies to help deal with my trauma. Therapy is something to think about - especially if you are experiences panic attacks and/or self destructive behaviors - you know what they are.

Creative Visualization:

Years ago, I read somewhere, something about Creative Visualization.
It takes about as much time as it would to take 5 deep breaths. I've practiced this technique for years and I'm sharing it with you because it really seems to help... especially when you are feeling particularly overwhelmed, negative or angry. You can do it behind a curtain, in a bathroom, in the med room, anywhere.
Close your eyes and "visualize" or imagine the color pink (or purple, or blue ...whatever brings you peace). Breathe the color in through your nose. Visualize the color entering your lungs, exchanging into your cells, travelling down to your fingertips and toes. Now exhale forcefully. Visualize cleansing black soot releasing from your body and coming out of your mouth and nose.

Instant "Attitude Adjustment". I swear.

Meditation:

I attended a conference recently where Dan Harris presented his take on Meditation after experiencing a live "on air" panic attack... This 13 minute video is worth your time.

Meditation? The way I look at it... can't hurt - and might help.

PTSD and the Trauma Nurse

Sunday

[Credit: Getty Images]
Trauma Nursing was my thing and I was really into it.

Gunshots and stab wounds? Broken bones and collapsed lungs? Bring it on! An adrenaline junkie for sure and proud of it. My life as an ER nurse was entwined in that sort of thing and I had very little time or patience for those who just didn't 'get it'. My friends were ER nurses, techs, docs, RT's, ER clerical staff, cops and firemen. We spoke the same language and I really wasn't interested in developing relationships with 'outsiders'. No need to measure my story-telling with them, nothing could gross them out. I worked hard, partied hard, smoked like a freight train and fastened my seatbelt only after witnessing dental trauma of those who chose not to. I was young and indestructible. And totally desensitized.

My 'cold, hard slap in the face' came when a dear childhood friend (after being regaled by my bloodiest and guts-iest and coldest stories of the ER) said..."Joanie, what happened to you? You sound like you couldn't give a shit."

Thanks. I needed that.

Ahhhh, and that was why 'normal' people and their trivial complaints pissed me off so much.

So, I gave my head a shake, re-evaluated my trajectory in life and took an opportunity that presented itself in corporate America as a Clinical Educator with a manufacturer of bedside monitoring systems. Nice. I travelled extensively and totally engrossed myself in clinical technology. A healthy change.

When the staff of the various OR's, ER's, and ICU's I visited learned that I had worked in the ER's of Parkland and Baylor, I was frequently encouraged to share 'war stories'.  I choked. Literally. Just couldn't do it.

Then, while on a flight and flipping through a magazine I saw a spread on Trauma Centers. A full page photo of of a Trauma Room - after the trauma - was featured.

Inexpicable. Heart pounding, throat tightening, palms clammy. can't breathe. It got hot - really hot. I turned the fan on above my head for relief. A panic attack? No way. I've been on planes a million times. Closing my eyes, I attempted to calm myself. Slow, deep breaths. Whew. I was OK. Opening the magazine where I had left off... the symptoms returned -with a vengeance.

Therapeutic counseling was in my future.

Post Traumatic Stress Disorder (PTSD) - I had only heard of this disorder when referring to military war survivors. Was I (and so many of my sweet, kind, dedicated nurse-buds) afflicted by it? Who knows? But certainly food-for-thought.

This began my journey into understanding just how witnessing, inflicting and internalizing the pain of so many affected me.

Your 'take-away' here might be to look into PTSD and determine if it affects you or those you love. Treatment for those affected by PTSD? The experts agree that what works for one may not work for others.

Here are some links that you might find helpful on the subject...

PTSD in Emergency Workers
Post Traumatic Stress Disorder
Increased Prevalence in PTSD and Critical Care Nurses
PTSD in Nurses

Namaste.

Our Dirty Little Secret: Lateral Violence

Friday

I wish I could give credit to this artist...
Two years ago, I retired from bedside nursing. My initial anxieties of "what next.?", were soon relieved by sleeping late every day, volunteerism, crafting and oil painting. Ahhhh, Nirvana. A two-year nursing honeymoon period, for sure.

Last week, in an effort to maintain licensure, I attended the American Association of Critical Care Nurses' National Teaching Institute (AACN-NTI) where over 8,000 Critical Care Nurses converged on New Orleans, La.

I chose this conference because I could knock out over 20 CE's in 4 days. 

Coming to terms with recognizing my interests no longer lay in "Advance Concepts in Ventilator Management" or "Cardiomyopathies: Understanding the Complexities of Diverse Diagnosis", I chose to attend classes on topics that are rarely discussed outside of nursing circles... "Workplace Violence: Do You Have A Plan?", "Impact of Moral Distress on Perceptions of Work Environment and Patients Safety", " Bullying: An Unhealthy Intrusion in the Work Environment", "Silence: A Never Event" were just a few.

And I grieved. 

I grieved for the thousands of nurses broken by workplace violence, bullying, lateral (aka Horizontal) violence and workplace violence delivered at the hands of patients. 

I grieved for my oppressed and subjugated peers. I know it sounds bad - really bad - and for so many, it really is - but it's time to talk about it and delve into why it occurs so frequently in a profession that is consistently ranked as the most honest and ethical by the public.

In my twenties, a manager taught me a valuable life lesson ..."Don't come to me with a problem unless you have a solution." So I'm writing about 'our dirty little secret'. Not to 'slam' nurses - but to share what I have learned, if only to begin the uncomfortable conversation and possibly support those who are experiencing the phenomenon and to prevent future pain to those who are on the frontlines of healthcare delivery. 

Incidentally, ER Nurses are subject to this form of violence at a much higher rate than any other specialty.
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25 years ago, Meissner coined the expression... "Nurses Eat Their Young". I disagree. In my experience, many of my peers have a less discriminatory palate and will "eat" anything that has let their guard down (ie: the nurse who has been on their feet for the past 12 hours and too tired to fight) .

I was 50 years old. An ER nurse for 25 years, it was the lateral violence I experienced at the hands of several young ER nurses that helped cement my decision to leave ER Nursing permanently and try my hand in the ICU. Usually, it was non-verbal, eye-rolling and sarcasm during patient-report at the end of my shift that really got to me. Giving "report" became dreaded. Miffed, badgering and nit-picking nurses who would get their egos massaged by trying to prove just how much more knowlegeable they were. It wasn't just one nasty nurse or one isolated incident. It was repeated several times a week. And it got old.

Wisdom told me that the confrontational report had very little to do with me. It had everything to do with them and their perception of themselves and their personal power. But I was getting to old for this shit and recognized that staying in the ER was not a healthy personal choice for me any longer. I transferred to ICU full-time.

Lateral Violence: Definition.

A consistent pattern of behavior designed to control, diminish or devalue a peer (or group) which creates a risk to health or safety (Farrell, 2005).

Some specific examples are:
  • Overt. Name calling, bickering, fault finding, criticism, intimidation, gossip, shouting, blaming, put-downs, raised eye brows
  • Covert. Unfair assignments, refusing to help someone, ignoring, making faces behind someone's back, refusing to only work with certain people or not work with others, whining, sabotage, exclusion, fabrication.  See more at: Break the Spell and End Lateral Violence
My experience was minimal compared to many, and I admittedly did not have the skill set (nor the inclination) that was necessary to deal with the problem. I was fortunate enough to have an 'out'. 

Several years earlier, our hospital offered a 6-week program in ICU Nursing. Although I loved being an ER Nurse, I knew the frenetic pace and physical requirements of the job could possibly be impacted as I aged. Attending those classes and gaining some part-time work in ICU nursing was one of my best career decisions made. My personal ICU nurse-nurse experience was by and large, welcoming, supportive and nurturing. It worked for me. 

But for those of you who can't bear the thought of leaving the specialty of where you work, I have a few suggestions...
  • Consider creating (or joining) a multidisciplinary departmental committee on Healthy Work Practices.
  • Develop a departmental"Safe" word or phrase when you are feeling oppressed or bullied by someone ("Peace").
  • Develop a departmental "Safe" word or phrase when you recognize someone is failing to complete job requirements or slacking (ie: "Dude")
  • Develop or tweak the current "Code of Conduct"
  • Violations in Code of Conduct should include clearly defined disciplinary actions
  • Prepare now for an 'out'. 
Now, take a long, hard look in the mirror. Could you be the problem? Maybe it's time to reflect and regroup.

My own, personal 'Year-of-the-bitch" was 1995. It wasn't pretty. And then I gave myself an attitude adjustment. Why was I such a bitch? Just like the experts say... I was feeling oppressed. powerless and silenced. Simple as that. Fortunately, I (hopefully) made amends to those nurses I may have hurt.If not, I am truly sorry. 


_________________________________

In an effort to promote healthy work practices, I plan on writing about the ways I have learned that we, as nurses can care for ourselves. 

Who knew?

Some of this info I gleaned from the NTI - some I just made up. I hope it helps. I look forward to hearing from you and your experiences in this area as I have learned that "getting your cards on the table" is generally a good place to start when the topic causes discomfort.

Driving in England: Lessons Learned

"An adventure!"
"It'll be fun!"
"A whole lot easier than having to drag luggage."
"Driving on the 'wrong side of the road'? No problem!"
"Hell, I drove in L.A. - what could be worse than that?"
"Maureen (my BFF) drove in Ireland!"

... All were thoughts while making the rental car arrangements for our two-week tour of the English countryside.

We arrived at Europcar and picked up our adorable Peugot at 11am. With 'Mr. Something' behind the wheel, we were on the road within 20 minutes. Our chosen mantra? "Stay to the left, stay to the left, stay to the left". Within 15 minutes it changed to ..."Let's just call a cab to come get us, let's just call a cab, for God's sake, pull over and call a cab..."
Source: AMC
Let me explain... We started our rental car experience in the historic city of Bath and highly recommend Europcar. I booked online and was careful to request a car with automatic transmission - I noticed that the car prices quoted are for standard transmission cars only. The sheer thought of driving a stick in England, using my left hand would be disastrous problematic.

Yay me.

The 'die was cast' however, when the Europcar guy handed me a map of Bath. It was then, that I realized, driving all over England would be a crap-shoot for us. Our car was outfitted with GPS (SatNav) and although we are thankful for that, we really just needed to take the train. That being said, GPS  was our virtual life-preserver.
City of Bath, England
In retrospect, Bath was probably not the best choice when picking a place to start driving in England.

If you look carefully, there are few streets that go north/south/east or west. They're just all over the place. Really.

The width of Bath's city streets originally were made to accommodate horse-drawn carriages. Metal barricades were plentiful and in place to prevent innocent pedestrians from getting run-over. 'Roundabouts' common circular traffic intersections failed to make sense to us. Familiarizing ourselves with U.K. traffic laws was purely an afterthought...

A perfect storm.

So, after our initial terror had subsided and we had traveled in the completely wrong direction, circling Bristol a couple of times,(and God only knows where else) our 1 hour car trip had turned into 5. We finally made it to Stonehenge - amidst flying expletives - only to learn that it was 4:05 pm and Stonehenge closes at 4:00 pm.

I needed a drink.

Mr. Something explained to the guard that we had traveled soooo far and were leaving the next day... She caved and told us we could "park and walk about 3/4 mile through 'the pasture' to take a look". After our lengthy drive, we looked forward to the exercise.
I had no idea we would be on the cow's turf.
(City-girl)


Excuse us...
Stonehenge
So, after viewing the famous rocks ... my offer of driving back to Bath was quickly accepted by (the rattled) Mr. Something and we were off. Being aware of the 'roundabouts' and having devised a plan to "just-hug-the-inside-lane-and-keep-circling-until-we-see-our-exit", our trip back was less trying... with the exception of my hitting a parked truck with the Peugot's left side-view mirror.

It was just a flesh-wound.

Lessons Learned Driving in Britain:

  1. Get online and review British Traffic Laws and signage before driving in the U.K.
  2. Request Automatic Transmission. You might have to pay a little more but it's worth it.
  3. Stay to the Left.
  4. Following the car in front of you really helps.
  5. Be aware of the left side of your car. It's really easy to hit things (cars, people, buildings etc.) Just sayin'.
  6. The Highways in the UK are great. When in doubt - find a highway and get on it.
  7. Eating and smoking while driving is illegal in England.
  8. A GPS/Sat Nav is priceless.
  9. Carry plenty of change for parking.
  10. When entering a traffic circle - hug the inside lane and keep circling until you find your exit.




Paranoid in South America

Anticipating travel to South America was both exciting and scary. Admittedly, reports of muggings, kidnappings and police corruption go...