The Tea Room
Welcome to the Nurses Station Blog. An opportunity to have a say about things affecting you. Email us on [email protected] if you have a burning issue you want to talk about. We'd love to publish you!
From The Nurses Station Team: Teniah, Anne, Anita, Melissa, Maddy, Lisa & Jill
|Posted by Teniah on August 2, 2015 at 12:40 AM||comments (0)|
Sometimes nursing is a thankless job. Management does not always acknowledge how much of ourselves is poured out to care for the clients we nurse. They very likely do not even know you by name. Depending on your specialty of practice you may work with clients who despise the role you play in their recovery, resent your very presence, or simply are oblivious to what you do to support them. Nurses at times are called the most horrible names imaginable, spit upon, abused, and disregarded...It is not all bad news though, friends...
Let me take a moment to really encourage you and remind you that the love and generosity shared with those around you is NOT unappreciated or unseen. Your choice to serve others – in particular those who are very difficult to care for – is valued. YOU, my fellow nurses, are truly a remarkable bunch of people.
While you may not hear a “thank you” at the end of that rough shift – when you haven’t had a break for hours and your head is splitting and your blood pressure is raised. Write it up on your wall at home, or put it in a special place where you can look upon it at a time of need. Be reminded that “You are making a difference. Your kindness and understanding towards others is appreciated. No matter the circumstances surrounding you; you are enough.” (Or something along those lines...something that helps you to feel appreciated.) In this present moment, your efforts matter, and will have a positive effect on the nurses coming behind you on the next shift.
While upper management and clients themselves may not always voice their appreciation or even acknowledge who you are... As a nursing team, let’s take a moment to really remind one another of our value as a whole; our value as a team. Together we do make a difference. While nursing can at times feel like a truly thankless job...Let me be the first to say that I truly appreciate each and every one of you. I appreciate your courage, your commitment, your patience, your values, your dedication to the profession, your team work and understanding towards one another, and your kindness and generosity towards your colleagues and your clients. Keep up the good work, and let’s make the culture of nursing one that recognises and appreciates one another.
|Posted by Teniah on May 14, 2015 at 11:55 PM||comments (0)|
A common thread of “needing to find balance” has been a topic of discussion among young nurses and new graduates across all fields of nursing. Finding work/life balance is particularly hard within that first year of nursing practice, but I believe that this “tug of war” between what we would “like” to be doing with our lives and reality, actually continues throughout the nurse’s career. The nursing profession requires that we always seek to further our knowledge and improve our performance. This, obviously, requires continued education and taking time to self-reflect. While I am no expert, I will take a few moments to discuss what I believe are some helpful tools in establishing this work/life balance. In learning how to manage this balance in our own lives, we will then be better equipped to give of ourselves to others.
Mindfulness is something that is relatively new to nursing research, but an art that has been around for centuries. I would suggest that actually mindfulness could be the missing link in the chain of balance.....Perhaps if we could find a way to increase our ability to be present, we could better attend to each task at hand, and then when finished, we could put that task away and move forward with the next thing.
Mindfulness is essentially the skill to recognise thoughts and feelings in the moment, acknowledge them, and then let them go. It is not about getting anywhere, or achieving anything. It is often referred to as a “non-striving” mode. Mindfulness allows you to be aware of your thoughts and feelings and find compassionate acceptance of them.
I believe that practicing mindfulness could impact a whole number of areas within nursing that most of us struggle with: not enough to time to spend with patients, managing relationships with our colleagues, separating our emotions and the experiences we listen to as professionals, setting boundaries between work and home. Those are just some examples that many young nurses have voiced. I actually believe that if we could learn the skill of mindfulness we could be more present with our patients, offer more compassion to our colleagues, improve the skill of emotional intelligence, and find true BALANCE in our own personal lives.
I used to think that when I graduated nursing school the whole drama of having to work full time and study was behind me....I used to think that I had graduated and would have plenty of time now to develop a social life, volunteer in my community, and actually RELAX – much like the Tui add, the reality of that is...“yeah, right!!”.....Finding time to have a movie night, play games, read a book, paint, or sit back and listen to music, is actually a real struggle. I don’t think it is just me, I believe it is a struggle that all of us face, whether you have been nursing for one week, or for decades; the struggle is still there.
I am by no means an expert and I am still developing my own personal strategy for finding balance. However, these are the things I have found most helpful:
1. Practice loving kindness meditation (It only takes about 10 minutes, helps promote good sleep, and allows you an opportunity to compassionately reflect on those whom you have crossed paths with).
2. Positive self-talk and self-awareness – At the end of your shift, reflect on how the shift went, and find something positive that you can take home with you. It could be that you encouraged someone, helped out a colleague, dealt with a difficult situation well, or had good time management. Whatever it was, feedback that positive reflection to yourself. I personally believe that self-awareness is one of the keys to effective and safe nursing practice (but that is for another blog!) This opportunity also gives you the chance to leave behind any negative feelings or words that were said to you on shift. Be mindful about that experience and how it made you feel; then let it go.
3. Roster time for you – I know that sounds silly, but I am a diary person, and I have pretty much every hour of every day booked out. So, I actually roster myself time. I circle a couple of hours per week that are totally MINE. (At least once a month I devote an entire day– this might include time with a friend but the focus here is on having FUN!) It might mean that I have to turn down doing a favour for someone else, but it means that I can re-charge and have the energy to give 100% to the tasks that are important to me.
4. Exercise – Going for a walk/run directly after work allows you a chance to unwind before moving onto the next thing. Exercise does not always mean sweating! Yoga is another form of stress relief/relaxation that I am a huge advocate for. I will not go into all the positive effects of yoga, but it is sufficient to say that it is a life-changer.
5. Boundaries – Set clear boundaries for work and personal life. Where possible, don’t hang out with work-mates after working hours. I’m not saying you shouldn’t appreciate the team-building lunches or opportunities to get together, but where possible, it’s best to develop relationship outside of work. Join a sports team, knitting group, singing club or whatever you are interested in. Make friends with people who share other things in common that you enjoy besides nursing. (This hugely promotes balance, and prevents burn-out.) While we all love our profession, we are complex people and we are so much more than nurses......don’t be afraid to pursue the other things in life that you love, and that make you happy!
6. Supervision – I’ll talk more about Supervision in another blog, but if you have not hooked up with professional Supervision, Workplace Support, or some form of debriefing/reflection, I highly recommend it. This is a healthy nursing strategy to find balance in your life, and to improve your nursing practice.
Balance is not something you find, it is something you create ~ Get creative and find what works for you!!
|Posted by [email protected] on May 14, 2015 at 4:00 PM||comments (0)|
By Judy Hitchcock
International Nurses Day is here again, 12th May already! This year is flying by: it hardly seems any time at all since I wrote about the motivational promotional material provided by the International Nursing Council last year, inspiring us with the slogan:
NURSES: A force for change – A vital resource for health.
I was rather pleased to see that the slogan has not been changed but expanded upon to focus on the most challenging aspects of delivering health care, that being the cost.
It’s a topic that is close to my heart and many of my peer group. Only yesterday, I shared on Face Book this poignant quote from a Canadian ER nurse who posted on Kevin MD .com ‘The issue boils down to whether the healthcare industry can tolerate highly educated, vocal , critically thinking, engaged nurse collaborators who, in the interest of their patients will constructively work with- and challenge , if necessary-physicians and established treatment plans. Or does the industry just want robots with limited analytical skill, who blindly and unthinkingly collect vital signs and carry out physicians orders? More importantly, which model presents the best opportunity for excellent patient care?”
Within a few moments the replies started pinging back; a sadly overwhelming opinion that the cheapest model of care already prevails, with jarring undercurrents of cynicism, stating that Western medicine is just big business; a perception that the nurse and the patient have just become part of the process to throughput the client as cost effectively as possible; with no care for nurses who are being asked to undertake more with less. It could be argued that morale is indeed in need of a massive shot of motivation and passion.
The fact that the cost of caring has been highlighted as a responsibility that we all share, to balance effective caring against the cost of providing that care; is a challenge not just for the coming year but the foreseeable future. It is right up there on the electioneering political agenda, with the twitter feed buzzing with how to not just fund the NHS but to improve service delivery. It is of great interest to us all because the latest trends and models of care in the UK follow suit here, irrespective of cultural and demographic influences. The important fact to remember is that health delivery is not a one size fits all. What works in the metropolitan areas does not necessarily work in the rural, so applying state wide standards is going to be contentious. Is it any wonder “The way we do things around here” still prevails; because it certainly does; primarily held in check by an aging work force who are the custodians of that very mantra; but by the same token they are holding many health services together.
It’s not just radical changes that need to be addressed; inefficiencies, poor communication and mismanagement could save the health service mega bucks by simple measures, such as basic stock control: not so tight that one extra admission requiring antibiotics puts pressure not only on ward stock but also the “after hours” supply, and not so loose that veritable condiment mountains can be found in some ward kitchens, with enough jam, vegemite and honey stored to feed an army! There are some places that I have worked in Australia that are ‘the place to go to’ should you find your own supplies short changed; sock rooms and store rooms positively bursting with supplies, whereas in NZ it’s very different. We have been watching our budgets so tightly for years; nothing ever has a chance to reach its use by date!
Last year, at the neonatal nursing conference in Christchurch, NZ, keynote speaker, Philip Darbyshire, Professor of Nursing and Global Health Care consultant, encouraged all nurses not to rest on our laurels but to be more proactive in redefining the role of the nurse, to practise articulating the difference we make is providing care, not just undertaking tasks. We should all be able to easily describe what we do all day, why we do it, how we could do it better and be crystal clear in knowing why what we do makes a difference, as opposed to anyone untrained undertaking the role, let alone robot care givers being currently researched.
In order for this to be fully appreciated by those holding the purse strings, caring must be described in cost effective terms, not woolly, emotive descriptors. This is probably the most challenging aspect of engagement in the process, to be objective and business minded whilst paradoxically extolling the virtues and financial benefits of caring. It must be seen as fundamentally essential to the patient recovery providing “Optimal care at an affordable price”. It is a complete U turn to the current perceptions that the care factor for patients and nursing staff is too expensive. It is a skill to be able to articulate the benefits in terms that are of interest to the accountant, who will be delighted that the cost of the patients stay was reduced but not necessarily because the patient’s recovery was improved by being nursed at home.
That old maxim ‘Time is money’ prevails and how we best use our nursing hours is being recorded on trend care to predict effective patient acuity with nursing skill match. It is therefore essential that we not only fully engage in understanding the cost of caring but can articulate the savings to those looking at the f shaped curves on important graphs and wanting to improve the budget by cutting costs. We also need to take courage and look at ways we could do things more cost effectively, ergonomically and efficiently. We need to think outside the square and bravely challenge the way we do things, asking is there a better way to do this? And that is not easy, especially when entrenched practises and personalities dictate work culture. We need to stop blaming the culture of the establishment for stifling motivation because each and every one of us is the culture and responsible for the culture we accept. It is well known that ‘culture eats strategy for breakfast’ and yet paradoxically, we all want to be part of a culture that is dynamic, motivated, supportive, receptive to innovative ideas, caring about nurses as well as those whom we care for.
Service redesign needs to be done skilfully to retain the very best attributes whilst improving cost effectiveness and meeting targets, be they waiting list surgery, emergency department wait times and length of stay. In theory it sounds achievable but budgets are blown by ever increasing variables; that is the unexpected nature of un-wellness. I think there should be more money invested into wellness in the first place but that’s a whole new topic and debateable on many levels.
Neonatal care is notoriously expensive and there’s plenty to debate on how cost saving initiatives can be implemented when research is slow to have impact in the work place. One really exciting area currently being trialled in Canada, Australia, and NZ is Family Integrated (FI) care where parents care for their own infant under direct supervision and guidance from nurses. The pioneering research was originally shared at the Belfast conference in 2013 by Canadian researcher, Professor Shoo K Lee, neonatologist and Paediatrician-in-Chief and Director of the Maternal-Infant Care (MICare) Research Centre at Mt Sinai Hospital and showed encouraging results. Outcomes were much better, family unity and bonding improved, cross infection dropped, iatrogenic infections reduced, drug errors were minimal, breast feeding success increased and length of stay reduced. Literally a win, win, win outcome! Win for the baby, win for the parents and win for the hospital with overall cost of care in the short and long term reduced. We need more outside the square ideas like this, often originating out of necessity which, after all, is the mother of all invention.
The International nurse’s day kit provides extensive, positive promotional material, motivating us to actively engage in policy making whilst preserving the x factor, that care factor that makes a registered nurse essential in the goal for improved outcomes in health delivery. It is well worth reading and being inspired to think outside the square. As Florence Nightingale said…..
'Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back' – Florence Nightingale.
|Posted by [email protected]l.com on March 22, 2015 at 2:45 PM||comments (0)|
Young Nurses’ Opinion: Pay Differentials And My Future In Nursing.
by Jed Montayre
The issues surrounding pay differential between nurses and management brings heated discussion among individual nurses who feel that fairness does not always exist. The generous pay rises received by top management personnel in comparison to what nurses are getting, receive criticisms in the context of pay equality and reflect on the value of what nurses do as part of an organisation.
As a young nurse, knowing about these issues made me think about my future. I always see myself to be a nurse with specialist skills in the future or perhaps to continue nursing and be an expert in this field or to become a good resource for new nurses. But these thoughts somehow change when I come to think of how nurses’ compensation gets “disregarded”, despite experience, long–term service or expertise. The term “disregarded” may mean to most nurses as not being paid reasonably and I do agree with that, but in this case, I want to refer to this as an implicit reflection of how management views nurses and our representation in the business side of things ---“nursing is a cost”, and therefore preventing further cost is necessary. No wonder we don’t get generous pay rises and pay differences between nurses and managers are worlds apart, because putting more pay and money into nurses means expanding costs.
I remember Maslow’s Hierarchy of Needs, and I relate this to what motivates every individual to live and continue living, which is also the same for nurses to continue nursing. The hierarchy starts from the very basic needs to be fulfilled such as food, water etc. and progresses into more complex and abstract needs. The last step of the hierarchy is the concept of “transcendence”, which simply means one person’s ability to help and nurture others. This is achieved when one person has fulfilled the previous physiological, psychosocial needs in the hierarchy. In reflection, this is what nurses do everyday, nurturing people, extending wisdom, providing health teaching and with selfless thoughts. These could be considered as an extreme form of transcendence, despite the tight conditions with regards to pay, missing out on family activities due to shift work, altered sleeping cycle due to shift changes and many more, which would normally affect an individual’s fulfilment of physiological and psychosocial needs if we think the same way as Maslow.
Maybe because nurses cope well in many different difficult situations, this means we can handle and still do the job without even looking at some of the gaps that should have been filled up and allows us to maintain our motivation to continue nursing, because firstly it provides us enough financial resources to seek further self advancement to achieve that feeling of self-worth and be able to share and nurture other people. But because nurses feel disregarded, the next question might be, for how long will nurses continue nursing?
If other career pathways offer better options in fulfilling our hierarchy of needs and nursing does not guarantee this, I think sooner or later we will appreciate the very nature and the humanness of our existence - and that is to seek brighter options that could benefit both our personal and professional lives. This results in nurses leaving the profession especially for young nurses like me.
My point in here lies on how these issues impact on young nurses as they plan their careers in the future. Maybe when one is asked where he or she views oneself ten years from now, we are likely to receive an answer like this:
“I always wanted to become a nurse specialist… But actually…maybe I really want to be a CEO”
|Posted by Lisa on November 26, 2014 at 4:20 AM||comments (0)|
There has to be a first for every new nurse, the first medication error, the first fall on your watch, the first needle stick injury.
Does the first mistake of your career almost mark a milestone in your graduate nursing evolution?
I questioned why I have suddenly started making mistakes 9 months after commencing the job, when in reality, I have made mistakes all along the way. Now the level of responsibility is rising, the new mistakes have more consequences than the old ones.
When we chose to become nurses, we chose to take on a tremendous level of responsibility, large workloads and multiple demands. This teamed with being new to the profession sets the scene for mishap. In my case it was a port de-access, everything was laid out in front of me, the saline, the heparin, the dressing, a three step process, yet I de-accessed the port, completely neglecting to heparin lock. I knew it had to be done, I just didn’t do it. I was too busy chatting to my adolescent patient about Game of Thrones to be concentrating on the one thing I had to do.
The mental punishment I self-inflicted over the next few days was enough to be carcinogenic, I spent my nights reliving it in my head - the look on this needle phobic boys face when he heard me say I would have to reaccess the port…. It was enough to make me quit nursing, run away and change my name. Fortunately we could remedy this mistake; I tried telling myself I was lucky for the fact; however it didn’t make me feel any better. At the time I was so afraid my colleagues would think less of me for it. Now I’m so convinced everyone make mistakes, I’m willing to share my shame.
It shouldn't have been a surprise to me, but I actually work in an error tolerant workplace, where incident reporting is used to squeeze all the information out of you so that others may avoid repeating your error. Similarly, around the same time it was observed that Lignocaine and Heparin plastic ampules (both housed on the CVAD trolley) look similar, an easy mistake to make with unfavourable consequences. The Clinical Educator who observed the potential issues has learnt to become wary from her own error history – thankfully incident reported, crisis averted, safe heparin for everyone!
So Mistakes can be a humbling experience, helping one to realise their practice will always evolve and reiterating the importance of reflection. We will make mistakes, the reason there are so many policies in place to manage risk is that nurses before us have too made mistakes….. we are human after all. It is only because you care that you punish yourself more than anybody else, realising your mistakes, learning from them and helping others to prevent repeating the same, is what makes a good nurse.
|Posted by [email protected] on October 28, 2014 at 4:20 PM||comments (0)|
The current Ebola outbreak in West Africa raises some very curly questions amongst health professionals – nurses in particular. Nurses (and other health care workers) are the most likely to care for Ebola patients and therefore most likely to be exposed to the virus and most likely to contract it. Over 150 health care workers have died from the disease in the current outbreak with infection rates twice this number. The main causative factor is a lack or inadequate use of personal protective equipment (PPE). Of the few cases in the United States, two were nurses who cared for a patient who died from the disease.
Despite these cases among health care workers, effective use of appropriate PPE and good infection control precautions diminishes the risks to virtually nil. Organisational preparation and training in anticipation of any cases in New Zealand is well underway and now would be a good opportunity to hone those PPE skills.
What we have to realise though, is that the risk of any cases of Ebola arriving in New Zealand let alone anyone here contracting it is low. And if it does, nurses will be well prepared to handle it. What we should be considering is how we as a group of health professionals can support those already suffering the effects of the current outbreak. There are already a number of New Zealand nurses who have travelled to West Africa to provide care, and many countries are providing support for failing health care infrastructure as a result of the outbreak. New Zealanders are also at the forefront of efforts to diagnose Ebola early, resulting in earlier treatment and containment.
Nurses should be advocating for our government to step up our international response to the outbreak – what resources have we contributed as a country so far to help prevent the spread of the disease and care for those people suffering from the virus? Just because we are a small country in a remote corner of the South Pacific doesn’t mean we shouldn’t support the international response to Ebola. A small team of government supported, highly skilled health professionals may well be of use in relieving already exhausted health professionals or providing training for locals in the use of PPE. Sanitation and infection prevention are essential. With our new role on the UN Security Council, New Zealand should be at the forefront of the global response to Ebola in order to prevent its spread and relieve the suffering of those in West Africa. Even using agencies such as the Red Cross and UNICEF who are already providing support would give the NZ government and public the opportunity to contribute.
Come on New Zealand, step up!
|Posted by Teniah on September 29, 2014 at 3:40 PM||comments (0)|
The topic of emotional intelligence has come up multiple times in my journey through nursing school and into the "real world" of nursing. When the topic was first mentioned to me, I had never heard of such a thing before, and really never considered the need to become competent in this area.
Emotional Intelligence, essentially, is the ability to recognize your own feelings, emotions, and responses, as well as those of others. Now, we recognise these emotions in different ways - some people journal, some people simply contemplate, and others discuss with trusted mentors/supervision/work place support etc. The importance in understanding where we are at in our own lives allows us to more easily interpret the emotions and responses of the patients we work alongside. It is easier to help our patients find strategies for coping that work for them, if we have first acknowledged and recognised our own strengths and abilities to cope. Nurses cannot relate to patients and help them if they are themselves in an emotionally unstable place.
One thing that I have noticed in my own practice, is that in order to truly develop a therapeutic relationship with a patient, I must be able to differentiate between my own thoughts/emotions and the situation. I have to be able to know what I think and believe about myself and yet not push my own thoughts/beliefs onto my patient. I have to be able to recognise that my patient's strengths and ways of coping will be different than my own. In my experience this ties into the idea that we all possess a "shared humanness". While we share a lot of the same emotions, experiences, desires etc.; each one of us is unique and individual. While we all have different strengths and ways of coping with the challenges of life, we all still share the experience of being human. Therefore, we can offer each other grace, knowing that we are in many ways the same.
A patient's journey can be made easier by having a nurse who will walk alongside them, who understands that human experience. A nurse who has themselves faced challenges and experienced a range of emotions. A nurse who can relate to them, but also recognise their uniqueness. It takes an emotionally intelligent/competent nurse to do this. It takes someone who has explored their own thoughts/beliefs. Someone who is not only able to recognise their own strengths, but can also recognise the individual strength of their patient.
I encourage you to take some time out this week to look at your own life closely. Explore your emotions, begin some reflective journal writing, or meet up with a trusted mentor and talk about what you are experiencing in your own life. When you are interacting with your patients, take some time to get to know who they are as an individual - what makes them tick, what is important to them personally, what are their individual strengths.....These are the building blocks for empowering them to be fully engaged in their own recovery process.
|Posted by Teniah on August 26, 2014 at 8:30 PM||comments (1)|
I have had many recent conversations with young nurses from my graduating class, as well as the new graduates who joined our nursing team in January, about the process of building confidence in nursing practice.
It would seem that for many, confidence is something that progressively builds over time. As our skills, knowledge, and experiences increase, we become more certain that the decisions we make are indeed the right ones. We learn to adapt more quickly, and to trust our instincts. For me personally as a new grad, I found that it took several months to really feel that I could trust my instincts and my decisions and stand strong in advocating for my patient's care and for the decisions that I believed were the right interventions for my patient. I would say that there was probably a significant jump in my confidence at about five months into my nursing career. I felt at that point that I had learned to trust myself a bit more, and had gained valuable skills and experiences along the way.
At our DHB, the new graduates do a department switch at six months. This meant getting "knocked back" a bit with my confidence as I was then in a completely new environment and relying on skills and judgment that I had not yet developed. I found, however, that this time around my confidence grew faster and within a few months I felt much more capable. In talking to others it would seem this is a common theme.
For me, I have found that confidence is something that grows (almost in a step-ladder type of fashion). It builds on the experiences and skills that you gain as you continue your nursing career. I say this to really encourage those young nurses out there who are starting out and are only just beginning to realise your potential within the nursing team. Remember that it is a process. It will come with time. Offer yourself the grace to recognise that it will take time to build the trust in yourself, and for the team in which you work to trust your judgment as well.
It has also been my experience that the team you work with can either build or break down your confidence depending on how they respond to your nursing practice and your suggestions for patient interventions and care. Working with a nurse who is demoralising and cuts you down every moment of the day, can really make you feel small and insignificant. It can be extremely hard to build your confidence in this circumstance. On the contrary, when someone encourages you and says that you have made the right decision, it can do wonders for building your confidence and your trust in your own decision making. I would like to challenge you to be type of nurse that lifts others up. Be the one who helps to build other's confidence by offering words of encouragement to your coulleagues. (Especially the young nurses and student nurses whom you might be working alongside).
I am moving into a new role next week, and will once again be starting off in an area where my experience is limited. As I embark on this new journey, I am aware that at first my confidence may "take a hit", but through my past experience I know that it will quickly build back up again. I am encouraged by this, and do hope that I will be lucky enough to be supported along the way by my coulleagues. We can only hope that if we give good out, we will have good returned to us.
~ Be the change you wish to see in the world.
|Posted by Lisa on August 20, 2014 at 10:00 PM||comments (4)|
I can still remember the excitement I experienced when I opened that email stating I was chosen for employment on the Gold Coast, I leapt out of my seat and ran down to the hotel where my fiancé was working, not forgetting, but ignoring that I was wearing pyjama pants with imminent rips in the backside, impatient to express my delight!
Everyone was supportive, if not a little surprised, only months earlier during a pep talk on our first day back of the third year of nursing school; the students and I were informed that not only New Zealand was facing a job shortage, but Australia was also a doomed destination, with no interest in New Zealand graduates, due to their own influx of new RN’s. I must have done something to stand out, 1500 applied for 300 jobs at the Gold Coast University Hospital last year. It could have been my dry kiwi sense of humour, slightly above average GPA or my efforts to attend a very distant interview, but I am now lead to believe the panel looked upon my volunteer work with St Johns Ambulance favourably.
Obviously it wasn’t all holes in pants excitement; I had work to do… I was going to nurse children; this was a placement I hadn’t experiencing throughout nursing school. What are their normal ranges? Am I confident with weight based dosage calculations? HOW DO I CHANGE A NAPPY?!
While my tertiary education delivered most of the clinical skills necessary to survive in this profession, nothing could prepare me for the ‘hit the ground running’ mentality that is life on the ward. Especially the Children’s Ward, it takes at least double the time to do anything with an infant as it does an adult. Every medication, despite its class, is independently double checked by another RN, and instead of having a separate neurological, respiratory, oncology, orthopaedic or colorectal surgical ward; all the various conditions in these tiny humans are placed into the one area.
Initially I was overwhelmed, and if I had been asked to write this blog 4 months earlier it would have consisted of hysterical sobbing, self-doubt and repetition of the phrase ‘oh god’.
It is fair to say I was a nervous graduate, I suffered many sleepless nights considering the various ways my patients could crash the next day, I would get home from work only to torture myself with thoughts of tasks I may have done wrong, ‘what if‘, ‘did I remember to’, ‘was that right?’
This went on for at least three months, until that highly anticipated time, when all experienced nurses told me that it would just ‘click’, and it did! Suddenly my time management was to a point that I would actually leave at 3:30, I felt satisfied with the job I had done and was able to leave work at work, I stopped dreaming about the patients, and started trusting that when I handed over to the next nurse they would actually be okay.
While determination replaced melancholy, it wouldn’t have happened without the support of those around me, I had compassionate Clinical Facilitators on the Paediatric Ward and a team of New Graduate Facilitators who visit every second day, a sympathetic mentor who has worked in the same area and who could understand my fears and tell me I was actually normal to have them, and friends both here and in New Zealand that were going through the exact same stages of the new graduate grief cycle; feeling overwhelmed, wanting to quit, convincing self to go on, and eventually overcoming all fears and doubts, to finally realise the profession is, and has always been what you want to do.
Now when I am preceptor to student RN’s, I tell them not to accept the fear instilled in us at nursing school, I tell them that there will be jobs, to be proactive, to gain as much work experience in as many different medical settings as possible – like the ambulance service. I tell them to apply anywhere and everywhere despite what they are told about ‘the job crisis’ and I speak of the success of my peers regarding those who did not receive new graduate programs and gained fulltime employment as RN’s.
Now when I go to work and am faced with something that scares the ripped pants off of me, like last night nursing a 3 day old under double phototherapy – instead of running and hiding in the sluice room, I think to myself - I will be a better RN for this experience. And at the end of a long, demanding and often disorganised day, what still brings a smile to my face is being able to write ‘Lisa Yelverton, RN’ at the end of my progress notes, because 3 years, $20,000 and several nervous breakdowns later, those are the letters I’ve earned.
|Posted by [email protected] on June 18, 2014 at 8:55 PM||comments (0)|
There has been some comment in the media of late regarding burn out and stress among nurses. This has provoked many responses from throughout the country, many from nurses empathising with the situation and sharing their own experiences of difficult working environments. The issue is that this not only affects nurses personally (leading to sleepless nights, sickness, anxiety, absence from work and in some cases, leaving the profession altogether), it also affects patients. Because when patients are in a vulnerable place and seeking care from competent, professional nurses, but can’t receive that care because there are not enough nurses or their nurses are vulnerable too, then patients health will suffer.
Nurses who are vulnerable, over worked, stressed and burnt out because their organisation pressures them to come to work when they are sick, won’t replace them when they do call in sick, have too many very sick patients to care for, and are just simply unable to provide the best possible care they want to, will ration the care they can provide. And by rationing, we mean they may be unable to help a patient wash, get out of bed, mobilise, drink sufficient fluids, or eat. Sure, the patient will get their medication, their IV fluids will be monitored, any deterioration in their condition will be picked up on, and they’ll probably make it to surgery on time, but they may not recover as quickly from that surgery if they are unable to mobilise, do not drink sufficient fluids or do not eat. The patient may fall when trying to get to the bathroom because they do not want to soil the bed or disturb the nurse because they can see how busy and stressed they are. They may develop a pressure ulcer or urinary tract infection.
So the upshot of it all? A working environment that leads to burnt out and stressed nurses who feel unsupported in their workplaces, will lead to poorer patient outcomes. And there is plenty of research that shows this. For example here and here.
So why is this and what can we do about it. Well, Jill’s blog below on the 2014 budget shows just how financially stressed DHBs are and will continue to be over the coming years. And one of the cheapest ways of reducing costs is to reduce the cost of labour. Who has the highest cost of labour? Yep, you guessed it, nurses. So if we just hold off for a few weeks on appointing to that vacancy, or not replace a nurse or two who call in sick we should save some money. Oh, and if we appoint a less experienced nurse to a position, we can pay them less as well.
Anyway, it’s one thing to moan about it, it’s another to have some strategies to deal with it. First of all, we need to look after ourselves. Here are some tips:
- If we are sick, then we call in sick and we stay home. We don’t feel pressured to come to work because we know we won’t be replaced, because if we do, not only will we make our patients and colleagues sick too, we’re not going to get better either. And don’t feel guilty about this. It’s not your fault you are unwell.
- Check your rosters, make sure they meet the criteria laid out in your MECA. If you’re not sure, check here. Your rosters should be set up in a way that will optimise your circadian rhythms. See the page on our website about shift work as well.
- Look after yourself. Use the Employee Assistance Programme (EAP) to speak to someone independent and neutral. It’s free and these guys have some good tips for managing stress. Let me say that again, it’s free.
- Speak to someone you trust about what’s going on for you. If you can’t use EAP or just don’t want to, get together with someone you trust to chat or with a group of friends and provide each other with some mutual support.
- Find yourself a mentor. A mentor is someone who can often help you see a way forward where perhaps you can’t see it yourself. It they are a nurse they will at least be able to empathise with you! Check out more information on mentorship here.
What about actually addressing the root cause of the problem. Well, this one is more difficult but there are a few things we know work. Here are some suggestions:
- If you are short-staffed at work – fill in an incident report, file it, and follow up on it. Keep a copy. When you follow up, you can take your wad of incident reports with you and ask what is being done.
- Talk to your manager about how you can help implement the core elements of safe staffing and healthy workplaces identified by the Safe Staffing Healthy Workplaces Inquiry (2006) into your workplace. For those of you who aren’t familiar with them, here they are (remember none of these should be prioritised over any of the others):
o The requirement for nursing and midwifery care – including appropriate staffing levels.
o The cultural environment.
o Creating and sustaining quality and safety.
o Authority and leadership in nursing and midwifery.
o Acquiring and using knowledge and skills.
o The wider team.
o The physical environment, technology, equipment and work design.
- Don’t keep your concerns quiet. Talk to your charge nurse, manager, colleagues, member of parliament, NZNO delegate, NZNO organiser, NZNO professional nurse adviser.
- Vote for a government that will recognize these issues and bring about change. This year is an election year so make your vote count.
Well, this is a bit of a rant, but hopefully you have some ideas about moving forward from where you are now.
Remember: you’re a nurse, and you’re a good one.