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3 Small Ways to Bring Mindfulness to the Bedside

Nurses multitask.  We are expected to be flexible.  We accomplish more than any one person should be capable of achieving in twelve hours. We do it all with a smile on our face, at least most of the time.  Behind the smile, our minds our often far from the bedside.  We are thinking about the patient in another room, when pharmacy will tube up the medication that is late, whether our lunch buddy is back from eating, and the charting that needs to be finished from morning assessments.  It is difficult to be truly present with the people that we provide care.  There are many distractions for our attention and energy.  Nursing is also an emotional career.  Supporting, caring and healing people exposes nurses to intense emotion from patients, family and friends of the patient and the nurses own emotion.  Stress, crazy workloads and intense emotions can be huge barriers to nurses having mindfulness at the bedside.

Three tips to put mindfulness in action at the bedside:meditation-clipart-meditation-clipart-animal

 

  1. It is what it is This is one of my go-to-mantra’s.  This is not a surrender to fate, it is an acceptance of the limits of my power as a nurse.  When I truly have done all the intervening and advocating possible, I accept the outcome.

 

  1. Being present Mindfulness requires us to pull up a stool, sit down and be with our patients.  It is letting go of everything else in the world for a small space of time in order to be present.  It is important to connect with each other human to human.  Being present also allows our attention to focus on this patient’s needs, fears, wants and hopes.  Not being present causes errors and decreases the trust from the patient

 

  1. Suspending judgement Being critical of our patient’s actions, feelings, choices or lifestyle prevents us from being present and having mindfulness. It is important to meet people where they are in life.

 

We will not always be able to be 100% mindful as a nurse.  These three tips can help us be more mindful with our patients for their benefit and ours.

 

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at The Balanced Nurse Blog. Find out how to participate.

 

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Nursing is Bigger on the Inside

tardis

 

I love Doctor Who.  For anyone that is not familiar with this British television program, the basic premise is as follows.  There is a cool alien that looks human, but regenerates every few season to look like the next actor to play him.  This alien is called the ‘Doctor’ because no one can know his real name.  The Doctor is a time lord from a planet called Gallifrey and he travels in what looks like an old police call box, much like a telephone booth.  This police box, the TARDIS, takes the Doctor anywhere in time and space, but that is not the only amazing thing about the it.  The TARDIS is bigger on the inside.  We don’t know how big, but imagine the Star Trek Enterprise stuffed into a telephone booth and you get close. 

Nursing is like the TARDIS.  

People think they know about nursing.  The public only sees the outside. They see that nurses work 3 days a week and are paid well. They see that nursing is not a glamorous job. They see smiling faces and skilled hands.  

Nursing is bigger on the inside. 

doctor-who-its-bigger-on-the-inside

A lot of nurses look cute in scrubs, but even those scrubs lose their appeal when they are covered in various bodily fluids.  I am frequently told by family, friends and random strangers that they could never be a nurse.  I get it.  Nursing is not for everyone.  

Some of us do work 3 shifts a week.  Those 12 hour shifts stretch into 14 or 15 hour days when you add in lunch, report, extra charting and commute time.  The majority of nurses that I have known work much more than 36 hours a week.  

For the most part nurses can at least fake a good mood and do their best to smile.  Smiling and chatting with patients they perform the technical skills that keep patients safe and comfortable.  

Nurses need to be smart, caring, brave, strong willed, strong stomached and have a sense of humor.  We see the worst and best of humanity in our work.  We are happy when our patients do well and cry when they are not.  Nurses monitor, clean, feed, medicate, assess, educate, entertain, console, listen, advocate for and document about patients day and night.  After doctors, therapists, family, friends and even dietary leave for the night, nurses remain at the bedside.  

Caring for patients is rewarding, gratifying and exhausting.  To be trusted to such a degree by a stranger is an honor.  Helping people meet health goals or guiding them through milestones is an amazing feeling.  Even when our patients pass away, helping the patient and family through the process is fulfilling.  

Nursing is much bigger on the inside.  It is easy to get lost in charting, policy reviews and quality audits and forget the art of nursing.  Nurses need to be reminded of the amazing impact that we have on peoples lives.  Nurses not only impact health at the bedside, but have the power to transform healthcare practice.  

 

Take time to remember how big nursing is and why you do it. Energize and renew your yourself at the Art of Nursing 2.0 event from anywhere in the world.  

 

 

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This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at ElizabethScala.com. Find out how to participate.

Nurse Blog Carnival

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The Secret Awesomeness of Night Shift

The hospital feels different after 5 PM.  

The scheduled surgeries are finished for the day.  The short stays and clinics are emptied and closed.  Administrators, executives and their assistants all begin vanishing like the sun over the horizon.  The last few tired nurses clock out and the hectic cloud of day shift follows them into the elevator.  What is left behind is an alternate hospital universe that only true night shift staff discover and appreciate.

The bright lights are dimmed to signal to patients, visitors and staff that night has arrived.  The coffee and tea come out to greet the healthcare team to another night.  Some nursing units brew their own caffeinated delights,  others take turns making massive runs to Starbucks, Dutch Bros or another favorite coffee spot.  Patient assessments are completed and medications are passed.  Nurses and ancillary staff move quickly to check off all the tasks on their lists.  If they are lucky they will be able to tuck themselves in to the nursing station to chart and chat the hours away until dawn.

Everything is more a little more relaxed.  No topic is taboo by 4 AM.  Night shift staff know each other, the good, the bad and the unmentionables.  If a manager or administrator happens to come in on night shift, the news spreads quickly and the books, smart phones and uncovered cups disappear in an instant.  Those late night visits from administration are rare. Night-shifters learn to depend on each other like family.   

The calm can be misleading.

In the darkened corners of the nursing unit lurk the possibility of chaos.  Disaster can interrupt the laughter at the nursing station, despite the careful observation and care of patients.  When emergencies occur, the night shift team leaps into action.  The juicy conversations and cat videos are abandoned and the only priority is the patient.  An outsider may not see an emergency on a nursing unit as seriously as the team working in it.  It does not usually look like it does on television.  There are a lot of people.  Everyone is in motion.  It is often quiet with one or two people calling out times and actions.  Faces are focused.  Minds are alert and assessing, searching for causes and solutions within milliseconds of coming to the bedside.  They have done this before and settle into their comfortable roles.  The night shift team are a little more earnest and confident.  They know that reinforcements are not coming.  This is night shift.

nurse6

When the emergency has passed, for better or worse, the team returns to its tasks.  The work and night continue.  

Despite the craziness and sleep deprivation, night shift is awesome.  Most people dread working at night and do not understand why any sane person would choose to work the late shift.  It is not the frappicinos.  It is not the chance of watching cat videos for hours.  It comes down to the men and women sharing the nursing station with you.  They don’t always get along, but they are always in it together.  They create the secret awesomeness that is night shift.  

Shhhhhh don’t tell the boss! 

 

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A Call to Labor Nurses: Go to the Bedside

One to One Nursing Care for Actively Laboring Mothers

Not all hospitals are able to, or choose, to staff their labor units according to AWHONN guidelines.  Many hospitals recognize that one to one nursing care for actively laboring mothers is the gold standard and is safer for mom and baby.  I have worked in both types of facilities.  Nurses that are able to care for mothers one to one can give a great gift of time and attention to their patients.  Mothers in labor do better when they have continuous support.  I feel lucky to work at a hospital that strives for one to one staffing.  I am making a call to labor nurses, go back to the bedside.  I love working with you ladies and gents.  You make me laugh.  The nursing station is a fun place to joke around with people whom understand you in a way that even your family can not.  I love swapping war stories and sharing photos of babies with you.  As much as I love this interaction with you at the nursing station, I ask you to go back to the bedside.  The mothers need us.  Laboring mothers need continuous support.  Remember labor sitting?  We need to bring that back!  With continuous support mothers are less likely to need medical interventions.  You will be able to recognize subtle differences in your patient’s status.  You will have more time for observation, assessment, education and supporting the mother and her family.  One to one staffing is a great gift for both the nurse and the mother.  Sometimes a mother will request less of your presence at the bedside.  This is rare.  All mothers should have continuous support during labor, even when they have has an epidural.

Quietly sitting, charting and guiding the mother is reassuring and decreases maternal stress.

It may seem awkward at first.  It will become normal very quickly.

 

nursing station

 

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Nurse Burnout: 12 Ways to get Your New-Grad Happy Back

Nurse burnout happens.  No nurse is immune.  If you are a nurse you are at risk for burnout.

despondant

 

 

 

 

 

 

 

 

 

Remember how it felt to be a brand new nurse?

The only thing more shiny than your new stethoscope was your happy face.

happy dance

 

 

 

 

 

 

 

 

 

 

 

I diagnosed myself with nurse burnout when I started thinking that driving my car off a cliff sounded better than going to work.

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I was able to get back to my nursing happy place and I am in love with nursing again.

Here are some ways to get you back to happy-dancing your way to work.

 

 

1.  BLOG!  I love it and I’m not the only nurse on the interwebs!  If you are not a writer then read nursing blogs.  There are all flavors of nursing blogs, from informative to hysterical.

Some suggestions to get you started: Mine of course!   Adventures of a Labor Nurse   The Nerdy Nurse     Nurse Together     Mighty Nurse     Scrubs     Digital Doorway

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2. Go back to school.  Getting your BSN, MSN or DNP will make you more marketable and open up more options.

Going back to school will reenergize you about nursing.

You will read a LOT about new nursing research, which will get you out of a nursing rut.

You will be so busy making powerpoint presentations and writing discussion posts, you will have no time to think/complain about work.

grad

 

 

 

 

 

 

 

 

3. Get certified in your specialty.  If you are burned out then you probably have been a nurse more than 2 years.  Congrats!

That means that you are qualified to become certified in your specialty.

There is a certification for just about everything nursing related.

Look for your specialty on ANCC or NCC to start.  You will be recognized for your knowledge and add to your credentials.

Maintaining certification means that you will need to keep up continuing education in your speciality, which will prevent you from becoming stagnate.

victory

 

 

 

 

 

 

 

 

 

 

4.  Take your vacation days!!  Everyone needs a break.  Nursing is stressful.

If you don’t take vacation for yourself, then take it for your patients.  Being a relaxed and refreshed nurse will benefit them.

vacation

 

 

 

 

 

 

 

 

 

 

 

5. Celebrate wins.  We are always focused on what we need to improve and what we are doing wrong.

When you or your team have a win, celebrate!

raise the rooof

 

 

 

 

 

 

 

 

 

 

 

 

6. Take some time for yourself.  Nurses know how important self-care is, but its difficult to find the time. Find it!

me tume

 

 

 

 

 

 

 

 

 

 

 

 

7. Join a committee.  Make changes.  Give your input.  Does your hospital have shared governance or unit representation to make decisions?  If yes, join.  If no, start it! You can change nursing practice.

 

change

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.  Be active.  Exercise can help improve mood and is a great outlet for work frustrations.

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9. Go to a Nursing Conference.  

There is nothing better than going to a conference full of nurses.  People think that ComicCon is weird, but they have never been to a nursing conference! We have crazy nurse fun!

It is a great time and it is a place where you are reminded why the heck you became a nurse.

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10.  Spend some time with your work buddies away from the call lights and nurse rounds.

You know you love your team.  An out of work activity can remind you that your work pals are awesome.
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11. Attend a continuing education course or webinar about a topic that interests you.

Will you be inspired by experts talking about the topics that they love.

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12.  Quit.  Not nursing, but quit your job.  Sometimes you really don’t have nurse burnout, but job burnout.

One of the best things about being a nurse is the vast opportunities you have for employment.

If you need a change of pace, location or specialty do it.  Give a proper notice and leave on good terms.

You never know when you may work with those nurses again.  (It will happen.)

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Nursing is a rewarding profession.  If you feel yourself getting disenchanted, actively try to get the magic back.

 

If you are successful you will be back to the new grad feeling which is good for you and your patients.

 

princess

 

 

 

 

 

 

 

 

How do you beat the nurse blues?  Leave your suggestions in comments.

 

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Mission Impossible

The next time a mother or father asks you for something that is not a common practice, take the time to listen.  Ask yourself if it is safe, or could it be safe.  Check to see if her request has research to back it up.  Many practices that we consider standard today were thought to be radical in the recent past.  It is our ethical duty, as nurses, to advocate for our patients and support their autonomy.  Work with a mother to help her make the best choices for her.  Respect her choices even when you would make different ones.

camfeet

 

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The Red Tent

novel cover

Poster

The Red Tent of My Heart

(May Contain Spoilers)

I read the Red Tent, by Anita Diamant, when I was in nurse midwifery school.  It was was an assigned book for the last class I took before I switched programs.  I went tent camping with my husband and three children and threw it in my bag so I could keep up in class.  Once I started reading it I could not stop.  I was swept up into Dinah’s life.  Sitting in woods, by a fire I read about the lives of women.  I recognized the women from long ago in myself, my sisters, mother, daughter and friends.  It may have been the romanticism of reading the story while living in a tent, but I fell  madly in love with it.  I was already infatuated with midwifery and birth.  The way that Diamant described the interactions between women, birth and death struck me to the core.  Although I did not pursue the midwifery path, I still feel the burn of the call.  I get a glimpse of it from time to time in the hospital.  Women supporting each other in the most intimate way while walking the line between death and birth.  Although birth has become safer in many ways, birth attendants still feel and fear death lurking in the corners of every delivery room.  I believe that is why a lot of well meaning over medicalization has occurred.  Not all of it, but a lot.  The novel did a wonderful job capturing the beauty and struggle of a guiding women through childbirth.

I was giddy when I fount that the novel was being made into a mini series.  Lifetime did a decent job telling the plot of Dinah’s life.  They were’t able to capture the beauty of birth and midwifery as well as the novel.  The relationships between the women were recognized fully in the last few minutes, but were not given as much development as in the book.

I have recommended this book, over the years, to everyone that has the look of wonder in their eyes.  I recognize the look right away.  It is a look that belongs to a person that is in complete awe of birth and the power of women.  I am not the only woman that loves this story.  Red Tent communities have popped up all over social media and in real life.  Women crave the type of connections found in the red tent.  Many of us have few, if any, sisters, move far from our mothers, do not get along with our mother-in-laws and do not make time for our girlfriends.  Twenty-first century life can feel so isolating.  Births continue to bind us together.  I step into a stranger’s room and become a friend/sister/mother within moments.

The bond of women during the sacredness of birth is strong.  The trust they give me is an honor.  Like Dinah, I will carry all the special women from my life with me.  There is not a red tent for us to take refuge.  I will carry my red tent in my heart.  With it I will create the safe and beautiful places for my sisters to bring their babies into the world.

Generations of women learning, laughing and sharing together.
Generations of women learning, laughing and sharing together.

If you enjoyed the miniseries, read the novel.  You will laugh and cry and love all the things Dinah loves.

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When Pain Ruins a Good Time

Dyspareunia, painful sexual intercourse, is a symptom that people can be reluctant to speak with their health care team about.  It is a difficult to bring up at an appointment, but it can negatively impact quality of life.  Both men and women experience painful sex.   Although men can experience this symptom it is almost exclusively reported by women.  Up to 22% of women will experience it at some point in their life.  Dyspareunia can be associated with vulvar, perineal, or vaginal trauma and repair, but these are not the main contributors.   Postpartum dyspareunia can also occur in women who give birth by cesarean section.   According to the Mayo Clinic up to one in five women experience this symptom before, during or after sexual intercourse.  Half of women resuming sexual activity around the average 6 weeks postpartum point will experience dyspareunia.  Dyspareunia affects persons from all demographics, life stages and gender.  Although in most cases the underlying cause can be treated and this symptom eliminated, it is underreported to care givers.

Pain during sex is common, especially in postpartum women.  Are we talking with mothers and fathers about what it is, why it happens and what to do about it?  Postpartum advice about resuming sexual activity usually consists of wait six weeks and use water based lubrication if you experience dryness.  That doesn’t nearly cover the topic.  The table below is a quick break down of this condition.

 

* Watch the YouTube Video coming out this week for an in depth look into this important topic.

 

Dyspareunia

Risk Factors/ Health Status Disease Injury
Insufficient lubricationSurgeries or medical treatments.Scarring from pelvic surgeries i.e. hysterectomy, episiotomy

Radiation/Chemotherapy

Psychological problems: Anxiety, Depression, Self image, Fear of intimacy, Relationship problems, Stress

Abuse

Reactions to birth control products: creams, foams, jellies, diaphragm, latex

Inflammation, infection or skin disorderUrinary tract infectionEczema

Endometriosis

Pelvic Inflammatory Disease

Uterine Prolapse,

Retroverted Uterus,

Uterine Fibroids Cystitis

Irritable Bowel Syndrome

Hemorrhoids

Ovarian Cysts

Sexually Transmitted Infections:

Gonorrhea, Chlamydia, Herpes

Vaginusmus, Vestibulitis

Injury, traumaAccidentpelvic surgery

female circumcision

episiotomy

congenital abnormality

 

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Why the Golden Rule Doesn’t Apply in Healthcare

The Golden Rule has been preached to those in healthcare for decades.  As nurses we were taught that we should treat our patients as if they were our mother or grandfather.  I have heard doctors concluding consults with, “if it were my sister I would tell her to do X procedure.”  I know well meaning nurses whom call all their patients sweetie, because that is how they address family and they want to treat their patients like family. Empathy for our patients, care, and recommendations based on how we would like to be treated seems to be the ethical and correct behavior.  It is not the right thing to do.  To assume that we know what a person should choose or how they would like to be addressed is presumptuous at best and patriarchal at worst.

We should leave the Golden Rule concept in the past.

The Golden Rule, although a benevolent seeming concept, is fundamentally flawed.  Not everyone wants to be treated the way that someone else thinks is right.  This is concept is clearly evident in labor and delivery.  Women that choose to pursue normal means of birth, such as waiting for spontaneous rupture of membranes, are commonly labeled as difficult.  Women that decline an epidural or pain medications are often met with impatience and pressure to not suffer through the pain.  Mothers that wish to give birth vaginally, after one cesarean birth, are discouraged, badgered and bullied into submitting to a repeat surgery.  All this is done by health care providers that believe that they are treating the patient according to the Golden Rule.  Pain is bad, so healthcare providers want to take pain away from mothers.  Vaginal birth after cesarean comes with risks and they would not choose to try it.  By attempting to apply the Golden Rule in these ways, we are actually doing more harm.

We need to think about the Golden Rule in a new way.  It does not mean that we do for our patients what we would like done for ourselves or our loved ones.  We do not decide for a woman, what she should choose to do, based on what we would want our sister to choose.  A truer interpretation of the Golden Rule is respect for our patient’s wishes, requests and declinations.  Ultimately I would want my healthcare providers to respect how I want to be treated.  That is how I take care of my patients.  If they don’t want to know the details of every intervention, then I won’t tell them.  I know that education is important, but some patients do not want to hear how a urinary catheter works.  Many patients want to know every detail, and I accommodate their requests.  Personally, I prefer unmedicated labor and feel that moms miss out on something amazing when they get an epidural.  I do not treat my patients how I like to give birth.  I support them with what they prefer, whether it is an epidural, unmediated birth or somewhere in between.

I feel comfortable sharing my opinions when asked.  I give advice, but I never assume that I know what is the golden answer for each woman.

The old Golden Rule does not apply in health care.  Patient autonomy, as a priority in our nursing care, should become the new Golden Rule.  MC900439242

 

 

 

 

 

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