Archive for January, 2011

More than passing the scalpel…

January 27th, 2011 | General Nursing | 0 Comments

Almost every single time I tell someone that I am a perioperative nurse, they ask, “So, do you get to pass the scalpel? ”. Inwardly, I roll my eyes.

There is a perception out there that perioperative nursing is not patient oriented and therefore not ‘real nursing’. I would argue that to be a perioperative nurse is so much more than passing stainless steel instruments to surgeons.

The scope of Perioperative Nursing practice is a continuum ranging from a basic to an advanced level of professional nursing that focuses on identifying and meeting the individual needs of the surgical patient, immediately preoperatively, intraoperatively, and immediately postoperatively.” http://www.ornac.ca/standards/essentialrn.pdf

Everyday in the OR I find myself using the nursing process. http://en.wikipedia.org/wiki/Nursing_process.

Recently I was the “circulating nurse” for a young patient. http://www.aorn.org/CareerCenter/CareerDevelopment/RoleOfThePerioperativeNurse/ It was a busy case, and the surgeon was having trouble inserting an implant. He made a quiet comment that there was a chance of tearing a vessel. My mind went to work….

-       If the patient starts bleeding ….

  • Do we have blood? No
    • With the anesthetist’s help, draw blood for a cross-match
  • Do we have adequate intravenous access? Not really, only a small #22G
    • Go under the drapes and assist with initiation of #18G IV
  • Will we need to get access to the chest to control bleeding? Maybe
    • Go get sternal saw and chest retractor pans to have available

http://en.wikipedia.org/wiki/Nursing_process.

There is a dichotomy that can be encountered everyday when working in the OR. On the one hand, there is relative predictability and routine. Induction of anaesthesia is normally a simple, straight forward event. On the other hand, there are constant unexpected situations that can arise where the nurse must be able to respond. All team members need to be able to work under pressure when necessary. This environment is the perfect one, in my mind. I really enjoy the balance between routine and eventful responsibilities.

Nursing in the OR requires a great deal of knowledge, skill, critical thinking, flexibility, teamwork, and the ability to work under pressure. A highly respected colleague of mine told me this: “A good OR nurse must be able to move fast, anticipate, and have broad shoulders.” I aspire to that ideal every day.


Code Blue…..in the Face

January 26th, 2011 | General Nursing | 1 Comment

In class as a nursing student, my ICU seminar group was going over patient situations, and one described was a critical pre-code situation. Our group recognized the obvious – call the code, check patient’s code status, secure airway, grab O2, start IV access, clear the room, and PHEW the code team has arrived! To our startling reality, our group had a moment of silence when our tutor said, “Um, you guys, you ARE the code team. Well, not now, but you WILL be.”

Given slow and steady increases in the nursing work force (http://www.cna-nurses.ca/CNA/news/releases/public_release_e.aspx?id=272), it was shocking to think that a within a year or two of graduation, new graduates can be considered “senior staff” in their places of work. We know from Dr. Duchscher’s research on transition theory and shock that new graduate nurses will go through a trajectory phases and feelings in their first year of practice. How can new graduates and senior nurses stitch-up these statistics during that first year?

#1) ADVOCATE

New Grads: advocate for yourself and follow your gut. It is ok to be unsure, ask for help and remember that while you are doing these – honesty is the best policy.

Senior Nurses: if you see a new grad trying to help themself, reach out! Often, it is the simplest things we need – someone to co-sign, report off to, show us where supplies are, and teach us something if your experience is sensing I’m going to have a busy shift.

#2) KNOW WHAT YOU DO NOT KNOW

New Grads: be clear about limits. If you know you don’t know something in its entirety take a step back and two steps forwards, and ask for help. The only thing your colleagues care about is patient safety, and it is YOUR responsibility to uphold this. Find out about learning opportunities at work, connect with educators, and learn where readily available resources are.

Senior Nurses: You don’t know how a new grad is doing unless you’ve asked them. Likely, they will be ecstatic you reached out, and have a few questions for you. We are so eager to befriend you and willing to learn the ropes, so please show us!

#3) REFLECT

New Grads: this doesn’t mean writing in a word document and citing journal articles. Just take time to think about your day, research a procedure or policy, ask other nurses questions when it’s slow, and reference nursing books every now and then. While you are doing this, set simple goals for yourself; being the nurse you want to be will take a few steps, and you’ll be taking those steps faster with simple goals.

Senior Nurses: Ask yourselves these questions, How your day at work? What was it like? What went well and what did not? Why, and what can you do next time about this? New nurses in their first year of practice do not have the worldly experience you do, and rely on you to help make changes in areas they cannot see yet.

Please remember that NTF is here to support new nurses during these phases of entry-to-practice, and connects with nursing schools and stakeholders to help them prosper in their workplaces and our profession. Contact us for more information at http://nursingthefuture.ca


Mental Health Promotion Is Not Only for Patients!

January 15th, 2011 | General Nursing | 0 Comments

It starts off early in your nursing education; your ambition to be an incredible nurse, your drive to succeed in your studies and practicums, and your desire to make sure that every patient you encounter is well taken care of. Once you graduate, this feeling to succeed is only furthered once you start working in the “real world”, only now you have the pressures from your employer to perform independently, to be efficient, to work overtime if needed, and to come to work on time and ready to care for patients. Before you know it, you’ve been working 7 consecutive night shifts, are struggling to keep up your personal life, and you feel like you can’t do anything. The question begs to be asked…where do we fit in? Where do we find time for ourselves to really, truly take care of our own well being?

Facing Depression

It has been well documented that high stress jobs increase the risk of depression, and nursing is no exception. Between stressful patient assignments, shift work, staffing issues and negative interactions with other nurses or healthcare professionals, it’s easy to imagine how the job could take its toll on one’s mental health. One article notes that on a crowded, busy unit, the rate of depression in nurses can be 10x that of a calmer unit (http://tinyurl.com/hospitalimpact). The same article notes that depression among nurses is a major factor for job absenteeism. So why is it that this problem seems so largely ignored?

What Can Be Done

A good friend of mine hit the nail on the head when she said, “No one wants to admit they are mentally unhealthy. I was scared to tell others because of the stigma of mental illness.” All nurses, fledgling or seasoned, have an opportunity to create a culture of support. The Cleveland Clinic, for example, has created an exceptional program called “Code Lavender” (http://tinyurl.com/codelavender [see page 14]), where employees can call for a team to come help them cope with stressful and emotionally difficult situations. What a brilliant idea! Described as a “Code Blue for the Human Spirit,” this program has helped nursing staff cope with stresses such as patient deaths, moral & ethical dilemmas, and difficult patient assignments. Creating a culture of openness and support within a facility, or even on one unit, can make a big difference in not only your own mental health, but potentially other nurses as well.

At “Nursing Made Incredibly Easy”, they have suggested an easy pneumonic to use when considering depression: (http://tinyurl.com/nursesanddepression)

K – Check for the symptoms of depression

E – Educate yourself about depression, beneficial to not only yourself but to your patients & colleagues (Find out more here: http://tinyurl.com/depressioninformation)

E – Evaluate the signs of depression in yourself, and your colleagues. You may be the first person to raise a flag for a colleague.

P – Periodically examine your stress level and it’s impact. It may be time to make changes to your routine!

Most of all, remember to take care of YOU.  Take time to relax, eat balanced meals, and exercise each day. Talk to your colleagues openly about the stresses of your job. If ever you should experience symptoms of depression, remember this: it is NOT a sign of weakness, you are not alone, and there is help!


If You Can’t Say Anything Nice…..

January 14th, 2011 | General Nursing | 0 Comments

Remember that old adage often expressed to you by your mother or teacher from your school days? If only we knew then just how valuable this piece of advice was! It seems as though in today’s world of blogging, Facebook status updates, and the ever buzzing world of texting, that we have become a society of people willing to say and do just about anything to just about anyone at any time. My question is this…whoever gave us the entitlement to say anything to anyone without any forthought into how our words and actions affect others?

Understandably we all have the freedom to our own opinions and voicing of the same. And rightfully so! We are each individuals with unique values, views and moral tendencies. To be able to communicate these frankly, directly and with realistic views is truly a valuable skill. It is how we learn from one another. But how often have you been a participant in a conversation that quickly goes from constructive to destructive??? A fine line occurs between opinion sharing and simply  making unjustified assumptions and expressing antagonistic judgement, the latter of which can be interpreted by those around you as hurtful, harmful and may be detrimental to the provision of a healthy environment in your workplace or social network.

Thats right…Im talking about ‘bullying’, ‘lateral violence’, ‘psychological violence’, and ‘harassment’ within nursing and carried out by nurses. It does not matter which term you use as its description, it takes the same form. Check out the Canadian Federation of Nurses Unions Position Statement on how we characterize negative workplace behaviour @ http://www.ona.org/documents/File/positionstatements/CFNUPositionStatement_Bullying_200703.pdf and how that behaviour creates the following adverse outcomes;

injuring personal dignity, psychological and physical integrity…

marginalization, discrediting, excluding

increase frequency in absenteeism and sick time at a cost to the institution and nursing peers (i.e replacing sick time)

early exidus from the proffesion (especially withint the first 6 months)

ineffective and sub-par patient care

The most important thing we can do in learning about bullying is to agree that it is unacceptable! Simply to accept that bullying happens is not enough. The old wive’s tale of nursing being a profession where we are required to ‘prove ourselves’ or conform to an attitude(s) in order that we become ‘accepted’ by our peers is futile. We are a profession that lives and grows and flourishes using the artistic foundations that include benevolence, compassion, honesty, understanding, acceptance, and first and foremost -care. So why are we frequently excluding exactly these traits when we interact with one another!

So why does it happen and how do we deal? The Centre for Addiction and Mental Health Website (2010) shares philosophies on why bullying happens and implicates work strain as the culprit driving this negative behaviour within nursing.

a high degree of accountability coupled with a low degree of autonomy

unsustainable workload levels

Read more on this at http://www.camh.net/Publications/Cross_Currents/Winter_2005-06/nursingbully_crcuwinter0506.html to find out how to better understand, and therefore cope with bullies. Most notable is the advice to

take ethical and legal responsibility

advocate for yourself and others

So in those moments when the fine line is being drawn between constructive and destructive conversation/gossip/negative judgement, choose to take a moment and think about what is being said and done and how it could be affecting those around us. Don’t be afraid to bring awareness to others of how their actions and words could potentially be affecting another or yourself. Bring yourself above and away from the adversity of bullying. Think of the wisdom shared by Elizabeth Gilbert in her  New York Times Best-Seller Novel – made- Blockbuster Movie Eat Pray Love;

“The hope that the expansion of one person – the magnification of one life – is indeed an act of worth in this world…” Liz Gilbert