Tag Archives: ICU nurse blog

Nursing student advice – are you an adrenaline junkie?

please share. as we start the fall semester, it’s time to think about the challenges ahead

ACLS again
I spoke with a nursing student yesterday who took ACLS this  summer during an internship, and she told me two things. First, during the class she loved the competitiveness of trying to “win” the ACLS scenario. Next, during the internship she saw the practical applications of ACLS at work, and she profoundly agreed with one of my previous blogs in which I wrote that the main idea of ACLS is to prevent the need for such intense intervention and to be pro-active.

Then she said it: ” I admit, I am an adrenaline junkie.”

I laughed. Been there done that.

Adrenaline produces a “rush”

Most people have heard the term, and way way back in 1991 there was a movie named “Point Break” in which the hero went out of his way to experience danger.  (oddly enough, that particular movie combines big-wave surfing with bank robbing and skydiving.)

In the TV show “ER,” every time they showed the team responding to a cardiac arrest or trauma code, the soundtrack would ramp up, pulsating and flashing.  ( nobody supplies a similar soundtrack in real life, except occasionally there are surgeons who use a playlist in the OR to keep the team relaxed – creating the opposite effect and enhancing “flow”)

With the growing popularity of women’s sports, as evidenced by the Olympics, more nursing students come to the profession with a background of knowing how to compete and wanting to “win.”

Here is a definition of adrenaline junkies

Adrenaline junkie is a colloquial term used to describe someone who is addicted to thrilling and fear-inducing situations. The act of conquering fear creates a rush of endorphins that is simultaneously energizing and relaxing. This natural high leads adrenaline junkies to seek out ever-bigger thrills and excitement.

Some adrenaline junkies place themselves into dangerous situations. Others prefer to know that they are physically safe, but pit themselves against obstacles that make them feel unsafe. Halloween events and roller coasters particularly appeal to adrenaline junkies.

And of course, a self-assessment

You can determine for yourself if you have the tendencies to become an adrenaline junkie, here is a self-test that focuses on your present approach to life.

Maturity

And of course, the paradox. First, you need to be pumped up and “on it”  in order to deal  with emergencies effectively. Second, in the long run, you need to cope with stress and to develop a mature approach. If you are a young student, there is an undeniable appeal to all the technical details of high-tech nursing care, and when you are in your early twenties you are at the peak of brain power in terms of training your memory. At some point though, you will need to engage in self-care activities, setting limits on your own stress-seeking behavior.

the answer

Naturally, I have a ready-made solution for you… a two part prescription.

the Nurse’s Brain.

If you are using a Nurse’s Brain, you already have a major tool for keeping your stress level in check.  You need to adopt this tool to gain the skills needed to step onto the playing field.

balance and – mindfulness

Taking inventory of the stressors and dealing with them. Whenever I have been with critical care nurses and somebody outside the ICU suggests this, the response is always eye-rolling and incredulity – every critical care nurse knows that simple stress-reduction techniques are not enough unless they are coupled with a clear-eyed approach to the challenges of clinical practice. In other words, at a stressful clinical site, the management and team members must all participate in effective problem-solving. All the meditation and Kum-Bye-ah in the world will not help the stress unless you have supportive coworkers and an effective manager.

But seeking balance in your life, affirming the good things and valuing your own self, are still the way to go.

http://stress.about.com/od/situationalstress/a/adrenaline0528.htm

http://stress.about.com/library/adrenaline/bl_adrenaline_self_test.htm

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Part 4 – the Nurse’s Brain – joining the borg!

Nurse Brain

Florence once said that to own a pen was more iimportant than to know how a stethoscope worked.There were three parts to the discussion about the Nurse’s Brain so far, and buried in the discussion after one of the entries was a question from an experienced nurse:

Joe,  I do like your brain and it looks like a good way to teach students. However, we have a ten minute overview report followed by bedside report, then it is go go go. Do you have a preprinted template your new nurses can just fill in? I’m not sure when a floor nurse would have time to make a detailed outline for the day.

That was  a great question which deserves to be addressed in a separate blog altogether. As I have said, a brain is a way to organize data, and if your happen to be at a hospital which has a good informatics system, there must be a way to set this up so that much of the stuff gets a nurse-friendly printout. Any number of templates will do…. in my blogroll is a site where you can find a collection of such things.

Answer – join the “borg!”

In the meantime, here is my answer:

One option is for the nurses to get there a bit early and scout these things out.

But here is another way to use it: In the 1980s I was nurse-manager of an ICU/CCU in a community hospital in rural Maine. At that place, all the nurses used a brain, it was a four bed unit with a lot of CCU ( this was in the olden days,  prior to TPA and the modern era of thrombolysis, that tells you how old I am….). The team there had adopted a twist to the system (prior to the time I ever got there) which was very helpful.

One of the duties of the off going nurse was to construct a nurse’s brain for the upcoming shift of next nurse, one for each patient. Obviously it would be subject to change, but it was a good way to start. It consisted of a handwritten summary of assessments, labs, IVs, treatments, etc  and it was used along with the Kardex and chart, during report.

When the system worked (most of the time) it was terrific. (of course, there were times when the plan changed dramatically the next time somebody went into the room, but that is another story…)

You might consider adopting some system such as this. It’s way to get the staff involved into the subject of what we nowadays refer to as “handoffs” and accountability.

Oh, and by the way….

Some people will be scratching their head, asking “What is the borg?”

Any fan of Star Trek will tell you. There was a planet in Star Trek where every person was hooked directly into the main computer so that they completely lost the ability to have an individual thought, but on the other hand, each person shared the collective wisdom of a billion humanoids…..

The end result of using a Nurses Brain is effective teamwork and preparation. Here on planet earth there are different models of achievement. If you can adopt a Nurse’s Brain, you will be just like the person in this video. trust me!

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Part 3 Nurse’s Brain – Nurses and Obsessive-Compulsive Disorder (OCD) – how is yours today?

NOTE: run your mouse over this section, and the hyperlink will show up……take the quiz!!!! the whole point of this blog is to discuss your reaction to the quiz….

True Story of my daughter when she was five

One March, a blizzard started working its way up the east coast of the USA, and in Maine we had five days to read the daily report on the front page of the local newspaper which breathlessly warned what it was going to be like by the time it got to Maine. It was the topic of conversation every day. My younger daughter was worried. we lived out in the country. In addition to the lights and fridge, we had a well with an electric pump. We expected to lose power.

To assuage her worries, the family sat down with paper and pencil over a cup of cocoa, and made a list of all the things to do to be prepared for a blizzard. Buckets of water ( to flush the toilet), flashlights, candles, wood from the woodpile, snow shovels handy, groceries stocked up. Every thing. then we checked off the list and said ” the only thing left is to make snowmen when it gets here and keep the driveway shoveled.”

It helped. the blizzard was serious, but we felt better about it. we were ready. The list was useful. the fears were greater than what the truth turned out to be. And in the meantime, our daughter got the demo of a terrific coping tool.

Thought for the day

Are we raising a new generation of nurses to have Obsessive-Compulsive Disorder?

Recent blog entries

I have written about the ways to use a Nurse’s Brain in the recent past, and also about ways to succeed at the job search as well as at work once you get the job. I gave contradictory advice as to whether nursing students should be taking ACLS or not, and I also heaped praise upon the book by Atul Gawande, The Checklist Manifesto.

It’s been clear to me for years now, that if you want to succeed in a hospital staff nurse role, you have to develop a system for keeping track of dozens (hundreds?) of small details during the course of a day, in order to be on top of what is happening. The Nurse Brain is an aide to your brain to do that without going crazy.  We have developed an entire discipline, “Informatics” to study the science of how to assist people in doing this kind of detailed work.

There is a point, however, when you have to step back and ask yourself whether you have stepped off the path of sanity and into the wilderness of doubt,  and developed Obsessive-Compulsive Disorder.

Take This Quiz.

AT a site named Psyche Central, they have a self-quiz.  I invite you to check it out – take it. you don’t have to share the results with any body.

Rational fears versus irrational fears

Naturally, there are flaws with the questions – for example, the person who built the quiz probably thought they were dealing with takers that had the irrational fear of such things as death, accidents, contracting AIDS, etc.

The truth is, in many nursing settings, for many nurses, these are entirely rational fears. We have a job that is a bit unusual in that respect. “Do you find yourself washing your ahnds every five minutes or perhaps cleaning compulsively?” – yes I sure do especially if my patient has a communicable illness…… so – I suppose it may be skewed – or maybe it is one more indicator that what I am talking about is real. You can go overboard….. or can you?

In defense of the Brain

if it is any consolation, one way to use the Nurse’s Brain is to re-assure yourself that you did do everything you set out to do – and then to fold it up and shred it at the end of the day, knowing that you do not need to worry anymore about what you left undone. We are all in search of certainty, the knowledger that we did what we could. Certainty is not exactly the same as serenity, but it gets you there…..

Hospitals face a challenge with OCD among nurses

this will be a short blog, but I leave you with one thought. after you have checked your own OCD level, look at that of the nurses you work with. If the workplace is dominated by nurses with OCD, chances are, they spend time focusing on the small details, beating each other up as a means to feel better about perfectionist behavior. I would politely say that such a work environment is out of balance, and not a healthy one.

And it’s worse if the manager has OCD

OCD is a reaction mechanism to try to control things that are essentially not able to be controlled. Yes, a nurse with OCD can be a great nurse, but what happens when such a nurse is hired to be in a leadership role? usually they are the ones who have the least ability to delegate, the least flexibility, and the least ability to inspire and lead.

what do you think? take the quiz and let us know the result ( if you are brave…). agree/ disagree?

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If you, as a nursing student, MUST learn EKGs…..

want to learn what’s really important in nursing? it’s not what you think… I don’t often get to the point of revealing my deepest secrets to the world, it takes a lot  to actually put these things in print.  For example, even though I know the name, hand gesture and usage of the  One Universal Surgical Implement, when I was initiated into the cult I was sworn to secrecy that I will only reveal it to those cognoscenti that show themselves capable of handling such knowledge…..

Responsibility always comes with knowledge.

Remember that. Before i would ever reveal anything, you must prove yourself worthy. And of course, the first step is to buy and read my book about Nepal. It’s the kind of book you can give to the nurse in your life for Nurses Day or for graduation from nursing school.

Anyway, there were too many protests to last last blog

They call this “push-back” – readers who said they just needed to be ekg-certified….. O to be young again!

The Six Rhythms

There actually only six you need to know. trust me. This Pearl of Wisdom has been enshrined in the American Heart Association Manual for twenty years, but somehow people gloss over it and say, it can’t possibly be so simple….

Link to a website

In Nepal I met Jason Waechter, an MD from Canada who was working with Patan Hospital.

He was wicked cool.

has all kinds of great stuff about critical care on his website.

I particularly recommend the handout on basic ekg.

also – I have a two-page handout on rhythm strip analysis which I will share.

To get the two-page handout,

subscribe to the blog,

share with all your friends, and

send me an email. joeniemczura@gmail.com

ten-four, over and out in Honolulu today…..

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What if every nurse did this today? Major TIP for today

Want to make a good impression at you nursing workplace? I have worked in hospitals all my adult life, and I am about to impart a secret that will help you get ahead, every time.  When you use it, let me know how you make out. All I ask in return is that you share this blog with as many friends as you can, and consider adding as a subscriber. For an added bonus, look at the fan page for my book about Hospital Care in Nepal. 500 photos, some videos and commentary on health care in Low Income Countries.

There is a secret group of employees at your hospital

They are unseen, and often unrecognized, but you can’t do your job without them.  It’s the housekeeping staff.

Once I had a student group at a Catholic Hospital in the Northeast. I like and respect Catholic healthcare ( yes, I am Catholic myself and I do go to church. Yesterday’s sermon was about Abraham and his obedience to God. we were all happy that Abraham’s son got off the hook, even though it was last-minute if you ask me).

But I digress – back to the Catholic Hospital

The C.E.O. of the place was a Catholic nun. Wonderful person. Truly. She had this amazing ability to appear on the ward at odd times just whenever there was some sort of conflict happening with a patient or family. It was like magic. Uncanny.

I discovered it by accident

Turns out that the housekeeping staff all had cell phones and she’d given them her cell number. The housekeepers there were all longtime employees – we are talking thirty years or more in some cases. The CEO would host them  for breakfast now and again. The CEO always had a good word for me, because I had long ago adopted a policy to be nice to housekeeping. There was one who was Polish-American  and I sang her my favorite Polish Christmas Carol.

Now – I have never seen such an effective under-the-radar surveillance system at any other place. But whether this kind of informal network exists or not, you can do your self a favor by adopting one simple practice. Learn each housekeeper’s name, say hello to them every day, and be friendly.

That’s all you need to do. that’s the tip for the day. I think especially for a new nurse, a hospital setting is overwhelming and there are so many people to figure out, that it is easy to retreat into a small shell and only interface with people who are above you in the food chain somehow.

try it for a week, and let me know how you make out….

and yes, if you are applying for a job, be kind to every person along the way, including such persons as the receptionist in the Human Resources Office. Even if they do not have the CEO’s cell phone number…..

 

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Filed under nursing education, resume and cover letter, resume writing

How to avoid the Nursing Work Culture From Hell

please subscribe to this blog. click the button at right. If you agree with this post, please share as widely as possible. together, we can work to improve the daily worklife of every nurse and every nursing student.

Culture at the workplace?

A workplace becomes a surrogate family for the people who spend time there. When people spend so much time together, the personalities come out. A group will adopt a set of informal rules that guide each day. This becomes “workplace culture.”

If you have been a nurse for any length of time, you develop a sixth sense for this. The minute you walk on to the patient care area, you get a vibe of what it’s like there.  It may be calm and peaceful, it may be chaos, it can be happy or tense. It can be this way independently of how much nursing care the patients require. When you interview for a nursing job, be advised: the best managers know about workplace culture, and they are looking to add staff who will value it and honor it. A theme of this blog has been to encourage new nurses to live up to their caring potential, and it includes caring for those around them as well as for the patients.

Urban Community Hospital – a “war story”

My first nursing job was not a place for teamwork. It was an “urban community hospital”  and chronically understaffed. Each shift was a contest to see whether you could get through all the work yourself, and the assignment was heavy. It was a trauma ward, lots of gunshot wounds and stabbings and victims of beatings, along with a population of heroin addicts and homeless persons. Lots of crime victims. The staff consisted of a head nurse who had worked there since the dawn of time, and each spring there was a fresh crop of new graduate RNs. The hospital would hire a batch of new grads all at once, they would stay a year, then leave once they got “the golden year” of hospital experience. Or at least they were planning to leave then; most left my particular unit before hand, chewed up by the system of unsupportive coworkers. The crew of nurses aides were all older than the young RNs.

Walking Rounds

We did “walking rounds” there, change-of-shift report consisted of a procession of sorts, all the nurses in a group  following the kardex from bed to bed like it was the Bible at the beginning of Mass. The circus was led by the head nurse, same age as my mother. She generally arrived each morning with an attitude, and would heavily criticise the night nurse, pouncing on any inconsistency she found between the way the patient looked and what was written in the kardex; or how the story was presented.  Very theatrical. As report was read, she would examine each patient (“you said the IV was NS w 40 of K, why is it I see a bag of LR hanging?”) This included getting on her hands and knees to look under the bed, on occasion, as well as barbed sarcasm. Every day.  One day she chased a rat out of the ward, to the cheers of the rest of us…. but that is a whole nother story ( it was a very large and well fed rat). Yes, she was teaching us how to have standards and to follow them; but nowadays we would call her approach “horizontal violence’ or “verbal abuse” or “eating the young.”  That was the way it was in that time and place.

These days there is a national movement toward something called “Magnet Culture” – hopefully to eradicate that sort of approach. UPDATE: a former student emailed me after reading this, to alert me to some excellent work published by Sigma Theta Tau about Bullying in the Nursing Workplace.

New RN working nights

I was on eight-hour shifts, a day night rotation and soon found myself working nights about eighty percent of the time – the only time I was on days was on the head nurse’s weekend off.  The day I passed my Boards I was Charge RN whenever I showed up from then on. That was how I spent my first year as an RN. Since I was on nights so much, it meant that I got to be the person going through the gauntlet every morning. And yes, I did well at it – better than the others. In those days I could be just as sarcastic and unforgiving as others. I would spit it right back at the head nurse, to the astonishment of other first-year RNs on the crew.

I no longer treat others that way.

The usual night staffing was two RNs for up to thirty patients, and even then, I went out of my way to help the other RN be ready, which was appreciated. I promised myself I would never be the kind of nurse manager  that I was now working for, and that if I ever had anything to do with it, I would be kind and respectful.

In other words, it was the Work Culture from Hell. Got the picture? I can go on and on – you got me started, but like a bad dream, I need to wake up and remember that this degree of dysfunction is not the way to go through life. Let’s focus on positive ways to interact, here.

Teaching workgroup culture. learn it and live it.

What I do now is to incorporate healthy work behaviors into nursing school. Nursing school is not simply to learn about patient care; it’s to learn the way a professional person acts and thinks. Sometimes in the Fundamentals lab, a student acts as though the only thing they are there to accomplish  is to learn how to perform a specific skill according to the checklist. They don’t care whether others also learn, and don’t help their classmates or spend time coaching somebody slower to grasp the concept. Somehow there is a subset of students who think it’s okay to be a jerk to those around them while they focus on their own learning needs. This may work for Jack Sparrow, but will not lead to success in a hospital workplace.

This tells me that such a student has a learning opportunity.  Focusing on yourself is not the way to go through life. You are missing a major part of the ride.

(Note: a few years back I developed a one-page handout for how to act in the nursing school lab which I will send to anybody who emails me and asks for it)

How to Succeed as a team

Want to develop the habits of a helpful work group culture? here are some ideas. They are not a “Code” – more like Guidelines.

In both lab and clinical: Your work is not finished until the work of everybody is finished. Nobody sits down until everybody is able to sit down. If one person is getting swamped, we pitch in and help them. In the lab, it’s the students and faculty together, who tidy up and make the lab ready for the next group of students. Don’t rely on somebody else to clean up after you.

In the clinical setting: learn about  each other’s patients. Depending on how morning report is handled, this can be a challenge. If it’s a group report that’s easy; but if it is nurse-to-nurse report, you have to go out of your way to do this.  Find a way to check in with the other staff nurses (or the other students) after an hour or so.

Nobody lifts or transfers any patient by themselves.  There is a strong evidence-base out there regarding nurses and prevention of back injuries, so we have an important reason for this. Some wards have many “heavy” patients, and this attitude makes a big difference. But it’s also a chance to create and strengthen relationships among the staff.

say thank you. this goes a long way. there’s an old saying that “People may forget what you did or said but they won’t forget how you made them feel.” think about it.

use names. there is a parade of people through every hospital area every day. Learn who they are, and use their name in conversation.  You don’t have to go to Happy Hour with them or learn their kids’ names, but why not humanize the workplace? this includes housekeeping, the docs – everyone.

name tags. Ever been in a college class where the professor never learned your name, even by the end of the semester?  At my nursing school, we teach the same course to a different cohort each semester, there are fiftysix or sixty new names to learn. On the first day I always set up a system of using name tags, keeping them at the lab. The students collect at the end of each session. We call each of the students by name. They are not allowed to melt into the woodwork, which is often a surprise for the students.

just like a basketball team
Huddle. this picture was taken in Nepal, but any of my students will recognize this gesture. When I wave my hand at waist  level, they know that I want them to approach. I never have to raise my voice when calling them over. (and yes, they know i will not bite…) At lab and clinical practice,  I call a huddle every now and again. soon the students learn to call their own huddles without me.  Communication is a big part of teamwork. We use the time to share and to plan out our work and get ideas.

The Bottom Line about workgroups

The fact is, we all have a choice to create a healthy work culture, or not. which will you choose?

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Filed under classroom management, nursing education, Nursing in Hawaii

Back to Honolulu and ready to start teaching here in Manoa

The trip to Nepal for 2011 is complete, and it would be misleading to continue blogging from there, but fortunately wordpress has a solution for this – leave the old blog up on the intertubes; start a new blog!

And that is what I will do.

Anyway, I am back to Honolulou and to teaching at University of Hawaii School of Nursing And Dental Hygiene. (SONDH).

I am “refreshed” – and grateful that UH SONDH allows me the flexibility to do what  I do during my holiday. I can honestly say I love my job. The students are wonderful and hardworking. They always step up to plate a nd reposnd to the challenges of nursing education. I have some terrific co-workers.

I am seriously considering book two. More on this later. I have lots of research, the basis for a plot and characters, and the idea that a work of fiction set in Nepal woudl be of interest. Wider interest than a work of nonfiction.

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