“Chummy” and nursing. a delicious archetype!

Call The Midwife!

be sure to click on the hyperlinks!

Yesterday was episode three of season one, here in Hawaii. I gather that my friends in U.K. and Oz saw this series last winter. And it has also been thoroughly reviewed. In that respect, this is like dating your best friend’s girlfriend – you feel torn between wanting to know what they thought on the one hand, and wanting to experience things yourself  with no forewarning.

My own bias?

I am person who hates most medical shows. If they don’t get the medical details just right, or if they do not show the emotional involvement of the nurses, or (worst of all) if they don’t show the nurses as full professionals with a practice of their own, I find myself turning the channel. trash.

Anyway, Call The Midwife is excellent. The portrayal of nurses is exquisite. A balance between the skill and what the nursing professors would call “caring.”

Chummy.

we all know people like Chummy. Imprisoned, I suppose, by the realization that she will never be captain of the cheerleaders. Her biggest obstacle is herself. I have several women in my life like Chummy, and I would not trade them for anything.

The setting is a convent in the East End of London during the post-war baby boom years, and there is a wonderful group of older female actors who portray the nuns. The convent does double-duty as the dorm for the younger nurse-midwives, and that is where the main character comes in.  But there is also – “Chummy.”Maureen Ryan, The reviewer for Huffington Post, wrote:

 Jenny Agutter provides “Call the Midwife” with a solid center as the head of the order of nuns with whom the midwives live and work, and several other razor-sharp character actors fill out other roles extremely well, but Miranda Hart, who plays Chummy, walks off with the show. By the time the sixth episode rolled around, the fate of her tentative romance with a working-class policeman made me alternately joyful and tearful, never mind all those babies or Nurse Lee. Chummy’s nervousness, her inherent kindness, her fear of upsetting her upper-class mother and the dawning realization that someone could actually love her are all depicted with delightful skill, sweetness and humor. A second series of “Call the Midwife” has been ordered, and if Chummy’s not part of it, I may stage a public protest.

I have had Chummy in my class. about a dozen times.

Oh no, that does not mean that I taught midwifery in the 1950s. That does mean that I have been privileged to see the personal growth of  certain young women who were previously sheltered from the world. Let me tell you about one such.

I will call her Barbara. Barbara was overweight and very near-sighted, shy and not athletic. At the University level, Barbara was taking classes alongside other students who had been cheerleaders in high school, or airline stewardesses,  or captain of their volleyball team.  Sometimes when I assess these latter type of students, it becomes clear that everyone gives them a bit more slack than they ought to have, simply because they have better social skills and are more outgoing. YAVIS syndrome is alive and well. Compared to these other students, Barbara was not an attention seeker.  Probably did not expect attention. Probably the kind of kid that was teased in junior high school.

Barbara at lab

Each student needed to be able to demonstrate various sterile procedures. Barbara’s hands were chubby, and it took five long minutes for her to don the sterile gloves. I took her aside and said “I have big hands too. When you have big hands, don’t rely on the gloves in the kit. always carry your own sterile pair in a size that you can don quickly.”

I always used to go to coffee at the same time as the whole clinical group, and I emphasize team bonding.  But it was at the University cafeteria that I noticed something. I was eating lunch while the students happened to be having a study session nearby. Every time there was a question, Barbara had the answer, and it was invariably correct.  She was a resource for her whole group, and they knew it.

And so I made my assessment of this student. I think her nearsightedness contributed to her lack of interest in sports.  Maybe she did not have the kind of social life growing up that her peers had as members of the cheerleading squad; but –  if it was a question of personal effort, hard work and study, Barbara was going to show them a thing or two.

Which was exactly what she did. When Barbara came to me and asked for a letter of reference for a prestigious summer internship at the biggest hospital in town, it was time for “payback.”  And what exactly did I do for “payback?” I wrote:

“Barbara is a bit shy at times but do not underestimate the effort or time that this person devotes to studying nursing.  She is a resource to her group and is very helpful in sharing her knowledge. She will work hard and will outshine the more glamorous students in her peer group. She will be a positive addition to any workgroup she joins.”

In other words, not just the stock letter of reference. She got the internship, and the rest is history. To this day she still does not know what I wrote in that letter. And the best part of the story is, I saw her not too long ago and she is still a staff nurse at that hospital, she loves her job, and seems to love her life. For me, the privilege comes when I realize that I got to be a part of her journey into becoming a professional person. I have had many other such students.

Back to Chummy

I like to think that nursing, as a profession, rewards skill and study, and is more than just a glorified charm school. That’s why I think Chummy is so intriguing.  I am predicting that Chummy will also learn and grow over the course of the series.

Nurse Burnout, Reality Shock, Marlene Kramer

note: all words or phrases that are underlined lead to hyperlinks – be sure to click on them and see what happens ;-)

The B word?

In my recent blog about adrenaline junkies, I got a private message reply asking for advice: What if you were an adrenaline junkie now verging on burnout?

Well, naturally my first reaction is to tell that person to go to Amazon and buy my book about nursing in Nepal. One basic premise of the book is to explore what happens when you are a lifetime adrenaline junkie and you finally get to a problem so big, so overwhelming, that God can’t even deal with it. Yes, such problems exist, and yes, God has a special way to address them over the course of time. There is an answer – but you will have to read all the way to the end.

this book is about medical missionaries in Nepal. sure to become the number one beach read for summer 2014! go to Amazon and pre-order your copy at
http://www.amazon.com/Sacrament-Goddess-Joe-Niemczura/dp/1632100029/

you could also buy my second book. see picture of the cover at left.

Marlene Kramer,RN, PhD

I read a lot of papers written by nursing students on the topic of burnout when I teach the senior-level leadership, management and issues classes. I always check to see whether the person was diligent enough to find the book “Reality Shock: Why Nurses Leave nursing” by Marlene Kramer. This one is old by now – written waaay back in the 1970s – but it was such a classic that it still deserves to be studied and cited. (note: On Amazon there are only three used copies, and the minimum price is $199.50… go figure…). In fact, one Google source indicated that it has been cited 743 times in subsequent scholarly work. Dr. Kramer is now retired but had a long distinguished academic career. Her work on reality shock and burnout created a national dialog at the time which led to the work of Patricia Benner and others.

Kramer and Magnets

There were many who thought that Kramer portrayed nursing in a highly negative way, and this reaction produced a result that is still evolving today. The argument was “Okay, you have showed us what is wrong but why can’t we focus on the good things that are happening?”  Which is of course, what a reasonable person would ask.  Nursing advocacy, the heart and soul of what nurses do, is based on righteous indignation and the desire to make things better, and so Dr Kramer was firmly in the tradition started by Florence Nightingale herself.

Magnet Hospitals

The reaction to Dr Kramer caused the American Nurses Association to promote the studies about magnet hospitals – places where the new nurses were being nurtured and developed. and from there to the whole Magnet Nursing Service movement.  There is now an independent non-governmental agency which evaluates hospitals that voluntarily apply for Magnet Designation.  Can we agree that this is a good thing? We still have a long way to go, and the budget climate is not helping us, but an argument could be made for saying that Kramer gave the entire profession the wake up call that led to this work. She got the ball rolling. Every hospital should have a Magnet Nursing Service.

Return to wallowing in negativism

back to burnout. There are four phases.

the honeymoon. This is where the new nurse is still being oriented and everything is wonderful. The preceptor is so smart! The staff is amazing! The paycheck is HUGE! we all love to be around such a person and delight in the innocence of youth.

crash and burn. the onset of this is hard to predict, but usually about the six-month mark. Takes place when the nurse starts getting feedback from every direction, not all of it is easy to take because people are telling him or her that they are not perfect. The nurse is now saying “These people are jerks. This hospital has its priorities wrong. nobody is listening. Why did I ever want to be a nurse?”  This person can be angry and depressed.  Nothing is wonderful anymore. The road has a fork in it. One choice is to leave; the other choice is to stay.  When the nurse  leaves (regardless of where they go), it  causes the cycle to repeat with new nurses.  Turnover of this nature is expensive for all concerned. The National Council of State Boards of Nursing has recently recognized that up to 25% of staff nurses who do get a job, leave their first position within a year, which has caused the NCSBN to work on what they call “Transition to Practice” issues. In this way, we wonder if anything has changed since the 1970s……

recovery.  This is a phase of letting go of anger and depression, characterized by the return of a sense of humor. The preferred outcome of crash and burn.  The nurse wakes up and realizes that some things are good, some are bad and not everything is perfect. Or Burnout the nurse quits the job and goes to another job (to enjoy another honeymoon!) or maybe leaves bedside nursing altogether.

and resolution. where the nurse develops a sense of perspective and is able to contribute effectively.

The Care Plan for the Nurse?

The key is to assess yourself and those around you, and adopt some specific interventions.

the honeymoon? keep the new nurse grounded in reality. No, it’s not as perfect as you think

crash and burn? similar to above. No, it’s not as bad as you think. Hang in there and keep working at it!

recovery? find new ways to be productive now that the new nurse has been around the block.

and resolution? find joy and happiness in leading your life, with nursing being just a part of it…

Water over the dam

There’s been a lot of work on related topics since 1975. For example, the whole “codependence” thing came and went – the more codependent the nurse is, the more likely they are to experience burnout.  Closely related to this is the idea of OCD, and I gave my two cents on this in a prior blog. We have had periods of cost-cutting when a new wave of managers rejected efforts to nurture and  mentor new nurses through their role transition issues. Sometimes it feels like all the negative and positive trends are now stewing in the same pot…..

The Bottom Line

Probably the most important lesson is that you may go through these phases by yourself, but you are never alone. Use your peer-group resources. Each nurse has to start by assessing themselves as to where they lie on the four-phase continuum. Keep your sense of humor, and keep your self open to sharing with others.

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…..

 

tips on writing a resume for new nursing graduates

Tips on writing a resume for new nursing graduates

 Don’t miss the series

I am writing a series of blogs on the topic of making your way in the world now that you are being launched. I already wrote about cover letters for your resume. Please consider subscribing  to this blog. shar eit with your friends!

Future topics:

Some tips about asking the faculty for recommendation letters and how to enlist their aid;

My own response to the recent article on Medscape that asks whether there really is a nursing shortage; 

things you can do while you are still in school, that will help – the so-called foot-in-the-door strategy.

How to find a mentor will be part of your winning strategy – what I call assembling you personal Board of Directors. Than in and of itself, is a secret that is worth a million dollars.

To be sure to see these when they are written, go to the box on the right that says “sign me up” and click on it.

 The zen of resume writing

 To write a resume is always an assignment for the last semester of nursing school. The faculty is about to launch you like a rocket headed into outer space, and the resume is fuel for the trip.  Depending on the faculty for your senior level course, though, you may not get much feedback. Sometimes the person has not read many resumes in real life, or been a department head who interviewed any potential employees. They may not have the background to predict for you how a potential employer will react to your resume.  

 A resume is an exercise in zen, On the one hand, there is a formula for this. You need to have some dates, places, and accomplishments. But on the other hand, you also need to focus on what makes you special and what you wish to feature. If you can do that, your resume  will sing like a TV commercial. The question is, how to get to that point.

 Inventory your skills and pick your selling points

 The tendency is to write a chronology of your life. You will need to provide that sooner or later. But an important early step is to write down a list of what’s the most important, and prioritize those items. When you actually get to formatting the resume, find a way to put these first. If you can’t think of what would go here, ask the people who know you, or your mentors, how they would describe you.

 Overcome your humility

 There is something peculiar about nurses and nursing students. And especially if they were raised Catholic (like me). We are taught from  early in life that it is bad to seem like you are prideful, or to overtly bragging in some way. Take a minute and think about this. Then get over it. If you did something really good, here and now is the place to describe it – don’t bury it in the middle where somebody has to dig for it. Front and center! For example, a student of mine spent summer 2011 at a Mission Hospital in a truly remote part of Africa, where she delivered some babies, worked in the E.R., and developed skills of personal leadership while exploring some very high ideals of Christian service. She gave it exactly one line in her resume, and didn’t even follow the Outcomes Rule (below). She succeeded in a very difficult environment where more experienced nurses would have been overwhelmed. This was more than just a summer job in a USA hospital.  Say wha?

 The I word. is it really about – me?

Okay okay okay, it can be overdone – for example, go through the cover letter and see how often you use the word “I” – don’t start every single sentence that way – but usually nursing students are the last ones to fall prey to this problem. Don’t hide your light under a bushel!

 Focus on outcomes not tasks

 When I take students to clinical practice, the end of the day is occupied with writing a draft nursing note in the DAR format.  For a beginner, the usual first drafts of a note often consists of a  list of the tasks, not the assessments. For example: “dressing changed, tube feeding given, vital signs taken” etc. 

 When I read that kind of note, my response is “okay, but how did the wound look? What was the residual volume? Was there a problem with the B/P or the temp? what did you do about it?”  sometimes students take a while to ‘get it’ and start writing about nursing process others  take a little longer. When I read a note that says “wound is nine by seven cms, no undermining noted, scant amount of serous drainage noted.” Or “residual volume was less than fifteen cc, stool is soft, skin turgor normal.”  This gives a lot better info to the reader.

 The equivalent on a resume is to write:

 “2006-2011 – part- time server, Bubba Gump Shrimp co, Ala Moana Center”

 Or

 “2004 -2009 nurse’s aide, Hawaii Medical Center, SNF department”

Each of these could become much more valuable if they were reframed in the following way:

“2006-2011 – part- time server, Bubba Gump Shrimp co, Ala Moana Center. Assigned to six tables during busy dinner shift, including beverage service and daily specials, used computerized order-entry system. Received 2008 customer service award, worked 20 + hours per week to support myself during college. ”

 Or

 “2004 -2009 nurse’s aide, Hawaii Medical Center, SNF department. 50 –bed unit with average daily census of 35. Two patient populations – short term rehab after joint reconstruction and long-term post-brain injury  with severely altered mental status. Functional nursing model. Usual assignment was to share 12 patients with another aide. High emphasis on personal organization and accountability to licensed staff. Perfect attendance on rotating shift schedule.”

The key is, a well-written descriptor can guide the reader or interviewer with specific followup questions that are intriguing and beg to be asked.

 The original versions of each don’t get much of a reaction from the reader. The revised example, though, hint at skills that might also apply to a nursing setting. When a potential interviewer reads the revised examples, they are prompted to ask certain questions. “tell me more about multitasking?” “are you good with computers?” “what exactly did you do to achieve the customer service award?”  that sort of thing. The idea that they might be able to discuss this with you, makes them more likely to want to interview you as the next step. A well-written description can serve as a tease, begging for a followup from the reader or interviewer.

 Or the interviewer might followup with the second example by saying, “if I asked one of the licensed staff about what it was like to work with you, what would they say?” or “of those two groups, which was your favorite?” or maybe “how did you stay motivated every day when you knew that progress would be slow?”

 Outcomes, not tasks.

In summary, don’t simply describe what the job description was, focus on the what you accomplished. You want to portray yourself as a doer, even if all you have held were “worker bee” jobs. These sort of statements convey the idea that you have skills for accountability, dependability, and customer service.

 Final point for now

 If you have just graduated, be sure to put “(your name), BS Nursing, right at the top. When you pass NCLEX start putting RN right up there in big letters. You are applying for nursing jobs, after all, and you worked hard for that credential.

 I will continue this blogging theme  in coming days. Keep those cards and letters coming. send an email to joeniemczura@gmail.com with your question if you are too shy to add a comment. Feel free to browse this blog, and also consider buying my book about hospital care in Nepal.