Tag Archives: time management in nursing

Nurses and OCD (Obsessive Compulsive Disorder) – is it good or bad?

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Why WordPress is a terrific blog host

I am  satisfied with WordPress as a blog host. I like the interface and the themes. Did you know that when you own a blog, you can access the statistics as to the number of hits? WordPress helps me see how many hits I get (highest was 479 in one day!) or which countries the hits originate from (about 110 countries – nearly everywhere except China and Francophonic Africa) or how many hits each entry received ( the blog about “myths of Nurse Practitioner education” was surprisingly popular). It’s a great way to get feedback in ways that go beyond waiting for a comment to appear or not.

But one intriguing thing is, I get a daily list of search terms that somebody typed into their machine and which somehow led people to this place.  There is one particular topic I have meant to expand upon and now is the time.

Obsessive Compulsive Disorder among nurses

I think this shows up because I wrote a series of blogs about the Nurses Road Map and I observed that attention to detail, ability to execute a complex plan, and work with checklists, is a trend that is not going away. To some degree, we are raising a generation of new nurses to be checklist-users. The field of nursing informatics is designed to sift through the mountain of clinical details available at the bedside and help the nurse get through all the little events of the day (while keeping track of the big ones). Anyway, there is an online quiz you can take to evaluate your own OCD. Most nurses will laugh at this because it highlights the relationship between fears of death or disease and the development of OCD; for the lay person this may seem irrational but for nurses the fear of catching a fatal illness can be entirely rational.

Now to the meat of this blog

The short answers, not based on science but based on a lifetime of observation.

OCD While in Nursing School

 1) A little bit of OCD can be helpful. As a nurse, you are accountable for followup on things you are told, and this includes organizing patient care. Read my blogs about the Road Map, please. it is my gift to humanity ( though I did not invent it)

2) too much OCD  is disabling. True story: I once worked with an IV nurse (i.e., specialized in intravenous infusions, all day long, starting, hanging meds, and running them including hyerpalimentaiton and Chemo rx) who had every symptom of OCD. She once spent fifteen minutes starting an IV on a person who had died. without noticing the lady was not breathing. Fortunately, the patient was a Do Not Resuscitate. But still……..I would have noticed, myself.  If you have OCD you can get wound up by little details and lose sight of what is important.

3) nursing school is a place where you will get feedback on how much OCD is too much.  We have all heard the war story about the straight-A student who could not actually function in real life. If you are in nursing school now, look around. You will most likely see people who are extremely persistent and meticulous. This is the kind of student who argues with the professor about every single exam answer (should it matter if they are already getting an A? experienced people know that there is no such thing as a perfect exam); asks questions in class about obscure medical syndromes (let’s focus on commonly occurring things, shall we?) and is consumed by the idea that “this is important what if somebody dies because I don’t know this?”   ( not likely. trust me). Ask yourself who in your class is dealing with OCD.

Sometimes the faculty are a bit timid and don’t call out Obsessive behavior. They are not doing the student any favors by letting it slide. I had a student not too long ago who thought it was okay to phone or email the faculty with questions at all hours, and who got huffy when there was no immediate reply at 0300 on a Sunday. Hot tip: this is not a way to impress the faculty.

4) clinical with real people is the place where the rubber hits the road. Often, a student with OCD will relax and start to “get it” when they go to clinical, because this is the ultimate place to “test reality.” You can’t always predict every single thing that will happen in clinical, not altogether a bad thing. Nurses benefit every time they meet a patient who demands that the plan fit the patient’s expectation, not the nurses expectation. As an aside, we have a new emphasis on simulated learning these days – using tightly written scenarios with expensive mannikins. When we do this, we delete the possibility that there could be a  useful  serendipitous encounter between a student with OCD and a patient who demands flexibility. The richness of the actual clinical milieu is not to be taken lightly. Simulation is like eating beans; clinical is like enjoying cassoulet…… beans are still part of a good cassoulet but there is so much more……

5) A crisis is not always a bad thing. Let me describe that another way, giving an example. Sooner or later, it’s a common occurrence in nursing school that the clinical day does not go anywhere near the way you planned it, and you feel like a failure. For a student with OCD, this gets magnified into a total crisis, because they often have the belief that they can or should control everything. ( if I can’t be perfect  I should not even try!)

Don’t let “perfect”  be the enemy of “good.”  If the faculty person is wise, this time becomes an opportunity to discuss the zen of staying on track and a whole lot of other higher-order-of-magnitude stuff. A crisis can be a “teachable moment.” Often, a breakthrough. A good way to look at ways to keep OCD in check.

In the Workplace

As I said, some small degree of OCD is probably desirable, but too much is not helpful, and it would be great if everyone got a handle on this before entering the workforce. It does not work that way in real life.

1) don’t take the work home with you. One of the great aspects of effective use of a Nurse’s Brain is that when the shift is over, you can feel good about not missing anything, and clear your mind when you walk out the door.

2) If you have OCD and you are on a nursing team, my personal experience is that you can make life miserable for everyone around you. Other nurses may have a different style of work, and if your OCD causes you to be inflexible, you will descend into madness. I will be blunt: Nurses with OCD tend to become critical of others and to engage in what Marie Manthey called the “Three B’s”. There needs to be limits on this behavior.

3) OCD is not a leadership skill. Sometimes a staff nurse with OCD is chosen to become a charge nurse or nurse manager. This is nearly always a mistake. A person with OCD lacks the ability to weigh and evaluate the relative imprtance of things, and tends to see everything in black and white.

The Great thing about nursing

I will edit this blog entry over the next few days, but the clock is ticking and hey, “it’s good enough now.”  For so many schools, fall semester begins in  two weeks or so, consequently I will hit the Publish button for this first draft.

The great thing about nursing is that to be a good nurse is to call upon your own capacity for healthy problem-solving behavior and healthy coping which keeps OCD under control…….

June 2014 update: click here for a link to an excellent blog about how to cope with anxiety if you are a nurse.

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part 1: Secrets of a Nurse’s Brain – six steps to success at clinical practice, or anywhere!

Shhhhhhh…..

I don’t normally share the deepest secrets of my trade with just anybody.

But you?  you are special!

pull up a chair and listen closely….. I will reveal to you a mystery of life which will change your destiny….. if you can handle it….. after this your nursing school trajectory will be brighter and happier….. and while you are at it, subscribe to this blog. At the bottom, you can click on a “Share” button to help your friends. Don’t you want them to do well too?

9781632100085-SOTG-Nepalt.indd

The back cover of my book. If this were a bookstore, you would read the back of the book-decide to buy. Find this on Amazon at https://goo.gl/PGTW30

 

 

Oh, and buy my book. It’s a novel I wrote to convey what it is like to work overseas in a missionary hospital. It’s not a sugarcoated version – the medical details are extremely accurate and well researched. It’s not the usual textbook but some schools have added it to the Global Health reading list. There is a love story of course!

Skills are more than psychomotor by nature

Okay, so I teach beginner nurses how to be a nurse. We start with well-meaning intelligent kids and turn them into professional persons. When people think about the skills nurses need to have, they list things such as giving a shot or doing a dressing change.  Using sterile technique and doing the Five Rights of medication administration.  Close your eyes and picture a nurse at work, and this is the image that comes to mind. These are the psychomotor skills, hands-on things we do for people.

It’s just as important to learn how to juggle time, set priorities and estimate workload, but these are “soft skills” – and a behavioral scientist might argue that since these can’t be demonstrated, they do not exist….. now – an educational paradox exists.

The Road Map to Success

The key to learning these skills is to learn how to use a Nurse’s Brain, what I also call a road map, and to incorporate it into your daily life.  If you are not now doing this, it will be the biggest single revelation of your trip through nursing school.

Simplest version of instructions

This is part of teaching a new nurse how to prepare. Depending on your curriculum, the faculty will tell you ” go to the hospital the day before and learn about your patient.” A less experienced faculty member might leave it at that, and set you loose. Nobody tells you how much is “enough,” but a less experienced faculty will reserve the right to criticize you when you didn’t do it right.

Long ago I learned that beginners need to be shown how to prepare and given a specific description of what this entails. Effective prep is a skill in and of itself.  Here goes.

Here is how to prepare

You will read the chart for all kinds of things – the diagnosis, allergies, meds, etc.  your school will give you a template as to things you are looking for. look up each med the person is receiving. that sort of thing.

BUT, in addition to this – when you read the chart, you find the specific list of interventions and activities for the day. they will be always be somewhere, in the old days it would be found in the “Kardex”.

Six Steps to actualize it into reality and answer the question “what do nurses do all day?”

1) Start with the “Doctor’s Orders” (which aren’t really “orders,” we just call them that…we carry them out but that is not done blindly) a typical list goes like this:

allergies: none known

diet: NPO

v.s. q 4 h

activity OOB to chair TID

midline w > d dressing to abdominal wound q 8 h

I & O

foley catheter to bedside drainage

veno-dyne boots to LEs while in bed

pain med PRN

IV D 5 NS at 125/hr

that sort of thing. okay, this was simple enough. your job is to make it happen

2) The next step is to assign a specific time to each activity. so you make a piece of paper that looks like this:

0700

0730

0800

0830

0900

0930

10 00

1030

1100

1130

you can make a template for this, and there are lots of examples of sample Brains out there….

3) next, take all the items on the first list, and add them to the second:

0700 – nurses report, find out who the nurse is.

0730 – take vital signs, ask about pain, assess dressing, check venodyne boots and IV site, look at catheter

0800 – mouth care ( since he is NPO),

0830

0900 – ask about pain med again,

0930 -dressing change

10 00 – get OOB to chair, check I & O,

1030

1100

1130 – take vital signs again (it’s four hours since the ones you took this morning)

4) next, go through the list again, and add stuff that is assumed to be needed, according to the routine of the unit

0700 – attend nurses report, find name of staff nurse also covering your patient

0730 – take vital signs, ask about pain, assess dressing, check venodyne boots and IV site, look at catheter

0800 -look at IV site q 1 h

0830 – bathe patient

0900 – ask about pain med again, -look at IV site q 1 h, give 0900 meds if any

0930 -dressing change, ask about pain if the patient got some med in advance

10 00 – get OOB to chair, check I & O, -look at IV site q 1 h

1030

1100 – write DAR note in patient chart, complete ADL checklist

1130 – take vital signs again (it’s four hours since the ones you took this morning), report off to staff nurse

0700 – attend nurses report, find name of staff nurse also covering your patient

 5) next, add some details that might not be obvious. put a box next to each item so that you can check it off when it is done.

0700 – attend nurses report  ___,

find name of staff nurse also covering your patient ___________

read specific instructions for dressing change and check to see if supplies are in the room _____________

0730 – take vital signs, ______________

and report to staff nurse,____________

ask about pain,______________

assess dressing, _____________

check venodyne boots _________________

and IV site, ______________

look at catheter, ______________

check sacrum and heels,____________

reposition if needed,___________

listen to Bowel sounds____________

and lungs______________.

confirm that ID band is in place________________ (so you will save time later when giving meds).

check call bell and make sure patient knows where it is ___________

0800 -look at IV site q 1 h ______

assess mouth and do oral care ________________

see if any other students need help with turning their patient or incontinence care _____________

doctor’s rounds _____________

0830 – bathe patient ______,

do cath care ___________

complete head-to-toe assessment sheet from School for care plan.___________

ask patient about discharge plan, _______________

assess need for teaching _____________

leave bed in low position after bath __________

0845 – short coffee break _________

report to nurse that you will be leaving for fifteen minutes _____________

check to see doctor’s orders if any new ones were written ___________ check lab results for today _______________

0900 – ask about pain med again, _________________-

look at IV site q 1 h, _____________

give 0900 meds if any. ____________

make sure you took B/P _________before giving meds. ___________

decide what the theme of the DAR note will be. _________________

0930 -dressing change,____________ (follow recipe)  ask about pain if the patient got some med in advance,

10 00 – get OOB to chair,_______________

check I & O,_____________

-look at IV site q 1 h_____________

1030

1100 – write DAR note in patient chart___________,

complete ADL checklist ___________

1130 – take vital signs again (it’s four hours since the ones you took this morning), ____________________

report off to staff nurse _________________

This is the short version. When I first teach people to do this, they may have up to forty items on the list, because they need reminders of everything.  As you can see, the Brain evolves as you add things to it. doing a dressing is more than just doing the dressing – it’s checking the pain med, checking the order, gathering supplies, and negotiating a time. each of these gets their own spot on the checklist.

If your whole clinical group is using something like this, you can plan your work as a team; you can make time to help others; and you learn to share a language as to when each team member needs help or not.

6) During the time at clinical:

http://www.amazon.com/Sacrament-Goddess-Joe-Niemczura/dp/1632100029/the Nurses Brain goes on a clipboard, and you refer to it every fifteen minutes. cross off each item as you do it. at 0900, every item that was assigned a time before 0855 ought to be done. If not, you now know which are the priority items. when something happens during the day, such as a med not in the drawer when you go to get it, you make a note to yourself using this sheet, to recheck later. assign a specific time to every event. which specific time doesn’t matter as long as there is one!

Florence Nightingale herself once said that for a nurse, learning to use pencil and paper was far more important than learning to use a stethoscope. Okay well, we’ll teach you the stethoscope too, but this Brain is what the pencil and paper are for!

There is an old rule that if you get your stuff done, and become known as a person who always completes their tasks, you will be rewarded by being assigned more tasks the next time.  You can not possibly achieve this state of bliss unless you use a checklist. The staff nurses always make snap judgements regarding the students – if you prove to them that you are using this, they will be positively impressed. They hate it when you fail to do something and then also fail to communicate with them. If you’re not going to be able to do something, you can use this tool to estimate what that would be and then tell the staff nurse in advance, which will safeguard the patient from problems. We are all  part of the team!

Using your brain is a key to college – using the Nurses Brain is the key to successful nursing!

tomorrow: part two: checklist culture and your role in quality.  There is a lot of attention being paid to this issue, and if you are the kind of nurse who makes “to-do” lists, you will succeed in nursing and in life.

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Filed under Nurses Brain, nursing education