Bias, stereotypes, and prejudice. Oh my?

In case you didn’t know (and because I’m a closet selfish person who thinks it’s a holiday), tomorrow is my birthday. 

The older I get the more I contemplate things in my life. No need to recap my history, but I’ve been alive long enough to understand some things just by observation. 

Like we can be good, but the bent toward evil plagues us all. For all my backslid ways, I recognize and acknowledge the hand of God and our innate battle to do the right thing. I battle it everyday. 

I also recognize that many times there’s something good that crops up out of terrible situations even if we can’t see it until years later. 

Another thing that is always apparent to me is the role bias/prejudice can play in how we deal with people. We are human and mentally require a way to understand things in our lives. We are prone to classify things in boxes to keep things sorted and that sorting can end up with labels that affect how we interact with our world. 

I’ve harped on stereotype and prejudice because they aren’t the same. One can be harmless and the other can lead to lynchings and shootings. I’m going to give a short, sparkly talk on what’s on my mind and perhaps one day I’ll do a better post on this. 

First my definitions of things. 

Stereotype: super simple view of a group. All women… All little girls wear pink. All men… 

Prejudice: when those views are morphed into something not found in truth leading to hostility, fear, and violence. 

I expect people to have some stereotypical views especially when you’ve never encountered that people group. What gets hard is when people refuse to recognize and let go of those stereotypes. When you can’t see how you may be biased, you can’t understand the struggles of the other group. 

Let me mention my own bias that I recognize. When I’m at work, I automatically see all doctors as nasty demagogues who treat nurses like crap. That’s my experience and it’s hard to shake that particular bias and how it affects my relationships with physicians. When I work with drug users who put their newborn at risk, I also struggle. I also see my own fear and bias when I live in a predominantly white/rural area. It was in a rural area that I had my run in with someone shouting racist epithets. Nothing is scarier and isolating than a true terror that comes when you aren’t sure if your skin color could result in someone attacking you. I’ve met many welcoming people, believe me! It’s not an unfounded view, but it’s hard to shake it when I’m somewhere more rural. 

I struggle against my bias. Mine is more of how the behavior of others can hurt me, but I’m sure I hold other beliefs that make me avoid helping those I should. 

Our current social climate is tense. We as a people group don’t realize how deep our collective bias/prejudice runs. We can’t see it so we don’t change it. In movies, it’s the automatic roles that those of color or women fall into and the way we don’t question it. The gangster, the bimbo, the ghetto queen. Those stereotypes stem from our own incomplete understanding of people.things rutted in age old beliefs. 

Bias can and does affect certain people’s ability to get a job. How many studies exist showing how equally qualified individuals are side by side and interviewers don’t even give the person with the more ethnic name a chance. People argue that it’s the company’s right, and I’m not disputing that. What I’m trying to get people to see is that the bias exists and people are ignored and put at a disadvantage because of it. 

We all like to believe we are sinless when it comes to sexism, racism, any ism but the truth is some of our isms are societal and taught. It’s engrained and subtle. We are not absolved just because we say “society made me think it”. We have a responsibility to recognize and change our prejudices. There is no free pass simply because you are a Bible believing Christian. You need to open your eyes and see if your bias is making you treat others as less than. 

For example…

If you ever said,”they should get off their butts instead of leeching off the government and support themselves.” What makes you say that? How is it changing your willingness to be a possible champion? How does it help you to ignore the need in this group? 

I’m no wrist slapper and I’m not here to shine a light in anyone’s eyes except my own. But… If your pupils dilate and you see a little better, everyone wins. 

So, back to traveling, huh?

Travel on, road warrior 

The cost of resentment 

Adios, Plymouth! 

I’ve made my way home which means I’ve completed another assignment. This was one of my best assignments even with the usual crazy staffing situations we ran in to. And after how difficult I found my previous location, I needed somewhere welcoming. 

Quick plug: any licensed Mass travelers, look into Beth Israel Deaconess in Plymouth labor and delivery. In 10 years of nursing, they have the best providers I’ve ever worked with in my career. Nothing but respect and comradery amongst nurses/doctors/midwives. If I wasn’t such a rolling stone (and didn’t possess such an aversion to winter), I’d put down roots. I never felt like “the traveler”. My help was appreciated and that made me feel like an asset. I do plan to return AFTER winter because I think it’s a good place to work. 

There was a little bit of a shake up right as I was leaving. It made me think of things that happen in our lives that breed hard feelings. 

No relationship is perfect. Things irritate us about our loved ones and its hard to not let resentment build up. In a love relationship I can be feeling unappreciated or taken for granted or not listened to. In a working relationship it can be making decisions without regard for staff or a lack of team work or punishing the whole staff for the behavior of one employee. 

But looking broader, resentment can come when someone voices a hurt, concern, trauma and instead of responding with compassion or action you ignore, belittle, or downplay the pain by pointing to something that has little to do with what’s being brought up. Looking at some of the issues facing our country today, it’s evident we have a serious resentment problem that’s exploding into something dangerous. People who aren’t heard tend to react with anger, sadness, violence. Why keep trying when you simply disengage and shout your anger to the world? 

So what’s the answer to resentment? Aside from Jesus and a bat to the back of the head? 

Listening: always the first step. If someone keeps saying they want something or are hurting, don’t add your two cents! Open ears and shut your mouth. 

Checking in: ask how they are and care about their answer.  Don’t let what they say be about how you feel. Let me repeat. DO NOT LET WHAT THEY SAY BE ABOUT HOW YOU FEEL. If they are talking about issues in their life, your response should never be explaining how you feel about it or how it has an effect on you. 

No excuses or apologies, but action helps: we want better relationships. It’s easy to say it’s not your problem and they need to open their mouths or fix their lives or stop complaining. That doesn’t change anything. You’ve added more anger and resentment to an already tense situation. Instead be an advocate, counselor, teacher to others on their behalf. Be a champion. 

That makes change. Listening and hearing and acting make change. 

Where to next? I’m actually headed closer to home. I’ll be in Charleston, WV until the beginning of December. So I’ll be in WV for a while for those in the area. They are going through and medical records conversion which increases their need for staff. 

I’m nervous because I’ve not truly worked in the state in over 3 years. I’m not used to the people or the issues anymore. I’m also not sure how I’ll be received. I want to be liked and seen as someone there to help. How will things be? We’ll see soon enough!

Travel on, road warrior. 

“I’m so glad you’re working tonight.”

Hello from New England. Summer has officially crept in, which means I’m down to 3 weeks remaining on this assignment. It’s all downward slide from here. For me, it means I’ve reached that point where I’m not quite coasting, but I’ve hit my stride and see the light at the end. 

This hasn’t been a bad assignment. Once my anxiety from the previous assignment diminished, I was able to see how this could be a good place to work once they fixed their staffing issues. Honestly, hands down the best physicians/clinicians I’ve worked with ever. Respectful, collaborative, and not condescending. It’s like a dream. I’d take these docs and midwives and add them to my dream hospital. Seriously, you should come work for me because my dream hospital is going to be Ah-Mazing. 

I’ve oriented a lot on this assignment, which is strange. I’m a traveler, how am I going to teach you what you need to know to do well at this facility? I mean, I can show you how to manage a labor, but the individual intricacies of your work place? I just know enough to make sure I don’t overstep my boundaries as a temp worker.

I have knowledge and experience specific to L&D, but I’m no teacher anymore. Okay that’s not true. Once a teacher, always a teacher especially as a nurse. I just don’t always feel comfortable teaching as a traveler. Telling you what I know to be true in labor and what your facility wants isn’t the same thing. 

A girl I’ve oriented here told me the day before she was always glad to see me at work. She said she felt better because she knew I knew what I was doing. That made me feel… Like a grown up. Haha. 

I’ve turned into someone a younger/newer nurse could look to for advice? When did that happen?? 

What I am is an encourager. I like to cheerlead new hires or transfers to a floor. I like to tell them they can do it because they can. I like to offer words of advice and a smile that says go get ’em. I like to ask if they are doing okay and need help because it’s nice to know you have back up in a crisis. 

I’m still learning and my true teaching days are on hold, but (like I said) you’re never truly done teaching. It’s exciting and challenging to realize that 10 years in, I’m not a baby nurse anymore. Someone is glad I’m working that night because they know I’ll help. 

Here’s to teaching and being always teachable. 

Travel on, road warrior 

Acknowledging the past, not ignoring it. 

It’s the start of week 9 here and it’s been a lot of radio silence. I apologize for that. Some could be the result of residual indifference I feel on this assignment. 

Odd to be feeling that way because in many instances it’s really not been bad. Great providers! Shoot, many doctors expect to be called by their first names and seem to listen and respect both the nurse’s opinion and the patient’s desire for a vaginal delivery. They tend to hold out on surgical intervention until it’s absolutely necessary, which I appreciation. I’ve not encountered too many high risk instances here that feel outside of my particular level of expertise. Even faced with such a nice set up, I still battle some of the worst anxiety I’ve felt in a long time, don’t really feel that usual connection I get at work, nor feel any desire to remain there that I usually consider at this point in my assignment (when things haven’t been bad). 

I can’t put my finger on it, but I know with 5 more weeks remaining, I’ll be moving on to somewhere else soon enough. 

Ambivalence aside, I wanted to discuss something that I encounter a lot as a labor nurse. And no, it’s not the self-important anesthesiologist who seems to expect the nurse to wait on him hand and foot. That’s another post… 

I’ll get a patient for admission, someone at the end of their pregnancy and in a committed relationship with their husband/significant other. I’ll start to browse through their history and read something that goes a little like this… 

Patient has (an STI/history of drug use/something serious in their past), HUSBAND DOES NOT KNOW. 

Uh oh. 

This puts me in a spot where I have to attempt to get a clear history, including medications they are on and sexual history that may affect the baby, but I have to figure out how to do it with them in pain as their significant other supports them. 

I understand what it means to have a past you don’t want to discuss and how it would be hard to bring it up, but I question the level of trust you have with someone you’re married to if you didn’t feel safe enough to reveal a big part of your history that directly impacts them. 

The basis of a marriage is trust and adding a child to that is asking for more trust between the two of you. Opting to withhold things that could damage established trust when it came out later could be detrimental. Is it a matter of acknowledging you’ve picked the wrong partner or exploring why you don’t trust them enough to reveal yourself? 

Plus you’ve got me in a bind as your nurse in trying not to be the one to ruin your relationship by accidently spilling the beans. Revealing secrets and ruining marriages, I’d like to not to add that to my résumé thankyouverymuch. 

This makes me think of things I still keep hidden. It’s hard to open up, but holding back when you’re in an intimate relationship (friendship, family, love relationship, discipleship group) can definitely breed more mistrust when truth comes to light. I guess it’s a matter of creating that space in your relationship to be honest or asking what holds you back from honesty. 

Bottom line: don’t make me have to be your secret keeper in labor. I’m not a good liar. 

Travel on, road warrior. 

Your first name is Dr. So and So

Two weeks over here in Plymouth and so far and cautiously optimistic about how this place will be. In review, this place is an LDRP similar to my home spot. They do between 600-800 delivers a year and have 10 beds, so far smaller than what I was doing in south San Fran. As usual, they are having a staffing crisis that started two years ago and has only gotten worse. 22 people have quit or gone per diem in the last 2 years. That number is insane to me for one floor considering how small they are. 

I had two 12 hour shifts of orientation of which there were no labors so I shadowed a nurse caring for postpartum patients. They were swamped with patients the few days prior to me starting so of course they drop down when I get there to orient. Which means I end up doing labor as soon as I’m off orientation. I can do labor anywhere, heck I can do postpartum anywhere. It just gets dicey when they have a mountain of paperwork I have to try to muddle through. I’m still trying to make sure I’ve crossed all my Ts and dotted my Is. 

I also find their relationship with their doctors interesting. 

After 10 years of nursing, I’m formed a distinct opinion of physicians as a whole. When you’ve been yelled at, belittled, questioned, or had things thrown at you, you allow that to shape your respect for those with DO or MD after their name. I’ve adopted a guilty until proven friendly approach with all physicians. They may be very nice outside of work, but the first time they treat me terribly, I only interact with them as far as work is required. We aren’t friends and we could barely pass as colleagues. I’ll advocate for my patient when we have to talk, but beyond that we don’t have much need to converse. 

This place is different because they have good relationships with their docs. First they happen to be really nice and willing to work with the nurses, and second, they let themselves be called BY THEIR FIRST NAMES. 

Wait… What?! 

I was talking to a fellow traveler and we both remarked on how bizarre that is. Not just that they address the docs by their first name, or that the docs introduce themselves as such, but this is the nicest group of physicians I’ve encountered in my career. 

Someone help me find a flat surface because I feel faint. 

It made me examine how I’ve allowed the bad behavior of previous doctors to make me use the title of Dr as a shield. Part of me understands the natural level respect for someone’s title. You’ve worked hard for that degree so you deserve to be addressed properly. Whether I like you or not, my mama raised me (semi) properly so those with a certain level of authority have earned a certain amount of respect. 

That’s on one hand, but on the other, titles can be used as a way to distance yourself from understanding or caring for someone. They are a doctor so of course they’re prone to arrogance, outbursts, disrespect, and disregard. I’ve been taught to give the barest level of respect, but you’re nothing to me beyond my interaction with you in caring for my patient. Terrible behavior on my part. 

Look, even though these docs seem very nice and personable, I don’t anticipate most physicians to be friendly or willing to be addressed by their first name. I don’t see myself doing it either, but I should try to stop letting my preconceived notions of how docs have behaved to turn me cool to all docs. 

Heaven help me, I’m entering into a new era. I’m going to need some time to make this attitude adjustment/change. 

12 weeks to go. And it’s felt fast even with me working 40 hours a week. Of course I’m already thinking of where I go next… 

Travel on, road warrior 

The Canea C Family Birth Center

I’m ready to start at the new place, which means I made it safely to Massachusetts after a few minor mishaps. One of which included losing my wallet at the welcome center clear on the other side of Connecticut. But prayer is a pretty miraculous thing because not long after my fruitless searching, someone called saying they found it and would mail it home. Yay!

Starting at the new place also means it’s orientation time again. Seriously, after 3 years, I’ve sat through so many orientations I could run them myself. I stand by my theory that every orientation is the same. “We’re a great hospital, you should feel privileged to work here, listen to all the important people talk”, times two days. I’m just hoping I get a free voucher for the cafeteria. I’m also hoping for no surprise tests and coworkers who treat me well. Fingers crossed.

With the start of orientation, I always think about floor set up. What’s my ideal hospital? Aside from one that treats nurses like they are the backbone of the system and includes them in decisions? Well, when I inherit a windfall of money, purchase an LDRP floor, have it dedicated to me, and design it how I see fit, this is what I’m imagining. Picture it!

The Canea C Famil Birth Center or the CCFBC for short.

My ideal floor would be situated so the nurses can actually navigate the floor and not run down multiple corridors in the event of a staff emergencies. I already walk 5 miles at work, there ain’t no need to add 5 more miles to that because the floors are the length of a football field.

Pods would be acceptable with desks at each one, but i require a better central monitoring system so everyone can see on large screen when patients are having decels. And on the topic of monitoring systems, I need one that’s actually user friendly. What’s that mean? Stop with multiple tabs, charting in a bazillion places, and clicking around forever to find the box or test I need. Lab results should be easy to locate and print. Everything should flow over. Labs, vitals, doctors notes. I shouldn’t have to hunt for that consult. In other words, I need to you actually consult the nurses who work the floor on how to set up the computer system and I shouldn’t have to retype vitals signs so many darn places

I want tub rooms and a home like set up for those who want a natural birthing experience, with the ability to quickly transfer patients to traditional hospital set ups if necessary. I want in house doulas who understand how the hospital works and behaves accordingly. Lobby for your client but meet halfway on how things should go.

What about staffing, acuities, and set up? I don’t think the floor should be split, because patients have the right to remain in the room they’ve delivered on. I believe the staff should be split and rotate. Labor and postpartum. Minimum staffing is 3. Someone to triage/charge, a labor nurse, and a postpartum nurse. Four would be ideal, but I know that’s not feasible in non-ratio mandated states. You staff up as the number of labors increase. You can run two labors if they are early or do two inductions at nights. One becomes active so you hand it to the free nurse, labor/deliver/recover that more active patient, transfer her care to the postpartum nurse, and then take your previous labor back over or open yourself up to assist with triage/take a new patient. The free labor nurse can triage (if needed to help charge), assist with breaks, take postpartum patients. So if you have a scheduled section, an active labor, 2-3 couplets you’d staff 1 for charge, 3 to do labor, 1 to do postpartum = 4. Your section has a buddy in the free nurse, you can have charge be present for immediately after the vaginal delivery (until baby is out and okay) or have your PP nurse second the vaginal if the charge is busy. Everyone gets a turn as postpartum or labor, and you don’t get out of helping!

This means, no gyno patients. It also means you’d increase staffing for the number of labors/couplets. 6 couples is two for postpartum, 3 couplets a piece with them free to take a 4th each. 3 labors is 4 nurses for labor. You’re always one labor nurse over to buddy or take a patient. Anyone in early labor can be doubled if you’re busy and staffing is short.

I want CRNA’s on the floor, rounding for epidurals. They are sooo much easier to work with than regular anesthesiologist. I also want all doctors (OBs and anesthesia, also surgery in some form) present in the morning and at night for board report. So you know who’s a possible c/s, epidural, rapid progresser. Everyone is in the loop.

I want a modified bedside report. Report the brunt at the desk and then go together to greet the patient and examine lines. Off going nurse writes names on the board.

I’d love a better reward system for nurses who excel. Something that really breeds ownership. Meetings that are convenient for all the staff. An opportunity to grow with mentorship programs. New staff orienting to all aspects of obstetrics. Start by making them the second nurse for deliveries so they are more comfortable handling neonates at delivery, progress to monitor reading and caring for laboring patients, then recovery period, lastly postpartum. Then training sessions/ didactic that fills in the learning gaps. Learning PPH, Mag administration, preterm labor, etc.

I also believe that sending staff to training outside the hospital is imperative. AWHONN conferences, Lactation consultant seminars, or whatever educational things would enhance both the nurse and the floor.

And no more than 2-3 groups of doctors with 3 doctors in each group. I don’t have time to figure out who is on and when. Keep that mess simple. Also, more midwives! Good ones who understand practice and their limits. I’d love for there to be a midwife in triage or a OB hospitalist. They’ll be in house at night, available for precipitous deliveries, and just to make it so I don’t have to wake up that doc I dislike talking to all the time. Can I have an in house pedi to attend deliveries when needed??! Yes, I can have that.

Whoa! This got long, didn’t it? But seriously, I could go on and on. And on and on. This is just my quick ruminations of what it would be like if I was ever in charge of anything other than myself. A girl can dream, can’t she?

Here’s to a world where i dream big and get what I want.

Travel on, road warriors

I’m not saying we’re Sensitive Sallys, but…

My travel life is a series of furnished apartments and hotel rooms. I can’t say that bothers me, but it definitely made me chuckle as I gathered my breakfast this morning. That’s travel life for you though, I’m an semi-permanent tourist/resident. 

Anyway, my trek up to Plymouth starts this coming weekend. Someone asked me how I was feeling about it. Usually the nerves start right around now, but I just kinda want to get the first 3 weeks over with. I want to know if it’ll be a good temporary fit or if it’ll be 14 trying weeks. Fingers crossed for the good fit, eh? 

On to my topic. I’ve noticed more and more we’ve become a society of sensitive people. Everything offends us. Every. Thing. 

The question is: are we really so sensitive?

(Note: I wrote a post last year about being over sensitive. Before I said it hinders discussion, but now I think it has the ability to lead to great discussion if we ask why.)

It’s argued that 20 years ago we weren’t so easily offended by everything. We also weren’t a society so tied to our electronics. Many times when you were offended, you’d hear about it and beat each other up. Now saying things offensive across the interwebz could lead to you losing your job and serious ridicule. 

Many things said that others consider offensive are. Think about it. What you see on the Internet is racially charged, sexually offensive, derogatory, and nasty. I ask you why those things should be allowed without consequences? Why someone gets a free pass to spew anything without backlash? 

No one can encroach on another’s free speech, that’s your right. There are many places where free speech is stifled in every way. For a lot of our complaints as Americans, we have a ton of freedoms. But you aren’t free from consequences of exercising said freedoms. I call it being mindful, responsible, and self-aware. Others may not agree, but I’ll come at you another way. 

If you’re on the receiving end, you expect someone to be mindful of how they talk about you or your family. More than that, a lack of that personal awareness shows how little you care about the margianalized person you’re talking crap about. I challenge you in that case. If you look at me and can then say whatever you want about black Americans or women then I question your Christian concern. 

Lastly, I challenge you to ask why someone became offended by it. Reverse the roles and check your pulse, then get back to me. 

We want to be understood. Understood, valued, and recognized. We want our history, our struggles, and our present selves validated. Nursing teaches about cultural awareness and how that can have an effect on a patient’s care. I challenge everyone to recognize how a broader understanding can make others make sense. 

Here’s what I’ll say in closing. A recent conversation about how we deal with those with addictions and how we care for them made me think. It was mentioned that coming in with an attitude makes people mistrust and lie to you which impedes caring for them AND their infant. Dialing back your conscious and subconscious prejudices/judgments makes people open up. 

Yes, we are a sensitive lot of arm chair, internet warriors. Some of the stuff that fires us up is silly, but some of it is worth the fuss. Some of it is worth asking why it bothers someone soo much. 

Off my soapbox, for now. Just wait until I start talking about slippery slopes. Definitely saving that for another day. 

Travel on, road warrior. 

There’s a strength in there somewhere 

One of the things I think about is the stresses of managing others. Whether it’s patient management/teaching, management of staff, management of students, etc. it’s all hard. You’re dealing with imperfect people who seem to make it their goal to turn you gray early. 

I’ve taught. I had, and at times still have, great aspirations as a teacher. No matter what level you teach at, you go into it believing in the crusade. 

“I’m here to give and make the person I give to better.” 

We go in strong determined to make an impact that changes lives for the better. Somewhere along the way, as I taught, the paperwork/attitudes/lack of support wore me down. Instead of feeling like I was making an impact, I felt like a failure. It was difficult to see how the students were improving from my interactions with them. It was tough listening to their complaints. I walked away. 

I’d never take on management. Why? Because there’s too much pressure above and below you. Too many people to please at the expense of your sanity. Someone loses and most of the times its you (and your staff). 

So let’s call this my ideal world. I’ll be discussing my ideal labor and delivery floor. Not today, but soon because I like to daydream about a world where it isn’t about money and the nurse finishes her shift feeling like she had everything she needed. You can picture it already, can’t you? Nurse Nirvana. 

Today I’m going to talk about building staff up. 

Everyone has strengthens. My ideal manager pinpoints the strengths in each employee and let’s them shine. Someone likes committees, let them be involved. Someone is passionate about breastfeeding, send them to be a lactation consultant. Someone is whip smart, put them in charge of researching current evidence basis practices to present to the floor (doctors and nurses imcluded). 

These people thrive and feel real ownership from their involvement. It has to be deeper than gift cards. It has to target them where they can feel valuable. 

But what about weakness? The first thing I always say is address the offender instead of punishing the whole floor. The person in question will not change their behavior because they do not see how they are the problem. My ideal manager goes to the source instead of putting the whole floor on blast for issues. 

The next thing is how do we change behavior?? Unwillingness to help, laziness, disrespect. How do you target those things? Maybe it is a matter of hearing it from their peers. Or it’s a matter of assigning tasks to them directly. “You will be so and so’s buddy. You are to take this patient from Kate because your load is lighter now.” Sometimes that’s necessary. Even though you shouldn’t have to tell people to help, but many times that’s the only way to keep others from drowning. 

My ideal manager listens and comes back with honesty. Even if that means they say they understand and maybe that change isn’t possible right now. They pull you aside and hear.

The personalities of the floor are hard to deal with. I don’t understand all the dynamics of keeping a floor on track. I don’t want to do that behind the scenes work. 

I think of a conversation today about people we care for who do drugs. It’s easy to look at someone and the things they do  and just wash your hands of them. They’re difficult and an addict. We’re challenged to change our views in order to deliver good care. Learn their story, get them to trust you, be non judgmental, adapt an approach that makes them open to and (maybe) willing to change. 

We can apply that to the work environment. We aren’t going to fix the people we work with, neither patient or staff, but we can alter ourselves. Sometimes that means helping someone even when they refuse to help you. Saving a life that seems wasted. Buddying a coworker’s delivery even though they left you hanging before. 

We continue teaching and trying even when it seems hopeless. One kind word can lead someone to change. Helping even when they didn’t help you can lead them to help next time. Our vulnerabilities and understanding can lead to something good. We’ve seen it and know it’s possible in spite of our cynical selves saying differently. 

Here’s to good managers. I’ll never be one so I commend you for trying to wrangle cats all day. 

Travel on, road warrior

Skill set talks 

And laziness (sits at the desk and does nothing) walks. 

I’m holding off writing another post for… reasons, but something else is on my mind anyway. A little self reflection after being home for a bit. 

In case you didn’t know it, I’m a little bit of a perfectionist. I’d not go so far as to call myself type A, but I’m definitely an overachiever. Perfectionism, for me, has a tendency to devolve into personal nitpicking and self-criticism. Anxiety and depression are also symptoms. 

I say this because I’m really really sensitive to other’s talk and behavior. Which includes talk of other people. Who’s lazy or doesn’t pitch in or not a good clinician. I pay attention, wince, and force myself to work harder. 

The desire to get it right every time can make me overextend myself. I never ever want to be spoken about by others as the lazy/unsafe nurse. They’re always talked about at work because they do more talking than actual work

I fear being seen that way, but know I’m not a perfect nurse. 

Every shift ends with me remembering something I forgot to do that I promised I would, me rehashing events and seeing ways I should’ve done better, or me feeling inadequate because I failed to measure up to my personal standards of care in even the smallest thing. That can be crippling and it’s something I struggle against daily. 

I always say I’m open to gentle correction. If you think I’m lazy or missing critical thinking steps, please tell me as nicely as you can. I don’t want to continue on in a way that puts myself or my patient at risk. But while I’m open to it, I also fear it for the same reasons. My mind can’t help thinking I shouldn’t have missed the mistakes anyway. How critical we are to ourselves at times, right? 

I’m sure I’m not alone in the struggle. It’s a double edge sword in that it makes us strive to be better nurses/people but it also traps us in a cycle of anxiety at work. 

In case no one has told you (or has told you many times and you refuse to believe it), hear me right now when I say this to you… 

You are a good nurse. 

Let go of that attitude that says you have to kill yourself mentally in order to be successful. Do everything you can to make your shift safe and a good experience for your patient, but don’t take every little mistake home with you. You are valuable, important, and offer things that make the floor better. See your potential and personhood for what it is, a way to be light to others. And in case you missed it, here it is one more time: You are a good nurse. 

Read that again to remind yourself, okay? I’ll try doing it as well. No one’s perfect, bottom line, and we all have missteps in our career. Own it, but don’t let it unravel you. 

Travel on, road warrior. 

The staff that orders take out together…

Gains 15 pounds together 

Seriously, a post about staff dynamics has been brewing for years. I keep meaning to write it, but I’ve put it off for more important things. Like food. 

What I’m about to say applies to every place I’ve worked so far. This isn’t me singling anyone out. When I say I wanted to write this forever ago, I mean it. 

I’ve worked in a number of hospitals and environments throughout my career. I’ve worked with people who will always ask if you need help and jump in without much prompting, and I’ve worked with people who will do as little work as they possibly can in a 8-12 hour shift. Both nurses can be part of the same team and that’s why we get excited when we work with a certain crew. Why? Because a good crew can make even the busiest, most trying shift do-able. 

To me, good staff dynamics can make or break a floor. 

My first year out? I was friendly with my coworkers but there were times I definitely felt alone during a shift and didn’t always have the help I needed. The year I went to OB was the defining year(s) as most people I worked with I could count on to jump in. They’d help, they treated me like a colleague, it felt like a family. There were hard working older nurses who taught the younger ones and younger nurses who felt respected and backed up. Everyone grew collectively. That set up, of people working together for the success of the floor/shift, shaped me. I am a nurse who offers to help because it breeds an attitude of collegiality in coworkers. Even if we’re sinking, we will band together to get to 7:30am come hell or high water. 

When that attitude is missing, the floor becomes a high stress zone. People overwhelmed, unable/unwilling to help each other. Bad attitudes become almost cancerous and the level of unnecessary drama and headache multiplies. It’s nurses fighting each other when the census is crazy or you’re short instead of banding together. It’s ugliness and I keep telling you God don’t like ugliness. 

I loathe the thought of treating the hospital like a business, but there is something to be said for using the same corporate personality tests to figure out how people can work better together. Who is a take charge doer? Who needs to be paired with the right secondary nurse because they work better together? Who shuts down when they are overwhelmed, turning toward laziness instead of helpfulness? 

Team building isn’t always possible, but management that comes to the nurse and praises them for a job well done is important. It goes beyond gift cards into face-to-face meetings to evaluate and individually build up your staff. Staff that feels appreciated by their bosses work harder. Stop ignoring the grumbling and get to the root of their complaints. 

It’s staff that sees individual personalities and offers help anyway. It’s being together outside of work to better understand why people behave how they do AT work. It’s building a family atmosphere because as much as you may not like it, this is your work family and it can be as miserable as your regular family if you’re not careful. 

I challenge managers and staff alike to examine their work dynamic. What kind of people are working on your floor? Can they be guided toward working better together and how can I as a manager facilitate that? Staff can ask if they are part of the chaos that tends to elevate the level of drama? Are you really helping each other survive a shift or are you refusing to pitch in and be a solution?

A quick fix is better staffing, upper management that acknowledges hard work, doctors that stop acting like entitled prima-Madonnas, and reasonable patient loads. Since that isn’t always possible, look at yourself and see what you can change to at least alter the tone of the floor. Is it switching assignments around or passing meds for the busy coworker? Do that. Ask yourself what you’re willing to do to help before you’re even asked. 

Having grown up with a good work family, it is possible. Oh, and keep verbalizing what you need to be successful. Lobby on your behalf even if no one listens. Maybe the point will come when they do and whispering among yourselves isn’t going to do the trick. 

Did I even offer any solutions here? Probably not. But sometimes self examination can go a long way to personal satisfaction. So, if you think I’m part of the problem, gently tell me so I can fix my behavior. 

Staff that plays (orders take out) together, stays together. 

Travel on, road warriors.