Mitigating and Managing

Hello and welcome to the circus!

Seems wrong to call life a circus, but at times it feels like I have no idea what’s happening next (in my immediate sphere or outside of it) and how I’ll react to it. Maybe gasps. Maybe cheers of excitement. Or crying hysterically. Apt, don’t you think?

Well, in assignment news, a decision has finally been handed down. I won’t say too much until I’ve signed my contract because in this circus, the act can change in an instant. Just know I’m glad to finally have something done with 4 shifts left in this current assignment. It took a lot of reminding that things weren’t out of control just because I didn’t know what was happening next.

Now that I know I can move on to more exciting things. I’ve got a couple big trips lined up on my 3 weeks off. Both trips I’m very excited about for vastly different reasons, but excited nonetheless. One I’ll tell you about next week (travel nurse conference) and the other I’ll spring on you last minute as I’m trying to keep other parties calm on that front.

Thinking about my second upcoming trip makes me think on ways I mitigate and manage things in my life. We all have people, jobs, forces in our lives that we try keeping calm and juggling around.

I have a tendency to be majorly influenced by those who rotate in my orbit. It’s something I hate and appreciate. Appreciate because I have people whose opinions I value a lot. Hate because if they disagree with something I’m planning on doing, I can’t always shake off their strong opinion. Is it my decision not to do this or am I being influenced too heavily by someone? And how do I manage when said strong opinion becomes upset that I didn’t heed their advice? It’s been a life long struggle of mine to find the balance.

Mitigation and management come in handy not just in those moments in my life (it’s better to ask for forgivensss than permission by the way), but in work.

Negotiating pay packages. Advocating for patients. Dealing with bonehead doctors. Trying to figure out changes in insurance. Or why my HelloFresh box was randomly canceled. All things that require the ability to explain what you need, see the best solution to the problem, smooth ruffled feathers, and get the best for both parties if possible. While not screaming like a crazy lady

It’s not always possible to come to a solution that pleases everyone. Someone is going to walk away unhappy no matter how you try appease or conjole. But… I hope to have left the situation having handled it to the best of my ability

The words of the reckless pierce like swords, but the tongue of the wise brings healing 

from Proverbs 12:18 NIV

Frankly, my mouth gets the best of me. I’m trying to be levelheaded and calm because that’s what the situation requires, but the moment I’m affronted, cooler heads don’t always prevail. 🙈 Hey! Im trying to do better, be better, act better, but the tongue is a sword for a reason.

I need to heed the lessons I speak into this space. That means actually watching my mouth and trying to grant dignity to others. I just need to remember to not do those things at my personal expense. Sacrifice is important, but I tend to give more than I should to others. Balance.

Life is a circus. I’m trying to tight rope walk/juggle/clown car my way through it. Aren’t we all though?

As always, let’s all try to do better, shall we? I’ll lift you up a little and you extend the same arm to me until we manage to get there.

Until next time.

Travel on, road warrior.

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The End

Sorry for the radio silence over the last few months. As time has ticked by from week one to week 17 of this last stint, I think I have a great idea for something to say, but then life would get away from me. In the end, what started out as something I wasn’t so sure about ended up being an assignment that I found enjoyable. Having not worked with the demographic common to my home state in a long time, it was good to be closer to home and get reacquainted with the issues of Appalachia.

But being done, the approaching end of the year, and life in general has had me thinking of ending.

Things always end. Always. The recent death of someone I knew drove home how sudden the end can come. Life is finite in ways I forget until confronted with death. How we don’t consider meeting our maker until we are step out of this life into the next. It makes me take account of how I’ve led my life so far. 32 years is long enough to make mistakes, have regrets, have great accomplishments, and joys. What can I say about myself in the end?

On a less morbid note…

I talk often about leaving a legacy. Even if I never return to a place I’ve worked at, I hope I leave behind the impression of a person who works hard. More than that, I hope I leave the idea of kindness in some form. I admit I gripe at work, but I hope my attitude with my patients and coworkers overall is one of helpfulness and giving.

There’s joy and sorrow in endings, but life continues on even in the midst of both emotions. 2016 (a not so fun year) will end. It’ll usher in a new beginning with its ending. It’ll have left its mark, for good and bad.

Remember me fondly even when my mistakes are unearthed. Remember my care, my compassion, my concern, my humor, and my smile. When I’m gone, remember those things because that’ll be all I can leave behind.

On to new beginnings. San Jose after the New Years! Too soon to be worried about anything except vacation.  I’ll try blogging a little more often now. Until then, thinking on your legacy.

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

Stop me if I’ve said this: nurses who aren’t satisfied leave

Actually, just go on and let me talk. 

Day 4 of orientation and I’m still processing my feelings about day 2. Day 1 or 2 tends to be the day upper management and administration speaks so you know what was discussed as per the last post. 

Anyway, one thing I got stuck on was JOB OWNERSHIP. 

My loose definition of that is a sense of pride that comes from doing what you do, feeling valued enough in it, that you remain and are retained and produce out of your satisfaction with your work. You promote your business as though you’re the CEO and draw outsiders in because of your love. 

Fancy terms thrown around here are attrition, retention, and recruitment. You hear these terms in hospitals, colleges, big business. Everywhere that numbers play a huge role in the health (and wealth) of an institution. 

So why do people leave? Why do specialized, skilled individuals who went to school specifically to help people leave? It all starts with job satisfaction.

To save myself and you the extra read, check out this article on Why Employees Quit. Go on, I’ll wait. 

That says everything I’d say anyway, but I want to put some emphasis on value. I’ve worked so many jobs and I always think about why I’ve left them. It comes down to value.  My first year out of school I had few coworkers who cared if I sank or swam on a shift. By the subsequent years on OB, I found a family I loved working with, but wasn’t satisfied anymore just working the floor, school followed, and then I started teaching. I left because I felt under appreciated by administration. Yea, the students drove me nuts, but no support and no push to be more burned me out. 

So now I travel and I’ve learned to detect staff dissatisfaction quick. Some of it’s selfish because dissatisfied employees will make terrible coworkers. 

Let me say it again: people who hate their job will not be good team players. 

I don’t have time for that mess so I try creating as much camaraderie as I can. Help me and I’ll help you. But that’s just my own thing. 

They complain about staffing. That the manager won’t come in. What do I hear? No one cares if we put our lives or licenses or patients’ lives in jeopardy. Inadequate staffing sends a message. 

They complain they aren’t valued for their skills. They hear things like “we can train a monkey to do your job.” Comments about people being replaceable send a message. We don’t care about you in your current position. 

Soapbox: First, nursing is a skilled profession and second we suffer from a shortage. You take me with nearly a decade of experience who can hit the ground running or the new grad you have to train. Or you get no one. Pick. But stop treating me as though I’m expendable when I’m not. 

You can tell the satisfaction by the rate of turnover. If you’re losing 14 people in a month and replacing them with 8 you have to train from the beginning, you’re losing. You want to know how you lose? By being forced to spend more money to recruit. Bonuses get people but don’t keep people. You’re also losing knowledge base. It’s your seasoned nurses who leave, leaving brand new nurses with no one to raise them up. 

I could go on, but I won’t. Shoot, I’m not even scratching the surface of what goes into keeping people. Know that employee value is important. Caring about your employees above patient satisfaction is important. If your employees know you care, they will go above and beyond for you. If not, they leave and you’re left with no one to run your business. 

Again, you are valuable. 

Travel on, road warrior. 

What week am I on? 

I believe I’m down to 5.5 weeks? 

Sorry I’ve been super quiet. Between a stretch of shifts, my birthday, and switching back to nights I’m not exactly brimming with things to talk about. 

I’ll just touch on a couple of thoughts quickly. Some are work related and some… Aren’t? 

1. A small mental shift 

I talk to a good friend of mine about once a week. It’s an opportunity to share both spiritually and about the wide variety of topics in the world. I appreciate the depth of our conversations on many levels. Especially when it comes to topics that Christians have a tendency to beat to death and alienate others over. It’s refreshing to my soul. 

Recently, my friend passed along an article about a man with a particular inclination Christians like to crusade against. His issue isn’t what I cared about, but the heart of what he discussed is. He mentioned that when coming to God, He isn’t worried so much about the issue you’d like to get rid of, but about changing our hearts to see our need for Him. The sin is always a manifestation of our trying to do things apart from Him, but the more we change our minds (the more He changes our minds) the less that sin or issue will manifest. 

I’m paraphrasing poorly, but the core of it hit me. I ask constantly for my sins to be removed from me so I’ll stop doing them. God says come closer to me, let me change the heart of you first, the rest is just a reflection of that need. Paul asked for his thorn or affliction to be removed, but God said His power is made perfect in our weakness. Stuff doesn’t just go away, but God is in the heart fixing business and as hearts mend behaviors alter. Will my struggles always be struggles for me? Yes, I believe they will, but that’s okay. Not a license to continue, but an understanding of it not being the root problem. It’s not about the struggle itself anyway, but my heart. I’ll let that get worked on first. 

2. I took a job back home 

Well, kinda…

It may surprise people, but I took an OPT position back home. It’s not uncommon for people to remain per diem at their old perm hospital when they travel, but I gave mine up when I started because… I traveled too much. Only being home between contracts 2 days makes it tough to convince myself to work. 

I realized though, I need a home base work place again. Even though I initially had some anxiety about it (mostly because it feels too permanent. Yes, I know I’m crazy) I realized I needed to do this. You can’t think in what ifs, but my mother is getting older and I know a time will come soon when I’ll need to stop traveling and come home. Being established and having a small amount of roots is important even if it scares me 

Which leads to my next point 

3. I don’t have an assignment yet 

As I’ve mentioned before, I like having my next assignments well in advance. Months in advance actually. This time I’m coming up short. Partly because I need to get in hospital orientation at UHC (5 days. 5. Days. Why? Just… Why??? I’m a former employee. What’s changed in a year?) and because I only want to work 8 weeks. 

I’ve interviewed a few hospitals and altered my plan. Turned a few down and been turned down by a few. Decided to change to 13 weeks which takes me through the new year. With 5 weeks left, an iffy start date because of  orientation, and not even being sure what state I’ll end up at, I’m getting nervous. I shouldn’t be nervous, but I am. 

Where will I be next? I’m waiting to hear if Inova will accept 13 weeks, if Martha’s Vineyard will accept my start date, or if someone else better will call. I don’t know and I hate not knowing. 

That’s it for now. Sorry for the unusual radio silence. Life is being life right now and I’m just trying to stay awake to enjoy it. I’ll keep you updated as I figure things out, eh? 

Travel on, road warrior. 

A certain disposition

Well, I’m here. It was a rocky start that threatened to throw the next few weeks in a bad light, but I’m pasting on a grin and thinking of the carefully crafted blogs I will post! Haha. I’m due for a post on nursing and social media, but I wanted to cover a particular topic first.

What kind of disposition do you need to have to be a nurse?

Now this post started far more narrow in my mind. My rough start made me think of the attitude you needed to be a traveler, but a travel nurse is just a regular nurse on the go. I firmly believe you have to have confidence (in yourself and your particular skill set) in order to travel. I’ve talked about it before, but I decided being more general would be better today.

Does nursing require a certain attitude? Do nurses have one personality type in common?

This is an impossible question to answer. If I stand beside a fellow nurse and look at our personalities, I doubt we’d find a ton of commonalities. I’m not sure personality type is a good gauge. Maybe it comes down to willingness, desire, and drive?

Nursing is about caring and caring involves sacrifice. Caring involves stepping into strangers’ lives, seeing their problems (physical/emotional/mental/spiritual)and offering healing.

I’m not good with strangers. At all. I’m usually extremely uncomfortable meeting new people. But… I can step into a patient’s room and do everything I can to make them comfortable. I can overcome my natural aversion in order to help.

What makes that possible? What makes it possible for people who are so different to come together and execute a code or work a delivery or deal with an emergency?

I think I’m asking more questions than offering answers. I think that’s because there is no right answer.

Nursing requires people willing to give, people with a soft voice and a steel spine, people who are smart with an attitude of a lifelong learner, people who are flexible, who know how to be firm as needed, people with a wicked sense of humor.

This is a rough business, the business of nursing. It has a tendency to break the unprepared and wear out the committed. You have to remember why you do this in the moments that make it hard to do so.

And travel nurses? Well, we go where others flee. It’s a regular nurse on speed with commitment issues! I subsist on coffee and constant change personally.

Maybe it is obvious. Do you think a certain personality type is needed to be a nurse?

Coffee and change work for me!

Travel on, road warrior

Not Quite Home

About to board a plane to head to Nantucket. Wasn’t even home 48 hours before I had to turn around and leave again. It was two days of doctor’s appointments and errands so I got to hang out with approximately zero people. I promised myself 2 weeks off after this contract so I could just recuperate, which leads to my next thought…

The more I travel the more I notice that home isn’t really “home” anymore.

West Virginia, the place I’ve lived for 20+ years is home, but it isn’t where I feel comfortable anymore. It’s weird heading to places I know and feeling weird for being there. I’m so used to being a stranger that being in the familiar no longer inspires the same safe feelings in me.

I think that’s the thing with chronic wanderlust and not being able to stay still. I’m much more comfortable being uncomfortable. It’s strange to say that, but being mobile makes me feel stable. Knowing that I’ll be somewhere different in a few months, weeks, or days is exciting to me. It’s normal! If I sleep in my old room a month total in a calendar year, I’ve been home a ton. I’m far more acquainted with hotel beds than my own. I find I like it that way.

Losing that feeling of being comfortable at home is a little sad though. It’s not the same. There’s certain obligations when I’m home that I don’t have when I’m on the road. My relative anonymity and lack of additional expectations adds to traveling’s appeal.

Please don’t misunderstand. I love being home when I am. I love visiting with friends and family, but I don’t feel that same settled feeling others get when they come home. That renewal comes not when I come home, but when I leave. And I’m always leaving.

The road has become my home. The unfamiliar has become familiar. I find comfort in change and being somewhere different. Two years of travel for my job and previous years of traveling for leisure has made me this way. Permanent wanderlust without a cure.

Am I the only traveler with this problem? Surely not! Wanderlust isn’t a single person disease. Come on, admit it, you’re infected, too!

😉

travel on, road warrior.

Treating Docs like Taylor Swift treats haters

I’m shaking that attitude off!

Had my first run in with a doctor and my knee jerk reaction was to tell him he was a…

Anyway, after shaking off my bad mood I remembered something important: doctors will say and do whatever, but I still have to care for my patients as I’ve been taught.

Every nurse learns the best way to deal with doctor’s attitude and nastiness. The bad part about traveling is relearning doctors and what to expect in every new place.

Doctors act like bears everywhere you go.

I blame a certain amount of entitlement on the doc’s behalf. They are lifted to a certain height and expect to be treated a certain way even if it inconveniences others. The nurses have an issue with catering to and reinforcing said behavior. I’m guilty of it because I know they can (and have) make life hard if I don’t. It’s the black spot in nursing; simpering and coddling the physician.

There’s a saying about one’s response to an action saying more about you than the action itself… Or something like that.

I admit my response wasn’t that great and usually isn’t. My skills and knowledge being called into question always makes me defensive.

What does that mean? I need to check my response. If I’ve done things as right as I can, I’ll have to let the attitude roll off.

Shake it off as I walk out the door!

Not every doc is going to be surly every time, but I can take a deep breath when they are and smile my biggest smile.

“Would you like a lemonade while you do your repair, sir? Maybe a bit of sweet with all that sour will make you feel better.”

😊

Don’t let them see you sweat!

Travel on, road warrior.

Nurse C’s Judgy Face

Here it is…

Here’s where I admit that I have moments where, as a medical professional, I judge people.

There aren’t many things that gross me out. My low gross-out tolerance stems from the fact that I’ve been a labor and delivery nurse for too many years. As glorious as the birth process is, it’s nasty. Blood, amniotic fluid, pee, poop. You name a body fluid with a smell and I’ve seen it or been splashed by it!

I’m not one to call people out… Okay, I’m occasionally known to do that.

I’m calling people out right now. I’m calling out the people who use the restroom and don’t wash their hands.

You’re gross.

You peed, walked out of the stall, checked your hair in the mirror, and left.

Gross

Think about this… You’re wiping your butt with 2-ply that is at most 1mm thick and I’m being generous. Say you double that up? Still not enough coverage considering urine and feces soak through the ply and get on your hands. Why do you think I wear gloves when I’m cleaning someone else up? Because, ew!

Boys, you’re not off the hook. Touching a body part of any kind transfers what’s on your skin to anything you touch. Think about flushing the urinal after everyone who’s flushed the urinal before you? You picked up whatever someone deposited on the knob and because you didn’t wash your hands you’ve passed that on to any other surface you’ve touched.

Not only transferring that to surfaces you touch, but your face, your mouth, your eyes when you touch your body with dirty hands. Again, ew.

Hand washing is the number one way to combat the contracting of certain communicable diseases. 15 seconds of washing with soap can decrease your chances of getting sick and I know for a fact that some of you (and I’m not naming names) are lousy sick people. Use a paper towel to open the door leading out of the bathroom if you can.

Listen, I know other people are gross, infection spreading, fomites, I also know that it’s impossible to avoid touching surfaces that may have nasty stuff, but practicing basic hygiene can cut the time you spend huddled under the covers moaning because you’re ill.

Think about this and wash your hands if for no other reason than you don’t want to see my judgy face which looks a little like this

2015/01/img_6435.jpg

No body wants to see that face!

Plan changes can be like dirty diapers

Sometimes they happen and they stink.

As travel days go, yesterday was a stinker. We’d set out early in hopes of exploring Roswell for New Years Eve.

Except Mother Nature decided to throw a huge curveball in the form of some really really bad weather. Ice on the roads, multiple accidents, and severe detours. We made it to Roswell, but 6 hours later than intended and with the inability to do anything at all. Our next stop had to change because the threat of worse weather being a big deterrent. So the Grand Canyon is out for today as well. Big bummer as that was one of the places I really wanted to see in this cross country venture. Maybe it’ll be a trip I take some other time.

It made me think of how change happens and how we handle it.

-Unexpected job loss
-Surprise (and potentially unwanted) pregnancy
-A travel job not being what you thought
-Not going to the school you’d hoped to

It’s easy to look at each of those and spit, cuss, throw up your hands, or think life is against you. I’m finding sometimes things are better in the end.

-You get a better job or a better opportunity comes for you
-That child does amazing things in its life
-You learn something great or meet someone great on that assignment
-The school you do get in has a huge impact (for the better) on the person you become

I’m not saying we can’t be upset about change. It’s hard not to be when things don’t go how you want. It’s hard to see any potential good through the panic/disappointment/depression. I’m not even saying I’m all that good at being positive. Shoot, I’m the queen of anxiety and panic attacks when things even hintat going wrong.

But if I can look on the bright side even once? If I can see God’s possible plan and rely? If I can trust that maybe the plan change is better even if the “better” is my safety in travel?

I’ll try to see a little clearly.

Here’s to a new year of looking at things differently.

Travel on, road warrior.