Brie Gowen

Savor the Essence of Life

Four Ways to Disgruntle Your Nurse 

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I recently took care of the absolute sweetest patient ever. He was pretty sick, which was why he landed in ICU, but even with tubes hanging out of him this patient managed to be simply charming. And his wife! She was so perfect I wanted to fold her up, put her in my pocket, and take her home with me. It was a wonderful day. 

You see, wonderful days are a necessity in nursing. You have to throw at least a couple of them in there every now and then to make up for the really horrible days. And great patients are needed too. They make up for the interactions with difficult people. Basically difficult people make a nurse’s day go downhill quick, and certain episodes may leave a nurse fatigued, disheartened, and downright disgruntled about the act of providing care. 

No one wants a disgruntled nurse, but here are four things that will do just that. 

  
1. Cussing out your nurse. Any nurse that has been in the field long has probably been cursed at, and we completely understand when it comes from confused patients. Those don’t count. No, it’s when we are cussed out by the angry ones that really hurts. That’s right; it hurts. As professionals we completely understand the stress of injury and illness, but that doesn’t mean it doesn’t wound us when we’re talked down to like a dog. Heck, worse than a dog. 

The thing is we’re doing our best, and we’re doing our best for our patients; so if we miss an IV stick on the first try for a squirming, dehydrated patient we’re not worthless. And we’re certainly not deserving of foul language directed at our person. It’s disrespectful, unjust, and personally hurts my feelings when it happens. I typically try to build up a pretty thick wall to insult in my profession, but occasionally your ugly words cut me. 

2. Demean your nurse. You don’t have to drop four-letter words to be demeaning to your nurse. While it is very frustrating to be talked to poorly as a professional, it’s just awful period to be treated like less than a human being. Whether it’s your waitress at the restaurant, the person changing your oil, or even your nurse, it’s never decent to speak to people like they owe you something. While you may be paying for services you are not paying enough to treat someone like a servant or slave that deserves a tongue-lashing when they don’t perform fast enough in your eyes. 

It’s degrading, and it leads to a disgruntled person who only desired to help you. 

3. Set unrealistic expectations. The role of Supernurse are tough shoes to fill, and nothing brings a nurse down like feeling that they have fallen short in their duties. Nurses are often working in a stressful, demanding environment where staffing resources may be short. They are expected to hold a large amount of knowledge in regards to their field, and be without mistake when carrying out their duties. 

I’m trying to say that the expectations on nursing are huge to begin with, but pile on top of that unrealistic ones, and it’s just too much. 

Nurses have to eat, they must use the bathroom occasionally, and they can only be in one place at one time. They cannot control what’s going on in another patient room, or how that may keep them from their other patient’s presence. They can only carry out orders that they are given, and cannot magically make pain go away. They get tired, sick, and depressed. Sadly they cannot always do things in a timely manner that is pleasing to everyone. 

When people get upset at situations outside of a nurse’s control it’s beyond frustrating. It’s exhausting, and the unfair reactions often crush a nurse’s spirit. 

4. Forget nurses are human. I’ve seen nurses labeled as many wonderful things. Angels. Heroes. Lifesavers. I am humbled by those descriptions, and we certainly do try to be all those things, but at the end of the day we are only human. 

Our feelings get hurt, and we even grieve too. Sometimes we lose our tempers, and sometimes we use too harsh of a tone. We even make mistakes on occasion. Some days we may feel like all we’re doing is making mistakes. 

Sometimes we become frustrated, and often times we feel unjustly treated in a very difficult profession. After all, it’s not always easy making everyone happy all the time, but especially in the face of serious illness. Occasionally, following repeated insult in the process of trying so very hard we may even become disgruntled. Sigh. 

But the thing is that no one hates disgruntled nurses more than the disgruntled nurse. This is because we actually like what we do. In fact, we love it. We want to be all smiles and rainbows. And nothing brings a smile to a nurse’s face more than a well-placed “thank you,” a sincere compliment, or even just an air of understanding that is present during the hectic times. 

After a shift with a pleasant patient, even if it was crazy, busy, I always leave with a lifted spirit, encouraged sense of self, and determination to be an even better nurse for those I serve. 

For Nursing: News You Can Use

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An article I recently discovered in Fatigued RN magazine:

In emerging healthcare news physician and nurse researchers are working fervently to fix the flaw in the pain assessment system. Even now they are working both day and night to develop a new scale where the patient’s response to questioning more closely coincides with the assessment of the questioner. 
The need for a more appropriate pain scale comes due to the growing confusion of healthcare providers everywhere who are left perplexed as they leave the bedside of a patient experiencing 10/10 pain, but who is snoring in a deep sleep when the nurse returns with a syringe of Dilaudid (since they are allergic to Morphine).

A recent interview with just such a confused RN quotes her as saying, “I just don’t get it. I asked him to tell me his pain level on a scale of 1-10, with 10 being the absolute worst pain he’s ever had in his whole life. He quickly answered an 11 as he took another large bite of the Whopper Junior his girlfriend brought him hidden in her purse.”

It’s not just on MedSurg or ICU floors where the scale is being found to be flawed either. Even in the ER, where pain relief management is easily maintained due to the low level of visitors seeking pain control, practitioners there are finding it difficult to treat their patient’s pain adequately with such erroneously constructed pain scales.

A seasoned ER Nurse Practitioner recently voiced his concerns. “We’re finding that on a scale of 1-10 most ER patients are located right around the number 10. We’re also finding the higher the number of visits to the ER in the past month, the more likely the patient’s pain will be rated as a 10. This seems to coincide with the incidence of benign stomach pain without findable cause, as well as the incidence of positive drug abuse history, which only more confounds the issue. I mean, people with such an intimate relationship with pain should definitely understand pain levels. Obviously the scale is to blame!”

Hospital administrators everywhere are discovering these faulty pain scales are to blame for undeserved, low, patient satisfaction scores. Complaints are flooding in from patients whose pain is not being adequately brought to a zero according to the pain scales available. Not even a 1. 

Such was the case with this recent survey from a rural hospital. The patient, whose name will remain anonymous, stated, “I take two Hydro tens at home for my chronic back pain, and all they wanted to give me was morphine, but only every two hours since my blood pressure was 90/50. I told them that stuff don’t work for me, and it makes me sick. But they gave me Zofran instead of Phenergan. I can’t rest with that! My pain was 10/10. You can ask my sister. We were laughing at a story about her neighbor’s cat the whole time I was dying of pain. Plus I couldn’t breathe! I told them that!”

A new nurse graduate was written up promptly for her behavior towards the aforementioned patient. It was discovered by her supervisor that she treated the patient’s pain level according to presentation rather than what the patient rated it on the pain scale. She didn’t think the scale meant what the patient thought it meant. 

  
The supervisor responded to the incident. “I told her pain is subjective. If the patient says it’s a 10, even if they’re slurring their words or nodding off to sleep, then it’s a 10. She should know this! A new scale needs to be implemented that is more in-line with the patient’s needs. I think a 1-11 scale might work.”

But rest assured, due to the seriousness of such a misunderstood scale currently in use top researchers are hitting the grindstone to design something more fitting to objective, assessment perception verses subjective, patient vocalization. 

One physician working with an influential group of medical professionals to perfect the pain scale has said, “Our goal is to have a scale where a presentation similar to the Wong-Baker smiley face cannot be an option to be what’s now called a ten on the 1-10 numeric scale. Basically this face 😵 should be a ten on the scale we are perfecting. We hope this will alleviate current confusion with nurses.”

Stay tuned. We’ll keep you up to date as new scales are implemented. Until then, remember that pain is subjective. It’s a 10. Even if they’re whistling Dixie and doing the Electric Slide.

*I love being a nurse. Many aspects of the job are quite challenging, and often times due to the difficulty of performing well in such a stressful and taxing environment nurses enjoy laughing and joking about some of the harder aspects of the field. We’ll use satire and poke fun as a way to reduce work-related stress and forge camaraderie amongst one another. All jokes aside, I can honestly say that there is no greater joy in nursing than to alleviate pain and make a patient feel better.  

What I Tend to Forget About Nursing

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I was working night shift when she came in through the ER, and it didn’t take a rocket scientist to know she wasn’t doing well. I mean, you can’t breathe like a fish thrown up on the dock and be considered to be doing just fine. And as I watched this frail, elderly woman do just that, sucking hungrily with infrequent gasps for the life-giving air her lungs so eagerly desired I knew I was in for a night. 

Two things happen when a patient can’t breathe. You either fight tooth and nail to create a way for them to exchange air, or two, they die. It’s really that simple, but the pathway to the eventual outcome differs with each person in distress that you encounter. 

On this night it just so happened that my patient would die, but the difference from so many other scenarios I had seen before, the ones where we pushed frantically on someone’s chest, cracking ribs and shaking their lifeless body almost barbarically, was that this lady would die on her own terms. She would exit this world comfortably without a young woman like myself poking, proding, or shocking her. 

It was my first year as a nurse, and this woman was my first patient who became a DNR once it was determined they were dying. She was the first patient I ever had who I would let go rather than fight to keep around, and at first I wasn’t sure how to proceed. I came into the room performing my every two hour, full body assessment, as if I could even do anything with the findings I acquired. I mean, I had to do something. 

But somewhere along the way, as I kept busy with the auscultation of continuously diminishing breath sounds, I struck up quite the conversation with my unresponsive patient. I spoke to her like she could hear me, and I touched her softly as if she felt each gentle caress. I spoke quietly with her daughter at the bedside, and I learned a lot about the legacy this woman would leave behind. 

By the end of the night I knew her favorite hobby, crocheting, and I knew each grandchild’s name. Even one that was growing in utero while she breathed less and less, and less. Other than lots of conversation and hand holding, though, I didn’t think I did much. She lived through my shift, suprisingly, and I left feeling like I wished I could have done more. 

That feeling made it all the more peculiar when the patient’s daughter returned to our unit a couple of weeks later. She brought with her a prayer card from the funeral, a long letter about my performance, and also the last blanket her mother had crocheted. The letter went to my manager, but the blanket was for me. It seemed I had made quite the impression. 

That happened eleven years ago, but I still think of it often. The memory rests in a special place where I hold certain interactions with patients and their families over the years. I thought I had done nothing special at all.  

The thing is in the field of nursing there are many demands. That coupled with the frustrations of the field and the negative occurrences you encounter can easily bring even the most zealous nurse down. 

Sometimes in my busyness I forget how special my time is considered to those under my care. 

Sometimes in my frustration and stress I forget how frustrating and stressful being sick can be, and I forget that I can help lessen that to a large degree. 

Sometimes while carrying out my repeated routines I forget that in the eye of my patient I’m really doing something special. I forget that being a nurse is really special. 

Sometimes in my fatigue and weariness of completing the multiple tasks at hand I forget how important the tasks I’m performing are to those in the bed. 

And especially sometimes I forget the amazing opportunity I have available to me. I forget that for someone out there I may be the kind word they need most, the soft touch they’re missing, the encouragement they’re lacking, or the warm laughter they long for during such a dismal time. 

It’s easy to become caught up in the chaos, burned out, frustrated, grieved, and simply oblivious to the true gift that nurses hold in their hands every day. The fact is that nurses hold the key to healing, the answer to wellness, and the ability to comfort when they can’t be the former things. Nurses are the hands and feet of medicine, and they are the cornerstone of healthcare. God uses nurses to be His comforting touch. 

When I think that I’m on the verge of forgetting the gift I have been bestowed to mean so much to so many I go back to my secret place of fond, patient memories. In this place even the instances where I was certain I had done little, somehow I was shown I had done more than I knew. What a wonderful opportunity nurses hold, to be able to touch lives even when they think they are not. 

It’s easy to forget that sometimes. 

It’s easy to get lost in long hours, demanding workloads, ever-changing policies, and patient complaints. It’s easy to forget the role we hold, the proud profession we embody each and every day. Even on the bad days. 

But the fact remains that to someone in your care you make the difference. You are the bright light at the end of the tunnel that calls them through their illness, whether that’s back to health, or even to an afterlife beyond the four walls of the hospital room. To someone you have done a very good job, and that’s worth remembering always. 

Why Nurses Get Burned Out

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This morning as I stood in the hot shower spray prior to leaving for my job as a nurse in the ICU I prayed like I do every other work morning, and the petition was a familiar one at that.

“Help me to hear your voice, Lord, and do no harm.” I prayed. And while my words weren’t exactly, “help me not to kill anyone today,” let’s just be honest. That’s pretty much what I meant.

Nursing is one of those jobs where how you perform is pretty important, and having an “off day” mentally isn’t really a viable option. The margin for error is extremely small, and really you want to avoid mistakes period. Because when you mess-up real human beings suffer the consequences.

No, that’s not stressful at all.

So it’s not so much that I pray out of fear, but rather that I beg for strength for the difficult road ahead. After all, you never really can foresee what you will face when you walk in the door, and patient care assignments typically resemble Forrest Gump’s box of chocolates. You never know what you’re going to get.

But it’s not the uncertainty alone that makes it challenging. It’s not even the thirteen hour day. Sometimes it’s just the expectation of performance that makes it so tough.

Despite how you’re feeling personally on any given day, you will arrive with your game face on. You won’t be allowed to slip into the chaos slowly, but rather you’ll be forced to dive-in head first. That’s just the nature of the beast. You’ll perform quickly, proficiently, without error, and with a smile on your face. And if you happen to be short of staff, or find the hospital at maximum capacity, you’ll still perform at an optimal level. You won’t have a choice.

I know a guy who owns a restaurant, and he told me that when they get really busy, and absolutely cannot produce more than they are currently putting out then they take the phone off the hook. That sounded pretty good to me, and I’ve had days where I would like to do the same. But people don’t stop getting sick because my co-worker called in, and they don’t even take a break from their illness when I really need to pee.

As a nurse when you hit the wall mentally and physically of what you can do you aren’t allowed to take the phone off the hook. In life and death situations you can’t even walk away for a second to collect yourself. So when you reach the end of your rope you just magically find some more slack. You push, and push, and push. Without error. Without mistake. With a clear head and professional demeanor. This is the expectation.

Also, aside from the expectations of your employer and the general public at large, you are scrutinized by the worst judge ever. Yourself. You would think you’d give yourself a little wiggle room. After all, you are faced with the continuous interactions with some of the most difficult people in the world to deal with, and you must deal with them in the most difficult and stressful situation they have likely ever encountered. You’ll speak compassionately in the face of unnecessary and undeserved insult, and empathetically soothe even the most unsoothable of the population.

You’ll treat ten out of ten pain for someone playing Candy Crush on their phone, and feel the shame when the next day you’re given a different assignment per the patient’s request because you refused to give them a pain shot right when they asked for it.

You’ll answer as best you can questions outside of your scope of practice, but even then you may be undermined for your answers when they differ from “my brother’s girlfriend who’s a nurse.”

Yet despite your understanding of the challenging populace you serve, you will still not measure up in your own eyes. Regardless of the continuous and changing knowledge base you must keep up-to-date, you will feel like you don’t know a thing some days. No one will chastise you more for missing an IV than yourself, and no one will be more disappointed in your daily performance under stress than you. It’s true; your expectations for yourself go way beyond what even the most demanding patient could ever hold.

The weight of so much responsibility, the strain of being stretched beyond your limits, and the unrealistic expectations held by others, but especially by yourself, will make you wonder on the really bad days how you can hate something you love so much. How you can cry in supposed defeat, frustration, and grief over a vocation that on the other hand gives you so much joy.

On the days that end with you running off your unit, or dragging yourself from there, and eventually settling into the quietness of your car where you cry hot tears, those days you feel a little burned out. Maybe a lot.

But then something strange always happens to me. A coworker will send me a kind message, thanking me for all my hard work, and their appreciation for what I assumed was my failure actually takes my breath away.

When I encounter a former patient, and they tell me how I changed their life, or saved their life, or even meant the world to them during such a difficult time, I am left speechless. “Who me? The blundering dunderhead?” (That’s certainly how I feel after a code. No matter how many I’ve been through.) Yet they mean it. They really mean it. I am left blessed, and I am left lifted from my low places.

When a loved one calls me asking for my opinion and advice on health issues I am honored. If it’s 1 a.m. I am frustrated, but I am also proud to be part of a profession where others seek my counsel and assistance when they are frightened and unsure.

When a terribly sick patient, like the kind of patient that you are sure will die, pulls through and gets better, I feel elevated. I feel like I could fly when I realize that I held a small part in the healing and restoration of someone’s life. No feeling compares to that.

A smile, a laugh, a compliment, or a thank you are ultimate motivators to my weary body and mind.

And then I’m not burned out. Almost, but not quite.

So I go to bed early, and I wake up even earlier. I stand in the hot shower spray in anticipation of another thirteen hour day, and I pray. “Help me to hear your voice, Lord, and do no harm.”

And then I’m good.

Why Being a Nurse is So Flipping Hard

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Being a nurse is hard, but I’m aware there are a lot of hard jobs out there. I was in the military, and I would probably be of the opinion that it’s more difficult than being a civilian nurse. There are probably hundreds of jobs in fact that are more challenging than my own, but since I’m a nurse that’s what I know about. And I just know that it’s flipping hard to be one. 

It’s not the skills I have to know, and while they are many and extremely challenging, it’s not that. It’s not even the plethora of knowledge that I must cram into my brain, or the fact that it is ever-changing. It’s not simply the twelve hour shifts, missed lunch breaks, delayed attempts to empty my bladder, or even the repeated weekends and holidays spent away from my family. And while it’s extremely stressful to hold a position where your actions can inflict grievous bodily harm on another person if a mistake is made, it’s not even that huge nugget that makes it so hard. 

You see, the fact is that no one really, truly understands what it’s like to be a nurse except for other nurses. And nothing is more unpopular to the general public than for a nurse to complain. As a matter of fact many people reading this now probably think I need to get over it. In a way I can totally understand that. Indeed we hold a highly respected position in the community, and people just assume that we love it. Well, the truth is, we do. We do love it, but that fact doesn’t negate the hard truth that it’s an extremely difficult job. And I guess for me sometimes the hardest flipping part about being a nurse is that I can’t talk about how difficult, stressful, and exasperating my profession can be at times. Not all the time, but because yes, sometimes it is. 

By a majority of society nurses are seen as the angels of healthcare, and I honestly love that perception, but it’s also a hard role to carry. And it’s hardest in the belief that because we are who we are in patient care that we absolutely cannot experience dissatisfaction with our position. I mean, we love being nurses, right? So we can’t get angry, discontent, or flustered! It doesn’t fit.  

I have been writing about nursing for a few years now, and many of my words have reached millions of people across the globe, but in that I have received some negative feedback from others. I’ve been told by complete strangers that I am a “terrible nurse” that they hope “never takes care of them.” I’ve been told I “should be ashamed of myself” and that I “don’t deserve to be a nurse.” These comments have hurt me deeply, and they all came because I honestly spoke about the trials, difficulties, and struggles I experience in my field. But to many people out there I’m not supposed to speak about such things. I’m not allowed to get frustrated with the difficulties of my profession, and though the rest of the world can complain, as a nurse I cannot. It’s considered disrespectful to my profession to be in essence a human being with human feelings. Instead I am expected to be a smiling pillar of strength for my patients, even the difficult ones, and though I love being that fortress of security and encouragement to my patients, the truth is it’s hard. 

Many people will say I should have known what I was getting into, but I don’t think you can ever know for real until you’re in the thick of it. The thing is now I do know, and I wouldn’t have it any other way, but sometimes I need to talk about my day. Sometimes it’s not pretty, but I want to feel like someone out there understands. The hardest part of nursing is feeling alone in the frustrations of a field you love and can’t imagine not being a part of. 

Many people will say I get paid handsomely for the stress I endure, and while I’ll agree that my income is substantial compared to others, I just don’t think you can ever put a dollar amount on a vocation where you hold the key to wellness in your hand, and the difference between someone’s life or death rests on your shoulders. But I’m not supposed to talk about that either. In fact, if I complain period I’m probably just in it for the money, but any other nurse will tell you that’s not true. Money is irrelevant when it comes down to the meat and potatoes of why we do what we do. 

You see, this morning I woke early and unexpectedly with thoughts of work in my head. I was sure I had forgotten some piece of documentation, and this remembrance brought my sweet patient to mind. I said a prayer for her recovery, and I hoped that the teaching I had given to her and her family on preventing pneumonia complications during the rest of her hospitalization would be helpful. I wanted to see her get better and get back home, and I could only hope I played a part in that eventual outcome. 

Because the truth is I love my patients. All my patients, even the difficult ones. And I love nursing. We all do, and this is why so many times I answer the phone at work and it’s a co-worker enquiring about the patient they cared for the day before. Yet sometimes I get frustrated, and sometimes I want to share my feelings with others. It’s nice in life to feel like you’re not alone, to feel like someone understands your situation and agrees. It makes it not so hard. 

As it stands I don’t know if I can continue to write about nursing. There are just too many people who don’t benefit from the topic it seems, and as a nurse and human being my greatest gift is helping others and lifting them up. 

Nursing is flipping hard, and being misunderstood as a nurse is even harder. It’s especially hard when you can’t say it’s hard out loud. Perhaps some of you out there will understand exactly what I mean, and for that I say thank you.