Nursing School is Just The Beginning of a Career of Learning

One aspect of changing nursing specialties, or being a new nurse for that matter, is the agreement to do homework to get up to speed. Being a certified oncology infusion nurse, while helpful, does not make me an expert in my new oncology nurse navigator position. Though working with preceptors who generously share learning, the responsibility of identifying my knowledge gaps, and seeking resources to fill them is mine.

Newly graduated nurse, I hate to break this news to you: graduating from nursing school doesn’t mean you’re done with homework. It’s the opposite. Nursing school provides the tools for finding information you need to succeed in any nursing job throughout your career. I’m serious. When early in my career a pediatric intensive care nurse befriended me, and agreed to be my mentor, the first thing she did was hand me a hardcover, 1,000+ page copy of Mary Fran Hazinski’s then gold standard text, Nursing Care of The Critically Ill Child, saying, “Read it. You can keep it too, because I just bought the newest edition,” cluing me in that expert level nurses continue learning.

I read the tome twice: the first time by looking up the diagnoses of every patient I was assigned to learn their assessment, and then understand the medical care plan. The second time, a few years later, I read it cover to cover preparing for pediatric CCRN certification.

In similar fashion, these days my evenings and days off are occupied with an hour or more of reading about nurse navigation. Yes, I’m a bit of a nerd, but the fact is I haven’t been this excited about nursing in years. Nursing school is just the beginning of a career of learning.

Shifting Closer to “Where Science, Humanity and Art Converge”

A goal is a dream with a deadline.

-multiple Internet attributions.

 

I have a new job, one that I envisioned when I transitioned from pediatrics to oncology nursing in 2001.

I am an oncology nurse navigator.

If you don’t know what an oncology nurse navigator is you’re not alone. Most of the time when I tell another nurse about my new job, his or her eyes go blank, and I get a sincere, but confused, “Oh congratulations!” Surprisingly, or maybe not, it’s my layman friends who get it right away, “It’s about time the medical profession started hiring people to help us find our way through the complexity of health care.”

I can’t agree more.

Patients are referred to a navigator after a diagnosis of cancer. The role involves patient education, distress assessment, providing resources, and emotional support throughout treatment. The goal is patient-centered care that prevents patients from “falling through the cracks” of the health care system. Confusion arises because some duties of the nurse navigator resemble those of case managers and social workers, however, nurse navigators offer comprehensive oversight of patient care needs, and advocacy. Further, the American College of Surgeons’ Commission on Cancer mandates patient navigation for cancer program accreditation. A source of more information is the American Academy of Oncology Nurse Navigators’ website.

One of many adjustments is my work hours have increased from nearly full-time to full-time. But there’s so much to write about! As I get a handle on things, I suspect the focus of JParadisiRN blog will shift closer than ever to “where science, humanity, and art converge.”

 

Hope is a Feathered Thing

Hope is the thing with feathers t
hat perches in the soul,
 and sings the tune without the words, 
and never stops at all,

And sweetest in the gale is heard;
 and sore must be the storm
 that could abash the little bird
 that kept so many warm.

I’ve heard it in the chillest land, 
and on the strangest sea;
 yet, never, in extremity, 
It asked a crumb of me.

Emily Dickinson

A few weeks ago I witnessed a miracle.

No, really, I did.

While running along the Willamette River in Portland’s Waterfront Park, a flock of seagulls (not the punk group; the kind with feathers and wings) scavenged for food several yards ahead. From the neck of one of the birds a plastic grocery bag dangled in the sight breeze like a cape.

In 2011 Portland’s city council outlawed the use of plastic grocery bags by retailers for environmental reasons. This sea gull’s plight illustrates one.

The bag was a death sentence. Besides scavenging, gulls feed by dipping for small creatures from the river, and this action will fill the bag with water. When the bag becomes heavy enough, it will sink below the river’s surface and drown the gull.

From habit, my nurse’s brain searched rapidly for an intervention. Briefly, the ludicrous image of me somehow restraining the bird and removing the bag flashed by, but before I was completely convinced of this impossibility, the birds took flight and landed on the river including the unfortunate gull with the plastic bag cape fluttering behind.

“Oh no,” I thought.” I’m going to watch the poor bird drown.” Mesmerized the way people become when they can’t avoid watching a train wreck I stopped running and leaned against the rail of the sea wall, following the bird with my gaze.

The gull bobbed on the river’s current, the plastic bag making him easy to spot. He dipped forward and placed his beak beneath the surface of the water. I saw the bag fill, then sink. Pulled down by the weight of it, the gull fought, flapping its wings wildly as it struggled to take flight.

“This is it, I said out loud, though no one else was watching.

But it wasn’t it. Miraculously, the bag slipped away from the gull and he was airborne. I watched the bag, half submerged, float down the river like a malignant cell seeking another victim.

Okay, maybe it wasn’t a miracle, but it felt like one. I had been so sure the gull was doomed.

Maybe the miracle is that I received an object lesson about embracing phenomenon, to stay hopeful, to marvel.

Because hope is a feathered thing.

Book Review: Nursing From Within, a Fresh Approach to Putting Out Fires and Self Care Work Arounds

In her book, Nursing From Within, a Fresh Approach to Putting Out Fires and Self Care Work Arounds, Elizabeth Scala, MSN, MBA, RN takes on the chronic dissatisfaction most nurses experience at some juncture in their career. With change rapidly dominating the landscape of health care delivery, nurses are stretched to the breaking point in their ability to provide safe, patient centered care.

Nursing From Within, a Fresh Alternative to Putting Out Fires and Self Care Work Arounds by Elizabeth Scala, MSN, MBA, RN

Nursing From Within, a Fresh Alternative to Putting Out Fires and Self Care Work Arounds by Elizabeth Scala, MSN, MBA, RN

This problem is not new in nursing, according to Scala. In fact, it’s existed in some form or another for decades. Scala considers,

It is possible that nursing, the entire profession as we know it today, is stuck. Bogged down from the energy that is created with the funnel. Looking left and right, turning around or glancing above us-who do we see? What do we hear? Where do we go for answers?

We hear the same things, talk about the same things, and live the same things.

While nursing has come a very long way in terms of scientific skills and critical thinking, can we say the same thing for our own personal and professional evolvement as a whole? Are we developing in a way that will help us to thrive and move forward as a group? Or is the mindset of ‘this is how it’s always been done?’ keeping us stuck in the funnel of nursing limitation?

 In a conversational voice, Scala uses stories from her personal experiences to illustrate how she changed from a nurse on the brink of burnout into one with an expanded viewpoint of where an open mind and change from within can lead. The creative career solution she chose at the book’s ending surprised me. It validates the versatility of a nursing license, but I’m not sure it answers the question at the heart of the book’s premise.

However, this does not take away from the truth of Scala’s observations, or the value of the  tools she presents for self care. Scala’s openness and authenticity shine through. Her topic is important, demanding recognition and discussion among nurses. I found much of what she wrote inspirational.

Nursing from Within: A Fresh Alternative to Putting Out Fires and Self-Care Workarounds is available now. Get your copy today by visiting Elizabeth Scala’s website or purchase directly from Amazon

Normal Is a Cycle on the Washing Machine

In my mind, as long as the weather is good, summer isn’t over. However, the beginning of the new school year, and the return of football indicates that ritual outweighs my imagination.

Sigh.

It’s good to let an imagination run free from time to time, so I took the summer mostly off from blogging.

Preparing paintings for display. Image and paintings by jparadisi 2014

Preparing paintings for display. Image and paintings by jparadisi 2014

I’m back.

I think there’s a tendency to view creative work as less taxing, dare I say less challenging, than nursing. I wouldn’t say less, so much as different: Different types of knowledge, different sets of skills. The biggest difference, I think, lies in accountability. Harsh criticism of their work can damage an artist’s psyche.Missing a deadline for a post or art exhibition is unprofessional and negatively affects the editors and curators writers and artists work with. It leaves them in the lurch, which in turn negatively impacts the artist’s career.

In nursing, however, medication errors can seriously impact a patient’s health, with potential life-changing consequences for patient and nurse.

I discovered something this summer: Taking time off from creative projects creates a vacuum into which other projects, out of nowhere, are sucked in, filling the “free” time I worked so hard to create. I see this phenomenon in the lives of the retired too. In fact, I often tell my Mom, “You’re scaring me; retirement looks twice as busy as working life, without the paycheck.”

Mom just smiles, and says, “Remember, ‘normal’ is a cycle on the washing machine. Don’t wait for things to slow down. They won’t.”

She’s right.

An unexpected project close to my heart this summer was the opportunity to hang my paintings and monotype (one of a kind) prints in a health care setting. It is a very satisfying experience to work with a design team to select and hang art with the intention of improving patient experience. In the past, I’ve sat on selection committees choosing artists for hospital art commissions, but this was my first experience as the selected artist.

For me, it came together when a patient, unaware that I am the artist, made this remark about the art, “It makes me think of other things than why I’m here.”

Bingo. That’s exactly the result I was looking for.

The Adventures of Nurse Niki is back too. The latest episode, At The Raleigh, posted Monday.

Summer vacation brought fresh insights, generating posts for AJN’s Off the Charts. In a drop-in life drawing studio I drew a connection between art and nursing. A road trip with my husband inspired this post. And a close call with danger inspired yet another.

Normal is just a cycle on the washing machine.

 

 

 

Where Science, Humanity and Art Converge

JParadisiRN blog began by discussing art and nursing. For the most part it remains so, through observations of the way science, humanity, and art converge, transferring these observations into blog posts.

Nursing is a tactile profession, at least when practiced at the bedside. It’s difficult to do the work of a nurse without actually touching people. Nurses learn that some skin or veins are so tough they almost repel an IV catheter, while other types are so fragile, even the paper tape used to secure a dressing or IV can easily tear it.

Nurses bathe the newborn’s firm, plump flesh, or rub lotion into the loose, wrinkled flesh of the elderly to prevent its breakdown. We measure and weigh the under and overweight, then calculate body surface area to administer the correct dose of chemotherapy.

This summer, I enrolled in an open life drawing studio. A model sits for a few hours, while artists, in meditative silence, draw the human body on paper.

Drawing is also a tactile experience: holding charcoal against toothed paper, making shapes and lines into limbs and torso, adding shadow to give them volume.

Patients and models allow nurses and artists into the sacred space of their nakedness. This privilege demands respect. Administering nursing care to a patient, or capturing the model’s likeness on paper requires concentration, skill, and love of humanity.

 

Latest Posts: AJN’s Off the Charts & New Nurse Niki

Drawing From Life is my latest post for Off the Charts, the blog of the American Journal of Nursing. It posted yesterday. Often the lines between art and nursing easily blur, like soft charcoal lines smudged on paper. You might want to check it out, or leave a comment.

The Adventures of Nurse Niki now posts new episodes on Mondays, instead of Thursdays. Be sure to read week’s episode, Moving On..

The Adventures of Nurse Niki Moves to Mondays!

The Adventures of Nurse Niki

The Adventures of Nurse Niki

I’m having fun re-prioritizing a few things, one of which is my other blog, The Adventures of Nurse Niki: fiction so life like, it’s almost real. I’m enjoying writing fiction more than I’d expected. Niki and her friends have integrated into my waking life, and the story lines come faster than I can write them down. Therefore, The Adventures of Nurse Niki will post on Mondays instead of Thursdays.

I am not shutting down JParadisiRN blog. This is a shift, not an ending. I’ll still post thoughts and images. In the meantime, tune in on Mondays for new episodes of  The Adventures of Nurse Niki: fiction so life like it’s almost real, starting today.

You can discuss or interact with Niki on The Adventures of Nurse Niki’s Facebook page. Please don’t forget to “Like” it too. Show Niki some love! Thank YOU!! to the readers following The Adventures of Nurse Niki, the retweets of @NurseNikiAdven (Hashtag #NurseNiki) and those who Like Nurse Niki’s Facebook Fan Page. The support is very much appreciated!

 

 

 

The Sacred Space of Patient Care

One of my hands is soaking in a shallow bowl of soapy water, while a nail technician holds the other, turning it one way, then the next. She files my chipped and broken nurse’s fingernails into a more attractive shape. As she does so, she says “relax” whenever I hold my hand too stiffly for her to manipulate it. This catches my attention, because I had just come from work, where I’d spent the day starting IVs in patients, telling them, “relax,” so the catheter would thread more easily into their veins.

by jparadisi

by jparadisi

I often preface starting an IV with, “I know this is easy for me to say, being I’m not the one getting stuck with the needle, but the more relaxed you are, the easier this will be.”

I realize that a manicure is a much more pleasant experience than having an IV placed. What manicures and IV starts have in common, however, is the need to trust someone, often a stranger, touching your body, and literally putting yourself in their hands.

With this in mind, I’m astounded by the trust patients put in nurses. I mean, think about how we poke them with needles, whether in their chest ports or in peripheral veins, and then infuse chemicals otherwise known as “chemotherapy” into their bloodstream; medications so potent that the patient signs a consent allowing us to do this to them. The chemicals are so powerful, in fact, they can cause other varieties of the very disease (cancer) we administer them to cure.

This is a pretty huge demonstration of trust.

Once a hairstylist stylist told me, “When I cut someone’s hair, I’m in their sacred space.” I’ve kept this statement in mind ever since, whether it was performing a bed bath in the ICU, or now, taking a blood pressure or drawing blood from a vein with a butterfly needle.

No matter how clear our communication with patients, no matter the level of caring we demonstrate, if we forget that we have entered the sacred space of our patient’s body, these administrations will not be received with the intended appreciation.

Developing a soft touch in patient care, whether it’s honoring an adhesive allergy by finding a less irritating occlusive dressing, offering to numb a peripheral IV site or port before inserting a needle into it, or simply placing a hand on the shoulder of a patient who is visibly upset, are ways we tell patients we respect the sacredness of their bodies. We are there to help them relax.

Nurses Make Birthdays, One Year at a Time

by jparadisi

by jparadisi

Part of our institution’s medication administration policy is asking patients to state their name and birth date, scrutinizing the information against the medication label. Patients of a certain age, more women than men, customarily wince while saying the year in which they were born. Often they say, “I’m getting so old.”

Perhaps it’s none of my business to respond, but as a cancer survivor and an oncology nurse, I can’t seem to help it. This reply escapes my mouth with hardly a thought in between: “That’s what we do here. We help you grow old, one birthday at a time. That’s why you and I are here.”

It always gets a laugh, and more often than not a, “Well, I suppose you’re right. That is what we’re doing here, isn’t it?”

Like many things in life, the ability to enjoy growing old is a matter of perspective.

It’s a funny world we live in. People bemoan their birthdays and growing old; yet endure chemotherapy and procedures, fighting to add years to lives threatened by disease.

I don’t love the effects of aging on my body. I color my hair to hide the gray. I exercise and eat right, and avoid over indulging in things that destroy a body’s ability to maintain its health. But these things enhance life, they do not prevent the inevitable. I know my days are limited. I know some day I will cease to exist in the manner I do now.

You may feel depressed by reading this post, but I say to you, knowing that life is finite is the most freeing of all thoughts. It bestows the gift of living everyday to the fullest, to make choices honoring integrity, and loving relationships. Life is too short to dwell in unhappiness. This is the least that nurses can do to honor the memory of the patients we have known and lost: live life as if each day were the last.

And, yes, I will take another slice of that birthday cake.