Category Archives: Nursing Lifestyles

Life Outside of Patient Care Areas

Hospitals Are Not Restaurants

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A Blank List photo: jparadisi 2012

My horoscope says today is a good day for diversion, but I disagree. This is one of those mornings I wake up with a to do list forming in my head, which means I am already behind. One of the things on the list is writing this post. Be charitable as you read it; I haven’t finished my coffee yet.

This feeling of being behind before the day begins is familiar in our home. David, a hospital pharmacist, and I work the same weekends, and this weekend we both worked the Saturday, Sunday, Monday stretch. For some reason, all hospitals I’m familiar with staff units lighter on weekends: no unit secretary, linens are not delivered, IT support is unavailable. Pharmacy has less support, meaning nursing waits for medications to arrive; everything slows down.

This mindset is puzzlement. Why would weekends be more or less busy in a hospital than any other day of the week as if they are restaurants?  I’ve worked in food service. For restaurants, happy hours and dinners are consistently busier on Fridays and Saturdays than weekdays. Restaurants catering to the business lunch crowd are understandably busier Monday through Fridays.

People do not schedule how sick they are going to be according to the day of the week.

Granted, most doctors’ offices are closed, and surgeries are usually not scheduled on weekends. I get that. However, this leads to the proviso that people who are admitted for hospitalization are too critical to wait until Monday for surgery or treatment. Trauma and sepsis do not wait until the doctor is in. They keep the weekend health care team pretty damn busy.

I’m not complaining, just pointing out a reality of life in health care, by way of explaining today, our first day off, both David and I are feeling a little frazzled. The evidence of this is on our dining room table. Rather than a place for a leisurely, home cooked meal, over the weekend it has become a catchall for the implements of our trades: his messenger bag, my tote. Both of our notebooks charge quietly, their green LED lights reflected in the luster of the table’s finish. Valentine’s Day cards, still without a permanent home, remain on the table.  Although our home is a disorganized mess, there is love.

We’re out of food though. Add a grocery store run to the to do list.

Living With Our Mistakes & Holes in Our Socks

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Knitting Two Socks at a Time on a Pair of Circular Needles. photo: jparadisi 2012

I’m learning to knit socks. If you read this blog regularly, you’ll recall learning to knit socks is one of my New Year’s Resolutions for 2012.  Since I don’t know what I’m doing anyway, I decided to learn the new method of knitting two socks at one time on a pair of circular needles, instead of one sock at a time on a single circular needle. Never mind only a few years ago I defined knitting as: making a tangled mess with yarn and sticks. Hey, I’m a girl who loves a challenge.  My audacity stems from years of the “see one, do one, teach one” on- the- job- training mentality most nurses rely on.

Fortunately, learning to knit socks two at a time is accompanied by patterns with clear diagrams and photographic illustrations. I found mine in Knitting Circles Around Socks by Antje Gillingham (Martingale & Company, publishers).

I’m happy to report I have successfully turned both heels. The most vexing problem has been confusing which of the four needle tips to use, then having to rip out and knit again previous rows after doing it wrong. I found one dropped stitch too, which is so far back at the beginning there is no way in hell I will rip out my work to redo it. I’ll simply learn to live with it.

If only nursing mistakes were as inconsequential. Who wouldn’t go back in time and fix the med error, rephrase the statement that made you sound dumb in front of coworkers, or treat differently the symptom, which turned out more significant than you realized at the time? Wouldn’t it be great if we could rip out our mistakes and knit them again like stitches dropped from a pair of needles?

We can’t.

Instead, I am aware of the importance my words carry when patients come to me with concerns or fears. I answer the same questions multiple times over the years of my career, but for the patient, their fears are new.  For everyone, I hope to get it right the first time: the right amount of compassion, the right understanding of the meaning of their words, the right kind of wisdom needed for a particular moment. If I get it wrong, coming across as abrupt, disinterested or intensifying fear rather than calming it, there is no going back to rip out stitches from the fabric created by my words and actions. They hang in our memories like dropped stitches; leaving an unsightly hole.

Nursing is more complex than knitting two socks with four needles. Often, there’s no way to go back and fix our mistakes. Sometimes the best we can do is learning from errors, acquire the necessary grace, and live with the resulting holes in our socks.

*Update: I finished knitting my first pair of socks last night.  See photo.

My First Pair of Knitted Socks! photo: jparadisi 2012


Staycation

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Reflections on the Willamette River photo: jparadisi

I am on staycation this week. It means I scheduled a week off from the oncology infusion clinic, and spending the time here in Portland, where I live.

I admire nurse colleagues their ability to schedule travel vacations months in advance. They bring brochures of exotic places like Machu Picchu, Sidney, Tuscany, Spain, etc. to work, having booked cool hotels and fabulous dinner reservations. One coworker planned an extensive road trip, driving solo, through national parks. Besides being courageous, she has a sense of humor: she purchased an “inflatable man” to occupy the passenger seat of her car during the trip. Then she gave “Joe” away as a white elephant gift at our staff Christmas party. Better than a gnome.

My staycation reflects a lack of planning on my part. A few days after Christmas, I realized my mind wandered when I listened to small talk, the small talk my patients generate adapting to their role, connecting with me, making the experience pleasant for all of us. My sudden inability to concentrate on more than actual patient care signaled to me I let too much time lapse between vacations. There wasn’t enough time to coordinate David’s work schedule with mine, nevertheless, I needed a midwinter break sooner than later. Our scheduler received my request for vacation time that week.

So, how am I spending the time off? I booked a fallback Pedi Mani, then met a girlfriend for Happy Hour at a new tapas bar the first day. Over the weekend, David booked a two-night stay for us at a hotel on the Willamette River. The off-season rates were great. We saw the French film Le Havre, leisurely dined at restaurants we’ve only talked about, and slept in. I’ve booked a spa day for myself, complete with green tea service, and lunch later this week.

After that, who cares?

Learn and Live

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Hawthorne Bridge photo: jparadisi 2012

American Heart Association, are you messing with me?

I was a wee bambina sitting at the dinner table the first time I heard the acronym CPR. My father, a volunteer firefighter for the small town where we lived, certified that afternoon. I remember him saying, “It’s a terrible thing to need to do, but everyone should know how to do it,” and his words are true. Everyone should know CPR.

I got my first CPR card in high school, recerting off and on until becoming a nurse. Now, I recert (renew) every two years. All hospitals I have worked for in two different states require Registered Nurses to have current BLS certification. There is no grace period. If the card expires, the nurse cannot return to work until he or she has renewed their certification.

I love The Heart, however, few things swizzle an experienced nurse’s placid pool of confidence more than CPR recertification, aka, BLS (Basic Life Support). I know this, because I renewed my card last week. Everyone in the class expressed anxiety. Anxiety occurs because, every two years, we have to relearn breath to compression ratios, and how many compressions per minute. For one rescuer or two? Is the victim an adult or a child? The ratios are different for each. And what the hell is that little rhyme you’re supposed to repeat while changing positions with the other rescuer because you’re getting chest pains yourself from the exertion of doing (how many, again?) chest compressions? Don’t forget, you’re trying to save a person’s life while doing this.

Our instructor assured us changes occur only every five years, but it seems different every time. Not only for staff I work with: once, I was running behind two women runners on the Hawthorne Bridge, and overheard them talking about CPR, and how confusing all the numbers are to remember. I sprinted to them, asked if they were nurses. They were. We ran together for a while, commiserating over this albatross of our working lives.

So you can imagine my chagrin, last week when our instructors explained the changing numbers confuses so many health care professionals and lay people, they were not even attempting CPR outside of hospitals, for fear of doing it wrong. This led the AHA to research hands-only CPR. They found:

• Hands-Only CPR (CPR with just chest compressions) has been proven to be as effective as CPR with breaths in treating adult cardiac arrest victims.
• The American Heart Association has recommended Hands-Only CPR for adults since 2008.
As of June 2011

I support the American Heart Association listening to our concerns. I applaud its continual research, which saves lives. Everyone should know CPR.

All the same, does this mean, these past twenty-five years I’ve been a nurse, whether it was one or two breaths between compressions has never really mattered?

American Heart Association, are you just messing with me?

To find a BLS/CPR class near you, click on this link.

Next Career, No Body Fluids

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XXXL Pajama Pants pencil and pastel by jparadisi 2012

“Next career, no body fluids.”

That’s what I tell myself.

I admire hospital management their ability to wear cute dresses and pumps to work or, if they are male, slacks and sweaters. Oh, and jewelry: modestly dangling earrings and longish necklaces. I knew the most talented and charming surgeon who got away with it too, mostly because she’s so damn good at what she does. I once saw her come from the OR wearing green surgical scrubs, a string of black pearls around her neck, and pumps covered in paper surgery booties. I was so impressed I splurged on a string of black pearls for myself, and wore them to work with green surgical scrubs too. Imitation truly is the best form of flattery.

I digress.

I don’t wear cute dresses, few necklaces, or modestly dangling earrings to work because I do direct patient care.  A pediatric nurse quickly learns dangling jewelry is a handhold for infants and children to grab, snapping them or ripping an earlobe. Adult patients suffering dementia put a nurse and his or her jewelry at risk too, and long necklaces tangle into stethoscopes.

The other day, in the adult ambulatory clinic, I started an IV. Unexpectedly, a gush of blood erupted, running warm down my pant leg as if it were the slope of a volcano. I couldn’t get my leg out of the way because I was trying to keep up a calm facade for my patient (“Everything is just fine, just fine.”) while frantically taping the IV in a successful effort to maintain it. When I saw the blood on my pant leg, it looked like I had stabbed myself.

I remembered the last time my clothes were soiled this badly at work. I was a new PICU nurse and a child threw up ALL OVER my pink scrubs.  A nursing supervisor acquired clean scrubs from the OR dressing room for me, and I finished my shift.

I work in an outpatient setting now. There are no kindly nursing supervisors willing to go to the OR for fresh scrubs. I had to think of something else.

In ambulatory care, patients wear their own clothes. Our linen closet is not stocked with an array of gowns or pajama bottoms; however, I managed to find a pair of XXXL pale blue drawstring pajama bottoms stuffed behind the fitted bed sheets. They were so gi-normous, I had to hike and tie the drawstring waist at my bust line. The pant legs were three times wider than both my legs put together. You can imagine how ridiculous I looked (if you can’t, I drew a picture for you above) even with a white lab coat buttoned over the ensemble to hide it. My coworkers were busy, and unaware of my dilemma. When one noticed, all she could say was, “Uh oh.”

Clearly, I needed another plan. Fortuitously, David had the day off, and was near where I work. I called for help, and he brought a pair of pants for me from home. I changed, and resumed patient care.

Apparently, I need a preparedness plan for my clothing at work. Do any ambulatory care nurses have one?

Next career, no body fluids.

A Social License Part II

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Occupy Portland Encampment (first week of November 2011) image: jparadisi 2011

“Oh, that’s too funny! Well, thanks for letting us know. See you in a few days.”

Those were the words of the charge nurse at the infusion clinic, when I called to let her know that, because of jury duty, I would miss the next day’s shift too.

The jury was selected. The judge outlined the case and instructed us in our responsibilities as jurors. Then we were dismissed for lunch.

The trial began when we returned. It was expected to last through the late afternoon of the next day. If the jury reached a decision quickly after the closing arguments, our job would be done. If not, a third day would be required to complete deliberation.

When court resumed, thirteen jurors took their seats. The thirteenth juror, an alternate, would hear the entire case, and then be identified before deliberation. The alternate would only participate in deliberation if another juror became ill or had an emergency preventing him or her from serving. Looking at each face in our group, I wondered which one of us would be kicked off the island (Survivor reference). Was it me?

The only other potential juror, beside me, who had been called out, had not been selected for duty. It was her opinion that cases seeking medical damages resulting from a car accident, such as this one, are always based on greed. She was rejected as a juror because she could not set aside her opinion to hear the case.

The plaintiff suffered neck and shoulder pain since her car was rear ended three years ago at a stop light by the defendant. She was suing for pain and suffering. The defendant was driving his sister’s car at the time of the accident, because an intoxicated driver totaled the defendant’s car two days before he rear-ended the plaintiff.  The defendant had been on his way to school when the accident occurred. He was not intoxicated nor using his cell phone. His foot slipped off the brake. It was a low impact collision. The sister was not in the car at the time of the accident, but was included in the suit because the car belonged to her.

That first day, I wanted to side with the plaintiff. I have seen serious injuries occur from seemingly insignificant impacts. I imagined the plaintiff sitting at her desk job in pain everyday. I listened carefully to her lawyer’s lengthy circumlocutions about her suffering, and the testimonies of her primary health care provider and chiropractor on her behalf.

I left the courthouse at the end of that first day believing the case was motivated by fear: fear of disability and loss of income, fear of a healthcare system that will likely fail the plaintiff when she needs treatment in the future. I felt disheartened.

At the end of that first day I left the courthouse. The defendants‘ lawyer would present their case the following day. Across the street, the people of Occupy Portland gathered among their tents and makeshift shelters.

I felt the onset of a melancholy I cannot identify in the chill of the autumn air.

Next: A Social License Part III

A Social License: Part I

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Occupy Portland Encampment. Early morning, first week of November 2011. image: jparadisi

I arrived at the courthouse shortly before 8 am. There was a long line of people standing on the sidewalk in the frosty morning air of 32° F.

“Is this the line for jury duty?” I asked the man standing in front of me.

“Can’t you tell by our smiling faces?”

Three weeks ago, I reported for jury duty, the first time in my life. In order to appear, I had to take the day off from work at the oncology clinic.

Across the street, Lownsdale and Chapman squares were crowded with tents and makeshift shelters of the Occupy Portland movement. I noticed that no one was up yet at the encampment. It must have been a cold night for the protestors.

Slowly, the line passed through the security checkpoint. I placed my tote bag on the x-ray scanner conveyor, and then I set off the metal detector passing through it, so I removed my belt and shoes, placing them on the conveyor too. The third time, I walked through without setting off the alarms. “This is just like going through the airport,” I remarked to the woman behind me. “Only, I’m not in Maui when it’s over.” We both laughed.

In a large room crowded with 161 other people, I settled into a black vinyl chair, wishing I’d brought a respiratory mask, because of all of the sniffling and coughing in close proximity. Ah, humanity!

At 10:30, my name was called, and I joined over a dozen people taking the elevator to the 5th floor. We entered a courtroom into the presence of a judge, the defendants, their lawyer, the plaintiff and her lawyer. We filled the pew-like benches and the jury box. The judge explained the process of selection.

I was confident I would not be selected. A lawyer once told me they never choose nurses or doctors for juries, because we are motivated by rule of law. In our professions, we follow policy and procedure, tend to interpret the law as policy: if you violate the policy or law, you are guilty. Lawyers prefer more wiggle room than that.

The case concerned medical damages suffered in a car accident. I was not surprised when the plaintiff’s lawyer called me out, “Ms. Paradisi, you are a nurse. Fellow jurors often perceive nurses as experts and leaders. Are you prepared to listen thoughtfully and not guide the deliberation process with your own prejudices?”

“I am aware that people give weight to the opinions of nurses in health care matters. I know what I know. My background is oncology, and pediatrics. I am not an orthopedic doctor.”

We were excused from the courtroom while the lawyers and their clients agreed upon the jurors.

Holy Moly, I was selected as a juror!

Next: A Social License, Part II

Artist Matt Lamb

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Matt Lamb is an internationally recognized artist who uses his fame and resources promoting world peace. Umbrellas for Peace is one avenue of this global pursuit. I have not had the pleasure of meeting Mr. Lamb, but I have read his biography Matt Lamb: The Art of Success, by Richard Speer. Drawn to his story of finding his voice as an artist after a serious health crisis, and leaving a lucrative career, I found many of Mr. Lamb’s insights  about life, death, and creativity resonated within me, a nurse, cancer survivor, and artist. I posted a comment on his blog, thanking him for sharing his story.

Last night, I was pleasantly surprised to find that Matt Lamb wrote a post about my work as an artist and a nurse. His respect for both professions is clear, and I am appreciative of his generosity and kind words. Be sure to check his art, his blog, and Like his Facebook page.

Keeping Toddlers Safe in an Adult Only Home

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Scarletti Confetti pencil and markers on paper 2011 by J.Paradisi

With the onset of late summer hot weather many local children are falling through the screens of open windows. (Another frequent danger to children during hot weather is drowning.  AJN editor-in-chief, Shawn Kennedy posted an excellent article on that subject for Off The Charts).

When I was a Pediatric nurse, the falling diagnosis was nicknamed failure to fly, but only if the child was admitted for nothing more serious than observation and a few bruises. Often the injuries are life threatening or worse, and in truth such an accident is no laughing matter. Perhaps this is why Sesame Street has never featured an episode titled Things That Don’t Fly, in which I imagine Elmo singing a list of things that don’t fly: rocks, books, and YOU!

Okay, that’s not funny either; it’s a poor attempt at humor stemming from recent anxiety while babysitting my favorite toddler, the sister of my favorite twelve year old. A decade has passed since I’ve babysat a toddler, and I worried over her potential for injury while in my care. I’m a nurse, and a former Pediatric Intensive Care nurse at that. It’s a lot of pressure. Of all the people in the world, she should be safe with me, but from the moment she entered my home I realized how dangerous the adult environment David and I share is for an active toddler, even after efforts of childproofing, which included taking all of our CDs out of their towering storage rack and laying it on its side so she couldn’t pull it down on herself, locking under the sink cabinets, installing socket covers, and removing from reach all small, swallowable objects. The balcony door was fastened the entire visit, and she was not allowed on the balcony, even with adult supervision. All windows were closed and locked. There would be no failure to fly on my shift.

Here’s some other tips gleaned from over fifteen years in pediatrics, the news, and personal experience. In no way is this list complete or infallible:

Grandma, What’s in Your Purse? I have no idea how many accidental poisonings occur because a small child finds prescription pills in an unattended handbag. It’s so common that I have removed my little bottle of ibuprofen, used for headaches at work, from my purse. It’s inconvenient; sometimes I have to mooch from my coworkers or walk over to the hospital pharmacy and purchase ibuprofen when a headache comes on at work, but that’s how it is.

 ABSOLUTELY KNOW WHERE THE CHILD IS BEFORE STARTING THE CAR’S ENGINE. This applies when there is more than one adult with the child. Too many children are run over by a car while it’s backed out of a garage or driveway. The driver of the car and the adult in the house each assumed the child was with the other. When I was fifteen years old in Drivers’ Ed, the instructor taught us to walk behind the car to see what might lurk there before getting into the driver’s seat. This is an especially good idea when small children are near.

Never Leave The Child Unattended With The Family Dog. Dogs that are not accustomed to children are unpredictable around them. Dogs that are accustomed to small children are unpredictable around them. I once heard a story of a loyal dog uncharacteristically attacking the family’s toddler. The family was so shocked that after the dog was put down, they had an autopsy performed and found the dog had a painful ear infection. When the toddler touched her ear, the dog attacked him in pain. A very sad story. Protect both the child and the pet by never leaving them together unattended.

Secure That Big Ass TV. Towers of CDs aren’t the only things children old enough to crawl can pull down on themselves. TV’s that are not secure on their bases or bases that are the least bit wobbly put children into ICU’s with crushing injuries every year.

Do Not Assume Any Device Installed For The Child’s Protection Will Work. I’ve seen children who got under impossibly heavy hot tub covers and drowned. Baby gates fail and lead to falls. Years ago, I put my daughter’s baby acetaminophen on top of our refrigerator, safely out of reach when she was small. When she became a teenager, she informed me that as a child, she had climbed the kitchen drawers onto the counter and ate one or two orange flavored acetaminophen at a time while I took a shower, demoralizing me the way only a teenager can demoralize a parent.

The Best Protection for Children is Your Presence. Let the housework and phone calls wait. You are not the kid’s parent, so you’ll have time to clean up after they leave. Getting to know these little people is one of life’s most satisfying experiences. This is your opportunity to influence a developing new life in a positive way. There is nothing in the world more important than their safety and your peace of mind. Enjoy it while it lasts. They grow up so fast.

Scrubs Magazine Features JParadisi Paintings in Fall 2011 Issue

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Three Vases, Two Dollies, and a Thong. oil/canvas by J Paradisi 2011

Scrubs Magazine published two series of paintings by moi in the Fall 2011issue. It is a rare opportunity for an artist to publish more than one or two images in a article, so to see the newest series, Vessels of Containment: Part I posted on the Scrubs Mag website is gratifying. I usually create paintings in a series; while each one stands alone, they were intended to be exhibited together. Vessels of Containment: Part I featuring Catalina Island Pottery (made on Catalina Island from 1927-1937) and vintage dolls, explores collecting as a means of holding.

Also unique about the Scrubs Magazine, is that the print version is entirely different from their website. Previously available only in uniform stores, now you can subscribe for monthly home delivery. Past issues have included articles by popular authors Theresa Brown, RN, Garrison Keillor, and in the Fall 2011 issue, Dana Jennings, journalist and cancer survivor who posts for the NY Times Well Blog. You’ll find a very nice article about me, which features five paintings from my series, From Cradle to Grave: The Color White on page 48.

Incidentally, photo credit for all the images, both online and print, belongs to David E. Forinash, my husband.