I Wish I’d Said It

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When I was 5 years old, my mother always told me that happiness was the key to life. When I went to school, they asked me what I wanted to be when I grew up. I wrote down “happy.” They told me  didn’t understand the assignment, and I told them they didn’t understand life.               John Lennon

You’ve Come a Long Way Baby. Maybe.

Untitled. photo: jparadisi 2011

A friend of mine talks about aspects of one’s life occurring between bookends.  People use the cliché “things come around full circle” to mean the same thing, but I like my friend’s reference to bookends better. Coming full circle suggests ending back where one started, but the bookends metaphor implies a linear journey that includes revisiting one’s past, which is unavoidable if you live long enough. Personally, I prefer the bookends metaphor to the circle one, because I think moving forward is an important attribute of  happiness.

Today was my second shift using the new electronic medical record. Yesterday I practiced order entry, updating the home medication list, and documenting blood transfusions. Today, I focused on medication administration. The way the EMR works in our hospital, patients wear a bar code wristband and the medications are bar coded too. When giving a medication, the nurse deploys a laser scanner the size and shape of a pistol to scan both the patient and medications, verifying that the right patient receives the right medication, an important upgrade in patient safety. Scanning the bar codes exactly right so they register in the EMR is tricky. Most of the time I had to repeat the scan more than once before I got it right. I’m thinking it’s not very different from learning to start IVs: eventually my small motor coördination will develop muscle memory, and I will have a “feel” for getting it right the first time. It just takes practice.

Sometime during the course of the shift, however, I told a coworker that if my scanning ability doesn’t improve, my plans for a career at Whole Foods are doomed. We laughed. Then I remembered something from my nursing school days:

When I entered nursing school there was a nursing glut. Nursing shortages hadn’t occurred since before Salk invented the polio vaccine, and tuberculosis ran rampant. Around the same time, grocery store chains were investing in a new technology using lasers to scan bar codes on grocery items for prices at check out. After attaining my Registered Nurse license, I could look forward to eventually earning the same hourly wage as grocery clerks then. All through nursing school, both instructors and students joked about “scanning cans” for a living, if our careers in nursing didn’t pan out.

My very first nursing job paid an hourly wage of thirteen dollars and some change. Six months after graduation, the first wave of a nursing shortage hit where I lived, and my hourly rate nearly doubled in a single pay raise; a windfall. I never thought about scanning cans again, until today when I aimed a laser scanner at a patient’s wristband and medications, and I realized I have traveled a straight line punctuated by a bookend.

Everything Takes Longer Than You Think It Will

First Communion (Paper Dolls) mixed media on paper 2010 jparadisi

Everything takes longer than you think it will.

I believe this to be true, so my strategy for managing the unexpected things that happen while preparing an art exhibition is allowing ample lead-time. Since I’ve been exhibiting for a while, I have a checklist of universal tasks such as documenting the work, updating business cards, making post cards, vinyl lettering, framing, etc. If the artwork is traveling to a gallery in another city, I build in time for packing and shipping too. Once the paintings are made, I begin crossing tasks off the checklist. Even so, the unexpected will occur.

Take yesterday morning, for instance. When I began this post, David was solving a printing problem we discovered the night before. Several hours later, he fixed the problem and we made the prints. However, it delayed their delivery to Luke’s Frame Shop for packaging a few days, because the ink has to dry and cure first.

Sometimes unexpected occurrences are positive. Last week, while showing the From Cradle to Grave: The Color White portfolio to Anna Solcaniova King (see Pulling a Rabbit Out of Her Hat: An Interview with Anna S. King), curator and co-owner of Anka Gallery, I discovered a new relationship between two of the paintings, strengthening each.

This morning, I’m writing my artist bio for the show. Maybe it’s my experiences as a cancer survivor and an oncology nurse that makes the task feel like a prelude to an obituary. I can’t help it. Nowadays, with electronic media, I’m aware that every word I write about myself is recorded somewhere in cyberspace. The days where an artist or writer could destroy early work, and preserve only the work they wished to represent them after their death, are over. Same with the artist’s statement. When my thoughts about From Cradle to Grave: The Color White deepen and mature over time, the words I write about the paintings today may someday contradict my insights of the future. I hate feeling committed to an inflexible opinion as if my thoughts are butterflies pinned to a board and hung on a wall in a picture frame. I want the freedom to explore and gain wisdom.

But a thoughtful artist statement is required, and so I do my best to express who I am, and what my painting and writing are about, knowing that if I’m lucky enough to live a long life, some of the information will change. Like my art, I am evolving.

Everything takes longer than you think it will.

It Ain’t no Sin to be Glad You’re Alive

Bathing Sparrow (sorry it's hard to see) photo:JParadisi 2010

After weeks of daily rain, the sun was shining in a brilliant blue sky and the weatherman promised the warm weather would last all weekend.  My coworkers were feeling fine too: in the staff lounge, two of them sang “If I can’t have you, I don’t want nobody baby” and I joined in as the third Bee Gee, before traipsing to blood bank to retrieve a couple of units for a transfusion. On the way, I passed a surgery tech wearing cap and scrubs, who started dancing in the hospital hallway to the tune of his ringing cell phone. We both laughed when he caught me watching. I was still smiling when a woman stepped out of the elevator, looking haggard and sad. She was not hospital staff, and her sorrow reminded me that many people in the hospital were not having a good day at all. I quickly doused the smile and flipped on my professional demeanor switch.

It’s part of the job when you are a nurse. It’s not enough to like people and have excellent skills. Nurses need the ability to separate their personal lives from their jobs. Don’t bring your own drama in, and don’t take the drama of others out. This is a valuable survival technique for longevity in health care. I’m pretty good at it, but occasionally worlds collide.

Like this morning. My oncology patient mentioned she sure missed having a glass of wine once in awhile. We joked about it before I went into the room of my next patient. Filling out the admission record, I asked the required question: “Do you drink alcohol?” I was unprepared for the ferocity of my patient’s reaction, as she explained emphatically that she does not drink alcohol, and it ought to be illegal to drink it. I stopped the admission process, sat down on the rolly stool in the room, and listened to her. When she finished, her glaring eyes dared me to contradict her. I quietly asked, “Have you or someone you love been harmed by someone drinking alcohol?” She had. Or rather, her son was in an automobile accident caused by a drunk driver. Now he is ventilator-dependent and confined to a wheel chair for the rest of his life.

Joking with one patient about an anticipated glass of wine as a reward for going through chemo is supportive. Bringing the topic up with another patient is traumatic. Nursing requires the ability to respond thoughtfully to either patient, sometimes within the span of a few footsteps.

While warming myself in the sunlight on a bench in a neighborhood park after work, I thought about all of this, reminded of how good it is to be alive and healthy. At the end of even difficult shifts, nurses leave the hospital behind while the patients stay there and endure.

Next to the bench, a sparrow bathed itself in a tiny pond. I watched him scatter water droplets that glittered like diamonds in the bright sun, thoroughly enjoying himself on a beautiful day. He wasn’t paying attention to me. He wasn’t thinking about patients, car accidents, cancer, or a glass of wine. He was just enjoying the moment.

…it ain’t no sin to be glad you’re alive.” (Bruce Springsteen)


Interruptions Increase Errors. Really?

              

Nurse's Note artist: JParadisi. pencil and ink on paper

     I am writing this post while my husband pumps air into his bicycle tires in our living room (ka-chunka chunka-chunka), muttering about how much work cycling is. Finding uninterrupted time to write or paint is sometimes challenging. In nursing, where the safety of patients depends on accuracy, it is impossible. It is the biggest absurdity of my two careers.    

      This morning I read a Medscape article about interruptions exponentially increasing nursing medication and procedure errors. Researchers collected data for the study by observing nurses at two hospitals. Although the conclusion seems obvious, I appreciate hard numbers applied to a reality all nurses recognize. Collecting data is the first step towards change. Shockingly, according to the study a single interruption during medication administration increases frequency of errors to 25%.    

     In all my years of nursing, I have never completed a single task from start to finish without an interruption. A coworker asks a question, a patient or family member needs something, a phone call from a physician or another department and I am distracted. Once, on pediatric unit, I entered my first patient’s room to find him vomiting violently in the bathroom. While holding his small head out of the toilet, calming him down, and keeping his IV in place, my pager beeped. I had to ignore it, but as soon as the patient was safely in bed, I went to the nurses’ station to see why I was paged. There, a unit secretary lectured me about her expectation for an immediate call back to a page (although doctors have an unwritten, twenty-minute grace period to answer pages for non-urgent matters). Why was I paged? A doctor had a question. I did not need to explain myself to the secretary; when I did, her expectation remained unchanged. Whatever. I called the doctor back, and there wasn’t a problem. My point is interruptions can wait until a patient is safe. The problem is most nursing units have expectations that everything be done now. STAT is the most over-used word in health care. Is there really such a thing as STAT Colace? There is an unrealistic pressure on nurses to do everything at once. It is impossible, and patient safety suffers. It’s a no brainer. How sad studies are necessary to prove the obvious.    

        Creating a safe zone where nurses can draw up medications without interruption is a reasonable idea; however, it does not address the interruptions occurring in the patient’s room, like the pager going off in my pocket.  I am often interrupted while double-checking blood, accessing a port, or hanging chemo by the patient asking for a blanket “when you get a chance” or answering their cell phone. They do not realize how much concentration it takes to give safe care. More than once, I have explained to patients or family members “I need to focus on what I’m doing to keep you safe, and I will be glad to answer your question as soon as I finish.”  I’ve never had a patient or family member complain about it. They appreciate dedication to their safety.   

     Interruptions are a daily part of everyone’s life. Reducing nonessential ones is crucial to safe nursing practice, and adjusting expectations (including staffing ratios) is critical.     

     You can find the article   

Interruptions Linked to Medication Errors by Nurses    

At  medscape.com