Innovative Nurse (Kevin Ross) Reviews The Adventures of Nurse Niki

Last week, I had the pleasure of being a guest of nurse bloggers Keith Carlson and Kevin Ross (or, as I refer to them, ) on RNFM Radio. We spent a fast hour discussing the lifestyle of nurses, and The Adventures of Nurse Niki. I had a fabulous time, and one of the take-homes I went away with is the idea to hash tag forthcoming episodes of The Adventures of Nurse Niki on Twitter #NurseNiki, so regulars readers can discuss them on Twitter. Great idea, Kevin & Keith, thanks!

The Adventures of Nurse Niki

The Adventures of Nurse Niki

Following the interview, Kevin (who turns out is a huge Nurse Niki fan) wrote this awesome essay The Adventures of Nurse Niki: The Daytime Drama You’re Not Reading. The title doesn’t reflect Kevin’s wonderful review of Nurse Niki, or his thoughtful expose of the life of nurses, which is actually the most important part of the review. Here’s an excerpt from Kevin’s post:

Julianna has embarked on something special for the nursing community. The Adventures Of Nurse Niki is one of the most intelligent perspectives of life as a nurse. These are the experiences of a “real nurse” if you ask me. Nurse Niki is a smart and dynamic character who works night shift in the PICU at a California hospital. A good television show or fiction novel could certainly draw out the sexiness of working in the ICU, but with Niki’s story we quickly discover that this dynamic character is also struggling to cope with life at the bedside, and as a mother and wife. Hidden within each chapter the discovery is that Nurse Niki is in fact you. She’s me. Well that is of course if I was a woman.

Niki’s struggles are really no different than yours. She’s trying to find work-life balance and has the same inner turbulence that never seems to allow for the seat belt sign to be turned off. Niki’s hope was to work for awhile as a nurse and then be able to stay home with her daughter when she was born. She so desperately wants to feel that same connection with her husband that she had with him in college, but how can she possibly put her day in perspective for someone who isn’t exposed to the same emotional trauma that a nurse endures day in and day out? Sound familiar?

Our well laid out plans rarely seem to work out in the way we picture them, and so far it certainly hasn’t for Niki as she deals with the conflict of the same characters we all try to play each day in our own lives. What we believe work-life balance should be is really what I like to call controlled chaos. With a house full of boys around here we often find ourselves having to put up barricades and call in the crowd control teams to herd what seems like a bunch of cats out the door for their next soccer practice or school performance.

Just like many of us either currently or in the past, it’s never just a 12-hour shift and only 3 days a week. Nursing is not a part-time job by any stretch. When you work in high acuity settings like these it seems as if you never leave, even with a couple of days off in between your shifts. It’s really a constant you can depend on. Your co-workers become your family. The frightening difference is that they are the ones who understand you the best, and so the plot thickens.

In case you missed it, The Adventures of Nurse Niki Chapter 16 posted last Thursday. I don’t want to spoil it for new readers, but this is a chapter you’ve waited for.

If you haven’t discovered The Adventures of Nurse Niki, the blog is formatted with the most recent episodes first. However, you can conveniently begin at Chapter One by clicking here. Previous episodes are also archived by month on the main menu.

Don’t forget to Like The Adventures of Nurse Niki on Facebook, and follow her on Twitter @NurseNikiAdven #NurseNiki. Let’s do this!

Listen to JParadisiRN Interview on RNFMRadio!

 Keith Carlson (@NurseKeith) and Kevin Ross (@InnovativeNurse) invited me to guest on their internet radio show, RNFMRadio.com. In case you missed it, you can listen to the interview by clicking on this link. It was my second appearance on the show.
I had no idea Kevin is a Nurse Niki fan! We tried hard to avoid any spoilers, both for potential new readers, and for Keith, who’s only caught up to chapter 7.
Besides discussing The Adventures of Nurse Niki, the interview includes our thoughts on night shift, the attachment ICU nurses sometimes feel towards their patients or their families, Kevin’s love of daytime dramas, and me being asked to do CPR compressions in a strapless dress at a Christmas party. Oh, I read chapter 11, Beer for Breakfast from The Adventures of Nurse Niki on air too.
If you aren’t listening to RNFMRadio.com, you should. Keith and Kevin are not only entertaining, with an expansive choice of nurse guests; they provide a dynamic medium for the online nursing community to share news, ideas, and ventures in a collaborative spirit. If you’re not listening, you’re missing out!

01:09

Julianna Paradisi, Nurse Writer and Artist

Please join us for the second RN.FM Radio appearance of Julianna Paradisi, an accomplished nurse, writer and visual artist. Julianna’s paintings have been featured in the American Journal of Nursing and Scrubs Magazine, and she is… more

http://www.blogtalkradio.com/rnfmradio/2013/10/15/julianna-paradisi-nurse-writer-and-artist

Are Nurses Attracted to Gardening Because We Work in Close Proximity to Death?

On a beautiful late spring morning, I sat in my favorite chair, sipping coffee and writing. Through the window, I watched a hummingbird sip from the newly-potted salvia on our tiny deck. He is so at home that he actually perched on the railing while drinking from the tubular blossoms.

Hummingbird by jparadisi

Hummingbird by jparadisi

It was satisfying to watch. The hummingbird’s presence deepened my enjoyment of our small container garden.

Years ago, before changing course to make time for painting and writing, I had a huge garden. The limitations of container gardening make me miss my ambitious gardens of the past. As I write, I imagine a larger garden after I retire from nursing, whenever that may be.

What is the connection between nurses and gardens? I don’t think I know a nurse who doesn’t grow something, if only a lowly houseplant on a windowsill. Every spring, it’s common to find potted plant starts in the staff room from one nurse’s garden brought for another nurse to plant. I know nurses who raise prize-winning orchids. Another farms trees in his spare time.

Are we attracted to gardening because we work in close proximity to death? Does placing a dormant seed into carefully prepared soil, waiting for it to burst forth and blossom, satisfy something in our souls, deeper than merely beautifying our homes?

Nurses wear gloves to prevent soil from staining our fingers, keeping them from seeming unsightly as we palpate a patient’s vein to start an IV. Still, garden soil often seems cleaner, more wholesome, than the invisible bacteria populating the skin of human beings.

At work I overheard nurses giving one another advice on killing garden slugs. I was horrified when one said she snips them in half with garden shears. However, a few days later, when I found one in my container garden, I didn’t think twice about dowsing the poor creature in salt. Encrusted, he reared up, pillar-like, then moved no more. Was my action any less cruel because it evokes the Biblical image of Lot’s Wife? Are my coworkers and I applying oncology principles to gardening: both tumors and slugs must be removed, either through cutting (surgery) or by chemo?

My final observation about nurses and gardening is this: how little nurturing we are inclined to lend a plant for its survival. Universally, I hear, “If it doesn’t live, it’s not meant to be,” and I share this sentiment about plants. I wonder if nurses have such low tolerance for a plant’s inability to thrive because we give so much of our hearts to our patients?

Nursing Interruptions: When the Light Gets in Your Eyes

Running through Portland’s Water Front Park for exercise one morning, the sun silhouetted a Coast Guard helicopter flying low over the river. The loud noise of its rotating blades captured the attention of a group of preschoolers playing nearby in the grass.

by jparadisi

by jparadisi

The children stopped to watch the helicopter, but the bright sunlight behind it glared into their eyes so they turned away and resumed their activities — except for one three year-old boy, who held one hand before his eyes, using it as a filter to block the intense light of the sun. This allowed him to stay focused on the helicopter while it glided through clouds and blue sky.

I carry this image in my mind’s eye and pull it out often, like now, while writing this post, distracted by checking Facebook updates, emails, and shopping an online department store sale. I remind myself to focus on the job at hand, like the preternaturally wise three-year old.

For nurses, the need to focus is critical, and the distractions more numerous. In fact, multitasking while performing patient care is encouraged among nurses as a job skill, with mixed results.

According to a 2010 article posted in Medscape Medical News, nurses that are interrupted during medication administration run a risk of making an error:

For each interruption, there was a 12.1% increase in procedural failures and a 12.7% increase in clinical errors, with the association between interruptions and clinical errors independent of hospital and nurse characteristics. More than half (53.1%) of all administrations were interrupted (95% confidence interval [CI], 51.6% – 54.6%), and nearly three quarters of total drug administrations (74.4%; n = 3177) had at least 1 procedural failure (95% CI, 73.1% – 75.7%).

Teamwork requires the flexibility to prioritize the needs of patients against the needs of unit workflow. Nurses need some sort of filter for incoming stimuli so that the essentials — like medication administration — are sorted from interruptions that can wait. Even for nurses with strong prioritization skills, many shifts pass in which no single task is completed from beginning to end without interruption.

Multitasking is as much a team sport as it is a personal responsibility. For instance, when checking medications, particularly chemotherapy, it’s helpful if the team withholds unrelated interruptions from the nurses checking chemo until after the check is completed. Providing a separate space such as a medication room would prevent interruption, but not all clinics or hospitals have the luxury of this much vacant real estate.

To decrease interruptions, some hospitals distribute badges that flash an LED light alerting coworkers when a nurse is in the midst of medication administration. If this works, I’m afraid that the temptation to keep the light flashing my entire shift would overwhelm me.

What are your suggestions for decreasing interruptions during medication administration? Does your institution provide a medication room or use other indicators to prevent interruptions while checking chemotherapy? If so, does it work?

The Adventures of Nurse Niki Chapter 9 is Posted: No Good Deed Goes Unpunished

The Adventures of Nurse Niki
The Adventures of Nurse Niki

The Adventures of Nurse Niki Chapter 9 is posted!

In this week’s post, Niki unintentionally stands ER nurse Corey up for breakfast after her patient’s early morning code. As if that wasn’t enough, Niki meets a traffic cop on her way home from the hospital.

Off the Charts has this to say about The Adventures of Nurse Niki:

This blog is made up entirely of first-person episodes told by a fictional nurse named Niki. Each episode is short, detailed, and engaging, and it’s easy to keep up with it on a regular basis, or quickly catch up if you haven’t yet read any episodes.

                      Jacob Molyneux, AJN senior editor/blog editor

You can interact with Nurse Niki on her Facebook page, and don’t forget to “Like” it. Show Niki some love!

Thank YOU!! to the readers following The Adventures of Nurse Niki, the retweets of  @NurseNikiAdven, and those who not only Like Nurse Niki’s Facebook Fan Page, but post comments too. The support is very much appreciated!

Waiting in Line at the Post Office, Yet Again

Yet again, I’m waiting in line at the post office to mail packages. Frequent readers of JParadisiRN are probably thinking, “Holy carp. I thought she said she’s a nurse. She spends more time at the post office than in a hospital.”

The White that Binds (Pinnning Ceremony) jparadisi 2010

The White that Binds (pinning Ceremony) jparadisi 2010

Actually, I don’t, but I do mail packages at the post office throughout the year. This is the penalty of an ambitious child who moved far away from some of the people she loves most in the world to follow her dreams. Mailing gifts acknowledges the birthdays I am not present to celebrate.

I’ve noted similarities between hospitals and post offices before. Today’s line is much shorter than they are at Christmas. Regardless, the seasonal change does not remedy all the coughing and runny noses among those waiting.

The worst cough belongs to a woman already standing at the window loudly questioning the clerk about every conceivable option available for mailing the midsized envelope she clutches. Her hair is held by a twist-tie in a messy ponytail, revealing a rash on her pale face, which is positioned 18 inches from the postal clerk’s face. The woman coughs often, in a peculiar fashion: She lifts her face to the ceiling and covers her mouth with her fist while turning her entire body 180 degrees. This creates the effect of a Rain Bird sprinkler, spraying fat water droplets (or, in this case, respiratory droplets) upon the clerk and throughout the lobby.

It gets worse. After 20 minutes of asking the clerk questions and coughing, the woman ends the exchange by saying, “Thank you.” She replaces the envelope into her tote, and leaves without mailing it. I fear the people in line in front of me may knock her senseless, but she leaves unmolested.

At the very same moment, a second clerk returns from a back room, scrutinizes the long line, and says to the first clerk, “You certainly fell behind while I was on break.”

Exasperated, the soggy clerk responds, “I had a person asking a bazillion questions.” She beseeches those of us in line for support. One customer says, “You were very kind.” The others nod and mumble in agreement.

What does this story have to do with nursing? Directly speaking, not much. Yet I can’t help but connect the similarities between the postal clerk, nurses, and the special skills required to work with the public, sometimes at the risk of our own health. Topping off this encounter with criticism from a coworker who is unaware of these special qualities after a particularly stellar performance dampens the spirit, like water from a Rain Bird sprinkler.

The lessons learned: Our jobs are hard. Be kind. Look for the positive in coworkers and in yourself. Don’t wait until Nurses’ Day to recognize staff and colleagues.

The Adventures of Nurse Niki Chapter 5: Dirty Dishes, Stress Dreams & Earthquake Preparedness

The Adventures of Nurse Niki
The Adventures of Nurse Niki

The Adventures of Nurse Niki Chapter 5 is posted. This week Niki navigates dirty dishes, a  stress dream, and earthquake preparedness. Sound familiar? You probably work night shift!

On her Facebook page, Niki posted a video of a song she was listening to on her CD player. Notice the shopping carts? You’ve probably read Chapter 4. Last week, Niki posted Simon’s recipe for Macaroni and Cheese with gluten-free substitutions. Anyone tried it yet? You can interact with Nurse Niki on her Facebook page, and don’t forget to “Like” it. Show Niki some love!

Many thanks to the readers following The Adventures of Nurse Niki blog, the retweets of  @NurseNikiAdven, and those who not only Like Nurse Niki’s Facebook Fan Page. The support is very much appreciated!

It’s That Time of the Month Again: JParadisiRN’s Post for Off the Charts

Yes, it’s that time of the month again. Before you go thinking JParadisiRN is giving out Too Much Information, let me say that I’m referring to my latest monthly post Who Will Watch the Watchers? Consider Nurses for Off the Charts, the blog of the American Journal of Nursing.

In this latest post I contrast nurses’ accountability to protect the privacy of our patients while maintaining their privacy under the oversight of HIPAA, against the current debate over personal privacy versus national security, and who should have oversight of the NSA and the information they collect.

Read the post at Off the Charts and leave a comment. We’d love to know your opinion!

Diet As Tolerated

by jparadisi

by jparadisi

Sitting in a trendy restaurant sipping a cocktail, I pick Marcona almonds from a small plate set between a blonde woman and myself. We are guests celebrating the birthday of a mutual friend. We grin self-consciously before introducing ourselves.

She asks, “What do you do for a living?”

Do all nurses dread this question at parties? Admitting I’m an oncology nurse is a buzz kill. The dread I anticipate appears in her eyes but not for the expected reason. She says her father is hospitalized in another city and “not doing well.” She can’t visit as often as she’d like.

She asks, “Do you like your patients? Is it hard taking care of them?”

I wonder, how much information can she tolerate? A few morsels or an entrée?

Cancer conjures images of wraiths drinking reconstituted chicken broth from Styrofoam cups or receiving nourishment through tubes. It would be untruthful to say this never happens, however, the social ambience of the clinic where I work surprises newcomers.

Instead of lounge chairs lining the walls of a single, cavernous space, our clinic has private rooms. Long-time patients have favorite ones. It’s not unusual to find Happy Birthday written in Sharpie on a piece of fax paper taped to the sliding glass door of a room of its “regular” occupant. Sometimes there’s birthday cake too. Cancer patients can eat birthday cake, like the rest of us. They eat “diet as tolerated.”

Patients with lengthy appointments are offered lunch, and some choose their infusion day based on the cafeteria’s soup du jour. Many choose to bring food from home, however.

Often, patients make their meals at the infusion clinic a special occasion by bringing utensils from home. I particularly admired a hand-thrown ceramic bowl brought by a special patient. Weekly, it was filled with something new: pillows of wonton, pea pods, and water chestnuts in broth, or brown rice with chicken. On rainy days, it cradled creamy macaroni and cheese, and an heirloom silver fork delivered each small bite to her awaiting mouth.

These meals are prepared with love. Families take pride in the accomplishment of feeding a loved one with cancer. The family table marches onto the foreign field of cancer proclaiming, “We will not surrender our loved one without a fight.”

Back in the restaurant, I see our hostess heading our way. The blonde woman has concerned eyes. There is only enough time to offer her with a small morsel of information.

I consider my answers to her questions, “Do you like your patients? Is working with cancer patients hard?”

“I love them,” I say. “Working with cancer patients is hard work but I can’t imagine a more rewarding job.” Her eyes relax. She takes a sip from her wine glass.

Like a fairy godmother, the birthday girl hugs me, kissing my cheek. Pouf! I am restored to a guest at her party, sipping a cocktail.

*This post was originally published on TheONC website.