Sins of Omission: Latest Episode of The Adventures of Nurse Niki Has Posted

The Adventures of Nurse Niki
The Adventures of Nurse Niki

Sins of Omission, The Adventures of Nurse Niki Chapter 28, posted today. Corey describes a typical litany of ER patients, while Niki ponders who to tell what about her and Corey’s new relationship.

The Adventures of Nurse Niki is a work of serial fiction. The blog is formatted so the most recent episodes appear at the top. New readers not wanting spoilers of The Adventures of Nurse Niki may begin at Chapter 1 and scroll up from there.  Chapters are archived by month (click on the lined square icon on the home page). New chapters post weekly on Thursdays.

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

Kevin Ross, aka @InnovativeNurse wrote a review of The Adventures of Nurse Niki, with this highlight:

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.

You can 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!

Nursing The Unexpected Job Change

Besides reimbursement changes, The Affordable Care Act (ACA) calls for the formation of Accountable Care Organizations (ACOs): joint ventures coordinated by hospitals and providers in communities in which they stop competing and create coordinated services for patients, thereby reducing the cost of care.

I said NEO, not Nemo by jparadisi

I said NEO, not Nemo by jparadisi

In this vein, the hospital I worked for has undertaken collaboration with another hospital to provide outpatient oncology care for patients. As a result, after working for the same healthcare system for nearly 20 years, I have become an employee of the other hospital. Though my job is basically the same, I unexpectedly find myself working for a new healthcare system.

In many ways this change is actually beneficial. However, it has also created turmoil for my coworkers and me.

For instance, there is the expectation that we occasionally float to locations other than our home unit, involving commutes for some. Vacation plans beyond the new hire date are uncertain; we’ve been asked not to request vacations until after the end of the year (2013). New benefits packages require reading, new retirement options must be considered, and there is a different pay scale than what we were accustomed to. I want to reiterate, none of this is a bad thing, but when a job change is unexpected it creates disruption. Here are some coping skills I learned, in case it happens to you:

  • Get your vacation plans approved by your manager as soon as you are aware of the job change. Merging two staffs means some people won’t get the time slots they desire.
  • Polish your resumé. Find the addresses of the schools you attended, remember the names of past managers, and assemble reference contacts. Even if you are automatically offered a job with the new employer, you will have to fill out a job application.
  • Anticipate drug testing as part of the hiring process. This was my first time ever!
  • Make dental, vision, and medical appointments, and renew your prescriptions before the new hire date, in case your new insurance coverage makes it necessary to seek new providers.
  • If you can’t rollover your sick leave or vacation time, consider using as much of it as you can before the job change. It might be taxed at a lower rate that way.
  • Remain calm, and avoid the rumor mill. Find out who is authorized to answer your questions, and get as many answers in writing as possible.
  • Be patient. ACOs are new for everyone. Administrators and human resources personnel are also learning facts as the project develops. They are not necessarily purposely vague. They really may not know the answers to your questions yet.

Finally, remember this: Regardless of the changes, patient care and safety are pretty much the same everywhere. Your employer may change, but you still know how to be a nurse.

This Week: EHRs & The Nurse’s Voice, Collusion & A Nurse Asks for Help

A physician, standing in a busy hospital unit, was overheard telling a resident,

“If you want to be certain something gets done for your patient, find the busiest nurse in the unit, and ask her to do it.”

It’s true, nurses thrive on getting the job done.

Here at JParadisiRN blog, things are hopping. Besides transitioning to a new employment opportunity, I’ve been busy writing, and making art.

In case you missed it, Do EHRs Rob Nurses of Voice and Oversimplify Descriptions of Patient Care? is the title of my latest post for Off the Charts, the blog of the American Journal of Nursing. While I mostly love EHRs, the voice of bedside nursing is lost by reducing the nurse’s note to check boxes and smart phrases. However, not everyone agrees. What’s your opinion? BTW, the I made the collage illustrating the post; the text is from Florence Nightingale’s Nursing Notes.

Weekly, I write and illustrate a post for TheONC, The Oncology Nurse Community website. This week’s post, Which Came First, The Chicken or the Nurse? ponders the lack of privacy and personal space for nurses.

Chapter 13 of The Adventures of Nurse Niki is posted. In  Collusion, Niki’s creative solution for managing her patient’s under medicated post-surgical pain last week yields an unexpected result, in which she coaches a father how to ask his daughter’s surgeon to treat her pain. How do you handle similar situations?

I receive comments from nurses, some asking questions. A recent comment submitted to an older post, Of Medication Errors and Brain Farts is a single line,

I made a med error and lost my job how do you go on

If the comment touches you, please reach out with support and advice for this nurse in replies to this comment. Let’s help out a fellow nurse, yes?

What? U.S. Women’s Soccer Team Looks Like Nurses?

The Christening Gown. mixed media by jparadisi

This morning fellow nurse blogger Joni Watson at Nursetopia urges our friends here in Oregon, Nike, to make scrubs for nurses. I like the idea, considering the physical nature of our jobs, which requires both strength and endurance. What really caught my attention, however, was the link she included to an article criticizing the U.S. Women’s Soccer team for looking like nurses in their white uniforms at the World Games. I can’t help but to track back to my recent post The Color White and the series of paintings I made From Cradle to Grave: The Color White.

The White That Binds (Pinning Ceremony) mixed media by jparadisi (sold).

The Color White

From Cradle to Grave: The Color White (water color and ink on paper) by jparadisi

This post was originally written as the artist’s statement for my series of paintings From Cradle to Grave: The Color White.

From Cradle to Grave: The Color White

     When some hospitals, in the name of customer service, decided nurses would again wear white, I began thinking about the symbolism of white clothing in western European culture. Patients complain it is difficult to tell nurses apart from other hospital staff. Interestingly, color-coding nurses was chosen as a solution, rather than promoting the professional identity of this primarily female occupation.

The burden of the color white for women of western culture is laden with moral innuendo.  For nurses, it conjures images of Nurse Ratched, Hot Lips Houlihan, and Jenny Fields, the nurse/mother in John Irving’s novel, The World According to Garp. It is paradoxical that when women wear white it represents virginal purity, yet evokes sexual fantasy, fear, or both.

From Cradle to Grave: The Color White depicts the rituals for which I’ve worn white. Baptism, First Communion, two weddings, and the iconic white nurse uniform of the “pinning ceremony,” marking the completion of nurses training.

I considered rituals or occupations requiring men to wear white clothing:

  • Baptism
  • House painters
  • Chefs
  • Meat packers
  • Ice cream vendors
  • Medical professionals
  • Colonel Sanders
  • The Navy
  • The Pope

The robes of the Ku Klux Klan take the color white to its sinister extreme.

The color white comes with expectations for women who wear it: only the pure and virginal, never before Memorial Day or after Labor Day.

Speaking Up at the Dinner Table

Last night I attended an educational program. During dinner conversation, the topic of Certified Registered Nurse Anesthetist (CRNA) came up. It’s a hot topic of debate where I work. A non-nursing hospital professional remarked that they “hated seeing the physician anesthesiologist’s role reduced to a technician level.” Ouch. Although I am not a CRNA, I had to speak up. Nurse Anesthetists are BSN trained Registered Nurses, with a minimum of one year acute care hospital experience, and pass certification after completing a graduate program in nursing. I stayed out of the debate, but it is important for people to understand the professional identity of the CRNA. The person who made the remark sincerely thanked me for the education.