Finding Creative Permission, my new post exploring creativity and nursing, is up at TheONC.
And Happy Valentine’s Day!
New Post on TheONC: Finding Creative Permission
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Living With Our Mistakes & Holes in Our Socks
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
I Wish I’d Said It
When in charge, ponder.
When in trouble, delegate.
When in doubt, mumble.
__Good Life Almanac, by Ruth Smalley.
Found taped to the desk at a nurses’ station
TheONC: A New Blogging Community for Oncology Nurses and Teams
Last week CancerNetwork launched TheONC; an online community for oncology nurses and staff. TheONC is a gated site for professionals so login is required to participate. The video link below explains more fully:
video.asp?section_id=1687&doc_id=238579
TheONC features bloggers with a wide spectrum of expertise writing on various aspects of cancer care. As a contributing blogger, I write from the perspective of an artist working in oncology. Through weekly posts, readers and I will discuss creativity, and its pursuit, in nursing. Images of my artwork accompany the posts. My first went live yesterday.
Shift Observations: That First IV Start After Vacation
photo: jparadisi 2012
Why does that very first IV start on the first shift back from a vacation always cause just a little apprehension?
My patient waits silently while I collect the supplies I need: a sterile IV pack, the angiocath, a normal saline flush. I tear a few small strips of tape and stick them to the edge of the bedside table, easily within reach, ready to secure the IV once it’s in the vein.
How many IV’s have I started over the past twenty-five years? Why does the first one after a vacation always feel like the first one ever?
My gloved fingers palpate the chosen vein one more time before I swab it clean, leaving a glistening sheen and contrasting shadow along its hill, a cairn on his forearm.
Collecting my thoughts, I focus on the vein until they are as sharp as the needle I use to puncture his skin and thread the catheter into the vein. A flash of blood tells me I’m in. Using one of the strips of tape, I secure the IV, then cover the site with a transparent dressing. It flushes easily.
I release my breath, which I realize I was holding.
I’m back.
Staycation
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
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?
I Wish I’d Said It
Keep your chin up,
No one expected you to save the world,
Otherwise, you would have been born wearing a cape and tights.
Just do the best you can.
AJN’s On the Web
This morning I’m drinking my first cup of coffee, thumbing through the January 2012 issue of the American Journal of Nursing. A familiar sentence catches my eyes in On the Web, page 22. It’s a line from a post published (and I wrote) on their blog Off the Charts. Thanks AJN!
It’s gonna be a good day.
Shift Observations
photo: jparadisi
Three nurses at lunch break in the staff lounge, focus intently on their phones. A fourth nurse enters.
She asks, “What would we do without our smartphones?”
Silence.
One nurse looks up, smiles, and says, “Talk to each other?”
A longer pause, then shrieks of laughter.
All heads return to their phones.
