Hand

 “All nurses are different. Some just jab the needle into you, and it hurts.”

-A patient

White Gloves by jparadisi

White Gloves by jparadisi

Few things make me feel more successful as a nurse than when a patient says, “That was the most painless port access, (IV start, or injection) I’ve ever had.” I can never promise a patient I won’t hurt them, but when I don’t, it makes my day. I strive for a gentle hand. 

In art the term “hand” describes the workmanship of an artist, and nurses often tell patients going to surgery, “You’re in good hands,” referring to a surgeon’s skill with a scalpel. But “hand” refers to the way we treat people too.

Whether educating patients about chemotherapy and radiation regimens, explaining home medication administration, or simply discussing current events, it’s important to remember that even the most optimistic patient is emotionally fragile. Tone of voice, the abruptness of an encounter, and our choice of words all contribute to the “hand” we touch them with emotionally. Too heavy of a conversational hand can pierce a patient’s soul as painfully as any needle or scalpel.

I forgot this during a shift memorable for both the number and acuity of its patients. Everyone had complex questions about their care. I enjoy patient education; however, this shift I was doing so much that I began pulling information from my knowledge base as if it were files from a computer. By this, I mean remotely. I wasn’t paying attention to hand, my personal touch.

During the course of an assessment, a patient revealed she wasn’t taking a prescribed home medication because of its side effects. The patient also reported a symptom, which I recognized was caused by the discontinuation of the home medication she’d just mentioned, and I just sort of blurted out my observation. Immediately, I regretted my heavy-handedness as I saw this otherwise optimistic patient crumble nearly to the point of tears. I had carelessly broken a tender reed.

Needing to make amends, I sat on the rolly stool, and I apologized. I complimented her involvement in her care, and her ability to sense changes in her body. I also apologized for abruptly responding to the discontinuation of her medication. I regained my gently touch, she forgave me, and we devised with a care plan.

I hope I made up careless hand. I had hurt her as if I’d jabbed her with a needle.

Using Perspective As a Tool Against Nursing Burnout

The death rate for humans on the planet Earth is currently 100 percent. I know this is not a pleasant thing to read while enjoying your first cup of coffee this morning, or perhaps you’re enjoying a calming glass of wine later this evening. It’s unpleasant enough that perhaps you will not finish reading this post, but it’s true nonetheless.

Ravens by jparadisi

Ravens by jparadisi

Running parallel to our fear of dying is our pursuit of eternal youth. Cosmetic surgery and procedures are a billion dollar industry. Many men and women consider regular treatments for balding, teeth whitening, the prevention and removal of wrinkles, and coloring gray hair part of normal maintenance. Some choose to have  the evidence of time wiped from their faces by a surgeon’s scalpel.

The struggle nurses face in striking the right balance between hope and realistic outcomes for our patients is in part due to society’s mythical belief that death is preventable, when in fact, it’s inevitable. As humans, nurses buy into the myth to some extent also.

Discussing this, a nurse friend and I joked about gray hairs and wrinkles. She remarked, “Getting old is terrible.”

“No,” I said, “It’s not. It’s what nurses do for a living. We help people stay alive so they can grow old.”

See? It’s a matter of perspective.

Whenever someone asks, “Is it hard being a cancer nurse working with dying patients?” the above thoughts come to mind. The answer is, “I don’t see oncology nursing from that perspective.”

Yes, oncology nurses work with the dying, but I perceive our practice as helping people live to their fullest capacity.

Nurses cannot guarantee patients a cure or how long they’ll live, but by promoting prevention, treatment, and providing tools for managing chronic disease, we encourage them to pursue their best life possible as things stand. If nurses lose this perspective, how can we hope to share it with our patients?

There is balance in the realization that death is part of life. Death and loss cause grief, a normal response. Grief and loss are painful. We fear death and loss, but they are a natural occurrence of living. Maintaining a realistic perspective is a tool for burn out prevention among nurses.

All people die. Nurses are here to help patients live until that day.

I grieve their loss, and mine, because I glimpse my mortality too in the faces of the dying.

Thank you for reading this entire post.

Nine Fictional Clinicians I’d Like to Meet (Yeah 9 Not 10. I’m Picky)

In nursing, where years of working long hours can leave us feeling at times as if the tumor always wins, finding meaning is essential to happiness. People find meaning in different ways — some through spiritual practices such as meditation, others at a church, temple, or faith center.

photo by jparadisi

photo by jparadisi

When I can’t make sense of life by other means, I find meaning within inspirational themes of literature and art. Sometimes that meaning surfaces by way of humor. It’s been said that laughter is the best medicine. Maybe, at its finest, humor becomes a place where science, humanity, and art converge.

With humor in mind, last year, Scrubs magazine posted a list of “Top fictional nurses and docs YOU want to get trapped in an elevator with.” Getting stuck in an elevator would cause me the same escape anxiety that makes a wolf chew off its paw to escape a metal trap. However, the article did make me think about my favorite fictional nurses and doctors, and what I would say to them if I ever met them.

Here’s my list of clinicians and what I would say to each:

  • Dr. Frankenstein: In light of your previous laboratory experiments, what is your position on stem cell research?
  • Major Margaret “Hot Lips” Houlihan, RN ( M*A*S*H, TV version ): Thank you for evolving from a rule- and sex-obsessed stereotype into a nurse comfortable with being compassionate, smart, and sexy. TV audiences would have been satisfied with just sexy.
  • Alex Price, RN ( An American Werewolf in London ): Exercise caution if you’re going to date your patients.
  • Phil Parma, RN ( Magnolia )You are an unsung hero, the home health nurse. You take on the pathos of the dying and their families alone. Without judgment, and through unorthodox means, you found a way to fulfill your dying patient’s last wish.  And when no one is looking, you grieve.
  • Hana, RN ( The English Patient ): Make more time for self-care and fun, instead of dating guys who are as self-destructive as you.
  • Gaylord Focker, RN ( Meet The Fockers ): Dude, if you were my coworker, we’d be BFFs.
  • Dr. Hawkeye Pierce ( M*A*S*H ): What time is happy hour?
  • Catherine Barkley, RN ( A Farewell to Arms ): Have you ever felt, like I do, that your dialogue is written in a way that sounds as if Hemingway never spoke to an actual woman?
  • Jenny Fields ( The World According to Garp ): You are the fictional nurse I’d most like to meet, despite your shortcomings. Your fierce independence is both a blessing and a curse. Despite this, you are a true healer, demonstrating profound love of humanity in all its diversity, weaknesses, and beauty. You inspired me before I knew I would be a nurse. I pray to have a heart as open and generous as yours someday. I think of you often.

Which favorite fictional doctors or nurses would top your list?

Tips for Learning Chemotherapy Administration

I attended a chemotherapy and biotherapy course. Most of the nurses attending had administered chemotherapy for years, but a group of nurses new to oncology sat at the far end of the table. By the end of the first day of class, none of them had spoken a single word after the morning’s introductions.

photo by jparadisi

photo by jparadisi

Concerned, I approached the instructor. She had noticed their lack of participation too and told me these nurses had expressed feeling overwhelmed by the amount of knowledge needed to safely administer chemotherapy.

I can relate. I recall, years ago as a pediatric ICU nurse, admitting a patient in anticipation of tumor lysis syndrome (TLS). Although chemotherapy certified nurses administered the chemo, I was responsible for the patient’s well-being in the ICU. I asked a lot of questions, probably too many. Weary of me, the oncology nurse coordinator remarked, “You worry too much. It’s just chemo.”

Somewhere between this coordinator’s cavalier attitude and the paralyzing fear of a nurse unfamiliar with oncology is the middle ground for teaching chemotherapy and biotherapy administration. Here are some suggestions:

Fear is the nurse’s friend. Fear makes you look up medications and regimens you are unfamiliar with administering. It makes you ask a more experienced coworker for help. It makes you call the oncologist for clarification of orders when you are unsure, but don’t let it paralyze you. Fear is your friend. Embrace it.

Build on what you already know. Safe administration of all medications, including chemotherapy, is founded on the cornerstone of The Five Rights:

  • Right Patient
  • Right Medication: In oncology, this includes becoming familiar with the overarching chemotherapy regimen ordered.
  • Right Dose
  • Right Route
  • Right Time

Right Now is what my husband, a hospital pharmacist, jokingly refers to as the “sixth right,” as in, “the doctor wants the chemotherapy given right now.” While promptness is a virtue, chemotherapy administration is similar to teaching a small child to safely cross a street: “Green means go when safe.” Don’t give the chemo until all the double checks are completed to satisfaction.

Teach evidence-based practice, not your old war stories. None of us older nurses are as entertaining to new nurses as we think we are. As a preceptor, keep your pearls of wisdom short and relevant to the teaching situation.
“Knowledge isn’t knowing everything but knowing where to find it,” said my ninth grade algebra teacher. Teach new oncology nurses the value of looking up medication administration information in your facilities’ policies and up-to-date references. Assuming the information provided by a coworker is reliable instead of looking it up yourself is unprofessional, and won’t hold up as your defense in a sentinel event review.
What helpful advice would you offer new oncology nurses?
What oncology references do you find particularly helpful?

The Art of Subtraction

Fascinated, I watched as a sculptor created a face from a lump of clay. With deft fingers, he tore into the pliable medium, pulling away bits and pieces. A pair of sightless eyes, cheekbones, a nose, and finally lips appeared out of the shapeless mass. No clay was added to create the facial features. Throughout the process, clay was only removed to reveal a face in the inanimate material. Before this, I added clay to form features and appendages.

Sergei by jparadisi

Sergei by jparadisi

I realized that the art of living well — like sculpting — is a process of subtracting clutter and revealing purpose.

I struggle with clutter. At home, David politely refers to my “three-dimensional filing system.” In part, it’s because I am an artist. I find potential for creating art from the seemingly useless. I don’t expect to change dramatically.

I Googled “creativity” and “clutter.” More than 3.5 million references popped up in 0.19 seconds. A single article embraced clutter. The majority reported that clutter siphons creativity through disorganization and inefficiency. One even linked to poor health and obesity. Clearly, subtracting clutter enhances creativity and efficiency.

In my nursing practice, I strive to remove clutter and maximize efficiency in patient care. Here are a few ideas to reduce clutter and increase efficiency during your shift.

  1. Embrace technology. Using a Smartphone eliminates hunting for calculators. Apps like MedCalc keep calculations for doses, BSA, ANC, and more at your fingertips. Several apps can help your own health by logging calories consumed and burned through exercise, and we all know the benefit of removing the clutter of extra weight. Some companies offer employee discounts for Smartphone plans so check your benefits.
  2. If your institution uses electronic health records, learn to use them. Creating “workarounds” is inefficient and defeats the purpose. Electronic records save time. Charting in real-time prevents the need to reconstruct events from memory at the end of your shift.
  3. Avoid mission creep. Stick to the care plan. In the ambulatory infusion clinic where I work, patients arrive with lists of concerns having little to do with their appointment. It’s easy to start calling physicians’ offices and making unrelated appointments for them. Handle the appointment-related work, and provide resources for the rest. Don’t confuse patient advocacy with enabling dependent behaviors.
  4. Bring your lunch to work. Sit down and enjoy your 30-minute break instead of standing in line buying food. You’ll save calories, and money too. Many nurses spend $5-$15 rapidly consuming a high-calorie takeout meal in a depressing staff lounge. Wouldn’t you prefer saving the money and calories for a leisurely meal with friends or family during off hours? Just saying.

I’ll leave you with one last thought:

The cost of a thing is the amount of what I call life, which is required to be exchanged for it, immediately or in the long run.

 Henry David Thoreau

 Now, if I could only do streamline at home. Any suggestions?

 

New Year Resolution: Don’t Wait Until Late in the Afternoon

It was late in the afternoon when my patient arrived at the oncology clinic. The treatment

Kaboom (ceramic) by jparadisi

Kaboom (ceramic) by jparadisi

prescribed required more hours than we were open. The oncologist prioritized his treatment for that afternoon and scheduled a second appointment for the next morning to complete it. The only problem with this plan was my patient didn’t realize he needed two appointments until I told him. His eyes expressed disappointment, but it was an expletive that escaped his mouth. He immediately apologized. “I’m sorry; it’s just that I don’t have that kind of time anymore.”

I understood exactly what he meant.

It was on a New Year’s Eve when I discovered a lump in my breast. At that time, I was a pediatric intensive care nurse working 12-hour shifts and a single mother. Life as I knew it came to a grinding halt. Once chemotherapy started, my oncologist prescribed light duty.  No longer a bedside nurse, I worked on office projects for the PICU manager instead.

My oncologist was hopeful. Still, I remember hearing her say there was a 32 percent chance I would die in 10 years. I was afraid. However, as a PICU nurse, I knew life could be short. This knowledge helped me gain perspective on my predicament. I’d had a good life. If this were it, how would I spend the next 10 years?

Since childhood, I wanted to be an artist. At 15, I announced my plan at the dinner table. In his thick Italian accent, my father said, “Sweetheart, you are talented and can be whatever you want, but get a job first. You will gain life experience, and then you will have something to make art about.”

Eventually, I became a nurse.

I thought about this while my chemo-bald head perched like a cue ball on the armrest of the sofa, eyes staring at the ceiling. I still wanted to be an artist. If this was the last decade of my life, I would spend it making art. I needed to start right away, because I may not have that kind of time anymore.

After recovery, I enrolled in art school and then transitioned into adult oncology nursing. In 2009, I completed a certification in fine arts and became certified in oncology nursing.

Today I am an artist and an oncology nurse. Cultivating creativity not only adds joy and accomplishment to my personal life, but it also flows into patient care. I believe it sustains my love for nursing after 26 years of practice.

Are you setting aside your creativity until late in the afternoon of your life?

Are you waiting for retirement or for the kids to leave home?

What if you discovered you don’t have that kind of time anymore?

What would you change?

 

Today: JParadisiRN On Doctors Radio Channel on Sirius XM 10am PT/1pm ET

Today @ 10 -1030 PT & 1pm ET  I discuss challenges of dating after a cancer diagnosis on Doctors Radio channel Sirius XM. I’ll be speaking from the points of view of both an oncology nurse, and as a cancer survivor.

Oh yes, there will be a blog post in the future about this one!

I Wish I’d Said It

I can’t understand why some people believe completely in medicine and not in art, without questioning either.          

Damien Hirst