Writing to The So What?

First of all, I apologize to my friends and family on Facebook for the uncharacteristic political updates.  Thank you to those  who continue to follow me, whether or not we share   viewpoints.

xxx

Detail/artist: JParadisi (2009)

Since I began publishing JParadisiRN blog, I strive to maintain a balanced voice. Drama is not my thing, not as a nurse, not as a blogger (with the exception of The Adventures of Nurse Niki). Before hitting the “publish” button, I use my So What? filter, as in “Why did I write this, and so what?” It is my practice to write to the So What?

At least part of this instinct as a writer is traceable to my former role as a pediatric intensive care nurse, where I learned to report my concerns about a patient in concise, direction-oriented sound bites, in the middle of the night, by phone, to a doctor I’d just woken. For instance, if I assessed fluid overload, and suspected the patient needed a dose of furosemide, I presented the numerical values of fluid intake, urine output, central venous pressure, blood pressure, heart rate, etc, sometimes finishing the report with, “Would you like to give an extra dose of Lasix?” Most often the answer was, “Yes,” and I received an order for the desired dose before the doctor went back to sleep.

So what, all nurses do this to some degree,” a reader might respond. They are right.

However, there’s another kind of nurse-call to a physician. It’s born of anxiety, a feeling that something isn’t right; that an otherwise stable-looking patient is on the verge of  downward spiral. Their vital signs are within accepted limits, the lab values unchanged. But, standing at the bedside, “eyeballing” the patient, a subtle change is noted: they’re just a little dusky, a touch mottled. Sometimes those are the only signs warning a perceptive nurse of her patient’s declining status. It’s intuitive: The heart monitor still beats a normal sinus etching across its screen. The numerical values of pulse, blood pressure, and respirations remain unchanged. You keep a watchful eye on your patient, perhaps pulling a bag of normal saline, and a bottle of albumin to keep at the bedside, just in case.

As I grew into my PICU role, I learned to trust this intuition, my nurse’s gut. It saved more than a few lives. I joined the ranks of my more experienced colleagues, nurses who, when they call a doctor and say, “You need to get in here now,” the doctor does just that. He or she can’t explain our intuition either, but once they know a nurse has it, they listen, regardless of what the numbers say.

“So what?”

Here’s what: My nursing intuition is going berzerk in the current political climate. I can’t shake this feeling of impending doom. I am not an anxious person by nature; it’s my training to maintain order and calm. But I can’t shake this feeling: Where there’s smoke, there’s fire.

So what?

A Meditation on 15 Minutes

The problem with committing to writing or drawing something for 15 minutes every day isn’t finding the time to do it. The problem is convincing yourself that 15 minutes is worth the effort in the first place, which is funny if you think about it. I mean, if you were starting an exercise program for the first time, 15 minutes would feel like an impossible amount of time to run in place or around a track. 15 minutes of laps in a pool would be a goal of achievement to an out of shape swimmer. Hell, meditating quietly for 15 minutes is hard to do for the initiate. But for an artist or writer, 15 minutes of creating something feels barely worth the effort. For most artists and writers, (notice I did not say bloggers, a genre of creatives who often boast about how fast they can whip together a post) it takes 15 minutes of staring into space or working out a puzzle just to limber our minds enough to type a thoughtful sentence or paint a meaningful stroke on canvas. Once it’s in place, we are known to again stare into space, read, or work a puzzle for another length of time before inspiration strikes and the next sentence or gestural stroke is generated. 15 minutes? Why bother?

ink drawing by Julianna Paradisis 2015

ink drawing by Julianna Paradisis 2015

Here’s what I’ve discovered in a few days about committing to writing or drawing for 15 minutes everyday: during my waking hours, whether home or at work, I now find I am thinking about what I plan to create when I get home and set the kitchen timer for 15 minutes. This post in fact, began vaguely in my head sometime after lunch today while I was at work. By the time I came home and ate dinner, I couldn’t wait to get to my computer and start writing. How did this happen?

Actually, I already know the answer. It’s because what you focus on expands (Wayne Dyer). It’s very New-Agey to talk about intention, and mindfulness, but intention and mindfulness are euphemisms for “Pay attention!” as in when you were a little kid and your mom or dad yanked you by the arm out of the way of something or someone, and hissed, “Pay attention!” Or maybe you weren’t spanked as a kid, and instead your teacher dropped a book on your desk in front of you because you were daydreaming and not following along with the rest of your class, and then said loudly, “Pay attention!” until someone complained about that teacher, and now when someone doesn’t pay attention someone else makes a new rule and everybody has expend for the kid who wasn’t paying attention whether or not they were.

Self-discipline, the foundation of personal progress, is like that. If you pay attention, you can accomplish almost anything, and that’s why no one should think 15 minutes everyday isn’t enough time to change a behavior. It is. Give it a try.

 

Normal Is a Cycle on the Washing Machine

In my mind, as long as the weather is good, summer isn’t over. However, the beginning of the new school year, and the return of football indicates that ritual outweighs my imagination.

Sigh.

It’s good to let an imagination run free from time to time, so I took the summer mostly off from blogging.

Preparing paintings for display. Image and paintings by jparadisi 2014

Preparing paintings for display. Image and paintings by jparadisi 2014

I’m back.

I think there’s a tendency to view creative work as less taxing, dare I say less challenging, than nursing. I wouldn’t say less, so much as different: Different types of knowledge, different sets of skills. The biggest difference, I think, lies in accountability. Harsh criticism of their work can damage an artist’s psyche.Missing a deadline for a post or art exhibition is unprofessional and negatively affects the editors and curators writers and artists work with. It leaves them in the lurch, which in turn negatively impacts the artist’s career.

In nursing, however, medication errors can seriously impact a patient’s health, with potential life-changing consequences for patient and nurse.

I discovered something this summer: Taking time off from creative projects creates a vacuum into which other projects, out of nowhere, are sucked in, filling the “free” time I worked so hard to create. I see this phenomenon in the lives of the retired too. In fact, I often tell my Mom, “You’re scaring me; retirement looks twice as busy as working life, without the paycheck.”

Mom just smiles, and says, “Remember, ‘normal’ is a cycle on the washing machine. Don’t wait for things to slow down. They won’t.”

She’s right.

An unexpected project close to my heart this summer was the opportunity to hang my paintings and monotype (one of a kind) prints in a health care setting. It is a very satisfying experience to work with a design team to select and hang art with the intention of improving patient experience. In the past, I’ve sat on selection committees choosing artists for hospital art commissions, but this was my first experience as the selected artist.

For me, it came together when a patient, unaware that I am the artist, made this remark about the art, “It makes me think of other things than why I’m here.”

Bingo. That’s exactly the result I was looking for.

The Adventures of Nurse Niki is back too. The latest episode, At The Raleigh, posted Monday.

Summer vacation brought fresh insights, generating posts for AJN’s Off the Charts. In a drop-in life drawing studio I drew a connection between art and nursing. A road trip with my husband inspired this post. And a close call with danger inspired yet another.

Normal is just a cycle on the washing machine.

 

 

 

Latest Posts: AJN’s Off the Charts & New Nurse Niki

Drawing From Life is my latest post for Off the Charts, the blog of the American Journal of Nursing. It posted yesterday. Often the lines between art and nursing easily blur, like soft charcoal lines smudged on paper. You might want to check it out, or leave a comment.

The Adventures of Nurse Niki now posts new episodes on Mondays, instead of Thursdays. Be sure to read week’s episode, Moving On..

Fast Food Nation: When Customer Service Competes with Patient Safety

by jparadisi

Drive-Thru Health Care by jparadisi

Calculating chemotherapy doses by surface area (m2) or kilograms was a smooth transition for me, a former pediatric intensive care nurse. In pediatrics, every medication, even acetaminophen, is dosed by weight. Tailoring chemotherapy doses to a patient’s weight was already a familiar concept; likewise dose reduction or withholding treatment altogether based on the patient’s lab values and assessment.

It’s a rare patient, however, who understands that her chemotherapy is prepared to order, not mixed ahead of time and awaiting her arrival, as if it’s fast-food made for the masses, preserved under a warming lamp.

This doesn’t matter as much if the patient receives his or her care in the hospital, but sometimes it creates unrealistic expectations in ambulatory oncology clinics. Somewhere along the line, good customer service has become confused with fast service, resulting in more and more patients with unrealistic expectations for their appointments.

It was one of those shifts when appointments backed up. Several factors contributed: Harsh weather conditions meant some patients arrived either late or too early for their appointments. The rapidly approaching holidays caused schedule changes for some patients. Of course, there were the normal, garden-variety delays: lab values requiring attention and patient veins that refused to accommodate IV catheters, etc.

Throughout the shift patients asked, “What’s the holdup?” Each time I thanked them for their patience, and validated the importance of their time. All shift long I explained, “One of the difficulties is that administering chemotherapy is not like making fast-food. Each treatment is made to order, measured against your lab values and tolerance. Our most important service is guarding your safety.” The explanation was received well, refocusing expectations on patient safety. Patients expressed appreciation for their nurses, oncologists, and pharmacists watching out for them.

The shift reminded me of a statement made by my husband, “Health care is neither inexpensive nor convenient,” and another one I heard a celebrity say on TV, “There’s never enough time to do things right the first time, but there always seems to be time to fix the mistakes later.”

Delivering prompt care is part of customer service, and as nurses, we should endeavor to keep appointments on schedule. However, our most important responsibility is patient safety.

How do you help patients keep their expectations regarding their care realistic?

Nurses: Keeping Your New Job From Feeling Like The Titanic

Complaining about being overwhelmed by a job in this economy is a little like complaining about too much sunshine. It’s a complaint of the fortunate, particularly when the work involves caring for cancer patients: Certainly the grass is not greener on their side of the infusion chair.

by jparadisi

by jparadisi

Nevertheless, the reality for those of us fortunate enough to have jobs is that everyone works harder, for longer hours compared to when the economy was robust.

I’ve thought about this a lot during my job transition to a new employer. Learning new expectations is overwhelming for everyone involved, not only for my previous coworkers and myself, but for the new coworkers too. For instance, it takes a lot of trust to cosign chemotherapy administration with a nurse you’ve never met before. Both new and previous colleagues are confronted with this. Physicians I’ve never met have been welcoming, and willing to learn that I know what I’m doing. I am a new face for the patients too, earning their trust as well.

I’m relearning skills I’m already good at using new equipment. An example of this occurred when a new colleague asked me to start an IV. “I got this,” I thought, until opening the IV catheter package. In it, I found an over-the-needle system I’d never seen before. I asked my coworker how the safety gizmo worked, feeling a bit dull-witted. I practiced with it once on a tissue box, all the while thinking of that scene from the movie Titanic, where Jack makes Rose practice swinging the axe a couple of times before letting her take a swing at the handcuffs binding his wrists to a pole while the ocean water rapidly rises. Like Rose, I was successful on the first attempt. Whew!

For those of you making a job change in the clinical setting, here are some tips for managing new job-related stress:

  • Allow extra time. Something as simple as changing a PICC line dressing can take twice the expected time if you can’t find the special wrap the patient wants to secure his PICC in an unfamiliar storeroom.
  • Bring a water bottle, and keep hydrated. Have a packaged protein snack handy for low blood sugar.
  • Go to bed early. Stress often interrupts sleep in the form of processing thoughts during the night. Allow for extra rest.
  • Minimize outside obligations. Spend leisure time with your family or significant others. They benefit from your job, and will support you when the going is tough.
  • Remind yourself that you know how to be a nurse. You may not know where to find gauze or tape, but you know how to keep patients safe. Rely on those skills.

What other suggestions are helpful when starting a new job?

The Adventures of Nurse Niki Episode 31 & Real Nurses Featured in Call Lights Magazine

The Adventures of Nurse Niki
The Adventures of Nurse Niki

There’s Always PhotoShop The Adventures of Nurse Niki Chapter 31 posted this morning. In this new episode Niki attends the Call Lights Magazine photo shoot, and meets an old friend from high school.

Call Lights Magazine, is a fictional plot device of The Adventures of Nurse Niki. Nonetheless features factual articles about real nurses and their creative projects. Featured in the past two weeks are Scissored Moon, a book of the collected poems of Stacy Nigliazzo, an emergency department nurse in Texas. Nigliazzo’s poems are published in many venues, including the American Journal of Nursing, where I first read her work. Links for purchasing a copy of Scissored Moon are included in the article.

Included this week is an interview of Peggy McDaniel, RN, BSN, a nurse living abroad, who’s ocean-inspired photography is available as notecards through Sailgirl Designs.  McDaniel the sole proprietor of this nurse-owned and operated business. The proceeds from sales of her notecards help orphaned children in Kenya. Read her exciting story. Links to the Sailgirl Designs website, and Redbubble (for purchasing the cards) are included in the article.

Follow Call Lights Magazine on Twitter @CallLightsMag and Like Call Lights Magazine on Facebook.

The Adventures of Nurse Niki has a new format. The homepage is now static with Chapter One, like a book. The latest chapters are found by clicking the chapter number above the blog’s header, or from the Chapters drop down box at the upper left corner. Each chapters now has a brief description. The changes are in response to suggestions by faithful readers (you know who you are) and are intended to make The Adventures of Nurse Niki friendly to first-time readers, while keeping navigation easy for those following the story from its beginning.

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!

Surviving The Realities of Nursing

Adriamycin by jparadisi

Adriamycin by jparadisi

One of the things I love about blogging is conversation through comments on posts with people I may not otherwise meet. I learn as much from the comments as I do writing the posts.

I received a comment from a nursing student, quoted in part:

I am finishing up my RN degree and so want to go into oncology, but I fear that it will turn into nothing more than a loosing battle. A battle that I lose almost every day. Do you ever feel this way and do you ever wonder if the chemo is worth the pain your patients suffer through sometimes?

I think this sensitivity makes her an excellent candidate for oncology nursing. I wanted to answer her honestly. After taking a few days to consider, I responded:

You must have done some clinical rotations in oncology if you have interest in it. I’m wondering what experiences led you to believe it will turn into a losing battle? As a cancer survivor, and a nurse, I would answer, “Yes, the chemo was worth it.”
I suspect the question you might really be asking is,
“When should curative treatment be withheld or stopped?” and that is the big question in any nursing or medical specialty. I’m sure you are aware that some chemo, surgery, and radiation are done to control cancer symptoms when cure is not possible, and that is different.
Doctors and nurses do not have crystal balls. The best we can do is listen to our patients, offer advice when asked, and respect the decisions they make. Nurses are patient advocates. We cannot control outcomes, only do our best for each. Every nurse must find a way to reconcile this.

Perhaps I could have/should have added at the end, “in order to survive our profession.”

I thought about this nursing student’s question while sitting on the rolly stool gently pushing chemotherapy into the side arm of IV tubing connected to a patient. She asked how long it would be before her hair fell out.

There and then, I wanted to apologize for being the nurse dealing this blow to her self-image, but I did not. Instead, I reminded myself that the chemo might very well save her life. The blow I administered was to her tumor. Her hair will grow back.

This is how I have to look at oncology nursing for my patient’s survivorship — and my own.

Do you feel nurses face a losing battle? How have you reconciled the harsh realities of treatment with your desire to help others? How would you advise this student?

New Episode! Is There a Doctor in The House? The Adventures of Nurse Niki

The Adventures of Nurse Niki
The Adventures of Nurse Niki

Is There a Doctor in The House?  The Adventures of Nurse Niki Chapter 29, posted this morning. Niki and her sister Raquel go out for cocktails and girl talk, but their evening out is interrupted.

The Adventures of Nurse Niki has a new format. The homepage is now static with Chapter One, like a book. The latest chapters are found by clicking the chapter number above the blog’s header, or from the Chapters drop down box at the upper left corner. Each chapters now has a brief description. The changes are in response to suggestions by faithful readers (you know who you are) and are intended to make The Adventures of Nurse Niki friendly to first-time readers, while keeping navigation easy for those following the story from its beginning.

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!