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!

I Wish I’d Said It

“To relieve a full bladder is one of the great human joys.” Henry Miller

Nurses, agreed?

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.

Can Nurses Change Course? Thoughts on Inertia

When I hear the word inertia, the meaning I think of is actually paralysis:

The loss of the ability to move (and sometimes to feel anything) in part or most of the body, typically as a result of

Take One Daily by jparadisi

Take One Daily by jparadisi

 

illness, poison, or injury; inability to act or function in a person, organization, or place.

The actual definition of inertia is:

A property of matter by which it continues in its existing state of rest or uniform motion in a straight line, unless that state is changed by an external force. Inertia is the inability to change course.

Nurses experience inertia when we are unable to switch gears from the high emotional output of our jobs to the more “normal” activities of our personal lives.

I wrote about my difficulty changing course in “The Hostess With The Mostest.” In that post, I describe struggling to transform from on-duty nurse into a party guest at the end of a shift. The difficulty is not only in physically changing from work clothes to party wear. It’s also in retooling my brain for party talk. I have to remember how to talk about favorite restaurants, or the latest film I have not yet seen, instead of cancer nursing, blogging about nursing, or the other related things I spend large amounts of my time doing, casting a shadow over a perfectly good cocktail party.

I think about this while observing people who are not nurses enjoying themselves by taking funny pictures with their cellphones while I avoid being caught in any photographs I wouldn’t want an employer to find on Facebook. Do I worry too much, or is it this a characteristic that makes me a nurse?

It’s healthy for nurses, like myself, to avoid inertia and change course through external activities after leaving our places of work. I find it easier said than done, however, not because I can’t relax, but because “normal” life sometimes fails to hold my attention.

I suspect other nurses find normal life less interesting than their nursing roles, too. If we aren’t over-scheduling ourselves with committee meetings, working overtime, all the while being the World’s Best Soccer Mom, we don’t feel busy enough.

This point was brought home to me by a friend who commented that I seemed tired after I said I was going for a run after getting off a 12-hour shift early. I told her, “No, I’m not tired. I only worked eight hours today.” She replied, “For most people, eight hours is a full day’s work. Go home and get some rest.”

I didn’t. I went for the run. I do my best thinking while running, not meditating on a yoga mat. It’s hard to walk when you’re born to run.

Do you think preferring a busy and sometimes-hectic lifestyle is a characteristic of nurses?

Boston Marathon: Tears of Relief and Tears of Sorrow

Like the rest of us, I grieve for the victims of the Boston Marathon bombings, and am thankful for the rapid response of the health care providers who were suddenly thrust into a scenario resembling a war zone.

I found out about the attack moments after the bombs went off, by turning on the TV. I had come home early from the clinic, because our census was low. Earlier in the morning, I told my coworkers that my cousin was running the Boston Marathon. Now I wondered where was he? Were he and his partner safe?

You can imagine my relief when he quickly responded to my text, “I’m ok.”

I called my Mom, to let her know too.

Soon afterwards, my cousin posted the same message on Facebook. Dozens of friends and family expressed relief.

I am grateful for the safety of my family. My heart breaks for those who were not as fortunate, and are suffering still. My thoughts and prayers go out to the victims, their families, and the teams responding to this senseless emergency.

JParadisiRN Guests (Live) on RNFM Radio: Nursing Unleashed March 18 9pmEST/6pm PST

Sometimes a Surgical Mask feels like a Gag by jparadisi

Sometimes a Surgical Mask feels like a Gag by jparadisi

I’m honored to have received an invitation from fellow nurses and radio talk show hosts Keith Carlson and Kevin Ross to interview live on their internet radio program, RNFM Radio: Nursing Unleashed!
We’ll discuss incorporating art into nursing practice.
If you aren’t able to listen during the live show, each episode is archived on the site for listening at your convenience. We’ll discuss ways to incorporate art into nursing practice.
Here’s the details:
  • JParadisiRN guests (live) on “RN.FM Radio: Nursing Unleashed!”, the newest internet radio station for nurses.
  • The LIVE interview is on Monday, 3/18/13 at 9pm EST / 6pm PST. You can listen in here: http://www.blogtalkradio.com/rnfmradio
  •  Even better – CALL IN with your questions, comments, thoughts, or just to say “hi!”
  • If you can’t listen in, bear in mind that the show will be immediately archived and available for listening on Blog Talk Radio (http://blogtalkradio.com/rnfmradio), and will also be quickly available as a free downloadable podcast on iTunes.
  • Call-in # is: (347) 308-8064.
  • The link to listen in on Monday, 3/18/13 at 9pm EST / 6pm PST again is: http://www.blogtalkradio.com/rnfmradio

I look forward to connecting with you then!