Flu Shot? Yes, Check That Box

This week I got a flu shot, free of charge from the hospital. I bared my deltoid muscle, allowing a nursing student to practice her immunization and injection skills. She did a pretty good job. It barely hurt. Those are penguins on the adhesive strip she covered the tiny bead of blood from the needle prick with, in the photo to the right.

Flu shot? Yes. Check that box

Flu shot? Yes. Check that box

I hardly thought twice about getting a flu shot this year, which hasn’t always been the case. In fact, in the past I opposed mandatory flu shots for nurses; arguing against someone else making rules about my body. While I was never threatened with job termination for refusing flu shots, some hospitals did make nurses refusing them uncomfortable with policies mandating they wear respiratory masks in patient care areas during flu season, or producing notes from their primary care provider explaining the nurse’s choice to avoid it; stuff like that.

What changed my mind about flu shots? I don’t know it has actually changed. What’s changed is my attitude: I don’t feel it’s worth the fuss anymore. It’s not a battle I choose to fight. I don’t know if this is a sign of maturity, or aging, but it’s lost its importance in the greater scheme of my life.

This year, and the last, I got a flu shot, and then I went back to work.

What about you? Are flu shots still a hot topic for nurses like they were in 2009, during the height of the H1N1 virus epidemic?

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?

Let Me Tell You One More Thing You Already Know

Intubated (Baby with a Breathing Machine) mixed media on vellum by JParadisi

Maybe it happened because I was tired after working a string of long, busy shifts.

Maybe Mercury, the communication planet, went retrograde last week.

Last week I wasn’t as good of a communicator as I would like to be.

I am one of those nurses who learned something in the Therapeutic Communication module of nursing school. Before you judge me as the nerd I kinda am, I do not go around repeating, “What I hear you saying is…” Such phrases are not what someone wants regurgitated back at them. The phrase is a tool, not a mantra. Instead, I learned to carefully listen to the words a patient uses and watch for any mismatch of those words in their body language. Then I speak to the body language. As a visual artist I first think in images, then put the ideas represented by the images into words, like a songwriter fitting lyrics to a melody. For me, the pictures come first, then the words.

Here’s what happened:

A colleague introduced me to a nursing student whose next clinical rotation is pediatrics. She told her I was once a pediatric intensive care nurse, and the student asked if I had any pearls of wisdom to share. While I am not so vain to believe my words possess a cure for the deep wounds of a human soul, I am vain enough to believe I occasionally have something insightful to say. So I offered this advice:

  • Always consider the parent-child unit as your patient
  • Even if a parent doesn’t know pathophysiology, they know their child better than you do.
  • The smaller the patient, the more important it is that you get it right the first time.
  • If you are unsure of what you are doing, find a nurse who does know. Stick close to your preceptor.

I finished and saw the glazed look on the student’s face. Her shoulders already turned away from me. She didn’t really want my advice; she was only being polite. David tells me when he sees this look in the eyes of the pharmacy students he precepts, he adds, “Let me tell you one more thing you already know.” She was not my student, however, so I shrugged it off.

A few days later, I was starting an IV in a patient. I had started IV’s in this patient before, and this particular day, while I did so, she told me about a bad experience she had as a child when a nurse started her IV. As before, her body language was the picture of calm while she talked. I inserted the IV easily. As soon as the patient saw the blood flash, confirming the IV was in the vein, she passed out, just like that. I yelled for help, but by the time my coworkers arrived, she was already coming to. With the innocent expression of a child she looked up into my face, and said, “Oh, it’s you.”

I disappointed myself. Her words had not matched her body language, and I missed it. I didn’t know how much courage it took for her to come in for treatment. I gave her some juice, and a little time to herself. When it was clear that her inner child had safely returned to her soul’s play room, I told her I was sorry. She apologized for not telling me how she really felt. She didn’t want to be a difficult patient. We talked about her fear of needles, and came up with a plan. She decided to finish her IV treatment, and I learned one more thing I already knew.

What I Learned in Nursing School about Customer Service

Detail of painting (2009) artist: JParadisi

     Many of my patients are recently discharged from the hospital. Most of them tell me about the wonderful care they’ve received there, and even mention their favorite nurses by name. I know a patient who memorized the names of all twenty nurses caring for him during a lengthy hospitalization, because he is so impressed by the care he received.

     Patients sometimes ask  if it’s difficult taking care of sick people. I always laugh when I’m asked this question, because it reminds me of the summer job I had before my last semester of nursing school. My classmates took summer jobs as certified nurse assistants, honing their new nursing skills. I needed a new, used car that summer, and working as a cocktail waitress in a resort town dining establishment paid better than working as a CNA.  

     While most dinner/cocktail customers I served enjoyed their evenings out, occasionally I’d get a cranky one or two. Besides the perennial customer complaining that his “medium” steak was not medium (is there any more subjective term in cooking than “medium”?), my favorite story is of the drunken male customer who began making lewd gestures and statements while I brought drinks to his table. I refused to serve this customer anymore alcohol, and he complained to the restaurant’s owner, who tried ordering me to serve him. I told him I wouldn’t do it; if he wanted to fire me on the spot, right before Labor Day, fine; I’d already earned the money I needed to buy the car and I was going to be a nurse soon anyway. Realizing he had no influence over me, the boss took a tray of drinks to the offending drinker and his buddies.

     Minutes later, the drunken customer jumped up on the  stage where live music was playing, and stripped off all his  clothes, butt naked. Horrified, my boss tried to man-handle the guy off the stage. He was prevented by the customer’s drunken buddies, who jumped up from their table and threw my boss out the door of his own restaurant,  dead-bolting it behind him. The bartender yelled to me, “Juli, get behind the bar,” and called the police.  I did as I was told this time.

     I’ve had one or two comparably difficult patients, since becoming a Registered Nurse. But, for the most part, I’m gratified by the graciousness, and kindness of the people who come in for care, trusting that my colleagues and I will take good care of them.