The Red Thread of Nursing Experience

An invisible red thread connects those destined to meet, regardless of time, place, or circumstances. The thread may stretch or tangle, but will never break. ~ Chinese Proverb

Calligraphy by Julianna ParadisiI’m headed for Seattle. Making the experience surreal is that I’m traveling without David for first time since we married. I’m attending the West Coast Regional Meeting of the AONN (Academy of Oncology Nurse Navigators). It’s been years since I’ve attended an out of town nursing conference. Truth be told, I’m pretty much a homebody. Home is my happy place. Yazzie (detail) by Julianna Paradisi

Yesterday, in preparation for this trip I had a mani/pedi, and Bree, my manicurist, mentioned the Chinese proverb above. I hadn’t heard of it before, but it immediately resonated. I’m sure there’s a red thread connecting David and me, and he agrees. I believe I’m bound in a similar way to my family, and a few friends too.

This trip is about forming connections. In my new role of oncology nurse navigator, it’s important not only to close gaps in my knowledge base, but to form relationships with other nurse and patient navigators. Textbooks and continuing education can only advance a nurse’s education so far: Experience is vital to competent decisions, and critical thinking. The fastest way to gain experience is from other nurses. Conferences are about nurses creating red threads of connection between ourselves by collectively sharing our knowledge and experiences.

My hope for this conference is to learn to be a better nurse navigator, and maybe find some nurse red threads.

Nursing School is Just The Beginning of a Career of Learning

One aspect of changing nursing specialties, or being a new nurse for that matter, is the agreement to do homework to get up to speed. Being a certified oncology infusion nurse, while helpful, does not make me an expert in my new oncology nurse navigator position. Though working with preceptors who generously share learning, the responsibility of identifying my knowledge gaps, and seeking resources to fill them is mine.

Newly graduated nurse, I hate to break this news to you: graduating from nursing school doesn’t mean you’re done with homework. It’s the opposite. Nursing school provides the tools for finding information you need to succeed in any nursing job throughout your career. I’m serious. When early in my career a pediatric intensive care nurse befriended me, and agreed to be my mentor, the first thing she did was hand me a hardcover, 1,000+ page copy of Mary Fran Hazinski’s then gold standard text, Nursing Care of The Critically Ill Child, saying, “Read it. You can keep it too, because I just bought the newest edition,” cluing me in that expert level nurses continue learning.

I read the tome twice: the first time by looking up the diagnoses of every patient I was assigned to learn their assessment, and then understand the medical care plan. The second time, a few years later, I read it cover to cover preparing for pediatric CCRN certification.

In similar fashion, these days my evenings and days off are occupied with an hour or more of reading about nurse navigation. Yes, I’m a bit of a nerd, but the fact is I haven’t been this excited about nursing in years. Nursing school is just the beginning of a career of learning.

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?

Why Nurses Need to Make Art

The first thing people usually say to me when they find out I’m an artist is, “Gosh, I can’t even draw a straight line.” My response to that statement is, “Nobody can. That’s what straight edges are for.”

Detail of oil painting by jparadisi

Detail of oil painting by jparadisi

When these same people discover I am also an oncology nurse, the second thing they say is, “Painting must be so therapeutic, after dealing with so much death.” My response to this statement is more complex than the first.

First, there’s not really “so much death” in oncology, as treatments improve and many cancers are managed as chronic conditions, which is great. There is still sad sorrow, however. Ironically, when I’m most engaged in a real life human drama, that’s when I find it the most difficult to unleash my creativity. On those days, I’m more likely to calm myself by going for a long run, or knitting, which I consider hobbies.

For me, the creative act of painting is often as uncomfortable as a difficult day of patient care. This is because, I believe the difference between art as therapy, and art as art, is that art as art usually begins with a question or inquiry, and most importantly, results in an insight. Art as therapy requires neither. However, if art as therapy results in an insight, it can also meet the status of art as art. Simply speaking, strong works of art, like strong nursing, involves critical thinking, not simply performing rote skills.

Attaining insight is the reason I believe it is so important for nurses to open up to creativity. Insight leads to an understanding of motivation, our own, and that of others. When we understand our motivations, we are better able to communicate with others. In this dynamic time of The Affordable Health Care Act, nurses need to publicly communicate our role in health care now more than ever.

For instance, the nurse blogosphere is full of posts championing Advanced Practice Nurses as primary care providers. Proponents focus on filling the gap created by a shortage of Family Practice physicians, and reducing the cost of care. While these goals are admirable, the time is now to take creative control of the Nurse Practitioner image by promoting the characteristics differentiating medical science from nursing science: an emphasis on preventive care, in-depth patient teaching, and patient-centered care, which are in some ways superior to that offered by medical science. By creating an image, or branding, if you will, for APRNs, they are appreciated as a unique profession, not as a watered down brand of medicine, or “doctor lite.”

Unflattering, and inaccurate images of nurses are created through tradition, novelists, and outside observers, but rarely by nurses themselves. In order to dispel the nursing stereotypes we despise, nurses will need to rise up and create new ones through visual art, novels, screenplays, and films of such quality that our vision of ourselves transcends into mainstream culture.

Note: This post originally appeared in March 14 2013 on RNFM Radio: Nursing Unleashed!