Applying Nursing Process and Knowing When to Quit

The Queen of Cups II
Collage 6.5″ x 4.75″ by Julianna Paradisi 2017

It was several more days later   before I ripped out the knitted sleeve I wrote of in my last post. I blame part of my reluctance on nursing process: Nurses are trained (to the point of reflex) when confronted with a problem or undesirable outcome to devise further interventions to create the desired outcome. Likewise, I attempted to apply nursing process to the problem of the knitting mistake.

I measured the sleeves of my favorite sweaters, discovering I habitually wear sleeves an inch or so longer than the pattern I’m using prescribes. Then I did some math, and calculated I could still make all the required increase stitches, if I were willing to accept a longer sleeve, but it would be a very close call between longer and too long. As an artist, and nurse, I felt compelled to take the challenge. Artists like to work with process too.

The hard part about nursing process, however, is knowing when to call it quits: How far backwards is one willing to bend to make something work? This can also apply to dysfunctional relationships or work environments. Carrying out interventions beyond the limits of healthy boundaries quickly becomes denial and co-dependence.

In the end, I conceded the sleeve was too long. I ripped out every stitch, turning my head away so I didn’t have to look, the way a patient undergoing a procedure with only local anesthetic does while the doctor takes a scalpel to their skin.

The deed is done. There’s no more anxiety about the outcome. I did what I had to do.

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.

If I Could Save Time in a Bottle

Oregon agates in their natural state. photo: jparadisi 2011

It’s late Sunday evening as I write this post. Usually I’ve already written one and clicked the “publish” tab by now, but what the hey, I’m not a trained seal, you know?

Anyway, David and I went to the Oregon Coast for a brief trip to celebrate a family birthday. Surprisingly, it was sunny there, and sunny days are as rare as agates on the beach this spring. Now we’re back in Portland, and the clouds darken the sky as if someone put a gigantic hat over the city. However, my day was brightened to find that Dr. Dean Burke mentioned my post from last week among those of other talented nurse bloggers in The Millionaire Nurse Twitter Chat edition. Thank you!

Normally, when I know I’ll be out of town, I plan a post in advance so it’s ready to publish on Sunday evening, but this week time flowed away faster than a spilled latte at the nurses’ desk. First, work was crazy busy: the kind of shifts that make you come home and go bibbety-bibbety-bibbety, while drooling. Despite this, I felt strangely fulfilled. My colleagues and I worked well as a team, and we made some significant improvements in the lives of our patients. Being busy is not the same thing as being frustrated. Hard work resulting in good outcomes is its own reward.

Speaking of which, I was accepted into a juried art exhibition this week. I really wanted to make it into this show, but now the work begins. There’s an artist statement to write, a résumé to update, and framing to do before the show. Achievement comes with a to do list. Being an artist requires a level of professionalism similar to any other career. It’s not all crayons and finger paint.

Added to this week’s frenzy, my favorite 11 year-old had a band concert. He plays trombone, and shows promising talent. I wouldn’t have missed it for anything. In fact, I showed up late for a gallery reception I promised I’d attend months before rather than miss it.

On the drive home from the Coast, David asked me how I was doing after such a busy week. I told him I am tired, but content. If I could save time in a bottle, this is how I would spend it: in meaningful relationships, and doing meaningful work. David said, “What else is there to spend it on?”

Obituary for a Cat



Lucas died a couple of weeks ago, in the midst of the preparations for The Acorn Contains the Tree, and “One more than four”.

Lucas was my husband’s cat, a grey American Tabby. I say “my husband’s cat” because the little sh*#   never accepted me into their relationship.  After eight years, we managed a fragile truce, because he realized he was dependent on me to feed him if David wasn’t home.

In the beginning, Lucas went out of his way to let me know he didn’t want me around. He’d hiss when I entered the room. On one memorable occasion, as I walked past him on my way to work, he lunged, claws drawn like tiny daggers, and drew blood from my shins, underneath the stockings he just shredded. I was late to work, after cleaning my wounds and changing stockings. I fumed about it to my coworkers, threatening to open the balcony door when I returned home, then turn on the vacuum cleaner (Lucas was afraid of it) and telling David that I didn’t know why the little beast had jumped to his death.

Of course, I never harmed Lucas. It’s a hallmark characteristic of most nurses that even when we face abusive behavior from patients, from physicians, staff in other departments, or from each other, we usually go out of our way to do what’s right. That’s why people depend on us. Even at home, I did what was right by Lucas. Not for his sake, but for my husband’s; at some point, I came to the realization Lucas and I had something in common: we both loved him.

So when Lucas began to fail, I encouraged visits to his vet to see if  his symptoms could be alleviated, to make sure he wasn’t in pain. At each visit (there were several) we were told that Lucas was an old cat. There was nothing to do about it. He finally went into renal failure, and that was the end. Lucas was sixteen years old,  93 in people years.

My coworkers asked if I was relieved, knowing how much trouble Lucas had caused. Thinking it over, I realize Lucas taught me a valuable lesson. He taught me how to put aside my own feelings for the love of another. I learned to make room for Lucas in my life, because I love my husband. Lucas helped me to become a better person, and for that I am grateful.