She didn’t know her words would haunt me for years to come. It was a night like any other night. I stood at the bedside of a relatively stable patient, and I was dutifully giving him his meds. The floor was quiet, patients and nurses preparing for the night shift a few hours away.
Like a fire klaxon, a voice cut through the relative peace of the hospital floor. “My husband is dying! My husband is dying!”
Instinctively, I dropped the medicines and darted out of the room. In the middle of the hall, a middle-aged woman ran toward me, screaming about her husband in the room across the hall. “He’s dying,” she yelled into my face.
Mouth dry, heart pounding, I pushed past her and entered the patient’s room. Of course, he was unconscious, blue, and not breathing. I started CPR, but the craziness was not over.
I wasn’t exactly a new nurse. I had been through a few codes, and they all went rather smoothly. I never experienced the stomach-churning nausea of having a family member witness their loved one dying.
The patient wasn’t mine, but I knew about him. He had recently had coronary artery bypass grafting surgery and was due to be transferred to the ICU any minute because his heart rate and rhythm were abnormal. His doctor was on the floor, writing the paperwork for the transfer.
Others had heard the wife call out in anguish, and everyone came running, including the doctor. He burst into the room, shouting, “I need an intubation kit! Get me an intubation kit!”
I could hear the rumble of the crash cart coming down the hall, but it hadn’t quite reached the room yet. The doctor continued to yell at me, to point, to spit. His hands shook, but I had been here before. I yelled back, “Hold on a second! It’s coming!”
I realized then that the doctor was more afraid than I was. The cart arrived, the patient continued to code, and the doctor got his intubation equipment. Although we managed to get a sustainable rhythm on the patient, he soon died in the ICU.
Of all the codes I experienced over my years as a nurse, this one sticks out as the most horrible. When codes start, nurses become the ultimate professionals. No one runs. No one yells. Everyone works as a team.
As a relatively new nurse, I never experienced the terror that “normal” people experience when someone starts to die. For me, I knew how to handle it. A patient going south deserves my close care, but the emotion is usually not high during care involving advanced cardiovascular life support. Afterward, I would cry and shake, but not when I needed my faculties about me to do everything I could to save a life.
This code was different. In fact, I can live it over and over in my mind, and I still feel as scared now as I did then. The wife and the doctor were breaking the rules. They didn’t know how to deal with death, and I don’t really blame them. I just know their actions scarred me deeply.
Trauma is a real problem in nursing, and situations like these can cause a nurse to relive moments that didn’t go well. This is especially true of new nurses. New nurses make mistakes, and they haven’t developed the ability to be the calm professional yet. This means that the trauma of extraordinary events can stay with them forever.
I never dreamed that I would face a family member who was screaming that her husband was dying. I can only imagine the torment she was going through, the heartbreak of knowing that her loved one was slipping away before her eyes. She reached out for the only help she could.
And that help was me.
Her terror has stayed with me all of these years. In that moment, I became her. I empathized with her, as any good nurse will do. I felt her sorrow, and despite our best efforts, we couldn’t save her husband. I find myself imagining how she felt when he actually passed away.
I will admit that this situation scared me, and I have dwelt on it more than I should. Nurses, especially new nurses, have to develop a sense of detachment from the patient and family. But what about the human side of the equation? Too much distance leads to too little caring.
I am happy to say that I took part in codes after this one, and I did the best job I could. In fact, I was praised for my work in situations where a life was on the line. But I never forgot the distraught woman in the hallway, or the surreal feeling of dread that her words—”He’s dying!”—caused in me.
It remains a trauma that has impacted my life forever. Nurses need to realize that they experience traumas, too, and that it is okay to talk about them. It is okay to be afraid. It is okay to reflect on the situation and examine the emotions the trauma awakens. Without this reflection, the emotions become buried. Ignored emotions manifest as substance abuse, out-of-control feelings, and hatred of the job.
My trauma is just one example. Almost every nurse has a story of when she or he was scared and traumatized. Talk about it. Don’t pretend to be so strong that you don’t need to ask for help.
I wish I could have saved that man. I wish I could have wrapped that wife up in my arms and made it easier for her. I couldn’t, but it will stay with me forever as the trauma in my career that haunts me, because I couldn’t hide behind the façade of the calm professional.
I am the calm professional, but I am human, too.
November is National Diabetes Month and while many nurses know the exceptional challenges their patients with diabetes face, some know the obstacles personally.
As a nurse with diabetes, taking care of yourself is extremely important. And while managing diabetes is 24/7, the holiday season can be especially difficult. Nurses have seen patients go through all the ups and downs of this disease including trying to keep blood sugar levels within range when faced with holiday dinners and parties. Add some pressure from family and friends (both well-meaning and some that’s just uninformed) to “just try a little” of each and every buffet dish and getting through the holidays while trying to manage a disease that varies based so much on food is exhausting.
Both the American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases recognize this month with tips and information to keep yourself healthy. But as a nurse, you can share your experiences to help your patients and sometimes even learn from what they say.
The holidays make things difficult. You’ve got additional responsibilities – from cooking to gift buying to volunteering to hosting – and all the changes those new tasks bring about. Staying with your normal routine can help, but that’s not always possible. Planning ahead and developing strategies will help keep you on an even keel.
If you shop for gifts, you often have to manage that with your normal work and family duties. And if your time to get all that done hits during a mealtime, you have to be prepared and think ahead. Are you going to grab something quick, eat at a restaurant, or pack something to bring?
This year’s presidential election is affecting just about everyone. It’s causing so much stress, arguments, and overall negativity, that we couldn’t even get any nurses to go on record with tips on how they remain less stressed in this crazed political time and help their patients remain so as well. Many were concerned that if they gave their opinions—even about how to help others—that because it had to do with politics, they may be reprimanded or even possibly lose their jobs.
That says a lot. Most nurses love to help other nurses. But in this case, the fear was tangible.
Instead, we contacted professionals in the mental health field to get their advice on what you can do to reduce your stress in this final week before the presidential election and how to keep it reduced after it’s over.
Use the Oxygen Mask First
If you’ve ever flown on an airplane, you know that the flight attendant always instructs people that in case of an emergency, to put your own oxygen mask on first. You won’t be any good to others, if you can’t breathe yourself.
The same case applies with lowering your stress. “In ‘helping’ professions, it is common for providers to ignore their own needs. Focusing on self-care, though, is critical during high-stress times like election season,” says Lisa Long, PsyD, a licensed psychologist, executive coach, and interventionist as well as owner of a private practice in Charlotte, North Carolina. “Taking a personal inventory of one’s stress level and well-being is a good start. Paying attention to yourself is a major aspect of doing and feeling your best. If you notice changes in yourself and how you are feeling, make the time to get connected with people you can talk to. Keep a list of things that make you feel relaxed, and make time to do at least one—even when you feel you have the least amount of time for it. Listen to your own body and needs—just like you do with your patients.”
Laura Dzurec, PhD, PHMCNS-BC, ANEF, FAAN, a dean and professor of the Widener University School of Nursing in Chester, Pennsylvania, says that recognizing that an individual, emotional response is not going to change the election is an important first step in lowering your stress. “The stresses accompanying the debates, deliberations, discussions, and arguments surrounding the presidential election have encouraged emotional responses,” she explains. “One important tip to use in lowering stress is to pay attention to personal responses. Are they defensive? Angry? Anxious? By backing away from pointless debates and thinking through responses that are immediate, nurses can lower their own stresses regarding what’s happening with the election.”
Tips To Help You Reduce Your Stress
Let’s face it—although we’ll get some relief after Election Day, there will still be fallout for some time no matter which candidate wins. Now that you have been reminded to take care of yourself first, what can you do?
“Humor is a fantastic coping strategy when it comes to situations that seem out of our control. Think of all the political parodies at the current time. Turning to humor helps reduce the experience of stress,” says Marni Amsellem, PhD, a licensed psychologist with a private practice specializing in health psychology. “Another great strategy—regardless of the stressor—is trying to tune out or take some time away from the stressor. For example, if the negativity of the conversation happening around you is becoming overwhelming, temporarily remove yourself from the situation, turn off the TV, take a social media holiday, and the like.”
One of the easiest things you can do is just breathe. “My tip for all nurses is to set the alarms on their watches or cell phones to remind themselves several times per day to perform two activities—breathe and practice mindfulness. Three nice deep breaths several times a day can do a world of good to clear the mind and refresh the body. As for mindfulness, take a few seconds, clearing the mind of all thoughts except for noticing the temperature in the room and being mindful of all safely and calmness,” recommends Mary Berst, PhD, the associate program director of Sovereign Health Group in Palm Desert, California.
Amy Oestreicher, a PTSD peer-to-peer specialist, health advocate, and speaker for TEDx and RAINN, suggests deep breathing as well and agrees that humor works. “Humor creates a common language the breaks barriers,” she explains.
Oestreicher also suggests that nurses try a couple styles of management with themselves, two of which are Active Management and Calming Management. With Active Management, she says, you take all of the energy that’s fueling that stress and use it—exercise, run, shout, or scream. Do whatever makes you feel better.
With Calming Management, you do just that—take actions that will work to keep you calm. That might be breathing deeply, meditating, getting a massage, or even taking a warm bath.
Finally, A.J. Marsden, PhD, a former Army surgical nurse and current assistant professor of psychology and human services at Beacon College in Leesburg, Florida, suggests that nurses encourage optimism and refute negative thoughts. “Smile! Research shows that people who smile really will feel better,” says Marsden. “Focus on all of the good work you’re doing. When we feel that our work is making a positive difference and an impact on the world, we feel more positive and happier.”
As a nursing student, asking for accommodations can help level the playing field by giving you a different environment or approach so you can adapt to any kind of physical or cognitive disability. As mentioned in a previous blog, extra time on tests, a quiet environment , or possibly even a note taker in class are all accommodations that can help nursing students perform their best.
Once you graduate and enter the workforce, how can you make sure you have accommodations you might need?
Many laws in the Americans with Disabilities Act prevent discrimination or retaliation based on accommodations, but the workplace isn’t always as adaptive to requested accommodations. If you know what you need, can request what has worked for you, and the accommodation will fit into the required job description, then your chances of successfully blending the two are much greater.
Keep in mind realistic expectations. If you can’t lift more than 30 pounds due to a previous injury, that will restrict you from doing some specific hands-on roles. But you might be able to with assistive devices. And if you have a hard time writing discharge information or charts in any kind of excessive noise, knowing that will help you prepare for what you need—possibly just a quiet space. If hearing loss makes listening difficult, amplified equipment can help. But not being able to lift heavy things, needing a quiet place to do administrative work, and progressive hearing loss never mean you can’t be an excellent nurse.
In fact, asking for an accommodation when you know it helps you do your job better keeps nursing standards high and ensures patient safety. Asking for an accommodation at work is often done through the human resources department where they can help guide you and determine what will best suit your needs and those of your unit or department. You might be asked to provide medical verification or some kind of official documentation of your disability.
From that point on, you are not obligated to share the reasons of your accommodation with anyone else at work. Accommodations are often a personal matter and many nurses fear a pushback or a stigma if others realize a change has been made for their benefit.
Is that fear realistic? Possibly. Revealing too much personal information in the workplace always has the potential to return to you in unexpected ways, so it is better if you keep the details to yourself. As long as your workplace helps you and assists you in working out a new approach or by offering different equipment, you can continue to do your job with the exacting precision expected of nurses.
Deciding when and how to talk about accommodations depends on how big of an impact it has on your work and then you should consider the impact it might have on your career. You don’t want to mislead a potential employer and you also don’t want to do substandard work because you are afraid to disclose your need for an accommodation in your current role. For example, if you have progressive hearing loss, but it is not impairing your job now, you might choose to wait a while to disclose. But if you are having trouble haring through a stethoscope, you cannot wait to bring that to the attention of your employer so you can get assistive equipment.
The decision is personal and weighing when and how to tell an employer is crucial to making sure you can do your job while also ensuring you are meeting the high standards expected in the nursing profession.
With International Infection Prevention Week upon us, take the time this week to reassess your own health practices and to share advocacy tips with your patients.
Why is infection control so important in health care settings? Controlling the spread of infection cuts down on unnecessary illness and infection in patients, family members, nurses, and physicians. No one wants to acquire or have to treat an infection that could have been prevented.
According to the National and State Healthcare Associated Infections Progress Report that was released by the Centers for Disease Control and Prevention (CDC) earlier this year, there’s good news. Infections are down in many areas, but that doesn’t mean there’s no problem with infection control. Considering the devastating effects one infection can have on a person’s life, eliminating all chances of spreading infection is a top priority for nurses.
Washing your hands so frequently all day long becomes so rote and so routine that it’s easy to remember to do it when you are having a routine day. But a nurse’s day is never routine, so being aware of always washing your hands before touching a patient, equipment, or food is crucial.
According to the Association for Professionals in Infection Control and Epidemiology (APIC), even protective equipment like gloves and masks won’t stop the spread of germs if they are not handled correctly before and after use and used correctly during wear. Even removing protective equipment needs to be done with care and within guidelines to prevent contamination.
And, of course, nurses need to protect not only their patients but also themselves from infection. The APIC recommends keeping your vaccinations up to date and to review and carefully follow guidelines for handling sharp instruments, needles, and syringes. Being vigilant with these implements can prevent a terrifying, and potentially health threatening, needle stick or laceration.
While every nurse encounters patients who are well versed in infection control, it helps to have open conversations with them to remind them to be vigilant with their own care. Encourage them to make sure hospital staff are following proper procedures. When they are leaving the hospital, emphasize the importance of a clean environment at home while they recover and the importance of insisting that caregivers know and follow guidelines for clean hands and sterile equipment.
In your off-work hours, do your best to get rest, good nutrition, and exercise as all will help boost your immune system and keep you healthy in an environment where lots of germs are present. The APIC also recommends washing your work clothes separate from any other clothes and using hot water and a hot dryer to kill any lingering germs and bacteria.
A few small but consistent habits can help stop spread infection incidents.
Women represent nearly 80% of the healthcare workforce, and they represent 77% of hospital employees. Also, 26% of hospital and health system CEOs were women in 2014. Statistics show the number of women in healthcare is rising, but there are still challenges. One of the most widely talked about challenge is gender inequality, including the lack of women in leadership positions. While gender inequality is important, this issue is not why women in healthcare are an endangered species.
Women in the healthcare industry are just as likely (if not more) to suffer from anxiety, stress, depression and other mental and emotional issues. Like most healthcare workers, women who are physicians, registered nurses, home health aides and more enter the field with a passion to help others. But if you fall into these categories, how many times have you neglected your own needs? Shouldn’t you treat yourself with the same care as a patient?
While the term endangered is normally used in reference to animals, you’re surrounded by just as many threats as a leopard in the wild. For decades, women in healthcare have suffered from stress, fatigue, strain due to schedule, insufficiency in internal training, and injuries from physical tasks. According to the American Foundation for Suicide Prevention, female physicians die by suicide at a 400 percent higher rate than women in other professions. One article posed the question “who takes care of the caregivers?”
The answer is YOU!
There are some issues in healthcare that is a work in process, but you have the power to positively influence your well-being today. Your patients need you. Your family needs you. And, you need you. So, treat yourself with proper rest, prayer, stress management techniques, supportive relationships, and be the first thing on your to-do list by adhering to your discovery checklist.