Pausing for Palliative Patients.

Why am I sitting on my lounge with a stiff drink in one hand and a slab of mud cake in the other?

Well folks, that'd be a combination of my shift today and sticking my finger up at my food intolerances!

For me as a nurse, there is nothing more frustrating than not being able to deliver the care our patients deserve. This can be caused by staffing shortages and/or an increased workload, sometimes it's because the skill-mix isn't ideal (this includes our fab colleagues in allied health), and sometimes its because nursing usually constitutes us making a solid plan to follow on a shift that becomes a distant memory by the second hour on the clock that we try and adapt through ten percent 'winging-it' and ninety percent interpretive dancing from one bed to the next.

The biggest lesson we all learn as nurses is that the job is 'twenty-four hour care', and that the constant pursuit of perfection is an expression coined with healthcare professionals in mind. And generally, I'm okay with handing over tasks to the next shift knowing I did my absolute best. I work on a busy surgical ward and that's often the nature of the beast.

What doesn't sit well with me is triaging a palliative patient at handover as my 'priority', and not delivering the goods. Sure, pressure area care is done, pad is dry, regular mouth care is done; I have assisted them to eat, the patient is comfortable.
But have I spent real, 'slow down and listen' time with the patient?
Have I stopped to hold their hand and give them comfort? Do I even know the names of all their family members?
Are the family members happy with the care I've given?
Was I truly present for that patient?
No. The answer is no to all of the above.

In my ideal world, there would be a dedicated palliative ward in every public health facility at best, and at the very least solid education given regularly on every ward regarding the management of palliative patients. In fact, it is one of my dearest goals as a nurse to see this wishful thinking through to reality.

We have all experienced loss. Many of us have had family members or friends who received palliative or end-of-life care. The stress and grief we feel at times such as these can be greatly alleviated or escalated simply by our level of confidence in the primary care givers (us nurses). This is why it is so important that no matter how busy we get on a shift that's gone from bad to worse, when we are supporting colleagues and putting out fires, that we find the pause button to truly communicate with all of our patients and their families.

We want patients' and their families to feel safe and confident in our capable hands, because they don't know what's happening behind the scenes and nor is it their prerogative to; they won't know if you shed a tear for them behind closed doors.

Patients and families only know what they see and hear you do in one eight-hour window, and if it happens to be a someone's last few hours of life then we need to make every moment count with all the care we can give with the resources we've got.
That is our pledge.

The Curious Case of the Clicky-Topped Pen

 

Peering out of your top pocket, I greet the 0645 sunrise as you huffy-puffy your way up the slight incline heading up to the main entrance. Whoa, you almost lost me running for the lift-

And, we’re in.

You’re running late to handover, and you forget to use the alcohol-based hand rub before you whip me out of your shirt and start jostling for a good spot at the bedside. Oh, look, you’ve put me down to check a patient's wound… and I think I’ve got a few traces of last night’s oozing dressing on me now.

Thanks, buddy. Sigh.

Ooh look, an S8 check! It’s for a VRE patient, so don’t forget to use the Triclosan, you know we need to use that so we kill the bugs- ah, you’re in a bit of a rush so you’ve used the hand rub. That totally did nothing. Sheesh. Look, I’m feeling a bit germy, so can we please-

I DO NOT WANT TO GO BEHIND YOUR EAR LIKE THIS!

              Is that a full pan? Because I’m not really feeling great about being dropped in there like last week, so can you please remember that I‘m still in your pocket? Thanks.

At least you got one thing right this morning.

              Ewww! I don’t get it! How can you be a sympathetic gagger, but not care about what’s on me when you grab for the chocolates at the nurse’s station? Have you no shame?

              You know you could at least wipe me down before we go home today, it would really be a-

Okay.

No worries.

Maybe next shift.

Wash your hands. Wash your pens. Wash your pass.

You know EXACTLY where they’ve been.

Why I Called in Sick Today

Today, I backed into my Dad’s car when I went to pull out of my parent's driveway.

Not because I’m a terrible driver (well, not really), but because I was so tired that even walking past the van right before jumping in to my own car was not enough to stop my frazzled brain making such a stupid mistake.

It would be an untruth to say that never in my life have I experienced physical and mental fatigue equal to that which I experience as a new nurse, however it would be fair to say that as a nurse there is very little room for rocking up to work in a zombie-like state that would be acceptable in other circumstances. After the multitude of tears and apologies abated, the first thing I thought was, ‘what if it was four hours later and I’ve just made a medication error at work?’

Would I call that too, a ‘stupid mistake’?

So, I called in sick for my shift.

No matter what is going on outside of work you absolutely have to learn to compartmentalise. Let’s not even go there because we’re all adults (or in disguise as one, like I am) who have families to support, sick relatives, financial stresses and mouths to feed. I am still trying to perfect the art of deep breathing. That fixes stuff, right? I keep trying to get to a yoga class at my local gym but I am always working (surprise!), and even though I desperately want to catch up with friends and have a social life, I feel more drained than relaxed afterwards. I have caught more than eight hours of sleep every night this week, but feel wrecked. Am I suffering from a teensy dose of burnout, here!? Probably. Every shift has felt like a marathon, especially with accreditation chasing our tails. The irony here is that like most nurses, I can’t find the time to look after myself properly. Ha!

The scariest thing about being a health professional is that there are very few ‘small’ mistakes that we can make. Having made (many) mistakes before and only having worked as a nurse for under two years, I can affirm that this comes with the territory of the work. The saying that the master has failed more times than the beginner has tried? Yeah- pretty sure that the person who said that was a nurse. The difference here, is that if I go to work and I know I’m unsafe to be there, if I make a mistake I’m not going to feel like it was a learning experience. I’m going to feel like it was negligence on my part. So, there’s a substantial dent in the bumper of my car- but at least I can rest easy knowing that without the zombie-nurse version of me today, my patients will remain intact.

See you tomorrow, nursing.

I'd Better Start Somewhere!

So I suppose I need to christen this page!

Hello, world wide web! Although not my first blog, this will definitely be my first public blog. Which means, I had better introduce myself to whoever may read this.

So I am a nurse in Australia. I've only been nursing just over a year, and it's been the hardest thing I've ever done.
Which is saying something, because I've done university-level chemistry AND I've played Twister.

I had no idea what nursing was until I started the degree. I honestly never considered it as a career for me, although while growing up and helping to nurse my great grandmother as she suffered with Alzheimer's and some form of undiagnosed cancer (not a recommended way to go, by the way), my mum suggested it to me.

I'm actually kind of ashamed to admit that the reason I didn't want to consider it is because I knew how hard nurses work and how little recognition the field receives by a large proportion of the population. I always wanted to be a High School Teacher, and went on to complete a double major in Performing Arts (Drama and Music) at college, and dancing outside of school ( everything but ballroom and tap). When my baby cousin died from leukaemia in the spring of 2008, I decided that maybe I could be of better use in the health field.

And now, seven short years later, I am a Registered Nurse just trying to keep the dream alive in a busy Tertiary public hospital!

Which involves a lot of singing on my part, much to many a person's bemusement (patients and colleagues alike).

So, welcome to my challenges, my triumphs, my questions and my discoveries!

Until next time,

Nurse-E.