Archive for the ‘Nursing’ Category

Is it time? Now or never?

Three years ago I planned on going to school to complete a CRNP (nurse practitioner) program. Life changes got in the way and I didn’t go to school. I moved out of my house, I got divorced, I bought a new house, I changed jobs…three times. My girls went to college (where they remain) and I’m really wishing I had continued my schooling.

Is it too late? Just hit my 53rd birthday. It’s not that I don’t feel I’m capable. I worry about incurring (more) debt and having difficulty recouping expenses. I worry about working and going school at the same time and supporting the financial needs of my household.

I had three discussions this weekend that make me think, heck, just do it. My husband encourages me. A physician’s assistant I spoke with today encouraged me to just do it (thanks, Chris Hart). And thirdly, Dr. Laman, pulmonologist/critical care doc tells me I should do it; I should be doing something “more” than I am currently.

The market for CRNP is growing, growing. Even if I only work 10 years as a CRNP, it will be time well spent. So now or never? Go for it? What’s another $25,000, hmm? It’s only money, as my mother would say. I’m gonna die owing so why not pursue something I want?

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Job Angst

It’s bad. It’s so bad. I didn’t go in today, I missed my time in the “dunk tank” for our “Festival Days” and they made the clinical manager who reports to me take MY turn and her turn. My daughter had a doctor’s appointment, my garage got waterproofed today and I just couldn’t manage it all.

Yesterday there were two call-offs. Almost three but we managed to bully the third one into not calling off. Remarkably, she was *fine* all day. Not sick at all. Amazing recovery. We barely have a day go by where we do not have a call off and we are understaffed to begin with. I had to miss the last day of my ACLS class to accommodate the staffing needs of the floor. Kim, clinical manager, had to staff the ICU. This goes on and on, day after day, week after day.

Why are we short-staffed? Well I don’t know. Back in January, I submitted an analysis that said we were short at least six RNs. My supervisor insisted we were not, despite my spreadsheet which clearly showed how the shifts were not covered. And when two more RNs resigned, she did agree to replace them, however, she only agreed to replace them with LPNs. OK, fine, I’m happy with more staff, regardless.  After a debacle of a week of staffing–eight months later–she reviews the schedule and announces to me as if it’s a revelation, “You’re short six RNs! No wonder we’re in such crisis.”  Not to mention the shortage of nurse’s aides. I’ve hired six aides and we’re STILL short.

There are so many critical initiatives going on right now too. The conversion to an electronic medical record, due by December 8th. A Quality Blue initiative. The entire “Values in Action” program. Joint Commission accreditation coming up. Improving clinical outcomes on the units. Orientation programs for new staff (the nurse educator basically resigned to0). Annual competencies. Enhancing the critical thinking capabilities of the staff. Instituting an Orthopedics Program. And acting as the “float pool” whenever this is a call-off or staffing need and going into staff. It’s untenable.

I worked 12 hours on the floor yesterday as a staff nurse. I actually had a good time doing that; I like patients and I like the clinical environment. I’m good at it. I’m good with patients and with families. This administrative stuff has got to go. I want hands-on or I want out. I’ll go raise dogs and cats. Think there’s a living in that?

Punching Bag

This has been an exasperating week. Or maybe month. Year?  Trust me, though, “exasperating” is a mild term. We bandied about the expression cluster-f**k. It seems to fit.

I feel like a punching bag, getting swung at by irate physicians, angry patients and frustrated staff.  The way things are right now … well, they simply don’t work. I tried to think about things that are going well at work and I was hard put to name them. I have to say that I work well with my assistant–she is a hard-working, conscientious soul who gets put upon from many and takes it with aplomb. I also have to give kudos to my boss who is relatively new to the organization (just a few months shy of  my experience) and who has taken on more and more responsibility and is stretched thin. Yet she remains calm and committed and understanding of the work of nursing, not just the ivory towers of nursing theory.

I have been charged with fixing the ways of a unit that developed over 30 years. Some are surprised that it is not, yet, fixed and running like clockwork. In 8 months. A comment I hear frequently is “it’s been like this for years!” Or “No one’s ever been able to change this place; this is how we are!”  Eight months and it’s not been fixed yet. Go figure.

Clinical Reads

I’ve fallen behind in my clinical readings. I’ve been so caught up in the “doing” of my clinical and managerial duties — exhausting in their own right — that I’ve failed to maintain my daily perusal of evidence-based best practice articles and other clinical literature.  I don’t want to lose that clinical edge.

One of the common questions I use when interviewing candidates for nursing positions is, “What do you do to stay current in your clinical practice?” There is new information and recommendations on a near daily basis! I don’t want the nurse who took state boards 15 years ago and has never stretched his or her knowledge base any further. Nurses easily gain bits and pieces of new information by being in the workplace and passively absorbing that which is overheard or have thrust upon them in mandatory inservices. The nurse I want to hire is the one who actively seeks ongoing education, for the good of the patients and for individual edification.

Do I ask for too much? I don’t think so. Historically, I’ve been that nurse. I subscribed to three nursing journals and read them front to back. I read online articles and took quizzes and I delighted in getting high marks on education directed at physicians. This stuff, pathophysiology, clinical reviews, case studies, this stuff — it’s fascinating!  But I’ve fallen to the wayside, and it bothers me. A lot.

Another resolution, then. I challenge myself to read at least one clinical article per day. That’s the easy part, I think. The tough part would be if I challenged myself to blog on that article! OK, let’s see how far I can stretch myself.