weekends are for resetting

Yesterday was my Saturday and today is my Sunday. Next week my Saturday and my Sunday will likely be days other than Sunday and Monday; but who knows? Such is the life of a nurse, a night shift nurse, Vampire the Night Shift Nurse.

But yeah.

This week, today is my Sunday and yesterday was my Saturday which means that right now I am busy. I am busy resetting my body clock while I catch up on sleep, oh so precious sleep and laundry because there is much laundry to be done right now.

Oh, and sleep, because nightshift nurse problems and cat lady life.

me reflecting on the art of practicing the finest of Fine Arts

Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts

~ Florence Nightingale.

A little more than twenty-five years ago this happened.

It’s true we actually shouted “SMEGMA” as the photographer got this shot. New grad nurses, actually nurses in general can be kind of gross, sick and twisty in our humor, especially when tired, hungry, frustrated, grossed out, ready to cry or just about to lose our shit. The reality is posed in proper, starched nursing whites under a 90 something degree hot sun we were just about to lose our shit as it seemed to take forever to get this shot of my graduating class. Kick-ass, rockstar nurses we were all destined to be; but being able to line up and pose together as a group….not so much. So when the photographer directed us to say “cheese“, “SMEGMA” it was.

Literally a week later, two fellow classmates and I entered the NICU as new grad registered nurses. Dressed in the NICU’s pink scrubs, we walked through the double doors shoulder to shoulder to shoulder scared and excited all at once. Our NICU nurse educator ran up to us exclaiming, “Oh good! You’re here. We’re admitting a 27 weaker right now. You need to come and see this.

My first thought as she led the way was she seemed just a little too excited about admitting a baby born 13 weeks too soon. My second thought, as we approached the bedside and as the four caregivers stepped aside so that we could see was what in the world had I got myself into. That baby seemed to be no bigger than my hand. Her skin was translucent. I could see some of her blood vessels. She looked like a broken baby bird that had fallen from her nest.

Just a week later, I picked up her less than 2 pound body and flipped her from her tummy to her back, breathing tube, monitor wires and multiple IV lines all still attached to her impossibly tiny body. “You need to breath.”, my preceptor whispered into my ear…quite possibly the best advice I have ever received from an RN who helped to train and educate me; second only to always, always take a break when offered.

Twenty-five years later, I received a card from that baby girl’s mama that she, Baby Bailey, was expecting her first child.

Yeah, that seals it. I’m one of the old nurses.

Twenty-five years of always doing what I love to do…taking care of the tiny humans and their mommies, daddies, brothers, sisters and grandparents. Lots of babies. So many babies. So much love. So much laughter. So many tears. Learning so much…always learning…always….as one does when one is practicing one of the finest of Fine Arts. Always appreciating the opportunity to do what I love…enjoying the grateful hugs from a mommy and daddy as we together pack up their baby to finally go home from the NICU after literally weeks and weeks and then only a few hours later hugging a tearful mama who is literally experiencing the worst day of her life as she hears that her baby is dying.

Twenty five years. Some days are worse. Some days are better. Some days are frustrating and exhausting. But rewarding, exhilarating and wonderful all the same. Some days are hard….horribly hard. But most days are good…the goodest of good which literally saves you from the most heartbreaking, pain-filled days. Then years later receiving a card like Bailey’s mama sent me reminds me again the good my practice has done because Bailey is soon going to be a mommy. That, my friends is indeed Fine Art, Fine Art that I can lay claim to as is each and every tiny, mighty human and their families I have had the privilege to lay hands upon for over the last twenty five years in the NICU. Here’s to many more years, for as long as my mind, my heart, my eyes and my body allows me to.

thinkers and dreamers we are

And just in case I have not been paying attention to what’s in the news in and around the Central Valley over the last couple of weeks, I have acquaintances to remind me…especially if it is news that might indirectly affect me, is indirectly about me or what might be important to me…bonus points if it is perceived to be news in a negative light.

Aren’t some acquaintances and friends good for things like that?

Yeah.

In the news recently here in the Central Valley was a recent article that suggests certain hospitals in the Valley are price gouging. Of course some people I know want to know how do I feel about being a price gouger?

Um…

Because while caring for critically ill babies, I am jacking up the prices of the care and services that I provide?

Here’s the thing, even the authors of this recently released study concede that they are not including discounts offered for care and services to the uninsured and insured patients. Factoring in these these discounts would have had a significant effect on the cost-to-charge ratio reported, and therefore the implications of the study’s results. Which goes to show you that one can not and should not just accept a study, any study as valid and absolute truth based on its conclusions…“Dr.” Wakefield’s study linking autism to vaccinespatients’ perceptions of nurses with tattoos and body piercings immediately come to mind.

For what it’s worth, as a nurse at the bedside, I am not setting the prices for the care I give, the medications I deliver, the equipment I use while doing my job. I’m too busy saving lives, providing healing care, providing education to my patients’ family members of their babies diagnosis, condition along with how the medications I administer and the care I give will help their baby and how to take care of their own baby while in the NICU and after discharge.

My workplace is the only hospital in the community of Modesto and Stanislaus County to provide care for everyone, regardless of ability to pay; that’s millions of dollars of uncompensated and charity care provided rather than charged. My workplace employs over 2,100 people, contributes well over $250 million to the local workforce annually as well as contributes over $3.7 million in local taxes every year. Our hospital and employees this year have provided over 50 educational seminars for local schools and community groups, participated in more than 70 community events and regularly contribute to over 50 local non-profit and charitable organizations.

Thinkers. Dreamers. That’s us.

It is what drives us all to serve our community the way that we do at the bedside directly and in and around the community and out-lying areas. It is being thinkers and dreamers that inspires us every day to do what we do and even do it better.

Our hospital continues to receive top grades in patient safety including our overall performance on safety outcomes, including preventing errors, accidents and infections. The unit I work in has had more than 6 years of ZERO CABSI incidents. It was thinkers and dreamers in our unit who dared to imagine that it was possible to have absolutely no catheter line associated bacterial infections. Such strong work has been recognized nationally and even within our hospital as the staff who cared for my darling husband talked about what we are doing in the NICU and how they are hoping to implement the same. Lucky for them, and other local agencies in the valley, one of my colleagues will be providing education next month on our journey to zero and how it is possible. Fellow employees at my workplace provide the type of trauma, stroke and cardiac care that is literally the Gold standard of care here in this Valley which Silver and Bronze awarded local facilities strive to emulate…something I am proud of and most definitely thankful for, you know, since they saved my darling husband’s life.

Yes, one study might contort and twist and suggest less than favorable things about where I work but, dear acquaintances and friends quick to point that out, I would counter do your homework and check the facts especially when you decide where you want to be when you need to be in the hospital. Me, I’m choosing a place with thinkers and dreamers who are providing the very best of care and often times making the impossible possible.

not even a wordless Wednesday: the nurses week edition

Yes, it’s that time of year again. It’s Nurses Week. Of course as a nurse I am celebrating and enjoying the well wishes from my co-workers and the parents of former patients and anyone else out there because it is kind of nice to have a week of recognition; which we share with teachers. The irony that two of the most thankless professions most days (as in if there is a problem it is, of course the teacher’s or nurse’s fault) share a week of national appreciation and recognition.

I took the time to send a note of thanks to Daniel’s teachers today. Actually I sent them a note and email about concerns about him not understanding the current chapter in his math class and his parents not understanding at all because what the hell is up with Common Core…and then I thanked them for all that they do to help support, encourage and teach Daniel…as I do every single time I send them a note, or email them, or talk to them on the phone, or face to face because Daniel has some pretty wonderful teachers and I can’t thank them enough.

Then I found some of my favorite nurses-related memes and cards that I pinned on Pinterest to remind me on the days when I am feeling especially tired, exhausted, thankless or covered in the most disgusting yuck that I am afraid to enter the Big Top for fear of spreading it. I laugh. I cry. I think. I give thanks. Then I am ready to put the scrubs on again and do what I do because I do love what I do. So in celebration of me, some of the smartest, funniest, loving, hard-working people I get to work with and who have literally saved the lives of some of my circus act, most recently the darling husband; I give you some laughter and some deep, heart-felt thoughts on what I do.

and one more because, yes, this has actually happened to me at least three times in my 25+ year career…true story.

Happy Nurses Week!

Thank a nurse. Hug a nurse. Buy a nurse a cup of coffee…a massage…lunch…maybe some sleep.

Bound by paperwork, short on hands, sleep, and energy … nurses are rarely short on caring.” — Sharon Hudacek

parenting NICU style

Wa-ay back when I was a nursing student, one of my professors shared a cautionary tale about patients and medical abbreviations. A nurse, preparing to assess her patient, sets down her clipboard. While she is carefully assessing her patient, the patient spies his name on her clipboard with the word “SOB” next to it. What followed, the professor shared, was more than awkward for nurse and patient.

In case you didn’t already know, “SOB” is a medical abbreviation for shortness of breath. The nurse’s patient had emphysema and indeed was struggling with shortness of breath. He might have also been an SoB too…then again, he might have been an all around nice guy. Who knows?

There were many takeaways for us to learn from that scenario that the professor shared. For me, the biggest one was to not let my patients or loved ones see my shift notes. I keep them in my pocket.

This lesson came to mind the other day while reading through one of the micropreemie parenting forums I participate in. A parent shared her frustration of over-hearing her baby’s nurse share with the nurse taking over her baby’s care that she had been crying. Not understanding what that had to do with anything, she vented that they should not be worried about her because their job is to take care of her baby. Who cares if she was crying? The NICU nurse in me wanted to comment as to why the nurses might have been talking about her during their hand-off report. The NICU parent in me knew that she just needed to vent because for many micropreemie parents, there are few, if any, safe places to vent off some of the tears, fears, pain, frustrations and anger that is life as a parent in the NICU.

As a parent in the NICU, I know too well that feeling of being watched over, scrutinized even. In the NICU where Daniel was, where I also worked, parents had access to the bedside chart and were more than welcome to look at it. It was not uncommon to see a note or more about Bill or myself visiting Daniel. Weird to be under a microscope and analyzed in that way…especially because we already felt intense pressure from social workers, family and friends who questioned our motives to want to be Daniel’s family. Stir in the fact that a number of my own colleagues were against our plans (and quite vocal about it) and my being called into my manager’s office a couple of times because staff and administration had a number of concerns about my wanting to adopt a patient in the unit because something like this had never happened at that hospital before. “People might think we are ‘giving babies away at Good Sam’!” 

The horror of such a thing! 

Not fun it was.

If only there was a forum like the one I participate in thirteen years ago!

With most NICUs in the US focused on Family-Centered Care and many hospitals keeping an eye on overall patient and family satisfaction, odds are families are going to be right there during change of shift hand-offs and rounds…unlike the “old” days when I was a baby NICU RN and the unit was closed to family visits and calls during change of shift so that we could focus on the hand-off of patient care.

Being a parent in the NICU is hard. Other people seem to know more about your own baby than you do. They tell you when you may touch them, when you can hold them, feed them, change their diaper. You feel guilt that your baby was born early, that you can’t be at their bedside 24/7, that your other children need you, that your husband needs you, that everything else going on in your life is being ignored. You deal with questions…questions all the time as to why the baby was born early, what did YOU do to cause that, what’s going on currently with the baby, why isn’t the doctors and nurses doing what your co-worker’s nephew’s baby had done to her, why aren’t you at the hospital right now, why aren’t you spending time with your other children because they need you too….and on and on and on. Doctors and nurses and staff either seem to act as though you’re not even there or are hovering not giving you just a quiet moment alone with your baby. And god help you if you break down and cry or yell and scream in the NICU, at home, in church, at the school drop-off, in front of your parents or your in-laws.

NICU parents, am I close?

For what it’s worth, speaking as a NICU RN, when we share with colleagues that mom was crying today, or dad keeps asking the same question repeatedly or the family’s only car broke down or almost anything else family-related it is because the care we give is Family-Centered Care. Our role is to care for the baby first but we also are caring for and supporting the family during one of the most stressful times in their lives as a family…until their baby is a moody teenager. It helps the staff to know that mom is having difficulty producing breast milk or that her mother in law doesn’t want to drive her to the NICU anymore or dad just got laid off or little brother is sick with the flu so that we can better address what the family and the baby needs right now…and what they need to be ready for discharge because, god-willing, discharge will happen sooner than a NICU parent can hope to imagine.

What an amazing day that is when your baby is finally free of every single wire, tube and tape that is attached to his body and you pick him up and hold anytime you want to!

It’s a day that every NICU parent and NICU nurse, doctor, respiratory therapist, social worker and unit coordinator looks forward to as well.

Meanwhile, dear fellow NICU parents, cry if you want to, vent away too, but most of all, hang in there. Your journey is just beginning and this right now is preparing you for the weeks, months and years after the NICU.