Looking back over my posts I realize I focused a lot on the negative side of nursing: the long shifts, the hard work, and worst of all the patients that don't make it. If I could start this assignment over, I think I would try to focus more on the positive. I would try to use my words to convey those days when you walk of the floor fulfilled, happy and knowing you have a purpose. I would talk more about the patients that heal both physically and spiritually. The lessons you learn about yourself and those you're able to pass on to others. The thing I'm most fearful of at this point is the idea that I may have scared someone away from this field. For the record, that was the furthest thing from my mind.
I set out to identify the negative feelings and impact the profession of nursing has on those who practice it. I personally feel as if I've done that. I now know it is a common condition known as compassion fatigue. I've also learned there are things that can be done to avoid it and when that's not possible, to treat it. I've shared some personal stories along the way, both the good and the bad. I guess you could say this blog has been more than an assignment in some class; it's been an emotional outlet for me.
Thank you all for reading and sharing in my ups and downs. I hope you've all gotten something out of it. I know I did.
Monday, April 16, 2012
Tuesday, April 10, 2012
Switching Teams
I just finished my first year as a nurse. It's had it's ups and downs as would any new career; however, nursing has a way of becoming part of who you are. If you're not careful it can take over your life. I started out looking to learn as much as possible about compassion fatigue and I really feel like I've gotten a good grip on what it is and what can be done.
The first step anyone has to do in this situation is step back and look at your life. I just recently found myself working 30 plus hours a week on a rehab floor, fighting to keep my A average as a full time student, and , oh yea, did I mention I'm expecting? Of course my work was getting to me. So was traffic and school and the lines at the grocery store. At some point in life, you're going to have to step back and say "enough."
That's just what I finally did. I've enjoyed my time on the rehab floor but it was time to let it go. I just started a job at a pediatric facility and I've already felt the difference. It's amazing. When I'm scheduled to get off at 8:00 I actually get off at 8:00. No one is there long enough to form an attachment and I don't have to worry about coming in one morning and finding out one of my patients had a major heart attack at 2 A.M. and didn't make it. I do miss certain aspects of my last job. I miss the patients and I will always miss celebrating their triumphs with them.
Every job will have it's ups and downs, good days and bad days. There's no way to tell which ones will get to you and which ones you'll forget about the moment after it happens. You just have to take things day by day and do the best you can. Take care of yourself. We have to remember to take a step back from time to time and breath.
The first step anyone has to do in this situation is step back and look at your life. I just recently found myself working 30 plus hours a week on a rehab floor, fighting to keep my A average as a full time student, and , oh yea, did I mention I'm expecting? Of course my work was getting to me. So was traffic and school and the lines at the grocery store. At some point in life, you're going to have to step back and say "enough."
That's just what I finally did. I've enjoyed my time on the rehab floor but it was time to let it go. I just started a job at a pediatric facility and I've already felt the difference. It's amazing. When I'm scheduled to get off at 8:00 I actually get off at 8:00. No one is there long enough to form an attachment and I don't have to worry about coming in one morning and finding out one of my patients had a major heart attack at 2 A.M. and didn't make it. I do miss certain aspects of my last job. I miss the patients and I will always miss celebrating their triumphs with them.
Every job will have it's ups and downs, good days and bad days. There's no way to tell which ones will get to you and which ones you'll forget about the moment after it happens. You just have to take things day by day and do the best you can. Take care of yourself. We have to remember to take a step back from time to time and breath.
Monday, March 26, 2012
Finding Others
If this isn't you're first time reading this you know I'm on a mission. I am determined to learn as much as possible about a condition we know as "compassion fatigue" among nurses. The first question I asked was "what is this I'm feeling" and I've just kept going from there. Recently, I've been very (pleasantly) suprised to find other blogs discussing compassion fatigue, two of which I have found extremely informative.
The Nursing Ethics Blog has a post titled "Compassion Fatigue" which discusses an article from the Wall Street Journal and takes a strong stand stating, "institutions of all kinds have a fundamental obligation to safeguard the mental and emotional health of employees." A second blog which I found on the Compassion Fatigue Solutions website offers anything from stories of traumatic stress as told by a paramedic to solutions to keeping yourself emotionally and physically healthy.
It is refreshing to see other bloggers out there sharing information on a situation that has been around as long as the healthcare field itself. I'm excited to follow these as I continue to search for others out there. The more sources I can find, the better, more complete, and hopefully more helpful, my answers can be.
The Nursing Ethics Blog has a post titled "Compassion Fatigue" which discusses an article from the Wall Street Journal and takes a strong stand stating, "institutions of all kinds have a fundamental obligation to safeguard the mental and emotional health of employees." A second blog which I found on the Compassion Fatigue Solutions website offers anything from stories of traumatic stress as told by a paramedic to solutions to keeping yourself emotionally and physically healthy.
It is refreshing to see other bloggers out there sharing information on a situation that has been around as long as the healthcare field itself. I'm excited to follow these as I continue to search for others out there. The more sources I can find, the better, more complete, and hopefully more helpful, my answers can be.
Monday, March 12, 2012
Rolling It All Into One
In my last post I shared with you some areas of nursing which seem to have the greatest number of nurses experiencing compassion fatigue. While the list was pretty long, ranging from hospice to pediatrics to oncology, the one department that seems to take the cake is emergency medicine. But why emergency medicine over all others? In order to under stand why this one area is more stressful than others I think we need to look at some of the other areas.
Hospice was first on the list I gave. For those of you who may be unsure, hospice is "end of life care" (MedlinePlus, 2012) including medical, psychological, and spiritual support. They give medical, psychological and spiritual support. Hospice nurses go into situations with patients already knowing the out come. The challage in this specialty comes when the rest of the nursing world's goal is to make you better and send you on your way, the hospice nurse has already accepted the fact that their patients aren't going to get better and does what he or she can to insure the patient's comfort and dignity remain intact.
Pediatrics is another area on the list. This is a broad term but usually encompasses patients from new borns to the age of 21 years old (older in some areas). Children are great and can bring a lot of joy to the world; however, the working with pediatric patients can be a challenge. It's hard enough for nurses to care for the ill without it taking a toll on them but when the one who is sick is a child it makes things that much harder. We look at children as innocent and often think of their loss as "tragic" while justifying the loss of an older person in our heads. While no one deserves to be sick, we cannot justify the illness of a child and watching day by day as they succumb to an illness can be heartbreaking.
I've just discussed two areas of high stress areas of nursing and just a few of the reasons for the stress. Hospice nurses we now know have to deal with death quite often and pediatric nurses often have to watch children induring pain or an illness both of which can wear on a nurse after some time. But why would emergency medicine/nursing be any more stressful or pose any higher of a risk to the nurses practicing them? Emergency medicine encompasses challenges faced by both of the other two areas. When working in an emergency department you're faced with trauma and death almost daily. Where do parents take their extremely ill children especially when it's the middle of the night and the pediatricians office is closed? The emergency department gets patients from all aspects of nursing rolling all of the challenges into one place.
Sources:
Hospice Care: MedlinePlus. (n.d.). National Library of Medicine - National Institutes of Health. Retrieved March 12, 2012, from http://www.nlm.nih.gov/medlineplus/hospiceca
Hospice was first on the list I gave. For those of you who may be unsure, hospice is "end of life care" (MedlinePlus, 2012) including medical, psychological, and spiritual support. They give medical, psychological and spiritual support. Hospice nurses go into situations with patients already knowing the out come. The challage in this specialty comes when the rest of the nursing world's goal is to make you better and send you on your way, the hospice nurse has already accepted the fact that their patients aren't going to get better and does what he or she can to insure the patient's comfort and dignity remain intact.
Pediatrics is another area on the list. This is a broad term but usually encompasses patients from new borns to the age of 21 years old (older in some areas). Children are great and can bring a lot of joy to the world; however, the working with pediatric patients can be a challenge. It's hard enough for nurses to care for the ill without it taking a toll on them but when the one who is sick is a child it makes things that much harder. We look at children as innocent and often think of their loss as "tragic" while justifying the loss of an older person in our heads. While no one deserves to be sick, we cannot justify the illness of a child and watching day by day as they succumb to an illness can be heartbreaking.
I've just discussed two areas of high stress areas of nursing and just a few of the reasons for the stress. Hospice nurses we now know have to deal with death quite often and pediatric nurses often have to watch children induring pain or an illness both of which can wear on a nurse after some time. But why would emergency medicine/nursing be any more stressful or pose any higher of a risk to the nurses practicing them? Emergency medicine encompasses challenges faced by both of the other two areas. When working in an emergency department you're faced with trauma and death almost daily. Where do parents take their extremely ill children especially when it's the middle of the night and the pediatricians office is closed? The emergency department gets patients from all aspects of nursing rolling all of the challenges into one place.
Sources:
Hospice Care: MedlinePlus. (n.d.). National Library of Medicine - National Institutes of Health. Retrieved March 12, 2012, from http://www.nlm.nih.gov/medlineplus/hospiceca
Monday, February 27, 2012
Everyone is Affected
A few weeks ago I set out to answer some questions I have about the impact caring for others takes on caregivers, more specifically nurses. I am satisfied with the answers I have found for the first question (What is this I'm feeling?) so for the last few weeks I have attempted to find out as much as possible to answer the next one. How many nurses are impacted?
The truth is every nurse in the world is affected by those they care for to some degree. Whether they have made you smile, broken your heart, or just pissed you off your patients have impacted you; but is it to the point of compassion fatigue? Maybe not everytime but from reading and talking to others I realize every nurse is bothered by symptoms associated with compassion fatigue at some point in their career, some more often or to a greater degree than their counterparts. But why?
All of this has led me to add more question to the list. Which nursing specialties pose the greatest risk for experiencing compassion fatigue, or worse, burnout? Is there a "safe" area of nursing? That's where I leave you today as I begin seaking the answers to my newest questions. I can't wait to share what I find.
The truth is every nurse in the world is affected by those they care for to some degree. Whether they have made you smile, broken your heart, or just pissed you off your patients have impacted you; but is it to the point of compassion fatigue? Maybe not everytime but from reading and talking to others I realize every nurse is bothered by symptoms associated with compassion fatigue at some point in their career, some more often or to a greater degree than their counterparts. But why?
As children, growing up we think of nurses in white dresses and little oddly shaped hats that work in the doctor’s offices and hospitals. The truth is nurses go beyond the hospitals and doctor’s offices to flight lines, law offices, rehab facilities, government agencies and much more. There are unlimited nursing specialties each as individual as the nurses practicing them. As with any career field there are some specialties considered more stressful than others. Recently I read “Nurses and Compassion Fatigue” by Laurie Barkin RN, MS in which I believe she summed it up nicely,
"It is difficult to assess how many nurses develop compassion fatigue. In a recent review of seven studies of secondary traumatic stress among nurses working in forensics, pediatrics, emergency medicine, hospice, ICU, and oncology, rates of secondary stress symptoms ranged from 25% to 78%. A study of emergency nurses, found that nearly 86% had moderate to high levels of compassion fatigue."
Monday, February 20, 2012
Shit Happens
After multiple days off, I got to my floor and begin doing "turnover." Amy, the day shift nurse, put down her pen and stared at me, waited for me to look up and make eye contact. When she was satisfied she had my full attention she proceeded to inform me Mrs. Smith, the new post surgical patient is a little constapated, making those finger quotation marks around "a little constapated." Being constipated is nothing new for post surgical patients. The anesthesia and all the pain meds tend to slow your systems down. They usually get some colace and a lot of fluid, not a big deal. By the slightly amused smirk on her face, I could tell there was more to it. I stared back at her waited for her to get to the point.
"By a little constipated I mean, she actually needs an enema. The doctor JUST wrote the order for it so that means you're going to have to do it. I have to pick up my kids from school," and just like that she handed me the keys, the enema, and the order and walked away.
I don't have a weak stomach and I have no issue with blood, mucous, vomit, and even urine but not feces. Luckily, as if answering my prayers, the nurse working the other side had overheard everything and grabbed my hand and the box. She started pulling me toward Mrs. Smith's room and assured me she'd handle most of it as she can't handle vomit and would rather do this torturous deed than actually clean up my lunch.
We get in the room. Tracy, the other nurse, quickly goes to work as I remain at the patients head offering unconvincing words of support. Tracy's face goes blank on the other side of the bed. I assume it must be a ton coming out. I mouth the words "thank you" but she shakes her head and waves me into the bathroom. Confused, I follow.
"Nothing's going in...." it took a moment for the words to fully make sense. Then it hit me!
"Oh shit!" Not realizing how true those words could be. My patient was impacted. That's right, the nurse that can't handle feces has to now go in a break up a large impaction. (A large, hard lump of dry stool blocking the rectum.) The treatment for this is to go in manually, that's right with your hands, and break up the lump so that it can come out and clear the way for everything else. I started to gag thinking about it and I realized I was giving Tracy the puppy dog eyes silently begging her to do it.
"No, absolutely not. NOT going to happen. I love you but I can't. That's where I draw the line. I'll get sick!" she proclaimed as I followed her out of the room. For the second time that day, my prayer was answered. The shift RN overheard us from around the corner and came to my rescue.
I entered the patient's room with my two heroes trailing behind. The RN, Steph, took her place at the right side of the bed. With the patient still lying on her left side from earlier, I grabbed her right knee, the one on top, and pulled it toward her chest. Tracy took her place to my left toward the foot of the bed ready to assist. With her fingers well lubricated, Steph went in. Instantly, the smell consumed the room, tears filled my eyes my gag reflexes kicked in. Steph handed Tracy a large chunk of something that looks like a melted ball of snickers. Tracy's composure went out the window the second it touched her gloved hand and immediately she was tearing up holding back her own vomit. Steph continued the process, in and out, in and out, but begins laughing so hard at the two of us her eyes filled with tears too. The whole time in the room I was thinking this is one of those things that make me want to quit. The debacle continued for what seemed like a lifetime. In all actualitly we were only in there for maybe five minutes before we got the "all clear."
The other two nurses went on to do their own work and I returned to Mrs. Smith's bedside to give her something for the discomfort and make sure she wouldn't get backed up again any time soon. Upon entering her room I found her sitting up watching America's Funniest Home Videos and laughing hysterically, a start contrast to the woman crying in agony less than half an hour earlier. I apologized for the travisty and handed her the medications. She set up strait, turned the T.V. down and took her the little cup. After getting all the pills down she smiled at me and said, "No need to apologize, shit happens," with the largest smile I've seen in a long time. I couldn't help but laugh.
"By a little constipated I mean, she actually needs an enema. The doctor JUST wrote the order for it so that means you're going to have to do it. I have to pick up my kids from school," and just like that she handed me the keys, the enema, and the order and walked away.
I don't have a weak stomach and I have no issue with blood, mucous, vomit, and even urine but not feces. Luckily, as if answering my prayers, the nurse working the other side had overheard everything and grabbed my hand and the box. She started pulling me toward Mrs. Smith's room and assured me she'd handle most of it as she can't handle vomit and would rather do this torturous deed than actually clean up my lunch.
We get in the room. Tracy, the other nurse, quickly goes to work as I remain at the patients head offering unconvincing words of support. Tracy's face goes blank on the other side of the bed. I assume it must be a ton coming out. I mouth the words "thank you" but she shakes her head and waves me into the bathroom. Confused, I follow.
"Nothing's going in...." it took a moment for the words to fully make sense. Then it hit me!
"Oh shit!" Not realizing how true those words could be. My patient was impacted. That's right, the nurse that can't handle feces has to now go in a break up a large impaction. (A large, hard lump of dry stool blocking the rectum.) The treatment for this is to go in manually, that's right with your hands, and break up the lump so that it can come out and clear the way for everything else. I started to gag thinking about it and I realized I was giving Tracy the puppy dog eyes silently begging her to do it.
"No, absolutely not. NOT going to happen. I love you but I can't. That's where I draw the line. I'll get sick!" she proclaimed as I followed her out of the room. For the second time that day, my prayer was answered. The shift RN overheard us from around the corner and came to my rescue.
I entered the patient's room with my two heroes trailing behind. The RN, Steph, took her place at the right side of the bed. With the patient still lying on her left side from earlier, I grabbed her right knee, the one on top, and pulled it toward her chest. Tracy took her place to my left toward the foot of the bed ready to assist. With her fingers well lubricated, Steph went in. Instantly, the smell consumed the room, tears filled my eyes my gag reflexes kicked in. Steph handed Tracy a large chunk of something that looks like a melted ball of snickers. Tracy's composure went out the window the second it touched her gloved hand and immediately she was tearing up holding back her own vomit. Steph continued the process, in and out, in and out, but begins laughing so hard at the two of us her eyes filled with tears too. The whole time in the room I was thinking this is one of those things that make me want to quit. The debacle continued for what seemed like a lifetime. In all actualitly we were only in there for maybe five minutes before we got the "all clear."
The other two nurses went on to do their own work and I returned to Mrs. Smith's bedside to give her something for the discomfort and make sure she wouldn't get backed up again any time soon. Upon entering her room I found her sitting up watching America's Funniest Home Videos and laughing hysterically, a start contrast to the woman crying in agony less than half an hour earlier. I apologized for the travisty and handed her the medications. She set up strait, turned the T.V. down and took her the little cup. After getting all the pills down she smiled at me and said, "No need to apologize, shit happens," with the largest smile I've seen in a long time. I couldn't help but laugh.
Wednesday, February 15, 2012
Coming Full Circle
I've read back over my previous post and I see I'm putting a lot of emphasis on the negative impacts. While I don't want to shy away from the negatives, I want to show the positive as well. I've gained a lot from nursing and from each and every person I've had to privilage of caring for; however, I think in order for others to understand exactly what those of us who do this job take away from it you have to ask, "why did you choose this career?"
I began asking some coworkers and other friends in the field. Suprisingly, 12 of the 15 I asked gave similar answers. They had lost someone they cared about. I personally had many reasons for choosing this path (my mother's a nurse, I love knowing I made a difference...blah blah blah) but the main reason, the one that keeps me going back is the same I heard from so many of those I asked. I was 21 when I recieved the phone call informing me my 39 year old father had lost the battle. He died in 2009 from non-diabetic kidney failure, leaving behind three children. Two of which were still in high school and depending on him as their only parent.
Now this wasn't a sudden death, but it was a suprise. He had been ill for a few years at this point. In and out of the hospital, dialysis two then three times a week, special diets, countless drugs, tests, and procedures. It all became a normal part of our life. It was his routine. The fluid would build up, he would go to the hospital for a few days, feel "all better" and go home. Then repeat the process two or three months later. At first the dialysis slowed the cycle but in the end kidney failure leads to heart failure and no matter how strong your spirits you can't beat nature. I watched him taking in every minute I could as this horrible, painful process continued. One of the things I noticed was my father's mood. Whether it was his dialysis nurses or the nurses in the hospital during one of his many stays, his mood fluctuated depending on who his caregivers were that day.
I knew through phone calls accross the country who his favorites were and who he despised. I could hear in his voice whether today was a good day or bad day. During the last four years of my father's life I had been serving overseas for two of them. My father wasn't married and my siblings were busy with their high school lives (my father insisted they try to live normally, regardless of his condition); it was the caregivers by his side more than anyone else. It amazed me. These people, who were just doing their jobs, had such an influence on my father.
Standing at the graveside on my 22nd birthday, watching as they lowered the casket into the ground, I realized life really is short and you have to make it mean something. Shortly after returning from Texas I started nursing school. I feared the moment I would be assigned a dialysis patient. I am very self aware. I know what I am capable of as well as what my limits are. Taking care of a patient dealing with that horrible condition was not something I could EVER do.
Then it came. I was assigned a man in stage 3 renal failure; he had just had surgery placing the dialysis shunt (the port under the skin that the dialysis machine hooks up to). It was challenging not to burst into tears everytime I walked into the room, but I did it. After he was discharged I recieved a letter from his daughter. She thanked me for my compassion and empathy and told me her father had compared every nurse he's had since then to me - TO ME! It was the most humbling yet amazing feeling I've ever had. It was like everything had come full circle. I couldn't do anything to make my father live longer, but I could honor him and his struggle by providing the best care possible to those who need it.
I know I emphasize the negative impacts but no matter how much negative there is, it will NEVER out weigh the positives I get from what I do. I have days where I am tired and just know I can't go on. I have nights I want to crawl under a rock and bawl. I get angry with God for taking those from their families. I have shifts that make me swear I am going to quit but no matter what, I wake up the next day smiling, excited to go back.
I began asking some coworkers and other friends in the field. Suprisingly, 12 of the 15 I asked gave similar answers. They had lost someone they cared about. I personally had many reasons for choosing this path (my mother's a nurse, I love knowing I made a difference...blah blah blah) but the main reason, the one that keeps me going back is the same I heard from so many of those I asked. I was 21 when I recieved the phone call informing me my 39 year old father had lost the battle. He died in 2009 from non-diabetic kidney failure, leaving behind three children. Two of which were still in high school and depending on him as their only parent.
Now this wasn't a sudden death, but it was a suprise. He had been ill for a few years at this point. In and out of the hospital, dialysis two then three times a week, special diets, countless drugs, tests, and procedures. It all became a normal part of our life. It was his routine. The fluid would build up, he would go to the hospital for a few days, feel "all better" and go home. Then repeat the process two or three months later. At first the dialysis slowed the cycle but in the end kidney failure leads to heart failure and no matter how strong your spirits you can't beat nature. I watched him taking in every minute I could as this horrible, painful process continued. One of the things I noticed was my father's mood. Whether it was his dialysis nurses or the nurses in the hospital during one of his many stays, his mood fluctuated depending on who his caregivers were that day.
I knew through phone calls accross the country who his favorites were and who he despised. I could hear in his voice whether today was a good day or bad day. During the last four years of my father's life I had been serving overseas for two of them. My father wasn't married and my siblings were busy with their high school lives (my father insisted they try to live normally, regardless of his condition); it was the caregivers by his side more than anyone else. It amazed me. These people, who were just doing their jobs, had such an influence on my father.
Standing at the graveside on my 22nd birthday, watching as they lowered the casket into the ground, I realized life really is short and you have to make it mean something. Shortly after returning from Texas I started nursing school. I feared the moment I would be assigned a dialysis patient. I am very self aware. I know what I am capable of as well as what my limits are. Taking care of a patient dealing with that horrible condition was not something I could EVER do.
Then it came. I was assigned a man in stage 3 renal failure; he had just had surgery placing the dialysis shunt (the port under the skin that the dialysis machine hooks up to). It was challenging not to burst into tears everytime I walked into the room, but I did it. After he was discharged I recieved a letter from his daughter. She thanked me for my compassion and empathy and told me her father had compared every nurse he's had since then to me - TO ME! It was the most humbling yet amazing feeling I've ever had. It was like everything had come full circle. I couldn't do anything to make my father live longer, but I could honor him and his struggle by providing the best care possible to those who need it.
I know I emphasize the negative impacts but no matter how much negative there is, it will NEVER out weigh the positives I get from what I do. I have days where I am tired and just know I can't go on. I have nights I want to crawl under a rock and bawl. I get angry with God for taking those from their families. I have shifts that make me swear I am going to quit but no matter what, I wake up the next day smiling, excited to go back.
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