eric135

One down, eight more to go... Planning for a trip to Europe...

Pumpkin
Watercolor, Sillman & Birn Alpha-series Sketchbook

I've just completed my first 8-week module for my masters in nursing. It wasn't too bad. It was another exposure to all of the nursing theorists, a topic I have tackled multiple times in the past. I must admit that I did learn a few things. I never quite got the point that nursing theories come in "Grand Theories" (very broad, subjective) to "Middle Range Theories" (less broad and subjective, more objective) and "Practice Theories" (very specific and objective). My favorite nursing theorist has always been Jean Watson's Caring Theory, and for the first time, I had to truly describe what I liked about the theory, and why I found it suited me better than all of the other theories. I also feel that I have a better understanding of Caring Theory, and realize for the first time that it is unlike most of the other nursing theories because Caring Theory is not a skill or task, but rather a system of belief and values. I think that's why so many hospitals struggle to implement this theory. It sounds really good because it talks about all of the values nurses believe are important -- kindness, dignity, caring -- but are also so difficult to measure, and thus document or teach.

The next 8-week module will be on nursing research, which, to be honest, I should be able to handle with my eyes closed. We're going over the "Qualitative vs. Quantitative" thing right now, and I'm basically just beating the urge to go into my BSN files from a couple of years ago and re-use those. But I won't do that. I'll actually do the reading, and come up with new content.

I've been taking a break from work. We had originally planned to spend a few days visiting San Francisco, basically doing the tourist thing. But we had screwed up and scheduled doctors' appointments during the time, and we decided we wanted to save up for a trip to Northern Europe in 2018. Now that I've visited my native homeland, Brent wants to visit his mother's homeland of Denmark, so we're thinking of Amsterdam, Copenhagen and Stockholm. I think I like the planning as much as I like the travel. There are so many resources now to help plan for an affordable and inspiring trip. 

Pursuing my Masters in Nursing... Why, dammit, why?

Flowers from a photograph taken in Milwaukee Wisconsin in April 2017

I've started my first course for my master's degree in Nursing. I don't exactly have plans for what I would do with the degree, which I won't be able to complete for 2 1/2 years (the program should take only 1 1/2 years). I don't intend to climb the leadership ladder, but who knows, I may not be able to be a bedside nurse until the day I retire, and I may have to go for some kind of leadership position (although I have noticed they never last more than a few years). What I do plan to do with it is to be able to teach nursing students, either in clinical rotations, or a lecture-format real-time class, or in an online format. In fact, I can do that as a way to keep some income going even during my retirement years. I just know that, if I retire and if I don't have a compelling reason to get out of bed, I might not. 

So here's to another 2 and 1/2 years of endless papers. I'm just amazed at how proficient I am at writing all of these papers. I said this during my bachelor's preparation for Nursing -- I've never written so many papers in all of my life. It feels good to write so much.

NASCAR 1: Planned Parenthood 0, What if nurses got paid per patient instead of by the hour, Culling our Platys...

• I read on the internets that the House voted out Planned Parenthood, and is continuing to fund NASCAR. What's that all about? I've never been much for either -- parenthood or NASCAR -- but how have our priorities gotten so effed up? I personally don't consider NASCAR a "sport" per se, although yes it does take some skill -- right up until you run up against a RIGHT turn -- but, hell, the only way I'd get into it is if they required the drivers to txt while they drove, or if the audience got to throw obstacles randomly into the road.
• I wonder how much health care would get fixed if nurses got paid via capitation (per patient) rather than by the hour, or if physicians got paid by the hour instead of by capitation. I mean, let's just say a nurse is paid $30 bucks an hour for a 12 hour shift for taking care of five patients. That comes out to $72 bucks per patient. I wonder, as much as we nurses do belly-ache about patient safety and all that, how many of us would take another patient (or more) to get another $72 (or more) a shift. More interestingly, I wonder how many of us would choose to get $72 per shift less in order to be assigned one patient less? I'm totally not saying we should do this, but I wonder how the discussion would change, if it would change at all?
•  We just had to thin our population of platys in our 10-gallon fish tank. We started out with several species of fish, but over the past couple of years, everyone died out except for these Platys. They just kept breeding, and at this point there must have been 70 fish (most of them juvenile) in the tank (along with one bad-tempered Beta that probably hates kids). We looked it up on the internets, and it seems one of the more humane ways to euthanize tropical fish is to drop them into ice water (actually the most humane methods were clove oil or a fish anesthetic called MS-222 or alcohol -- we had none of these). But it still felt strange catching 10-15 baby fish and dropping them in a bucket of ice water. A bit traumatizing, considering how much heartache we go through when our goldfish die.
• I have been playing iTunes, and for whatever hellish reason, I keep playing the theme song from The Sound of Music over and over...

Admit Nurse Moments

 

 

[ME] OK, so I'm going to ask you a few questions about the medications you take every day.

[PATIENT] (exasperated sigh) I wrote all that down so you won't have to ask me again.

[ME] Your typed list is great, but I'd like to go over the meds individually, for your safety.

[PATIENT] I know, you guys ask me the same thing every time, that's why I typed it all out, so I don't have to repeat myself over and over. Can't you just read the list?

[ME] OK, so... you're saying this list is complete, and that you are taking these doses, and that you haven't changed your medications or your doses since you typed this?

[PATIENT] Of course it's right... I wouldn't have spent all that time and energy typing all that and then print it out if it wasn't right... I mean, dammit, how many god-damm times do I have to repeat the same things over and over? Just read the list for Christ sake...

[ME] Well, just for laughs, let me just go over the first one with you... is that OK?  I know it's probably all correct, but let's just see, is that ok? Let's take a look-see at this here list... Ah, the first one here... Pepcid, you take Pepcid 20mg once a day, right?

[PATIENT] Oh God no, I haven't taken Pepcid in MONTHS...

[ME] … … ...

...of the myriad verbal and written reprimands that I have written over the past four years, it turns out that I have written up three times as many male workers as female workers.

I don't know why write-ups are on my mind of late.

One of my co-workers was talking about write-ups on our unit, and she told me that I was "known for being more lenient when disciplining males, but am more knit-picky toward females."

Well, as a leader, I am well aware of the fact that some folks have perceptions that I can't help them with. But this one sort of hit home, because in my business, there are more females than males and I always strive to be fair. So when faced with this criticism, I of course went back and looked it up.

As it turns out, of the myriad verbal and written reprimands that I have written over the past four years, it turns out that I have written up three times as many male workers as female workers.

Which puzzles me even further. I mean, given our demographics, I really should be writing up females about four to five times more often than males, but for whatever reason that isn't happening.

And contrary to the opinion of that coworker I mentioned at the beginning of my post, one of the men I gave a written warning to wrote a letter to the clinical director that I personally had a bad attitude toward him because he was an older male with grey hair (which really shocked me given that I was, even then, 75% grey myself).

What seems to piss me off, possibly on a sexually biased level:

• I obviously don't like foul language. Although I am relatively tolerant of "casual" profanity, I have a peculiar distaste for profanity that is yelled or spoken in anger.

What I seem to discipline evenly across the sexes:

• I don't like it when folks disobey the chain of command (some of my write-ups were for workers from other departments that were rude to my staff instead of coming to me with problems).
• I don't like it when folks make patients feel guilty or bad for being sick (that just gets my gall considering what industry we are in and how we are paid for a living).
• I don't like it when folks go to another charge nurse when I've already told them "no".

Interesting... Something to keep in mind for the next appraisal year...

Maybe knowing what we look like down the sights of loaded shotguns is an ideal way to get to know your boss?

I rarely get written up. No, really, it just doesn't happen very often. Of the handful of times I've gotten a write up, it almost always has been due to by absences (we get in trouble after the 6th absence in any 12-month period, and the trouble gets very serious at 9 absences a year). But having a history of kidney stones, I have always had a straight-forward attitude about my attendance: I do the best that I can, and I try to make up for it by doing other things (I worked a total of 24 extra shifts in 2008, plus a lot of extra "projects" for the unit).

So it came as a surprise when the interim clinical director asked me to meet her in her office.

I had assumed it was to be introduced to the new permanent clinical director, but I realized pretty quickly that the tone of the meeting was serious.

The exact details of the write-up are not all that noteworthy, in that, like almost every other employee I have ever had to write up for this infraction or that, I refuted the factual basis (and even questioned the truthfulness of the interim clinical director). Most of the complaints were that I simply didn't like the interim CD and tended to make that pretty obvious in our daily interactions.

Suffice it to say that I made the decision to live with the write-up and work toward building a relationship with the new clinical director. I decided, after a few days of thought, that it was more important to move on to the bigger problems of two inpatient units that had been through more than a year of hell, and needed to get over all of the conflict and just move on.

It was a good decision, in retrospect. It has been five months since that write-up day, and the new clinical director and I have forged a good professional relationship, despite the fact that we have both, literally, seen each other from the business end of a loaded shotgun (the write up meeting took 90 minutes -- I've never had a write up meeting that lasted that long, with basically me arguing with two clinical directors -- much of the meeting was heated and even mean-spirited, myself included). We've been able to work together on several projects, and I've come to trust her judgment and her sense of fairness and justice.

Maybe that initial meeting -- little ol' me seated on one side of a wide desk with two "bosses" taking turns arguing one point after another -- helped me get to this point faster than my peers. Nurses on my units are amazed at how quickly I "turned around," from considering to resign to becoming a real partner in difficult times. Of all of the charge nurses, I have become the new CD's main supporter.

Maybe knowing what we look like down the sights of loaded shotguns is an ideal way to get to know your boss?

A meeting with Jean Watson... 2 stars out of 4...

Jean Watson spoke at our hospital the other day.

I had worked the night before, and my shift ended at about 0630am, but the meeting wasn't scheduled until 8a. So I spent more than an hour sitting in my car, parked in the employee parking deck, watching Rachel Maddow shows on my iPod.

The meeting was packed, with about 50 nurses attending. All of us were either charge nurses or clinical directors with a few clinical educators mixed in.

I think Jean Watson thought all of us were well-versed in her theory, and that everyone in the room was accustomed to the spiritual, metaphysical and existential nature of her work. I don't think she realized that very few of the nurses attending were very familiar with her book. Thus it surprised me when, with very little by way of introduction or preparation, she proceeded with a meditation exercise. She brought out a "singing bowl" very similar to the one pictured here, and she rubbed the rim with the stick which caused the bowl to resonate.

I've never been very good with meditation. I've tried several times to meditate and I just can't do it. So while everone else in the room bowed their heads and closed their eyes, I started to get a serious case of... the giggles.

To stop myself, I started calculating the Fibonacci sequence of numbers in my head.

Not a great beginning.

It's not that I don't believe in the theory. I do think it is important to appreciate our patients as a total, unique, spiritual, significant human being, and not simply a machine. That's something I can get behind.

But I was sort of hoping the meeting would be more of a "hands on" session, with all of us charge nurses discussing how to actually use the theory.

• What specific behaviors would be seen when observing a nurse that is well versed in the theory?
• What sort of verbalizations should be used? In other words, what needs to be said?
• How do you document use of this theory?
• How do you use the theory if your background and comfort zone is more scientific / numerical / logical / empirical?
• As a charge nurse, with scientific background/personality, how can I teach or model this theory for my nurses?

We didn't really go into that at the meeting. In fact, at one point, one of the nurses finally simply asked Jean Watson to go over the 10 Caritas Processes, to which she surprisingly replied, "Wow I'm not sure I can do that, I'm not sure _I_ even know them."

One of the nurses handed her a copy of her book, after which she did give a pretty good review of the basic concepts, but I was still taken aback that she didn't know her own material well enough to cite them from memory (although she did admit that she planned to do a more thorough discussion of the theory in a more general-audience meeting later in the day).

I guess if I had to rate the meeting, I'd have to give it 2 stars out of 4.

Jean Watson: Caring Theory of Nursing... Caritas Processes...

Updated 3/14/2009

   Our hospital network is adopting Jean Watson's Caring Theory of Nursing.

Most nursing theories are based on Nursing as a humane and compassionate application of a scientific method. Jean Watson encourages us to "return to our core values", and recall the "original reason we all went into nursing", things we as nurses tend to forget when carrying out the "clipboard nurse" type of nursing, where we exhaustively collect data in the form of measurements and numbers. Watson asks all of us as nurses to be more "in tune to the moment" when interacting with our patients (she doesn't like the "customer" model of the modern hospital), and realize that our interactions can be more humane, significant, and caring.

Nursing, as the underling of the medical profession, often works to turn the human being into the human body, further breaking him/her down into just a "body", and eventually just a "machine."

Nursing work too often focuses on "doing" rather than "being", and has become too easy to "do something" to a machine, things we would never consider doing to a human being.

Watson describes ten "Caritas Processes". Originally "Carative Factors," she redefines these essential "core values":

Formation of humanistic-altruistic system of values, becomes: "Practice of loving-kindness and equanimity within context of caring consciousness

Instillation of faith-hope, becomes: "Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared- for";

Cultivation of sensitivity to one's self and to others, becomes: "Cultivation of one's own spiritual practices and transpersonal self, going beyond ego self";

Development of a helping-trusting, human caring relationship, becomes: "Developing and sustaining a helping-trusting, authentic caring relationship";

Promotion and acceptance of the expression of positive and negative feelings, becomes: "Being present to, and supportive of the expression of positive and negative feelings as a connection with deeper spirit of self and the one-being-cared-for";

Systematic use of a creative problem-solving caring process, becomes: "creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices";

Promotion of transpersonal teaching-learning, becomes: "Engaging in genuine teaching-learning experience that attends to unity of being and meaning attempting to stay within other's frame of reference";

Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment, becomes: "Creating healing environment at all levels, (physical as well as non-physical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated";

Assistance with gratification of human needs, becomes: "assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials', which potentiate alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care"; tending to both embodied spirit and evolving spiritual emergence; Allowance for existential-phenomenological-spiritual forces, becomes: "opening and attending to spiritual-mysterious, and existential dimensions of one's own life-death; soul care for self and the one-being-care-for.

 

Our new Clinical Director gave all of us Charge Nurses a copy of Watson's book, which I dutifully read and attempted to absorb over a weekend.

It's going to be a challenge for me. I've never been that "spiritual" or "metaphysical", instead relying on my scientific background thoroughly grounded in skepticism and empiricism. A lot of these carative factors / Caritas Processes are difficult for me to understand on anything more than an intellectual basis. In other words, I have been unable to bridge the gap between vocabulary and meaning.

Jean Watson is scheduled to come to our hospital tomorrow, and I'll be meeting with her along with other charge nurses throughout the hospital in a 90-minute presentation.

Links:

Jean Watson's information page from the University of Colorado Denver.

The Watson Caring Science Institute's page.

From RNJournal.com, a good overview.

Search Query Results from PubMed.

A Pragmatic View of Jean Watson's Caring Theory.   A Word document giving a general review of Watson's Theory and a case study of its implementation.  (Viewer).

 

 

Books I'm reading... Has the recession hit nursing? Arizona nursing layoffs...

I've been off for five days. I had made all these plans to go exploring with my Garmin Nuvi, but got a big huge attack of agoraphobia and stayed indoors almost the whole time (we did go groceries, and I drove to pick up another bag of IV fluids for LadyKitty, but other than that, I stayed in the whole time.

// Reading

I've moved on in my reading to two other library books:

  Yes I'm working on another Trek book, but this is the first one that deals with the crew of the very first crew of the enterprise, with Captain Jonathan Archer. It's been very well written.

 

After I finish the Star Trek book, I'll be reading another Dean Koontz novel.

 

// Has the recession hit nursing jobs?

 

Our hospital system has just introduced layoffs. I believe between the two hospitals, there were about 40 jobs lost. Most would be eligible to return to our hospital when hiring resumes. On our floor, we lost only one worker (that's one among a total of about 120 employees, and it was not a nurse).

 

I still feel that there are nursing jobs out there. What I think is happening is that, as the payor mix sours (more patients covered by less/no insurance) metropolitan hospitals will see the biggest change in their income. But I think if a disaster hits and I find myself laid off (which still seems very unlikely in my specific case) I would just hit the road and travel. There are plenty of places still hurting from the ongoing nursing shortage. The point will be to find work where the locals just don't want to go. I mean, I personally don't want a >20min commute, but if the only way to put food on the table is to travel 60 minutes each way, then that's what I'll have to do.

 

http://blog.azhealthenews.com/2009/01/15/banner-layoffs-deepen-gloomy-outlook-on-az-hospitals.aspx?ref=rss

 

http://www.nursezone.com/Nursing-News-Events/more-news.aspx?ID=18765

 

http://www.nursezone.com/Nursing-News-Events/more-news.aspx?ID=18803 (the link to the income/cost of living comparison is interesting).

 

http://allnurses.com/new-york-nurses/nursing-layoffs-300518.html

 

http://query.nytimes.com/gst/fullpage.html?res=9F00E7DF1430F93AA2575BC0A960958260&sec=&spon=&pagewanted=all

 

 

 

 

The Vice Presidential Debate ... A lot can change in four years ...

I thought it was a clear win for Biden, and so far the polls would agree.

I must admit, we watched the debate (24 hours later on Tivo) with the same anticipation some folks watch those "When Animals Attack" video's, wondering if I'd have to turn my head when the bloody part came. But Palin pretty much held her own. But I thought the raw construction of her answers was the same  evasiveness she showed in those tragic Couric interviews. I thought if either Biden or the moderator had the opportunity to really keep her on topic, and drill down for the gritty details, it would have become as incoherent and fragmented as her answers on the Couric interview.

She did get a good shot at Biden, when she said something like, "Oh Joe, I gotta wonder how much you guys are really thinking about the future when all you seem to do is point to the past." This after Biden continued to connect McCain to Bush. But it was a good jab that came off well on the TV.

On a side note, we got our early ballots today. My room mate took off with them, threatening to fill mine in with the Obama vote. I guess he never forgave my Bush vote 4 years ago, against his Gore vote.

Well really, I didn't know how it would turn out.

Those were such different days. My top concern four years ago was 9/11. All I could think of was that I didn't want another 9/11, and I didn't care if we had to hang the American flag -- from every capital building in the world. I joked about renaming Middle East countries as "New Texas" or "The Republic of Exxon." I really meant that back then.

Not so much now.

I still dread another 9/11, but don't automatically take the Hawkish view.

I worry more about the cost of my health care than the cost of a gallon of gas.

I have more to say about the definition of marriage and adoption rights, even though I plan neither.

I don't think it takes a Republican in office to keep my 401k afloat.

I worry about what I'll do when/if my doctor retires, moves or decides on a less demanding life.

I think about work from the perspective of 80 employees, not so much as one nurse and five patients.

I make cynical sneers at those "Be a Nurse" commercials on TV, even though I can't think of anything else I would rather be.

I fear more of us will die in horrible needless pain.

When I face angry patients, I first look at their hands (looking for weapons).

I used to look at their eyes.

So... a lot can change in four years.