Saturday, February 26, 2011
You can tell when you love something...
Because working on it consumes your thoughts entirely. I have been working on the CNSA website, forums, and social media pretty much non-stop since I got admin rights. I just LOVE it. I love playing with the code (although, admittedly, I am entirely self-taught and barely know anything), I love improving the site nav and content, and I LOVE seeing the numbers climb after I installed Site Meter Pro.
I had some struggles with the old forum software (phpBB 2.x) and not having access to the database so I could mod the registration page to at least semi-prevent spambot registrations. I ended up manually adding approved posters to a group, and then giving that group permission to post. It's not ideal and I am worried I may have killed the forums, but they were pretty much dead anyway. One page worth of posts in a year...
I sent emails to the CNSA web host, Director Communications, and President of CNSA to try and persuade them to upgrade the entire site platform to vBulletin. From what I've seen, people either love it or hate it, and the people who hate it seem to be developers who are looking for ++intensive modifications, which doesn't affect me. I played with a demo version of the admin panel and I am pleased with vBulletin's community-centric nature. I WANT Regional Executives to be able to upload their own content and maintain a web presence for their community. I want the BoD to maintain blogs and reach out to the members. I want people to visit cnsa.ca and want to BE a member.
I'm also intrigued by the calendar functions, the events manager (hugely important for an organization which exists primarily through conferences), and social networking integration such as Facebook Connect. If we make it easy for our members to get involved and stay involved, they might actually take an interest in it - particularly those members (such as myself) who live in areas where CNSA has no physical presence.
Anyway, Reading Week is drawing to a close and I am scrambling to finish the major adjustments to the website so that, by Monday, I have my head back in the clinicals game ;)
I had some struggles with the old forum software (phpBB 2.x) and not having access to the database so I could mod the registration page to at least semi-prevent spambot registrations. I ended up manually adding approved posters to a group, and then giving that group permission to post. It's not ideal and I am worried I may have killed the forums, but they were pretty much dead anyway. One page worth of posts in a year...
I sent emails to the CNSA web host, Director Communications, and President of CNSA to try and persuade them to upgrade the entire site platform to vBulletin. From what I've seen, people either love it or hate it, and the people who hate it seem to be developers who are looking for ++intensive modifications, which doesn't affect me. I played with a demo version of the admin panel and I am pleased with vBulletin's community-centric nature. I WANT Regional Executives to be able to upload their own content and maintain a web presence for their community. I want the BoD to maintain blogs and reach out to the members. I want people to visit cnsa.ca and want to BE a member.
I'm also intrigued by the calendar functions, the events manager (hugely important for an organization which exists primarily through conferences), and social networking integration such as Facebook Connect. If we make it easy for our members to get involved and stay involved, they might actually take an interest in it - particularly those members (such as myself) who live in areas where CNSA has no physical presence.
Anyway, Reading Week is drawing to a close and I am scrambling to finish the major adjustments to the website so that, by Monday, I have my head back in the clinicals game ;)
Wednesday, February 23, 2011
CNSA.ca - tell me what you think
I got the keys last night to the CNSA.ca website so that I could finally get started in my new role as Informatics Officer. One of the big jobs I see is improving the navigability, content, and transparency of the CNSA website. My term hasn't officially started yet (it begins on April 1) so I am just puttering around until the new Board of Directors begin their terms and I can harass them for additional content.
I would really appreciate if you could take a little mosey over there and tell me what you think about the current website. Be honest and give me some constructive feedback. I won't be offended - I didn't make it :) But I am looking to improve it.
It's a good thing it's Reading Week right now. I get so excited over web projects that I tend to stay up all night working and forget other commitments.... wait, did I feed my bird today?? ;)
I would really appreciate if you could take a little mosey over there and tell me what you think about the current website. Be honest and give me some constructive feedback. I won't be offended - I didn't make it :) But I am looking to improve it.
It's a good thing it's Reading Week right now. I get so excited over web projects that I tend to stay up all night working and forget other commitments.... wait, did I feed my bird today?? ;)
Sunday, February 20, 2011
"So... how's she doing?"
It was right around 1800 and I was in the middle of spiking new bags of TPN and lipids. I had forgotten the PICC IV adapter and was halfway out the door to grab one when her visitor peeked around the corner.
Before me stood a woman about the same age as Mary, my patient. She held her purse with both hands and peered at me questioningly. I paused and smiled at her, told her she was welcome in the room - Mary was awake for a change and watching TV.
She hesitated and looked at me again, eyes darting briefly between me and the room behind me.
Eyes wide, she asked it:
So... how's she doing?
Whoa, loaded question.
My mind lurched briefly and then started racing. Who are you? What do you get to know? How much do you already know? What do I know? Where's the line supposed to be, and how do I draw it?
Mary was not doing particularly well. She was currently weak but stable. The severe ischemic colitis was a major complication; if it turned gangrenous, the mortality rate could be as high as 50-75%. At this point it was a wait and see game, to determine whether she'd recover some bowel function and be able to live a normal life, or perhaps her bowel might perforate and she would have to be treated for life-threatening peritonitis. Surgery could entail resecting the bowel, or even removing it entirely, and creating an ileostomy. Mary was also experiencing some mental status changes, had pitting edema to one leg, and was becoming increasingly gaunt.
So *I* knew all of this. But I was also acutely aware that this visitor would hang on every word I said, and I would have to be as diplomatic as possible, but there was no time to really think about what I would say because every moment I hesitated she grew ever more concerned. There were also concerns of who was she, and what was she entitled to know. What was I entitled to share? How could I put it?
So, with my heart pounding in my chest, I asked the visitor who she was. Mary's best friend since we were in high school, she told me. We go way back.
'Okay,' my mind raced, 'a friend. Good friends, by the sounds of it.'
I took a deep breath.
"Mary's surgery is healing well, but she has developed a complication with her GI system." Her eyebrows raised and I cringed internally. GI? Who the hell says that?
"Her, uh, bowels are having some problems, and we are, uh, keeping an eye on her." I winced inside. It was extremely hard for me to find the right words that would simultaneously protect Mary's privacy, avoid false reassurance, and also respect the friendship of these two women; made harder still as she watched me, nodding carefully and hanging on every word I said. "She is doing well today and you are welcome to go and visit her."
"So, when will she be able to leave the hospital?"
Good question, I thought, I have no idea either. "When the doctors feel she is strong enough."
"So we are just waiting for her to get strong enough, and then she can leave?"
Yes, if she doesn't perforate and go septic... or lose her bowel function entirely and need major abdominal surgery to create an ileostomy... and if that surgery doesn't develop complications too--
"Pretty much. She should be discharged then."
"Okay, thank you." She smiled at me, and I smiled weakly back at her as she walked into the room and gave Mary a big hug.
I let out a huge exhale. My heart was pounding. They never taught us how to deal with that in school...
Before me stood a woman about the same age as Mary, my patient. She held her purse with both hands and peered at me questioningly. I paused and smiled at her, told her she was welcome in the room - Mary was awake for a change and watching TV.
She hesitated and looked at me again, eyes darting briefly between me and the room behind me.
Eyes wide, she asked it:
So... how's she doing?
Whoa, loaded question.
My mind lurched briefly and then started racing. Who are you? What do you get to know? How much do you already know? What do I know? Where's the line supposed to be, and how do I draw it?
Mary was not doing particularly well. She was currently weak but stable. The severe ischemic colitis was a major complication; if it turned gangrenous, the mortality rate could be as high as 50-75%. At this point it was a wait and see game, to determine whether she'd recover some bowel function and be able to live a normal life, or perhaps her bowel might perforate and she would have to be treated for life-threatening peritonitis. Surgery could entail resecting the bowel, or even removing it entirely, and creating an ileostomy. Mary was also experiencing some mental status changes, had pitting edema to one leg, and was becoming increasingly gaunt.
So *I* knew all of this. But I was also acutely aware that this visitor would hang on every word I said, and I would have to be as diplomatic as possible, but there was no time to really think about what I would say because every moment I hesitated she grew ever more concerned. There were also concerns of who was she, and what was she entitled to know. What was I entitled to share? How could I put it?
So, with my heart pounding in my chest, I asked the visitor who she was. Mary's best friend since we were in high school, she told me. We go way back.
'Okay,' my mind raced, 'a friend. Good friends, by the sounds of it.'
I took a deep breath.
"Mary's surgery is healing well, but she has developed a complication with her GI system." Her eyebrows raised and I cringed internally. GI? Who the hell says that?
"Her, uh, bowels are having some problems, and we are, uh, keeping an eye on her." I winced inside. It was extremely hard for me to find the right words that would simultaneously protect Mary's privacy, avoid false reassurance, and also respect the friendship of these two women; made harder still as she watched me, nodding carefully and hanging on every word I said. "She is doing well today and you are welcome to go and visit her."
"So, when will she be able to leave the hospital?"
Good question, I thought, I have no idea either. "When the doctors feel she is strong enough."
"So we are just waiting for her to get strong enough, and then she can leave?"
Yes, if she doesn't perforate and go septic... or lose her bowel function entirely and need major abdominal surgery to create an ileostomy... and if that surgery doesn't develop complications too--
"Pretty much. She should be discharged then."
"Okay, thank you." She smiled at me, and I smiled weakly back at her as she walked into the room and gave Mary a big hug.
I let out a huge exhale. My heart was pounding. They never taught us how to deal with that in school...
Friday, February 18, 2011
Vascular Surgery, Week 2
Today's evening shift marks my 6th day on the unit (Only? Wow!). It would have been 7 except I had to miss a day for flu-related conditions. This week has been interesting.
I've been assigned one patient for the last few days - a lady in her 70s who presented to Emerg with a big DVT in her leg. A CT found AAA as well as an aneurysm on her common iliac. They decided to remove the clot and repair the aneurysms at the same time, landing her on my unit after some time in Intermediate Care. Turns out she has developed a major complication from the AAA repair, ischemic colitis. They put pictures from the scope into the chart.... that was a sight to see. The colon is pale and there are patches of necrotic tissue. There are what seems like grey perforations in the bowel and a lot of mucousy yellow slough. It's crazy to think that's going on inside her body.
Right now, I think they are managing her symptoms and trying to ride it out and see if the bowel will recover some function. She's on TPN and a couple of antibiotics; pretty much everything else is from pre-existing conditions.
So, she's a pretty sick patient, and it's been a busy few days for me. I have been able to hang IV meds & TPN to my heart's content and provide pretty much total care for her, which I have been enjoying immensely. It's like all the good stuff from 1st and 2nd year, plus being able to do almost everything for my patient, with a cosign of course.
"Can I have a shower today?" she asked, squinting up at me in the afternoon sun.
She had been looking kind of, uh, smarmy and I was elated to hear her awake enough to request a shower. It was a hell of a production. The primary nurse and I (despite my protests - I definitely could have managed, but she wanted to be there too) brought the patient into the shower room along with her smart pump. We cling-wrapped her PICC and peripheral IV. We put bags over the pump. 20 sweaty, humid minutes later, we had her scrubbing under the showerhead, and her relief and sighs of satisfaction made the whole thing absolutely worth it. She said it was the best shower she'd ever had. lol :)
Unfortunately the pleasure of providing her with a much-needed shower was tampered by a very unfortunate mishap involving incontinent ischemic bowel... everywhere...
That makes my Code Tally 0 code blues and 2 code browns. They are smelly but no one dies.
So, after having such a crazy start to my shift, the rest was absolutely slow. My patient slept most of the evening, barely waking up for meds, and then zonking out again.
Finally, after I awoke her for 2200 meds and HS care, she popped back to life and asked me what was on the menu today. "Nothing," I smiled, "you've had quite a day; it's now 10 PM and it's night time."
"Oh. Were [unintelligible]?"
I leaned closer. Come again?
"Were those yard apes here?"
I laughed. Yes. "Your family was here. They watched Ellen."
She shook her head and smiled. She picked up her toothbrush and examined it. I waited patiently, watching her for signs of agnosia. She felt the handle and brought the bristles close to her glasses.
"Modern science!" she proclaimed appreciatively, and then proceeded to brush her teeth.
Just after I set up her sidestream nebulizer, and before I turned off her light, she turned to me and asked.... "So, any chance I can have that shower today?"
I've been assigned one patient for the last few days - a lady in her 70s who presented to Emerg with a big DVT in her leg. A CT found AAA as well as an aneurysm on her common iliac. They decided to remove the clot and repair the aneurysms at the same time, landing her on my unit after some time in Intermediate Care. Turns out she has developed a major complication from the AAA repair, ischemic colitis. They put pictures from the scope into the chart.... that was a sight to see. The colon is pale and there are patches of necrotic tissue. There are what seems like grey perforations in the bowel and a lot of mucousy yellow slough. It's crazy to think that's going on inside her body.
Right now, I think they are managing her symptoms and trying to ride it out and see if the bowel will recover some function. She's on TPN and a couple of antibiotics; pretty much everything else is from pre-existing conditions.
So, she's a pretty sick patient, and it's been a busy few days for me. I have been able to hang IV meds & TPN to my heart's content and provide pretty much total care for her, which I have been enjoying immensely. It's like all the good stuff from 1st and 2nd year, plus being able to do almost everything for my patient, with a cosign of course.
"Can I have a shower today?" she asked, squinting up at me in the afternoon sun.
She had been looking kind of, uh, smarmy and I was elated to hear her awake enough to request a shower. It was a hell of a production. The primary nurse and I (despite my protests - I definitely could have managed, but she wanted to be there too) brought the patient into the shower room along with her smart pump. We cling-wrapped her PICC and peripheral IV. We put bags over the pump. 20 sweaty, humid minutes later, we had her scrubbing under the showerhead, and her relief and sighs of satisfaction made the whole thing absolutely worth it. She said it was the best shower she'd ever had. lol :)
Unfortunately the pleasure of providing her with a much-needed shower was tampered by a very unfortunate mishap involving incontinent ischemic bowel... everywhere...
That makes my Code Tally 0 code blues and 2 code browns. They are smelly but no one dies.
So, after having such a crazy start to my shift, the rest was absolutely slow. My patient slept most of the evening, barely waking up for meds, and then zonking out again.
Finally, after I awoke her for 2200 meds and HS care, she popped back to life and asked me what was on the menu today. "Nothing," I smiled, "you've had quite a day; it's now 10 PM and it's night time."
"Oh. Were [unintelligible]?"
I leaned closer. Come again?
"Were those yard apes here?"
I laughed. Yes. "Your family was here. They watched Ellen."
She shook her head and smiled. She picked up her toothbrush and examined it. I waited patiently, watching her for signs of agnosia. She felt the handle and brought the bristles close to her glasses.
"Modern science!" she proclaimed appreciatively, and then proceeded to brush her teeth.
Just after I set up her sidestream nebulizer, and before I turned off her light, she turned to me and asked.... "So, any chance I can have that shower today?"
Monday, February 14, 2011
Flu or something
Blargh.
Luckily it hit immediately AFTER my weekly mandatory lecture at school, saving me some BS "make up" assignments. Regrettably I had to miss my riding lesson. I was working on leg yielding last week and maintaining canter leads on a figure 8 (i.e. not allowing geriatric old showhorses to autochange) and I was really looking forward to trying some more.
Right now I am febrile, nauseous, and experiencing some awesome muscle aches. I heard that influenza doesn't really make people nauseous so I am hoping it is not that. Rough timing as I really need to be awesome this week, in order to impress my instructor enough that she provides a decent reference for me in my UNE application due sometime this month.
Buddy shift tomorrow and I am hoping I feel up to it; shift is 1530-2330 so I have some time yet.
Since I am not riding.... next best thing!
Luckily it hit immediately AFTER my weekly mandatory lecture at school, saving me some BS "make up" assignments. Regrettably I had to miss my riding lesson. I was working on leg yielding last week and maintaining canter leads on a figure 8 (i.e. not allowing geriatric old showhorses to autochange) and I was really looking forward to trying some more.
Right now I am febrile, nauseous, and experiencing some awesome muscle aches. I heard that influenza doesn't really make people nauseous so I am hoping it is not that. Rough timing as I really need to be awesome this week, in order to impress my instructor enough that she provides a decent reference for me in my UNE application due sometime this month.
Buddy shift tomorrow and I am hoping I feel up to it; shift is 1530-2330 so I have some time yet.
Since I am not riding.... next best thing!
Thursday, February 10, 2011
Vascular Surgery, Day 2
Second buddy shift down. I had the same RN to shadow. It was a great day, lots going on!
Tomorrow I am taking my first patient, an older guy with rectal cancer who had a new ileostomy created. It'll be the first ostomy I've cared for. My instructor doubles as an ICU nurse when she's not teaching and expects solid research from us about our patients. I am happy about that - patho doesn't REALLY make sense to me until I see it manifested in a patient.
So LOTS of research to do tonight on ostomy care, cancer disease processes, head to toe assessments, and meds. Sooooo many meds.
Whee!
Tomorrow I am taking my first patient, an older guy with rectal cancer who had a new ileostomy created. It'll be the first ostomy I've cared for. My instructor doubles as an ICU nurse when she's not teaching and expects solid research from us about our patients. I am happy about that - patho doesn't REALLY make sense to me until I see it manifested in a patient.
So LOTS of research to do tonight on ostomy care, cancer disease processes, head to toe assessments, and meds. Sooooo many meds.
Whee!
Wednesday, February 9, 2011
Day 1: Vascular Surgery, and other stuff
Yesterday was my orientation onto the new unit, new instructor, new everything. It can be pretty challenging to change gears like we do as we move from one rotation immediately into the next. Especially given the circumstances from the last instructor, I found the adjustment a little difficult, but I think once I hit my stride with my own pt load I will be okay.
I wasn't sure what to expect with this unit, since my last surgery rotation was orthopedics. I think there will be a lot of similarities. Older patient population, multiple comorbidities, people who are more or less paying the price for a lifetime of unhealthy choices. Sure makes me re-evaluate my own healthy habits. There are amputations, bypasses, carotid endarterectomies, a whole plethora of vascular surgeries I don't yet know about, and general surgery.
My precepting nurse today was a new grad herself, class of 2010. I shadowed her and rounded with her on her 4 patients, getting a feel for the unit's flow and routine. I was pleased to see the teamwork dynamic on the unit - an AWESOME change from my maternity rotation, where the floor had some serious politics that they made no attempt to hide. Like the day I had to request a new nurse because mine spent the entire morning griping to me about other nurses and work environment instead of letting me care for my assigned patients - wow, awkward.
It was nice having a newer nurse to shadow today. It helps to give me a visual on where I would like to be when I graduate. Usually, when I shadow really experienced nurses, I get blown away by how much they know and what they know to expect. It can be intimidating when they are connecting dots long before the questions have even formed in my brain!
Today's patients included a middle-aged woman with a brand new ileostomy, a senior who'd had her gangrenous leg amputated, a patient with a gianormous gallstone and pancreatic issues, and a man in his 60s who was about a week post-op from a fem-pop bypass.
The unit is pretty old-school in terms of layout; it is a horseshoe with rooms around the perimeter and the nursing station at the opening. Being oldschool, there isn't really anywhere to chart comfortably or congregate with other students to do research. I got pretty used to that on my last rotation - couldn't go 10 feet without running into a charting station complete with computer and task chair :)
I am feeling good about this rotation EXCEPT my instructor will be leaving in a few weeks and will be replaced by someone, but we don't know who. So my current instructor will be doing my midterm evaluation and then a new instructor will be doing my final. This could play in my favor, as I have time to find my feet and then the new instructor will come in and see me being awesome, or it could go the other way.
I am looking forward to my leave of absence from my job; I will be off March-April so I can focus exclusively on clinical. This will be a first for me and I intend to take full advantage of it in terms of home study and knowing my stuff - I should get another 20-25 hours per week to myself! Unfortunately I will be completely broke for 2 months. :(
In other news, I attended my STTI chapter's executive meeting to offer my assistance with maintaining a web presence via The Circle. This kind of evolved into them asking me to give a presentation at the next meeting to show them how to use it. Ironically, the next item on the meeting agenda was succession planning. IMO, the single best way to recruit my digital generation into any role is to create accessible information and make it easy to become involved. Honestly, the first thing I did when I got invited to STTI was go to the website. Same with CNSA. Same with Alberta Health Services. I am probably a little more gung-ho than the average student in terms of finding information, and a little ballsy when it comes to getting involved, and I think more people would love to get involved if the process of becoming involved was straightforward and clear.
I believe we are at an awkward stage in terms of information accessibility; a lot of the areas in senior management that are responsible for coordinating information grew up in the era of newsletters and paper applications. Information was accessed days or weeks from the initial request in terms of fax or mail or answering machine. What you knew was directly related to who you knew, and "in person" was often a requirement. However, these outdated methods of Finding Out no longer meet our expectations. We want to find information in seconds. This dichotomy is causing tension between old methodology and what we've come to expect from online resources. It's no one's fault, of course, that we are taking our time getting information more freely accessible - healthcare is a little unique in terms of extremely important confidentiality issues. I definitely see a huge potential for information distributed almost exclusively through digital media. There really is no reason to have paper anything (unless you live in Canada and have paid attention to recent events involving Usage-Based Billing). It is my hope that I can do my part through CNSA and STTI Mu Sigma to encourage freely accessible information and improve involvement in these organizations.
By the way - I don't know if I mentioned it, but I was elected into an informatics position on the Board of Directors of CNSA! It is currently an Officer position which reports to Director of Communications, but informatics is a massive role in its own right and I see potential for the position could be expanded to Director of Informatics at the next National Assembly. Obviously it will take a whole lot of work on my part to make that happen. I am really excited about this opportunity. The website is going to improve a lot over the next year. It needs improved navigability, richer content, frequent updates, CNSA projects and involvement, and clear role descriptions for the BoD. There are some lacklustre forums on there which need better organization and spam filtering. There are opportunities for greater integration with CNA's NurseONE (I met the project lead at the conference) and hopefully nursingideas.ca. I have a lot of ideas and am hoping to get together soon with the webmaster to discuss the back end process for the website. My term doesn't officially begin until April 1 so no rush.
Wow, I had a lot more to say than I thought. I am so, so, so excited about all these possibilities. Going to bed with visions of awesome, engaging, easy-to-navigate websites dancing in my head. Second RN-shadowing shift tomorrow!
I wasn't sure what to expect with this unit, since my last surgery rotation was orthopedics. I think there will be a lot of similarities. Older patient population, multiple comorbidities, people who are more or less paying the price for a lifetime of unhealthy choices. Sure makes me re-evaluate my own healthy habits. There are amputations, bypasses, carotid endarterectomies, a whole plethora of vascular surgeries I don't yet know about, and general surgery.
My precepting nurse today was a new grad herself, class of 2010. I shadowed her and rounded with her on her 4 patients, getting a feel for the unit's flow and routine. I was pleased to see the teamwork dynamic on the unit - an AWESOME change from my maternity rotation, where the floor had some serious politics that they made no attempt to hide. Like the day I had to request a new nurse because mine spent the entire morning griping to me about other nurses and work environment instead of letting me care for my assigned patients - wow, awkward.
It was nice having a newer nurse to shadow today. It helps to give me a visual on where I would like to be when I graduate. Usually, when I shadow really experienced nurses, I get blown away by how much they know and what they know to expect. It can be intimidating when they are connecting dots long before the questions have even formed in my brain!
Today's patients included a middle-aged woman with a brand new ileostomy, a senior who'd had her gangrenous leg amputated, a patient with a gianormous gallstone and pancreatic issues, and a man in his 60s who was about a week post-op from a fem-pop bypass.
The unit is pretty old-school in terms of layout; it is a horseshoe with rooms around the perimeter and the nursing station at the opening. Being oldschool, there isn't really anywhere to chart comfortably or congregate with other students to do research. I got pretty used to that on my last rotation - couldn't go 10 feet without running into a charting station complete with computer and task chair :)
I am feeling good about this rotation EXCEPT my instructor will be leaving in a few weeks and will be replaced by someone, but we don't know who. So my current instructor will be doing my midterm evaluation and then a new instructor will be doing my final. This could play in my favor, as I have time to find my feet and then the new instructor will come in and see me being awesome, or it could go the other way.
I am looking forward to my leave of absence from my job; I will be off March-April so I can focus exclusively on clinical. This will be a first for me and I intend to take full advantage of it in terms of home study and knowing my stuff - I should get another 20-25 hours per week to myself! Unfortunately I will be completely broke for 2 months. :(
In other news, I attended my STTI chapter's executive meeting to offer my assistance with maintaining a web presence via The Circle. This kind of evolved into them asking me to give a presentation at the next meeting to show them how to use it. Ironically, the next item on the meeting agenda was succession planning. IMO, the single best way to recruit my digital generation into any role is to create accessible information and make it easy to become involved. Honestly, the first thing I did when I got invited to STTI was go to the website. Same with CNSA. Same with Alberta Health Services. I am probably a little more gung-ho than the average student in terms of finding information, and a little ballsy when it comes to getting involved, and I think more people would love to get involved if the process of becoming involved was straightforward and clear.
I believe we are at an awkward stage in terms of information accessibility; a lot of the areas in senior management that are responsible for coordinating information grew up in the era of newsletters and paper applications. Information was accessed days or weeks from the initial request in terms of fax or mail or answering machine. What you knew was directly related to who you knew, and "in person" was often a requirement. However, these outdated methods of Finding Out no longer meet our expectations. We want to find information in seconds. This dichotomy is causing tension between old methodology and what we've come to expect from online resources. It's no one's fault, of course, that we are taking our time getting information more freely accessible - healthcare is a little unique in terms of extremely important confidentiality issues. I definitely see a huge potential for information distributed almost exclusively through digital media. There really is no reason to have paper anything (unless you live in Canada and have paid attention to recent events involving Usage-Based Billing). It is my hope that I can do my part through CNSA and STTI Mu Sigma to encourage freely accessible information and improve involvement in these organizations.
By the way - I don't know if I mentioned it, but I was elected into an informatics position on the Board of Directors of CNSA! It is currently an Officer position which reports to Director of Communications, but informatics is a massive role in its own right and I see potential for the position could be expanded to Director of Informatics at the next National Assembly. Obviously it will take a whole lot of work on my part to make that happen. I am really excited about this opportunity. The website is going to improve a lot over the next year. It needs improved navigability, richer content, frequent updates, CNSA projects and involvement, and clear role descriptions for the BoD. There are some lacklustre forums on there which need better organization and spam filtering. There are opportunities for greater integration with CNA's NurseONE (I met the project lead at the conference) and hopefully nursingideas.ca. I have a lot of ideas and am hoping to get together soon with the webmaster to discuss the back end process for the website. My term doesn't officially begin until April 1 so no rush.
Wow, I had a lot more to say than I thought. I am so, so, so excited about all these possibilities. Going to bed with visions of awesome, engaging, easy-to-navigate websites dancing in my head. Second RN-shadowing shift tomorrow!
Sunday, February 6, 2011
Time-out for my brain
So after spending the entire weekend feeling sorry for myself and (involuntarily) lying awake pondering the intricacies of human nature, I feel mostly at peace with the events from Friday. I owe a lot of that to you guys for your support and kind words. Nobody gets it like another nurse does and I felt SO much better after seeing your comments and emails.
To answer the common question - I have decided that I will not pursue the matter against my instructor. I am heading into another full-time clinical rotation on Tuesday (vascular surgery, yay!) -- with a different instructor, thank god -- and I just don't have the fortitude to deal with ongoing illogical bullshit. Even if I did call for some kind of inquiry, it would be my word against hers, and how can you argue with someone like that?
I would prefer to be that person who stood up for the masses and blew the whistle... but my school has a history of blackballing, and I just don't see how I could win. One more year of this and I will be answering only to me: ugrn, RN. And CARNA. :)
I did submit anonymous feedback on my instructor before my evaluation. Our school asks for feedback on all instructors up to the day before final evaluations. I was extremely fair in my assessment and delivery, maybe TOO fair considering how she was with my evaluation, but I think my feedback is more likely to be taken seriously than someone who rants unintelligibly.
My mark isn't terrible. I got a B. I think I deserved much more than that, but it's acceptable. If I escalate my concerns with the ivory tower, it would be a whole lot of BS just for the sake of 'being right'. If my instructor had been someone I looked up to or wanted to emulate, I might care more, but frankly I think her bedside manner stinks. I don't need her to validate my hard work. I didn't then and I don't now.
FYI, because this past couple of posts have been pretty specific about one instructor (she'd obviously know it was about her), I have been carefully monitoring incoming traffic. If I feel like I may have been discovered I will be temporarily pulling down my blog or removing some posts.
Anyway, enough about that. Happy birthday to my blog! It turned 3 on February 3rd. I got it a birthday cake because it has grown so much since that first post. I really have to thank all of my readers for sticking around this long. It blows my mind to think of how far I've come since that day. One more year... one more year... then I will have to change my blog name!
In celebration of my blogiversary, I tweaked my page design a bit. I like it. It's a lot cleaner than the last one, which was the result of the various glare and texture filters in Artisteer being vomited all over the page... I also whipped up a slightly modified header since I discovered the joy of Adobe Illustrator. Anyone else want a shiny logo? I'm having a great time with it, lol. Too bad it costs $1500 for a licence. I have 28 more days to enjoy the trial. :)
For some reason I have been getting a ton of visits from Israel coming to learn about cranial nerves. One of my friends is Israeli. She showed me some pictures of the homeland and I was amazed by how many sexy people live there. Wow. Hello, good looking people, and welcome.
I do have a post coming for the CNSA Conference recap. However I have a date with football, beers, and wings so I will have to catch you up later :) Happy Superbowl Sunday!
To answer the common question - I have decided that I will not pursue the matter against my instructor. I am heading into another full-time clinical rotation on Tuesday (vascular surgery, yay!) -- with a different instructor, thank god -- and I just don't have the fortitude to deal with ongoing illogical bullshit. Even if I did call for some kind of inquiry, it would be my word against hers, and how can you argue with someone like that?
I would prefer to be that person who stood up for the masses and blew the whistle... but my school has a history of blackballing, and I just don't see how I could win. One more year of this and I will be answering only to me: ugrn, RN. And CARNA. :)
I did submit anonymous feedback on my instructor before my evaluation. Our school asks for feedback on all instructors up to the day before final evaluations. I was extremely fair in my assessment and delivery, maybe TOO fair considering how she was with my evaluation, but I think my feedback is more likely to be taken seriously than someone who rants unintelligibly.
My mark isn't terrible. I got a B. I think I deserved much more than that, but it's acceptable. If I escalate my concerns with the ivory tower, it would be a whole lot of BS just for the sake of 'being right'. If my instructor had been someone I looked up to or wanted to emulate, I might care more, but frankly I think her bedside manner stinks. I don't need her to validate my hard work. I didn't then and I don't now.
FYI, because this past couple of posts have been pretty specific about one instructor (she'd obviously know it was about her), I have been carefully monitoring incoming traffic. If I feel like I may have been discovered I will be temporarily pulling down my blog or removing some posts.
Anyway, enough about that. Happy birthday to my blog! It turned 3 on February 3rd. I got it a birthday cake because it has grown so much since that first post. I really have to thank all of my readers for sticking around this long. It blows my mind to think of how far I've come since that day. One more year... one more year... then I will have to change my blog name!
In celebration of my blogiversary, I tweaked my page design a bit. I like it. It's a lot cleaner than the last one, which was the result of the various glare and texture filters in Artisteer being vomited all over the page... I also whipped up a slightly modified header since I discovered the joy of Adobe Illustrator. Anyone else want a shiny logo? I'm having a great time with it, lol. Too bad it costs $1500 for a licence. I have 28 more days to enjoy the trial. :)
For some reason I have been getting a ton of visits from Israel coming to learn about cranial nerves. One of my friends is Israeli. She showed me some pictures of the homeland and I was amazed by how many sexy people live there. Wow. Hello, good looking people, and welcome.
I do have a post coming for the CNSA Conference recap. However I have a date with football, beers, and wings so I will have to catch you up later :) Happy Superbowl Sunday!
Friday, February 4, 2011
The maternity wrap-up Pts 1 & 2
I originally started this post last night while I got ready for my final clinical evaluation today. Because I am having a total mindfuck of emotions right now, I'll break it into two parts: Part 1 was written last night and Part 2 written now.
Part 1 [Last night]:
Thank you all for your patience while I get back into the groove! I had an a-maz-ing week at the CNSA National Conference, as you can tell by my various phone updates, and I will recap it for you as soon as possible. I came home on Sunday and it has been a total whirlwind since then, which is pretty much my life during clinicals.
@Cartoon Characters: Thank you for your awesome supportive comments. I really appreciate you stopping by to say something! Especially given your career :)
Today marked the last day of my experience in Maternity. I have mixed emotions about it - since my final evaluation is tomorrow, I wanted to really reflect and consolidate my patient experiences before going into my eval. I don't feel especially confident in my instructor's appraisal of me, partly because I have NO IDEA what she thinks of my practice, and mostly because I have found her pretty hard to gauge.
A word about instructors... I think one of the most important traits to have is transparency in your opinion. If you think I did great, please say so. If you think my practice sucks, PLEASE say so. But even more than that, it is so important to have an instructor who is willing to share in my challenges and in my victories. I had a huge win yesterday - I'll explain in a bit - and I wanted to share that with SOMEBODY, and so I turned to my instructor. She gave no opinion at all and just stared at me with a blank face until I trailed off and awkwardly walked away. It didn't diminish my feelings of success because I KNOW that I did well and no one's lack of championing my actions can change that. But it would have been nice to have some external validation as well.
Part 2:
She slid the evaluation towards me.
"Do you have anything you want to say?" She asked, eyes glittering, lips in a tight smile.
My heart was pounding in my chest and tears blurred my vision. I had a lot to say, but I was too overwhelmed to get any words out without falling apart. I scrawled a signature accepting my grade and gathered my books quickly, charging towards the door before I lost control.
I was reeling from the evaluation. It felt like series of accusations. Fails to show professional behavior. Fails to maintain professional-social distance. Does not know what she should know. Incompetent. She told me that she didn't think it would be in my best interest to act as a reference for a undergrad nursing position this summer.
As she read these phrases out to me, it felt like she had to be talking about someone else. Fails to maintain professional distance? What could she possibly mean? I wanted to ask but could not; I didn't want to start an argument that I couldn't win. The grades had already been assigned.
I mulled it over and over, trying to pinpoint a time I may have breached that professional boundary - moreso, trying to imagine a time that she might have actually been around to witness it. The only moment I can think of is where she breached the professional boundary and made an off-color comment to one of my families, jokingly referring to their (first, miraculous) post-term baby as a "peeler" and asking the father if he had any stories about 'The Peelers'. He was mortified ("Uh, no, actually, I am not into that at all....") and so was I.
Incompetent? How could this be? I'll be the first to admit there's a lot I don't know. But I ask. I work within my scope of practice and I ask as I go. I practice safe care, I keep my eyes and ears open, and I study at home to try and learn something for next time.
Nothing made sense. My patients expressed nothing but gratitude for the care they got. I independently assessed a need for breastfeeding support on several of my patients and got them the help they needed. I coached new moms through that initial latch and encouraged them to listen for the swallows of their feeding infants. I intervened on a gagging baby and got him to burp the biggest burp he'd probably ever made in his short life. I talked a young couple through how they felt about their changing from a couple to new parents. I demonstrated initial baths to several proud dads and their cameras. I found twin heart beats for an NST on my first try. I palpated fundi, I provided comfort measures, and I once dug through a bag of nasty post-birth laundry to retrieve a pair of tiny baby socks when everyone told me they were as good as gone. And not once did anyone say anything less than thank you with that look that said they meant it.
About that big 'win' I mentioned earlier - I left the hospital on my second-last day knowing I did good for someone. I had spent the entire day providing postpartum care to a new family stuck up in Caseroom until a Postpartum bed opened.
The mom delivered at about 0600 and was still up in the caseroom at 1230. Baby had been showing early signs of hunger but was also quite sleepy. She was an anxious mom, asking about feeding her baby, and the L&D nurse assigned to her provided very vague answers about how to get started with breastfeeding. I stepped in when the L&D nurse deferred their questions, and they had lots of them, like new parents should. I hunted down a pillow and helped prop her up in bed. I stole some breastfeeding pamphlets from Postpartum and sat down with her for close to an hour of teaching. I coached her on positions, and we finally settled on 'football'. I showed her how to get baby nice and awake, and ready to eat. Eventually, with plenty of teaching, patience, and false starts, mom and I got baby with a solid latch and feeding like a champion.
Elated, I went to find my instructor and show her, and further convince anxious mom that she was doing well. I found my instructor getting her hair trimmed by a service aide in the utility room, but I digress. Instructor came in and saw mom and baby feeding well and applauded mom. A few minutes later, at the desk, my instructor told my assigned RN that mom was successfully feeding babe despite all of the challenges and concerns she had before. The RN was happy and asked my instructor if 'we' did that. My instructor reiterated that mom was successfully feeding babe.
I was honestly crestfallen with that statement. I had, in my mind, been a huge advocate for this family; despite their staying up in the L&D caseroom all day, I made sure that they had the same quality Postpartum care (to the best of my ability) that they would have gotten on that unit. Nobody guided me to make these interventions. I saw the need for them to learn, so I stepped up my game and taught them. It was like opening flood gates: they asked about SIDS risks, carseats, skin-to-skin, jaundice, and the list went on. That family was so thankful and grateful for the time I took to spend with them, helping them transition into the role of new parents. That was the family who left their new baby's tiny socks on the birthing bed when they finally did get transferred to Postpartum - the ones I ran back upstairs and convinced Housekeeping to let me dig through dirty laundry bags to find.
So yes, I *did* do that - in the sense that if I hadn't intervened, that mom and baby might not have had the same outcome. They didn't transfer downstairs for another hour, and shift change wasn't for another 90 minutes after that, and I'd bet my stethoscope that poor baby would be screaming blue murder if he had to wait that long for his first meal. Screaming baby + already anxious mom = anxiety through the roof, and who knows, that anxiety could have shaken them so badly that baby would be on formula by now.
And where was my instructor? Selling me short, and telling me in my final evaluation that I was not knowledgeable and crossing professional boundaries.
To think that I started this clinical terrified that I was going to screw it up. If it wasn't for the incredible response I've received from my patients, peers, and especially the unit staff - who frequently expressed how glad they were to have us, and often gave me a high five or a hug at the end of the shift - I would finish this clinical convinced that I am a shitty nurse. If it wasn't for how I felt going home a few days ago, when I KNEW I'd made a lasting difference with my families, I would doubt myself. But I know I did well. One voice to the contrary can't change that.
One thing did jump out at me at my evaluation. Despite all of the bullshit incompetencies on my final evaluation, there was not one bad thing my instructor could say about the quality of care I gave. There was absolutely nothing wrong with my practice as a nurse. The angles she took to undermine me were personal and nebulous. I really wish I had asked for concrete examples of these incompetencies; I would have liked to hear her try to describe them as specific situations.... but I was just too upset with disbelief to argue the point.
I think of the few times she was around to witness my practical skills - Vitamin K injections, initial baths, newborn assessments. She said I did them fine. I even asked her for critique and she had none.
I think of all the times she was around me as a person, not as her student. Very clipped responses, sarcasm, awkward silences.
And I wonder - what on EARTH had I done to make her dislike me so much that she would want to attack me like this. I still draw a blank. Maybe I reminded her of someone.
The lasting damage has been done. Her appraisal of me as a future RN has been decided, written, and filed away somewhere to inevitably reappear when I want to apply for a cool opportunity at my school. I will not let this define me. I will continue to advocate for my patients and provide them with exemplary care, and I will not let personal grudges EVER get in the way of that.
As my peers told me later while I cried into a cup of coffee, I grew so much through this clinical and I did it without my instructor's guidance. I became a better nurse despite her instruction, not because of it.
Part 1 [Last night]:
Thank you all for your patience while I get back into the groove! I had an a-maz-ing week at the CNSA National Conference, as you can tell by my various phone updates, and I will recap it for you as soon as possible. I came home on Sunday and it has been a total whirlwind since then, which is pretty much my life during clinicals.
@Cartoon Characters: Thank you for your awesome supportive comments. I really appreciate you stopping by to say something! Especially given your career :)
Today marked the last day of my experience in Maternity. I have mixed emotions about it - since my final evaluation is tomorrow, I wanted to really reflect and consolidate my patient experiences before going into my eval. I don't feel especially confident in my instructor's appraisal of me, partly because I have NO IDEA what she thinks of my practice, and mostly because I have found her pretty hard to gauge.
A word about instructors... I think one of the most important traits to have is transparency in your opinion. If you think I did great, please say so. If you think my practice sucks, PLEASE say so. But even more than that, it is so important to have an instructor who is willing to share in my challenges and in my victories. I had a huge win yesterday - I'll explain in a bit - and I wanted to share that with SOMEBODY, and so I turned to my instructor. She gave no opinion at all and just stared at me with a blank face until I trailed off and awkwardly walked away. It didn't diminish my feelings of success because I KNOW that I did well and no one's lack of championing my actions can change that. But it would have been nice to have some external validation as well.
Part 2:
She slid the evaluation towards me.
"Do you have anything you want to say?" She asked, eyes glittering, lips in a tight smile.
My heart was pounding in my chest and tears blurred my vision. I had a lot to say, but I was too overwhelmed to get any words out without falling apart. I scrawled a signature accepting my grade and gathered my books quickly, charging towards the door before I lost control.
I was reeling from the evaluation. It felt like series of accusations. Fails to show professional behavior. Fails to maintain professional-social distance. Does not know what she should know. Incompetent. She told me that she didn't think it would be in my best interest to act as a reference for a undergrad nursing position this summer.
As she read these phrases out to me, it felt like she had to be talking about someone else. Fails to maintain professional distance? What could she possibly mean? I wanted to ask but could not; I didn't want to start an argument that I couldn't win. The grades had already been assigned.
I mulled it over and over, trying to pinpoint a time I may have breached that professional boundary - moreso, trying to imagine a time that she might have actually been around to witness it. The only moment I can think of is where she breached the professional boundary and made an off-color comment to one of my families, jokingly referring to their (first, miraculous) post-term baby as a "peeler" and asking the father if he had any stories about 'The Peelers'. He was mortified ("Uh, no, actually, I am not into that at all....") and so was I.
Incompetent? How could this be? I'll be the first to admit there's a lot I don't know. But I ask. I work within my scope of practice and I ask as I go. I practice safe care, I keep my eyes and ears open, and I study at home to try and learn something for next time.
Nothing made sense. My patients expressed nothing but gratitude for the care they got. I independently assessed a need for breastfeeding support on several of my patients and got them the help they needed. I coached new moms through that initial latch and encouraged them to listen for the swallows of their feeding infants. I intervened on a gagging baby and got him to burp the biggest burp he'd probably ever made in his short life. I talked a young couple through how they felt about their changing from a couple to new parents. I demonstrated initial baths to several proud dads and their cameras. I found twin heart beats for an NST on my first try. I palpated fundi, I provided comfort measures, and I once dug through a bag of nasty post-birth laundry to retrieve a pair of tiny baby socks when everyone told me they were as good as gone. And not once did anyone say anything less than thank you with that look that said they meant it.
About that big 'win' I mentioned earlier - I left the hospital on my second-last day knowing I did good for someone. I had spent the entire day providing postpartum care to a new family stuck up in Caseroom until a Postpartum bed opened.
The mom delivered at about 0600 and was still up in the caseroom at 1230. Baby had been showing early signs of hunger but was also quite sleepy. She was an anxious mom, asking about feeding her baby, and the L&D nurse assigned to her provided very vague answers about how to get started with breastfeeding. I stepped in when the L&D nurse deferred their questions, and they had lots of them, like new parents should. I hunted down a pillow and helped prop her up in bed. I stole some breastfeeding pamphlets from Postpartum and sat down with her for close to an hour of teaching. I coached her on positions, and we finally settled on 'football'. I showed her how to get baby nice and awake, and ready to eat. Eventually, with plenty of teaching, patience, and false starts, mom and I got baby with a solid latch and feeding like a champion.
Elated, I went to find my instructor and show her, and further convince anxious mom that she was doing well. I found my instructor getting her hair trimmed by a service aide in the utility room, but I digress. Instructor came in and saw mom and baby feeding well and applauded mom. A few minutes later, at the desk, my instructor told my assigned RN that mom was successfully feeding babe despite all of the challenges and concerns she had before. The RN was happy and asked my instructor if 'we' did that. My instructor reiterated that mom was successfully feeding babe.
I was honestly crestfallen with that statement. I had, in my mind, been a huge advocate for this family; despite their staying up in the L&D caseroom all day, I made sure that they had the same quality Postpartum care (to the best of my ability) that they would have gotten on that unit. Nobody guided me to make these interventions. I saw the need for them to learn, so I stepped up my game and taught them. It was like opening flood gates: they asked about SIDS risks, carseats, skin-to-skin, jaundice, and the list went on. That family was so thankful and grateful for the time I took to spend with them, helping them transition into the role of new parents. That was the family who left their new baby's tiny socks on the birthing bed when they finally did get transferred to Postpartum - the ones I ran back upstairs and convinced Housekeeping to let me dig through dirty laundry bags to find.
So yes, I *did* do that - in the sense that if I hadn't intervened, that mom and baby might not have had the same outcome. They didn't transfer downstairs for another hour, and shift change wasn't for another 90 minutes after that, and I'd bet my stethoscope that poor baby would be screaming blue murder if he had to wait that long for his first meal. Screaming baby + already anxious mom = anxiety through the roof, and who knows, that anxiety could have shaken them so badly that baby would be on formula by now.
And where was my instructor? Selling me short, and telling me in my final evaluation that I was not knowledgeable and crossing professional boundaries.
To think that I started this clinical terrified that I was going to screw it up. If it wasn't for the incredible response I've received from my patients, peers, and especially the unit staff - who frequently expressed how glad they were to have us, and often gave me a high five or a hug at the end of the shift - I would finish this clinical convinced that I am a shitty nurse. If it wasn't for how I felt going home a few days ago, when I KNEW I'd made a lasting difference with my families, I would doubt myself. But I know I did well. One voice to the contrary can't change that.
One thing did jump out at me at my evaluation. Despite all of the bullshit incompetencies on my final evaluation, there was not one bad thing my instructor could say about the quality of care I gave. There was absolutely nothing wrong with my practice as a nurse. The angles she took to undermine me were personal and nebulous. I really wish I had asked for concrete examples of these incompetencies; I would have liked to hear her try to describe them as specific situations.... but I was just too upset with disbelief to argue the point.
I think of the few times she was around to witness my practical skills - Vitamin K injections, initial baths, newborn assessments. She said I did them fine. I even asked her for critique and she had none.
I think of all the times she was around me as a person, not as her student. Very clipped responses, sarcasm, awkward silences.
And I wonder - what on EARTH had I done to make her dislike me so much that she would want to attack me like this. I still draw a blank. Maybe I reminded her of someone.
The lasting damage has been done. Her appraisal of me as a future RN has been decided, written, and filed away somewhere to inevitably reappear when I want to apply for a cool opportunity at my school. I will not let this define me. I will continue to advocate for my patients and provide them with exemplary care, and I will not let personal grudges EVER get in the way of that.
As my peers told me later while I cried into a cup of coffee, I grew so much through this clinical and I did it without my instructor's guidance. I became a better nurse despite her instruction, not because of it.
Subscribe to:
Posts (Atom)
