I confess: I’ve kind of done a 180 in the area of job satisfaction, at least for the time being.  I have so many friends, husbands of friends, friends of friends who are out of work right now, that I’m singing a different tune.

Though I am hopeful the economy will turn around sometime in the near future, I hesitate advising anyone to give up gainful employment in hopes of finding something they like better.  And you know what, I don’t think working a job you don’t love is the worst thing in the world.  In fact, it might be just the thing to help a rather spoiled nation of workers get back in touch with reality.

There are a lot of people in this world who are grateful to do ANY type of work to earn a very small amount of money in order to feed their families.  There are people who have worked a job they hated their whole lives to provide a comfortable home for those they love.

We feel entitled to get great satisfaction out of the work we choose.  And we’d like to get paid well for it.  But the truth is, if those things happen, it’s a blessing, not a rite.

I have been very fortunate in my life to have had many jobs I loved.  I currently have a wonderful situation where I only work a few hours a week.  But times are changing, and I need to be prepared to suck it up and go find a full-time hospital position with benefits, working nights and every other weekend if that’s what it takes to put food on the table.

I’ve been spoiled and I know it.  I enjoy being home during the day, going out for coffee with friends, meeting my husband for lunch, getting my kids off to school in the morning, and welcoming them home when it’s over.  But if anything were to happen to my husband’s job, I have a profession that would keep a roof over our heads.

We all have to do our part when the economy tanks.  And the beauty of it is, we’re all capable!  It’s in times like these that we get to find out what were really made of.  And if you’ve already made it out of nursing school, you’re made of good stuff.

As health care professionals, we have a first row seat to the drama as it unfolds.  We know the stories of patients who have insufficient or no coverage.  Who have not received the care they needed because it was too expensive.  Who don’t take their prescribed meds for the same reason.  Who are denied coverage because of a pre-existing condition.  We also know the stories of the doctors, hospitals, and clinics who can barely keep their doors open because reimbursement is so terrible.

It’s a mess, everywhere you turn.  Unless you’re the CEO of a big insurance company.

My goal for this post is not to tell you what I think about this topic, it’s to hear what you have to say on the issue.  It’s each of our jobs, as nurses and as health care consumers, to stay informed.  The problem is, it’s hard to feel informed if you have to count on the media to give you the information. 

Maybe we can help each other get a handle on this important conversation by sharing our knowledge, questions and ideas.

So, tell us what you think.

Not listed, but also expected: picking up paperclips from the floor, trying to keep my piles neat, and telling someone when the Kleenex are running low.  And really, truth be told, I probably spend as much of my day doing the things that aren’t explicit as the things that are.

A couple of weeks ago I was filling in at the other end of the clinic.  I took a phone call from a patient who was basically gasping for air on the other end of the phone.  She had been in a couple of days earlier with bronchitis, but was worse.  She wanted was another prescription.  What I wanted was for her to call 911.  Our compromise was an appointment at the clinic in about 45 minutes.  I told her to call a cab because her husband was out of town and she didn’t have any friends who could bring her.

In the end, she came in with lungs that sounded like they could be coughed up at any moment.  The doctor called an ambulance to take her to the hospital.  She hobbled out to the desk where I was sitting and started talking about her puppies.  Her distress had much more to do with how they would be cared for than the fact she was about to be admitted.  Before I knew what had happened, she was digging through her address book looking for names and numbers of people who might be able to check on them. And she wrote them down for ME to call. 

Say what?  She also wrote down her husband’s email address because he was at a conference out of state and could not be reached by cell phone during the day, but would have his laptop opened.

Next thing I know, I’m emailing this poor man to let him know his wife is headed to the hospital via ambulance.  Once that was out of the way, I had the task of finding those darn dogs a babysitter. 

As I left messages on various answering machines, I realized the ludicrousness of the situation. 

When I hung up for the last time I said to the doctor, “I don’t remember this being in my job description.”

But as I said, much of what happens in nursing isn’t actually about the job description.  It’s the little things we do everyday that go above and beyond the expected that really speak to who we are.  We are a helpful and caring lot.  We see what needs to be done and we do it.  We care about more than just the physical needs of our patients.  At least that’s what I hope we’re about.

So what have you been asked to do lately that wasn’t in your job description?

Then Wednesday night hit.  It was the beginning of a 24-hour period that had my adrenaline in overdrive.  One thing after another kept happening, and I was at my wits end by Thursday night.

Here is a brief overview:

The camp pastor fell on a horseshoe stake and injured his leg.

A 12-year-old boy fell off a 10-foot platform face first.

A 10-year-old boy was brought in on a back board after injuring his neck inner-tubing.

Another 10-year-old boy fell and injured his arm and ended up in the ER.

Now, between these injuries were several bee stings, a sprained ankle, a minor eye injury, and all the minor stuff mentioned above.  Those were easily dealt with and forgotten moments after they happened (for me, if not the patients).

It was the others that had me reeling a bit.  Three of them I was alerted to before I saw the victim.  The fourth happened in front of me.  I watched the fall through the lens of my camera.

In each case, my stomached dropped.  Remember, I’m a Family Practice nurse, NOT an ER nurse.  It’s amazing what comes to your mind when everyone is looking to you to deal with an injury.  Honestly, after the “Oh crap” thought left my head, I went into an immediate prayer.  It went something like this: “God, please help me to be sufficient for this situation.”  Short and sweet. 

I was completely aware that I might not have the experience needed to care for the injured party, but I was all they had in that moment.

I am smart enough to know that my very first responsibility is to remain calm.  If I don’t, no one else will either.  It’s all an act, of course, but they don’t have to know that.  Beyond that, I just start doing whatever comes naturally (or supernaturally in some cases).  I take control, ask questions, and pretend they are in extremely capable hands as I start attending to whatever need they have.

If you’ve been reading this blog for a while, you may remember that my first camp nurse experience didn’t go so well.  Actually 99% of it went fine.  It was the 1% named Tony that was the killer.  Tony was electrocuted by a fan in the camp kitchen and died.  He was 17.  I did everything I knew to do, but he died anyway.

We all face situations as nurses where we aren’t sure our abilities will be enough.  Where we don’t know if we know enough.  Where we feel insufficient.  Sometimes, in fact, it’s the truth.  But more than likely, we have everything we need to do the right thing for the patient.  Tony died because he was electrocuted, not because I did anything wrong.

And our patients deserve our confidence.   What could be worse than feeling terrible and have the person who’s supposed to be taking care of you acting like they don’t know if they can?  Talk about adding insult to injury!

So the next time you have to do something you aren’t sure you can,  fake it.  Even if you have to get some help, ask for it in the most confident tone you can muster.  You are a professional.  Other people assume you’re qualified.  Act like you are.  And if you’re still a little uncertain, you can always try my approach and pray.  Who wouldn’t want to believe there is a higher power who can bridge the gap between what they have and what they need?

The thing is, conflict is a part of life. So we all have to learn how to deal with it.  It happens at home, at work, even at our places of worship.

The older I get, the more I have come to realize that conflict doesn’t always end in a negative way.  Sometimes it can strengthen a relationship.  If it’s handled with respectful honesty, it can enlighten both sides and bring change and understanding.

Two years ago I had an opportunity to test this theory with my boss.  He had hired a new MA to help cover his expanding hours.  Unfortunately, she needed more hours than he was offering…so he gave her mine.

Needless to say, I was a little miffed.  Out of the blue I get a call from the supervisor telling me I’d be working with a different doctor on Tuesday afternoons starting the next week.  I cried for days.  I loved the doc I was working with.  I had been with him for over seven years and had known him for eight years before that.  The hurt I felt was overwhelming.

At some point, he found out I was struggling and called me.  I’m sure he was sorry he did about two minutes into the conversation.  I had gotten over my fear of conflict at let him have it.  Not in a mean, yelling sort of way–but in a “let me bear my heart to you through deep guttural sobs” kind of way.  He was speechless.

I got a beautiful floral arrangement the next day with a lovely card saying, “Wishing I’d been more thoughtful”.

I’m not saying I handled this well. But because I was willing to be honest about my feelings and willing to forgive his initial lack of them, we were able to resolve the conflict.  He apologized, I accepted.  He figured out a way to give me my hours back, I swallowed my pride, and went back to work for him.

It involved give and take on both sides.

Throughout the whole ordeal, I realized some things about myself.  I am extremely loyal.  I love feeling like I’m part of a team.  I want to feel like I matter, like I make a difference, like I’m important.  Being made to feel like I was expendable was excruciating to me.

I also realized that I would probably be a terrible business person.  He was making a good financial decision.  It costs him less to have an MA.  In order to get her, he needed to give her more hours.  It was logical for a guy who felt the need to tighten the expenditure belt.  He was not in the wrong, he just left out the part about explaining his situation to me.  If he had, since I’m loyal and a team player, I would have moved on–sad but with understanding.

It’s been two years since then.  I’m still there.  The MA has moved on and hasn’t been replaced.  My doc and I have a very good relationship.  He gets me and I get him.  He still makes me crazy now and then and I occasionally overreact to things.  Our relationship is no worse for the wear.  Maybe it’s even better.

I have lots more stories about conflict with my family, but I think I’ll keep those to myself.  I don’t always handle those with poise and grace either.  I do find that on the homefront, humor goes A LONG WAY in helping to resolve conflict.  If I can make my husband or kids laugh during a heated discussion, I know we’ll be okay.  It’s often the turning point for us.

Do you have any tricks to getting through conflict?  We’d all love to hear them.  I’ll start the list:

1)Respectful honesty

2)Humor

3)Yours????

Love her or hate her, she certainly has generated some strong comments from our readers.  The general consensus was that the TV show, which depicts the life of a nurse, is unrealistic.  Some find it offensive, some find it funny.

We could argue the rights and wrongs of this particular show for days, but here’s what I would like to know.  How would a good television drama or comedy portray a nurse?  What are accurate stereotypes of nurses? What storylines would be interesting enough to keep an audience entertained for 13 episodes a year but also be realistic?

Give us your ideas.  Maybe we could name the show Reality RN

Like you’re trying to move forward with something but you’re walking through deep, thick mud.  You have some task in front of you (like writing a blog post) and you just can’t seem to get it done.

I’m just coming out of a period of time where my whole life felt that way.  I couldn’t seem to keep my house clean, couldn’t find the motivation to lose those extra pounds, couldn’t get my paperwork in order.  Everything felt a little too overwhelming.

I was talking to a friend after I had finally started a diet and conquered one of my house projects, and she used the word momentum.  I had finally found some momentum.  Forward motion.  Progress.  I don’t exactly know how it happened, but man, it felt great.

Don’t get me wrong.  It’s not like I’ve turned my life around here or anything.  I’ve only lost 11 pounds in 6 weeks, there are many more house projects to start,  but I have momentum.  It’s kind of a feel-good word for me at the moment.  It means I’m moving forward.  It means hope.

Work can be the same way.  I start the day with piles and piles of charts in front of me.  I get overwhelmed by the sheer volume, not to mention the work each one entails.  The only way I can begin to get a handle on it is to sort, separate, rearrange, and organize.  I make stacks and label them with sticky notes.  Then I start one pile at a time, handling the fattest charts first.  I love to see the pile shrink by half simply by addressing a couple of charts.  It gives me a feeling of…momentum.

So what do you do to give yourself a little momentum when you’re feeling stuck?  How do you psych yourself up to dig in?  How do you start an overwhelming project?  It may not be an everyday thing for most of us, but we each face that thick, gooey mud now and then.  And since that pile of paperwork is still sitting in my kitchen, I’d love to hear some fresh ideas!

I, on the other hand, am not panicked.  I am annoyed.  The phones of every doctor’s office in the country, and possibly a few other countries, are ringing off the hook.  Every person with a fever, every kid with a cough, every kid who sat next to a kid with a cough: They are all worried to death (or at least their mothers are) and looking to the medical profession for answers.

Unfortunately, the answers I want to provide are sarcastic.  “Do you know how many people die of influenza every year in the US?  36,000!  And do you know how many have died of H1N1 flu in the US so far?  One!  That’s how many.  So go home and take some Advil, get some rest, and drink plenty of fluids.  Trust me, the chances are pretty good that you’ll live.”

Fortunately for my patients, I never actually say what I think.  It doesn’t actually matter what I think.  What matters is that people are scared.  My job is to care for them.  In part, that’s relieving those fears, but it’s never dismissing them.  The term pandemic is scary.  It causes a low-level hysteria that rapidly grows into a high-level hysteria as news pundits discuss it day after day.  I can share my personal opinion with friends, but not with my patients.  I have to handle each person and each concern like it matters to me.

My best friend is an advice nurse in California.  She told me yesterday that they have received thousands of calls in the last couple weeks about the Swine flu.  The other day they were 6 1/2 hours behind on answering calls.  Of course, people were calling with “normal” stuff, too.  They also had to wait to be called back because of the flu calls.  It’s completely overwhelming.  But one call at a time, they go through the protocol, giving advice, making appointments as needed, and talking people off the ledge.

I guess what I’m saying is that it’s okay to feel frustrated about stuff like this, it’s just not okay to show it.  At least not to our patients.  They deserve to feel like their illness, real or perceived, is important to the ones they have entrusted themselves to.

I thought it was PVC’s, which I have occasionally, but it felt a little different.  I took the stethoscope that was hanging around my neck and listened to my heart.  Wow, I thought, that’s pretty fast.  As I counted the beats, I tried to take some deep breaths and calm it down.  I looked up at the other two nurses standing there and said, “My pulse is 160, and I feel a little weird.”

Next thing I new, I was in a room with a gown on and hooked up to our ECG machine.  “Do you want to stay here while I go get a doctor?” my co-worker said.

“You’ve got to be kidding!  Of course I don’t want to stay here!” I said.  “I don’t want to be a patient.”  I got dressed and headed down the hall to find my doctor consulting with another doc, ECG in hand.  Before I knew it, I was in another exam room getting my carotid massaged.

Now the reason for this little story is not to sound dramatic or to get your medical advice regarding my SVT. It’s to remind you that being a patient sucks.  It’s uncomfortable.  And I’m not talking physically.  It puts you in this place of feeling totally out of control.

And you know us nurses: We like our control.  But I don’t think we’re alone in that.

So the next time you’re caring for a patient, try to put yourself in their shoes.  Try to remember what it was like before you knew anything about medicine. Imagine how they must feel as you spew your new-found knowledge all over them.  Think about the last time you found yourself wearing nothing but an ugly, and all- too-thin piece of cloth (or in my case, paper).  Try to imagine being told that something inside of you isn’t working the way it’s supposed to.  Or that you will soon be having someone with a very sharp knife standing over you.  Or that there’s nothing more to do to make some horrible cancer go away.

None of it feels very good.  Emotions soar.  Fear hovers.

You may not be able to relate to every patient you care for, but you can certainly try to remember a time when you felt out of control, too.

So put on your best empathetic face tomorrow.  Acknowledge your patients’ feelings before they even have to voice them.  Help them feel like they still have a little dignity.  Like they aren’t stupid.  Like they aren’t a bother.  Like they’re exactly where they’re suppose to be: Getting the best care they can get.

Trust me.  It makes a difference.  And soon enough you’ll know just how much.

I walked into work one day and one of our little patients went into respiratory arrest right as I finished getting report on her.  We spent the next 12 hours saving the life of this poor little girl.

The patient had been born with problems (though all these years later I have no idea what they were) and was blind and deaf.  In fact, she was non-responsive.  She had been in the hospital since birth.  Her mother was already pregnant with child number four and hadn’t been to see her in several months.  It was her father who had been faithful in holding vigil and wanted everything possible done for her.

It wasn’t the intensity of the day that sent me running.  It wasn’t the profound sadness either.  It was the fact that we put this 6-month-old through hell for the entire shift.  Sure we kept her alive, but I felt no pride in that.  I was so conflicted during the entire shift.  I worked my tail off to keep this child alive while praying the entire time she would die and wake up in heaven.

She finally died, but not for another two weeks.  Not until we had spent a few hundred thousand more dollars and put that child through every imaginable horror.

It was ethics that finally made me resign.  It seemed wrong that all I truly wanted for this child was release from this life though I worked heroically to keep her in it.  I finally decided a good PICU nurse should only think about life, so I moved to Colorado and started a career in Family Practice.

I would handle such internal conflict differently now.  Maturity of self and career gives one perspective only time allows for.  The truth is, much of life is filled with ethical dilemmas, but we, as medical professionals, seem to face them on a routine basis.

Have you had some situations like mine?  How did you handle them?  Do any of them still haunt you?

I came across the story of another nurse who faces a similar conflict.  You can find it at http://well.blogs.nytimes.com/2009/03/18/a-nurses-distress-over-a-dying-patient/?hp

It’s so helpful to all of us when we see ourselves in other people’s stories.  It makes us feel like we’re not alone, wrong, or just plain crazy.  Take a few minutes and share your story with us.