"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"


Monday, February 29, 2016

What's Next

Hey everyone! Welcome back. 

So, the past couple months have been a whirlwind of excitement, turmoil, and an incredible learning experience. Let me recap. 

I spent the entire fall not only learning my hospital networks newly adapted Electronic Health Record system, but then teaching it in segmented classes to all of my networks nurses and nurse managers, supervisors and executives. I loved it so much. I never thought I'd make a good teacher, but once I got up there I had the incredible need to share as much information with everyone that I could. I wanted them to know as much as I did, I wanted them to get as excited as I was. I saw how much better this would make our healthcare for patients and I wanted them to see it too. Being a nurse, I was able to bring the information to the nurses and make it relatable. I was able to give them scenarios on why this was helpful for them, a good change. I got great reviews because I was so relatable. I loved it and I wanted more. More teaching, more IT, more knowledge. But then we went live with our software change and unfortunately I was faced with the challenge of my temporary assignment being over and I was then assigned to go back to my nursing unit to work as a nurse until further notice. At first I was terrified, and disappointed. I was terrified because I had been off of the unit for about 5 months and I wasn't sure how well I'd do being submersed back in at full force. I was disappointed because part of the reason I took the temporary assignment in the first place because I was feeling burnt out and run down from Med Surg Nursing. Don't let anyone tell you differently, whether you love it or not, Med Surg Nursing after a few years will take a toll on anyone. So going back was terrifying for me. During my absence many new people were hired, some thought I was the new person since they hadn't met me yet. Every turn I made I met someone new! (And 2 months later, I still am!)

Luckily, like a lot of my friends & family figured, jumping back into bedside nursing truly was like riding a bike. Besides a few minor hospital policy changes, or minor unit workflow changes, or a change in where something is located, I picked up everything within a shift or two. 

Our new software change, in my opinion, has made wondrous incredible changes on the nursing frontline. This makes the geek in me extremely excited. The system prompts you to complete all your necessary work that you still have left to complete for a patient, and it is patient individualized, which means not every patient has the same "To-Do" list! We also get alerted if our patient is deteriorating by the system actually watching our patient's vital signs and observing trends. Not just that but there are may workflow changes that have been improved that are now much more efficient. No more double-charting. No more losing charting. No more downtime. There are so many analytics and reports viewable for our patients that it is incredible, it really makes looking at the patients "whole picture" much easier and user-friendly. Communicating with doctors is more efficient, nurse friendly and faster. Reading progress notes from clinicians is no longer a chore or a handwriting-analysis exercise. All notes from every health care clinician or provider including Doctors, Nurses, Therapists, Case Management, etc., are all typed into this software, and of course readable! This way nurses can better understand (and read) the patients actual plan of care and case. There is nothing I don't like about it! I can confidently say that it has made me a better nurse 100%. Also, with this new change we also were able to adapt devices that have this software loaded onto a small device very similar to an i-phone where nurses and aides can take this from to room to room and have all of their patients information loaded in, and they can chart intakes & outputs, vital signs, complete blood work AND even document medications right from this little device. This also makes the nursing workflow incredibly easier and more efficient. This device uploads in real time and no docking required, unless to charge! 


But even though I find myself becoming a better nurse, I find myself feeling burnt out still from the politics of healthcare and Med Surg nursing. I am ready to move on and am so happy to accept a new position of a Clinical Informatics Analyst starting in 2 weeks! In this job I will be on a small team that analyzes how clinicians and IT work together to improve healthcare and technology. We will improve documentation, fix issues or build workflows, innovate new ideas, make new processes, etc. We are the bridge between IT (non healthcare personnel and nursing). This is super exciting for me because I have been raised on computers. My father comes from a long career history of working intensely with computers and has taught his daughter well. I also probably inherited some genes of being very interested in technology. I am always interested in the newest gadgets, how they work and more importantly, how they can improve human life. So now I will be looking at and working with healthcare gadgets, how they work and how they can improve patient's lives! 

So, as you can see- many changes coming in my life & career. So I want to take a moment to reflect back on my bedside nursing experiences and what I expect for the future. 

As a new graduate, I started on a women's health specialty oncology unit. Having only 11 beds and working nightshift with only 1 other nurse, I had to pick up the skill of autonomy very quickly. With high acuity patients, it was a crash course in nursing. I then transferred to a bigger hospital in my network where they I worked on a Med Surg Telemetry unit where I am now. A lot of things changed when I came here, because not only was I transferring campuses, but my old hospital had just been bought out by the hospital network I transferred to but hadn't quite completely integrated all of their changes into my old hospital by the time I left. So even though I was transferring within my network, It felt like I was transferring to a whole different world. I was also crossing state lines, where there was different healthcare rules. In my new hospital, now nurses and aides were responsible for all blood work.The laboratory   only ran tests, no more on the floor phlebotomists. Nursing and aides were also responsible for EKGs, which actually used to be done by respiratory therapists back in the day at my hospital. I also had to quickly adapt to a sicker patient and higher acuity workload on a telemetry unit. At my old hospital, I had the pleasure of having "telemetry techs" that sat in a room and watched every single heart monitor rhythm in the hospital. They simply called me if there were an issue. I am ashamed to say that within my first few months, the tech called me and told me my patient had a few beat run in Vtach, and I remember replying..."oh. Thats bad, right?" Sigh. Whereas in my new hospital there was no tech and I was responsible for not only caring for 7 patients but also keeping an eye on their telemetry heart monitor rhythms too. 0_0 

Needless to say, I survived but not a day went by where I felt like it was easy. It was always challenging and kept me intrigued. But my home life started to wear away as this increased stress load starting eating away at me. I would lie awake at night and wonder if I did something wrong, if I charted everything okay, did I waste every med? Could I have saved that patient? Did I miss something? I started dreading going in to work and my headaches and nausea incidences picked up immensely. I can't even count the amount of times I have been in a shift and thought, "If I can make it through this shift, It will be a miracle. I will be so thankful to be back home and hide under my covers." 

Yes, Its true. And I'm sure every single nurse that you know or that reads this knows exactly what I'm talking about. 

Over the past 4.5 years of nursing, I picked up a lot of skills and I consider myself a mixture of Proficiency and Expert in Patricia Benner's Novice to Expert Nursing Model. However I always was self conscious and thought it to be a weakness of mine that I never really developed a special skill. I was never the "best IV stick" on the floor. Or the "best charge nurse". Or the "best wound care person" ( i never really grasped wound care), or the best person to know X, Y, Z. I rather considered myself a jack of all trades. Or should I say a Jack of all nurses? I felt like even though I never really mastered one skill to its maximum, my "skill" was that I knew a little bit about everything. I had gotten myself involved in a lot of different committees and PI projects and let me tell you, network is KEY to strengthening your career AND your knowledge base. I was always interested in learning and would read nursing books galore and take CE credit courses on my own time or attend nursing conferences. So i knew a lot but mastered none. I always considered this to be a weakness. I always thought to myself, how can I have been through almost 5 years of nursing and I'm still not absolutely great at putting in IVs? How come I never memorize what ABG results mean?? And more. But then I realized that my skill in having multiple trade skills was my super skill! I had the uncanny ability to remember patients information, to organize their care and to stand up for my patient. I had good judgement. I studied their plan of care by reading doctors note after doctors note until I understood everything about the patient. I was able to look at the patient's whole picture and situation and I would honestly take that learned skill over putting in the world's best IV any day. I think this skill has gotten me to exactly where I am today, as I have always had the passion to improve care for patients. Ever since my first day in nursing, I have always thought, "Why are we doing it this way?" I have always thought of imaginary new devices that could be invented to make nurses jobs easier, or new workflows. I have always been able to think out of the box. I know enough to understand the "textbook rules", but have enough judgement to throw most of that away and do whats actually right for the individual patient. When A, B, and C don't work, lets figure out what else will work for the patient. That was my super skill and thats why I think I will do well in informatics. 

Part of me is also terrified to leave the bedside. This time its not temporary, its permanent. I scare myself that I'm only 27 and I'm stepping away from the bedside, something a lot of nurses don't do until they are a lot older or have more experience. I want to stay current in what is going on in nursing and want to maintain my clinical skills. I don't want to get so involved in the IT world that I don't feel like a nurse anymore. I don't want to forget what it was like, so that I can remember how to make it better. 

I don't predict however that this will be the end of my bedside career. If I ever do return, I don't think I can ever realistically return to bedside Med Surg Nursing. It's simply not an option for my soul & heart anymore. If I do return, I am interested in three pathways that actually have nothing to do with each other. Either the NICU, Hospice Nursing, or Emergency or ICU nursing. So maybe that will be where I end up one day. I am not the type of person to stay in one position for forever, I am adaptable, a hard worker and always intend to move up or change positions to learn more or to try something new. 



Whew! I talked about a lot. Sorry. My brain had a lot to say. I am very excited. If you read that all, you are a true fan and a friend of mine. Like I said when I "came back" recently to blogging, I am mostly writing for me. I want to document my endeavors in nursing so I can look back on this in 20 years and see where I was in my career. If you like it and get something out of it, then that is absolutely fabulous! I want to help as many nurses succeed in their career as I can. 


With love, 

A Writer in a Nurses Body 




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