Go-Live Success

Well, as promised- I have returned for a second time in under a week! That's already an accomplishment! Also, as promised- I want to tell you all about how our Go-Live went. Now remember I'm not naming my hospital network or the system we went live with, but refer to my last post for a clue... Now anyway, the system is amazing, just like I knew it would be. It is fascinating having had the privilege of learning the system since September and teaching it to others, but so far only having seen it with fake patients. I was so eager just to get to see it work for real! As we drew closer and closer to the Go-Live Flipswitch, my coworkers fear and anxiety levels rose but my excitement drew higher.

Getting to work with it all weekend after that moment has been fantastic and very eye-opening. I remember having had "play time" on one of my last days of my own training where we were allowed to just play around and practice anything so that we felt completely ready to help once we went-live. I practiced and practiced and I thought surely, I know everything know- What other situation could arise that I don't know how to do?

Well, I should have slapped myself right there because the rest of the weekend I was "go-Live support" which entailed me running around the hospital ( I literally ran up and down some stairs a few occasions) in order to help all three of our units and the ICU, and handle any problems that were arising. Needless to say, my "to-do" list was about 20 items long and it kept me busy all 12 hours of my shift. I would cross one thing off and be on my way to handle another and then on that route another problem would occur. So, point of the story is I thought I knew how to handle everything but then when real patients are in with unique individual situations and the patients aren't fake, certain charting queries come up and there needs to be a firm solution on how to handle that. I was put on the spot many times and had to rack my brain at 3 am in order to get a solution.

It is interesting watching people learn. Like I said before, I had the opportunity all fall to teach fellow nurses, PCAs, and Nurse managers on how to use the system. We faced a lot of kickback, frustration, tears, confusion, etc. And although I saw a lot of frustration with the Go-Live as well, overall these nurses knew that frustration was not going to help their patient and that if they just sit back and let us teach them how to handle the problem, they would go a lot further. Therefore a lot more health care personnel were a lot more open to learning this time around since we were working with real patients, real time, real problems. It was also delightful getting a lot more "Ah-ha!" moments from our users.

It is a known fact that users always learn faster when emerged inside of a real situation. We can only teach these users so much and get them to remember when we are working with "John Playdough" instead of a real patient, and when we are teaching 2-3 months away from the Go-Live day. And yet when these users are using it every second of their shift because they have to for their real patients, they pick it up much faster. Just like learning a language- You learn French much better stuck in the middle of France than you do in a classroom.

Overall this whole experience so far has reinforced within my own self that I love informatics, I love teaching people and I still love healthcare. I can't wait to grow inside this field and to accomplish more tasks. I love being in charge of projects around the hospital and reporting to and talking directly to high-up administration (literally had multiple conversations with the vice president of my hospital over the weekend!) not because of a power trip- but because I like being trusted and knowing that people believe I can accomplish difficult tasks.

Well, another weekend of work ahead-stay tuned! In other news, I get to go to my orientation for my masters program tonight! Super awesome! And next Tuesday I start my class! So exciting! Nerdddddddd. :-)

A Story and a Dream

"If theres any body out there listening to me, all I have is a story and a dream. Here I am, and thats all that I can be." -Tori Kelly

Hi. It's me. I'm writing again. I'm here.

I've been thinking about this blog for a very long time. It started in 2009 and around 2013 I lost my drive, my writing mojo. All together. I tried so hard to keep it all together and as my nursing career was starting and going strong I began to lose the writers part of my brain. I began to feel burnt out as a nurse after my 3rd year and it started to consume my entire life, my entire brain. It made me not want to write anymore. I didn't feel like I had anything to say. For awhile I tried making 1-2 posts a year but that just made me feel even worse. Even more guilty.

I guess part of me didn't know what to say and the other part of me didn't want to let my audience down. I worked so hard bringing this blog to where it was, gained so many followers and internet attention as It was being born- and then during my block- sometimes I would think of a post and instead of just going with it like I used to- Who cared what people thought?- I would filter it and ask myself, is this good enough for my blog? And usually I'd talk myself out of it or then find myself too busy to log on and try so the thought wouldn't come to fruition. The evil cycle continued.

However lately, my life has taken many strange and exciting turns. It has been a rollercoaster, to say the least. Like I said, I've been thinking about this blog and have desired to start it back up for quite some time now. But again thought to myself, do I have anything to say? But now I have realized within myself- the same self that started this back in 2009 that who cares what people think? This is my blog, my writing, my self. Lately I've really started paying attention to myself and reacting and standing up for myself and whats right. So from now on I will write what comes to mind and if it bores you then great, find a list to the right hand side of my page with other fantastic blogs you should go read. I need this. I need this blog now to be an open space for me.

So where is my life now? Where is my career? In recent exciting news, I have gotten married! Yeah! Crazy. I married a wonderful gentleman back in October. To say the least, it's been an incredible but very busy fall! I thank fates and heaven every day for my husband and this wonderful man, even though i'm pretty sure he doesn't even know how thankful I am for him every day. I try so hard to be a "good wife" but its not in my genetic code to be very wifely. Once in awhile I pull through for him though. ;) He's so patient with me, takes care of me, encourages me, inspires me, questions me in a good way, watches out for me, protects me, and loves me so much. Just the other day I was explaining to someone else that found them self in a rather new relationship- the friend asked me how I knew this man was the one- I said because we can read each other's minds. Although that sounds telepathic and futuristic- Its true! We can't actually, but we almost always know what the other is thinking.

We haven't been able to take a honeymoon however, much to our dismay. Why? That leads me to my next exciting news. My career took an exciting change for the better in August. The Hospital Network I work for has recently decided to adapt a new electronic health record system. For privacy purposes, I won't outwardly say which one, but if you know anything about health informatics and what system is currently sweeping the entire nation- you can probably guess which one. In August I was selected to come on to a team of trainers to teach all the nurses and care assistants in my entire network on how to use this system before it goes-live. So even though I had spent the last four years on the nursing unit at the patients bedside, I decided it was time for a "break" from the bedside and to follow my heart into healthcare informatics. Although I had never really been a trainer or teacher of any kind before August, I dove right in and for the last few months have been teaching nurses!

My mom is a sixth grade teacher. Growing up watching what she did every day, I didn't think I had it in me-the strength to do what she did. I admired her but didn't think I ever could do it. But, it was what I faced at the time so I jumped right in and started teaching! I soon found out after a few bumps and practice runs that I actually loved to teach! Sure I had a ton of challenges and challenging people (turns out teaching adults is very hard!), but that feeling of sharing your own wealth of knowledge and seeing other people "get it", is very rewarding. I even had a student tell me I was the best teacher he has ever had, including nursing school, and grad school. Go figure!

I knew I was good at it and ran with it. I was good because I was a nurse, teaching nurses. I understood what they go through on a daily basis, because I went through it all too. I understood what I needed to teach them in order for them to be successful. I was able to relate to them, tell stories about my own nursing care, give examples and scenarios on how this new system will make *our* lives easier as nurses. It was the perfect recipe.

So that whole process of going-live with the software? Yeah, that starts tomorrow. I know I am prepared because being a trainer, I know the system inside and out. However I start my journey back on the patients bedside during this whole process, my trainer/teaching time opportunity is thus far all done. So the next couple weeks/months will be stressful at best as we all cope with this very big change in my network. I am personally excited, even though I know it will be stressful. I am excited for the end result because I know the system will eventually better our patient care, give us more time with our patients instead of unnecessary charting. Just, in time. Everything good happens in time, right ? Something like that?

All that time all fall in the classroom has also inspired me to *finally* begin my Masters of Nursing program at a local university, in Clinical Nurse Leadership. I start in a week and a half and I am sooooooooo excited, but also nervous! I LOVE school, and I LOVE to be a student, and I am such a nerd because I honestly seriously do LOVE to learn new things. I want to soak up all the knowledge in the world, the only trick is remembering it all! And paying for all that knowledge. -__-

So upcoming between my return to the unit and starting school, I will have a ton to write about! I will also need this venting space now more than ever. I don't know how I will find the time, but somehow I found the time during my Bachelors program so I can find it now too.

Also in recent months, my beloved 85 year old grandma and best friend, has moved into my state! I tried for it to be the same town, but two towns over isn't too shabby either. She used to live in Long Island, New York, and on a good day it was 3 hours to go see her. On a bad day, up to 6 hours. With her increasing age and frailty, that was too long to travel on a moments notice. So the past couple months has been lots of realty and picking things out and spending time with lawyers, but best of all spending more time with my Grandma. She moved December 10th and I have been able to spend so much more time with her since. I already considered her my best friend prior, I have since I was a child- but even more so now. I am able to get to know so much more about her, and her I. The best part is with all this time spent with her, I felt inspired of all her tales about her life that I wanted to write about it all. So I'm writing a brand new, fresh start, new book. I know I've said that before, but this one feels different... It just does.


Well, this has been a long enough first blog back. I work all weekend as we "go-live", but I assure you after this weekend, I will post again to tell you all about how that all went down. Probably with a glass of wine. ;)

For the followers that still follow, thank you from the bottom of my heart for still having interest. For any newcomers, welcome!


With love,


A Writer in a Nurse's Body


P.S. That quote up top and the title of my post. There's a (small) story to that. As I tried to muster up the courage to come on here and write again, as I loaded the webpage, a song by Tori Kelly called "Where I belong" came on and I heard these lyrics and it was exactly what I needed to hear. Because thats exactly what I think, what I am, where I belong. I am just a girl with a story and a dream.

Paralell Universe Begun

This post is way late because I have simply not had a single spare moment to write it since...last thursday! I had friday and saturday off and it was spent either sleeping in (MUCH needed- TRUST me, packing (moving into a new apartment in less than a week!). Craziness!

But its been on my mind, and I definitely wanted to share.

Recently I had a post about working with student nurses, and that I liked it. Well, that day when I made that first blog, they asked when I'd be working again with them and we figured out it would be this past Thursday. I was actually looking forward to teaching them again and all week anticipated their arrival.

However, when Thursday eventually came, we decided THAT morning to switch how we do our entire med pass system, in anticipation of our upcoming major medication renovation system. We are slowly converting to a much more modern and convenient way of doing our med passes. However just because its going to eventually be convenient, doesn't mean its convenient to switch now when I'm in my fifth week and just learned how to do med pass in the first place. Yikes.


So, here I am, on thursday. I have a pretty high acuity patient load. I had a very unique set of patients and no one in my section was particularly easy, one of them being the hardest yet I think I've ever had. Like, Ever. As an aide too.

So, processing my interesting section in my head, trying to organize my thoughts and getting used to these new med carts, all of the sudden, I see the students in the hallway.

I thought to my self, there is no.way. I cannot handle a student right now. I can't! I cannot. I am already behind, and swamped and how can I give a student report on my patient when I can't even gather my thoughts long enough to know what the hell is going on!? Part of me at that moment wanted to hide and wished I didn't have a student that day. I just didn't think I could take it on.

But, sure enough, a student came up to me. All bright eyed and ready for the day, with her new notebook. They already know wayyyy more about my patient, because here's how it goes:

Me: I get a 5-10 minute report on what my patient is in for, what we're doing to help him, how he/she did overnight/what has to be done this coming day and when he/she can go home. Thats it. 5 minutes

Student: Come the night before, write everything down from the chart (like, lab values dating back to two weeks ago), go home, research that ONE patient, and come in the morning, read the chart again to see if they missed a detail or two, and then  they come say hi to me. 

Boy, do I miss those days. One patient for the day. Research all night before you get them.

I used to think, when I was in clinical, that I better know everything on that chart because the nurse is going to quiz me! I thought for sure the nurses knew everything in that chart, and if I didnt know every detail then I was definitely going to fail. But as it turns out, I haven't "looked through" a chart, since I've started. Other than what I've HAD to do, to figure out why an order is the way it is, or to sign off on orders, or to track progress, etc. I have not had time to venture beyond "physician notes, nurses notes, and history and physical (thats if I'm lucky)" No time!

So, the students know more information than me, yes. But they don't know how to use  it. They don't know what it means. They haven't learned yet whats important.

So, back to my story, this student comes up to me. Even though in my head, I'm thinking of how far behind in the morning I am and how much I reallllly don't have time for a student, I put on my happy/nice nurse face persona and gave her report (did my best). She asked if she could not only do anything involving the patient she was assigned, but also follow me around for the day. I told her I was a little frazzled, to be honest,  and that I needed to just make a plan for the day and collect my thoughts but that I would definitely pull her into any out of the ordinary learning experience any of my patients had.

Eventually, I got in to see the patient she was specifically assigned to. She was with him doing therapeutic communication (even though I can't say I've heard that patient talk more than a whole sentence strung together at one time, so i'm not sure how that was going....) and I taught her how to do my kick-ass nursing assessment that I learned from my school. After we left, I taught her my kick-ass way of documenting that assessment on my paper before I had time to put it in the computer. After that, we went to go assess my other patient, who had far more interesting abnormalities, so I got to teach her a lot about why that was the case.  I made sure to answer every single one of her questions, and make myself open to ask more questions if she so chose (I think thats really important). That way, even If I DO get really busy with other patients, she shouldnt

So I got to do a lot of education, about medications, assessments, vitals, nursing in general, and that was just me "getting by", I was really just trying to do my best with her and praying she wasnt thinking I was a complete neurotic nut that was all over the place.


Well, turns out, when she was done for the day, she was supposed to come give me "report" on my patient. I remember those days too, but now that I think about it- that concept is pretty silly. I was with the patient as much as she was and was already familiar with what was going on, but I listened to her report anyway.

She gave me a tiny report (there really wasnt much to say on the guy) and then right before she left, she told me something I'll never forget. She told me that I changed everything for her. That she learned more from me in two hours then she has learned all this time so far in school ( I found that hard to believe!), she told me that driving here on the way to clinical, she thought to herself that she didn't think she could do this anymore- this nursing profession road. She thought she wasn't capable, that it wasn't for her. She told me that after last clinical, she had such a rotten time that she went home crying (I remember those days, too). But today (thursday), everything changed when she was with me. She told me I made things make sense. It just did. She told me I made it possible in her eyes that she could do it too one day, and reassured her that there were nice nurses still out there. She thanked me a million times for being so understanding, kind, patient, caring and thoughtful and overall a fantastic nurse.

I have to say, I pretty much just stood there, looking at her. I did not know what to say- I couldn't believe what I was hearing. Was she talking about me?

She then went on to say that everyone in her nursing class should have a one day session with me as the nurse, and that way everyone could learn as much as she did that day.

I was absolutely flattered. But I couldn't believe it! I even told her, that she was very sweet but that I was honestly just doing my job. I explained to her I was just recently in her shoes less than a year ago and will never ever forget what its like. I won't forget tomorrow and I won't forget in twenty years. Nursing students, despite their lack of critical thinking and overall knowledge base, are the future. If you want future nurses to be terrible, then don't teach them. And then be pissed at them all the time when they are new graduates and never learned the right way. Or, take the time to really teach them. Show them tricks, take them under your wing, be NICE. From that you grow a nurse just like me. Thats how I grew. Not only did I learn from bad and good nurse examples in clinical and remember every moment on how I was treated as a student, but I have spent the past five years watching good and bad nurses on my floor. 


So, she told me that because of how great her day went that day, that I changed her mind about her career, and now she wanted to stick with nursing. I was honest and told her there was a long road ahead, but its so worth it in the end. Its worth it. And, it gets better, it really does. I also gave her my number if she ever had another crises where she didn't think she could do it anymore and needed encouraging words. Was that too far over the top? Probably. Who knows. But to know that I changed someones life? Thats huge! Hopefully she'll make a good nurse and I changed her life for the better. Its just amazing and hard to believe that because of me, because I was at work that day taking care of that patient, that I changed how she thought of the entire career. Pretty cool :)



As for myself, I'm definitely putting some thought into becoming a student again sometime soon within the next two years. Its crazy how much I'm already learning. I can't wait to take my experience back to the classroom and learn even more to build on top of the experience I'm already getting. In this lifetime, I will never go to med school to be a doctor. I'm already 23 and that is never going to happen. However I'm starting to realize that I probably could have been a doctor, but I'd make a better nurse. I'm starting to get to that point now that I can anticipate what the doctor will want when I call him on the phone. I suggest things for him. I come up with diagnoses in my head (I dont share them...yet- in fear of being wrong). I know being a doctor has got to be one of the most stressful jobs ever. Especially when they don't know whats wrong and they have to figure out the mystery. But besides that, they just follow protocols, follow standard type treatments, treat abnormal lab values, infections, surgeries, maintain health, etc. They have guidelines (for 70% of their patients).  But who knows....I'm sure it really is a lot harder than I think it looks. I didn't think nursing looked (that) hard when I was just an aide. I was way wrong.



So, its been a fantastic couple of weeks. So much learning, so much fun.....I have a good set of patients this week and can't wait to go back tomorrow.



Goodnight, with love--

~WNB




.

Blast from the Past

Hey!! So, Week three was absolutely insane! As expected....I moved up to 4 patient load. The first day with 4, I went home an hour and a half late. I kept all my patients safe, made no mistakes, but ran the entire shift, and charted none. Thats why I had to stay late, to friggen chart to make up for not charting since 7 am. So, thats definitely something I need to find a "system" for.  I'll have to try a couple things out.

But, the most important lesson of the week, was actually a blast to the past. School!

Ok, I'll explain. This week, the local college of nursing began their clinicals, in our hospital. Well, on day 2 this week I saw them in the hall but didn't really interact with them much.  But they were everywhere! I sort of just tried to avoid them because I already had too much on my plate. But much to my surprise, on day 3, after I got done with my second assessment, I had two nursing students hovering by my little binder. I sort of smiled and said hello, and they said hello but just kept standing there. Then eventually, they told me they needed report. So I was like......"Okay....." and then it was awkward silence. And then, I got it. I asked, with a squeaky voice, "Wait....report from Me?" And they nodded. I was like, seriously? They gave me students to supervise? I mean, I vowed, when I was a student nurse in their shoes, that when I became a real nurse and got my own little students, I would be the nicest, best educator I could possibly be. But seriously, I was three weeks old! Was it even safe to give me students? Apparently someone thought so.

So, I gathered my self, picked my mouth up off the floor, and gave them a report, and delegated them some easy things they could do for the day (assessments, report back to me, communication, vital signs, etc.) They are in their first year so that was pretty much the extent of what they could do. It made me giggle, reminiscing back to me, 3 years ago, in their shoes.

Listening to them give me a "report" back at the end of their "shift", was very....interesting. I of course had spent the day with the same patients, so I was listening to see if their assessment matched up with mine. But their thinking was drastically so very....simplistic. They can't make circles yet, no critical thinking yet. They focus on the obvious. Facts. What they can see. No putting two and two together. No advanced physiology.

But at the end of the day, the student's teacher (who also works in the hospital as one of my ex-bosses) happened to be very nearby and the students told the teacher right in front of me that they both request me as their nurse for the next week again, that I was a very good teacher and made them feel very comfortable, and I really "knew my information". Again, I had to pick my mouth up off the floor. I was shocked.

I found it funny, because really- being so busy all day, just because I have students under me doesn't mean I don't do anything. I'm still completely 100% in charge, working with the doctors, giving the meds (they dont do that yet) and coordinating patient care, and taking care of my other two patients that the students didn't have at all. Complicated enough? Quite.

So all day, the best I could do to keep up with everything and educate them, was to just think all my thoughts out loud, and hopefully they would follow that. And they did! I thought aloud but at the same time, talked in their direction so maybe they would think I was actually educating the right way! But it helped myself more than I thought to think aloud for the students, because as a new nurse myself, it helped me verbalize and think through the reasoning behind my actions. Why was I doing this? How do I do this? Why does the hospital do this? Why is our patient getting this medication? Is it the right dose? It helped my own brain slow down and double check everything because the last thing I want is to mess up in front of a student learning from me!

I got to have a cute little real "educational opportunity" with one of them. My patient was on a med I was not familiar with, and obviously neither was she. The order was written for the patient to have it exactly 30 minutes after breakfast. So thats about 0830. Well, I didn't get in there with it til about 1000 (c'mon not everything is on time when you have four pts on third week with 2 students!). So, it was in my best interest of course to investigate why it had to be that time period after breakfast, and if that rule could be bent. So I taught her how to use a drug book, and we looked up the drug together. It was suggested in this book as well to take it 30 minutes after breakfast, so I decided to give him a little something more to eat and gave the med. By doing this, we actually had the classic educational opportunity of, Why is he on this med? What will it do? What are the side effects? Does he have any? What are we gonna do about that? It really opened their eyes on how to think in circles.


But it was definitely an interesting experience. Being looked up to like that, being looked up to by some students older than me going back to school for nursing. thats impossible- since I'm the nurse, after all, not the student anymore. Its overwhelming to think about.

But, I think I liked it. Maybe I can be a nurse educator one day after all. I always threw that notion out the window- thinking there was no way I would ever make a good teacher, I'm far too spontaneous and erratic. But I pulled it together somehow and made it work. They learned from me. It wasn't a total disaster. Maybe I'll teach in "retirement" (aka social security will be zilch when im 70 and I'll be forced to work).


So, fun! Week 4 starts tomorrow......5 patients. Going to just keep getting crazier and crazier. Just have to take a deep breath and constantly re prioritize, and just keep going. *Breathes*.




With love,


~A Writer in A Nurse's Body



.

I Could Never be a Teacher

Isn't funny how you find a profession that is right for you, even if it may be extremely undesirable to others? For example, many many many people think nursing could never be for them. My own family has no idea how I do the jobs I do at work because they think it is extremely gross....but it just sort of fits for me I guess. At this point I can't see myself doing anything else (other than my dream job, of course- Pixar!). So everybody has that job in their mind that "they don't know how people survive in" or they think "they could never do". Mine is teaching.

I thought about it, going back to get my Masters and teaching nursing to college nursing programs one day....And its still a *slight* possibility, but getting smaller and smaller. This past week It was my turn to go to the Junior clinical (same place I was last year-ah!) and help them with their assignments. Our job was to pick out their patient, learn about their patient, go home and prepare questions to ask them the next morning, go the next morning to clinical, ask them all about their patients and watch them squirm because they are nervous and haven't learned anything yet, and then you feel awesome because you know things and they don't.

Well, I did fine with that part. But during the day the students come up to me asking me questions and I am thinking in my head, "What kind of a question is THAT? Where do you come up with these things???" And I think it is because of this: Nursing students are very inquisitive. As am I. They like to understand everything, to every possible extent. When learning about a disease their patient has, they want to know as much as possible, even if that means coming up with the smallest, most detailed questions about the disease. I remember doing it to my seniors when I was a junior and I remember asking my professor. Not because I wanted to put them on the spot, but because I genuinely thought they might know...They seemed so smart. They handled our questions so smoothly, when I, this week, probably looked at them very strangely and gave them the best answer I could.

 I could never be a teacher. This was my second experience working with someone that I was assigned to teach. It was weird because this time around, it was their patient- technically, not mine. I was only their to watch the student do the assigned work. But the way I work- I just want to get things done. I don't like to just stand there watching something (that also ties into my extreme ADD), so when the student is doing one thing, I desperately want to continue on to the next activity and complete that, even though I know she is supposed to practice. Oy. I guess I'm used to doing that at work, me and my fellow aides can practically read each others minds and can work as one being- with 4 hands getting the job done.

And then the students ask questions because they like rationale. Why are we taking her blood pressure again? Why does the pulse ox light turn on? Why is the sky blue? Why do we have to keep my patients feet up? Why does the shot she gets come prefilled?

So thats a minor update on last week...let me try and think of other things....

my NYT reading is not going great. I need more time! AH! But, i did buy an awesome book on clearance that is called "Smarter by Sunday" and every weekend you read about something new that they teach you about, and supposedly by the end of the year you will be a genius. So yesterday I learned about Illiad and the Odyssey and Homer, which I already knew about but it was a nice review. Also, I am reading a lot of Atul Gawande's work, and he is SO fascinating to read. I can't get enough of all these smart people.

Um...Cute moment of the week during babysitting:

I am cooking dinner.
4 year old boy, (R): What are you making?
Me: Chicken nuggets, green beans and mandarin oranges (weird combination-the mom picked it not me)
(R): I don't like green beans.
Me: Why not??? They are so good! They help you grow really tall and strong!! ( I made hand gestures)
(R): *skeptical* Okay.

*After Dinner* (He ate ALL of his green beans!)

(R): Julie!
me: What?
(R): I can already feel myself growing taller!!!
Me:  :-) !

I'm pretty sure thats all I have to update you on. I probably had a lot more in mind when I said last post "Oh my god I have a lot to update you on" but now I cant remember. So, sorry for that false excitement.

With Immense amounts of love,

~A Writer In a Nurse's Body