Physical Safety in Nursing

Awhile back, I had a patient who was a bit of a handful. Which isn’t saying much, because I feel like a lot of them are. One night, while I was changing one of his dressings, he was watching a particularly violent show on TV. He turned to me and asked a question I don’t think I’ve ever been asked before.

Have you ever been hit?

I was surprised, and without thinking, I told him yes.

He was shocked and asked if it was my boyfriend or husband that did it.

Of course I told him no. When he pressed, I told him that I’d been hit by one of my patients.

He became very invested in the conversation, asking, “Have you ever been choked?”

Ironically, yes, I have.

I work in geriatrics, and more often than not, there’s not just physical ailments that I’m treating. I treat many patients who suffer with mental illnesses as well. Dementia, bipolar, depression are incredibly common among the geriatric population. (I should say the ones in skilled nursing.)

I learned about it in nursing school, but the one thing I didn’t learn was how to be safe while taking care of patients who are unpredictable. 

When I was a brand new nurse, I had a patient who I liked very much. He and I got along and seemed to understand each other. He also had dementia. One night, while doing my rounds, I checked on him and noticed that his shoes were still on. Without really thinking about it, I went in to take them off. I’d done this dozens of times before, and usually he would wake up just a little bit, and I would tell him I was taking off his shoes and he would go right back to sleep.

Unfortunately, that night, that was not what happened. He woke up and grabbed me by the throat, trying to find something to choke me with. One of my personal decisions, when I became a nurse, was that I wouldn’t wear anything around my neck. At that point, I was grateful I’d done that, or he might have strangled me with my stethoscope right there.

I’d put myself into a dangerous situation, and I didn’t know how to get out of it. I’d gone around his bed, and now I couldn’t reach his call light. The door was on the other side of the room, and my CNAs didn’t know which room I would be in. They would have expected me to be gone for a while anyway, since I was doing rounds. I struggled with him until I could get free and then I got out of that room as fast as I could. I had the presence of mind not to run, since I knew that would aggravate him further, but when I glanced over my shoulder, he came running after me.

He grabbed me and threw me against the wall before pinning me there with his arm. Fortunately, at that point, I had gone far enough that I could call for help and my CNAs came and pulled him off me. I ended up giving him a shot of Ativan, and then I had to stay locked in the nurses’ station for over two hours until he finally calmed down. Even locked back there, he still came and tried to climb over the desk.

Nursing is a stressful job, and I wish that someone had told me to pay attention to my surroundings when I became a nurse. I walked into a dark room, placed myself where I couldn’t reach the door or the call light, and assumed I would be same. No matter what the patient, we never know when they could snap, or when something could trigger a violent reaction.

So pay attention to your surroundings, and always prepare for the worst.

Why I Love My Beta Readers

I’ve written for most of my life. Even back in 2^nd grade, I was writing fanfiction, even though I didn’t know that’s what it was. No matter how much I wrote, I think I only reached a certain level of achievement.

Until I got my first critique. It’s one of the most terrifying experiences, having a complete stranger read your novel and give their opinion. With family, you’re never quite sure if they’re trying to spare your feelings, or if they’re just saying what they think you want to hear. A stranger isn’t going to be quite so worried. And a fellow writer knows what kind of things your WIP needs to improve.

Since that critique, I’ve noticed a very steady improvement in my writing. Every single beta I’ve had has taught me something, and my novels always get better with each read-through.

Here’s an example of why betas are so critical:

I’ve been struggling with chapter 1 of Commissioned. I think first chapters are hard anyway, because there’s so much you need to build so that the reader feels like they understand what’s going on. I’ve had several betas mention that they’re confused, but none of them could really pinpoint what wasn’t working. Until I sent it to someone else to read. She told me that the issue wasn’t with my characters, it was with the world they were in. I hadn’t set the stage enough for the story to make sense.

With that information, I rewrote chapter one into something that I absolutely love.

I need good readers and good betas to keep me going. Without them, I would never be where I am now.

Surviving a Storm

The second year I lived in Spain, I lived with someone from church. It was her, her five-year-old daughter, and her elderly mother. They gave me a room and a part of their fridge, and I was allowed to go as I wanted.

A few weeks after I moved in, I went out with some friends, then started to feel sick. I went home and straight to bed.

Sometime that night, there was a really bad storm. During the whole thing, I had a raging fever, so I only remember bits and pieces, but here’s what I remember:

At some point in the night, the woman I lived with burst into my room, rambling in Spanish. I usually understood Spanish without a lot of difficulty, but because I was so sick, I only got bits and pieces. She said something about the rain, something about the ceiling, and then something about everyone going outside. In my very sick, very fevered state, my only thought was ‘outside cold, inside warm.’ I told her that I couldn’t go outside, and went back to sleep.

A little bit later, a man came into my room. I was so delirious that it didn’t even occur to me that I didn’t live with any men. My brain told me it was one of my neighbors, but to this day, I’m not even sure if that’s true. He started yelling at me, telling me something about water, something about holes, and something about firemen. Again, I told him I was too sick, and went back to sleep.

The last person who came into my room was a fireman. He told me I needed to get out of my room, and I refused to go. I really must have been out of it, because I didn’t even worry about why a firefighter would be in my room. I do remember that he inspected my room, especially my ceiling, before leaving.

The next morning, when I woke up, I had to walk down the hallway to the bathroom, and it looked like a disaster area. Turns out, there was hail, and it tore apart the apartment building. I was on floor five, and there were almost a dozen holes in the ceiling. All across Madrid, trees had been knocked into streets, and metros were derailed because of the hail.

Our ceiling after the hail

I woke up the only inhabitant in an abandoned apartment building, and I had no idea what was going on.

Have any of you had this kind of experience? Where your limited language skills put you in a situation you didn’t expect? 

Patients That Changed My Life: Wheelchair and Oxygen

As a nurse, I have the chance to meet a lot of people from all walks of life. Some are fun, some are not so fun. Then there are those that change my life, and changed the kind of nurse I am. For privacy purposes, I won’t use real names, but I want to tell you their stories.

To read about previous patients, click here

Before I was a nurse, I worked as a caregiver in an assisted living, and as a food server in a retirement home. That’s what got me through high school and college. While I was a food server, we had a very sweet couple who sat at the same table every night. When I asked them what they wanted for dinner, they would order, and then the husband would lean close to me and say “And we want a fruit plate. To share.”

He was a war veteran, who had an amputated leg at the knee, and used a wheelchair to get around. She was able to walk, but she had a hard time breathing, so she always wore oxygen. Whenever they went anywhere, she pushed his wheelchair, and he held her purse while her oxygen tank hung on the back of his chair.

They were my relationship goals. They were so devoted to each other, even after all their years, and with all of their illnesses, they used their strengths to support one another. Together, they were stronger than they would have been apart.

Having a Plan

Because I have a Bachelor’s degree in nursing, I’ve been in various management positions over the years. I’ve learned about the importance of having a business plan, of having short and long term goals, and keeping yourself responsible if you don’t make those goals.

Last year, I made the decision to treat my writing like a job. I wasn’t going to treat it like a hobby anymore, writing when I wanted to, or if I wanted to. I was going to have a plan, with long term and short term goals. That was in October.

My long term goals:

Focus on publishing.

Write more.

Then I created short term goals to accomplish those. In fact, I made a schedule for myself, one that I was going to stick to. In the month of October, I was going to outline for NaNoWriMo. In November, obviously I was going to write Book 1 of a brand new story I’d come up with. I told myself to spend at least 2-3 hours a day on writing.

When I first started, I didn’t think I’d be able to do 2-3 hours’ worth of planning in the month of November. Boy, was I wrong! Giving myself a time limit, as well as a plan gave me the chance to explore this world in a way I never imagined possible. I knew my characters inside and out, I knew the setting, and I had a very detailed outline. With it, I wrote book 1 in 14 days. In the next 14, I wrote book 2, which I wasn’t even expecting to do.

In December, I sat down and planned out the rest of the year.

December 10-February 15th. Rewrite Book 1 (I figured giving myself two months would be enough.)

February 16-March 30th – Rewrite Book 2 and send out to betas. (I was a little more ambitious, since I only gave myself a month and a half)

April – second revision of Book 1 during Camp NaNoWriMo (I figured that this wouldn’t be as extensive of a revision, so it wouldn’t need as much time)

May-June – Rewrite Book 2.

July – final revision of Book 1, fine tuning, send out to betas again

August – start sending out Queries of book 1

September – (didn’t have a plan for September)

October – Prepare for NaNoWriMo

November – Write Book 3

I love having a plan, and knowing what I need to focus on. Obviously, I haven’t followed it completely. I finished revisions of Book 1 by January 30^th, which meant I started revisions on book 2 much sooner than expected. Also, in May, instead of editing book 2, I ended up doing a cut edit of book 1, and polishing it so that I was ready to send it out to agents. By that point, I’d already sent it to two rounds of betas, as well as critters on Scribophile. In June, I started sending out queries and working on outlining for book 3 and preparing book 2 for CampNaNoWriMo in July.

Since November 1, I’ve written or edited 640,181 words. I’ve done three revisions of Book 1, and two of book 2. I have a clear outline of book 3, and I’ve even started outlining an unrelated book, which I hope to write in November, along with book 3.

The year before, I’d written one first draft, and done three revisions on different novels. I’ve already exceeded that, and we’re not even back to November.

Having a plan works as long as you keep yourself responsible. I don’t use a lot of rewards, but I’m the kind of person that needs to keep to a schedule, even if it’s self imposed. 

Country of Origin

When I was a brand new nurse in Saint Louis, I had one of the best jobs ever. The facility was definitely better than most of the other ones I’ve worked in, and the staff quickly became some of my closest friends. I worked the evening shift, and most of my CNAs were from Africa – mostly from the Kenya/Zambia regions.

I had two particular CNAs that I became very close with. We used to have a lot of fun pulling pranks on one another, and keeping the environment light.

I quickly learned that our points of view were very different on a lot of matters, but the biggest one was marriage and country of heritage. They were both devout Christians and took a literal approach on the man and the woman becoming one during marriage. Since my husband is Bolivian, they would ask me about Bolivia as though it was my country of origin.

Questions like:

In your country, do you eat…

I was reading about your country and it said…

At first, I was confused. My country is the USA. I was born here, and I was raised here. But these two CNAs kept asking me about my country of origin, Bolivia, because in marrying a Bolivian, they believed that I had become a Bolivian as well.

It soon became a running joke for us, mostly because they realized that they could get me aggravated pretty quickly when they asked those kind of questions.

“In your country, do you have salad like this?”

“I don’t know. In Colorado, where I grew up, we ate it. So what do you think?” 

Clearing a Room

When I was a nursing student, I got to meet a lot of interesting people. Saint Louis is a very diverse city, and I worked in Saint Louis University Hospital, right in the downtown area.

I had one patient who spoke a little English, not very much. She had probably ten or twelve family members crammed into her room, all laughing and talking in Spanish. Now, I’m just a little Asian girl, so most people don’t think I speak Spanish, which I guess makes sense. They assumed they could speak Spanish around me and I wouldn’t know what they were saying.

It’s an awkward situation, when you don’t know how to broach a topic, especially one that could cause embarrassment for anyone. In this case, when I went into the room to hang an IV, one of the patient’s nephews told everyone that I needed to get through. And, of course, there was a lot of teasing involved.

“You like her!”

“You think that nurse is cute. Why don’t you ask for her number?”

He was embarrassed, but he didn’t really say much. I worked on hanging the patient’s bag, but as they continued to talk to me, I started to feel uncomfortable. Finally, I turned to the patient, and asked, “De donde es?” (Where are you from?)

The room turned silent and the patient gave me a kind of smirk. Obviously it’s a simple question, one that anyone could learn in a first level Spanish class.

She told me, speaking quickly so that I wouldn’t understand her.

I smiled, connecting the tubing with her IV. “Y cuánto tiempo ha vivido aquí?” (How long have you lived here?)

It took less than thirty seconds for the room to clear. Everyone left, except for the patient’s husband. I’m thinking they were all embarrassed by what they said, realizing that I understood every word. I never saw the nephew again. 

I guess that’s one way to clear a room.