Nursing Burnout

Now that I work in a new place, I’ve been watching nurses. Mostly because there’s so many of them! In most SNFs (Skilled Nursing Facilities), I work with maybe 2 or three nurses at night, if that. In the hospital, things run a bit differently. But here’s something I’m starting to realize.

No matter where you work, burnout is a very real thing.

There are some nights when things just do not go right. (And days too, bad shifts do not discriminate). I think I’ve actually seen more nurses break down crying at this job than in other place. Crying because they’re overwhelmed, or they can’t catch up, or because there’s one specific patient who has tried their patience beyond anything. I’ve been there. Sometimes, I’m the one who breaks down crying.

Burnout is a huge problem in nursing. We deal with the day to day activities of the patients. We have to watch out for their care, keep an eye on their labs, and their orders, and we have to take most of the crap we’re dealt with a smile. It’s enough to make anyone feel frustrated.

Unfortunately, I haven’t learned the magic trick to dealing with burnout. Most of the time, once it gets to the point where every shift feels like I can’t get my work done, I tend to start looking for another job. In SNF, I’ve found that management likes to work with bare bones. Heck, I was management at one point. I understand the bottom line. But that doesn’t mean that the line we’re given is enough for the patients or the staff. Just because state tells us that we can function with that level of patients, it doesn’t mean that it’s true. So when you get a competent nurse (or CNA), it’s so easy to add extra work to their already heavy load, because there’s no other way for the facility to function. That’s when burnout tended to happen to me. When suddenly, they would cut nurses on the night that I worked because they knew I could pass the medications to all of the patients. Or the nights when I had a patient who was a 1:1, but they wouldn’t give me a sitter because they figured I could keep an eye on them.

I promise this isn’t a rant. It isn’t even complaining, really. It’s just a musing on the fact that nurses get burnt out. My solution has been switching jobs when I’m so overwhelmed that I can’t function. But I would love to know what the rest of you do to combat burnout. 

How do you reverse the process?

NaNoWriMo Music Video

Have you ever seen something and thought ‘I can do that’?

Maybe it’s just me. I’m one of those people that sees something and wants to try it for myself. A year ago, I started listening to a lot of acapella music, and I started thinking about how much I would like to beatbox. I talked to my awesome brother about how to do it, and after he taught me the basics, I started practicing on my commute to work.

I mentioned how much I was practicing to my wonderful writing friend, and the two of us started thinking about how we should make a music video for NaNoWriMo.

How hard could it be, right?

Yeah.

I had some awesome friends who were willing to try this with us.

Here’s the thing. Music videos take a lot more work than you’d think. First, there comes the actual planning part. Fortunately, two girls in our NaNoWriMo group had rewritten the words to ‘Counting Stars,’ so we had the lyrics and the song, but we also wanted to add our theme for the year. So after lots of brainstorming, I finally came up with a way to incorporate the theme into the song. Then we had to find props and somewhere to shoot.

Then we actually had to record the song. Now that took a whole lot more time. We found out that having the right microphone is a key element to recording a song. I think we spent about nine hours recording a clip that’s less than six minutes long.

Music Recording

Recording takes a lot of quiet

And once we finished that, we had to film. It took two days, and probably seven or eight hours to film and get everything together.

We had to record one by one

Can anyone guess our theme?

After that, I had to have my cousin teach me about film editing so that we could mesh all of the clips together.

It was a much longer process than we expected, but the final product was more than we ever expected.

Here’s the final product! What do you think?

Illegal Immigrants

Before I left the United States, I didn’t have a lot of friends who weren’t US Citizens. There were the Mexicans who I knew from church, but I hadn’t really stopped to think about where they came from.

When I moved to Spain, I was amazed by how many cultures and countries fit into Madrid. There were people from everywhere, and since I attended an international school, there were even more in my classes.

I lived in Spain during the time of the boom. Everyone wanted to live in Spain because it was doing so well, and because there were so many opportunities. The immigration system was a little bit different than it is here. For many of them, if they could last several years without being caught as illegal, and if they could prove that they’d lived, and served as upright people in the country, they could obtain their residency. That was an opportunity that many couldn’t resist. It’s not to say that they didn’t come with any risks. The main form of transportation, the metro, was always considered a trap. There would be random checkpoints where everyone trying to get onto the train had to show their paperwork.

I’m not quite sure when I realized how many of my friends were illegal immigrants from different countries. For me, they were just my friends. But after a while, I started to notice that those of us with papers would go into the metro stations before others, and then we would call up if they weren’t doing checks.

There was one evening, when we had an activity that ran over, that two of my friends ran to the metro before they were late. One of the girls had her paperwork, and the other didn’t, and that was the night when they were doing checks in the metro. They caught my friend, and she was deported back to her country.

It was quite a sobering experience for me, since I’d never had to live with the fear of being deported. I’d never left my country hoping for a better life, or for an opportunity to live in a better place. The way my husband described Spain was: “It’s like the American dream, but in a country where we could speak the language.”

It’s amazing how fortunate we are to have the opportunity to live in a country where dreams are made possible. Where we don’t feel like we have to escape to be able to have a fulfilling life. I wish that this opportunity could be true for everyone.

Things My Patients Say: Part II

As a nurse, I get to interact with all kinds of people. Some interactions are fun. Others are quite unpleasant. And then there are those that make me smile. I’ve started writing down a few things my patients have said to me, and I’d like to share them with you. If you'd like to read the first post, the link is here.

-          You always look so wide awake. (Said to me by a patient who called for help multiple times during the night. For some reason, I’ve had a lot of patients who assume that when I work nights, I’m sleeping until they wake me up.)

-          Thank you for your help, little one. (It was the little one that cracked me up.)

-          You’re doing it wrong! (Now, I wrote this one down a long time ago, and I can’t remember who it was that said it to begin with, but I hear this a lot. Many patients and families think they know better than their nurse)

-          I must be repenting for my sins. (Said by a little old lady who had broken her hip. She was such a sweet lady, and told me that her fracture was to pay for her sins)

-          You actually look nice tonight.

-          One night, when I was taking care of someone, I noticed something dangling from their ear. When I looked closer, I found out that it was a piece from their oxygen equipment. When I asked them what it was they said: “I don’t know. I found it, and I put it on my ear.” Fair enough.

-          I had a patient whose oxygen tubing wasn’t in their nostrils. It was between their eyes. When I went to adjust it, I told her, “It looks like your oxygen fell off.” She responded with: “Nope, it jumped up.”

-          And finally: “How do you say pee-pee in Japanese?” (There’s always one who comments on how Asian I look.)

Receiving Critiques

Writing is not a solitary activity. It may seem like it because we sit there on our computers, or at our notebooks and write on our own. But that’s not all that writing entails.

Once we get the words written, and once we’ve polished that sucker as much as we possibly can, then we need feedback. We need to hear from other writers and readers. None of us are perfect, and none of us can make this on our own. Feedback is really what makes us great, and it’s a never-ending process.

I remember the first time I received any feedback. I’d been writing on and off my whole life, but in college, I picked up a novel I wrote in high school and rewrote it. I was pretty proud of that little novel, and I was starting to think about possibly publishing it. I started researching and found a writers forum (now incredibly inactive) where different writers were offering to do critiques for one another. Not knowing what I was getting into, I decided to offer my little novel as well.

My first critique partner and I sent one another our first chapters, just to see if our critique styles meshed. She tore my chapter apart. She made me cry. It was the most devastating thing I’d ever experienced in my life. That was my baby, and she didn’t appreciate it! After a week of feeling sorry for myself, I picked myself up and decided to prove to her that there’s no other way to write that first chapter. So I rewrote it, knowing that the new chapter would be worse than the original. I was wrong. Her suggestions were spot on, and the chapter was amazing. I decided to keep exchanging chapters with her, and through those few months, I grew an incredibly thick skin. She was ruthless, and every time she tore something apart, I had to regroup with myself to figure out what to do. I had one scene that was absolutely pivotal to the story, one that I’d imagined from the novel’s conception. She destroyed it, and I knew there was nothing that could be better for the story than that scene. But, like I had so many times before, I decided to prove her wrong by trying something else. That scene is now one of my absolute favorites. And all subsequent readers of that book have said the same thing. The new scene outshines the old one so much that I’m embarrassed by how determined I was to keep it.

I don’t keep in touch with her very much anymore, but I still value what she taught me. Not everything I write is gold. Not every scene, not every idea is as amazing as I think. I also learned to think for myself. Now, whenever I get critiques, I really consider what they say, but ultimately, it is my decision.

I couldn’t have become the writer I am without feedback from the people around me. Every single person sees something different. I had one critique partner who told me that I had a specific phrase that I used way too much. I did a search for that specific phrase and found 33 instances in my novel. 33! I cut it down to less than 10. I had multiple critique partners tell me that they hated the ending for Commissioned.

Writers can’t write in a bubble. We all need feedback, and in turn, we should be providing feedback to others in our circle. 

Obtaining Citizenship

Last week was a pretty exciting week in the Quintana household.

Hubby just obtained his US Citizenship. It’s been a long road, especially for him, but he’s done so well since we first moved to the US seven years ago. When we moved to the US, he didn’t speak any English. He didn’t know anything about the culture, and he was completely lost for several months. But he’s worked hard, and look where he is now.

When we lived in Saint Louis, he started taking English as Second Language classes through the community, and we’re both so grateful to the teachers who were willing to spend the time and effort helping him understand the new language. His wife wasn’t always as patient or supportive as they were.

Once he advanced to the final level of those classes, he moved on to community college, taking English as Second Language classes there, focusing more on test taking, essay writing and note taking. Once he finished those courses, he moved on to get his generals. It’s been a long road, but he’s so close to finishing his bachelor’s degree, and I couldn’t be more proud. He’s put a lot of effort into his education, as well as adapting to the new culture.

We’d heard a lot about the citizenship process, including the super hard test, and when we drove down to Boise, I was definitely more nervous than he was. We went through the questions over and over until he told me to stop because he couldn’t concentrate anymore. His interview ended up being a breeze, mostly because he was confident in his English. The questions were second nature to him because we’d practiced so much.

We were given a paper for his citizenship ceremony, and when we arrived, I was astounded by how many applicants there were. They stated during the ceremony that there were 179 applicants and 53 different countries represented. Hubby was the only one from Bolivia.

The ceremony was very solemn, but incredibly joyful. You could see on their faces their excitement at obtaining citizenship. They didn’t take it for granted, and they had put in the effort for the rights that so many of us don’t even think about.

I’m grateful for my husband, and for the example that he’s given me. I’m grateful for this country, and for the rights and freedoms that we’ve been given.

God bless America.

New Job

I recently started a new job at the hospital. I love skilled nursing, and I still think that geriatrics will always be my first love, but the truth is, I burn out too fast. Every facility I worked at, the workload would be manageable, until short staffing or increased workload would burn me out. In the past 3 ½ years I’ve lived here, I’ve worked 4 different skilled nursing jobs. That’s an incredible amount to me, mostly because almost every single one, I start out thinking that it’s a great fit. I’m excited to start, and I like the new way of doing things.

It’s an unfortunate truth of skilled nursing, that there’s just not enough staff. Part of it is the stigma of working long term. Very few nurses want to work in geriatrics. In my graduating class of almost 300 nurses, there were only five or six of us who wanted to work geriatrics. It’s not exciting or glamorous.

Add to that, it’s getting increasingly difficult to earn money through skilled nursing. Patients can’t afford it, and families hate the idea of putting their parents in a ‘home.’ There’s more options now, like home health, which is more affordable, and more Assisted Livings are expanding, so that they can take patients that they may not have been able to several years ago. They might have an oversight nurse, or their own home health to take patients who have insulin or wounds.

Skilled nursing has really been struggling. At least from my vantage point. State’s regulations are pretty clear about staffing ratios. Unfortunately, those ratios don’t benefit the facility, the staff, or the patients. Most nurses and CNAs feel understaffed when in reality, they’re staffed as adequately as state allows. And when money needs to be cut, it comes from the support, whether in charge nurses, management nurses, or even the hours of Medical Records. I’ve seen all of that happen, and unfortunately, the extra load always falls on the floor nurses.

So for now, I’m taking a step back and trying something different. It’s difficult, adjusting my mindset from long term to acute nursing, but I think it’s the right step for now.

I hope that someday, I can return to geriatrics, because it will always be my first love.

Rexburg Teen Writers Conference

Today’s post is going to be a shameless plug.

Our region has been working on expanding opportunities for writers, and last year, we had our first ever writers conference. Afterward, I was able to meet the guy who ran it, and I became a part of the committee planning for this year.

We’re excited to get this out. Last year was awesome, and we learned what worked and what didn’t. This year is going to be even better, and we’ll be even more prepared.

And even more exciting than that, J. Scott Savage is our keynote speaker!

My Co-ML and I will be talking about NaNoWriMo, the Young Writer’s Program, as well as working under a deadline and finding writing groups. Every time I see my name on the same page as J. Scott Savage, I do a little happy dance inside.

Here’s the site! Take a look! And if you know anyone in Eastern Idaho, let them know! It’s going to be awesome!

REXBURG TEEN WRITERS CONFERENCE

Translation

I speak two languages. English and Spanish. Because they’re both commonly used, I’m often asked to translate for various things. I’ve had Spanish speaking friends who ask me to go with them on a doctor’s visit to translate. Sometimes, for church, I’m asked to translate a meeting. Or, as a nurse, I need to translate an assessment so the patient can understand.

I learned Spanish while living in Spain, by hanging out with friends. We would talk about every-day things, we’d talk about weather, about plans, about activities, or transportation.

We didn’t really use words or terms that I’m asked to translate now. Recently, I did an assessment with a Spanish speaking patient, and I realized the few words that I just never used before.

Afterward, I talked to my husband and asked him about the different words. Words like tingling or numbness. Words like stroke, cataracts, blurry vision. I don’t ask a lot about suicide, or advanced directives. We went through each one, until I at least heard the words once or twice.

The nice thing is that even if you don’t know the word, you can still explain it. It makes the translation a bit long winded, but that’s okay.

Instead of blurry vision: Do you have a hard time seeing? Like it’s not clear?

Instead of tingling or numbness: Do you have a hard time feeling your feet? Do they sometimes feeling like they’re falling asleep?

Hubby and I once translated a church meeting from English to Spanish. His first language is Spanish, and mine is English. We started just passing the microphone back and forth when one of us got lost. I had an easier time translating stories because I understood it as the speaker told it. My husband had an easier time translating doctrine because he knew the terms in Spanish already. As a team, we did pretty well.

Translation isn’t a perfect science. It’s hard, especially when you’re in a situation where you can’t prepare. I really admire those who do it on a professional level. I get tongue tied when I have to go from one language to another for too long.

Night Shift as the Clean Slate

I love working nights. I could work four or five nights in a row without a sweat, but when I have to work days, three is probably my limit. I do not do well with waking up early. When I work days, I’m always worried about going to bed on time, or early so that I get enough sleep. When I work days, I need a good 7-8 hours of sleep. When I work nights, I really only need 5-6. I can’t explain it, but my sleep schedule just appreciates nights better than days.

There’s other advantages to working nights. There’s less chaos during the day. I always think of night shift as the clean slate crew. They take all of the leftover needs, clean it up, and leave it fresh for a new day. In one facility I worked at, I would spend my entire first night going through orders, double checking that everything had been filed correctly. In another, I would actually reorganize the nurses’ station, because everything would get tossed around, left wherever, because the day shift didn’t have time to put things back. Sometimes, I would even wipe down the counters and sweep the floor.

Even when I worked management, I still believed in the importance of a clean slate. Before I left for the day, I would organize all of my thoughts, make sure that I didn’t leave any loose papers on my desk, and then wipe down my desk. That way, I know that the next shift – still me, wouldn’t have to clean up from the day before.

In one facility, when I was off for three or four days, I would come back to a huge pile of orders and papers. Things that none of the other nurses deemed important enough to go through. Here’s the thing. When it’s just one day’s worth, it’s not that hard to do. When it’s three or four, then it gets a little exhausting to go through. It’s so much easier to clean as you go, but on day shift, that isn’t always possible. That’s why we need to work as a team.

There are some things night shift can’t do. Phone calls get hard. Doctors’ offices are closed at night, and calls are only for emergencies. I know day shift covers my back. Why not cover theirs as well?

So I do my part. I clean up, I organize, and I leave them a clean slate.

September Plans

Does anyone know where August went? I’m not even sure if we had the full 31 days. It’s been a whirlwind, and unfortunately, it feels like writing has taken a backseat while I try and get my life back on track.

But this month, I’m going to focus on my writing. Now that the vacations and fun time are over, it’s time to buckle down.

I’ve learned over the past year that the best way to get things done is to set goals, and let other people know those goals so they can keep track of me. My writing partners are fantastic at keeping me responsible, but also being forgiving when things get in the way. But I’m also going to post it here so I can remember my goals.

1.       Finish this revision of Hooked. I got about 2/3 of it done during July, and then I’ve only got a few scenes done in August. September is the month to start!

2.       Start outlining for book 3. This year’s NaNoWriMo, I’m planning on writing book 3 of this series. We’ll see if this is the end or not. I need to develop some characters, as well as finalize the sequence of events.

3.       Start preparing for new book. Last year, during NaNoWriMo, I was so excited to write that I blasted through book 1 in 14 days. Fortunately, I had a good idea of what would happen in book 2, so I ended up just writing that book in the remaining 16 days of November. I want to make sure that I have a backup, in case I get through book 3 faster than expected. Also, I’ve been wanting to write this story for a few months now, so this seems like the best time to do it!

Nothing too extreme, but definitely something to work toward! What are your goals for September?

Marriage Advice

I attended the wedding of my cousin this weekend. She was radiant, and they were both so happy, and it was exciting for us to see her start this next step of her life.

Watching her reminded me of the time that I attended her sister’s bridal shower. We had my aunts, cousins, and her grandma there. Multiple generations attended, and it was fun. During the festivities, we went around the circle, and each of us gave her some marriage advice.

One of our great aunts told her that she should never complain about him to other people. I interjected, telling her that if she does need to complain, to do it to his mom, because she already loves him. There was a short silence, and then they continued.

After that incident, I told my hubby that I wasn’t sure why the ‘traditional’ marriage advice seemed off to me. Or why everyone seemed shocked that I would complain about him to my Mother-in-Law. The more we talked, the more I realized that I had a specific reason for talking to her about our issues. Most of the time, I was verifying if this was normal behavior or not.

Hubby is from Bolivia, which means we come from two different cultures, and from very different expectations. Sometimes, he does something that’s so out left field for me that I don’t know how to respond. That’s when I talk to my Mother-in-Law. I’m basically complaining, but also making sure that this is something that isn’t normal for them either. Sometimes, she tells me that it’s how everyone in Bolivia does something, and I again remember how different we are. Other times, she supports me and tells him to shape up.

Cultural differences, as well as beliefs and attitudes can be wearing on a marriage. But before we jump to conclusions, we try and find out if it’s just personal differences or if it’s something cultural. It’s saved us from numerous unnecessary fights.

Obviously, I don’t complain to her about everything. But it’s nice to know that I can trust her enough to let me know if I’m worrying about nothing.

I love my Mother-in-law, and I appreciate the loves and support that she's shown me over so many years.

Patients and Patience

I love being a nurse.

Most of the time.

Just like any other job or career, there are ups and downs. Unfortunately, because of the nature of the job, nurses (and other healthcare providers) get to work with people who are sick. And sick people aren’t always happy. I don’t blame them. I’m not happy when I’m sick either. You feel gross, and on top of that, you just want to sleep. Then we come in, wake you up and ask you a million questions. We ask about your bowel movements, and force you to use a pain scale about something you can’t even quantify.

I don’t blame my patients for getting a little short with me.

Then there are the ones who are so demanding that I wonder if they understand how healthcare works. When I work in a skilled facility, my typical patient load is anywhere from fifteen to thirty patients. I don’t even have time to go into everyone’s room in an hour, or even two. I run for hours without stopping, and I do my best to meet everyone’s needs.

When you talk to a nurse, you have no idea what other things are going through their head. Maybe there’s the patient next door who’s having a hard time breathing, and she’s waiting for a call back from the doctor. Or maybe three other patients need pain pills, and she stopped in your room on her way to get them. Maybe she’s about to get an admit, and is trying to get everything under control before things get really hectic. Maybe she just had a patient die, and is grieving for their family. Or maybe it’s the first day of the month, and she still has to change over all of the charts for the new month. Then there’s the possibility of issues at home. 

We’re all humans, and we all carry baggage.

No matter what, we hold it in, and we put a smile on our face, because you're important too.

For those who are patient with me, I can’t tell you how much I appreciate it. The reason I got into nursing was for the opportunity to make someone feel better. I know my shortcomings, and I know that there are times when I won’t ever live up to expectations. But I have no intention of making you feel worse, or making you feel guilty for asking for help.

Please remember that your nurse is on your side, no matter what else is happening.