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.