How Mindfulness Can Be an Act of Self-Care for Nurses

I recently came across a new, to me, Blog: Nightingale. A 2017 post by Teresa Brown describes her initial exposure and reservations about mindfulness—I am not giving away the ending. Given I had just spotlighted Julia Sarazine, a qualified mindfulness instructor, I decided to reblog Teresa’s essay.
The Nightingale website looks interesting and promising, however, I didn’t notice any recent activity. Sara Goldberg, founder of Nightingale, may have been busy with her new book: How to be a Patient: The Essential Guide to Navigating the World of Modern Medicine, which was recently released. I read her book and will review it in a future post.

Nightingale

Nurse Burnout Won’t go Away Until the Industry Changes. But in the Meantime, Mindfulness can Help Nurses Prioritize Their Well-Being.

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This past November I attended a workshop on nurse burnout at the Johnson Foundation at Wingspread in Racine, Wisconsin. Clinical nurses, administrators, and researchers came together for three days to discuss this pressing issue that is epidemic in nursing. One survey found that almost half of nurses are burned out, meaning they’re so overwhelmed by the job that they’ve lost the capacity to really care about it or their patients.

I tend to be suspicious of talk about mindfulness in health care because it seems to place the onus for change on individuals instead of the overall system.

Several of the workshop presenters discussed “Mindfulness” as a way to alleviate burnout. I tend to be suspicious of talk about mindfulness in health care because it seems to place the onus…

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Book tour in Chicago

Saturday, June 1, 2019

I am scheduling this post to publish on Wednesday, June 5, 2019. That day, I will be in Chicago talking about my book to the Advanced Practice Nurses at Rush University. I have three other venues scheduled before I head home on Monday. In between events, I will spend time with old friends. I’m having lunch with one woman that I haven’t seen in over 20 years!

Frank Lloyd Wright Home and Studio, Oak Park, Illinois

On Sunday, I will be reading at the Oak Park Library, Oak Park, Illinois. My daughter and 15-year-old grandson will have flown from Raleigh to join me. Afterwards, my daughter will show her son where she grew up. Maybe we’ll visit the Frank Lloyd Wright Home and Studio where, to get a change from nursing, I volunteered in the gift shop. I learned so much about Frank in particular and architecture in general. I always wondered if my involvement with the FLW Foundation had any influence on my daughter’s choice of a career—architecture.

So, think of me in the Windy City as you read this.

 

How PTSD is hurting nursing

I came upon this post on KevinMD.com, written by a nurse. I am pleased that a physician has provided a vehicle for nurses to tell their stories and, in this case, share the heavy toll that working in a hospital setting can have on nurses. 

How PTSD is hurting nursing

ANNE NAULTY, RN | POLICY | MAY 22, 2019

Every time I hear that there is a nursing shortage in America, I feel myself cringe. There is not a shortage of nurses in America. There is a shortage of nurses who choose to work at the bedside. There is a reason, and it is called post-traumatic stress disorder.

Medically, we have learned that PTSD can occur after a single event or as a result of chronic stressors for a period of time. As a living organism, we know that the body can only sustain so much stress before it starts to break down. These ailments can be physical and/or mental. Sometimes they happen over a period of time, however often times we do not even realize the symptoms until they have forced us to take notice. As a nurse, I know when our bodies have had enough, and they need to rest, they will make us rest.

Bedside nursing is hard and very stressful. The bedside nurse is responsible for caring for multiple people every minute of every shift. That is, multiple sick and potentially dying people. The nurse is responsible for monitoring the patient’s response to treatment, the patient’s condition, the patient’s mental health, the doctor’s orders, assisting the patient with activities of daily living, and being there for the family.

Bedside nurses are the coordinators of care. We are the ones who make sure that all parts of the care plan are being carried out and that the system is working the best it can. We are the ones who comfort the patients when they need us the most.

We do not mind doing all of this. In fact, this is what we signed up for when we graduated from nursing school. We can handle these tasks if we have a partnership with the hospitals that we work for. This partnership all starts with the nursing grid. Each unit in a hospital has one. It is basically a chart that states how many patients each nurse should have. It is a chart that is supposed to indicate the safe number of patients that each nurse should be assigned every shift. It is a topic of heated discussion in the nursing world.

Normal patient-to-nurse ratios depend on the unit and the acuity of the patients. For instance, most nurses agree that in the intensive care unit (ICU) nurses should not be assigned more than two patients each. If a patient needs continuous dialysis or another procedure that needs to be monitored, then this ratio goes to 1:1. This is a common theme. If a nurse is assigned to a critical care unit or cardiac unit, then the patient to nurse ratio is acceptable and safe at 3:1. This means that each nurse on the unit should only have three patients. Acceptable medical-surgical unit ratios are usually either 4:1. This means that for every four patients, there should be a nurse. Another rule of safety is that there should never be only one nurse on a unit. Too many things can change quickly, and safety comes in numbers. Remember we are talking about human life.

When these basic rules are followed, then nurses and patients have better outcomes. Nurses stay at the bedside longer and patients do better overall. The problem that nurses are having is these basic safety numbers are not being followed, and we are burning out as a result. This has to change if we are going to keep our valuable nurses at the bedside. It has to change if people are going to receive the care they deserve when they are in the hospital.

Nursing salaries also need to be increased. Most nurses have their bachelors in nursing degree (BSN). Many hospitals require it as a condition of employment. A bachelor of nursing degree takes about five years, and the cost of the education starts at $50,000. Many nurses have to take out loans to pay for school. If we look at a 10-year repayment plan that does not include interest — a $50,000 loan means a monthly payment of $417.00.

I work in the Midwest. Our new nurses start at $22.00/hour. Some nurses earn a differential for working nights and weekends, too, although those shifts come with health and family costs. If we multiply $22.00/hour by the average 160 hours that most full-time people work each month, we end up with a gross monthly salary of $3,520. Most accountants say that taxes and benefits equal at least 30% of our pay. This means that on average, a new nurse can expect to bring home $2,464 a month. If we subtract the student loan payment, this means a new nurse will need to live off of a little over $2,000 a month. Trying to pay for housing, food, transportation, and utilities each month, forces many nurses to choose to work overtime.

Working 12-hour shifts are rough. In fact, 12-hour shifts often are 13-hour shifts, and many times, nurses do not get breaks. We want breaks, we do! They just become impossible with the increased patient loads and the increase in patient illness that we see. If a nurse somehow gets to leave to go on break, the relieving nurse needs to assume the responsibility for double the patients for the period of time. If that nurse is already having a hard time staying afloat of the assigned tasks at hand, then giving this nurse more responsibility doesn’t make sense. Bedside nurses are tired.

We also are often asked to float to other areas of the hospital — without training. Yes, I learned about basic orthopedics in nursing school; however as a neurology nurse, my knowledge of repairing bones is limited. Nurses should never be asked to float to another unit of a hospital unless they receive adequate training. This is a matter of safety. No other professional business would do this. A payroll accountant would never be asked to float to the sales department. A salesperson would never be asked to work as an architect. A cardiologist would not be asked to fill in for a neurologist. It just isn’t done. Why do nurses have to risk their licenses to do this? It is not safe patient practice.

We get scared.

When nurses have all of these stressors constantly, they may not even realize that they are having symptoms of chronic stress that can lead to PTSD. It sneaks up on us as we are caring for our patients. We learn to compartmentalize the constant stress and emotions that we feel, as we chalk them up as “another part of the job.” We suppress them, until one day, all of a sudden, the compartment opens, and we find ourselves overrun with anxiety and depression. We find ourselves having flashbacks, feeling guilty and having trouble sleeping. We begin to doubt our ability to be a nurse. We begin to question everything. We find ourselves unable to work, at least at the bedside at least until we heal, maybe never again.

Nurses need support from our hospitals, our government officials and our communities. We need regulated patient ratios and increased pay. Hospitals need to stop floating us to other units unless we are trained in that area of nursing. We need classes on caring for ourselves, and we need to take advantage of employee-assistance programs that offer free, confidential counseling. We need hospital-provided exercise rooms. We need to learn coping skills. We need to be able to process all of the emotions that we feel that have always been discarded as, “part of the job.” We need to talk about our issues, and we need to feel like we are being heard. We need to heal.

Anne Naulty is a nurse.

Back to where it started: Chicago

I flew into cold, snowy Chicago last week to discuss my book at the main facility of Erie Family Health Centers. This felt like a dream as I stood behind the lectern gazing at the audience that, believe it or not, included a few familiar faces from some thirty years ago. I had been invited to read from my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.I was discussing EFHC’s humble beginnings to this group of employees seated in the conference room on the third floor of an impressively designed modern building.

The main clinic that I remember was housed in a community center. Children’s laughter in the after-school program and the sound of the ball dribbling on an indoor basketball court easily penetrated the partitioned walls of the exam rooms. The dedicated staff experienced delayed pay days when revenue came up short. The clinic where I worked, a short walk from the main center, had mismatched chairs in the waiting area, second hand medical equipment, and roaches in the cabinets. In spite of the physical shortcomings, EFHC cared about the patients, the community, and its staff.

EFHC not only survived its humble roots but thrived and expanded. The non-profit organization now has 14 health centers, and more Advanced Practice Nurses (nurse practitioners and midwives) than doctors and is recognized as providing the highest quality of care by the US Department of Health and Human Services. The Chicago Tribune named EFHC as one of the top workplaces in 2018.

I am honored to be part of EFHC’s history.

 

Retired Nurse Practitioner & Author Marianna Crane presents her memoir,
Stories from the Tenth-Floor Clinic
On February 20, Marianna Crane, retired Erie nurse and author, met with our nursing staff to discuss her memoir, “Stories from the Tenth-Floor Clinic,” which movingly recounts her experiences as a nurse caring for the underserved elderly at Erie in the 1980’s.
We had a full room, a great discussion about the nursing profession, and over $300 were raised for Erie’s patients through the sale of her book!
Please join us in continuing to support Crane’s work! Keep up with her on her blog and website, Nursing Stories.
Buy the Book!
Proceeds from the sale of Crane’s memoir go towards providing quality care for Erie’s patients.
Crane with Dawn Sanks, Director of Health Center Operations at Erie West Town
Crane with Dr. Lee Francis, President and CEO
A full room!
Erie Family Health Center | 312.666.3494 (city) | 847.666.3494 (suburbs) | www.eriefamilyhealth.org

Nursing Truths for a New Era: Author Interview with Marianna Crane

A serendipitous meeting with Michele Berger reminded me of the long road I traveled conceptualizing, creating, and finally completing my book. Many folks that I met along the way inspired and supported my efforts. Most I never had the chance to thank. Fortunately, now I can tell Michele that her creativity workshop and follow-up coaching encouraged me to stay on track.

Thank you, Michele.

Below is Michele Berger’s recent post spotlighting me and my book.

The Practice of Creativity

Happy new year, everyone! It feels especially poignant to begin the first post of the year with a special Author Q&A. More than a decade ago, before I formally began my coaching practice, I taught creativity workshops at UNC-Chapel Hill’s The Friday Center. They had a thriving adult enrichment program. My classes were popular and I met and coached people from all backgrounds. It is always a delight to run into people many years later and hear about their creative adventures.

Two months ago at the North Carolina Writers’ Conference, out the corner of my I saw a distinguished-looking woman. Her face looked familiar, but I only caught a glimpse before moving on to my next panel. To my great delight and surprise, this same woman came up to me at the reception. We immediately recognized each other. She had taken one of my classes at the Friday Center and…

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Traits Every Great Nurse Has

I discovered a great nursing blog: Diversity Nursing Blog. Here is a post I especially liked. Hope you do too.

 

DiversityNursing Blog

Traits Every Great Nurse Has

Posted by Erica Bettencourt

Fri, Mar 23, 2018 @ 09:19 AM

 

What makes a good Nurse? What are the qualities of terrific Nurses? The Nursing profession is about kindness and caring for the whole person as well as medical, emotional and technical knowledge, and so much more. Below are a few traits that make Nurses so great!

 

GOOD COMMUNICATION

Communication is essential to patient safety, health and well-being. As you are at the center of patient care, it is your responsibility to facilitate dialog. As you care for older and more culturally diverse populations, you will need to strengthen your communication skills. Without strong communication skills, serious errors can occur.

 

EMOTIONAL STABILITY

As you know, Nursing is a stressful job where traumatic situations are common. The ability to accept suffering and death without letting it get personal is crucial. Some days can seem like non-stop gloom and doom. There are heartwarming moments like helping a patient recover, reuniting families, or bonding with fellow Nurses. But those moments are less common than the tougher situations. So remember to take care of YOU too so you can handle the inevitable crises.

 

EMPATHY

Empathy is a complex emotion and can be a complex concept while working with many patients who have different kinds of needs. Responding with empathy requires the ability to put yourself in your patient’s shoes, see situations from their perspective and demonstrate that you understand their feelings and are reading them accurately. Most importantly, it requires you to act on that understanding in appropriate and therapeutic ways.

 

ATTENTION TO DETAIL

Paying attention to minute details is important in the Nursing profession, especially when you have a lot on your plate. You must document everything you do on patients’ charts, listen closely to their description of symptoms, ask the right questions, and remember to bring medications at appropriate times. It’s critical to remember even the smallest detail amidst all of the commotion. At the end of the day, one small slip-up could become a fatal mistake.

 

PHYSICAL ENDURANCE

You encounter many patients with lifestyle-related disorders. With this in mind, a basic understanding of the role physical fitness plays in prevention and rehabilitation is key. You can be a positive influence on patients who have to make life­style choices if they see you’ve made good choices. If you stay fit, you not only feel good, you’re a great role model for your patients.

 

Physical fitness improves your ability to effectively perform the physical tasks you do every day. One study of 146 Registered Nurses, over a 12-hour shift, found they covered an average of 4 to 5 miles per shift. I’m sure you’re not surprised by this information!

 

DESIRE TO CONTINUE LEARNING

Medical knowledge and technology are advancing rapidly. As a great Nurse, you know the importance of working on your professional development and skills, and learning new things.

 

SENSE OF HUMOR

This is imperative! A joke and a few laughs can take the edge off of a tough day and…it feels good. Need we say more?

The Building as Character

 

My Book is on Amazon

Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers 

Paperback – November 6, 2018

by Marianna Crane (Author)

Running a clinic for seniors requires a lot more than simply providing medical care. In Stories from the Tenth-Floor Clinic, Marianna Crane chases out scam artists and abusive adult children, plans a funeral, signs her own name to social security checks, and butts heads with her staff―two spirited older women who are more well-intentioned than professional―even as she deals with a difficult situation at home, where the tempestuous relationship with her own mother is deteriorating further than ever before. Eventually, however, Crane maneuvers her mother out of her household and into an apartment of her own―but only after a power struggle and no small amount of guilt―and she finally begins to learn from her older staff and her patients how to juggle traditional health care with unconventional actions to meet the complex needs of a frail and underserved elderly population.

 

Review

“Marianna Crane writes with compassion and insight about what it’s like to serve on the front lines of the medical profession―treating the most vulnerable among us. Her vivid account is moving and enlightening, a valuable contribution to the literature of social justice.”
―Philip Gerard, Professor, Department of Creative Writing, University of North Carolina, and author of The Art of Creative Research

“Nurse practitioners are well known for their willingness to be primary care providers for the ‘underserved’―those people who are waking bundles of multiple chronic and acute illness and myriad ‘social determinants’ of poor housing, little income, and almost no family or friends to call a support system. Society prefers that such patients remain invisible, because acknowledging their existence is too unsettling. It is my fervent hope that Stories from the Tenth-Floor Clinic will find a wide audience of readers who are willing to meet and care about the people nurse practitioners allow into their lives every day.”
―Marie Lindsey, PhD, FNP, health care consultant and founding member and first president of the Illinois Society for Advanced Practice Nurse

 

About the Author

Marianna Crane became one of the first gerontological nurse practitioners in the early 1980s. A nurse for over forty years, she has worked in hospitals, clinics, home care, and hospice settings. She writes to educate the public about what nurses really do. Her work has appeared in The New York Times, The Eno River Literary Journal, Examined Life Journal, Hospital Drive, Stories That Need to be Told: A Tulip Tree Anthology, and Pulse: Voices from the Heart of Medicine. She lives with her husband in Raleigh, North Carolina.

 

Note: Still waiting for the cover to be designed.

A Story You Won’t Soon Forget

For the past ten years, I wrote my book in isolation. Long hours in front of my computer at my home, or a coffee shop, library and on Amtrak traveling between our home in North Carolina to Washington DC or New York City, and in other spaces I can’t remember. Wherever the location, I rarely chatted with others.

Now I am sharing my thoughts about my book and publishing issues with other authors. A whole new network of fellow writers has opened up to me. I no longer struggle alone but can discuss my experiences with those that have walked along the same path.

I spotlighted Nightingale Tales: Stories from My Life as a Nurse, by Lynn Dow in November. The book described Lynn’s nursing education and early hospital experience that was very much like my own. I spoke with Lynn three weeks ago and more recently with another author, Antoinette Truglio Martin. Both women freely shared their experience in their journey to publication, which publicist they choose, and how they promoted their books. I’m looking forward to contacting more authors as I travel this road.

Getting back to Antoinette Truglio Martin. She wrote Hug Everyone You Know: A Year of Community, Courage, and Cancer. Yes, it’s about cancer but it is not a depressing book. In fact, the Antoinette’s story is a thoroughly enjoyable read about her life as a wife, mother, speech therapist and special education teacher. Cancer is a tangential occurrence in her busy, happy life. She writes:

“. . . The less attention and verbiage I gave this cancer, the less real it was in my day. This cancer is nothing more than a detour—not a chronic condition or terminal illness. Audible words, long dialogues, and ownership would provide it with an embodiment. I tried to keep that to a minimum. The treatment I was willingly putting myself through was aimed to kill any trace of cancer that might have been left behind from surgery (lumpectomy). I believed it was completely gone, and the chemo and radiation therapies served as insurance against a recurrence. This cancer did not deserve an audience and would never be referred to with the personal pronoun ‘my.’”

Antoinette balances her story between her encounters with oncologists, chemo and radiation treatments, and stories of her extended Italian family, living in Long Island near the Great South Bay, and being supported by a group of caring family and friends. Coincidentally, four of her friends were also undergoing treatment for breast cancer.

I happily followed as Antoinette, a self described “overly squeamish, wimpy crybaby” who passed out during a blood draw, as she took charge of her treatments and confronted rude, uncaring and unprofessional medical staff.

One does not have to be faced with a cancer diagnosis to enjoy this book. Hug Everyone You Know opens a window on what it is like to navigate the health care system with a frightening illness. Antoinette educates us with a tender, engaging story that we will not soon forget.

 

 

 

 

A Broken Man Who is Hard to Forget

Richey rolled himself in a manual wheelchair into the exam room of the spinal cord clinic for the first time on a warm spring day in April. He managed to lift his quivering right arm to shake my hand. I was the new nurse practitioner in charge of his care. He had some ability to walk but he used the wheelchair to maneuver the halls of the VA. Luckily, he could schedule a hospital van to drive him back and forth to appointments. Having a spinal cord injury proved to be an advantage in the system.

Richey’s dirty blond hair stood in tuffs on his head. Dressed in jeans and a T-shirt, he could have passed for eighteen but in reality he just turned thirty, had an ex-wife, two preteen girls, and a few years of homelessness under his belt.

“What are all these scars on your abdomen?” I had asked.

“All the fights I had growing up,” he said. “Always in fights.”

When I met him he was living with his brother, his brother’s wife, and their young daughter. His brother was planning to leave for Iraq and his wife would move in with her family, so Richey decided to move back with his mother.

“Don’t do that, you’re crazy,” Richey’s brother told him. But Richey figured that his mother tried her best when they were growing up. He would give her a second chance. Plus, he said he would be near his ex-wife. He wanted to reunite with his girls.

Richey couldn’t get out of his own way to avoid trouble. He had a long history of drug abuse and alcoholism. He saw evil intent in everyone he dealt with. He could worm his way into a confrontation by just looking at a person. No one respected him. Not one person was supportive.

Richey hated our physician but he seemed to tolerate me. Most of the spinal cord patients flattered me because I had the prescription pad. They had pain and needed medication. Like all my patients, Richey signed a contact to submit to random urine testing. The first sample tested positive for marijuana along with cocaine.

“Knock off the cocaine,” I told him and added that I would look the other way with weed. Most of the spinal cord patients liked marijuana because it helped with spasms and improved their appetites.

Richey wasn’t too different than the spinal cord guys I cared for—“broken men” I called them. They had no incentive to look back and try to figure out what happened to turn them into the non-functioning adults they had become. They had no insight, no imagination, and no drive to make changes.

Richey’s problems revolved around his perception of not getting any respect. The receptionist in the x-ray department didn’t respect him so he didn’t get the x-ray I had ordered. The night nurse didn’t respect him so he left the rehab center I had worked so hard to get him into. Maybe she was mad that he broke the rules by wandering outside after hours, peeing in the bushes, falling down afterwards, and unable to get himself up until he was found in the morning. His mother didn’t respect him so he left her and went to Florida to live with an estranged sister who didn’t respect him so he went back to live with his mother who I found out used drugs and let him drive her car that he was physically challenged to drive in the first place. I suspect that if a policeman had stopped him, that policeman wouldn’t respect him for driving without a license.

His ex-wife didn’t respect him for having an affair. Nor did she respect him when he drove home with his ladylove in the front seat on the day she, his wife, was in the hospital giving birth to their first daughter. During that drive Richey flipped the truck over, his girlfriend was fine but he fractured his spine.

I have long forgiven myself for not being able to help Richey recognize that his actions caused most of his problems but I still think about him after all these years.

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