Dark Water, Wild Winds: Notes of a Flight Nurse

I must see new things
And investigate them.
I want to taste dark water
And see crackling trees and wild winds.
—Egon Schiele

IMG_2650Repatriation

I’m standing on the tarmac in Tapachula, Mexico, where there is indeed a wild wind; it blows debris across the runway yet does nothing to stave off the nearly intolerable heat. Sweat soaks my back and drips down the center of my chest. My limbs are heavy with lethargy. The heat index is 110 but it feels much hotter—even the Learjet fails to provide a haven from the southern sun.

We’d come to Mexico to repatriate an Englishman who’d been visiting family and was struck down by sudden and severe seizures. He’d spent weeks in the hospital, sustaining scans and diagnostics to pinpoint the cause, and endured the addition of one antiepileptic medication after another.

While the seizures finally ceased, he was left disquieted and uncomfortable, unsure which symptoms were due to the 7 cm brain mass that had been discovered and which were side effects of the myriad of antidotes. By the time we were dispatched for this mission, he was medically stable and ready to go home to deal with the ominous findings. Biopsies awaited and treatments would be considered. Plans could be made.

Conversations in the In-Between

His long flight was one that seemed to serve a purpose far greater than physical transport. Away from the confines of the hospital and the doting attention of his family, he had time to process the implications of a brain mass. He pondered aloud the best- and worst-case scenarios and all of the “what ifs” in between. He napped often, awakening to ask my partner and myself a series of questions of which we never tired. (“What if it’s malignant?” “Will they operate?” “How will they operate?” “What if they can’t operate?” “What if I have no time left…?”)

By the time we reached the hospital near his home, his questions had slowed and nearly ceased. The flight was cathartic, I think. Our patient seemed at peace. […]

The Quandary of Scheduling Vacation Time for Nurses

Illustration by the author; all rights reserved Illustration by the author; all rights reserved

While shopping in a grocery store, I passed a display of craft brew beer that caught my eye. The sign read Hospice Beer! After a double take, I saw on closer inspection that the label actually read: Hop-Slice Beer.

I realized I was badly in need of a summer vacation. Fortunately, I already had one scheduled on the books.

Summer is a traditional time for vacations, but often not for nurses, for multiple reasons.

Paid time off benefits vary from organization to organization.

Some lump vacation hours and sick leave hours into the same bank, while others separate the two so that nurses accrue hours into each per pay period. Paid vacation time accrues slowly when it’s used for paid sick time.

Further, after accepting a new job, nurses may find that as the newbie they accrue vacation and sick leave hours at a rate lower than their colleagues hired earlier; this practice, called tiered employment, exists within many industries outside of health care, whether they’re union or not. The practice can foster division between the newly hired and existing staff within units. Newer hires accrue less benefits for the same amount of work as their peers. The practice is a double-edged sword, however. It also means it’s cheaper for employers to hire new nurses than appease those with seniority.

After twenty-five years working continuously for the same health care system, I found myself in a similar position: a structural reorganization necessitated that I be hired by another organization. After working there for a year, I returned to the first organization as an oncology nurse navigator. The transition resulted in my accruing vacation time at the same rate as a newly hired nurse, despite 25 years of previous service.

I love my work, and I was happy to return to the organization. It was my choice. But it came with a price.

How vacations are scheduled in nursing units varies too.

In some, vacation time requests are required at the beginning of the year, forcing staff to make plans while they cope with holiday plans at home, along with winter illnesses and the accompanying short staffing that occurs with it at work. For many, thinking about a summer vacation in the midst of this melee is daunting, and so they don’t schedule vacation time, leaving it to chance when they finally do request time off.  In this scenario, they risk not getting an adequate vacation at all. […]

July 25th, 2016|career, Nursing, nursing perspective|0 Comments

Appropriate Use of Opioids in the Management of Chronic Pain

Painted by Martin Edwards as part of the Paint Your Pain program initiated by the Pain Management Center at Overlook Medical Center, Atlantic Health System, Summit, New Jersey. For artwork of other patients in the program, go to http://bit.ly/ 1Ns0PxL.The dangerous misuse of prescription opioids and drugs like heroin has been much in the news, but millions of patients continue to suffer both acute and chronic pain. For many, prescription opioids play a vital role in alleviating that pain. How can health care providers most effectively and safely use opioids in the treatment and management of chronic pain? Some answers can be found in a CE article in the July issue of AJN: “Appropriate Use of Opioids in Managing Chronic Pain.”

Related questions on opioids and chronic pain addressed in the article include:

  • What is the best way to assess chronic pain patients?
  • Which patients—for example the elderly, those with compromised renal or hepatic function, those with a history of substance abuse—may require special considerations when opioids are prescribed?
  • Which opioid medication or medications, if any, should you select for your patient?
  • And what are the legal and practical challenges to prescribing opioids?

[…]

July 22nd, 2016|Nursing, pain management, patient safety|0 Comments

AJN’s Top Five Most-Emailed Articles

IMG_2151We are sometimes surprised by the articles our readers are most interested in. The articles shared most often among colleagues are not always the articles being read by the most people. Here are AJN‘s current top five most-emailed articles, many of which deal with essential practice topics such as pain management or nursing handoffs or with various workforce and educational issues:

We encourage readers to visit AJN and explore the wealth of collections, archives, podcasts, videos, and much more. Some articles, such as continuing education features and the monthly Reflections essays, are free access; some require a subscription. And of course, feel free to let us know about topics you’d like to learn more about.

Lastly, here’s a much longer list of AJN‘s most emailed articles.

July 20th, 2016|Nursing, nursing perspective|0 Comments

Moral Distress: An Increasing Problem Among Nurses

moral distress

An ICU nurse struggles to reconcile repeated surgeries and transfusions for a comatose patient who has little chance of recovery. An oncology nurse knows a patient wants to refuse treatment but doesn’t do so because his physician and family want him to “fight on.” A nurse on a geriatric unit knows she’s not giving needed care to patients because of poor staffing.

Situations such as these are all too common and can give rise to moral distress. Moral distress occurs when nurses recognize their responsibility to respond to care situations but are unable to translate their moral choices into action.

As explained in “Moral Distress: A Catalyst in Building Moral Resilience,” one of the CE articles in our July issue, this “inability to act in alignment with one’s moral values is detrimental not only to the nurse’s well-being but also to patient care and clinical practice as a whole.” […]

July 18th, 2016|Ethics, Nursing, patient safety|0 Comments