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 Manaus, Brazil, 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 equatorial sun.

We’d come to Brazil 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

Summertime: Time to Write

karindalziel/ via Flickr Creative Commons karindalziel/ via Flickr Creative Commons

July 4th has come and gone and summer still stretches out before us. For many, summer is a time to relax and take things a bit slower. Working moms and dads don’t have to deal with school projects; faculty have no or at least fewer classes to teach. It’s the perfect time to write—or at least start—that article you’ve had on your “To Do” list for the last year (or two or three).

Many budding authors tell me that the hardest part about writing is getting started, so here are suggestions from a pair of editors and writers who teach writing workshops (included, along with several other writing tips, in my 2014 editorial on the topic):

  • Set a consistent time to write, even if it’s only 15 minutes a day. Make an appointment with yourself and honor it as you would an appointment with someone else. Make yourself sit down and write—and write anything to begin; you don’t need to start at the beginning or do an outline. Once you get rolling, you can always write for a longer time.
  • “Start anywhere, but start. And keep your hand moving, whether you’re using a pen or a keyboard. Whether it’s because of muscle memory or the mind–body connection, this works. Random thoughts will morph into coherent sentences, which you’ll later organize into paragraphs; before you know it, you’ll have 500 words and a good start to a short essay or an article.”

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July 11th, 2016|career, narratives, Nursing|1 Comment

Is It Time to Retire the Term ‘Midlevel Practitioner’?

Rachel_Scherzer_photo_and_calloutWhat are the implications of calling advanced practice nurses “midlevel practitioners”? According to Rachel Scherzer, a nurse educator and critical care nurse, such a term pigeonholes APNs in an implied (and disproven) hierarchy of value and quality of care rather than in relation to specific competencies and expertise.

In the Viewpoint essay in the July issue of AJN, Scherzer describes some of the reasons why such terms aren’t just inaccurate, they damage the standing of the profession:

Policymakers use the term while developing health care policy, health care economists use it when reporting data and performing cost analyses, and other health care providers use it in the clinical setting. . . . This term is both diminutive and inaccurate, implying that these professionals cannot provide the same level of care as other members of the interprofessional care team. Referring to APNs as “midlevel” practitioners contributes to a general misunderstanding of their role and of the services they provide.

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AJN in July: Opioids and Chronic Pain, Moral Distress, Prediabetes, More

CE Feature: Appropriate Use of Opioids in Managing Chronic Pain.”

Unintentional death related to prescription opioids has been identified as a public health crisis, owing in part to such factors as insufficient professional training and medication overprescription, misuse, and diversion. The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal.

CE Feature: “Moral Distress: A Catalyst in Building Moral Resilience.”

Moral distress is a pervasive problem in nursing: an 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. Moral distress has typically been characterized in terms of powerlessness and victimization. This article offers an alternate view: ethically complex situations and experiences of moral distress can become opportunities for growth, empowerment, and increased moral resilience.
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