Are you a Cowboy, MacGyver or Resource Rockstar?

There are many types of nurses out there, but today I’m going to talk about the Cowboys, MacGyvers and Resource Rock Stars. Yes, you know who you are. You might have even heard or used these terms before. You probably laughed at this title and thought, “I hope she isn’t going to make me take an internet quiz because I already know which one I am”. This is a helpful discussion in knowing the difference. Especially helpful for the new nurses who have 1,000,000,000 questions – I’m not as new and I still have about 1,000,000,000 questions. So hold on to the reigns tight, get out your swiss army knife, and get ready to rock…

 

The Cowboys

 

“YEEEEEEEE-HAAAAAW”. Full speed ahead! These nurses GET-IT-DONE. They take their assignment and get a thrill from all the “things” they need to fix. You apologize profusely to them for not being able to get that med up from pharmacy in time to give to the patient before the start of their shift. They say, “Partner, don’t get your boots in a bunch, I’ll take care of it” (please tell me you are reading this in a mid-western twangy-sounding cowboy accent, or like woody from Toy Story at the very least).

 

When the charge nurse comes around to ask if they need any help, they laugh. Straight-up-laugh at you and say, “Sheriff, I’ve got this town under control, now you go on and round up the other troops”. They can go an entire shift without a question. Now in all seriousness if they are an experienced nurse and the patients aren’t complex this is okay. If you are a new grad……

 

Whooooooaaaah nelly!

 

Cowboys are great because they don’t have much fear. Have a new admit with a sketchy report from an outside hospital? ~ assign it to the cowboy, because they will handle it. A little nervous in placing a Foley? Grab a cowboy to help boost your confidence. Want to work on your confidence in giving report? Give it to a cowboy, they got this “partner”. If you are a pediatric nurse with an unruly 2-year-old with no parents staying with them, let this cowboy round them up them and make the 2-year-old laugh in the process.

 

If you are a new grad, you SHOULD NOT be a cowboy. Now this isn’t saying that you aren’t confident, or that you wouldn’t be able to handle anything – because you absolutely can. But you shouldn’t try to round up all the complex problems of healthcare yourself without asking your coworkers. As a new grad, you aren’t going to be on the range watching tumbleweeds go by because there is no one else in sight. You are going to basically run over other nurses, interns, physicians, dieticians, physical therapists, chaplaincy, nurse managers, nurses educators, volunteers and nursing assistants on your way to find supplies….so ASK the burning question!

 

I’ve asked questions from:

 

“I have these four meds infusing, these three are compatible, but this isn’t, but this patient needs them all, so what are suggestions on getting them all the meds?”

 

to

 

“Can I microwave this Styrofoam?”

 

The negative to being a cowboy, is if you try to solve it all on your own, and you are unsure about something, you could end up doing it wrong – and hopefully it wouldn’t be at the patient’s expense, but as a cowboy, you take that risk.

 

So go ahead, jump on your horse and be a cowboy if you have years of experience and you truly have straightforward care and without a doubt can complete it without question. Yet, take that cowboy hat off the second you have a question, concern, or sense of uneasiness…because you will be a better nurse for asking that question, and your patients will thank you for that.

 

MacGyver

 

The older nurses have already laughed at this section, but myself being born in 1989, and even though I have heard this term, I had to refresh myself with who MacGyver was. MacGyver was a show airing from 1985-1992 and it followed a secret agent Angus MacGyver who would solve complex problems often with simple household items like a paper clip and Swiss army knife and get out of every situation. Here’s a short snipet of the show if you are interested:

 

 

 

MacGyver’s are some of my favorite type of nurses. They methodically look at a patient and get this super proud feeling after they get report because they know just the piece of equipment or care plan or cream that will make it better. They are the type of nurse that will ask for the shelf-pump so that one single plug can charge 4 IV pumps, and the teenage patient’s cell phone. How cool is that?

 

MacGyver’s are so cool. You can ask them to look at your patients IV and they will know that a little piece of gauze, with this specialized tape and a sticker will make it work like magic. When you are about to get report from a MacGyver, you secretly scream, “YESSSSSSSSSS!” in your head because you know how great your patient is going to be handed to you.

They can make clogged NG’s flush, unmanageable IV pumps STOP-FOR-THE-LOVE-OF-SPONGEBOB-AND-ALL-THAT-IS-HOLY! They can un-kink IV tubing, they can swaddle and position an infant so that they stop crying, they can seemingly take their Harry-Potter wand and make everything work like it should or even better.

These MacGyvers are excellent resources, co-workers and friends. Just don’t tell them their methods or fixes didn’t work, because THEY-WILL-EAT-YOU. Just kidding. Kind of.

Resource Rock Stars 

Let’s get ready to rock! These nurses would be the mayor, if the hospital workers were allowed to elect one. They know Bob from transpo, Carrie from pharmacy, George from lab, Tina from your sister unit, and okay basically EVERYONE. This nurse will solve problems by outsourcing, and using every ounce of additional help and guidance they can. They get excited when you ask them a question and they know just the right person to call.

 

You ask a question.

 

Their red curtains open.

 

The grab their microphone (or hospital phone and dial the number –from memory of course)

 

The show begins.

 

You get the answer you were looking for!

 

Curtains close, “microphone” is hung up.

 

AND THE CROWD GOES WILD!

 

They know the right “code” to use to order supplies. They know where the super secret hidden key to the super secret extra supply closet that no one is supposed to know about is. But shhhhhh….don’t tell anyone.

 

Resource Rock stars will print out a 10 page policy or procedure when you ask how to insert a Foley catheter…..and they will smile while doing so. They also know every policy/procedure and rule because they have preformed it so many times, and if it is a “new” act ~ they know EXACTLY where to find the policy so we can all know where it is next time.

 

Sometimes, the resource rock stars get “star-struck” and get dazed by all the policies, rules, procedures, codes, and need an intermission to snap back to reality, but they really are rock stars, and I would gladly take their autograph because they would know where the best quality paper and pens are too….and a nurse can never have enough pens right?

 

Resource rock stars also know how to showcase their best talented co-workers. They know that John the LNA can cuddle the crankiness out of a baby any day, or that Sue the LNA can talk to psych patients in a way that they feel comfortable and not terrified to take their medication. Lisa the housekeeper always does a fantastic job and cheers up patients, Tom from engineering knows how to fix the blinds, Joan from unit support knows who to call for computers, and resource rock stars know they can call the mega-resource rock star operators if they can’t figure something out!

 

~So whether you are a Cowboy, MacGyver, Resource Rock star…or are a nurse just asking a question to one of these three personalities, always remember:

 

~To ask or not to ask? That should never be a question!!!~

 

~Keep on Caring

 

Empathy ~ Pass it On

 

About a year ago, a mentor shared this video with myself and my co-workers via e-mail. It is so powerful…..please, please, please watch!

 

 

Empathy (Noun) The ability to understand and share feelings of another.

 

In my last blog, I was discussing coping or being “cope-a-licious’. Another way in which I have been able to deal with day-to-day nurse life is to bring to the forefront of my thoughts the concept of empathy.

 

Now for many nurses, some might say empathetic thoughts and actions are just part of the job. It’s natural. You go into nursing “to help people”. However, after watching this video I felt that there were different levels to empathy, and that this needed to be explored more.

 

Before, my day-to-day would involve surface level empathy…for instance giving a shot I would “understand” that it would hurt and do everything in my power to eliminate that pain. When working with parents of children with pyloric stenosis (this is when babies come in with projectile vomiting because the sphincter that connects the stomach to the small intestines narrows or becomes frozen) I would have empathy for their immense fear, and anxiety and would take the time to talk through how common this is and quickly treatable.

 

However, what I feel this video talks about is a different level of empathy. Much DEEPER than skimming the surface. This type of deep empathy is not assuming things of others, and to have an open and understanding attitude when interacting as a healthcare provider.

 

I love this quote every time I come across it….

 

“I’m an ex-convict. I have AIDS. I’m a prostitute. I’m poor. I’m lesbian. I aborted my baby. I’m a teenage mom. I’m a victim of gang rape. I’m a drug user. I’m an alcoholic. I’m a beggar. I have cancer. I have a contagious disease. ….but the nurse said ‘I’ll take care of you’. – Author Unknown.

 

First of all I want to point out that all of these “terms” weren’t clumped together because they are “scary” or “bad”. They are labels that at one time in history or in current time, society has either implicitly or explicitly excluded, rejected, turned their heads from these people who have these  or similar “labels”. I love this premise of this quote because it gets to allow you to explore concrete examples of empathy…because personally I used to read this quote and before getting to the end be like “so what”?

 

Oh wait! Ha! That’s the whole point….so what if you, me or someone are considered a label that society might not accept…we still deserve respect, dignity, and that best care that can be provided.

 

….and that concept isn’t nursing specific but a global concept everyone should adopt.

 

Second of all nurses aren’t angels, impenetrable to biases, prejudices and pre-conceived notions. Some of the nurses I meet I swear are truly angels or superhuman, however speaking for myself – I am human – and nursing was a career I chose, a calling, and a way of life. I have my own ethics, morals, ideas, and environmental upbringing. As much as I would like to think that I can have empathy for other because I am just awesome- I really am not all self-worshiping – and I think that nursing school training has taught me how to be empathetic.

 

On the tragic day of April 15, 2013 when the city of Boston Massachusetts was bombed by terrorists, my gut reaction was horror. Next, I felt sympathy (different from empathy) for all of the friends and family that lost people in this tragedy. As the next couple of days unfolded and they found the monster that committed these horrible acts of violence, I realized that he had also been injured and was going to need to be treated before going to jail. This sparked a few conversations from friends and family – and since Boston is so close to me it became a real thought….

 

If you were a nurse working that shift that this MONSTER was brought in, would you be able to take care of him?

 

Yes.

 

Unequivocally, without a second thought, yes.

 

Why?

 

I am a nurse. This is more of an ethical discussion now than empathy; however, I would do my best as a nurse to take care of this patient in the best way I could. Yes, I would want to eventually see this person go through trial and pay for what they had done, but it wouldn’t change my care. I think in this case that you would have to also be mature enough to know that if you were in an ethical debate with your-self, if your own beliefs, or values would indeed change the care you provided, that you would need to excuse yourself.

 

Sometimes, in real life – not nurse life…..I use empathy to help explain peoples actions….

 

So I have a story. My husband, my friend and I were driving to meet another friend. We were going through Boston. There was a truck that screamed across like 2 lanes, but was okay after that. We are in the car like:

 

“Where’s that 1-800-How’s-My-Driving Number!?”

 

We found it! My friend called and we could have been jerks about his driving. Straight-up mean jerks. But we weren’t so it was awesome, and went something like this:

 

“Hello, so-and-so business, are you calling about someone’s driving?”

 

“Yup”

 

“Okay can I have the license number?”

 

“1-2-3-4-5-6”

 

“And you name and number”

 

“Sally Sue 1-1-1-2-3-3-2”

 

“Okay, and what was this driver doing that prompted you to call?”

 

“Well I just wanted to call and say that this driver has been doing a really great job, and it can be difficult to navigate through Boston traffic, and they have navigated it nicely”.

 

“Ugh….do you have anything else to say?”

 

-You could tell how this operator didn’t get the “nice” phone calls too frequently-

 

“No- he has been doing a great job and so we just wanted to call to tell you that”

 

“Oh, okay, well thank you”.

 

“You’re welcome”.

 

We drove by this driver, and smiled.

 

Okay, okay, I know this sounds like promoting my friends and myself doing something nice. But really we don’t do nice things like this all the time, so don’t give us any awards yet. I will take chocolate though…but in all seriousness that wasn’t my purpose to share this story, and it was my friend’s idea not mine. But my purpose was that this truck driver could have been driving 14+hours, away from his family, missing home, and tight on his deadline –understanding this is empathy. That one phone call could have meant and done absolutely nothing, or it could have been the one good “check” that he needed to get a promotion, to then have enough money to send his daughter to nursing school – okay let’s be real he would have needed a whole LOT of phone calls for that – but I am optimistic and dream in the clouds.

 

Empathy is hard.

 

Especially when you have a whole bunch of “stuff” on your brain that you are thinking. Especially when the other person you are trying to have empathy for is mean, or loud, or ignoring you. But what if they have something horrible going on in their family? What if they just received horrible news? What if it is a parent who feels like they have no way to help or provide pain relief for their newly diagnosed child with cancer?

 

…What if?

 

It’s the what ifs that give us empathy towards others. Even if it’s not true. Even if that person might not have a substantial reason to act the way they are. Your empathetic response to their actions might make all the difference in their day. YOU have that power.

 

So the next time you walk by someone in the hallway, try to smile, or nod, or do a super awesome Zumba move to make them laugh – because you can’t even begin to know what their day has been like, and you could just help them for that one second not feel alone.

 

~Keep on Caring

‘Tis the Season of being Stressed

 

To get us all in the mindset of what I am about to discuss, let’s review the following video:

I am the Grinch in this video when it comes to stress. There’s no Cindy-Lou-Who about it. I became the Grinch, despite this self-righteous proclamation to be a better, more positive person. Last night, I was wrapping gifts and my husband was calmly watching TV. I look up at him,

Me: “Sam”

Sam: “What”

Me: “I can’t do it. I’m trying to be the best I can be in all these different aspects of my life. I’m trying to be a better instructor, a better nurse, a better mentor, a better friend, a better wife, daughter, sister, granddaughter, just better person in general……..and we have to clean, and cook, and wrap the presents, and go to all these family parties, and have you asked you aunt what we can bring? And we have to do the dishes. And vacuum. And mop. And why is my grandmother so hard to shop for. You better help me with chores you know. I just can’t do it.

Sam: “It’s all fine. It will all get done.”

Me: …shedding a tear “Why don’t you talk to me”

Sam: “I am, everything is going to be okay, you worry to much”.

Me: “Ugh! No I don’t”

It’s “humerus” now (get it? RN joke, its what we call the bone in your arm), but last night my shoulders were up to my ears and I could feed the knots forming in my shoulder muscles, and I was having this sense of overwhelming fear of disappointment come over me. First of all, I have an awesome husband – as high and in the clouds as my anxieties, ideas, and dreams are he is oh-so grounded with his engineering black-and-white thoughts, and brings me down to earth, and luckily we end somewhere in the middle. Yet, this stress is all to common for many nurses near and far; especially around the holidays where many competing work, and family needs.

 

How do we get this pattern of stress and worry? Well, with my students, every morning in clinical, after they have received report, I play the “worst case scenario” game. Not to be all “dark and twisty” (Grey’s Anatomy reference); but it helps them critically think on how to be prepared for any situation that may arise. So we are trained from basically day one to think the worst, and not just hope for the best, but follow every protocol and evidenced-based practice we can to make it the best it can be.

 

Oh How Nurses Worry? Let me Count the Ways:

-We worry how much you pee

-We worry about your vital signs

-We worry about your bowel movements (That’s poop- weird/gross I know – but it’s important- trust me I’m a nurse)

-We worry about your pain control

-We worry about your IV sites

-We worry about your labs

-We worry about you or your care takers knowing how to take care of you when you go home.

-We worry about your overall well-being.

 

….and that is just a slice of the worry pie. We worry that our documentation is on time, accurate, and doesn’t say GUAC negative instead of GUIAC negative (although we are hungry so we would probably prefer some guacamole right now rather than checking for occult blood in your stool), or phone calls to physicians include all the information – enough so that you can get exactly what you need ordered, we worry that the blood we just had to take on a 9 month old baby that’s hard to “stick” might be clotted (THE WORST).

 

• The biggest slice of worry pie is that…..We worry that EVERY SINGLE action or decision made by us directly can positively or negatively impact YOU and YOUR health.

 

So there are substantial backings to our worry. Yet sometimes our worry becomes too much and we just have to eat some of that worry pie, and let it digest (Yay for another GI reference!). This can be hard when you are 22 years old and you have previously been on a worry pie-free diet. No bills, no kids, no pets, no mortgage, no one to care or worry about except you and your awesome self.

 

Here’s another truth drop…..Nursing is a culture shock to your life. When you become a new nurse, now every ounce of your worry goes into caring for others, and this can be draining, especially when this hasn’t been your “norm” for 22 years. It’s not like we go through nursing school not knowing this, as we practice taking care of patients all throughout school – but you can only understand this big fat worry pie when you have your first shift on your own, and YOU, yes you now are the nurse and YOU have to fork some worry pie into your care – and that’s just part of being a good nurse.

 

I could keep telling you how many ways I can worry. However, I have a sugar-high from that worry – pie and I think I’ll go into the magical world of ‘Coping”.

 

Cope. It’s a strange concept. It’s meaning automatically suggests there is something BAD that has happened, and as a human we have to deal with it somehow, because it’s so alien to our desire for goodness and normalcy, that we need a mechanism to make it better – and that somehow is called coping.

 

Let me tell you how we were all taught to “cope” with stress. I’ll call this, “Cope-a-licious”. We were taught to:

 

1. Exercise on a regular basis (Ha!)
2. Eat 7-8 servings of fruit and vegetables EVERY-SINGLE-DAY (Okay, does lemon water count?)
3. Get 8 hours of uninterrupted sleep (Okay so if I work 7am-7pm, but its was a busy day so I get out at 830, have 45 minutes to drive home….that’s now 915, but I have to shower because a baby threw-up on me- that’s 945, OMG food, that’s now 10…okay try to relax, deep breaths, sleep by 1030, and have to set my alarm for 4:30-4:45 because I work the next shift)….wait what? Can I have a nap?
4. Do fun things outside of work. (Right after I catch up on sleep!)
5. Breathe (Oh got this one!)

 

Okay okay, but in all seriousness, you need to find things that work for you to cope because it’s not natural to help sick patients all the time. So you must cope or else you will get fatigued, which will lead to a nurse-zilla personality…which is definitely not cope-a-licious.

 

….and that’s not okay.

 

Truth drop: what do I do? I try to exercise, but it’s been poorly executed recently – I plan to work on this – hold me to it. Also, let’s not talk about food yet – that needs another blog – and I work on pediatrics- and it’s the holidays (such a truth drop right there – splash!). However, stressed is desserts spelled backwards, so there’s that.

 

Nurse-speak: Looking back when I was a new nurse… I find it funny now that I used to get stressed when the charge nurse would come up to me and say, “I have an admission for you”. I would actually get angry at them sometimes, because I would be so busy. Now there are still a few times when I am so deeply involved with patient care that I get stressed with a new admission, and hopefully you have a good relationship with your charge nurse that you can say, “Hey I’m so busy right now, trying to provide safe care for my other patients and I would be more than willing to take the next one, but is there anyone alternatively that can take this patient right now?” If that’s not possible, you can also ask your charge nurse to help with getting your new admits vital signs, priming tubing, getting equipment, asking admission questions ect. About a year ago, I adopted the philosophy to expect an admission is coming, which then I don’t get AS stressed (truth drop – I still slightly tense up), and this way it motivates me to push through documentation for my other patients as best as possible. And (this is my optimist-side in me speaking) if you expect another admit and don’t, you walk out of the shift like “Awww yeahhh, anticipation for the win, documentation is on time, so cope-a-licious”.

 

  I find POSITIVE PEOPLE.

 

I realize now when I do get stressed. I can feel my face getting hot, and now this self-awareness has pushed me to say:

 

“Self, get-it-together. You are doing the best you can. Ask for help if you need it. This isn’t forever. Can you delegate? You need to prioritize. Go take a 2 minute break, go pee and think through this”. Also remembering that NURSING IS A TEAM JOB….and if you couldn’t get every non-critical thing done, and it’s headed toward shift change, and it’s 1855… do what you can but don’t be a superhero, don’t try to rush through anything if it’s not critical, and understand that the next nurse has 12 more hours to get some things done that you weren’t able to. It’s not a failure on your part. You might have to look at your own time management skills the next day – but healthcare tasks don’t fit into pre-packaged 12 hour chunks, and this roll-over of tasks needing completion is expected.

 

Another piece that I found helpful, was brought up to me by a member of our chaplaincy team. Her suggestion was to have a mantra. So now I talk to my brain, yup I do – don’t be jealous – we get along great. As I walk in the door I say:

 

“Today, let me be the best nurse I can be”

or

“Let me find one thing positive to tell another nurse today”

or

“Today, let me have empathy for each and every family”

or

“Let me teach something new to another student today”

or

“Allow a nurse / nursing student to teach me something new today”

 

You can make this your own even if you’re not a nurse. Just going in to work with the intention to do these things during your shift/day, can change your entire attitude. TRUST ME. If you are religious, you could also use this as a prayer. I love this suggestion, and I am forever grateful and now pass this along to my students.  – and now to you thanks to this code white blog!

I do the same thing when I leave the unit. I say:

“Let it be”

EVERY SINGLE TIME. This helps me leave what happened at work to be left at work. It allows me to be more present when I get home. It allows me to start fresh the next day. Even if you had the best shift/day ever – saying “let it be” will give it closure, and allow you not to compare a possibly not-as-good shift to this great shift the next day.

Try it out. Let me know how it goes. Or don’t ….just truth drop yourself on how your attitude changes.

I will leave you with this:

“I will breathe. I will think of solutions. I will not let my worry control me. I will simply breathe. And it will be okay. Because I don’t quit”. – Shayne Mcclendon

~Keep on Caring