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Thursday, May 20, 2010

Work in Progress

As you know I work in psychiatry. When I'm out in the public I am reminded all the more that society is far, very far from understanding this population. The primary reaction I get from people is fear, and soemtimes disbelief that I love working with these people. I do not fear those with mental illness as the average joe who does not know anything about psychosis, or depression or bi-polar would. Who can blame him though? The media portrayal of those with mental illness is skewed. No wonder they are misunderstood. (uh oh, I might be opening a can of worms here...) Media tend to show only the the dangerous, the scary side. I am not saying that there is absolutely no violence related to this aggreate. 2009 had a number of incidents in the news. All I'm saying is that most of the mentally ill are not as dangerous as the movies or tv portray. As a group, mentally ill people are no more violent than any other group. According to the Canadian Mental Health Association, they are, in fact, more likely to be the victims of violence than to be violent themselves.

Only those in the same field, or those that have more experience with them will understand this. There is a show called "Stand up for Mental Health" created by David Granirer, a counsellor. He taught stand up comedy to those who have mental illness as a way for them to fight the stigma, to educate the public, and to counter discrimination. It's worth a look. Here's the website I didn't get to see it when they came to my little town but maybe next time :)

In line with this, I wanna talk about self-awareness... one of the most important skills to master when you are a nurse. The things that our patients have done before entering the hospital can sometimes be in conflict with our own values and beliefs. One needs to be able to withhold judgement, and keep oneself in check. This doesn't just apply to psychiatry.It goes the same for addictions, forensics etc.

For me, one of the hardest issues is suicide. When my patient is suicidal, I feel I need to exert more effort in taking a few moments before starting my interaction with the patient. Personally, it is very hard to be assigned to someone who wants to end their life. My personal values conflict with this. Especially as a brand new nurse, I'm still honing my therapeutic skills, and trying not to view actual cases as clear-cut textbook cases- as those are the ones I am used to. "Given situation A, steps 1, 2, and 3 have to be performed". That's not exactly how it goes in psychiatry. It is a science and an art at the same time. And I have a long way to go in learning to apply both the science and the art aspects. It's still a work in progress... Everyday, I bank on some experience and supplement the textbook knowledge that I have.

Nonetheless, I find that this helps me when assessing suicidality of a patient. Textbook, I know, but it's an important tool to incorporate in the interaction. It's from Shea's Psychiatric Interviewing.

Lethal triad:
o Presenting hx of a serious suicide attempt
o Presence of acutely disturbing psychotic processes suggestive of lethality
o Indication from the interview that the patient seriously intends to harm self (single most important indication of suicide potential)

The presence of any one of these should warn the clinician that suicide may be imminent risk

Friday, May 14, 2010

Getting (and staying) organized

Today is the last day of my 8 hour shifts. That was two weeks of working straight days. Having experienced working 12s in preceptorship (a mix of days and nights), I now know that I prefer the extended shifts. Granted, you get a lot more of your day on 8s and the sky doesn't look the same when you leave as when you started, but having weekdays off really was the deal breaker for me. Especially now that my hubby is off on Mondays, having 12s gives me the chance to have one of my days off on that day. It's just preference I guess. My friend was saying she likes the regularity of 8 hr days (M-F) because she doesn't have to be away from home at night. I personally don't mind working a couple of night shifts. After all, I'm so tired after my day shifts that I end up sleeping early anyway. We don't end up going out or doing anything really. He's usually on the computer and then I go to bed after watching a couple of episodes of Criminal Minds (yeah, that's our thing hehe. How romantic huh?)

Enough rambling, what I really wanted to write about is how being organized plays a major role in good patient care. As a new graduate nurse, I find that adjusting to the routine of the unit and the full scope of practice is facilitated by having an organizational strategy that works for you. I personally prefer having a sheet of paper or a small notepad (I'd actually pick the paper over the notepad because you can shred it afterwards- that way you don't have to worry about it getting lost and then confidentiality becomes an issue). I then put a tick box beside each task that I need to do for each patient throughout that shift. When I've done that task, I put a check mark on the box. That being said, it also means setting aside a few minutes before the start of the shift to think of what those tasks are, what the priorities for each person are and what the strategy is going to be for the first hour of the day which is really the bussiest.

Today I had two discharges and an admission. It doesn't seem like a lot, but I haven't really done all of that on top of a full load of patients before. It seemed like the 8 hours wasn't really enough, and I often found myself thinking, "I don't think I spent enough time with that patient." That's the real big change from being a student nurse. As a student you have much more time to be with the patients, having a lesser patient load and a limited scope of practice- no taking and processing orders etc. I also found myself looking at my "cheat sheet" many many times just to stay organized. The more organized I am, the more efficient I am with my 8 hours. Here are some organziational tools I found online. Obviously it needs to be adapted to your specific area of practice.

Clinical organization sheets - Nursing for Nurses: " - report sheets for 1, 2, 3, and 4 patients - sample worksheets for nurses - a post that has links to 4 report and time management tools that can be downloaded and printed out"

Saturday, May 8, 2010

Happy Mommy's Day!!!

"A mother is the truest friend we have, when trials, heavy and sudden fall upon us; when adversity takes the place of prosperity; when friends who rejoice with us in our sunshine, desert us when troubles thicken around us, still she will cling to us and endeavor with her kind precepts and counsels to dissipate the clouds of darkness, and cause peace to return to our hearts" -Washington Irving

I was on my lunch break at work and one of the other nurses was talking about the origins of mother's day. It apparently dates back to the greek era when a day was devoted to worshipping Cybele-the greek mother of the gods. This holiday makes me miss my mom so much more. As I said in my story I grew up with my father. My parents separated, and me and my sister moved to live with our father when I was 11. My mom lives in another country. We keep in touch mainly by phone and by email. I have seen her last in 2007- just after I got engaged. My sister is more fortunate to have seen her twice in the past year. She doesn't have the same time and financial constraints as I did since starting nursing school. But now that I am working, I'm planning to visit her this fall.

I love my mom very much. Although she wasn't physically there she was a great support for me and my sister when we moved here. She was, and still is my confidante. She has had her share of battles in this life and I really hope and pray to God that this year will be a good one for her. She said she's starting to like someone- that's a very good sign. See, my mom has been burned by bad, and I mean bad relationships, and because of this, she became obsessed about work and excercise. Now I can see that there is a balance. She seems happy :)

My favourite memory of my mom when I was little was my first jump into the pool. I can vividly remember her telling me to jump, andshe will catch me. She had a pink and black bathing suit on. It had diagonal patterns on it. She had long black hair and teased bangs (ok, this was early 90s people!) I was so scared, I didn't want to do it, I said I was gonna drown... but I did eventually jump after the coaxing from my cousins and all the other people around me. She caught me, and she held me and said, "See, do you think I'll ever let you drown? Mommy will never let anything bad happen to you."

I love you, mom. I am who I am because of you. Happy mother's day to all moms out there! You are all deserving of the world to worship you for your unconditional love.

Friday, May 7, 2010

I survived the first week!

I got through my first week in Psychiatry without going insane. Pun intended hehe. :) Not to say that it wasn't stressful. I haven't been in an acute adult inpatient unit in a while, so my techniques are a little rusty, but by the end of the week I felt more confident than ever. The thrill and excitement about being a real nurse started to come back and take over the anxiety and self-criticism of the first days. Today, when I left a message for a physician, I had a fuzzy feeling when I was saying, "Hello Dr. so and so, this is *****, a nurse from the ***** inpatient unit." Sounds silly, but it still feels so surreal! I wonder when it will hit me that this is it. I am it. Hmmm...

On a different note, I am really feeling the toll of working full-time. I have never worked a full patient load full-time. I am really tired! I worked all throughout nursing school on free days and after classes at times, but that was at the bank so I guess it was much easier. The closest to full time work was preceptorship, but that wasn't paid- and I still wasn't working my full scope of practice. This week I work five 8s. So the regularity is probably what's feeling unusual to me. I always start at 0700 hrs and leave at 1500 hrs. I know i'll get used to it; i'm just being impatient. I want to be seasoned nurse already! haha!
Today was a really hot day. It's really starting to warm up here in my beautiful Canadian city. Hubby and I had sushi coz we didn't really want any hot food. I'm loving sushi right now. Here are pictures of my favourites.

Negitoro roll (fatty tuna and green onion)

Spicy tuna roll (pretty strightforward- tuna and spicy sauce)

Smoked salmon and cream cheese roll

(just what the name says plus crabmeat)

Just writing about it makes me crave it more!!! But i'll hold off for now and maybe i'll just make a pot of tea... yes... that's what i will do.

Oh getting back to nursing, I received my new hire package in the mail today for my other job. I am so excited! So many forms to fill out though! Confidentiality agreement, union stuff, payroll stuff, HR and benefits. Thank goodness no more upfront fees! I need mt first paycheque! :) That's it for me guys! Take it easy and happy nursing week! Au revoir!

P.S. I found this status on facebook you guys may want to post it too..."Being a NURSE means you carry immense responsibility and very little authority. You step into people's lives and make a difference. Some bless you, others curse you. You see people at their worst and best. You see life begin and end. You see people's capacity for love, courage, and endurance. IT'S NURSES APPRECIATION WEEK. REPOST IF YOU ARE A NURSE, LOVE A NURSE, AND/OR APPRECIATE A NURSE!"

Tuesday, May 4, 2010

The Crazy Month of May

This is my third attempt at blogging. I just can't seem to get the hang of it. :( That being said, I am hoping that being in a "transitional" point in my life, I can commit to start journalling beyond what was a requirement back in nursing school. Ha! I talk about it like it was a long time ago, when in fact I only technically graduated a little over 2 weeks ago. I guess I'm still in the reminiscing mood as all of my classmates are. After all, we were together for four years. What I find interesting is that most of our experiences through nursing school is now fondly remembered. Whereas if we started to look back 6 months ago, it wouldn't all be positive remarks. It was a difficult 4 years. Lots of hard work, blood, sweat and tears-literally! :)

Anywhoo, April (the dreaded month)is now over- the end of preceptorship, registration exams, job applications and interviews are all in the past! The month of May has started and I am now officially a nurse! woohoo!!! it is starting to sink in now... A new month, a new title, a new job (actually, 2 jobs)... a new chapter in my life! It makes me feel like a brand new person. Like all new graduate nurses, I am full of energy and optimism for my new career.

I officially resigned for my teller job today. It is bittersweet! The bank has been my family these past five years. It has become a major part of my identity since it was my first "real" job. I worked all throughout my nursing program- and my fellow tellers have grown together with me. We're mostly university students so we pretty much have the same series of events happening throughout the year (we'd have the same exam periods, reading breaks etc.) I am so sad to leave the bank. There is a sense of security that I cannot put into words... but oh well, I know that this change is for the better. Like the saying goes, "Man cannot discover new oceans unless he has the courage to lose sight of the shore."

Thursday is my first official day at the hospital. I am working in Psychiatry. I am excited and nervous at the same time. I know that it will be a stressful couple of months, because it always is when you start a new job. It's the period of adjusting to the new role, building confidence and realizing that my days as a student nurse are now over- no more safety net! I am now completely accountable. No more riding on any other person's license yikes! Anxious much? :S
I also know that there's no way around this feeling. It's just one of those things- you gotta experience it; learn and grow from it. Like my preceptor used to always say, dealing with difficult situations will make you a better nurse. I hope he's right....

Just some tips for current preceptorship students around applying for jobs:

1. Apply early. They say you need to wait until mid-preceptorship (late Feb to mid-March for the winter semester) but most of my classmates who applied early (in January) are the ones who have jobs- others are still waiting to hear from the health authorities.

2. Role play an interview with your classmates. Yes they ask you about specific medications, symptoms etc. in a situational format so keep up with your knowledge and practice your critical thinking skills. Plus, this helps you review for the registration exams right?

3. Save your money. The last month of preceptorship is a very expensive month- considering the fact that you're not working that much, registration exams fees and paying for the registration itself can add up. It cost around $800 CDN for me- so unless someone else other than yourself is supporting you financially, refrain from retail therapy and eating out :)