Posted in Grad Nurse, Nurse Residency, The Operating Room

Catty Nurses

nurses-eat-young

image compliments of AllNurses.Com

I wish I could say this is an elephant in the room. But, it’s not. Everyone knows that nurses are complete and total assholes to each other. This is not news. But, let me say this…I had no earthly idea that it would happen to me. I know, I know. What an incredibly naive thing to think about oneself. Seriously, though, you guys…I am a very friendly girl who, for the most part, gets along with everyone.

Recently, I was pulled into my NM’s office to be given “some feedback”. While, in her words, I am “doing a great job,” my peers have given feedback that I am “chatty”. I blinked. Wait, I’m sorry. Did you just critique my personality? What does that even mean? How do I take that?

Not one person has told me that my friendly demeanor was a problem, nor that I am not progressing because of it. So, what gives? Why did I find myself in the nurse manager’s office hearing about myself being “inappropriately chatty”. I left her office feeling despondent. I had no idea what to do with that kind of feedback. And, what’s worse, she gave it to me at 11:30 in the morning. I had to go back to work for 4 more hours wondering who in God’s name went behind my back to tell my manager something like that and still do a great job at work for 4 more hours.

I didn’t eat lunch. I spent lunch hiding in the locker room annoyingly going over every single day in the past several weeks trying to figure out what I did that was wrong enough to end up in the manager’s office. I started crying. Not ugly crying — just what the fuck this is so frustrating crying. One of my  (favorite) preceptors found that unfortunate time to walk into the locker room. She immediately asked me what was wrong. I told her. She stopped and said “BB, this is why I told you weeks ago to come in here, just do your job, and go home. Because I knew that the cats would go for the jugular on your bright light”.

You see, several weeks ago my preceptor warned me that the place I am working, while on the surface is very friendly and upbeat, can be back-stabbing and petty most of the time. I didn’t put much stock to it, because I hadn’t experienced it. Everyone was SO nice and encouraging, and I was progressing. But, this week, she proved to be absolutely right. I was completely blind-sided. I took it home with me, vented to my husband, my preschooler, my mom, my educator, my fellow new-grad coworker.

24 hours later, I asked my educator if we could meet with my NM and a few of my preceptors to squash this rumor-mill. One preceptor was available. And so, the meeting began.

10 minutes into the meeting and I am seeing an entirely different nurse than I had known over the past 2 months. Things came out of her mouth in that meeting that were never so much as muttered to me. I couldn’t believe it. Who was she and what had she done with the preceptor I had known over the past several weeks. My rose-colored glasses had come off. THIS, this, is where I work. Now, I see.

That was the most important move I could have ever made for myself. I realized then that the issue was not that I was “chatty” the issue was I was unlike everyone else — hardened, so used to the hustle and bustle of the OR that they feel there is no room to be human. To smile, to give patients their undivided attention, or to treat others in the room as if they are human beings (which they are). I am not Nurse Her. I am Nurse BB, and how I am going to operate is going to be vastly different than her. I received my first Thank You card from a patient recently — a feat that is almost unheard of in the OR because our patients don’t necessarily remember us. A surgeon has requested me to be on his dedicated “team” when he is performing surgeries at our facility. I am doing a good job.

Now that I understood that the problem is not me, but the worn out, disconnected nurses that I work with, I had to deal with the very real fact that their perceptions were now affecting my livelihood by way of performance evaluation and shitty feedback. I let her speak. I listened. I agreed that there were times when I participated in conversations that are better left until after induction, much like waiting to answer a text until after I’m finished driving. But, then, I laid into her, professionally. I have to trust you. I have to trust that every single thing you say to me is the truth and is there to make me  a better nurse. If I can’t trust you to tell me the truth, if I have to keep finding out after you’ve gone behind my back to tell my management, how do I trust that you are a strong teacher? How do I trust that you have my best interest at heart? Her answer? She doesn’t want to scare me away from the OR. Oh, honey. Sweet, sweet, nurse.

YOU do not have that power. You cannot scare me by giving me the tools to be a stronger nurse. I told her never to smile in my face, and then go behind my back to chastise me about something you don’t have the balls to say to my face. Ok, I didn’t use those exact same words, but you know what I mean. She agreed. In the end, I got what I needed out of that meeting. I exchanged my rose-colored glasses for lasik corrected eye-sight; I made it very clear who they were dealing with and what I would NEVER put up with; and, I realized that sweating this was a waste of my time. Soon enough I will be on my own, and my practice will be honed then.

Do I still feel like I am in a great place to work? Yes. Am I going to be a raving bitch to those around me, now? Of course not. Am I going to watch out for myself? Absolutely. Am I going to stop sharing personal things about me? Yes. Because I can’t trust them like I could trust those before me. My trust is going to have to be earned, now.

How are you handling snark in the workplace?

Posted in Grad Nurse, Nurse Residency, The Operating Room

Staying Ahead of the Curve

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Well…I am in the throes of my Intraoperative orientation. Man oh man, do I have a lot to learn. Now that I appreciate the fact I’m expected to know all of this and then some, shit is getting real. I find myself writing notes and not really knowing why or what for. So, I’ve decided to chop the days up into tasks that I can manage. Reasonable wins, if you will.

In the OR, you have so so much to keep track of…more than just patient allergies and contraindicated medications. You have their history, the surgical assessment and plan. Their previous surgeries. The equipment that is going to be used in the room. The instruments that are going to be used in the room. The temperaments and preferences of every single person in the room. The warmth of the patient, the vital signs of the patient, the charting, charging, implants and explants. The implant logs. The sterility of the environments. What time a patient was in the room. What time the patient was out of the room. And then, for fuck sake, you had better get that next patient in the room within 15 minutes or ELSE.

It’s unreal guys. It’s seriously unreal. There are hundreds of procedures performed in our OR and we have less than 10 OR suites. Today, I was told that my turnover time took 35 minutes. 35 minutes! That’s forEVER in the OR!!!

Then I realized something really freaking important. I had a preceptor that pretty much just threw me in the pool and said “swim”.  Swim? SWIM!?! I can’t even put on water wings and you want me to swim? How bout we take a sip of water first, my friend. Dip in a toe or something. Swim? You gotta be fuckin’ kidding me.

So then I said to myself…I said, “Self. You are a bad ass. But, you kind of suck at this. Let’s make you look more badassy.” And so…I have set out to impress at least once person a day with something I know that they didn’t think I know. The issue I’m having (BIG TIME) both as a new grad and as a new girl on the OR block is EFFICIENCY, PRIORITIZATION, and TIME MANAGEMENT. Basically, I suck at every got damn thing that’s important in nursing. Literally, suck. I feel like every single thing I learned in nursing school has left my brain.

And the real kicker? How the heck do I get faster? How am I supposed to get faster? How do I learn how to circulate, chart at the same time, look up the next patient and both drop off and pick up the next patient all within 15 minutes? How is that possible? For me, it’s only possible by me showing up to work super early and looking up my patients before work starts. And I mean really getting to know my patients. I feel like if I knock that out of my way, the day will go by so much more smoothly and it will cut my turnover time in half – it will help me prepare for my surgeries for the day and it will allow me the time to focus on circulating my cases instead of barely surviving my cases. ESPECIALLY when I have a less than direction-giving preceptor.

All of you new nurses out there…how are you keeping yourself ahead of the learning curve? (wine doesn’t count!)

Posted in Grad Nurse, Nurse Residency

Making the OR home

Well, I have to say…it’s getting better. Mainly because I am finally in my home facility instead of training in the bigger facility where it’s common place for surgeons to be complete and total assholes to their staff.

I work for a system that has 5 satellite hospitals. The hospital that I was hired into is closest to my home and is staffed with really great physicians. The culture there is so much more mature and amiable than the culture in the hospital we spent 2.5 months training. I am so happy to be out of there and where I was meant to be.

I love my colleagues and I love our surgeons and anesthesiologists. Everyone is awesome and most importantly…welcoming. It just goes to show that if you are a new grad or nurse resident reading this and you feel miserable where you are…know that life is better and the grass is greener when you finally get where you were meant to be.

Posted in Grad Nurse, Nurse Residency

Mean Physicians

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Jeremy Liebman is the dude behind this artistically genius photo.

I’m reluctant to write this post. Not because I’m scared of what will happen should the asshat who is the subject of this post eventually read it, but because I hate to give him more of my brain space than I have already given him.

It has been exactly 1 day and 10 hours since I was berated for the first time by a surgeon. I was made to feel like I was the dumbest broad in the room. I had met this surgeon only 30 minutes prior and the only words I muttered to him were “nice to meet you”. That was the extent of our conversation – because he sure as heck didn’t say anything back. Oh well. I was getting used to people being completely and totally unresponsive to you in healthcare. From nurses to techs to physicians, people are just plain rude in healthcare. It’s crazy.

I digress.

In the OR, I am approximately 3 weeks old. 3 weeks. My 25-years-in-the-OR nurse went on break soon after our patient was draped and prepped for the case. I felt great because everything was as it should have been. Or so I thought.

The first question was barked at me “Is my coag on 15?”

I answered him. “Yes! 15 and 15!” I was so excited. BOTH of his bovies were on 15 coag.

“NO. NOT 15 – 15!! Coag on 15!!!!” he shouted.

“Um, yes. The coag is on 15.” My response was confused.

What in the hell?  I know, of course, that both his cut and coag were not on 15. I was answering the question given me which was in relation to coag settings, which were BOTH on 15. He had two bovies. I also know that cut and coag are often verbally stated as “40, 40,” for example. So, I could see why he wanted it said a different way. So, chalking it up to him being kind of an ass, I let it go.

5 minutes later, he attempted to use the bovie tip. It would not work. If it is plugged in, this is usually a safety mechanism to prevent the patient from being burnt in areas other than the intended target for coagulation – something that would only happen if the patient isn’t grounded. I looked at the machine, the screens were lit up. Everything was as it should have been.

“THE BOVIE PAD ISN’T ON!!!!” he screamed at the top of his lungs.

What the? What do you mean the bovie pad isn’t on?

“My goodness,” I agreed, and set under the drapes to get the pad on the patient. It took me approximately 10 seconds.

“ARE YOU KIDDING ME?!? SHE DIDN’T HAVE THE BOVIE PAD ON!?!? TELL THAT NURSE THAT SHE ISN’T TO GO ON BREAK EVER AGAIN. I’M SERIOUS.” he both berated at me while simultaneously ordering that my preceptor never leave the room.

Now. This physician did not curse at me. He didn’t say my name (he didn’t know it). But, he sure as heck made me feel like an insignificant piece of shit who is about as incompetent as a rock.

My mind immediately shifted to my age (early thirties), my adult responsibilities, my child, my marriage, my abandoned 13 year career in business and I stood in utter disbelief that someone just treated me like I had the intelligence of a lizard in front of everyone in that room. This person didn’t know my name, didn’t know anything about me, or how long I had been a nurse, but he knew I was brand new, and he treated me like I had no business being in the operating room.

I came home and told my husband about it, and I burst into tears. Today, my husband used that experience against me in an argument to quiet me and I relived the experience over again.

I have been analyzing and analyzing why I have held onto that experience so painfully over the past couple of days and how I’m going to move past it and go back into that OR another day. The only thing I can come up with is to focus on the positive experiences I have had.

Just the morning before I was in a completely different room with a surgeon who let me have all the time in the world to prep a patient. He was so patient, so nice and so encouraging. He and all of the staff in the room added to a day that would go down as one of the most memorable in my career. Yet, here I was spending all of my time thinking about the man who made me feel so small and insignificant.

My remedy?

kit-kat-snack-size-candy-bars-133484-im

Yes. KitKat bars. I’m going to focus on the good surgeons. The ones that make me feel like the beginnings of an awesome OR nurse. The ones who spend the time helping me become a good colleague and skilled nurse. I’m going to tape kit-kat bars to little thank you cards that read something along the lines of:

“Thank you for giving this new nurse a break. You fostered a safe, enjoyable work environment that was ideal for learning to take place. This is a skill that not everyone possesses, but I hope you find solace in knowing that you do.

Best,

Me.”.

Isn’t that great? Giving the great doctors the recognition they deserve while simultaneously giving his not so nice colleagues the hypothetical finger. What’s even better is that I can give them to staff as well. But, right now, my targets are the surgeons.

At least then I won’t feel so helpless at the other end of their terrible attitudes. At least I could feel like I did something about it, if only indirectly, by praising those who were good to me while completely and totally giving the KitKat shaft to the jerks who don’t deserve my time of day.

What do you do to deal with rude team members?

 

 

 

 

Posted in Grad Nurse, Nurse Residency

ORn’t you happy you didn’t say…

hllo

Hello…it’s me. So sorry for my excrutiating absence. But, I have to say guys, there really has not been much to talk about.

OK.

That’s a lie.

I don’t know if I told you but I made the decision between the best freaking hospital in the world and the local facility. In the end, it was an easy decision. I chose my family. I opted for the lower paying, not so famous local facility. And you know what? I still make enough money to be happy, I get to pick up (and often take) my little precious to school and every single day I still have enough day light to enjoy a swim in the pool, a trip to the beach or a jaunt in the park. I’m home in the evenings and on the weekends. My work life balance is AH-mazing and my commute is a dream. I’m terribly happy with my choice in facility.

Do I think about my other option? Sure. Of course I do. I wonder about the money. I wonder about the prestige. Then I think about taking call and having to drive 30 minutes every day in 9-5 traffic and I’m right back where I started, thankful for my 6 minute drive to work, and 12 minute drive to my son’s school.

So, I’m in a New Grad Nurse Residency. It’s this cool thing where for 12 months you are considered a “Nurse Resident” with approximately 70 other newly hired nurses – right out of college. Every 2 weeks we are brought together and taught core nursing skills, in-services and given the opportunity to network with each other. In addition, I am in a New OR Nurse Residency with 6 of my now closest buds. We circulate through all kinds of OR services and get to learn the ropes of the OR (which OMG is DAUNTING — but that’s another blog post). I have to say, while I know most people get the impression that OR nursing is not “real” nursing, I have to say being on this side of the shtick, I think OR nursing is hard as BALLS and takes an intense amount of critical thinking and massive cajones.

My cajones were tested recently.

I’m a big girl. I’m a few years into my 30s. I’ve given birth. I own a house, a couple of cars, I’m married. Ya know. I’m out here adulting and shiz. I consider myself a friendly chick, I don’t prefer to be in conflicts, but I’m old enough to be pretty comfortable if I find myself in one. I’m approaching the age where most people could care less what you think about them. Ya know; the normal aging stuff that happens.

Then, please, tell me why…OH WHY…did I allow myself to get tricked into risking my brand spanking new shiny nursing license recently??? I was asked to witness something that I totally didn’t witness. Like, I didn’t see it with my own pretty brown eyes. I had no idea if what they were telling me was the truth. I had no idea. But don’t you know, in that big bright room of daunting white with those big tall (at least they seemed tall) surgeons and scrub techs and nurses and sales reps and anesthesia providers and anesthesia techs and OR techs and everyone else in that DAMN room that knew exactly what was going in that OR when I didn’t that I, indeed, witnessed for something I didn’t even see happen!

I mean, c’mon. This is Nursing 101. We are brow beaten almost every single day in nursing school to NEVER EVER witness something that you didn’t actually see happen. EVERY DAY. So how excited was I when this brilliantly experienced personnel picked little old inexperienced, brand new me, to rope into this, quite frankly, shitty situation of nerves and fear vs rationality and still. WHY ME LORD.

Immediately after the incident I recoiled within myself like a sweet little 3 day old baby who just wanted its mommy’s teet and maybe some sweeties. I felt so brand new, and stupid and ughh…disappointed. I was so sad. The situation played in my head over and over and over again until I could do nothing but visualize my brand new license circling the drain. I told anyone I could get a hold of what happened. I told my peers (whom vehemently shook their heads as if they would have NEVER made such a ridiculous mistake). I told my educators, I told my precepting nurses,  I told my husband, I told my 4 year old, I told God, I told my wine and hell, now I’m telling you.

I was reassured, vehemently, that yes, while wrong – I was taken advantage of and the offender would be reprimanded. But, dude, I’m the one that screwed up! Sure, I should have NEVER been asked. NO ONE should have been asked that didn’t actually see it. But, c’mon man. I knew better.

But here’s the thing, and the point of my story, here, folks. NEVER underestimate the vulnerable state of being new in such a high-stress, highly skilled environment. I went from being a new orientee observer to an active licensed individual in the matter of 3 seconds and I didn’t even realize it was happening. It is WAY too easy to be preyed upon as a new nurse, and I was assured by my preceptors and educators that it would not be the last time I would be put in this situation. I was also assured that this would not be a situation I would ever be on the losing end in again. That these mistakes and “incidents” would be what formed my “practice” and what would make me a very strong nurse.

I beat myself up for what felt like DAYS over this incident. Despite the fact that my patient was absolutely fine. It was the fact that *I* made the mistake that I couldn’t get over; however, as the days go on, I find solace in my ridiculous mistake. Because, it’s true. It won’t ever happen to me again, because I won’t let it happen to me again. I will recognize it for what it is and call it out on its bullshit before it even opens it’s mouth. I will be known as “that nurse who you may as well not even ask” because they know not to try me. A few weeks ago, I was not that nurse. But today? I am that nurse.

As you all transition into your new practice, no matter the field, I beseech you to always stay true to yourself. NEVER let a situation intimidate you into faltering from what you know is right. Surround yourself with a team who will lift you back up when you fall. And ALWAYS, and I mean ALWAYS, own up to when you make mistakes. My integrity was successfully tried, but it was also successfully revived when I immediately told the truth about my incident and the way it made me feel.

All the best to you, fellow new nurses and nursing students!!

-HN