Today I ran around like a crazy woman trying to get all the crap together for this trip. I’m feeling a bit overwhelmed, and a bit under prepared. I realized 2 things.

1. My greatest fear remains getting there and not knowing how to take care of my patients. I’m working through that. Support from my family and friends has really helped. One friend wrote about leaving all my fear behind. I think I will get to that point…eventually.

2. My second greatest fear is getting there and having NOTHING to eat. They told us we’d get MRE’s, but I’m a picky eater, so I imagine I’ll be forcing things down nearly every day, just to get enough calories. I even find protein bars mostly repulsive, but I fear that the work will be so intense that I will melt away of hunger if I don’t manage to digest something. I’m taking an emergency jar of Nutella, and you can pry it from my cold, dead fingers.

3. My third greatest fear is dehydration. I’m now taking malaria pills, and, if my most recent dose of antibiotitcs is any indicator, I strongly suspect I will get diarrhea from those, if not from the conditions there (although I’ve got tablets to sanitize my water.) I’ve prepared myself with salt and sugar to make an oral dehydration beverage, and some Tang for flavor.

The bottom line is, I have no idea what I’m doing or what to pack, or how much. I’ve got way too many cleansing wipes, and way too much hand sanitizer, probably way too many protein bars, and way too much salt/sugar/Tang. I also have a multitude of flashlights (due to my strong fear of the dark) some of which I am going to have to part with, I’m sure.

I wish I could watch me packing. I think I’d be amused.

I leave for Haiti on Monday. Actually, I just got my official “orders” today, err, flight information from the agency who’s sponsoring my visit.

Let me start by saying that this is something I’ve wanted to do for years. In college (the first time…) I often tried to figure out what would be the most effective and quick degree that would allow me to work for Doctors Without Borders. In the ended, I opted for psychology, thinking med school would take too long, and since I had no hard science credits to my name, nursing would also keep me in school longer than I intended. (If I only knew then what I know now, perhaps I could have saved myself the additional three years and $30,000…) A psychology degree would have at least allowed me to counsel war survivors. Needless to say, I never got into counseling, but I never let go of the desire to do some international disaster relief work.

Fast forward to today. I’m going to Haiti in 3 days. Three! Good lord, where did the time go? Wasn’t I just a nursing student? Didn’t I just get my job in the ICU? Don’t I just barely have my sea legs? It feels like yesterday when I was dreaming of this kind of work, and back then, it seemed like a lifetime away. Now I’m only 72 hours away from a goal that I thought would take years and years.

I’m excited. For obvious reasons.

I’m idealistic. I’m going to do some good. I’m going to help people, and despite the cyncism that I’ve lately been enshrouded in, there is still a part of me, not so deep down inside, in fact right on my shoulder, that got into this profession to help people.

I’m proud. This opportunity didn’t just fall into my lap. I worked for it. I begged and pleaded. I researched and read. I annoyed the hell out of the right people at the right time. I was only partly lucky…I earned this for myself, and that feels really good.

I’m anxious. Haiti was never exactly safe before every building turned to dust. Now there are starving, hungy, angry people all over the place. I’m a small-framed female, and in Port-au-Prince, I’ll be about the whitest person anyone’s ever seen. I’ll be an easy target. Also, what will I eat? Where will I pee? How will I get in touch with people back home? What if there’s an emergency and I need to get out of the country fast? What if I get a disease…any disease? Will I get lung cancer in 25 years from spending 2 weeks down there breathing that horrible air? Is it worth it?

Most of all, I’m scared shitless. The bottom line is, I’m not sure I know how to take care of these people. Am I in over my  head? What will I do without all the technology? Without my patients on monitors that I can glance at and get an immediate sense of relief? What if someone is a hard stick, and I can’t get an IV started without the SiteRight? I haven’t put in very many foleys. Will the other nurses resent my presence because I’ll need to ask questions? What will I do without my supportive team?

What if I fail?

I apologize for the lack of posts lately. Frankly, there’s been a ton of change in my life, and I’m still kind of adjusting to everything. On top of that, I just found out that I’ll be leaving for Haiti on Monday. I won’t be blogging while I’m down there, but I do hope to journal the ever-lovin’-crap outta myself (although the crap will probably be gone quickly, so to speak, what with malaria pills and nasty drinking water…) and transcribe my experiences for the blog once I get back in the middle of the month. It’s sure to be a BrainScrambling adventure, to say the least. I hope to stay on your bookmark lists until then, and I promise to tell all just as soon as I can.

When I started as an ICU nurse, I was overwhelmed and stressed. Constantly. Having a preceptor made the pill easier to swallow, but when I came off orientation, I felt like I’d not only been hit by a metaphorical truck, but also tied to a railroad track and run over several times over. I immediately got sick, and thus far, have had just about every form of every virus and flu that one could have in the span of 6 months. (I’m currently on antibiotics for a double ear and sinus infection, which I’m hoping will allow my immune system to come crawling out of whatever damn corner it’s been hiding in and start doing its job again. Come out, come out, wherever you are…you little bastard. Thanks for ditching me in my time of need!)

Looking back, I realize that, at least in my case, a lot of the stress was probably self-perpetuated. I work with such a great group of co-workers that I wanted, really, really, really badly, to prove to them that I could be a team member, too. I always rushed to get everything done, because I hated leaving things for the next shift. To me, it signified a failure on my part. I didn’t want anyone to think I’d been wasting time, playing at the nurse’s station, surfin’ the net, picking my nose, or what have you. (I despise laziness, and would absolutely barf if the term was ever seriously applied to me.) Of course, I never applied the same standard when other nurses passed things on to me. I never minded at all, in fact. For everyone else, nursing was a 24 hour job. For me, it was a 12 hour job. What I’m saying is, I was responsible for 95% of my own stress. The other 5% is the perpetual kind that’s typical in the ICU. I didn’t know enough to be stressed about the other stuff, which is probably a good thing. However, the longer I’m in the ICU, the less of my stress is self-imposed, and the more of it is based on things I’ve seen and what I know could happen. Ignorance really is bliss.

How I’ve grown up, in just the span of a year.

I’ve learned to cut corners, mostly to preserve my sanity. For example, whenever possible, I used to try to get both patients bathed, walked, and into a chair before the doctors rounded in the morning. I thought the docs would appreciate seeing their patients put their best foot forward, thought it might help them transfer out of the ICU a little faster, and of course, it wouldn’t hurt my reputation as a nurse, either. I’m much more cynical now, and I realize that I can’t maintain that kind of pace. I still get my patients up pretty early, but I’ve removed the ton of bricks from my shoulders, and allowed myself to take it a bit slower. Why? Because it really don’t matter. Focus on the things that matter.

I used to skip my lunch and/or stay late to avoid passing things on to the next shift. Yeah, those days are long going. My shift ends when it ends, and I get a little internally pissy if the clock starts ticking and I’m still on the unit. I make a point to structure the last half of my day so that I can give report on time, finish my charting, and get the hell out of there. I often ask myself “what will happen if this task waits 30 minutes?” Very often, the answer is “nothing,” at which point I can go eat my lunch without having to worry. Truly, in most cases, 30 minutes won’t kill anybody, or even cause them a setback. That’s not to say that I won’t stay late, especially when there’s a serious event or an opportunity for a great learning experience. But all in all, I’d rather just go home.

And lastly, I used to get emotionally closer to my patients. I would have long conversations with them. I would make a point to sit in a chair and talk to them like a normal person, not a hospital patient. I did the same with the families. Now, I’m more distant, and this is the part that saddens me the most. I’ve learned to self-preserve, and in that regard, I think my patients miss out on a part of me that I used to give freely. I can’t do that anymore, except on the more rare occasion.  I don’t have the energy. I have to save something for myself, and for my family. Oh sure, I joke and have a good time with them, but something has changed about my interactions. I can’t quite put a finger on it.

In nursing school, I used to scoff at some nurses who I noticed couldn’t (or wouldn’t) connect on an emotional level that I thought was necessary to provide the best patient care. I used to secretly judge them, and I used to think I’d be different. The truth is, I get it now. Those nurses were doing the best job they could, under the circumstances. And some days, I’m afraid I’ve become the nurse I scoffed at.  It scares me.

I am so impressed with the outpouring of support from the medical community after the Haiti tragedy. Wow, folks. Even at my dirty little city hospital, nurses are clamoring over each other to get down there with our own disaster relief crew. It seems that we nurses share a very deep desire to help when the need is the greatest. I’m so honored to be a party of this group!

Of course, the trouble is that no one can get down there right now. Logistics are still terrible. The airport is a mess, the seaports aren’t open, the roads from the Dominican Republic are nearly impassable.

So nurses, what can you do?

No, it’s probably not as interesting as going down there and offering your services (it’s also not as dangerous and not nearly as difficult, either,) but consider donating money. I’ve added a widget to the sidebar of this blog. Scroll down about halfway and you’ll find a very way to donate to the International Medical Corps. While we wait for the logistics to stabilize enough to get our teams down there, your cold, hard cash is going to make the most difference for the people of Haiti. Let’s show them that we do care, even when we can’t be there in person. (And by the way, if you’re truly interested in volunteering, visit the IMC website for more information on that, too.)

Friends,

Bee-bop on over to http://www.emergiblog.com and check out the lastest edition of Change of Shift! It’s been a long time since I contributed, so I appreciate being included (rather last minute) in this edition.

Enjoy!

Nursing is hard. No if’s or ands (however, lots of “butts.)

That being said, one of my nursing New Year’s resolutions for 2010 was to “not complain.” Of course, it doesn’t mean that I am never going to say anything about my job. Wrong. However, I’m making a really serious effort to divorce myself from the constant  negativity that this profession seems to breed

I’ve had jobs that I hated. In fact, in the years between my first college degree and going back to school full-time to be a nurse, I can’t honestly say I had a single job like I like, much less enjoyed, much less even slightly looked forward to. Even simply disliking my jobs would have been a step up. I hated my jobs. It took a toll on my personal life, marriage, and everything in between.

Fast forward a few years…now I’m an ICU nurse. Not every day is perfect. There are plenty of things I dislike about my job. Hell, if it wasn’t a job, they wouldn’t have to pay me for it. Would I be a nurse for free? Probably not without a few changes…it’s just that it’s a tremendously stressful and physically demanding job. I won’t be a bedside nurse forever. My knees and my emotions just can’t take it. But I hope I’ll always be proud to be a nurse, and I hope I never forget my “roots” as a bedside nurse.

I feel like I’m rambling here…i do have a point. There are a lot of nursing blogs out there, many of which I enjoy very much. However, lately I’ve sensed a lot of negativity out there in the blogosphere. I’ve started unsubscribing from feeds that have become predominately negative. I’m all about providing a realistic viewpoint for all the nursing students out there, but I also have to preserve my own sanity. I’m unsubscribing to it at work, so it’s only fair I do it on the internets, too.

For me, a job has always been something similar to a long term relationship. For a couple years, I didn’t do so well on the job front, and I think it’s because I had the wrong attitude. Now that I’ve been married 5 years, I can tell you that nothing that lasts a long time is going to be easy. Longevity won’t just fall into your lap, not in your marriage, and not in your job. I spend entire days at work chanting mantras to get myself through the hour, or even the half-hour, if necessary. Part of any job is your mental attitude, and separating yourself from the things that bring you down.

So, to all the negative bloggers out there, I’m done reading. I encourage you to look deep within yourself to find something positive (or at least not negative) to write about. Maybe it’s time for a change.

Dear ICU,

There is really nothing quite like you, is there? Today when I got home from work, I tried to describe you to my husband. You’re hard to sum up, that’s for sure. This is what I told him.

Nothing breaks you down and tramples on your self-esteem quite like the ICU. In the same breath, nothing builds your confidence quite like it, either.

I thank you for that. The confidence part, of course. Aw, what the hell. Thanks for trampling on me, too. Sometimes it takes a hard kick in teeth (or in my case, a hard punch in the sternum) to teach you what’s good about life.

Thanks for teaching me, every day, how not to sweat the small stuff. For example…a sustained systolic blood pressure in the 300’s. It kind of makes a traffic jam look a little less annoying. At least for now.

Thank you for showing me the true meaning of a team. It’s having people backing you up so incredibly thoroughly and so consistently, that not for one second do you feel the need to question their judgement. It’s knowing that you’ll be 100% supported, no matter what happens. It’s bitching and moaning at the nurse’s station, elbow-deep together in poo, and some of the most twisted, wonderful humor I have ever come across.

Thanks for showing me that I might, in fact, be a bit of an adrenaline junkie. Nursing is what i like to call “Type 2 Fun.” Type 1 fun involves vacations, good wine, friends…type 2 fun involves walking up hill for 13 miles, and/or ICU nursing. Some days, the most stable patient is the one on a bunch of drips.

Thanks for teaching me to function with a blood sugar of 50 or a bladder stretched so tightly you think pee might squirt out of your tear ducts at any minute.

Thanks for teaching me about my own values. How I want to die. And more importantly, how I want to live.

See you tomorrow.

Sincerely,

Caroline

Here are the first posts of each month of 2009:

January: Where I’ve Been

February: Settling Into My Role

March: Nurse to Nurse

April: Getting My Nursing On!

May: Scrubsgallery.com Deals and Coupons

June: Assault

July: Busy Taking Care of ME

August: Great Experiences on the Night Shift

September: The Right Thing

October: 6 Months In!

November: 27 Going on 50

December: What I was Doing This Time Last Year

I mentioned in a previous post that I’ve based my 2010 resolutions on a chapter from the book “Better” by Atul Gawande. I recommend reading the book for the most information, but in case you read this blog post first, here are my nursing resolutions for 2010 (yes, seperate from my personal resolutions.)

OVERALL GOAL: Be a positive deviant.

1. Ask an unscripted question.

For me, this means better overall time management at work, and better management of my own stress. I was pretty good at the stress thing at the beginning, then I started to get worn down and my stress started to seep through. I’d like to do a better job of keeping my cool. This will involve taking some deep breaths, constantly reminding myself that nursing is a 24 hour job and there is no way I can get it all done on a single day shift, no matter how much I hate to pass things along to night shift, and…take a moment with each patient to ask one unscripted question. After all, part of the reason I love nursing is the people and their stories. In my hustle and bustle, I don’t want to forget that.

2. Don’t complain.

Pretty obvious, right? Right. My job is hard. Actually, difficult.  Most days, I don’t stop running.There are constant annoyances. Day shift is full of people who need your attention immediatly, all the time, and you are the gateway to your patient’s care, which can be difficult at times. But the bottom line is, I got the job I wanted at the hospital I wanted on the unit I wanted. I got an amazing preceptorship. I get paid well, and I have lots of vacation time. I love my co-workers. I have a wonderful boss. I’m 27 years old and I’m fulfilling a childhood dream. Every job has its days, and mine is no exception. But I’m lucky. And I’m going to try and be more conscious of not taking it for granted.

3. Count Something.

Sooner or later, I’m going to have to contribute something to my unit that changes practice. It’s how we get promoted…a Nurse II project is what they call it. I’m going to start counting something…anything, not only to prepare for this project, but to improve the quality of the healthcare we provide in my unit. I have a couple of ideas, such as counting the number of patients who use morphine PCAs and also end up with delirium, and counting the number of steps taking by new grads versus experienced nurses, and how we can help new grads become more efficicent. None of it is hard core, NIH-funded, consenting-signing research. But the woman who invented the Apgar score was pretty damn informal, too…my goal is to begin to notice patterns on our unit, and once I have some patterns, I’d like to start thinking of ways to fix them, preferably without incorporating additional charting for the nurses.

4. Write something.

My blog has been vascillating in terms of frequent posts, yes, I know. I’m going to make an effort to write more, even if it’s just a paragraph. We are a community, and as long as we can ask questions, seek opinions, and share stories, I think we’re that much stronger. I don’t have to write a best-selling novel to gain insight about my pratice. Little ol’ brainscramble.org does the trick just fine.

5. Change.

I will continue to be unafraid of change, because the worst thing that could happen is that it won’t work, and we go back to our old ways of thinking, right? I will continue to be open minded. And, I will attempt to add a few more initials to the end of my name. 2010 might just be the year of my CCRN exam. We’ll see.