Insights from a Girl Who Knows Better
Today, when you came to me after being involved in a motor vehicle collision, I was there for you. I made sure you were going to make it. I followed my algorithms, I started your IVs, I pushed your bed to CT scan…I wasn’t thinking of me, I was thinking of you.
Today, when you had lost so much blood and were still bleeding, I was there for you. I made sure your bleeding stopped. I monitored your blood pressure and your labs. I transfused so many units of blood. You were so grumpy, but I didn’t lash out. You smelled so bad, like rotten flesh, but I didn’t leave your side until after I pushed your bed to the OR and handed the baton to another nurse that would continue what I had started. I wasn’t thinking of my father, I was thinking of you.
Today, when you had been driving a car that was smashed by another, I was there for you. While you were laying there in pain from injuries that could potentially take your life, I bent down and I told you it was going to be okay. I watched as your blood pressure dropped and notified the doctors. I didn’t waste time, I ordered your blood, the blood that you desperately needed. I held the hand of the doctor who was learning to be a doctor and told him what we needed to do. I knew we had to act quickly, with not a minute to spare. I wasn’t thinking of my mother, I was thinking of you.
Today, when you were alone after almost a century on this planet, I was there for you. When other patients needed me, I took one look at you and knew how sick you really were. I made paramedics wait for me to take over their patient until I knew you had the care you needed. I stayed in your room, collecting the pieces to the puzzle because I didn’t believe that you were over-medicated. I knew you were on the verge of sepsis. I knew that at your age you wouldn’t be able to wait the 2 hours it would be before I could return once I had left. I respected you for being my elder and for being gifted with so many years on this planet. I wasn’t thinking of my sister, I was thinking of you.
Today, when you had left so much of your flesh back at the scene of your crash and you were writhing in pain, but scared and wanted your family, I was there for you. I called 5 different phone numbers on a wild goose chase but didn’t stop until I found your mother. When she arrived, I hugged her and I held her and I told her you would be fine. I made sure you both had the emotional support you needed. I wasn’t thinking of my second family, I was thinking of you.
Today, what you didn’t see was the text that I received from my mother at 1258. What you didn’t taste was me choking back the bile from my urge to vomit as my heart broke. You see, in that text, I found out that my “second dad” was found dead in that very moment. What you didn’t hear, was my screams inside of my own head saying, “NO NO NO NO NO NO NO NO”. What you didn’t feel was the pain in my chest knowing that the people I love, MY PEOPLE, were 6 hours away. What you didn’t know, is that in that very moment, at 1258, my world had changed forever. What you couldn’t know is that today, the whole world became a little darker. Jokes won’t be as funny because he won’t be here to tell them. Fish will never be quite as big because he won’t be here to catch them. Mischief will be lonelier because he won’t be here to instigate it. His wife will be second-guessing herself for years, wondering if anything she could have done would have made a difference and how she can ever move forward without him. His daughters will feel a little lost wondering what “daddy” would have told them to do when their life is in a slump or how happy he would have been to see them in times of great joy. His best friend will pick up the phone to call him for God knows how long and wish with all of his heart he could get him back. A piece of our family is gone forever and he has taken a part of my heart with him…a part I won’t get back.
But you didn’t know this. You simply saw me as your nurse. You needed me to help you on what you believed to be the worst day of your life, never knowing that it was one of the worst days of mine. You didn’t know any of this…because for the last 6 hours of my shift, I wasn’t thinking of me, I was thinking of you.
I have never been one to make New Year's resolutions. Instead, i prefer to choose a mantra...one that helps me find a new perspective. This year has been an interesting one for me. Somewhere along the way I let my spirit go. Literally, I let it go. I lost myself somewhere in between negativity and feelings of inadequacy. I'm not telling you this to gain support or affirmations. I'm telling you this because I know that some of you were probably guilty of this, too.
I remember a time when ER medicine was the most amazing career known to man. Fast-paced problem solving is purely addictive. It’s an adrenaline rush matched by no other. I also remember a time when ERs felt like a gigantic team. Working together to solve a problem in an opinionated, highly charged environment…ahhhhh, the good ol’days.
Now, ER nurses and physicians feel like baby birds in a nest, their necks stretched out as far as they can go, just waiting on someone to force the food of information down their throats. There is no more collaboration. There is no more opportunistic think-tank.
Management teams are at their wits end trying to solve problems when the easy answer is right there, within their reach. Here are a few simple ways management can improve a department:
- Truly give ownership to the staff. (Physicians, Nurses, and Techs) That is all it would take. No more threats of being sent home without pay. No more threats of being fired because we work in an At-Will Employment State. Employees who are paranoid are less productive and have bad attitudes.
- Make them BELIEVE that you BELIEVE in them by trusting their opinions. Don’t belittle them by poo-pooing their concerns behind their backs. It always gets back to them. ALWAYS.
- Make them feel valued by listening to them. Show that you have listened by making change. Nurses, Techs, and Doctors are in the trenches. They know the truth about the issues. Managing by metrics can only get you so far.
- Make them feel like a part of the team by keeping them in-the-know, instead of in the dark. The most effective management teams I have been a part of have been truly transparent. It may not be your preferred management approach, but type-A personalities generally need the “Why” attached to changes. If a rule doesn’t make sense, it will not be welcomed with open arms.
- Avoid the terminology EFFECTIVE IMMEDIATELY. This is a dictatorial approach to change that is rarely perceived in a positive light.
- Do everything in your power to make it feel like a light-hearted place to work. Laugh, be honorable, allow friendships to build. When people feel loyalty to each other, they will always go the extra mile.
- Stop managing one by managing all. Seriously. Remediate those who fall short and leave everyone else alone.
- Build an environment of trust. Keep your word. It’s that easy.
The problems in ER Medicine aren’t just problems with the mismanagement of its employees. It is time that staff members begin to hold themselves accountable for what they are contributing to the disease that is overtaking our field. We, as staff members, need to understand that we are often times part of the problem. Here are a few things that bedside staff members can do to improve our departments.
- Bring a positive attitude with you to work. Sometimes in life we have to “fake it ‘til we make it.” If you are having a rough time, don’t poison the rest of your team. Chances are that if you simply focus on the good, by the end of the shift you will be smiling, too.
- Choose your battles. Don’t buck every change that comes your way. Doing this only makes management perceive you to be negative and unwilling to change.
- Do your best, every single day. A systematic approach to the care that you give will make this task an easy one.
- Stay the course. Don’t be an employee who lives with “one foot out the door.” Be dedicated. Commit to stay to endure the ebbs and flows that your department will undoubtedly experience.
- Get involved. While often times it can feel that you aren’t being heard by management, sometimes it’s just a battle of wills. Don’t be afraid of retaliation. If you are handling yourself in a professional manner, things will go your way.
- Focus on your patients. They are the real reason you are there. You love helping people in crisis. If you didn’t, you wouldn’t be in the field of ER medicine.
- Be the kind of team member that you would choose to work with.
- Don’t tear people down, build them up. It doesn’t matter if you have been in this field for 2 months or 20 years, we all still have things to learn. Embrace each other. Acknowledge the special gifts that we all bring to the team.
I cannot imagine my life without ER medicine. It is because of this, that I am committed to making it better. Leaving isn’t an option for me. I hope that you feel the same. I look forward to walking this path with each and every one of you. Together, the future of ER medicine doesn’t have to seem bleak. Together, we can heal the world.
“When you tear out a man's tongue, you are not proving him a liar, you're only telling the world that you fear what he might say.”
It has been almost 2 years since the bullying and terrorizing began against me. Well, it has probably been going on for longer than that but my blog finally opened the door. It finally provided an outlet in which the snake could strike. (Lord knows I do not open the door for that in my professional life. I follow all rules.) I have been writing for years. It is one of the only things I do that I feel comes from my soul. I do it for me. I do it for you. I generally only write about things that I am passionate about. Nursing is one of those things. I am not unethical in my writing. I do not violate any laws. I don’t even “step right up to the line”. I write about things that all people should care about.
Civil rights, injustices, poor management…these are things very near and dear to my heart. I would write more often, but I have been censored. I want to speak out, but I am punished for doing so. (Not to my face, but instead in covert operations to sabotage my career.) There are no words to describe it other than retaliation, bullying, and abuse of power.
So today, I leave you all with the first amendment to the constitution and a poem regarding censorship. By not writing, I might as well be burning books. Shame on me. And to those who are censoring me…shame on you. How very un-American.
The FIRST amendment as adopted in 1791 reads as follows:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. 
"Burning a Book," by William Stafford
Protecting each other, right in the center
a few pages glow a long time.
The cover goes first, then outer leaves
curling away, then spine and a scattering.
Truth, brittle and faint, burns easily,
its fire as hot as the fire lies make---
flame doesn't care. You can usually find
a few charred words in the ashes.
And some books ought to burn, trying
but just faking it. More disturbing
than book ashes are whole libraries that
got around to writing----desolate
towns, miles of unthought in cities,
and the terrorized countryside where
own anything that moves. If a book
isn't written, no one needs to burn it----
ignorance can dance in the absence of fire.
So I've burned books. And there are many
I haven't even written, and nobody has.
Dear Kindergarten Teacher:
Tomorrow his world is changing. Tomorrow my world is changing. Today, in his eyes, I am the most magical person on the planet. I have shown him the moon and the stars. I have taught him songs to sing when he misses me. I have captured snakes to share with him. I have taught him how to plant a garden. I read books to him in funny voices and then he makes me read them to him again using my “real mommy voice.” I have taught him how to cook. (not on a plastic stove with plastic vegetables, on MY STOVE using real knives and real food.) He writes songs and poems and I video every single one of them so that we can play them over and over, reveling together in his awesomeness. I hold him and hug him any time he feels like he needs to be close to me. I fix all of his problems and kiss all of his ouchies. He makes me laugh and he giggles at me all of the time.
He is an interesting little kid. He thinks big but is content at home. He likes to run but loves to snuggle. He knows all of the words to all of the songs on the radio. (He says that Taylor Swift’s music makes his ears bleed.) He says his best friend is his daddy and loves his sissy with his whole heart. He asks questions that he wants real answers to and is never content with answers when he knows they aren’t true. He pushes all boundaries. He is loud and full of energy. He will make you want to kill him. He will make you question if he’s had any actual adult guidance whatsoever. (I assure you he has) Some days you will question whether or not he’s only five. Some days you will question if he is still three. When he gets nervous, he kind of acts like a jerk. You should know that most of the time, when he’s acting out, he really just needs a hug. In life thus far, he has a tendency to be more like a salmon swimming against the current and less like little lamb following the flock.
I hope that you embrace him. I hope that you can see the sweetness in those big brown eyes and his captivating smile. I hope that you can continue the fine balancing act I have been performing between shaping his spirit and not breaking it. You see, tomorrow and for five days a week for the next 9 months, you will be spending more time with him than me. You will ever so quietly slip into the “top spot” in his life. He will find you to be beautiful and amazing. He will slip and call me by your name when he’s at home. You will teach him how to read and to do math, things that I am not capable of teaching him, but things that will shape his future and give him the tools he needs to be successful in life. For this, I thank you.
Tomorrow his world is changing. Tomorrow my world is changing. In the blink of an eye, my baby will grow into a young man. Tomorrow he will begin this journey with you, but to me, he will always be my little boy.