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April 23 Salon: Healing for Nurses. April 24, 2008

Posted by mariemanthey in Nursing Salons, Values.
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Last nights Salon was another wonderful experience!

We touched on a variety of subjects from unhealthy work groups to the challenges of ethnic differences in end-of-life care to age disparities in nursing practice and their effect on workplace dynamics.

Take for example, that last item. Old-timers complained that  new nurses spend too much time on the computer and not enough with patients. Newer nurses complained about seasoned nurses being too judgmental about patient behaviors and values that are different than those held by the nurses. These comments yielded a rich and meaningful conversation that ended with a strong connection between the older and younger nurses in the room.

Another rich theme of the night was how do nurses handle the stresses and strong feelings that occur on the job (i.e., death of a beloved patient, family decisions about end-of-life care that result in patient suffering ) when they go off duty? Do our families really want to know about these issues? The consensus was “No!”  The conversation around how process these emotions when there is no one to talk to at home and no time to talk at work was really helpful.

Actually for most people, these Salons are providing this kind of an opportunity to process their work experiences in a supportive and healthy way. The check-out always yields comments about hope for the future, pride in the profession, and  personal validation of experiences.

Comments»

1. Katheren Koehn - April 26, 2008

I am sorry that I missed this last Salon. The pace of the work and the demands on the nurses during their shifts does not allow for the kind of reflection that is so critical to not only our professional growth, but to our professional survival. After a busy, and often frustrating, day, it is truly a blessing to be able to sit with a group of nurses and talk about “what’s on our minds” about nursing. No matter how challenged I am, I always feel more positive about the present – and the future – of our profession by the time the evening ends.

Marie is providing a real gift for those of us who are able to attend her Salons – and a roadmap for others who are considering replicating her process for others.

2. Connie Thach - April 26, 2008

I think the topic about seasoned nurses who feel that newer nurses do not spend enough time with the patient at the bedside is interesting and needs to be taken within context. I think it is also valuable to briefly respect the fact that the vision/mission from our schooling will vary across the decades. Some schools will want to impact their students into more research oriented nursing versus evidence based practice nursing. How each nurse graduates and behaves on the unit will reflect how they were taught in school.

Coming from an ICU standpoint, I think there are times where the patient is tired of having a plethora of staff constantly going in and out of their rooms (rooms that are made of glass doors so privacy/modesty is another compromise the patient must cope with while hospitalized) for blood samples, hourly physical assessments, doctor visits, routine xrays, medication infusions, constant alarms going off, and what have you, that time for destimulation/relaxation is key to the environment of healing. At the U of MN-TC, complimentary and alternative healing and interdisclipinary teamwork was strongly expressed and its philosophy is strongly rooted in my nursing process. Although I may not be right at the bedside for the moment, but instead, in a room attached with a window view to the patient, I can see that giving the patient a moment of quietness can lead to lowering heart rates (decreasing demands on the heart), decreasing blood pressure and respiration rates (allowing better tissue perfusion), alleviating agitation (enhancing patient comfort/coping), and increased energy for the next hour of ICU care. Sometimes, all it takes is seeing the furrow between my patients eyebrows slowly disappear.

There have been times where my nursing presence was not wanted per patient verbal expression; and luckily for me, I have a small closet room next to my patient’s room with a window view which also has a computer where I can chart and read the multidisciplinary team’s notes (e.g., dietician, social worker, MDs). As a new nurse myself, I am interested in reading these multidisciplinary notes because it has allowed me to have a better insight into patient care. During clinical rounds, I am able to add important information and pose questions for doctors (e.g., “I saw that the dietician recommended tube feedings, and this patient has not eaten since yesterday, can we start the tube feedings now?”). As I work before my fellow nurses and doctors, I want to feel and be competent and helpful to the patient and the team.

There are some excellent nurses who have the natural talent in remembering and quickly understanding how, when, and where all the nursing care must be done in order to support the medical orders and diagnoses that are constantly being made without needing to read all of the medical notes in the computer. Seasoned nurses have had the time to acclimate themselves into the unit culture and understands how some of the unit protocols can take place. They probably are more comfortable with time management and team coordination as well. Although some may feel that we aren’t spending enough time at the bedside, it does not necessarily mean that we are not thinking of how we ought to care for them. Reading and charting electronically correctly sometimes gives us the information and thus, confidence, we new nurses feel that we need before we return to the bedside with our organized nursing care.

For example, if my patient has a CT scan, endoscopy, 4 units of blood, needs an 18 gauge peripheral IV before CT, and needs to be catheterized all in the next 4 hours, I know how to execute each care competently. But, the key is optimal care. So how do I know how I should coordinate how each care needs to be done in order to give my patient optimal coordinated and streamlined care? Seasoned nurses have taught me the priority level specifically accepted on our ICU, the methods to calling CT and endoscopy, and when to page the catheter teams to get the IVs and urinary catheters placed. I have been told dozens of times that I should expect to feel that my orientation to the medical ICU will take at least a year. With time comes with experience and I look forward in having as much finesse and competence as the seasoned nurse.


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