Friday, December 12, 2008

Six Month Introspective

When I worked in ICU and precepted new nurses, the ones who had the hardest time acclimating to the new role were seasoned nurses. Sometimes, it's tremendously difficult to go from the top of one's game to not being sure of anything. Only time and repeated exposure to procedures and situations make a nurse comfortable in new positions. One opportunity after another to be successful is what gives us confidence (practice makes perfect). I used to tell new nurses that it would take six months to begin to feel confidence and up to a year to feel fairly good about things. Feeling expert at tasks can take years.

My transition from an intensive care environment into hospice has been no different. After six months, I'm feeling a bit more confident. I was not happy with certain aspects of my hospice training and promised myself that in six months, I'd re-evaluate where I stand. If still unhappy, I'd give myself permission to admit defeat and jump ship. In this time, I've developed a rapport with the doctors who support my efforts in the field; this has made a tremendous difference. I'm making fewer mistakes, really, only minor omissions on paperwork and that's helped in a huge way. It's so nice to seldom get a pile of papers back that I have to tweak. While I don't feel I've completely mastered the computer program we use, I do think we're on better terms these days. Very little cursing accompanies my interactions with my work laptop.

I've embraced the patient care aspect completely. I no longer feel unsure of myself in those encounters either. I use everything I have at my disposal-especially, the doctors. I still feel called to do this line of work. It's not true of everyone and I do work with some who seem a little jaded, as if this is just a way to pay the bills. Families and patients can always detect this in a caregiver. A nurse or hospice physician has compassion for a suffering human-or they don't. The fakers are almost always outed for what they are. This is my biggest time management issue. I am not a faker-out there only to make a living. This leads to those epic visits and starts of care that seem to go on and on forever. On a slow night, it's not an issue but on a busy night, there is no reprieve and nobody available to help. Other nurses tell me I need to get better with my time management and learn how to keep my patients and family members directed to the task at hand. Really?

How do you interrupt and redirect a dying person when they are discussing major issues? I can't. I'm giving notice that I won't. If my colleagues have a problem with this, I consider that their problem, not mine. I will practice the skill of being in the moment and most certainly will never leave a patient dangling in emotional crisis. I believe that dying a good death is a goal that can be achieved, one that requires attention to all aspects of life including the physical, spiritual and psychosocial aspects that make us human. To do otherwise would be a betrayal of the oath I've taken as a nurse.

It's only taken 25 years to heed the call and find my niche in this profession. I'm well rounded because of the detours but, I feel that I've found what I need to do with my career. I am finally, a hospice nurse. I think I'll stay here for awhile. My next mission will be to change the minds and behaviors of jaded nurses.

Do you think I stand a chance?


Anonymous said...

Hospice was a so wonderful to us when my husband's brother was dying of ALS. The care and the time the nurses put in with us/him, made a difficult time a bit easier. I am so thankful that there are nurses like you who are truly there for the patient, put the patient first. I think you can pave the way...or at least plant some seeds in their brains as you do your job. What a wonderful person you are. You have found your niche!

flydragon said...

Thanks for the reminder on just how special hospice nurses are. To go from trying so hard to keep patients alive, to making death as peacefull as possible has to be quite a change. I'm sure not that many could do it. If I wore a hat, it would now be off to you.

Lisa L said...

'Being present.' So, so true. And yes, there are many times you'll arrive at a home and someone is in crisis...its not like you can say, well, let me make an apt with the social worker/grief councelor for you...Instead you sit. You listen. You stop your busy mind. And tend to the task at hand. Its hard. Its worth it.
Fellow Hospice nurse

Rositta said...

I can't believe it's six months already wow. If anybody can change the "jaded", it will be you. You are a special human being...ciao:)

Winifred said...

You've hit the nail on the head exactly, you're a professional and one who has a true vocation. When you come across people who aren't it can be soul destroying. We need to make systems more in tune with what people need not what the organisation needs. Keep on, you've got it right!

It's a while since I've seen What Colour is Your Parachute? I used to buy copies for all our careers libraries. A really good self help manual that's been around for many years now.

Rose said...

Of course you do! Feeling called is the proof I think. I have yet to have any contact with a hospice situation but when I do, I hope I have someone with as much compassion as you do. I feel that teaching is similar; you must be called to do it in order to do it well. And I'm impressed with your self-analysis, another important component of who you are and why you're so good at it.

Brenda said...

Glad to hear you are accepting this change in your career. Life is so much easier when we can just accept things. I know it has to be better on your back. It also sounds like you are giving the best care possible to your patients. Many people don't give 100% of themselves to their jobs, and it shows. Being a good example is always the best way to get people to want to change, I think. You really amaze me with everything that you accomplish!!!

Rudee said...

Thank you to everyone. It was so nice to come home from a painful work night to find these comments here. It boosts my spirits immensely.

the rotten correspondent said...

I think - no, I KNOW - that you can do anything you want to. Being in the moment is an art, and as we all know, not everyone is an artist.
When paperwork and time limitations become more important than patient care, burnout is right behind.

I admire you so much for taking this on. I'm also drawn strongly to hospice, and hope that I will be able to do it at some point down the road. It's that learning curve that scares me. How do you go from grabbing epi to...not? It's a totally different mindset, isn't it?

I think they're all lucky to have you.

Rudee said...

RC, when the time is right, you'll hear yourself called. At least that's what happened to me. I love what I'm doing right now. The paperwork aspect, not so much, but the patient care is worthwhile and satisfying. I get wonderful feedback from patients and families and this helps keep me on track.

Gill - That British Woman said...

It is a calling to do your line of work, and it takes a very special to do it, and you are one of those people, and I for one am grateful there are people out there like yourself.

Gill in Canada