What Witnessing a Code Does to Us...

By: Sarah K. Wells, MSN, RN, CEN, CNL

What is a Code: For the context of this post, a Code is a coordinated resuscitation effort to deliver ACLS or PALS care to a patient

Who is the “us”: Members of the healthcare team that are part of the Code response or who witness the Code response

How witnessing a Code impacts us: Codes are traumatic to witness, let alone participate in. The impacts on those healthcare team members involved can cause a range of emotions with the negative severe effects potentially being as serious as conditions such as PTSD, depression, SI, etc

Why am I talking about this?: The tragic incident of #damarhamlin receiving CPR and a potential defibrillation on the field during this week’s Bills vs Bengals game exposed millions around the world to a Code. People are reacting strongly. Players at the game walked off the field. Discussion is happening about how people are feeling after witnessing such an event.

Where does that leave HCWs?: While the world gets to discuss and feel for days or more about witnessing a Code online, on TV or live at the game, HCWs are going to work and participating in Codes as just another day or night at the office. We need to start discussing better preparation options for HCWs involved in Code response work in terms of management of the stress and trauma for those involved, increased mental health support for all HCWs, and continue the meaningful conversations about the society’s disparity of expectations for the public vs those that work in healthcare.

Bottom Line: We save lives for a job, but we must protect ourselves above all else because what happens when no one is left to respond to the next Code?

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Reader: Are you a nurse or healthcare worker who has participated in a Code response? How have these experiences affected you? What helpful resources would you want other HCWs to know about?

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About the Author: Sarah K. Wells, MSN, RN, CEN, CNL is an 11+ year nurse with over 10 years of that working in the Emergency Department. Sarah has helped with countless Codes and has experienced many mental health effects due to this work.  Sarah hopes to see more work being done to support nurses and other HCWs focused specifically on providing psychological safety and increasing their mental healthcare access.

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The light in the dark of 2020

I have failed so many times this year.

I have failed to get out of bed on days where my body wouldn’t listen to me.

I have failed to be open with my family, friends, colleagues, and clients when the despair was too great to function.

I have failed to be as present as I could have been during this most unprecedented time – historical mostly due to failures in leadership, process, and procedure that have cost our country 289,000 deaths and counting as of the writing of this post.

But most of the time, I am able to do so much – get up, work, smile, speak, write, advocate, care, support, listen, live, be – and each action is a success that must be celebrated.  

These are the days that will define my life.

I was a high school student during 9/11, graduated college in 2008 during the Great Recession, and worked as an emergency and radiology nurse during disasters, epidemics, and the worst days in the lives of so many of my patients. But this pandemic, this year, these moments – these will be what I tell future generations about.

And while I will speak to them about working through PPE and supply shortages, not knowing what to do when others needed it most, shouting reassurances to patients through masks and goggles, managing the public misinformation, and drowning in cleaning supplies at work yet not being able to find basic hygiene products at home, there are other more important moments that I will share first and most frequently.

I will tell the future generations of nurses and other healthcare workers about the fear of others, fear of an unknown, and a fear of bringing an evil home that could harm or kill my loved ones. I will tell them about the loneliness – missing my family, my friends, and not knowing when it will be safe to be around them again. I will tell them about the isolation – not just the feeling of being alone but also the physical distance between people – eating lunches outside, not in the break room with my coworkers. About edging away from others because of the unease of being around people without a mask. And the feeling of fear that was not always of others, but of myself, not knowing if I was unwittingly passing on a novel evil to others.

I will tell them about the crushing weight of shame when I called out of work as an essential frontliner, not for COVID-19, but for anxiety and sadness that I could not get under control, no matter how much mindfulness, self-care, and therapy I sought out. I will tell them about the days when I couldn’t move without my husband physically hauling me out of bed and into clothes to get even the most basic things done.

I will tell them that even in the darkest, loneliest moments that I was still me.

I was still a nurse. And I was no less of a nurse because of my struggles. Every time I took a stronger dose of my SSRI - I was a nurse.  Every call to my therapist, appointment with a psychiatrist, and day I stayed in bed and streamed 12 hours of TV in an attempt at harm reduction – I was a nurse. I was nursing myself. I was nursing my mind and my brain chemistry. I was nursing chronic conditions called anxiety and depression that were exacerbated by the most unprecedented year in medical history.

And I never did it alone. I had my husband, my amazing partner in all things, who cared for me every day. I had my family and friends, IRL and online, who helped support me during my best and worst moments. I had my incredible nurse community – because we are a community that can withstand all things – who checked in, sent me packages, emails, texts, DMs, messages, and the most hilariously inappropriate memes to make me smile on days when I thought the world was ending. I will tell them that my nursing and healthcare people came together to support me because that’s what we do when the shit hits the fan – we roll up our sleeves and figure out how to fix it.

I want to tell everyone going into healthcare in the future that you are never alone.

You have generations of us - nurses, doctors, nursing assistants, techs, phlebotomists, imaging technologists, respiratory therapists, social workers, therapists of all varieties, and all the other medical roles that make up our incredible healthcare team – who have had those dark days, been in those paralyzing moments, and gotten through to the other side. We are here for you to lean on, get guidance, and receive all the wealth of our collective experiences. We are also here to represent those who have not made it. We know how impossible the work is, yet we continue to do it. Through the hardest moments, we are there to care for others, keeping them alive and comforted, making them better. 

But know that you will have dark, challenging moments too. And often those moments will be in your car, on the way home, or at 0400 when you are unsuccessfully trying to sleep. You will be replaying things in your mind, wondering what you could have done differently, or thinking about how all of it doesn’t matter anyways. You may despair. You may want to give up. And it’s OK. I want you to know that I have despaired. I have wanted to give up.

But I haven’t, and you shouldn’t either.

I have seen the dark, and yet I eventually got up out of bed again. I showered, grabbed coffee, and put my scrubs back on. I got my PPE. I grabbed food and my nurse bag and went to work. I put on my mask and goggles. I cared for others because that’s what I do because I am a nurse.

 When I tell others about 2020, I want to make sure they know all the parts.

And I want to make sure that no matter what year it is, the dark moments have happened and will happen again, but despite the darkness, there is so much light to be had. I show up every shift for the light. I am here to help you see it too.

Sarah @ New Thing Nurse

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life. 

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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Corona Conversations Vol. 3: Living with the Trauma from COVID19 for Nurses with Lauren Funiestas

Being a nurse during the COVID-19 pandemic is not just hard, it’s traumatic.

Did you ever think of that?

I was lucky enough to sit down with my dear friend and favorite human, Lauren Funiestas, an experienced mental health provider who is passionate about providing multicultural, trauma informed care, for an insightful conversation about the stress and trauma that working during COVID19 has caused for the mental health fo frontline healthcare workers. We talked about how best to manage that stress and what you can do to be mentally and emotionally well during this challenging time.

And like any good conversation, we recorded it on Zoom! Enjoy the latest edition of Corona Conversations over on the New Thing Nurse YouTube channel. Cheers!

Bio: Lauren Funiestas is an Associate Marriage and Family Therapist who has worked exclusively in the forensic/community mental health field since 2007. She is currently preparing to take the California BBS license exam. She’s provided multicultural, trauma informed and mindfulness based individual/group therapy, case management and psycho education services within residential treatment facilities, school-based children’s mental health programs, public health clinics and detention facilities. Lauren received her Bachelor of Arts in Criminal Justice from San Francisco State University and her Master of Arts from John F Kennedy University’s Holistic Counseling / Transpersonal Psychology program. Lauren self identifies as a Transnational feminist, Filipina/Island girl and a champion for the advancement of communities of color within the mental health field. She believes strongly in decolonization, honoring the spirit and using all of your paid time off for self care. Lauren is a former body builder, white belt jiu jitsu champion (that counts) and her favorite TV character is Olivia Benson from Law & Order SVU.

Resources for Mental Health Support:

• National Suicide Prevention Lifeline - 1-800-273-8255

• Crisis Text Line - Text HOME to 741741 from anywhere in the USA

• National Alliance on Mental Illness (NAMI) - https://www.nami.org

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Corona Conversations Vol 1: Nursing, Stress, Mental Health, PPE, & more with Sarah of New Thing Nurse & Anna of The Burnout Book

Is this pandemic over yet?

We’ve officially been sheltered in place for over a month here in Oakland, California, and I am feeling it. The stress of everything related to the novel corona virus/COVID-19 is making life in and out of the hospital hard. I have had up’s and down’s with my mental health. I feel that I am now on an upswing, but that definitely can change day-to-day. Some shifts at work are awful - I had a total meltdown this week in the ED. Other shifts are just fine.

On Monday, 4/13, I had the chance to sit down and chat with Anna Rodriguez of The Burnout Book via the almighty Zoom and discuss everything that is going on with nursing in the time of COVID-19. We decided to record the conversation and share it with you all. I hope you enjoy!

Without further ado, I present to you Corona Conversations Vol 1 on the brand new New Thing Nurse YouTube channel:

Description: Sarah from New Thing Nurse and Anna Rodriguez from The Burnout Book have a Corona Conversation about the status of their nurse mental health and wellness as of 4/13/2020 during the COVID-19 pandemic. Sarah and Anna also have a robust discussion on COVID-19 stress and the PPE shortage, how that affects our ability to provide compassionate patient care, and tools on how to reconnect with our patients and nursing community. Plus get Anna and Sarah's Top 3 Tips of the Week on how to make it work as a nurse during the novel corona virus crisis. Enjoy!

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COVID-19 & My Nurse Mental Health - I feel like shit that has been trampled by elephants.

I literally can’t get out of bed some days. 

Everything makes me cry. 

Going through the day feels like walking through waist-deep mud.

I am tired of talking to people who are not my nurse or healthcare friends. No one else understands.

This is what COVID-19 has done to me. I have not caught it. I am physically well but mentally, I feel like shit that has been trampled by elephants over and over again.

If you are in the healthcare field, you may know what I’m talking about. There is a constant dread during every waking moment. It is a heaviness that for me, is often on my chest, making it hard to breathe. I have heard others describe a giant pit in their stomach that will not go away. 

And your dread is valid. This effing novel corona virus is a REAL bitch, and it’s killing healthcare workers around the world. 

Plus, we are often being expected to work without the equipment we need to stay safe and keep our patients safe. It’s a time when we are being called “heroes” but are being treated like trash. 

Yet there are people out there who care. I see social media posts, public displays of appreciation, and huge philanthropic efforts to support us. Everyone I know texts, calls, or emails. They all want to know the same thing - “How are you?” 

I don’t know how to answer.

I want to say - “I am awful. I am afraid. I am worried about every one of my friends and loved ones getting sick or dying. I can’t see my family or best friends. I’m terrified that I am going to bring this wretched virus home to my husband. I am so lonely that I can’t move. Every shift gives me a panic attack before and after and sometimes during… but otherwise, I’m good. Have you watched Tiger King yet?”

I don’t think that’s what people are hoping for…

Thankfully, I have amazing friends.

A brilliant nurse friend and colleague of mine posted the most eloquent response to this question, which I have now borrowed with her permission and will use as the response for me, and I think, most nurses right now: 

“People keep asking how I'm doing. I wanted to be very honest, so here it is. Strap in - this is long.

We are struggling.

The burden of this pandemic weighs so heavily on us. We are bearing the weight of the world on our shoulders and we aren’t sure that we are strong enough.

We carry a rock in our stomachs and a lump in our throats which have taken up permanent residence and from which we cannot be released.

We put on a brave face, but we are taking enough antacids to medicate an elephant. If we are already on antidepressants, we’ve increased them. If we aren’t on them, we are considering starting them.

We’ve stopped worrying that we’ll bring this home to our families anymore. We’ve taken that as a given. We worry that our family members could be the vectors who unknowingly spread the virus to somebody else. We need to protect the world from US.

For that reason, we take social distancing extremely seriously. Guess what? That social distancing, though? It’s killing us. We are empaths. It is both our nature and our job and now we can’t give our love to anyone. Do you know how much we could all use a hug right now? We can’t have one. Our children miss their relatives and are begging for real in-person hugs and we can’t let them. Our hearts ache.

We worry.

We worry about all of the same things that you do. We worry about our families, but we don’t get to dwell on that because we’re worried about your families, too. We worry that you will be the patient we have to tell, “I’m so sorry, but due to the isolation precautions we will all be trying our best not to enter your room after I leave. Here is your call bell. Let us know if you need anything!” We worry that you will feel alone. We worry that it will be the last words you hear from another human before you are gasping for air and we have to intubate you with no family present and nobody to hold your hand.

We worry that our kids will internalize our grief, anxiety and depression due to what we face each day.

We worry that you call us heroes. We don’t feel like heroes at all. We are just as frightened as you are.

We feel guilty to be gainfully employed when so many are not. However, we worry what the ultimate price will be for continuing to do the job we love so much.

We feel sorrow for the lives lost and for the many more that we are bound to lose due to poor planning and preparation.

We feel disposable. Under a president who refuses to acknowledge the severity of this pandemic, the CDC making subpar recommendations for PPE, a national administration that has been unable to equip its frontline staff appropriately to protect themselves so that we can SAVE FUCKING LIVES – WE FEEL DISPOSABLE.

Despite all of this, we will still SHOW UP. Because when you are a nurse, it is more than a job. It’s a calling. It’s what we do. We SHOW UP.

To all of our colleagues – from EVS to RT to MD and everyone in between – THANK YOU for showing up.

To all other essential employees of the world – THANK YOU – for feeding us, delivering our mail, picking up our trash, keeping the streets safe. THANK YOU.

And to those who are forced and/or able to stay home, THANK YOU for doing your part to flatten the curve. We know that it is not without great sacrifices for many.

To those who are donating, volunteering, sewing masks and caps, lifting us up in prayer, helping your neighbors, and spreading kindness and love – THANK YOU.

This is a battle that we are all fighting together and everyone plays their respective part, so THANK YOU.”

 - Ginelle Rasch, Emergency Department Nurse

I know. Ginelle is THE BEST.

Things are so hard. If things seem impossible for you too, know that you are not alone. I feel the same. Ginelle feels that same. But somehow, together, we are going to get through this. 

And if you need a little extra help to push through, that’s totally ok too. In the past few weeks, I have switched my SSRIs, increased my talk therapy appointments (via telephone), and have had to be very open with friends and colleagues about my mental health needs. 

Your mental health is important, just as important as your physical health. Take time to care for yourself. And know that you are definitely not alone. 

- Sarah @ New Thing Nurse

Here are a few resources that I am using to help me get through the days. Maybe they will help you too:

Crisis Text Line - Mental Health Support via Text

National Alliance on Mental Illness (NAMI) COVID-19 Resources & Information Guide

Podcast: Kate Bowler - Everything Happens, “The Emergency Button”.

Podcast: The Hilarious World of Depression - Call a Friend, Find Out How They’re Doing.

I tried yoga once so far. It was nice. This yoga is free! - Down Dog

Connecting with friends:

Art of Emergency Nursing Podcast Episode with Me, Kristen Cline, & Kevin McFarlane

FB Live Fill Your Cup Virtual Meetup with Anna Rodriguez of The Burnout Book

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COVID-19 is here! 😳 What does that mean for nurses?

COVID-19 is here! 😳 What does that mean for nurses?

Generally, it means chaos in our workplaces. The information related to COVID-19 (aka Corona Virus) is constantly evolving creating confusion and misinformation everywhere. This can make every shift 12+ hours of stress for nurses and other healthcare colleagues.

Here are my top tips for managing the stress of being a nurse during a pandemic:

1. Stay up to date! - The information is changing hour to hour. Keep informed by following the Centers for Disease Control and Prevention (CDC) COVID-19 page. It has the most current information available with the recommended guidelines for healthcare workers.

2. Keep clean! - Washing your hands seems like an eye roll worthy recommendation, but it is necessary to decrease your risk of exposure and transmission. I found this great article that gives some of my favorite songs as tunes to use to make sure that you are washing your hands for the recommended 20+ seconds.

3. Sick? Stay away from others. - Like any time that you are ill, stay home, cuddle up, and watch some TV. If you want to really get into the outbreak spirit, check out the Netflix docuseries “Pandemic.” I LOVED IT!

4. Make some mental space for yourself while at work - Your shifts are stressful on a normal day but then you get to go to work in a pandemic - AHHHHHHH! Now is an even more important time to take time for yourself to create mental calm so that you can be your best self for work and home. Check out this New Thing Nurse Blog post that offers a few tips on how to keep calm during a stressful shift.

Remember - Take care of yourself so that you can take care of others.

- Sarah @ NTN

Resources:

Centers for Disease Control and Prevention COVID-19 Resource Page

New Thing Nurse Blog - When the Shift Hits the Fan

Atlanta Magazine - 9 Atlanta Songs to Help You Keep Time for Hand Washing

Pandemic Docuseries on Netflix

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life. 

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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Guest Post: Finding Balance as a Nurse and Mom with Lindsay Woolf Grainger, MPH, MSN, RN

To me, the most amazing individuals in the world are the #nursemom and #nursedad. Like unicorns, they manage to rock the world of nursing and parenting with a magic that smells like coffee and determination. While I am not a member of the nurse-parent team, I know many of our #newthingnursetribe are and that is why I invited my nursing school friend and esteemed colleague, Lindsay Woolf Grainger, MPH, MSN, RN, to tell us how she has tried to find work-life balance as an almighty #nursemom.

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Hello readers!!

I am delighted to be sharing my experiences with you on the New Thing Nurse Blog!! I am Lindsay Woolf Grainger - a nurse, nurse educator, wife, mom, and friend of Sarah’s from nursing school. Yes, I remember the “good ol’ days” of skills check offs, late-night study sessions with Sarah, and fun ,yet random, hair cutting parties (look - we had to be creative with our budgets as nursing students). I am humbled to have this opportunity to offer my thoughts on the daily quest to balance work and family priorities as a #nursemom.

My husband and I have three daughters - ages 1, 3, and 6. Our days can seem like a blur of feeding, entertaining, refereeing, comforting, and disciplining our kiddos. I love the privilege of being a parent, and with these responsibilities on my plate, my career has had to evolve.

The news of my first pregnancy created some immediate changes in my work as a new grad, nightshift nurse on a transplant unit in a large, urban facility in Georgia. For starters, I actually asked for help when moving patients. I was extra sensitive to smells and took better precautions NOT to inhale. My participation in doing CPR compressions was frowned upon. I also realized that nightshift combined with the fatigue of pregnancy was pretty intense, so I put my name on the list for a transfer to dayshift and was grateful when a position came up within a few months.

Some really groovy things happened during pregnancy too. I discovered a new-found confidence and assertiveness. This led me to schedule a meeting with our CNO to discuss my concerns about the hospital’s then-recent decision to cut the training time for new grad nurses in HALF. I don’t know if I credit the hormones or what, but I felt compelled to advocate for future nurses, and it seemed like my barely emerging “baby bump” was leading the charge.

After the delivery of our daughter, a whole new wave of realities came crashing into my life - the challenges of breastfeeding, the haze of post-partum hormone shifts, and severely truncated sleep. New career questions emerged. I had the luxury to return to work PRN, but even so I was clumsy at maneuvering pumping while on the job (in the bathroom—really people?), and I felt anxious to be away from home yet anxious to maintain my professional pursuits while at home.

So that delicate teeter-tottering of balancing career/family time began quickly for me. Today I work as a full-time nurse educator, and I appreciate the flexible schedule that it affords. I still struggle to manage all of the childcare needs (especially when the kid(s) are sick) and worry that my mind too frequently drifts to work plans or schedules even when I am hanging out with my kids. There are many competing interests to balance between the needs of our family and the demands of my job, but I try my best. And I try to forgive myself for the days of lopsided priorities.

A few things that help redirect me towards balance include:

• Open Communication - I think that effective partner communication is essential (with or without kids). The more my husband and I communicate about our concerns and our needs, the better we seem to be able to work as a team to equilibrate our jobs and family.

• Landing Intentionally - To state the obvious, working in health care can be really stressful. With lots of family responsibilities in the mix, it is important for me to be intentional about where I work. I have decided that on the job I need to land somewhere in between “bored” and “stressed out.” I need a job that remains challenging and engaging without driving me nuts from the stress.

• Being Creative - My entrance into the field of nurse education started with a random phone call one year out of nursing school when I was 3 months post-partum. I was sleep-deprived, unprepared, yet curious. So (naturally?) I said yes. I am so grateful for the opportunities that this career path has afforded me and our family. Being creative and open-minded with career choices and scheduling can make work/family balance easier to achieve.

• Sharing - One of my favorite ways to prioritize my family is to include them in my job! As a new nurse, I invited (ok…begged…) my husband to occasionally visit me at work. I wanted him to understand what I was up to each day on the job. I have taken my children (even as babies) to the hospital to introduce them to co-workers and (hopefully) foster their interest in and appreciation for healthcare. Now as a nurse educator, I look for ways to include my kids in the classroom. My kids have also enjoyed volunteering (alongside nursing students) with Meals on Wheels in our community. (Full disclosure: I *might* be guilty of dressing our girls in child-sized scrubs during these events to max the cuteness factor.)

So, I have mentioned a few things that point me more towards balance, but I should probably mention a few of the pitfalls that distract me in this pursuit:

• Others! I cannot look at the lives of others (the credentials they have achieved, hours they work, activities their kids do, accolades their kids have achieved, relationships they have with their partner, etc…etc…). I don’t live anyone’s life but mine. No one is living anyone’s life but her own. The comparisons that tempt me are unhealthy and unfair and don’t help me figure out how to balance my unique responsibilities and goals.

• Sleep! For the record, I have tried (as probably most of you readers have) to sacrifice sleep for the benefit of my job and my family. Prolonged sleep deprivation has not moved me an inch closer to balance, so I would call this the ultimate “anti-balance” pitfall!

Every day can be viewed as a new opportunity to reassess our work/family balance and to move weight from one end of the teeter totter to the other. If work is suffering, then refocus on work. If family life is suffering, then refocus on family. And always know that no one (not even an acrobat, or your co-worker, or even your distant social media acquaintance) is perfectly balanced or put together. All of you nurses out there who work tirelessly to serve your families and your patients. YOU are heroes!!!

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Photo: Lindsay Woolf Grainger, MPH, MSN, RN

About the Author: Lindsay Grainger, MPH, MSN, RN is a full-time nursing instructor at the Mary Black School of Nursing of the University of South Carolina-Upstate. Her academic interests include community health, public health policy, immigrant health and refugee health. She holds a Masters of Science degree in Nursing (CNL) from Augusta University and a Masters of Public Health degree from Emory University. Lindsay has worked at the bedside in organ transplant nursing and in general surgery. Lindsay has also taught undergraduate and graduate clinical courses at Augusta University.

Outside of the classroom, Lindsay enjoys spending time with her family. (Her three daughters keep life whirling and twirling!) Lindsay's hobbies include learning languages, practicing yoga, and writing music. Lindsay currently serves as a volunteer at the Greenville Free Medical Clinic and previously served as a volunteer for Friends of Refugees in Clarkston, Georgia.

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How to be a Successful New Grad Nurse

Author's Note: A New Thing Nurse follower recently asked me what advice I would give to a new nurse starting their first nurse job. This post is inspired by her and all the recently minted, new nurses who are starting their nursing careers! Congratulations to you all!

Are you a new grad nurse starting your first job?  Here are some tips to take with you to work to make things go a little easier.

1.     Be open to learning. – There will be so much to learn, and you can’t learn it all at once. Be open to days where you will learn a lot and other days where you may learn only a little. The important this is just to stay open to learning. If you close your mind to learning, you will never grow into the best nurse that you can be.

2.     Ask all your questions. – There are seriously no bad questions. Lives literally depend on your work, so ask anything that pops in your head.  Off-the-cuff tips and advice that I received from co-workers over the years have saved my behind so many times. Pepper your preceptor and colleagues with your questions and absorb all of their pearls of wisdom that you can.

3.     Document everything that you do. – The old adage is absolutely true. If you didn’t document it, it never happened. If people are rushing you and telling you that you do not have time to document, remind them that it’s part of your job. There will be a time where you have to learn a good pace to balance patient care and documentation, but it’s an essential part of nursing.

4.     Be kind to everyone you work with from the housekeeper to the CEO. – You never know who will save you on a busy day in the future. Frequently it’s the frontline staff that will help you the most in a pinch, so be kind to all.

5.     Remember that healthcare is a team sport. – Always be willing to help, as well as ask for help when you need it. No one can do this job alone. If you have a spare minute, make a bed or clear some trays. The good you put out will always come back to you.

And most importantly – TAKE CARE OF YOURSELF. Nursing can be hard. Don’t fall victim to burnout by setting too high of expectations as you start your career. Make time for self-care and find a good support system. You will a need a tribe to thrive.

Good luck! This will be hard, but you are joining the most amazing profession. And know that the #newthingnursetribe will always be here for you every step of the way.

-  Sarah @ New Thing Nurse

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Anxious about getting started at your new job?

Send me an email & we can talk about how New Thing Nurse can make your new job a little less stressful - newthingnurse@newthingnurse.com

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life.

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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FOLLOW NEW THING NURSE ON INSTAGRAM - @NEWTHINGNURSE

A Vacation from Nursing: I took one & you should too.

I love my job, but it was about to break me.

I have been an ER nurse for almost seven years. For some of you, that may seem like no time at all. I have met many a veteran nurse who has been grinding at the bedside for 20, 30 and 40+ years. I applaud you. You deserve to be knighted. Our healthcare system survives because of your perseverance and expertise. #careergoals

The rest of you might be thinking – “Dang! She’s been an ER nurse for SEVEN YEARS.” Seven years probably seems like a lifetime to those of you still in school or recently starting your nursing career. The truth is that seven years is kind of a long time to be an ER nurse. Emergency department nurses have one of the highest rates of turnover within all of the the nursing specialties – an impressive 21.1%.  Per a study completed by NSI Nursing Solutions, many emergency departments will turnover their ENTIRE RN staff within 5 years.

Why are nurses leaving so quickly?

• Low Salaries - Nurse salaries vary widely across the United States. However I started in rural Georgia at a whopping $20.13 per hour in 2011. Even after a whole lot of overtime, there was no way that I was going to pay off my student loans from nursing school in less than 10 years. While I loved my hospital and my job, I left and moved to California where I found myself making a much more competitive wage. This allowed me to pay off my student loans in less than 3 years and has already set me up better for retirement. While my story is just one example, it is one of many similar stories that I have heard where nurses cannot support their families on their full-time job's earnings. And the situation for LVN- & ADN-prepared nurses is even more difficult in many states. Lives literally depend on our work. It costs a lot to get our education. Nurses should get compensated accordingly.
• Staffing Issues - Unless you have been living under a rock, you know that there is a national shortage of nurses. Many facilities are trying to get creative with staffing, which sometimes leads to unsafe nurse-patient ratios. This increases stress on staff and increases potential for unsafe patient care. The U.S. Department of Health and Human Services states that "Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes..". Good staffing is good for nurses and patients alike.
• Stress - Healthcare is becoming more and more concerned with time. Nurses now have to do everything faster, while still ensuring perfection with every task. Medicine does not look favorably on errors. The essence of nursing is fast, efficient care that people's lives depend on. If that's not stressful, what is?
• Abuse - Nurses experience all kinds of abuse. Period. Verbal, emotional and physical, there are few days on-shift where I personally don't get the joy of one of these. This has to stop to keep nurses. The American Nurses Association (ANA) has a campaign called #EndNurseAbuse that is working to decrease the amount of abuse that nurses encounter in the workplace. In addition to the loss of nurses, the ANA cites that the financial cost of workplace abuse of nurses is $4.3 billion annually or about $250,000 per incident. Healthcare has to address this problem if they want to end the nursing shortage and improve patient outcomes.
• Nurse Burnout - Burnout is physical, mental and emotional exhaustion caused by stress, often being suffered by "helping professions", such as nurses.  With all the abuse and stress that nurses are facing in the workplace, is it any wonder that they are experiencing burnout and leaving the bedside?

How my job almost broke me.

Like I said earlier, I love my job. Sometimes, I love it too much. I am a fixer – a person that wants to get in there and find a solution to all the problems. I want to fix my patients. I want to fix my colleagues' problems. I want to fix all the issues in our department. I want to fix all the challenges in healthcare. I want to take it all on and solve the problems, so that everyone can be happy and healthy.

A few years ago, all of that almost crushed me.

All of the things that I was trying to fix led to increased stress and major burnout. I didn't have wa healthy work-life balance. It was all work. All I could think about was work problems at home, when out with friends and family, or laying awake in bed at night. I wasn’t sleeping. My health was poor. Things were not going well for me.

I decided to take a vacation from nursing.

There was a point when my husband and I decided that I needed to take a break from bedside nursing. I needed to be away from patient care. I didn’t need to be going to any meetings. I needed to not be at the hospital. I had to take a big step away.

I made some changes. I started working on that vacation.

Over the course of a few months, I started slowly taking steps to get away from work. Every time the Charge Nurse asked if someone wanted to go home early, I volunteered. I started asking the PRN/Per Diem staff if they wanted to pick up my shifts. I took some personal days. I started looking for a part-time or Per Diem position. When a Per Diem spot finally posted at our other campus, I applied and took it. I started in a new emergency department, not on any councils or committees. Just as a bedside, Per Diem RN.

And then, I took some time off.

I traveled. I hung out with my friends. I took time to explore the world of nursing. I gained some perspective and a new appreciation for my profession. The idea for New Thing Nurse started to cook in my brain. I grew as a person and as a nurse. 

I got my nursing groove back.

This plan won’t work for everyone.

I know that it is not possible for everyone to say BUMP IT to your full-time job and suddenly go rogue as a Per Diem nurse. However if you are feeling the symptoms of burnout, you need to make a change. Untreated stress and burnout will lead to the end of not just your nursing career, but also can manifest as physical and mental health issues. I have talked about my mental health journey before. It is no joke. You should do regular self-assessments of how you are feeling. Take the time to take care of yourself if you want to be successful in all things.

Things that you can do to combat nurse burnout –

• Take a vacation. - This can be anything from a few days off to a several week adventure. The main thing is that you GET AWAY from the clinical environment. Don't check your email. Block the short-staffed text messages. Give your brain some time to forget about patient care and focus on self-care.
• Find some quiet. - Do you dream of alarms going off? Pumps beeping? Your zone phone ringing to deliver another critical lab? You need to get out of that mindset. Find some quiet. Engage in silence. Breathe. Meditate. Take a nap. Just find a place where there is no beeping or buzzing going on that will take your mind back to the bedside.
• Exercise. - The mind-body connection is real. Your brain needs to be well for your body to be well and vice-versa. Exercise helps you manage stress. It helps you feel physically better. It is good for you. I am not saying to jump into an Iron Man, just encouraging gentle exercise. Try to move a little, and see how it makes you feel.
• Eat well. - You body needs to good calories to have the energy to do all the things. Try to avoid processed foods and soda. One of my favorite dietary tips is - "If it wasn't in the kitchen when your great grandmother was cooking dinner, don't eat it." Try to stick to fresh things that look like real food.
• Get enough sleep. - Sleep is foundational to everything. If you are not getting enough, you will be testy and experience increased stress. Everyone has their own sufficient, minimal amount of sleep, but always try to get that amount every night. If things are getting in the way, triage your tasks and find time for rest. It is essential.
• Appreciate yourself and others. - It is time to remember how amazing you and your team are. Take a moment to appreciate yourself and others. My department recently started a Shining Star Award and are picking one person a quarter to give it to. The winner gets a pack of Starbursts and their picture up on the staff fridge. It's not a big deal, but everyone so far has thoroughly enjoyed knowing that their work is appreciated.  

My Current Vacation from Nursing

I am currently on another vacation from nursing. I have been calling it my August sabbatical. While I am still working on New Thing Nurse projects, I am only working three shifts in the ED this month to give myself some time to take care of the projects and myself. I continue to LOVE my job and think that I am a pretty awesome nurse. 

But - I have come to recognize that time away from the hospital is just as important as time at the bedside to ensure that I continue to be the best nurse that I can be.

- Sarah @ New Thing Nurse

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life.

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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FOLLOW NEW THING NURSE ON INSTAGRAM - @NEWTHINGNURSE

An Interview with Anna Rodriguez from The Burnout Book

Confession - I really like social media.

I have been overly involved with social media for years, but got REALLY into my accounts when I started discovering the nursing social media community. From your phone, you can interact with nurses from literally all over the world. It is so wild how much you can have in common with people that you have never met and who are located in geographic areas that are literally thousands of miles away.

It was on Instagram that I first “met” Anna Rodriguez, the curator of the incredible IG account - @the.burnoutbook. I was immediately drawn into her posts about self-care, strategies to fight compassion fatigue and manage stress, her videos of her doing yoga with her Corgi, Walter, and her personal experiences that she would share about working through nurse burnout herself. I completely identified with her narrative and felt like I had found a kindred spirit who also wanted to help support the nursing community!

As luck would have it, Anna happens to also be very active on IG! We now have become regular commenters on each other’s accounts and decided to combine our passions for sharing nurse stories by featuring each other on our own blogs! Isn’t life neat sometimes?

It is now with much pleasure that I introduce you to Anna Rodriguez of The Burnout Book… or better yet, I'll let her introduce herself!

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Sarah @ New Thing Nurse (NTN):  ANNA! I am so excited! Can you introduce yourself to our New Thing Nurse readers?

Anna Rodriguez (AR): Hello! I'm Anna Rodriguez, I'm a critical care float pool nurse in Washington state! I've been a nurse for 10 years now (which seems crazy), and I've had a variety of roles in that time: bedside nurse in med/surg, telemetry, CVICU and then as a nurse manager in CVICU, then I transitioned back to bedside care as a travel nurse and then to my current job. In the future, my plan is to pursue a masters in nurse education. Through all the different jobs I've had, I discovered I find a lot of job satisfaction when I'm in a supportive role, helping others learn new things or helping make their jobs or lives a little easier. So, at the moment, I'm still working as a full-time nurse and started a blog on the side focused on nurse burnout reduction and prevention.

NTN: The New Thing Nurse Blog is all about learning from each other by sharing our professional journeys. How did you fall into nursing? And what area of nursing did you start in?

AR: I’m sort of an anomaly. I figured out what I wanted to do pretty early on and stuck with it, no changes in my major during college! I was in 6th grade and my best friend's mom worked as a CNA and her sister was a nurse, and so she introduced the idea to me. At the time, we envisioned ourselves in a pediatric clinic, playing with babies and kids all day and maybe having to clean up some vomit now and then. All these years later, we both became nurses but both ended up preferring to work with adults! But during high school, I made sure to do some volunteer work at the local hospital so I could be exposed to the environment and make sure I enjoyed it. I would help transport patients around to procedures or to their vehicles when they were discharging, and I found that I really like interacting with patients and being helpful. Nursing is a really good fit for me. I'm so glad I ended up choosing this path.

NTN: The focus of New Thing Nurse is supporting nurses as they find their "new thing." What made you explore nursing away from the bedside? And what was your first "new thing"?

AR: I believe bedside nursing has a bit of a shelf life, at least for me. I admire the nurses who are able to make a career out of bedside nursing, but I'm at the point now where I'm ready to branch past that that and into a non-traditional nursing area, like nurse blogging and education. That's probably what I'd classify as my first "new thing." Although, I'm always looking for opportunities to grow as a nurse, whether it's by attending a conference or volunteering on a committee!

NTN: What helped you make that transition into your "new thing"?

AR: First and foremost, I have an amazing husband who always encourages me to do new things and is incredibly supportive. I've also found an amazing nurse community on social media, and we're always encouraging and learning from each other. So definitely find your people who cheer you on. Second, I'm always staying curious and trying to learn new things and stay challenged. From a practical perspective, if you're a nurse who wants to start a blog, I highly recommend the book "The Nurse's Guide to Blogging: Building a Brand and a Profitable Business as a Nurse Influencer" by Kati Kleber (Fresh RN) and Brittney Wilson (The Nerdy Nurse). It's so, so good.
 
NTN: Do you have any tips for anyone out there who might be considering jumping into a "new thing" of their own?

AR: Don't wait until it's a "good time," there's always something going on that will make it inconvenient. You will find time for the things that matter to you. With that being said, it really helps if your new thing is something you're passionate about! Something that you think about non-stop, dream about at night, and talk to all your friends about. Pick THAT new thing, and you'll find time for it.

NTN: Your slogan says you're passionate about "helping nurses keep their spark!" What drives your work to help the nursing community fight nurse burnout? Did you have a personal experience with nurse burnout?

AR: My drive and passion for fighting nurse burnout definitely comes from a personal experience. I was working as a nurse manager for two years and during that time, I witnessed burnout in my staff and went through my own experience simultaneously. I was the manager when we implemented our new Extracorporeal Membrane Oxygenation (ECMO) program with nurses running the machine at the bedside. It tested us in a lot of ways, physically and emotionally. These are really sick patients who require a 1:1 nurse to patient ratio (sometimes 2 nurses for 1 patient!) and we were working extra shifts to account for this staffing matrix that we weren't anticipating. And because we were seeing sicker patients, there was a lot of moral distress and compassion fatigue occurring. I was considered a "working manager" and would frequently work full or partial shifts at the bedside to supplement the staffing needs while still doing my manger role. I worked some nights when we didn't have a charge nurse, I came in on a weekend for a family conference and missed a funeral for a very special long term patient of ours. We started experiencing nurse turnover (mostly on night shift) for a variety of reasons: interpersonal relationships with physicians, scheduling issues, the acuity of the patients, etc. I realized pretty quickly that I was putting in way too many hours and that my personality made it difficult to let go of a lot of the issues when I walked out the door. I would stress about conversations I needed to have the next day with staff or patient's families. It wore on me physically, mentally, emotionally and I was burned out within two years. I knew transitioning back to bedside nursing would help (at least from a time management perspective) so I helped train my replacement and moved on to travel nursing. It's been almost two years since I quit managing, and I'm still recovering from that experience. I share all my burnout tips on my instagram page (@the.burnoutbook) and on my website and blog, www.theburnoutbook.com.

NTN: If you could give our readers your top tip or tips towards avoiding burnout, what would they be?

AR: I’m going to link to one of my first blog posts, "What to Do When You're Starting to Feel Burnout." It covers the first steps you should take if you suspect you're in that chronic state of physical/mental/emotional exhaustion that we call burnout.

First, talk to someone who you trust. Not only can it help you feel a little less alone when someone else knows your struggles, but it can help provide perspective. Second, write your experience down. Reflective journaling can help you process emotions and deal with negative things. But most importantly, I love writing down the positive experiences: the patient thank you, the compliments from peers, the positive and humorous interactions that you have as a nurse. The Burnout Book started as a little notebook where I documented those positive things so that when I had rough days and felt burned out, I could go back and read through the book and remember why I do what I do.

The last tip is all about self care, which can take many forms. It can simply be saying "no" when the staffing office calls to try and get you to work an extra shift. It can be doing things on your days off that are relaxing or energizing. It can simply be spending time with loved ones. I highly recommend setting healthy work boundaries and know what your limits are. That can go a long way.

NTN: I love nursing professional organizations. You seem very involved with the American Association of Critical-Care Nurses (AACN). What can you tell our readers about the AACN, and how it has enhanced your nursing career?

AR: One of my favorite “new things” I've done recently has come about because I'm a member of a nursing organization, AACN (American Association of Critical Care Nurses).

The AACN is a national organization that creates a community of acute care and critical care nurses. There are a bunch of perks to being a member! You get access to a ton of continuing education, they have several journal publications that come in the mail, they provide discounts for certification tests and study material, they hold an annual nursing conference where you can meet nurses from across the nation (and around the world!), and a whole bunch of other online resources. There are other nursing organizations you can become a member of with access to similar things. This is the organization I chose 8 years ago because I was in a Telemetry unit with plans to go into critical care and it made sense at the time.

More recently, I've had the opportunity to be a volunteer on a committee to help create questions for a nursing certification exam, and I've been a social media influencer for their national nursing conference! I'm amazed at all the opportunities that have come because I'm apart of this organization!

NTN: Your IG account is full of videos of you doing yoga, often with your adorable dog Walter.  How does yoga help you? Do you incorporate yoga into your nursing practice?

AR: I’ve always enjoyed yoga from an activity standpoint. I love testing my flexibility and stretching, it's very relaxing. After going through my burnout experience, I've found a huge benefit from yoga because you are practicing breathing techniques and meditation to quiet the mind while being active. My mind used to be so distracted with what I had to face at work that I was constantly in a state of anxiety and even experienced what I'd call a panic attack. Yoga helps refocus my thoughts and bring them to the present instead of being fixated on things outside my control. But man, it takes time and practice. You can’t flip a switch. It takes time to retrain your thought patterns.

NTN: Do you have any "new things' on the horizon? New Thing Nurse wants to know!

AR: “New things” on the horizon: moving to a new city, I'll be getting a new job at that time, continuing to work on building The Burnout Book community online and collaborate with others! In the next few years, I hope to pursue my masters degree in nursing education as well.

NTN: Do you have any other advice for our readers?

AR: There are many things that can contribute to burnout that are outside of our control: staffing ratios, meaningful recognition, leadership support, etc. But what I suggest is find the things that ARE in your control and develop a self-care plan that works for you! Maybe it involves meeting your social needs by going out to lunch with a friend a couple times a month. It may look like finding new and fun ways to be active, like taking a barre class or going on a hike. Maybe it will come in the form of counseling, assertiveness training, practicing saying “no”, changing jobs, or getting a medical provider to help you with your physical and mental needs. You can't pour from an empty cup. Put your own oxygen mask on first.

Y'ALL - DOESN’T SHE GIVE THE BEST ADVICE?

Now - check out the Anna & Walter cuteness below!

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Want to learn more about Anna Rodriguez, The Burnout Book & Walter, the Corgi?

Email - anna@theburnoutbook.com
Website - www.theburnoutbook.com
Blog - www.theburnoutbook.com/blog
Instagram: @the.burnoutbook & @anna.the.nurse
Facebook: Anna the Nurse
Twitter: @anna_the_nurse

- Sarah @ New Thing Nurse

About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life.

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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FOLLOW NEW THING NURSE ON INSTAGRAM - @NEWTHINGNURSE

When the Shift Hits the Fan.

It is inevitable. It will happen to you.

No matter if you are a new graduate or veteran nurse, there will be that shift that will almost break you. Staffing is short. Your patient is crashing. Maybe it’s downtime to boot. The stress is overwhelming. You are heading to the med room to cry.

I have been there and shed those ugly tears. You feel like you’re drowning, and there is never enough help. I wanted to write a quick post with some advice about stress-management strategies that have helped me cope during those really hard moments when the shift is really hitting the fan.

Remember - You can’t do it all.

That moment when you start to feel like you need to clone yourself 10 times, stop and remember that you cannot do it all. THAT IS OK. You are a single human with a maximum capacity to take on tasks. Luckily, nursing is a team sport. Reach out to others and throw up the S.O.S. signal. Get some help. This is not a sign of weakness. This does not mean that you are not a good nurse. You are recognizing your limitations in the moment and putting patient safety first. It is appropriate to ask for assistance. If you try to do it all alone, you are putting yourself and your patients at risk. Don’t do it. That is never OK.

Take a deep breath. Try counting to 100 by threes.

Victor Lipman wrote for Psychology Today – “Get your body in hand first, and the mind will have a better chance to follow.” By using distraction techniques (like breathing and counting), you start to take control of yourself physically. This will help slow down your racing heart, help you avoid hyperventilation and allow you to think clearly. Nursing is a high-stress job. We are asked to do an impossible number of tasks (see the previous section) as fast as possible with less and less support. And not to mention, we are responsible for human lives. It’s normal for you to physically respond to that kind of stress. To succeed in a time of crisis, you will need to calm the body as well as the mind.

Triage. It is time to triage.

I am 100% an ER RN, so I am going to preach the importance of triaging your situation. It is time to get organized. You need to sort out what are the tasks that need your immediate attention, what you can delegate out to others, and what can go on the back burner. We already established that you cannot do it all. By triaging the urgency of your duties, you will complete the super STAT things quickly and figure out a way to get the other things finished without losing your mind. There is the possibility that you might not get it all done. And that is also OK. If all your patients are alive, your documentation is done, and no one is yelling at you, then all that extra stuff probably was not as necessary as you thought.

Don’t buy into the crazy.

When it’s busy, everyone gets stressed out. Emotions will be running high and sometimes, logic starts to fly out the window. It is SO important to not start down the road to Senselessville. Medicine has standards of care. Hospitals have policies and procedures. There is always structure to be found, even when it seems like the walls are crumbling around you. Let those rules guide you in the times of chaos. It can be very comforting (not to mention extremely helpful) to tap into those policies and procedures when the shift is blowing up. If you’re not sure if what is happening is kosher, take a minute and check the rules. You may be surprised at what you find.

Thank your coworkers.

Gratitude works magic. If you had someone come help you in a pinch, find them later and give them a “thanks” and a high-five. Nurses and other healthcare workers do not appreciate each other enough. We do some amazing work in ridiculous conditions. Find a minute to tell your colleagues that they did a good job. I find that appreciated coworkers are more apt to help in the future. 

Take time to decompress.

This is for after the shift-show has calmed down. You need to take some time to process. Whether it is in the car on the way home, in the shower after your shift or during a run the next day, find some quiet and let yourself go through the stress of the day. When we carry around too much stress, it can manifest as physical symptoms. By allowing yourself to work through the bedlam of your nurse life, you will find better balance in your personal life.

Have a great shift!

-  Sarah @ New Thing Nurse

About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life.

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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FOLLOW NEW THING NURSE ON INSTAGRAM - @NEWTHINGNURSE