by Paula Manuel Staff Nurse Interest Group

2020 New Year & Decade

I recall working when 1999 turned to 2000 and there was that doubt about computers related to Y2K would our world make the date change and survive; well we survived and I recall the city fireworks and the status of my patient.

This year has been different yet again, continued recovery and searching for a new position since August. One interview and the feeling of ho hum I placed as a runner up, but what’s changed in the job search is the social media medium and the need to tailor each application as per the job posting. Utilization of key words so that the software used by a number of Human Resource departments will identify my application as a good match.

I am confident my next position is out there and some days I feel under qualified though mostly I embrace the feeling of confidence that I can be whatever I need to be in a leadership position. So all the best to my audience for the coming year and if you have been seduced by the lure of resolutions read on.

I started a resolution in October, always a rebel to conformity, but it is specific and I have been committed to it for over 12 weeks. Boxing aka learning, training, and moving my body in a way that increased strength, flexibility, and stamina that are measurable outcomes. You know I will mention SMART goals; the criteria you all know when you review College of Nurses material, Specific, Measurable, Attainable, Results and Timed.

I will exercise more translates into I will attend a personal training session specific to boxing, weekly, with measurements of my body every 4 weeks and photographs. I actually exercise formally twice a week and this week will introduce a third session, the criteria is met and it’s attainable because I know I’m in it for the long haul not a six weeks and everything is fixed.

Resolutions range from physical, relationships, life skills, your job, and key is to remember change is easy to make progress you need to show up, work, and follow a plan (Tony Robbins, 2019). This means you need a care plan for yourself, identify some risks that you can change, influence, transform etc., remember to be mindful you’re human not perfect, and recruit a friend to be your cheerleader it’s not much fun without a cheering section.

Keep in mind you are a caregiver ensure you are the most important client, carve out 5-10 minutes for the next few days and give yourself the time to consider your life plan aka resolutions. No high achiever effort needed, pick one area and work on it for 4-6 weeks, you need space, time, and skill to change your behaviour, attitude, and celebrate success. If you invest now you will not reach a crisis point so easily i.e. burnout.


When written in Chinese, the word crisis is composed of two characters. One represents danger and the other represents opportunity.
John F. Kennedy

Passages of Time

This is a salute to colleagues who have died at the prime of life and it makes you stop and consider what your life is about.

Currently I’m between positions since August I have been resting, golfing, and taken up aquafit. As the weeks go by and I focus on my branding, network with colleagues, recruiters, and career counsellors, this evening will be special. Dinner with a number of managers from my previous agency to dine, enjoy some wine, have some laughs etc.

Through the years, loss is one of those themes that as a nurse I have had to navigate through. Losing someone whether a few hours, few months, few years was the nature of my practice. When it is a colleague, the rap of mortality gets quite strong and as I consider life, the past has truly passed and I consider some of those who are gone.

A nursing colleague to cancer a bon vivant who truly was a pillar of light, a laugh that carried down the hallway, a positive outlook and a tough spell when the diagnosis was confirmed. Hey hey Paula was her usual greeting and it was poignant to know that her voice had stilled; and her family would have to go forward without her, our world lost a great soul.

Another colleague who had left my first agency to work in a community hospital left an indelible presence. A former OR nurse she was brassy, assertive, funny, and one of the few who knew how to make the cautery device work instantly. Her death left many grieving for the nurse who once observed “what..nothing is changing…like the Titanic they have only rearranged the deck chairs!” As we paid respects her family shared that everything had been arranged by the lady herself, lipstick colour to the scrubs to be worn by her colleagues to her service. Detail oriented she left nothing to chance, she was light and sarcasm with generous portions of both.

Two physicians I had the privilege to work with have also now passed while in the prime of their careers as intensivists and researchers. Both were smart, skilled, and both highly regarded for their research.

One was Irish in nature and humour, he challenged and he supported and I am grateful for his kindness when going through my own challenges. He challenged the status quo, in that he questioned evidence-based medicine, he was knowledgeable about lung injury, ventilation, he was a skilled clinician, mentor to many and a ethically sound individual. He could supportively communicate “bad news” in a way that families could grasp the situations. His rounds would entertain and horrify as he wielded his wit to make a point, and sometimes time had to pass to recognize how much you had been insulted–all in the pursuit of excellence in care.

The other physician I knew from her rotation as a Fellow to Staff Intensivist she had battled the big “C” and won the first round. Her determination and strength was also drawn from her culture, family and her smarts. She had also chosen demanding research topics such as simulation training for staff to acquire knowledge and skills during paediatric resuscitation, rapid response teams effectiveness in paediatric academic centres, and she obtained a Masters degree in education. She was a physician who demonstrated compassion, humour, and a unique fashion sense.

To all who have had similar experiences with colleagues take some time to remember them and consider this Irish thought

Go raibh Maith Agat Mo Chara – thank you dear friend. We are all better for the time you spent with us.”


Self Care Self Aware Shiftwork

Night shift is a physical and mental strain that many nurses do not have expert knowledge to manage it. Current times of acuity and complexity means in many cases more workload and a fair number of patients require interventions through the night. This entry will cover what you, as an individual, can manage to optimize your shiftwork reality. Being mindful about what you need will optimize your experience as a shiftworker.


The principles for sleep are essential to a shiftworker here are some survival points

  • Know what your natural circadian pattern is for you; are you an early riser–shiftwork may be more challenging for you, ensure you have a nap before first night shift. Studies show individuals who are awake more than 17 hours can be impaired equivalent to having a bloodstream alcohol level of 0.05
  • Wear sunglasses on the way home to minimize light on eyes
  • Invest in a mattress that is comfortable and supportive
  • Leave your smartphone and tablet away from the bed, blue light plays havoc with your brain by disrupting your ability to get to sleep. No TV including live streaming and most assuredly news or day time programming
  • Keep bedtime routine the same for days as for nights
  • Keep bedroom cool, use curtains or blinds that darken the room
  • Use eye mask, ear plugs to protect your sleep time
  • Educate family, spouse, friends that day time sleep you’re not to be disturbed though criteria can be defined i.e. fire, flood, hurricane etc.
  • Aim for 7 hours of sleep during the day and post nights wake up 90 minutes after sleeping to reorient back to days


  • Caffeine needs to be minimal and most assuredly after 0200 h no intake due to effect of disrupting sleep
  • Be prepared take food to work, so those chicken wings from the local diner don’t end up on your hips. Eat complex carbs quinoa, brown rice, pasta.
  • Proteins use chicken, tuna, turkey, beans, soy and round out with vegetables, seeds, dried fruit, healthy oils i.e. olive, avocado, sunflower, a good non-cooking oil flaxseed, walnut etc.
  • Eat a hearty breakfast, have snack foods to pack so your blood sugar will be balanced i.e. trail mix, vegetables, fruit, apples and peanut butter
  • Drink about 750 ml of water during your shift to keep hydrated and you will be less fatigued
  • Eat with someone; social interaction is helpful for coping with nights

Thrive on Nights

  • Exercise on break instead of sleep to minimize fatigue, if you do nap limit to 20 minutes to minimize entering deeper stage of sleep cycle
  • Take activities to keep you awake, knitting, puzzle games, reading material, listen to music
  • Use practices like meditation to relax yourself for sleep both day and night shift
  • Keep a bright light on in the station to perk you up, light is the stimulation you need to stay awake
  • Discuss with your doctor or naturopath the benefits of Melatonin (hormone) and how it helps shift workers
  • Make sure you have social activities with family, friends, and time for yourself. Going to sleep may be the goal but you need human contact too.

Shift Work Disorder

You can experience negative health impacts and if you answer any below as yes; you will need to follow up with your doctor and/or occupational health and safety

  1. I feel drowsy when I’m at work, or in my “off time” during family or social engagements.
  2. I have fallen asleep at work.
  3. I’m not productive at work. I often can’t think quickly or make good decisions while I’m on the job.
  4. I have trouble falling asleep when it’s time to sleep (when my shift ends, or when I am “supposed” to sleep).
  5. I wake up too soon. I cannot sleep seven to nine hours continuously.
  6. My sleep is “broken” and I wake up frequently during the time I should be sleeping.
  7. I feel irritable or moody.
  8. My shift work schedule has created trouble in my personal life (with my partner, family, or friends).
Image result for night shift survival kit
Enjoy and Namaste

Do I giggle?

Giggler is not a word I use to describe myself, when I listen to an individual giggle it strikes as manifesting nervousness. I have a generally calm exterior, indeed I have a gear that can be described as “supercalm”. When my chuckle or laugh occurs it is one that is robust and comes from deep down, indeed when I asked friends, family, and acquaintances about whether I giggle there were more blank stares than not and more emphatic nos.

I am not averse to laughing at myself but I’m not a giggler, when I reflect on my childhood I do not recall much, interesting I recall events when photos are in front of me but truly I’m a forward viewer of life. The past is done and there’s plenty going on in the moments of now. In terms of laughing out loud these few come readily to mind.

  • Saskatchewan trip I was walking along a muddy path with a friend when my feet slid and onto my butt I slid and daresay slithered. My friend was bursting trying not to laugh and when it was deemed nothing was damaged except my muddy butt (right through to my underwear) the laughter burst forth and forth and even now we can easily capture the vignette of my decorously slow mo slide to muddiness.
  • When my nephew #1 was playing with coloured rings, I placed them on my head then tilted it to have them fall off, laugh with a toddler it’s a true workout
  • #2 nephew on a winter day we played at the park, running through the snow I chased him, caught him and twriled him in the air then swooped him into a snowbank. Laughter burst from both of us and time truly stood still–it was a moment.
  • Golfing one of my passions on this occasion I hit the ball off a tree, the ball careened into a bunker ran out onto the green and stopped inches from the hole. I doubled over chortling as I explained that’s just how I saw the shot being executed in my mind.

It is a great connection to yourself to really laugh, indeed experience and feel any emotion that has you move your life and choices forward. Laughing provides a small pause in the grand continuum of time I’ll close with the words of Norman Vincent Peale

The way to happiness; keep your heart free from hate, your mind free from worry, live simply, expect little, give much, scatter sunshine, forget self, and think of others.


Peale, Norman Vincent Power of Positive Thinking, clergyman & author

Three years ago I keyboarded an entry as my nephew headed to Northern Ontario to embark on his nursing studies. My Auntie status embraced his entry into this most demanding of academic studies and the acquisition of numerous cognitive, tactile, and sentinel skills.

During my vacation I coordinated our schedules and with this nephew we spent the day on a golf course, a pursuit for the individuals who enjoy the outdoors and the chasing of a wee ball into a hole in so many strokes. (google Robin Williams and golf to learn more on the game). We spoke on a range of topics as he related his experiences as a Personal Support Worker at his local hospital; observing the RNs on the team and he has a plan to optimize his chances of spending his pre-grad in the Emergency department.

He pointed out that he had considered my advice to be in medicine for some time then specialize, but he is forging his own path. As I listened to his vignettes of experiences it was evident he is linking his knowledge, skills, and judgment. The poignant moment when the team called a Code Pink and he recognize the agonized scream of a grieving mother. He recognized the effect this event had on the team, that the manager acknowledged the team’s grief, and that the nurses processed the event individually and as a unit.

My vacation has been a recharge time to rest, recreate, golf, spend time with friends, to have alone time and enjoy the quiet of a summer evening. Make time for yourself and invite those who lift you up and pursue some fun, though it’s hard to imagine not everyone enjoys a round of golf. Namaste.

Nursing Week 2019

Welcome back and what’s new?

Well the wellness journey continues and I am grateful for my boss who has been supportive and truly is one of my top 3 bosses.

As I reflect on what I consider to be a good boss the word trust comes to the fore. Trust is a word used a lot and I wonder if anyone considers how complex trust is; it’s a behaviour, an outcome, a process within an employee and supervisor relationship.

The transformational leadership framework has establishing trust as a core process, without it the sustained changes needed in heart, mind, and soul will be a challenge. As you navigate this term trust you have to ensure a shared understanding exists about the term; what does it mean, how is it built, how is it broken, and how can it be rebuilt. So trust is not a destination you will find it is an issue, action, and it’s about growth of one’s emotional intelligence.

Now trust (Reina, 2017) can be seen as a capacity for trust and there are 3 C’s that contribute to making a complex term more concrete, practical, and sustainable.

Capability is to acknowledge people’s abilities and skills. As a leader you will allow people to make decisions, include others in the decision-making by seeking input, and this builds succession planning as people learn skills and want to apply them (Reina, 2017).

Character is integral to trust, (Reina, 2017) and when you can trust you can manage expectations, others will behave according to “the rules”. The team to be effective means they do what they say they will do, this mutual reliability includes boundaries, consistency, delegate prn and appropriately. Say no if you can’t do it, renegotiate the task and remain true to the relationship–honesty, faith, reliable.

Communication you need information, we all need truth, disclosure of truth, to admit our mistakes, to exchange constructive feedback, to maintain confidentiality and to to speak with good purpose (Reina, 2017)

We all know good teams from bad teams and unless you prefer uncertainty, inconsistency, turf wars, conflict, silos, workarounds, and hidden agendas to name a few. Consider how trust can provide you with a team that is accountable, adaptable, effective and efficient, happy, innovative and comprised of high performers to name a few attributes.

Final thought

  • Be impeccable with your word
  • Don’t take anything personally
  • Don’t make assumptions
  • Always do your best

These are great life values and I’ve tried to live to them since I read The Four Agreements and fit right into trust.

Nothing other people do is because of you. It is because of themselves. All people live in their own dream, in their own mind; they are in a completely different world from the one we live in. When we take something personally, we make the assumption that they know what is in our world, and we try to impose our world on their world.” – Ruiz Don Miguel


As a Registered Nurse with many years of experience my time as an individual with a long-term progressive illness had been relatively short–a mere decade.

At first the condition was more of an annoyance, but my physical decline in the previous five years correlated with increased dosages of necessary medications and side effects that impacted my well being.

Living with constant pain, compensating continuously for increased movements, fatigue, and countering the effects with exercise, body therapies, and energy healing. My life was about carrying on and coping with an altered dynamic health status. As one physician observed, you are extremely high functioning. Translation I worked full time in a demanding managerial role, mentored and led RNs and RPNs and influenced Allied Health team members.

The emotional toll evolved into the characteristics of depressive qualities, crying jags were not uncommon. When the offer came to be evaluated for an innovative surgical option I readily agreed.

Two years from initial assessment to receiving a date for surgery was a mixture of anticipation and concern. I mean this was a procedure to alter my brain function, to drill into my cranium and place electrodes and a computer with power source. Twenty years in development it still had the elements of new territory, it was comforting to be told I had a good brain. So my view was that even if a few neurons were lost in the process I would still be okay.

Such an undertaking is not done alone, my family, friends, colleagues, team, and the health care team at the academic tertiary hospital were all instrumental in my successful recovery from the surgeries. The unexpected outcome was severe sciatica that affected all aspects of my life.

Pain unrelenting, all consuming, agonizing, frightening, debilitating it affected me physically, emotionally, cognitively, and a significant frustration that I was not being listened to, even when I researched and defined the working diagnosis.

My family physician, truly a gem, who invested the time to carefully consider what options were possible referred me to a pain management clinic. There a physician was intrigued by the surgical option for my condition and how well I had responded other than the life altering pain in my “ass”.

What’s the status now? Injections into the lumbar region of the back to cool off the nerve that had been firing out of control, secondary to the stimulation by something and here I am 10 months later gaining more control of my body, pain has minimized, my outlook improved, and the desire to move the body. Let me rediscover the athlete within and prepare for the 2019 golf season. Stay tuned.

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