by Paula Manuel Staff Nurse Interest Group

Archive for the ‘Uncategorized’ Category

Summer Days & Thoughts

In my locale of the world the temperature has been hot though it does not compare to what some in the world have faced–extreme weather, terrorism, strife and war, famine, fire and or flood.  A bright spot is the Olympics are underway and the athleticism is always amazing, how a human body can be trained to perform at such a razor’s edge; that a blink can be the difference between winning or losing.

The Olympics celebrate speed, daring, dedication, effort, and show us the difference between champion and participant is very narrow.  Competition is an interesting sidebar as the practice of being a nurse has my leisure time more focused on enjoying the experience not driven to win.  Opportunities to compete have revealed that I can focus, though likely a skill cultivated more in the myriad of details of critical care; and the skills of sportsmanship and being graceful in defeat fit into my toolkit of leadership behaviour–sure I can envision pretty much anything, having the certainty indeed the unwavering drive to capture victory is not the primary focus.

Okay some of you will say bowling and golf are not pure sports–daresay walk 18 holes on a day with a high humidex and you will know your body worked out.  Well it is for me and though some say the white ball spoils a good walk–there are the opportunities to revisit childhood those summer days hot and slow moving, lasted forever and play time was a primary pursuit.  Now it’s about carving a few hours here and there, alas adulthood can be a limitation.

My “sports” are both social in nature; in addition to being outside for a time one can also spend time with friends and share some laughs, that is good personal therapy indeed.  Fortunately I enjoy my status as a casual athlete I don’t earn my living playing golf, I do a fair job striving to be the nurse you would want to work with.  For that dimension my practice bag has knowledge, skills, leadership, political skills, and teammates.  There are even the equivalent of coaches, well senior leadership, and that is a great advantage to know someone is leading the team.  Enjoy what’s left of the summer and may calm conditions be the norm.  Namaste.

How to Help Yourself PRN

As Nursing Week is almost here it’s as good a time as any to reflect on your own state of health, as a nurse you are vulnerable to caring for others and excluding yourself from much needed health management.  The aim of caring for ourselves taking “me time” is not selfish behaviour indeed it is necessary behaviour; it does takes practice to reconnect, focus, organize, energize–well actually just do it.

The to do list to achieve and sustain wellness, and for that matter be the person you would like to work with, live with, play with, love with, can take on overwhelming dimensions. Gaining healthy habits does require clarity, desire to change, and you need margins for lapses because it’s not about attaining perfection.  There are so many avenues to gain information on health whether physical, emotional, financial, spiritual, and it means you also need to be an astute evaluator of information sources, wise who you will listen to, and open to new ideas and yet value common sense.  The desire to change and translating that into action means constructing a plan indeed your very own care plan, and as the nursing process lays out when you have assessed yourself (honesty is a good value to apply to yourself), decided on the priorities, defined the goals, set down the action plan, you    implement and of course evaluate.

What am I talking about?

Well in terms of being resilient what concrete tasks/to dos could be considered and acted on?

Obtain adequate sleep, it is a basic need and the impact of insufficient sleep cascades into any number of negative outcomes–fatigue, cognitive impairment, depression, hypertension, obesity, stroke, cardiovascular disease, the very quality of your life.

  • Here’s a starting point no electronics in the bedroom, only exception a music source but only to play music–when you listen to music it can inspire you, motivate you, in this case we’re seeking calm and relaxation (the lullaby effect).

What attitude are you exhibiting at work or even in your household?

The energy you send out positive or negative is what you will receive back. Consider this

  • Practice compassion for everyone you come in contact with; smile, make eye contact, be wholly present (not thinking of your next task), learn and apply what empathy is about and make it a strength.
  • Don’t judge–clarify with others what their motivations are and/or mindset about about the situation, be careful what stories you create in your mind that prevents you from truly knowing the others’ reality.
  • Seek out learning opportunities, embrace learning opportunities (instead of approaching it like a root canal), be change savvy instead of change resistant.
  • Share your knowledge, appreciate the lessons you have learned, share your wisdom through stories. Celebrate that you have survived through challenges, adversity, and loss in the same way you have had successes, exhilaration, and meaningful moments.  I have celebrated first smiles, first tooth, first walks, graduations and commiserated when divorces, death, and other significant losses were shared.

Life is such a privilege, lifestyle can be altered/influenced by your attitude, through mindfulness and if necessary with the assistance of professionals.  Life is not about having it easy, indeed for many of us having a higher purpose means a life that shows the effects of overcoming whatever life throws us. It could be the traffic woes when we drive to work, it could be crop failure for our family, it could be a raging fire overtaking where we live, it could be a prognosis that may well shorten a life. Write your own mission statement and commit to it, transform your life, connect to passion and if that includes your nursing aspect of your soul–well you are on your way to be the nurse you want to work with.


Now That You Understand the Problem…. Part 2

How To Care For Self

This video includes some ideas we discussed and identified as key elements for one’s own health during our Annual Think Tank.  In the last entry of the blog Life of  a Nurse you were able to see how staff nurses are vulnerable to burnout and compassion fatigue.  Managing the factors that result from burnout and mediating the effects of compassion fatigue is not an individual pursuit, indeed to really succeed you really have to build a team of individuals, and access a variety of tools to manage the stressors of working in health care.

Learn about and understand the effects of fatigue and how to mitigate them

Mindfulness and Meditation

The importance Of You Within A Workplace

Complementary and Alternative Therapies & Law of Attraction

Resiliency and Adversity = Resources for Hardiness, empathy and understanding vulnerability.




Self-Care Means Me First Part 1

“Everyone wants to live on top of the mountain, but all the happiness and growth occurs while you’re climbing it.” –Unknown

I have always (well most of the time) practiced self-care in a way that permits me to meet the demands of my chosen profession of nursing.  It is not possible to be an effective nurse if your own physical, emotional, and spiritual needs are in disarray.  Certainly I had episodes of burnout and compassion fatigue and my transformation came about by committing time, resources, and using all my knowledge, skills, and spirituality to nurture me. The ongoing journey has enhance my life and I strive to deliver service excellence without compromising my own well-being.

That said when reviewing info from various sources of note; nurses who are less experienced, exhibit decreased compassion satisfaction (emotionally not present, indeed unhappy) are at risk for burnout. Some individuals who exhibit high levels of caring, paradoxically, are more susceptible to compassion fatigue.  Literature has different criteria for compassion fatigue and burnout but generally the following captures the symptoms:

Cognitive, lowered concentration, apathy, rigidity, disorientation, minimization, preoccupation with trauma

Emotional Powerlessness, anxiety, guilt, anger, numbness, fear, helplessness, sadness, depression, depleted, shock, blunted or enhanced affect.Experiencing troubling dreams similar to a patient’s dream. Suddenly and involuntarily recalling a frightening experience while working with a patient or family

Behavioral, irritable, withdrawn, moody, poor sleep, nightmares, appetite change, hyper-vigilance, isolating

Spiritual, questioning life’s meaning, pervasive hopelessness, loss of purpose, questioning of religious beliefs, loss of faith/skepticism

Somatic, sweating, rapid heartbeat, breathing difficulty, aches and pains, dizziness, impaired immune system, headaches, difficulty falling or staying asleep. (Portnoy, 2011)

Burnout is a state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations, an individual can feel disillusioned, negative, and a heightened sense of vulnerability.

Compassion Fatigue is a type of burnout that can emerge suddenly, tends to be more pervasive, and inherently linked to empathy.  It is a natural consequence of stress, that results from caring for and helping traumatized or suffering people.  This condition can be more profound as you can experience a loss of meaning and hope, indeed have reactions associated with Post Traumatic Stress Disorder.

The personal impact can manifest as decreased motivation, apathy, lower morale, increased absenteeism, even deciding to leave the profession of nursing.  The costs are significant and the need for intervention are individually based and at the organization and system level.  Consider this and part 2 will arrive soon….Namaste

“Once you become aware of what stands in your way and become willing to release it, you signal the universe that you are ready to manifest the life you were meant to live.” Chérie Carter-Scott

Just a Nurse? Me thinks not….

This week there has been a profile of a beauty pageant contestant who shared her talent–she is a nurse and her realization she is not just a nurse.  The monologue was a reflection, shared publicly and there is a talent, how to translate what we as nurses contribute everyday and every night using our knowledge, skill, and judgement; contributing to the profession through practice, research, and teaching.  The monologue was not fully appreciated or understood by all.  The hosts of a daily show The View mocked the nurse’s talent, asked why she was wearing a doctor’s stethoscope, and that is when a veritable sleeping giant awoke.

Thousands of nurses posting to Facebook, Twitter, blog comments and it shows we are more than ready to advocate about our nursing role.  My own articulation; as a nurse we have  the knowledge, skills, and judgement inherent to educated nurses–we acquired our professional title through formal learning, experiential processes, certification exam and ongoing accountabilities to our profession we have a code of ethics, practice and professional standards, and performance frameworks.

We save lives, influence lives, act as sentinels, leaders, educators, researchers, and lead the way in public health, management roles, and senior leadership. We can be found on city streets, rural locations, outposts, community hospitals, academic teaching hospitals, tertiary agencies, nursing homes, long-term care, home care, health clinics, family health teams, and primary care to name a few–we’re trusted by the public.

We may have stethoscopes (one of our basic diagnostic skills) and right now my practice requires a BlackBerry, smart devices that harness the world of knowledge, can alert us to patient calls, IV pumps ringing, or monitors alarming, some nurses are in scrubs or business wear and others incorporate their culture or religious considerations. We have requisite skills that some call soft when very much they are fundamental to the therapeutic relationships we build with patients/clients and families; listening, empathy, caring and compassion.

Many of us engage in volunteerism through our professional associations, interest groups, attend workshops, obtain certifications, contribute to policy work, develop best practice guidelines, and advocate for nursing and health care and determinants of health. We are very much health care professionals and the discipline is nursing.  We are not averse to humour by the way, we are averse to ignorance, and I’m sure you can appreciate nursing is who we are not what we do…..thank you I am a Registered Nurse who now happens to be a Manager.  Namaste

Where Have You Been?

Spring was my last entry and on the road of good intentions regular blog entries did not occur for a number of reasons.  Last fall a new phase in my professional life captured my attention the realm of management and applying leadership principles even more formally.  From an interim status to an offer of a permanent position, I have transitioned from an hourly employee to a salaried, extended coverage, by virtue of responsibilities and accountabilities in my portfolio, honest to goodness manager of close to 70 souls and overview of a unit and program of close to 40 beds and a blood collection team.

I am grateful to my mentors for supporting me in my transition, there has been plenty of occassions  to apply my knowledge, skill, and judgment and to reap the benefits of investing time and monies pursuing further education, participating in committees, engaging in leadership opportunities, project work and enhancing networking skills to name a few.  In my matrix of knowledge and skills are the cumulative experiences of trials and tribulations, overcoming adversity, enhancing my healer abilities, as all those experiences have added dimensions of authenticity, credibility, vision, honour and integrity.  Rather necessary and key characteristics in this modern age of leadership, make that excellence in leadership.  Truly it is in the everyday tasks, conversations, modeling of behaviour, managing performance, being fair and consistent that transforms a team, and as necessary transformative moments.  Of course it also includes responding to grievances, recognize who are engaged and who on the team are to be blunt “deadwood”

Right now I am on a well earned vacation (boldly scheduded two weeks off) and here in the middle of the night answered the call to reconnect to this blog.  It helps to be here on the Bruce Peninsula, one of those divine places here on Earth where rocks, water, sky combine into an energy matrix of sorts that restores mind, body, and soul.  As a manager who also carries the framework of a nurse I am in need of a recharge to the energy reserves, yes this girl is one tired actualized being.

All things considered I enjoy my new position, on any given day I balance an array of demands that cover the intricacies of scheduling and payroll, managing budget concerns, to responding to family concerns, to building relationships among the Allied Health team, to inspiring young nurses to strive for excellence in practice, and to be a mentor to established staff such as my valued unit leader who capably handles the daily operations of our busy general medicine unit.  Add in the organizational priorities, covering for colleagues, quality management and the looming demands of accreditation and the workload is huge. 

A few key points; patient acuity and complexity are givens, they have vulnerabilities and the reality is so many hospitalized patients are increasingly in a more terminal phase of their lives rather than a curative path. Meaning there is a definitive need to clarify goals of care, appreciating indivdual needs and balancing what is possible, what is ethical, what is efficent and effective care….well that will need to wait right now I need some shut eye as my vacation is the priority right now.  Work and life are not easy to balance when one is committed to making a difference–as I am not perfect and a work in progress thank goodness I have a lifetime of experiences to draw from.


Spring and out of hibernation

On the never ending To Do list some tasks are enjoyable; it’s finding the time.  In the next week some of my time will be freed up as I complete my volunteer leader role as a Regional Representative.  As a Governor in my Professional Association I have extended my knowledge on issues and trends related to nursing and health.  I have enhanced my knowledge of policy in action; understanding politics is a means and policy an outcome.

As nurses our stories, experiences, and clarity of defining the issues can drive policy development because we have achieved credibility.  We are not complainers, indeed we prepare our platforms/campaigns to advocate for aims and objectives that are relevant to many of us in the public.  As a staff nurse I was a sentinel, rescuer, clinician, teacher, and mentor.  As a leader in a direct care role I challenged the status quo, honed my political skills, enhanced my knowledge of change, shared governance, transformational strategies, and leading the way (role model).

Whether to challenge the goals of care in the context of medical futility; to question…we can do everything to prolong life but is it the best option.  The quality of life and the need to really talk about palliative care, not as a short term and limited scope but a continuum that spans managing a health condition, navigating through the setbacks, grief processes for what was and what is now the reality.  In my new role of manager it is not uncommon to meet families who are unprepared, unaware, indeed I see indecision along with extreme hope, and recognize the pain that can be felt by those experiencing despair, burnout, and failure to cope.

The dialogue we can have may ease fear, the empathy we show can ease the pain of potential and actual loss.  Our professional values are signposts to guide us, as we apply knowledge, skill, and judgement; our profession is a practice discipline–we need to assess, question, motivate, act, evaluate and reflect.  Our work can be profound, making a difference by contributing to a new modality of treatment; it can be small interventions such as  handing over my scissors after snipping a lock of hair for a memory package.  The mother gave her son a haircut and thanked me for making it possible, as she gently kissed him and poignantly said goodbye I excused myself and implemented the intervention of privacy.  End of life exists in many forms, as nurses we appreciate moral ambiguity exists and our perspectives are needed to enrich the dialogue.  Some of us will have the time and resources to lead change, to inspire others to speak out; and ensure policy development takes place, and sometimes it will be a simple task that can transform a moment like a pair of scissors.  Namaste

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