Working in the ER, I see a lot of life altering events. I frequently realize any one of these could happen to me or my family. I try hard not to bring my work home with me, but sometimes the feelings are hard to leave behind. I can see my family members in the faces of visitors or the eyes of the patient. When I call home just to hear the voices of my children, my husband knows something tragic occurred that night. He doesn't ask; he expresses his love.

Sexual assault survivors are especially difficult to forget. The horror of their experience can not possibly be understood; the motive of the perpetrator may never be justified. It is not easy for me to participate in evidence collection or explain why I have to give them certain medications before they go home. When I discharge them, I know the road that lies ahead is uncertain and lined with obstacles they didn't ask to endure.

When I go home and see the faces of my children, I begin to fear for their safety. I have to hold back the urge to package them in bubble wrap. How can I as a mother, with the knowledge of an ER nurse, keep them innocent yet aware? I don't want to make them afraid or cynical.

After taking a class on Pediatric Sexual Assault, I realized I needed to do more than just talk about appropriate versus inappropriate touches with my own kids. Many cases presented involved people the children perceived as safe. The perpetrator coerced or manipulated their victims into silence, using fear. Children endured a behavior they didn't understand. They didn't tell anyone what was happening because the perpetrator threatened to hurt them or their parents. An adult would know not to believe this, but a child does not. I had to relay this to my kids.

The opportunity presented itself sooner than I expected. My daughter and I were having a girls' day, enjoying the warm weather and conversation between mother and daughter.

Finally, I asked the question I had been holding in my heart, "Anna, would you tell me if anyone ever touched your ‘privates' in a way they weren't supposed to?"

She kept painting her nails and nodded, "Yes."

"What if that person told you they would hurt Mommy or Daddy if you told?" I assumed she'd say yes, again.

Anna looked up at me. She tilted her head and scrunched up her nose. I could tell she was thinking about her answer. "I don't know." She said and resumed painting her nails.

I was surprised at her response. I thought my child would know better. I quickly informed her that Daddy and I could protect ourselves; she should tell someone anyway. She smiled and agreed.

That conversation was short, but very hard for me. I know there will be many more. I began to wonder if I am doing enough for my son, as well. We've had a few talks, but maybe it's time for another. I found two websites that gave me some more information:  Day One: The Sexual Assult & Trauma Resource Center and Children's Trust Fund and wanted to share them.

I know I can't fix things for my patients, but maybe their experiences can teach me how to help others. I also know sexual topics are difficult to approach, but educating and empowering young people can only lead to a stronger generation. So, next time you are given the gift of a child's attention, you can use it to share information that may help to protect their innocent lives.

I am thankful ADVANCE for Nurses has political coverage on their home page; I am not sure how well informed I would be about our current Presidential candidates without it. This winter my son and I kept up on the happenings because of his interest in politics. But, alas, it is now summertime. Swimming, camp, and the great outdoors have reclaimed my nearly 10-year-old son, leaving our television dormant most of the day. These days I catch glimpses of the news in the morning or just before bed. To stay informed, I peek in every now again at various websites to stay updated on areas that interest or concern me. And, of course, with the impending elections and health care crisis, I do my best to see what each candidate proposes to fix our country. Locally, I like to read what the general public has to say about health care.

After reading one such article titled: "Healthcare costs expected to rise over next two years" that appeared on a local televisions station's site, I felt like banging my head against a wall. The article ended with the statement: "So why is healthcare getting so expensive? According to an industry report, one of the main reasons is that those with insurance are picking up the tab for those without it."    

I will whole heartedly agree with the above statement, but so many people outside of the healthcare field do not realize all of the many pieces of the system that contribute to the problem. The largest problem of all is our culture in general. We are a society who needs instant gratification, can not wait for what we feel we deserve, and then when we don't get the answers we want fast enough, we sue for money to make us feel better.

Let me elaborate on that horrible run-on sentence. Last year, Massachusetts mandated that every single citizen carry their own health insurance. Unfortunately, Massachusetts is struggling with a shortage of doctors, according to the Massachusetts Medical Society . This means that even if people want a Primary Care Physician (PCP), they may have trouble finding one to accept them. Also, because of this said shortage, the PCPs we do have are so overwhelmed that they can not see their patients in the timely manner, as expected by our society, so instead of risk being sued, they send them to the ER for evaluation. Massachusetts is not the only state with a shortage of PCPs.

So the way I see it, the problem snowballs into one huge mess that is not fixed with one easy solution, such as universal health care. It will take years of small changes to the system and a lot of cultural growth before we can begin to untangle this mess we call health care. Patience, persistence, prevention, preparation and Primary Care are the five Ps I think we need to institute to save ourselves from healthcare doom.

Recently I had the pleasure of meeting the guys from the country music band Emerson Drive. Their song "Moments" has had an impact on me greater than I was able to express to them that night. It is difficult for me to put into words the emotions I have regarding this song. There are many complex pieces to put together, about homelessness and helping a person in need that I missed the first few times I heard the song. It wasn't until I listened to the words that I began to understand the story.

My first thoughts after seeing the video for "Moments" were about the homeless people I care for every day in the ER. Nine times out of 10 they are intoxicated and in desperate need of a shower and food. Sometimes they are kind, nice and fun to be around. Other times they are combative, argumentative and inappropriate.

In the 6 years I have been in the ER, many times I have thought about the regular "drunks" and wonder how they got to the place where they are in their lives. I often speculate what their story is, and wish at times I could ask them about it. It is those ‘moments' for me that these patients become human, more than just another "drunk" to take care of. Every time I hear this song, it reminds me to think of them in a more positive way.

"Moments" also tells me that every life has its ups and downs, and the Emergency Department is not the best place to see the positive side of people. As a nurse, I hear the sad tale of what brought that person to the hospital, not who they are every day. I see a mere glimpse into an entire lifetime of someone else. Another ‘moment' shared with them could reveal a different aspect of their personality. It can be hard to remember, but through the words of that song I can try.

Finally, I have come to realize the many types of ‘moments' that I have had in my life. I have done things that I thought I would not be able to do. I have survived challenges. I have had disappointments, but I have also had support along the way. Sometimes it came in ways I didn't notice or expect. Other times, I have found the strength within me to keep going. In the end, it comes down to one thing: what you do with all the ‘moments' you are given.

I hope that I am making the best of what I have been given, every day. Most times my job does give me the sense I am helping others; it is a privilege to have the knowledge to save lives. I can only hope to remain satisfied and avoid seeing the negative aspects of nursing in the ER. Songs like "Moments" can keep me going and seeing the world in a different way. So, Brad, keep singing and definitely choose "The Extra Mile" as your next single. It will be another song I can sing to keep strong even during the most extreme moments of my job.          

The trauma room was once an elusive place to me where lives are magically saved and miracles occur every day. I waited anxiously to receive notice that it was time to take the Trauma Nurse Core Class (TNCC) and orient to the elite status of trauma nurse.

Over the years, I have developed a state of mind that I refer to as my ‘Trauma Daze.'  This is a way of thinking that directly reproduces the concepts of TNCC and allows me to function effectively in a very fast-paced and unpredictable environment. It leaves no room for emotion or the nurturing aspects of care. Patients are initially nameless, naked, and treated so fast that they have no opportunity to object. Decisions need to be made quickly and actions are performed one after the other, sometimes simultaneously. In a matter of minutes a trauma patient can be in CT scan, the OR or downgraded to the regular ED. This is emergency nursing at its peak.

This process can be repeated again and again in one shift, leading to such a sharp focus that the ‘Trauma Daze' becomes difficult to shake. It's not often that I stop to think about the impact this event will have on their lives. I assess, intervene and send them on their way. On occasion, I wonder how they are doing, but frequently I don't have time to follow up. There is always another trauma patient on the way.

One recent news story, though, have led me to examine my ‘Trauma Daze'. Kimberly Dozier is a trauma survivor, injured in Iraq. She reminded me that permanent change occurs from one random event. In her story, Kimberly said that her road to recovery was paved with talking and writing about her experience. The hard part with nursing is that HIPPA binds into silence. Or does it? We all need to share our hard days. We all need to talk through the tough times. Maybe if we as nurses felt we could talk more we would last longer. Maybe we should just reach out to each other, through the ‘Daze' that we all have come to know. Nursing is emotional work; sometimes it's ok to stuff the feelings away, but sometimes we need to feel. So, next time I feel the ‘Daze' overwhelming me, I am going to take a step back and just try to feel.

Sometimes the ER can become a hum-drum shift of pacifying angry people. Working in triage can feel more like being in the penalty box than any other place on earth. In 2003, our triage and waiting area was redesigned with large picture windows to increase the safety of the patients in the waiting room. We can now easily see everyone in need of care. However, the downside means that they can also see us, the nurses.

As I have stated before, Baystate Medical Center is a large level 1 trauma center that cares for over 100,000 patients per year. In a nutshell, we are very busy, everyday. This means that we triage a large number of patients every hour. I work 3pm-11pm, the time when it seems everyone is suddenly very ill and in need of emergency care.

Alas, I have approximately six minutes to obtain medical history, allergies, vital signs, medication lists and FINALLY make a nursing assessment of the patient's triage level. It can be pretty draining to prioritize care when everyone believes their problem is the most serious I have seen all day. It is hard to remain upbeat and leave cynicism out of the equation.

I will never forget one night though, where one very small person made a huge difference in my shift. He was about three months old, with a smile that took up his entire face. He giggled and laughed at the slightest provocation, reminding me that even when times are tough, life can still be good.

He was chubby, with cheeks that begged to be pinched. His large brown eyes connected with mine as if he had known me his entire life. His grandfather proudly walked him around and around the ER waiting room with such ease. They were both visitors, waiting for news on the well being of a loved one, but neither complained about how long they had been there.

For hours, this boy passed by my window and shared his innocent joy with me. Countless people questioned how much longer it would be for them and each time I had to repeat the same answer: a long time, it's a busy night. But that smile kept me going. Each time I was blessed with his toothless grin, I felt more relaxed. Every time he giggled, so did I.

I have been thinking about that happy boy for a while now. Work has been draining me lately, with many issues that have yet to be resolved. But when I want to quit or get ready to run, I think of that pure, infantile view of life and know that I must persevere. I can do it; I know it will be alright. I have been told that my smile helps others through their day, so even when I don't feel like it, I force it. I may never know how many people it helps, but I think I am going to just keep trying.      

I mentioned in a previous blog, "The RSV Blues," the pediatric emergency department has had a very busy winter. The adult area is even worse. One day last month, we had over 90 patients registered and being cared for in our 31-bed unit. How can this happen? It seems the more room we make in the hospital, the more patients we have waiting to be admitted. Luckily, our management responded and the hospital decided to declare Plan D-a disaster situation. It has since happened again.

What is Plan D? It is when our emergency room is so overwhelmed with patients that the entire hospital becomes involved in patient care. Staff can be pulled from anywhere to attend to the needs of patients, more staff is called in, and working staff is required to stay until the demand has decreased. Typically this would occur due to a large number of traumas, e.g. an explosion at a factory. In this situation, our medical director, nurse manager and director of ambulatory services rolled up their sleeves and dove in to help. They pushed stretchers, answered phone calls, did what had to be done. They also called on other managers to open units not typically used for inpatient beds.

As one can imagine, a tremendous amount of resources and energy was required to make all of this happen. An already exhausted staff was pushed beyond their limits with no end in sight. The promise of a hospital addition dangles in front of us, teasing us with hopes of a brighter future we may not survive to see. Just about everyone is miserable. Complaints roll off tongues far more regularly these days; smiles are few and far between.

Our management has responded to us with the best of their abilities. Once the unrest was palpable, open forums were scheduled for all staff to attend. This differs from general staff meetings in that the leaders have no agenda except to hear our needs. Issues and concerns can be verbalized without fear of repercussions. True problem solving begins with honest discussion.

Response was mixed, with only a few attendees at each meeting. I made it a point to go, even though I didn't truly believe anything would change. I figured I had no right to continue complaining if I didn't offer my opinion on the situation. I am a valid member of this community and complacency can only do more harm than good.

I was filled with pride the morning I went to that meeting. My co-workers did more than just whine and cry. Solutions were offered and discussed. Brainstorming brought about goals that have been washed away in our continuing tide of patients. But most of all, we made ourselves heard and our leaders listened.

To date, I have seen a number of small improvements, a few minor changes. It's still chaos, don't get me wrong, but a few small baby steps can lead to so much more if we just give it time. Being a person who thrives on instant gratification, it can be hard to hear that a plan is ‘in the works'.

I cannot say if others have noticed; I've been too busy to ask. But hostility seems a little lighter; more ideas are forming each day on how to care for admissions waiting for a bed. We now have two on call plans-one for overflow and one for general ER patients. The response has been fairly positive, and I look forward to figuring out how I can participate.

So, for all of you out there who believe that open forums are for whiners and don't really accomplish anything anyway, it may be time to change your mind. Situations can only get better if an effort is made. Yes, both leaders and participants need to be responsive but you can start by setting the example. We, the staff nurses, are not powerless. We are front-line defenders of life in general. Why not make that work for our entire unit as well?

A few days after I read Kathleen Bensing's Media Watchdogs blog, an article appeared in my local newspaper. The headline read "Emergency Care Crisis."

It starts with a vivid story of a parent fearing for his daughter's life and leads into the current struggles all emergency departments are facing. It concludes with Baystate Medical Center's plan for a future hospital addition. I could not get beyond the first few paragraphs without fuming. I desperately wanted to clarify the role of the triage and head nurses. Maybe if the public understood our qualifications, they would feel more comfortable receiving a nursing assessment. They trust what we say, according to most polls, but do people really know that nursing judgment is more than just where we place you in the hallway?

Being a fan of Kathleen Bensing, I felt inspired to respond. I even started writing a letter. But in the midst of my fury, my husband, Mark, asked me if it was appropriate, being that I am an employee of Baystate Medical Center. Begrudgingly, I began to contemplate his comment. I weighed the pros and cons in my head and came to realize that I didn't really have enough leadership experience to make that kind of decision.

The next day, I turned to my manager, Ann. I had an instinctual feeling what her answer would be, but her explanation is what surprised me. She recommended I do not get involved, not because of the facility, but for myself. I'm paraphrasing, but she said that an emotional reaction to a lead-in paragraph would only open me up for more verbal attacks. Interesting point, I thought. I retorted with the importance of educating the public about what we, as nurses, do. We could eliminate a lot of the frustration the public feels when involved in health care if they understood the process of our decision making. After commenting on the great job her staff does everyday, Ann went on to point out that was not the real focus of the article. The article was really about the necessary, but controversial, expansion the hospital had planned, not the nurses. She suggested that this is not the proper platform to use at this time, smiling the whole time we conversed.

I chose to agree, but I wonder if I backed down out of fear. What could I be afraid of? First, I have a career to consider. I love my job and don't want to jeopardize my professional standing. Second, I wasn't sure I wanted to handle a barrage of comments that were sure to be spawned by any response from a nurse regarding the situation. And finally, I did not want to fall victim to the media. Ann was right; I found this when I reread the article. It was all about the new ER and what plans were in place for the future. An emotional case was used to peak the interest of the reader only. I had fallen victim to the old ‘bait and switch' tactic.

So, I began to wonder what my podium should be. I dream of some day representing nurses for the thinkers, decision-makers, and role models that we are. And then I remembered I have this blog. A culture takes generations to change, I realistically can't see myself altering the way the world views nurses by myself. But, together, with people like Kathleen Bensing, maybe I can start by changing the way we as nurses see ourselves, leading into a new way for the rest of the world to see us.          

It is almost the end of February. Spring can't come soon enough as far as I am concerned. I am undoubtedly experiencing the RSV blues. This has happened before, so at least this time I am better able to recognize it. I'd like to share it so you can be familiar with its effects and know, too, that this shall pass.

Let me start by sharing my evolution into Pediatric Emergency Nursing. It has happened so fast, and without my awareness, that I am not really sure where to begin. I've been an ER nurse on the evening shift for six years now. I have always been drawn to the Pediatric ER and feel very comfortable caring for Pediatric traumas. I also enjoy triage and all aspects of adult care. I am not really picky about where I work; I figure fate has a hand in placing me just where I need to be. But over time, I began spending more and more time in the Pediatric ER. Today I find myself there more often than not. And I love it!

Winters can be especially grueling. Kids get a plethora of viruses and illnesses that wreak havoc on their little bodies. Many kids get simple coughs and fevers that scare the daylights out of parents, requiring a little more education than the average adult discharge. It can be down right exhausting for everyone involved. But it's that darned RSV that lurks in the shadows, waiting to ravage little airways in a way that nothing else really can.

What is RSV?  Its full name is Respiratory Syncytial Virus. In short, it's a virus that causes cold-like symptoms. The problem is the severity of the congestion can lead to lower respiratory tract infections and/or respiratory distress. Two Web sites with more information are:  RSV Info Center and the CDC. Both Web sites present it as a problem for immunocompromised or chronically ill children, but for the past two years it has been running rampant in all types of children.

Last year, we diagnosed our first case in September, very early for an epidemic to begin. It lasted until almost May. I lost count of the number of children requiring intubation because there were so many. But, I survived and I hoped that this year wouldn't be so hard.

Just like last year, I am fatigued beyond belief right now. The stress of caring for so many sick families is starting to take its toll. It is not uncommon for it to take two weeks for the virus to completely clear up; parents can truly be maxed out. In addition, wheezing and a cough can last even longer. This leads to multiple ER visits and/or admissions. My only salvation is that spring is right around the corner. Soon I will be fixing broken bones under sedation, cleaning up abrasions and giving out helmets to children that have used theirs to prevent a head injury. Every illness has its season.

Ahh, maybe by August my RSV blues will be over and I'll be ready to face it all over again. Until then, I will be suctioning a lot of noses and administering updrafts in an effort to keep this viral monster at bay.

I had a conversation recently with my supervisor, Gillian, regarding reality versus perception. I cognitively know other people can have different perceptions of a situation than I do, but when it involves emotions, it becomes difficult to accept. In my personal life, I have worked very hard to avoid burdening myself with other people's tribulations. This struggle has spilled over into my professional life as well, but apparently I am not as good at setting boundaries as I thought.

It seems as though there is disparity between what I attempt to accomplish, through my priorities and assessment of situations, and what my co-workers see as priorities. This has led to conflict and a sea of negative emotions that I intuitively sensed, but did not consciously know existed. I have recently been made aware of their perceptions.

My initial reaction was to run. I always have. I don't acknowledge other ways to face adversity. I know how to back down and bury what I hold high in esteem. But this time I feel different. I think it is because I absolutely love working in the ER. At this point, I can not visualize myself doing anything but emergency nursing. This motivates me to hang tough and want to see through this difficulty. For the first time in my life, I believe in myself and what I stand for.

What is it that I believe in so strongly? Integrity: adherence to moral and ethical principles; soundness of moral character; honesty, as defined by my favorite dictionary website. I took the time to examine the current situation that my supervisor pointed out, and I now see how much I value my integrity.

As I alluded to in my last blog, "Learning to Lead," I have been seeking out role models of leadership. I am also trying to learn new ways to communicate with those around me. Of course my co-workers do not see what I am trying to accomplish because I haven't told them. I thought it went without saying. But from their perspectives, it appeared as something different. Their perceptions did not match my reality. Thanks to the guidance of the supervisors around me, I now know I have to talk in order to be understood.

I have started trying, at least a little. But what I have found is that I am opening myself up to criticism. That is hard to face and it hurts. But if I hold strong to my belief in integrity, I know I can make it through this. My only fear is that I will hide behind my convictions. I do not want to become so focused on what I believe that I discount others' thoughts and wishes.

Growing up is a lot more complicated than I ever imagined; giving up would be easier, but I already promised Gillian I would mature.

So, today, as I go to work, I am going to do so with an open, albeit wounded, heart. I am human, imperfections and all. I want to shut down and withdraw, protect myself from the hurtful projections of others, but what would that accomplish? I would simply be succumbing to a perceived reality that does not match mine. Real change takes time, effort, and apparently some pain. If I want to make a real difference, I have to be my real self.

In November and December, I had the pleasure of orienting new graduate nurses to the Pediatric Emergency Department. They are bright, hard working, and driven individuals. All three have different skill sets, personalities, and approaches to nursing. I do have to admit, it was challenging to complete this task, but also very rewarding.

The process of orientation reminded me, again, that I have been practicing as an RN for ten years now. How did I get to where I am today? How do I know what I know? A large part of my skill set has been from experience, but a larger majority comes from the mentors who have taught me along the way. I realize now that I am, to some, a mentor. This is a heavy burden to bear and I am not sure I want it. But, alas, it is what it is. I can choose to run or face it and learn to lead. It is at this time that I need to reevaluate who my mentors are today, as well as acknowledge the ones who have made a difference in my past.

To this day, I document with a concept presented to me in Nursing 101:  KISS. Dr. Brenda Millette taught us to Keep It Simple Stupid. Though it sounds easy, sometimes keeping words to a minimum can be hard, but it works. When I am faced with a lot of charting, I am comforted by Dr. Millette's words as they echo through my memory.

Another one of my professors that had, and still has, great influence on me was Joan P. Roche. She promoted the concept that patients "report" problems, not "complain" of problems. Everyday, I think of her because our nursing documents contain an area for "chief complaint."  Now, given that I am an ER nurse and need to document the reason the patient needs to be seen, I can rationalize this discrepancy rather easily. So, in her honor, my documentation always includes the words: "pt reports."  I do my best to portray patients in a manner she would see fit.

There are many other talented and influential people that I learned from while studying nursing at the University of Massachusetts. The list could go on, but today I am learning to lead. It is a topic that is only touched upon at the novice level. Becoming the seasoned nurse, the preceptor, and the resource person is hitting me square in the face, but I am able to pull from my peers to help me through this time of growth.

I must admit, I work in a department that contains an approachable leadership. I know that I can go to my direct supervisor with any issue. I also have a director, unit manager, clinical nurse specialist and educators that are all willing to offer guidance and support as needed. It is the first time I have ever worked with such a positive form of management where doors are open all the time.

But what about times when I am lost in the trenches? Who can I learn from directly? It can be hard to recognize those who stand right beside us. I think we tend to take other staff nurses for granted. I am not alone in this battle for I have the pleasure of working with a nurse I affectionately call "Cruella Deville."  Mrs. Deville has been a nurse longer than I have been alive. She has worked in the jungles of Colombia, as well as in Europe and the United States. She has extensive clinical experience in all areas of nursing, as well as management. I have come to rely on her for many of my learning needs.

Mrs. Deville is not everyone's favorite person; she's always telling me that I am too nice. But she is solid and strong, always dependable. She knows every policy and standard of care; how? I will never know. She treats families and children with patience and respect, always consistent in her ability to perform. She takes stressful situations in stride and rarely loses her cool. She makes decisions and stands by them. I realize more each day that these are qualities in her that I want to develop in me.

So, as time goes by and I am faced with more challenges, I am going to continue to learn from Cruella. I am at a threshold right now; she can help me cross it, whether she knows it or not. So, thank you Cruella. Wear that pin I gave you with pride. I am going to learn to lead and you can be my guide.

Looking back, I am surprised at how quickly 2007 came to an end.  In January, I read an article in Real Simple magazine about a woman who decided she did not need to be "right" all the time, as a New Years' resolution. This idea sounded intriguing, and, at the time, rather easy.  Now, as I reexamine the past 12 months, I must acknowledge the tremendous amount of work it has taken, as well as the positive impact it has had on my life.

For me, it started as a mantra:  "I don't always need to be right," repeated over and over, never really believing it would make a difference.  As life would have it, I was faced with my first challenge right away.  It was a busy evening in the ER.  Someone had a GI bleed that created a lot of pungent diarrhea.  A large portion of the waste was disposed of in our soiled utility room, causing that area of the hallway to be rather malodorous.  A family placed close to that area was not happy.  They expressed themselves vocally, using mostly profanity.  Now, if I had just taken a moment and repeated my mantra, things could have been different.  But, alas, I did not.  I marched over and stated, "You need to stop swearing."

The man was furious and began speaking loudly in response to my request, in Spanish.  I walked away, doing all that I could to maintain my composure, but my need to be right overtook me.  I turned around and said, "If you don't stop, I will have you removed."  His wife immediately came to his defense, leading to an ugly scene that was witnessed by much of the department.  But I said what I meant and felt "righted," even if I had not been soothing.

A few moments later, a physician placed the family in a better scented area.  His listening ear and understanding nods comforted the family.  I will never forget the chagrin I swallowed while I stood outside the room, eavesdropping.  He wasn't exactly saying they were right or that we, the staff, were wrong.  He just allowed them to express their feelings in a nonjudgmental way; he listened.  At that moment, I realized that listening is a not very strong part of my character.  Before I could let go of this need to "right" I must first hear what the other party was saying.  It is only then that I can be free to let it go.

Self-realization can be one of the greatest moments, if you allow it to happen.  Though I am not completely convinced I have this change fully integrated, I do know I learned a lot by trying.  I have had to address multiple weaknesses to create one small part of a new me.  Maybe this is why New Years' resolutions fail so quickly for so many of us.  In such a busy world, we do not often realize that change is a road to be followed, not a pit stop that we make.  True character growth involves digging deeper into ourselves and looking at the parts of us we may not like.  We will have failures along the way, reminding us of our own humanity. 

As I face 2008, I hold my chin up.  I will continue to try not to be "right" all the time; I intend to listen to my patients more.  Maybe this will lead me down a new path of growth where I can change something else.  Maybe if I stop fighting with so many people around me, I can focus on becoming more organized.  I can only begin to guess what may lie ahead as I try to think about that.

Fall is upon us, bringing a multitude of coughs, sneezes, and gastrointestinal disturbances. Needless to say, the volume and acuity of our ER patients has changed yet again, creating a gridlock of unhappy patients and family members. Just a few weeks ago, we were holding over thirty patients for admission. My hopes of maintaining a positive demeanor at work has been challenged more than I had anticipated. Winter is supposed to be our busiest time. How am I going to ‘cruise' through this season knowing that the worst still lies ahead?

The past few weeks, I have been working primarily in the Pediatric Emergency Room. To be honest, this is where my heart can be found. Though I love all aspects of emergency care, from triage to trauma, there is something in Pedi Nursing that beckons me. Some people balk at the perceived threat of parents' watchful eyes. Others fear the smallness of the patient's every body part. I thrive on it, knowing that, more often than not, I will actually be able to see the fruits of my labors. Children are notorious for rebounding from illnesses quickly; it is instant gratification at its best.

There are times, however, when answers cannot be found. Working with a new graduate one night, I found myself faced with a challenge I had previously chosen to run away from. It was a busy night-one filled with IV starts, fluid boluses and albuterol updrafts. Babies were crying and parents were angry from waiting. In the ER, it can be so easy to forget how to care. The nurse, Jess, I was precepting helped me to remember the pledge I had made to myself merely weeks before with one simple question, "What is ‘ALTE'?"

"Oh, that," I said casually, waving off the diagnosis. "It just means that the baby had a witnessed episode of MAYBE not breathing. It stands for Apparent Life Threatening Event."  I ran off to check on other tasks that needed to be done, leaving her to ponder what may or may not have happened at the family's home. But, her question stuck with me and rang through my head numerous times, before I finally took a moment to really explain it to her. It was then that I realized I had forgotten to address the needs of the parents, who were too scared to ask for help. I made a mental note to check on them soon.

Moments later, I walked into the room to complete the admission paperwork. Dad was holding the sleeping baby; mom was pacing. At that moment, the baby decided to demonstrate what had brought him to the ER in the first place.

Dad yelled, "He's doing it again!" Baby did not startle.

I looked down and saw a pale, limp baby. Instinct took over and I sternally rubbed the baby as I instructed Dad to lay him on the bed. Slowly he began to respond and opened his eyes. After what felt like an eternity, he cried.

"How are we ever going to let him sleep again?" Dad turned to me for the answer.

In the past, I would have deferred that question to the doctor. But, alas, I remembered the bottle of refreshment that I had stored during my last vacation. I uncorked it, took a chance and sat down next to the parents. "Honestly, I don't know," I sighed. "What I do know is that we are trying to find a cause. Right now, we are trying to rule out infection. Beyond that, we just have to go step-by-step and see if we find anything wrong."

Both parents' eyes opened wide in shock. "If you find anything wrong? What if you don't, then what?" The terror was plastered to their faces, breaking my heart more each second.

I droned on about tests and apnea monitors, knowing I was only trying to fill the space with some answer that may not exist. Until, finally, I relented, "As much as we try, we don't always have definite answers. It may be 2007, but there is still a lot about the human body that we do not understand."

Dad then asked the ultimate question: "Is this what causes SIDS?"

"We don't know," I said cautiously, knowing that his sanity hangs precariously in the balance. "That is why you are here. We are going to do everything we can to make sure your baby is ok and stays that way."

A visiting family member looked at me and quietly said, "Well, at least you are honest."

It was then I truly felt the power of nursing. I began to wonder how many of our patients exhibit anger and frustration merely because they feel we are not being honest with them. It was very hard to give that part of me away, but the gratitude in their eyes, as they were escorted to the children's unit, was far more rewarding than the ease of shrugging them off. The crew on my cruise ship was right; one person satisfied can make every sacrifice worth it.

The more I think about it, the more I realize how frequently I see infants admitted with the diagnosis of ALTE. It has led me to learn as much as I can about this problem as well as SIDS. I found a few web sites that were useful to me and wanted to share them:  Apparent Life Threatening Event is explained here: read and explanation of apparent life threatening event and more on SIDS.

I want desperately to be able to save the world; maybe that is why I went into nursing in the first place. But I think I have found what can keep me here: the patients and their families. Taking vacations and learning to relax will probably help me as well. I also think the secret lies in remembering that we are all human and small offerings can go a long way.

I was blessed to spend last week on a cruise in the Caribbean. On November 3, 2007, I boarded one of the largest cruise ships on earth:  Royal Caribbean's Liberty of the Seas.

I was amazed at the staff's desire to please, the perfection in atmosphere, endless food, and fanciful entertainment. Strangers struck up conversations anywhere on board about anything you can imagine. Everyone wore smiles, said ‘please' and ‘thank you'; I even heard ‘excuse me' from time to time and watched doors being held open.

One evening, early in the week, my husband and I had the chance to converse with a few crew members. They revealed that every employee signs a 6-month contract, agreeing to work 10 hours a day, 7 days a week. They are guaranteed a lunch break, but rarely get dinner. If they are lucky, they may get to see a port of call, but most do not get the chance. All three crew members stated that if even one person expresses sheer delight at their efforts, then the sacrifice is worth it.

I began to think of my life, my work, and all that I do everyday just to make ends meet. I knew that even though I was holding the ‘drink of the day' today, the hustle and bustle of the real world would eventually need to be faced again. As I felt the wind blow in my hair and inhaled the scent of salty air, I became determined to bring more than just souvenirs home with me. I dreamt of bottling this feeling, integrating it into every part of my regular day.

Upon exiting the boat, people became people again. Already at baggage claim, vacationers were grumbling and complaining, pushing others out of the way so they could have their luggage first. I smiled, reached into my soul and took a drink from the bottle of my own personal refreshment. The airport was even worse: throes of tanned people folded their arms and donned frowns deeper than the oceans we had just sailed. I wondered if the magic of the cruise would escape me just as quickly. I double checked my soul and found the "bottle" right where I had left it.

Today I am back to work. I am thrilled because I will be precepting a group of new graduates to the pediatric emergency room. All three of them are very intimidated by this population, but I look forward to guiding them through this time of growth. I think I have a lot more to offer now that I have experienced and appreciated a small slice of heaven.

For the future, I wish to continually revisit this feeling of peace that this vacation has instilled in me. I want to make my patients feel as special as the crew aboard the Liberty made me feel. I know that I have barriers to face and that each day the memories will become more and more distant. But if I try, really, really try, maybe somehow I can find a way to cruise through life, even when the seas are rough.

It happened again. Another teenager has demonstrated a show of violence that leaves everyone wondering, "How could this happen?" The details, as I'm sure most of us know already, are outlined here. My concern is that we will soon become complacent and accept this act of violence as part of our world; we will no longer feel that we can change this way of life. I am writing because I believe that we can make a difference with a little compassion and a lot of hard work.

I am not afraid anymore to tell you that I was an angry teenager. Look at that picture of bliss (below) and ask yourself: "Doesn't she look happy?" Yeah, well, I wasn't. I wanted to die, kill myself, and just plain escape from this world. That face ‘hated' everybody, especially herself. I never considered physically harming others, but my silent resentment drove me to make poor decisions, put others in grave danger. My nickname was "Smiley," because I hid the truth from all of those around me.

The road to depression is a long one. I can't tell you how I got there. It's a process that occurred over time, unnoticed by all, until a few pivotal people in my life stepped up and reached out. The very first was a high school vice-principal. She was notoriously mean and heartless. One day, she found me aimlessly wandering in the high school parking lot. I was spinning my new lacrosse stick in my hand, holding back the urge to smash the windows of cars around me. She took me to her office and just let me cry. The reason for the tears never mattered. Her knowing glances and kind touches after that brought me comfort beyond words.

The second person was a friend, someone I had known a few years that was angry at me for withdrawing. He saw the beautiful girl I didn't know I was. One night, at a local park he took my hands and forced me to repeat positive comments about myself. Again, he stayed with me while the tears flowed, never once asking why they were there.

The final, and most important person, was my mother. She knew what was happening right from the start. She tried with all she had to help me. Being angry and resentful, I fought her every step of the way. All of my negativity was directed at her. Yet, she stayed. She knew that I wouldn't be able to hear her at first, so she kept repeating herself; one day she reached me. 

It was shortly after Christmastime when I finally heard my mother's pleas to get help. I had watched a movie in biology class about chemically induced depression. I cried silent tears in the darkened room as I processed the information. You see, I thought that depression occurred because something bad had happened to the person. Nothing bad had happened to me, so what right did I have to feel depressed? There was an explanation that allowed me to feel depressed for ‘no reason.'

I was fortunate because my mother knew what to do. I had a pediatrician that treated me like a human being with an illness. We were able to find counseling appropriate for a teenager. Both of my parents became involved in my care. I was supported and loved through this difficult time.

Today, working in the ER, I see so many teens and young children with similar symptoms. The problem, though, is the lack of resources available to families. Western Massachusetts has one hospital that will take children inpatient for psychiatric treatment. It is almost always full. Right now it is in danger of closing, due to lack of funding. We are frequently forced to send kids to the eastern part of the state, out of state, or home with parents. What message is society sending to teens and children about psychiatric disorders? 

I know from personal and professional experience that it can be the small things that make a huge difference.  A moment of undivided attention, a soft, caring hand, and a strong will can be offered from a plethora of individuals.  One alone may not provide huge strides in change, but together a battle can be started. Asa Coon is a drastic example of a teen in distress, but I think we all need to face the truth that many teens are struggling. For whatever reason, we have been uncomfortable addressing this issue. Now should be the time we reexamine the psychiatric resources available to those in need.

Again, I have included a link to a video that I have found to touch me deeply. I have survived the demon of depression, more than once in my life. Others have their own burdens to bear, whether it's addiction, abuse, or loss. If these faces appeared to you, what would you say? What do you have to offer? I can tell you, A LOT!  Watch and think hard about "How to Save a Life" and maybe someday you will, without even knowing it.

My last few blogs have been about individual responsibility. I think I would like to explore that further, but take it down to a more personal level, demonstrating how taking care of myself can make me a better nurse and how being individually responsible is for the greater good.

There comes a time in everyone's career where personal and professional collide. Let's face it, everyone is human. Most of us strive to keep our life stresses separate, but just about everyone can tell a story of someone whose work life suffered as a result of personal struggles. I would like to share mine with you.

A few years ago, life events occurred that I had no control over. A person I was very close to suddenly withdrew from me. I desperately wanted things to be different and nearly made myself crazy trying to force it. The end result was an angry me, who hated people and a withdrawn me, who wouldn't let anyone in. I can tell you the feeling of abandonment is a very lonely place. I may have stayed there, if it had not been for a few pivotal events.

The first was a simple gesture of kindness. A co-worker, who had been trying to involve me in outdoor work adventures, pulled me aside one day. He noted gently that I had not been acting like my usual self and inquired if there was something he could do to help. I was so taken aback that I could not even respond. But the effort did not go unnoticed. It softened my heart and made me wonder if there was still some good out there.

With my eyes a little less cloudy, I began looking around my world again. How can I shake this sense of negativity? It had felt as if everyone was picking a fight with me. Each day seemed a struggle just to get something accomplished. I began to wonder if there was a different seat to view this world from. I found that seat in the trauma room.

I had taken care of a victim of violence, a trauma patient. His family expressed so much gratitude at my kindness and patience with them. All I had done was let them tell me a story of his recent success and his ability to get out of gang life. Could it really be that simple? Pieter's small act had given me some hope. As a result, I decided to offer something of myself to them, a listening ear. It seemed a few moments of sincere time with me may have helped them to feel the same.

I started my practicing this transition in triage. Everyone knows how long the wait can be to get into the ER. Each patient believes that they are the most important and absolutely need to be seen next. Some people exaggerate; others act out with threats and anger. My job can sometimes feel like crowd control. I began taking a few moments to explain the ER process, each and every time I triaged someone. Low and behold, many people began thanking me, instead of arguing. More people became agreeable and helpful, instead of resentful. In this case, it was information that made the difference.

Slowly, I came to realize that I can not change the people around me. All I can do is offer patience, kindness, and real-time information. By approaching even a horrible scenario with a kind gesture, I can bring some hope to those in need. I am, by nature, an optimistic person, always believing in the best. When I lost that optimism and focused, focusing only on the bad things in my life, negativity is what I received in return.

The idea of personal responsibility became a way of life for me. I had to become secure in my feelings and beliefs, thereby allowing others to hold their own. I began looking at situations from where the other person stood, while learning to maintain my own space. I had to clean out the skeletons I had in my closet, forgive those that had hurt me, and not assume another person was going to do the same thing. In the end, I chose love.

 It is from this idea that I believe individual responsibility can make the world a better place. By focusing on my shortcomings, I am a better able to be strong, giving. If everyone cared, in whatever capacity they are able, we may see a lot less violence and suffering in this world and more camaraderie and unification-something we all strive for. You may recognize the title of my blog as a song from the group Nickelback. The song really means a lot to what I have posted, but the video is even more motivating. Enjoy.