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The Nurse Card

Charmed, I'm Sure
May 22, 2016 9:31 AM by Diane Goodman

We live in one of the more volatile times for nursing, whether it is through aggressive political discussions, or the rising violence in cities across the country. Each day brings additional concerns, whether it is the latest statistics on the spread of Zika through pregnant Moms in the U.S., or the latest city/shooting/potential spread of terrorism.

So it is easy to understand the astonished looks I receive from nurses when I insist one of our biggest priorities is to remain charming.

I'm not talking about a Pollyanna attitude in the midst of serious life-threatening issues. "Charm is the ability to make someone think that both of you are quite wonderful". (Amiel Henri Frederic). Think about that. More than ever, we need this type of back-up.

I've been on both sides of the fence in healthcare. If you're a patient, and your analgesic is late, or your pill is not "due", the situation quickly becomes one of discomfort. Nurse A drops by the room, sticks her head in the door, and informs you the physician is in surgery, and often takes quite a while to return calls. Oh my. Now you're anxious AND uncomfortable. Maybe you shouldn't have waited to let the nurse know the pill wasn't helping all that much in the first place. You feel upset, anxious, angry with yourself, and wondering if you should call her back. You hate to be a nag.

Nurse B (different scenario) walks into the room to let you know the surgeon is finishing a case, and can't be reached. But don't worry, she states. She has a call into his partner to get something additional in the interim. In the meantime, how about changing your position, or getting a hot drink? Would you like someone called to be with you? The TV or music turned on? Suddenly, you feel soothed, and major muscles begin to relax. You're not alone, help is on the way. Her charm and confidence is contagious. You feel better about both her skill in taking care of you AND your ability to handle the postoperative pain. Maybe you waited too long, but it's going to be O.K., a plan is in place. The nurse's charm has worked wonders.

As a patient, and a nurse, I've seen both of these scenarios multiple times. I'm sure other nurses have as well.

I can vouch for the fact that charm is always the better approach. No time, you insist? A few words of encouragement (for the patient in pain) go a long way to let them know you care. Even a gentle touch or rearranging of pillows, linens demonstrate a caring demeanor.

Charm is the glue that holds it all together. Wouldn't it be nice to think patients were smiling as we exited their rooms, slowly closing their eyes, tension easing, muscles relaxing... as we're thinking "charmed, I'm sure".


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Born this Way; What Nursing Means To Me
April 30, 2016 10:39 AM by Diane Goodman

I came out of the uterus knowing exactly what I was placed on earth to do. I was lucky. So few people are that fortunate. To solidify the deal, my Mom named me after a nurse, so by the time I hit the nursery, I was on the job.

Other babies were busy looking cute and cuddly and drooling, not me. I might have looked like a full term infant, but I was busy assessing Apgar scores. That blonde baby in the corner, is her breathing OK? What about that little bald guy? Is he starting to appear jaundiced?

OK, so I didn't have language skills yet, but I was processing, making plans, assessing, preparing for potential emergencies. I wasn't there to just eat, burp, and sleep. I was a nurse.

By two, my dolls had a miniature stethoscope checking their "lungs" for abnormalities. I couldn't afford to set them up for tea parties; they might be coming down with colds or flu! You laugh, but we have Christmas photos of my toddler self, dressed to the nines in full nursing regalia, "assessing" her doll babies from head to toe. There was no mistaking the grin that was plastered all over my face, either. THIS was one happy little lady!

And so it went...through future nursing classes in high school, and working as an assistant at the hospital during summer breaks. The contentedness I felt when helping and being close to other people never left me. The chance to discuss the human condition, in all its glory and frailties, from the newness of life's beginning to the reverence for its end, I never lost the inner (or outer) grin that I gained from nursing.

Nursing allows you to laugh, curse, and cry with patients, and to become closer to human beings than you believed possible. You form lifelong friendships with people and cultures that you may never have known through geography alone. You cross barriers that seem insurmountable and bridge distances with the touch a of a healing hand. There's nothing like it.

There never will be. For many of us, we were born this way, and my God, were we lucky.

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Staying Inspired
April 22, 2016 11:23 AM by Diane Goodman

Nursing can be tough, and at times disheartening. You feel a pull and tug on heartstrings that ache at the end of a long day. At times, it's hard to find time to put the "zing" and inspiration back in your step. That's where a cohort of nursing friends come in handy.

Nurses often find similar hobbies through social media or other nurses at work. We find our "quirks" are not so strange when viewed through the eyes of another nurse. Nurses love to shop, and quilt, and do crafts, because it allows them to look at color and beautiful things. They also enjoy nature at it's finest, whether through art, baby animals, videos of family gatherings (especially seasonal functions!), freshly fallen snow, etc.

"Pretty" is not a word that would be used to describe nursing. Life in all its forms is usually crazy and messy, and nurses see the worst of what life has to offer. Those who work in the delivery room may see life at its most blessed event, but even they see sorrowful times. Most of us need to put back, and be re-inspired to give everything we can summon to the next group of patients awaiting care.

Me? I love watching old movies, ones I know bring me to a place of comfort, belief in the goodness of humanity. Not really old movies, but those in the top 100 of all time greats: Shawshank Redemption, Forrest Gump, Big, The Green Mile. If I'm not near a television set, a beautiful soundtrack will do.

I also believe nurses live a purpose-filled life. We know we are here to care for others beyond our inner circle. Posting inspirational messages on computers, smartphones, notebooks, and walls helps us to keep focused on the bigger picture and get past the angst of day to day frustrations. We tend to push ourselves too hard, work when we should stay home, and stay awake when we should sleep. An inspirational message is an excellent way to start the day, especially as we near nurses' week.

I will be posting soon, to describe exactly what nursing means to me. Until that time, I'd like to share the inspirational quote that's on my wall:

"Morning is God's way of saying one more time, go make a difference, touch a heart, encourage a mind, inspire a soul, and enjoy the day."  Unknown.

Be inspired, stay inspired-

D.

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Having A Disability Is Like...What?
March 29, 2016 2:23 PM by Diane Goodman

I am functionally disabled, but unless you examined me closely, you might not know. At first glance, I look completely "normal", whatever that word means.

My friends, family members, and close colleagues know, and perhaps those who shop with me. People ask me what it's like, because it's important that we teach patients with a disability or handicap to be prepared. According to the ADA, that's approximately 19.1% of the adults in this country, or approximately one out of every five of us.

So here goes...

Having a disability is just like... having anything else. It redefines your new normal. It is your life, but possibly a little slower. You get a chance to find out that people are more and less polite than you expected. Some will believe you can pick up the pace if they yell at you or beep their horn in a parking lot when it is raining...you can't. In fact, their rudeness is appalling. Others will surprise you with their ability to run in front of you to open a door, although they appear older and/or more frail! How sweet. It takes my breathe away every time.

You will find that the loss of speed and agility will become a new appreciation for sound, sight, texture, and flavor. As I struggled through a particularly tough morning's path to the hospital one day, I found myself glorying in a burst of birdsong. Smiling broadly, I mentioned it to the hospital CEO as he stopped to say "good morning". He hadn't heard the birds, he said. Too busy rushing to get inside and start his day.

I used to be like that too. So sad.

You learn you must ask others for help, tougher than we think. Nurses are particularly dismal with this. We vehemently dislike letting on that hands might have lost manual dexterity or the ability to open tiny packages without pain. Additionally, we would rather stand on a chair, trying to work with a gizmo or tool to "fix" an item, rather than ask for help. Having a disability means we learn to ask earlier, as opposed to spending time and money in the ER with a sheepish expression on our face. In the long run, asking for help is easier than months spent in an orthopedic shoe or boot!

When teaching patients or fellow nurses how to "live" with chronicity or a disability, I like to tell them...it is life, and it is just like anything else. There will be good days, and bad days, and days when you can strive for new highs. Attitude and a good sense of humor will take you further than just about anything. For those who beep, yell, or honk at you in parking lots, stand tall, breathe deeply, walk on. Speed isn't everything.

 

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A Feedback First
March 3, 2016 12:39 PM by Diane Goodman

All nurses are used to receiving feedback; it's become as natural to us as breathing in and out. We receive commentary from bosses, family members, patients, colleagues, and friends. Good, bad, or indifferent, we absorb and integrate it into our day, and then, hopefully forget about it. But what if it's our first review...and we receive feedback that, to us, barely makes sense?

This happened recently to a nursing colleague.

Alice* was relatively new as a Nurse Practitioner, but on Patricia Benner's model of nursing theory she was functioning at expert level, and communicating proficiently with patients. Imagine her surprise when the group of physicians who hired her sat her down for a performance review and critiqued her behavior as being too "nursey".

Too "nursey". Think about that.

What the heck does that mean, Alice wondered, as she posted her scenario on one of my blogs (Medscape, Why Nurses Did Not Become Physicians, 2-19-2016). Aren't we supposed to elevate our craft as we add more experience? Can we BE too "nursey"? How and why, and what would this look like in the eyes of another discipline (physician's group)?. Could becoming too "nursey" be a derogatory action?

Alice's comment generated dialogue among multiple groups. We assumed the physician's group expected her to meet specific quotas, as all do when hiring a nurse practitioner. Not to be negative, but these expectations need to be clearly identified at hire date. Uninformed physicians tend to believe hiring an NP or PA is a "cheap" way of adding another physician without paying the price. Not so. There is a learning curve on both sides when a midlevel provider is added to a practice, and an informed physician(s) will know that an NP brings many dimensions of nursing to the table: patient education, improved patient satisfaction, improved disease management, and possibly research and practice development. Those may all be classified as "nursey" behaviors. New NP's take time to learn their craft, and may not meet median patient quotas in their first six months on the job, but I doubt many of the physicians did, either.

I've been in Alice's shoes, but I had an informed physician as a practice partner. He not only understood Benner's model of nursing theory, he also supported "nursey" behavior. I'm not sure I would want to support medical providers who believe being more "nursey" is a negative.

What do readers think? Is this a feedback first, or one we might be hearing again? 

If we will be hearing this again, we need to figure out what, exactly, the concept means.

 

*not her real name

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Compassion First, Last, Always
February 15, 2016 10:32 AM by Diane Goodman

We see it in Emergency Rooms everywhere, as I saw again this week. I was amused, thinking of sharing the story with colleagues, as inwardly, I rolled my eyes and sighed. Here was yet another "frequent flyer", one of the patients for which healthcare has identified no solution. She had just been discharged, but here she was, suitcase packed, ready for another stay.

Soon enough, she begged her husband to remove the oxygen for a cigarette break, even though the windchill was subzero in the designated smoking zone. She also pleaded for candy bars to be stashed into her purse, stating nurses would "cut off her food". Mal-adaptive behaviors, I thought. Was she addicted to both, or just one? What do we really understand about the inability to curb these disruptive impulses? Does everyone have them? How far removed is an AM coffee and doughnut "addiction" from one that could become dangerous?

As I learned more professionally about the science behind addictive/compulsive patient behaviors, my compassion grew. If someone had told me twenty years ago that we could have Saudi Arabian teens able to become super morbidly obese and greater than 1300 lbs., OR that the rise in substance abuse over 14 years in the United States could increase by 42% (NIH, years 2001-2014), I would have been shocked. What has caused these dramatic changes to occur? Ease of access? Genetics?

The science of addiction would tell us we barely understand what is going on, whether it is a puff of nicotine, or the solace from a plate of carbohydrates. Brain behavior, neurotransmitter behavior, and the pleasure/reward systems of addicts may be different, and we may barely be on the cusp of understanding why.

That is why, as a nurse, before I inwardly roll my eyes, I must remember why I am here, and that is for compassion; first, last, and always. Yes, these patients may seem frustrating, and even ridiculously silly at times, but they need us now more than ever. They need us every DAY, until we understand what drives the physiology of human behavior, even the need to compulsively seek detrimental coping mechanisms.

As stated in AJN: "Our ability to show compassion is perhaps our best nursing skill, better than our proficiency with machines, computers, and even procedures. It may not be what we do so much as how we do it." Diane Stonecipher, in "The Heart of a Nurse", ajnoffthecharts.com, August 14, 2013.

This is definitely worth repeating. First, last, always.

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Fueled by Coffee
January 21, 2016 12:35 PM by Diane Goodman

Anyone who knows me has seen me working at some point fueled by cups of strong coffee. Apparently, I am not alone.

It appears that recent research on the consumption of coffee beverages demonstrates the #1 and #2 spots are held by nurses and doctors, respectively. We understand the mathematics of working long hours with minimal breaks and maximum demands. It is similar to running a vehicle and plotting MPG's. We wouldn't expect maximum performance with shoddy fuel or a near-empty tank. We go for what works, what consistently performs, and what is easily obtained.

Aaaah, the aroma of coffee. Quite addictive really. It draws you in.

If you're my age, you may remember when coffee was getting a bad rap. Coffee was accused of causing all sorts of maladies, perhaps pancreatic cancer, maybe heart disease. Not many in the health profession gave it up. Pots kept simmering away; we needed it to keep going. Eventually, studies were continued, and variables examined. Perhaps, they decided, it wasn't the coffee, but the behaviors that were conducted along with the coffee.

You know, the coffee with the lighted cigarette. The coffee with the fat-laden meal, the cholesterol-heavy dinner, the coffee ingested while sitting in a recliner rather than engaging in light aerobic activity, all those types of behaviors. Coffee with heavy cream. Perhaps it wasn't the coffee itself?

Now, I hear coffee is making the news again, only this time the news is good.

Coffee may prolong remission for certain cancers. Coffee overall may increase lifespan! Coffee, it seems, is a good guy. But really, we nurses knew this all along. Who else would keep us company all night long and still want to make an appearance for the day and evening shifts, warm and perky and smelling great?! That's asking a lot. That's high performance.

Here's to a long life and long career fueled by what else...nurses #1 beverage, coffee! Drink it in good health.

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SoundByte; The Connection of Nurses to Sound
December 28, 2015 1:38 PM by Diane Goodman

We hear a baby's first gasp and cry and we are often the ones to witness the last gasp of the dying. We honor these sounds with our presence, never forgetting the blessing to be there at the beginning and end to life.

In between, sound plays such an important part to a nurse's life we almost forget the beauty of it, the wondrous nature and rhythm of what we hear. We know when it gets out of hand, and it's too much for our patients, or our families, and we "shush!!!" others to keep the decibels down. We know when we don't hear a sound that is expected, and the agony that follows, whether it is the heartbeat of a baby presumably growing in utero, or the amplified pulse of a limb that appears pale and without life. We also hate the sudden stillness in a room previously filled with loud conversation, as someone announces a heartbreaking diagnosis, a sudden betrayal, or a break-up we weren't expecting. Sound. It has tremendous power over our lives whether we recognize it or not.

As an example: last spring the world lost one of its greatest composers, although nurses may not have known. James Horner died at the age of 61 in a tragic plane accident. I never knew him, but my heart was irrevocably broken. I have played his music for countless patients facing surgery or dealing with chronic pain, and their lives were changed. Their hearts would beat in unison with his breathtaking movie scores, their breathing slowed, and their anxiety lessened. Music and sound. So much power that we completely forget about it unless we desperately need it.

I will never forget James Horner. If you have a favorite movie, odds are he wrote the score...Avatar, Legends of the Fall, Aliens, Apollo 13, Titanic, Braveheart, Cocoon, Star Trek, I could go on and on. He left a legacy of sound for decades of patients, fans to enjoy.

In the years to come let the beauty of sound be as powerful as those first gasps of air. Provide more soundbytes for the soul, more awareness of what we can hear when we really, really listen.


 

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Have You Met Egophony?
December 12, 2015 11:27 AM by Diane Goodman

I am a reasonable person but also intermittently annoying. I invented the concept of "lunch and learns" simply to interrupt nurses while they were cramming down a meal. I loved it beyond measure; they greeted me with an occasional eye-roll and/or groan. What did they care about understanding egophony when their lunch was cooling?

Plenty, as it turned out.

They were hungry for better assessment tools, but had zero time for learning. Yes, they had heard the terms bronchophony, whispered pectoriloquy, and egophony in school but they were long-forgotten tools, like relatives they had seen but never really known. Now was the time for grasping the concept of really, really assessing patients, when they could make a difference, when they were seeing them consistently out on the floors.

Palpation was another nursing tool that was seldom used at the bedside, unfortunately. We began to schedule time in the lab for nurses to palpate a simulated patient, determining what was distention due to air versus fluid. Nurses could call for "bedside consults" on actual patients as well, where they would witness APN's palpating distended abdomens. This could be performed prior to grabbing a bladder scanner to "diagnose" the patient who needed to be catheterized versus the patient who was merely filling up with gas. I was proud to see insecure bedside nurses becoming stronger in their assessment skills, whether by listening to lungs, listening to bellies, or practicing palpation, which many had forgotten since their clinical days.

The last skill I make sure each nurse knows 100% at the bedside is Incentive Spirometry. The device does absolutely no good sitting on the bedside table or in the windowsill. Patients need a review. Breathe in slowly as if through a thick, thick milkshake, not quick sharp breaths. Ask the patient to work on the IS during every TV commercial while they are awake. Stay with them through the first or second try to make sure they've got it, it's worth every minute.

While you're with the patient, assess for my "friend", egophony. As the patient says "E" while you are listening with a stethoscope, the "E" will sound like a nasal "A" over areas of consolidation, scar tissue, or fluid. If your patient has egophony and a slight temp, act. They may need aggressive pulmonary toileting, perhaps an antibiotic. They are one of the lucky ones, because they had a nurse who was on her toes! They had a nurse with excellent assessment skills!

It might have started with an eye-roll and a piece of cold, leftover pizza, but once you've met egophony you never go back. You're hooked.

 

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Does Covering = Caring?
November 27, 2015 2:16 PM by Diane Goodman

Johnson and Johnson has long been an ardent supporter of nursing, especially this past year, when the ladies of The View seemed disinclined to remember that we deserve the utmost respect and admiration. So I was especially enthralled to see a recent band aid commercial airing during prime time TV. "Covering", the folks at Johnson and Johnson insisted, equals "caring". Cute. Catchy. But is it true?

I certainly hope so. I've been covering patients for decades, often to the frustration of my peers. Yes, that was me trying desperately to cover some aspect of the patient's exposed body as they were flying through the halls in full arrest, breasts and pubis on full display to anyone who happened to be nearby. I'd get yelled at, but I didn't stop. I would want someone, anyone, anywhere to try to protect my dignity no matter how inconvenient, as long as they didn't stop the process at hand.

I've been a covering type since my early days as a nurse. We were taught to protect the patient's dignity. If I saw an elderly patient being cleaned, clutching the side rail with their behinds fully exposed, I found a bath blanket and used it. No need to give them hypothermia as well as shame.

In my mind there are two types of caregivers; those that cover and those that don't get to it until later. Does it mean they are less caring? I don't know the answer. I do know it probably means they have spent very little time on the "other side" of healthcare. I prefer to cover...even if it means I will continue to get yelled at. Once, I angered a nurse by pulling a sheet partially over a woman's fully exposed breasts. I didn't feel it was necessary to transport her completely exposed to the world. The nurse promised to "rip my gown off and expose my chest" in a similar fashion should I need care in her unit in the future. Aaaaaarghh!!

You know what? I think that's OK. Because if covering = caring, as Johnson and Johnson has put it out there, I know one of my colleagues will be ready, willing, and able to apply a thick (and perhaps toasty warm) blanket to soothe me. In fact, I'm counting on it. I believe we have it covered.

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The Life of Riley
November 10, 2015 3:11 PM by Diane Goodman

According to the ANA, three of four nurses report feeling burnout during their career. Nurses in high stress and/or high turnover environments are more likely to experience feelings of burnout, as are shift workers, and those who work extended hours (i.e. ten to twelve-hour shifts). Nurses may experience weight gain, malaise, feelings of frustration, and apathy before they recognize the need to "refresh" their spirit and sense of well-being.

Nurses may or may not verbalize these feelings to peers or colleagues, or even to family members. Without intervention, nurses with severe burnout may leave the field of nursing altogether, or search for an alternate type of nursing where they can recreate feelings of caring and self-worth.

I didn't recognize my own sense of putting one foot in front of the other until the day I met Riley. Riley, a tiny bundle of white fluff that my husband believed was "meant to be", brought a renewed sense of purpose, family, and laughter. She was barely 10 weeks old, but like all puppies, she's adorable, incredibly busy, and full of a sense of wonder with everything in her world. So what if she chewed through the ties on my shirt? I had others. Suddenly, I remembered the importance of taking in moments aside from work, and remembering other loves: music, literature, and breathtaking art. My soul began to take in great big, gulping breaths of fresh air...as if the air had been stale for quite some time.

In nursing, we spend so much time giving we forget that it is just as important to "put back". Once we become empty vessels we run the risk of losing the beauty of our profession, the contentedness that allows nursing to be special. In fact, statistics have demonstrated that "caring" nurses (those who entered nursing because they believed it to be a calling) are actually at higher risk of burnout than those who chose nursing as a career.

So, please, take time to smell that bouquet of roses. Listen to birdsong while taking a brisk walk, or gaze for a few minutes at the last bit of nature's bounty in the display of fall color. Hang out with the precious innocence of new babies, either the animal OR human variety, for they renew our faith and hope for the future.

Burnout is almost a given if you're a nurse, especially if you work off-shifts or long hours. Take time to put back whenever you can.

And me? I've been dealing with losses along the way, but we've decided it's time to breathe life back in. She's little, she's cute, and possibly a handful, but for us, she'll be the life of Riley.

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Why Grief Can Be Divisive
October 23, 2015 11:12 AM by Diane Goodman

We lost one of our 4paw doggies this week. Kiki became critically ill without warning, and in spite of aggressive therapy, we lost her. You're never ready for one of these things, especially since we lost another dog last year. Maybe we thought we should be done for a while. We've lost parents, friends, colleagues...it's been quite a string of losses, as I'm sure a few readers have experienced. You get to that point in life, with the passage of a few birthdays.

One of the hardest lessons I've learned as a nurse and a human being is that grief doesn't necessarily become the glue to hold people together. Grief can cause friction, heartache, and divisive behavior. Like snowflakes, no two people grieve alike. Grief is highly individual as well as painful, and conflict can occur. As nurses, we learn a few skills to make grief and loss less difficult, even when it's our own inner circle. People who need to be alone to grieve can be driven nuts by those who want to talk through their emotions. The "talker" may need to find a close friend who can help during intensely lonely times, even if it's a brief text or two.

Learning what to say is as important as what not to say. Anyone who owns and loves an animal knows it's important not to say "well, she was just a dog", as dog-lovers feel that they have lost a member of their family. Saying that the loved one is in a "better place" is making religious assumptions that should probably be left unsaid, unless you know the griever quite well. Same with the phrase "God must have wanted to take her", although being reminded by a family member that the Pope said "all dogs go to Heaven" did bring a smile.

What you can do for the grieving person is to offer a simple "I'm sorry", and let them know you will be there. If they seem to be having difficulty with small tasks, grab their daily espresso and drop it off for a day or two, or pick up their mail. If you know one of the family members needs to have alone time, offer to take the others for a quiet meal at the mall, or dessert. Take them OUT for a chat, so they can discuss what they miss most or how they're feeling without guilt or infringing on someone else's quiet time. Do not package up dog toys or bowls or belongings without express permission, as people can get very touchy about these items.

People have fought for years over the fact one family member threw out the last paper cup a spouse drank out of without asking anyone's permission. Remember, handling grief is like snowflakes. No two people are alike. Be available. Be helpful with small tasks. Be genuinely sorry.

And don't touch anything.

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Every Woman's Story; Fighting Breast Cancer
October 1, 2015 2:15 PM by Diane Goodman

Erin was a lovely young woman, and she could have been anyone's patient, but she wasn't. She was mine. We started out on the wrong foot the morning of her surgery, with her physician yelling at me, fussing about finding the correct paperwork, appropriate analgesics, etc. He wasn't angry with us, he was displacing feelings of frustration. Everyone felt his angst and pain.

Erin's case was a tough gig from the moment we met. Sweet, gentle, totally unprepared for a diagnosis of Stage IV Breast cancer. She was 29 years old, a new mother who never had time to BE a Mom. Her physicians had assured her the annoying lump she found was a milk duct cyst...but of course it wasn't, and by the time she was officially diagnosed the cancer had invaded her pleura, lymph nodes, and the right lung. Erin wasn't surprised. She had known something wasn't right. Her gentle spirit led one to believe she was soft and fluid, passive, but underneath, she was solid steel, and she knew what lay ahead. She faced her disease with a dignity I have never forgotten. The world would have been a better place if Erin could have reached the age of 30 and beyond. She was a warrior, and I was so, so proud to have met her and participated in her care. I will never, ever forget her.

Erin's story could have been any woman's story, yours, mine or any of the 231,840 women who will still be diagnosed with invasive breast cancer in 2015. The statistics remain staggering and intimidating, yet Erin would encourage us to be strong. She would urge all of us to continue to fight the good fight and battle on against breast cancer. Caught early, breast cancer is a disease that can and will be conquered.

Schedule your testing, and encourage your loved ones to do the same, but please, don't stop there.

Follow your instincts. Statistics alone will not keep you well. If your body tells you something feels "off", check it out. Get a second, or even a third opinion.

October is Breast Cancer Awareness Month. Please...let's do Erin proud!

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Whose Hip Is It, Anyway?
September 8, 2015 1:15 PM by Diane Goodman

We have a shared joke among nursing peers. If a disease exists that is both rare and extremely painful, a NURSE will manage to be diagnosed with it. Never fails. Whether it is Murphy's Law, or some obscure nursing karma, this has proved to be true for my friends. As a result, we were not overwhelmingly surprised when one of us was diagnosed with advanced avascular necrosis (AVN) of the hip.

OK, it was me.

As soon as the diagnosis was confirmed, the unsolicited advice began, as well as the questions. Hadn't I been having difficulty walking?? Wasn't the hip painful?? Didn't I suspect there was a problem?? Yes, yes, and yes. As nurses do, I had acknowledged the pain, filed it into the deep recesses of my brain, and soldiered on. Once the clicking, snapping, and joint instability began to interfere with ADL's, I was forced to admit I needed to move to plan B. Plan B (as I knew it would) involved total joint replacement. Pushing through the pain had eliminated any possibility of early treatment or interventions, as I had suspected. Nurses aren't silly, but we DO have a tendency to function well in denial, as I'm sure readers might know.

Once I had a date for surgery, I heard from anyone and everyone who knew about "hips". Advice ran the gamut, from those who did extremely well and were golfing several weeks postoperative to failed hip replacements that required multiple revisions. And the pain...aaahhhh!! Everyone had a story about how painful the surgery would be. I listened, but really, I didn't absorb information. My hip wasn't public property; it didn't belong to a group of people who had unsolicited advice to offer. It was attached to me, a seasoned nurse who had ambulated for months on a dying joint that just HAD to be more painful than anything that could be placed fresh and new into the welcoming space. It was a hip, for Pete's sake. It wasn't open heart surgery, or multiple trauma, or sepsis, or any of the really difficult things we see on a frequent basis. It was a hip. I stayed calm and refused to worry, anxious only to move on.

In follow-up: the surgery wasn't a breeze, but it got done, thank you. And yes, it was painful. (Thank God for nursing care!).

I'm happy to say keeping it in perspective was the best thing to do. Advice is great, friends and relatives even better, but in the end, you need to deal with difficulty any way that works for you. I remembered that, in the end, it was my hip. It was attached to a survivor, a nurse.

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Please Don't Blow My Cover!
August 26, 2015 12:24 PM by Diane Goodman

When I've been hospitalized as a patient, I prefer to remain anonymous. If you recognize me, keep it quiet please. It's not so much that nurses can be difficult patients (we can be), but that the whole patient experience may begin to tank once our occupation becomes known.

You may have had this happen. Once identified as a healthcare provider, your whole experience begins to change. One of two things will happen during your stay. You will either be assessed more frequently by peers who seem suspicious that you could be grading them OR your care will drift into the opposite realm, where staff assume you know the ins and outs of the patient experience and therefore, need the minimalist approach....as in, could you handle your own hourly rounds for the next couple of shifts, lol?!

OK, so maybe it isn't that bad, but I have had peers explain to me that nurses neglected to teach them routine postoperative care because they assumed they knew how long staples stayed in place, how to cleanse incisions, etc., etc., etc. I've also had neurological nurses tell me they learned very little about new baby care (definitely NOT their field of expertise) because it was assumed they knew more than most new mothers given the nature of their occupation. This isn't all that uncommon, really! We're nurses, but we're not experts in ALL fields of nursing...please, don't skip the basics when we need education. Don't assume we already know facts we may have learned decades ago, or not at all!

The opposite effect can be just as scary. No, I don't mind if three students want to come in and observe a nurse accessing my port when I'm a patient, that's what senior nurses love. Just don't ask when my pain level is out of control, or I'm really nauseated, or my family member just got off work and I need that warm fuzzy moment like all sick patients do. I really don't mind wearing an invisible ID badge if I can humanize a bedside experience for another nurse, as long as I can slide right back into patient mode and moan, cry, turn off when I need to do so. Being a patient is tough work, especially in the wee hours when muscle spasms and loneliness seem to collide and coalesce and bounce off each other until the pain "number" starts climbing again.

So, bottom line, if you see me in the hall, or on a surgical schedule, proffer a wink or a smile and pass right on by. Don't blow my cover unless you really need to do so. Healing for nurses, at least in my opinion, is easier on the "down low", and much more informative, too!

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About this Blog


    Diane M. Goodman, APRN, BC, CCRN, CNRN
    Occupation: Clinical Educator
    Setting: Advocate Condell Medical Center, Libertyville, Ill

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