Tag: work

This will definitely make me a better nurse

Probably a better teacher too when it comes to that. This is the kind of insightful critiques that really help me to build the skills I’m going to require to be successful.

I suppose I should clarify; I had a paper returned for revision and among the reasons it was kicked back are:

Missing sentence case for article title – The titles of work appear in title case, with most words capitalized, instead of sentence case. 

Missing italics of journal title – APA style requires the use of italicized font for periodical volumes. 

Separate the single author and the publication date with a comma in-text. 

The abbreviated version of the word ‘volume’ is improperly included. 

All text should be double-spaced

Some rando evaluator

What I’d really like to get from an evaluation is maybe some indication of whether or not I understood the material from the class well enough to put together a coherent argument. What I get is ”MISSING COMMAS, IMPROPER ABBREVIATION FOR ’VOLUME’!”

Which would make sense if I was working on my masters in copy editing.

But I’m not.

This is one of the things I’ve been most worried about

ThedaCare requested Thursday that an Outagamie County [Wisconsin] judge temporarily block seven of its employees who had applied for and accepted jobs at Ascension from beginning work there on Monday until the health system could find replacements for them.

The employees were part of an 11-member interventional radiology and cardiovascular team, which can perform procedures to stop bleeding in targeted areas during a traumatic injury or restore blood flow to the brain in the case of a stroke. Each of them were employed at-will, meaning they were not under an obligation to stay at ThedaCare for a certain amount of time.

Outagamie County Circuit Court Judge Mark McGinnis granted ThedaCare’s request and held an initial hearing Friday morning. The case will get a longer hearing at 10 a.m. Monday.

McGinnis told lawyers for both health systems they should try to work out a temporary agreement by the end of the day Friday about the employees’ status until Monday’s hearing.

Otherwise, he said, the order prohibiting them from going to work at Ascension would be final until a further ruling was made. That means the seven health care workers would not be working at either hospital on Monday.

I intended to write about this when the saga first began because I was concerned, but then I though “Ha! There’s no way a judge in an AT-WILL EMPLOYMENT STATE would tell a bunch of employees they can’t quit their job”, but here we are.

A group of highly specialized hospital employees announced en masse that they were going to leave their current AT-WILL EMPLOYER to go to another facility that paid more. “After approaching ThedaCare with the chance to match the offers they’d been given, [one of the employees] wrote that they were told ‘the long term expense to ThedaCare was not worth the short term cost,’ and no counter-offer would be made”. Instead, the hospital went to court to get an order to prevent the staff from quitting.

And it looks like they’re going to get it.

This is only a preliminary injunction and it doesn’t tell the employees they can’t quit, but it does tell them that they can’t start a new job until the legal matter is settled. There is another hearing on Monday.

Keep in mind that 51% of Americans have 3 months or less worth of savings and 25% have no savings at all. The judge can’t order the employees not to quit but he can (apparently) prevent them from taking another job. I have no doubt the current employer knows, once their employees are prevented from taking another job, all they have to do is drag out the proceedings for a few weeks to a few months and their employees will be faced with the choice of economic ruin or going back to work for them.

It is no secret that hospital staffing is in a major crisis right now and a lot of what is driving that is people taking the opportunity to pursue better paying jobs. The femtosecond this ruling came down, I can guarantee that hospital CEOs all over the country were waking their corporate lawyers up and telling them to get to work filing for injunctions. Why pay competitive wages when you can just get a judge to force your employees to keep working for you? Why pay them at all in fact?

I am a highly specialized, essential worker who is not currently interested in doing the job that I am highly specialized to do.

I imagine people can see why I’m concerned.

Or maybe I don’t?

Bessel Van Der Kolk is a professor of Psychiatry at Boston University School of Medicine and president of the Trauma Research Foundation in Brookline, Massachusetts. He has been studying Trauma and PTSD for decades. His book The Body Keeps the Score was written pre-pandemic but has absolutely exploded in popularity since the whole thing started (I’m trying to wade through it myself right now).

Van Der Kolk was on All Things Considered on NPR this afternoon (his bit starts at around 6:18):

He makes a very compelling argument that, while the pandemic and it’s associated disruptions of every day life are deeply troubling and are, without question, causing an uptick in mental health complaints, those complaints most likely are not exactly “trauma” related. He takes the position that this is an important distinction to make because if you are treating people for pandemic related mental health complaints, and you treat them like they have PTSD or other trauma related issues when they don’t, they may not be receiving the best, most effective treatment for their condition.

I intend to discuss this with my therapist, and the psychiatrist I was referred to by Dr. Rando, but I think Van Der Kolk’s thinking is correct and it is much more likely that what I’m suffering from is garden variety stress and burnout rather than PTSD. I view this as good news because it means that, after my appropriately lengthy time away from work (it will be close to two months by the time I start my new job in February), and the addition of clonidine to my medication regimen, I should be able to get back to work without further issues.

I could be wrong but there is really only one way to find out: wait and see what happens.

Yeah, so I have PTSD

And generalized anxiety disorder as well, just for good measure (F43. 12 and F41. 1 for those tracking ICD-10 codes). I’ve probably had PTSD for a while now just based on the most common reaction I’ve had when I tell people this, which has been some variation of “Wait… you didn’t know?”

One of the funny1 thing about how my brain works is how it managed to have virtually every symptom of PTSD but somehow rationalize each and every one of them as being not only unrelated to PTSD, but as being completely separate issues that are unrelated to each other. Haven’t been sleeping well? I never sleep well. Been really irritable? Totally understandable, I’ve been busy and under a lot of pressure. Hyper-alert and anxious? I’ve been an ICU nurse for 20 years, being alert is part of the job and I’m just having trouble turning it off. Haven’t been able to make it through a whole shift at work because of overwhelming angst? Fatigue from cancer treatment combined with baseline laziness.

There were a few incidents which really made me think there was something more going on and my increasing dysfunction at work (documented in other posts on this site) was becoming unsustainable. I talked to my therapist, I talked to my primary care provider (actually I talked to Dr. Rando, MD because my regular PCP was booked out until the end of the month) and I got a referral to a psychiatrist. I’m off work until the middle of next month and when I go back to work I will not be returning to bedside nursing. As of the third week of February I will be a nursing supervisor at Swedish.

I’ll probably talk more about this new job later. I have a month to, as my father says, get my nervous system pulled back inside my body and then we get to find out if I can keep working as a nurse in any capacity or if I really have managed to blow out all my circuits.

1 Not like “ha ha” funny, more like “what’s that smell” funny.

I feel like I should put this here

I stumbled across this kind of randomly while wandering around the internets and, for a couple different reasons, thought I should share it.

As mentioned previously, I’ve had the pandemic right up in my face pretty much since the beginning. I’ve watched it spread, wax, wane, wax again and, most significantly I think, I’ve dealt with essentially nothing else in my professional life. My therapist pointed out to me recently that when you’re that close to something, it tends to look very large. Sometimes disproportionately so.

I am by no means downplaying what’s going on. We’re still really not in a good place when in comes to case numbers, rate of spread, and available hospital resources. Models are predicting that the omicron surge will peak in 2-3 weeks with close to 1,000,000 new cases per day in the United States. Keep in mind, too, that the official counts are still, very likely, drastically undercounting. This graph is wastewater analysis from Boston showing the increase in viral DNA in sewage. The spike from omicron completely obliterates the spikes from all the other surges we’ve seen so far suggesting that there are likely significantly more cases than have been recognized;

All that said, we have come a long way from the beginning and there is still hope that we can survive this with something that looks more or less like modern society relatively intact.

Now we come to what brought me here today;

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, biostatistician, professor, researcher, wife, and mom of two little girls. During the day she has a research lab and teaches graduate-level courses, but at night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions, rather than decisions based in fear. 

The most recent newsletter is entitled “There is good news” and is worth a read. Things are bad but they could be worse and they will get better. Eventually.

Anyway, read it and feel some momentary relief from the doom that I’ve been spouting.

https://yourlocalepidemiologist.substack.com/p/there-is-good-news

Another day, another surge

As has been noted previously, I have been putting in some hours doing contact tracing with employee health. This has been good in that it has given something to do that I can get paid for while I’m not at peak performance. This has been bad because it is a naked, unblinking look at the waxing and waning of the pandemic.

Over the last two days I was covering the afternoons on the covid symptom line, responding to people who have left voicemails reporting exposures or to get set up for testing when they have symptoms. I started at 4pm yesterday and found that there were “more than twenty messages”, according to the unjustifiably cheerful automated voice on the voicemail box. I spent four hours responding to messages, cleared 15 or 20 of them, and when I was done there were still “more than twenty messages” and I hadn’t gotten past messages left at 10:00 that morning. I did another four hours today, cleared another 10-15 messages, still had “more than twenty messages” in the queue and didn’t get past messages left at 11:30 yesterday morning.

The good news is that all the people I talked to that were positive for covid were vaccinated nd not terribly sick. The bad news is that there were maybe two or three that said they had been exposed at work and all the rest had a story that was some variation of “I got together with my family over Christmas and my [aunt/uncle/cousin/sister/brother/whatever] tested positive [the next day/a couple days later] and now I’m feeling sick”.

STAY THE FUCK HOME!

Apparently, mental health is a real thing

There is a possibility that I’m overgeneralizing somewhat with this, and I may also be doing some post-hoc revisions of my internal dialogue. That said, what follows feels true to me and has allowed me to resolve some very perplexing things that my brain has been doing.

For some time now I have been having a harder time than usual with work. I’ve been finding it increasingly difficult to go to work in the first place and once I’m there I have a really hard time staying. This is not an entirely new phenomenon, and is also not unique to me. Who looks forward to going to work and who is happy to be there once they arrive? Almost no one, that’s who. That said, this has felt very different than the usual vague malaise of dissatisfaction that comes from having to put down Animal Crossing and leave the house.

“Well of course you’re having problems,” you might say, “you’ve been in cancer treatment and dealing with fatigue from that. No one expects you to be at the top of your form!”

This is true. I have a very real physical medical condition and I have unquestionably been experiencing some physical side effects from my treatment. However, at this point there really isn’t any reason that these side effects should be as limiting as they appear to be and, if I’m completely honest, they probably aren’t as limiting as I have been allowing them to be.

As I have discussed here previously, my brain constantly tells me that I am malingering or exploiting the system somehow because, in terms of physical health, I likely could be working without any restrictions right now. The slow realization that there might not be an actual physical problem sapping my willpower and energy has kicked the “you’re just a lazy bastard” message from my brain into overdrive in the last few weeks

Again, though, I genuinely have been feeling like I’m incapable of working, and the worst scolding from my brain hasn’t made it any easier to keep pushing and just do the work, so WTF?

At this juncture it is important for the narrative that I mention my longstanding prejudice when it comes to mental health. My poor opinion results from long years of dealing with the healthcare consuming public, which certainly has no shortage of people with genuine, serious issues, but also no shortage of people just trying to game the system. The way my mind works, it comes down to Sick or Not-Sick. You can’t objectively measure depression, anxiety, and trauma so they probably aren’t real. Intellectually I know this is nonsense and when it comes to patients I try hard to stay aware of this bias and to not let it affect the care I provide.

When it comes to myself, though, it is something of a blind spot. Deep down, I don’t completely accept the notion that my mental health is a real thing that can actually affect how I approach the world. Again, intellectually I know this is nonsense but that seems to be how my brain wants to see things.

Keeping all that in mind, my thought process has been something like the following;

Stage 1

  • The only valid reasons for me being unable to work are physical ones.
  • I’ve been feeling very limited in my ability to work.
  • Therefore, something must be physically wrong with me.

 Stage 2

  • The only valid reasons for me being unable to work are physical ones.
  • I don’t physically feel all that bad, really.
  • I still appear to be limited in my ability to work.
  • Therefore, I must be faking it. 

Stage 3

  • The only valid reasons for me being unable to work are physical ones.
  • I still don’t physically feel all that bad, really
  • I still appear to be limited in my ability to work.
  • This doesn’t feel at all like I’m faking it.
  • ???

The explanation, of course, is that my first assumption is faulty. I really am limited in my ability to work but at this point it’s for mostly psychological and emotional reasons, not physical. 

In February of 2020, an emergency room doctor at Evergreen Medical Center in Kirkland was infected with Covid. His condition deteriorated quickly and he was transferred out of the ICU at Evergreen to Swedish Cherry Hill so he could be put on ECMO. He was the first Covid patient on the west coast, probably in the whole United States, to be put on ECMO. That was my unit and I was one of the lead ECMO specialists.

I lost count of how many more Covid patients we put on before I left Cherry Hill. They all were insanely sick1, insanely complex to care for and most of them died, as did most of the Covid patients we had that weren’t on ECMO.

This went on non-stop.

For months.

And it still hasn’t exactly stopped yet.

There was a lot of non-Covid unrest at Swedish at the time as well, of course, so I had plenty of reason to be discontent before I left. Given that mental health isn’t real, I attributed my angst to the external situation and didn’t think about it past that.

Since then I have changed jobs two more times for a total of three job changes in the last 18 months or so. Each of the jobs ended up feeling unsatisfactory for one reason or another and, like I had at Swedish, I felt compelled to leave. True, the working conditions weren’t (and aren’t) ideal but I’m also starting to think that there is an underlying current of mental disfunction that is making it nearly impossible to get comfortable and settle in.

The point is that it has been a difficult couple of years and perhaps there could be some lingering trauma that I’ll probably need to deal with at some point.

For all my airs of professionally detached objectivity, I may be merely human after all.

Looking after my mental health has never been one of my strong suits but entertaining the idea that I could be mentally fatigued enough to impact my job performance has been something of an eye-opener. It explains a great deal of what I’ve been experiencing and it has already helped me to get the asshole part of my brain to shut up every now and then. Beyond that, I’m not sure if this shift in thinking will make any difference or not.

This post was very long and has an unsatisfying conclusion. It also may not matter because, hopefully, I will be changing jobs again in the near future.

But that is a story for another day.

————

1 I’ve talked about this before too, although I can’t remember if it was here. I don’t think it’s possible to convey the actual reality of how sick these patients were/are to normal (non-medical) people. Even most medical people, I think, fail to grasp how sick they are. The best analogy I’ve come up with is that caring for these patients is like trying to keep someone who is on fire alive but you have to do it without being able to extinguish them. I love doing that kind of work but it is exhausting under the best of circumstances.

Oh look!

Now that I’ve neglected this to the point that no one is reading anymore, it’s safe to post again.

The truth is there hasn’t been anything happening on the cancer treatment front, I’ve more or less settled into a routine with work, and my mental health is better overall than it’s been in quite a while. Of course that has meant I haven’t needed to whine about anything here. And I pretty much still don’t but there are definitely things on the horizon.

Looming largest in my mind right now is another covid surge. I’m sure any number of the none people reading this have heard me lamenting that I couldn’t do another year of covid and it’s looking like another year of covid is a good possibility. Having spent no small amount of time ruminating on this, right now, from a mental standpoint I think I actually could do another year of covid. I would certainly be happier to not have to but, strange as it may seem, having a couple months mostly away from the bedside may have allowed me to recharge my batteries a little bit. Well maybe not another year of covid, maybe six months. I don’t know. Anyway, the point is I could definitely do one day at a time which is more than I would have been willing to say a few weeks ago.

As an aside – there really isn’t enough information on the omicron variant to make any definitive statements about what the next year is going to look like. What is noteworthy is that in South Africa, where omicron was first identified, the delta variant was pretty much the exclusive strain being passed around and omicron is out-competing it and is on it’s way to becoming the new dominant strain. It is a deeply concerning variant and an excellent reason to get your vaccine booster ASAP if you haven’t already.

Anyway, this revelation that stopping to rest for a while can replenish one’s stores of mental and physical energy is the latest in a series of startling discoveries I have made recently now that my brain has had time to reboot.

The first of these came to me maybe two weeks ago. I believe I have lamented here before that I didn’t really know what to do with the advice to “make time for yourself”. The foundation of my difficulties was that I had more things to do than time to do them and it was impossible for me to make time for anything else. Short of actually making time (see any number of science-fiction stories to learn why that isn’t a good idea) I genuinely couldn’t comprehend how I was supposed to “make time for yourself”.

My revelation came while putting together a to-do list for the week. As was usual, I knew there wasn’t going to be time to get to everything so I was triaging and prioritizing what I really had to get done and what I could let slide and it occurred to me that I could just put myself on the to-do list and treat it the way I would any other project. And that the time-for-myself project didn’t always have to be the one that got dropped when it came down to prioritizing for time. If I had been on the road to Damascus I would have fallen to the ground. This was a revolutionary technique that I could use to try and…

…right… make time for yourself… like everyone has been telling you to…

Ahem.

Right. So I’ve been making time for myself and the world hasn’t ended yet.

Clever Title

Back to school. This is (hopefully) my penultimate term in my masters program and what happens after that is not at all certain. I had hoped to have the basement done before I had to start school again but in spite of that I think I’m at a point where I’ll be able to manage.

Work has been interesting. There is an actual sick (in the previously discussed “sick or not-sick” sense) patient on the unit right now, one of the kind that I have spent the last 5-ish years specializing to take care of. The unit at my current place of employment has some very smart, very capable nurses and doctors but very few of them have a lot of experience caring for specifically this kind of patient. This is the kind of patient I would very much like to see more of on the unit and, I think, that is a goal that is shared by the Powers-That-Be at the hospital.

So there’s this sick patient and one of the assistant managers texted me to ask if I could come in to work tonight to help out. A couple more bits of relevant information; I worked last night, it was a pretty exhausting shift, and I didn’t get much sleep today for several different reasons. I’m really tired, is the point to all that. Even so, if this had been not that many years ago, I would have said yes without even pausing to think. I had told managers and physicians that I would live at the hospital 24/7 if that’s what was required to take care of the patient and I nearly did on more than one occasion.

I’m going to go on a little side-track here but we’ll get back to the main storyline in a moment. I have frequently thought that when I tell someone about the long hours and short sleep that I put myself through to take care of these complicated patients, they infer that this is due to some depth of character and dedication to the nursing profession that drives me to do these things. Nothing could be further from the truth.

The fact is, being a bedside nurse is kind of a shit job. All too often it is literally a shit job. Yes, it pays well, but really the only thing that makes all the, literal and figurative, shit worth it is if you’re doing something interesting. I pushed myself taking care of these patients because I wanted people to keep sending those kinds of patients to our unit. I wanted the admitting services to know that they could dump the sickest patient imaginable on us and we’d take it happily. Being a nurse is the only thing I know how to do that someone will actually pay me for so, if I need to keep working as a nurse, I need a good supply of crazy sick patients so I don’t get fed up with all the nonsense. This could potentially be a much longer tirade but I don’t want to lose focus.

The end of the story for today’s incident is that I did not go in to work. I really wanted to for all the above discussed reasons, but I also knew that it would really not be good for me and self-care won out.

Also, tomorrow we have our first D&D game in almost two months and I am not missing it.