Back to School

Those 3 little words…that get me all tingly from head to toe…BACK. TO. SCHOOL. Yeah, I get it…most people probably feel horror-movie chills as opposed to a buzz of excitement when hearing that phrase, but what can I say? Back to School Season GIVES. ME. LIFE. Don’t get me wrong, after graduating nursing school I was MORE than ready for a break from academia. I had spent the last 16 years of my life operating on a “school calendar year” and putting school first and I was SO READY to finally put LIFE first instead. And I did. It has felt so wonderful to LIVE these past few years post-graduation…to travel, to move to and explore new places, to focus on my career and developing professionally, to write FOR FUN, and to just focus on creating an independent life for myself.

But now I can tell I’m itching to hit the books again, to flex my brain, and to take this next leap of faith on my nursing journey. Going back to school has been in the plan for quite a while. I knew I needed time to rest and recharge, and now it’s time get back at it.

In just a few weeks I’ll be starting on the path to obtain my DNP (Doctorate of Nursing Practice) Degree from Creighton University. By the end of my specific program, I will be a Dual Certified (Acute/Critical Care and Primary Care) Pediatric Nurse Practitioner, and I may even add on a Certificate in Nursing Education, who knows? So how did I decide on this school, this program, this degree? I know deep in my soul that I am meant to serve and care for the pediatric population. I want to gain a deeper understanding of pediatric health, to learn more about contributing to nursing research, and to engage in the important clinical and academic work that advanced practice nurse leaders are doing in this day and age. I want to share my knowledge with others, by educating families and patients, and by mentoring nursing students. But I’m not sure WHERE I want to do this work. Primary, Acute, Critical Care, Specialty Clinics, some combination of all of that…I want a degree that will work for me, and allow me the most flexibility possible to create a career that can adapt to my life as it inevitably changes. And I wanted similar flexibility with the school itself. I’m approaching school in a different stage of life this time: I have a career I’m working on, a job, a life outside of all of that to balance. Creighton has designed this program to be online, requiring a short visit to campus once a semester for in-person clinical skill days, seminars, and workshops. But I can continue my current job, set up clinical rotations in my home area, and complete school work on my own schedule.

One of my favorite things about Creighton is their emphasis on the value cura personalis. This Latin term translates to “care of the entire person”…THIS is what it should mean to be a nurse, or any sort of healthcare provider. We’re taught in nursing school how to address ALL areas of a patient’s health (physical, emotional, social, etc.) and it makes so much sense when you study how all these different areas of health affect one another, but incorporating this into real-life practice is easier said than done. Healthcare workers and patients/families may often have similar “to do” lists for the patient situation, but they often prioritize different things. As providers we tend to prioritize interventions and data and physical health, making it more “about the numbers”. We often approach care in a checklist format, a list of things we need to get done to help the patient move towards recovery. I’ve found it’s more common though for patients and families to prioritize feelings and sensations and more personalized health goals instead (caring more about feeling less pain, being able to walk to the unit door to greet a visitor, being able to hold their baby to bottle feed them at last….less about what their net fluid balance will be for the day, how many milliliters of milk they drank, etc.) Not to say both parties can’t care about the same things…they often do. Families become deeply involved in their child’s care, and they do know about “the numbers”, the goals for intake and output and hemodynamic monitoring parameters and what they mean to the team of providers. And observant, involved providers genuinely care about the more personal goals of their patients. Much like in any type of relationship, it takes both parties being able to articulate their priorities and work to balance those priorities together so that everyone involved can be satisfied with the overall outcome.

It takes conscious effort and discipline to put cura personalis into practice. And the more I’ve reflected on it, the more I realize this value shouldn’t just apply to the care I provide my patients and families, but to how I care for myself as well, and how I approach life as a student. In the past, I had the tendency to focus on “the numbers” (grades, scores, getting my checklist of work done on time) and less on balance and prioritizing more “holistic” goals, like “feeling balanced this week between being productive and relaxing/being social”. I wasn’t always caring for myself as a whole person. I know there are others out there who have been in my shoes, and while we should certainly be proud of our accomplishments, we can always strive to try to achieve more balance.

Distance learning is going to be hard. It’s going to be lonely at times. Frustrating, confusing, overwhelming. It’s going to take an elevated level of discipline to maintain balance now. But it’s going to be worth it. I just need to remember my “why”, and focus on caring for myself as a WHOLE person. This isn’t just something I’m going to “get through” or just “get done as fast as I can”. I’m entering a new chapter of life and embarking on a journey…I want it to feel like an EXPERIENCE, not just a checklist of classes and assignments and exams I need to finish. I’m sure I’ll have good weeks and bad weeks. I’ll feel balanced for a few days, and then fall short. But I’m no stranger to getting up and pressing on after falling down (both literally and figuratively). It’s all about that ongoing journey to creating a sustainable balanced lifestyle, and striving to translate cura personalis into reality.

Make Every Day Your Masterpiece

Pre-COVID in the Milwaukee Art Museum, one of my favorite inspired spaces

Environment. Atmosphere. Ambiance. Wherever I exist at any given moment, the feel of a space matters to me. I feel like I’ve always been very sensitive to moods…my own mood, others’ moods, and the mood of the space I’m in and the day I’m living. For years now I’ve become very intentional about finding “inspired” spaces that will fit my mood and my mental energy needs for the day (my favorite thing to do in college was find as many different study spots around campus as I could). I’ve found that I depend heavily on my surrounding environment to nurture those feelings of inspiration, motivation, focus, and overall well-being. If I’m not in a good physical space, I won’t be in a good headspace to learn, work, and create.

The composition of a space, or my ideal environment for the day has always fascinated me. My late great-grandmother was a cook and even into her late years, she believed in the proper composition of a plate of food and flavors: warm, cold, crunchy, savory, sweet, sour (I can attest I am turning into this person as well). Much like how a chef creates a perfectly balanced meal, I believe there needs to be balance to the elements of my environment and space.

Lighting:

I worked night shift for about 2.5 years and I’ll be honest, I struggled. When switching myself back to “normal life” on my days off, I was so grateful for how natural light reset my mind and re-centered my soul. I’d force myself out of my dark sleeping cave and into the light: I opened the blinds, stepped outside, took a walk, or headed to an airy coffee shop filled with an abundance of natural light. This strategy did WONDERS for my mood, energy level, and for recalibrating my circadian rhythm. I transformed from a sluggish, groggy, unmotivated empty silhouette to feeling more “human” and “whole”. There is a calming, serene sense of healing and gentle warmth as I exist in the light.

Even though I no longer deal with “night shift hangovers”, I am still perpetually drawn towards the light and spaces with lots of windows. Some of my notable favorites include EPIC Software Headquarters in Madison (the campus was open to the public and I would walk around there for HOURS taking in all the light and scenery), the Milwaukee Art Museum, and the array of airy downtown cafes I frequent on my days off. The direct access to natural light is a truly transformative quality in these spaces, instantly bringing a sense of freedom, openness, and a breath of fresh air indoors. They melt away the sense of confinement naturally imposed by any walls, and allow one to be as close to the outdoors as possible, even if one desires or is required to stay indoors. In Rogier van der Heide’s 2011 TED Talk “Why Light Needs Darkness”, the lighting design architect expresses that light is essential to improving the quality of a space within the built environment, and that actually seeing the sun gives us a better life within this built environment. Similarly, Swiss-French architect Le Corbusier gives a nod to this notion as well, “Light creates [the] ambiance and feel of a place, as well as the expression of a structure”.  

One of the buildings and sections of the EPIC Software Campus in Madison, WI

Heliotherapy, or the therapeutic use of sunlight is nothing new and radical; it’s actually a foundational concept in nursing, dating back to the days of Florence Nightingale, who advocated strongly that fresh air and sunlight were seemingly small, but essential components to promote healing. She believed not only in the scientific advances for a cure, but also in creating an environment in which to heal. This is a consideration that I feel has a tendency to get pushed aside when considering patients’ lives or our own, even though we are taught as nurses that one’s environment plays a major role in influencing health. I think of the way light enriches my own life, and my mind drifts to the incredible ways we could enhance our patients’ lives with more direct access to natural light, even in the hospital setting.

Music/Sound:

Some of you know this, some of you may not, but I was very heavily involved in music and the performing arts from a young age through most of college. In some way or another, music has been a part of my daily life and I’d go so far as to say it is a requirement in my day. I’ve never really known how to describe my taste in music…but I can tell I’m quite sensitive to different instrumental sounds, keys, styles of voice, and interesting or strong rhythm or beats (I attribute that to my inner percussionist…I live for a good beat). In comparison to others, I’m just more sensitive overall to how a particular song makes me feel, and I have a much more visceral, definitive reaction to whether I like or dislike certain music. To me, different sounds and beats fit different moods, and it’s very important to me to listen to the specific style of music that will fit my mood in the moment.

The inner physical reaction to music is REAL; in my current job at Children’s Wisconsin, we have a Music Therapist who sees patients all over the hospital and uses different instruments (including her own voice) to help them cope with the physical and emotional stress response to hospitalization. She pays close attention to vital signs and explained to me how she coordinates her tempo and rhythm of a song to the patient’s physical reaction to the music…there is truly amazing science behind this form of therapy that perhaps one day I’ll explore more, but for now I will hold on to my favorite memory of the role that music played in creating an ideal environment. The Physical Therapist, Music Therapist, and myself all tag-teamed a particularly distraught toddler while the patient’s parents were gone for several hours. We ended up walking the patient off the unit and around the hospital, me pushing the IV pole, the PT holding the patient in her arms, all while the Music Therapist quietly strummed her guitar and sang lullabies to the patient. For over an hour, we existed in this healing environment we created, despite less-than-ideal circumstances. It will always be one of my favorite memories as a nurse, where the power that music has in creating an ideal space was manifested.

Aroma:

I’ve just recently had the realization of how important this element of a space can be. Looking back, I remember my friends and I would rub peppermint oil on our wrists and neck before every single exam we took in nursing school…the scent was vibrant and refreshing, and it became an important part of creating our environment of focus. I think my first “game-changing” exposure though to the power that aroma has in a space was when I worked in Madison as a Transplant Nurse. In addition to our usual transplant patients, we also cared for a very specific patient population who all underwent a rather cutting-edge atypical “transplant” surgery. These patients were often younger (in their 20’s-30’s) and had dealt with debilitating pain that took over their lives before their surgical repair. I loved caring for these patients for many reasons, but one of them being that they all had the “healing environment” nailed down. Most rooms I would walk in, it was very obvious you were in a hospital, but I just loved the feeling these patients’ rooms had…I’d walk in and immediately be greeted by dim lights, the patient with headphones on listening to their favorite music, a bed full of their favorite blankets and pillows from home, and I swear almost all of them had an essential oil diffuser. The healing aromas of citrus and lavender and peppermint filled the air and I remember forgetting I was even in a hospital room. Once again, these people were creating the environment they needed, even in less-than-ideal circumstances.  

I won’t lie, I’ve been having difficulty finding beauty around me lately and finding an inspired space. We’re coming out of a less-than-ideal time of year in Wisconsin. Late winter is just that time when daylight is short, the snow isn’t magical anymore and is just a nuisance to drive in, cars are covered in a thick layer of wintery grime, not even a poppin’ outfit can make me feel good, I feel a sickly translucent shade of pale, it’s too bitter cold to spend any time outside and the world just seems gray, lifeless, dull, and in desperate need of a deep exfoliation/moisturizing treatment overall. This isn’t new, this phenomenon happens every year, but I think it’s been particularly tough in the era of a pandemic. But if I’ve learned anything from my anecdotes here, it’s that in less-than-ideal circumstances you can still find that inspired, healing, refreshing space that will fit your mood and mental needs…you just need to put in some extra effort to create it.

So let’s get to work, my fellow creators! Let’s create our spaces, our environments, with attention to ambiance and mood. Find yourself some direct access to natural light for some heliotherapy, breathe in your favorite aroma (I am officially on the essential oil diffuser train and I LOVE IT), think about how you want your playlist to make you feel while you get ready in the morning, work out, cook, answer emails, etc., get yourself some greenery (fake plants low key changed my life and my living room), think about what you want to accomplish in your space at the moment, do you want to be alone in a crowd where you could (safely) perch yourself in a café, or do you want to steal away to a hidden nook for pure solitude? There are options aplenty!

I am hopeful, the feeling is stirring…there is something beautiful coming. But never forget your own power to create, to make each day, each space you exist in, your masterpiece.

When We Grow Up

“Staring…at the blank page before you..” Here we are friends: staring a brand new year in the face. It’s that time when fresh starts, big dreams, and a rejuvenated sense of motivation take center stage. Call me Type A, but I find it to be rather comforting to create a map of sorts at the start of something new…where do you want to go? What are some stops you’d like to hit along the way: things you want to accomplish?

It’s fairly obvious how this “mapping out the journey” applies to the context of a new year, but what I really want to chat about is the crucial role this played into the start of my career…and the role it can play in your professional and personal life too.

“What do you want to be when you grow up?” It’s a question we’re asked from the time we can talk, all through our adolescence. As the years go by, our answers may change, and the seriousness with which we regard this question increases as well. However though, this can quickly turn into a stress-inducing question for many, and there can be an unspoken stigma surrounding possible answers.

So here’s my challenge for us: Let’s take away that stigma, and that stress. Let’s broaden our view and make things a little more open for ourselves, let’s shift our “future focus”… let’s start asking “WHO do you want to be when you grow up?” Go further than just the “what”, and have this important follow up question in the back of your mind…WHO is this person?

Still confused? Sit back, relax, and let’s apply it:

“What do you want to be when you grow up?”

“I want to be an actress!”

*Cue the stigma*:  nervous glances between listeners, quick to judge and slow to remain open-minded and dig deeper, they whisper “Will she make it?” “What happens if she doesn’t?” “Will she really find a job?” Confidence cracks, doubt seeps in, and you start to grow weary, feeling like you need to justify your “what”.

HOLD UP, SISTER. You just stop right there. Let’s rewind, replay, and reword. Let’s have a little more open-mindedness when it comes to one’s “future focus”:

“WHO do you want to be when you grow up?”

“I want to be an actress! The kind of actress who uses her past experiences to connect with her characters, and connect with her audience. I want to be a person who feels inspired and inspires others. I want to be an actress who reaches out to mentor young children interested in acting and help them express themselves in a healthy way!”

See what we did there? By opening up our minds and shifting our “future focus” from WHAT to WHO, we encourage those we ask to get specific and really think about the kind of impact they want to have and characteristics they want to exhibit and values they want to hold no matter WHO they decide they want to be.

From around age 10, my answer to “what do you want to be when you grow up?” was “a nurse!” It never wavered, and my enthusiasm for my answer grew through the years. I would often receive this response: “It takes a very special person to be a nurse!” It was curiously vague, and made me start to wonder…who was this person, in my eyes? What characteristics did they have that made them a nurse? What would it mean to say “I’m a nurse”?

We talk a lot in this profession about how being a nurse really becomes a part of your identity. And to me, identity implies WHO you are, not just WHAT you are. So I wondered, how could I create an identity that was unique to me not just as a nurse but as a whole person, an identity that encompassed both my personal and professional goals and values? WHO did I want to be?

Here I was, “finding myself”. I wasn’t just in school to learn the skills necessary to be a nurse, I wanted to take the time to start mapping out my career legacy. What did I want to accomplish as a nurse? Who did I want to be remembered as?

So I created a personal brand for myself, my own mission statement that could apply to both my personal and professional life. My mission and purpose is to heal, inspire, educate, and care. To stay inspired, and stay passionate, always. I don’t just want to be a nurse, I aspire to be the kind of nurse who treats her patients like individual masterpieces. The kind of nurse who has a deep understanding of the pathophysiology of her patients’ illnesses. The nurse who is known for her ability to educate patients and families with care and clarity. The nurse who passes her knowledge on to students and mentors new nurses with open arms, never forgetting where she started. The nurse who inspires her team, her patients, her families, and everyone around her to believe that, despite the most difficult circumstances, achieving their highest potential is possible.

Taking my “future focus” further from WHAT to WHO I want to be has helped guide me immensely. I feel a stronger sense of purpose and motivation with this overall “map” to my career. I feel a stronger sense of confidence that I am right where I’m meant to be at the moment…my current work is “on brand for me” (as cheesy as that may sound!) …I feel like what I do now is helping me become my own unique version of this “special person” who has what it takes to be a nurse.

Work to create this timeless brand for yourself, one that will segue effortlessly through the changes and growth you’ll experience in life. One does this by working to discover their true purpose in life, by digging deep and asking WHO do you want to be? Let’s keep our minds open, let’s focus less on WHAT others are but WHO they are. Let’s ask our children “WHO do you want to be when you grow up?” Let’s inspire each other: create your mission, your brand, your vision for YOUR future and legacy. It’s never too late to start.

The Second Year

I’ve worn the letters “RN” behind my name for a little over two years now. And as of October 7th, I’ve spent one whole year serving the small patients in the Cardiac Intensive Care Unit at Children’s Wisconsin. We care for patients ranging from a few hours old to those on the verge of young adulthood; all of them working through the ups and downs of congenital or acquired heart defects, all of them far braver than I ever will be.

This position came along when I believe I needed it most. I was only a year into my career and my soul was craving a new form of inspiration…I felt myself being pulled down by the weight of burnout and it was a broken, frustrating feeling. And if I’ve learned anything from this transition to a new specialty, it’s that if your environment isn’t inspiring you anymore, then CHANGE IT. Burnout not only damages your own health, it damages the care you provide to the patients you serve. The beauty of the nursing profession is that it is infused with opportunity; with just one degree you have countless opportunities to create a career that inspires you, and inspires your patients.

I had dreamed of working on my current unit since before I graduated nursing school. I remember my brief shadowing experience there as a student: I was looking for my nurse mentor for the day and I found her in a patient room, bouncing a small, wide-eyed baby. The first thing she said to me was “On our unit, our patients’ hearts can’t tolerate sustained agitation, so if we walk by a room and hear them crying, we have to go in and comfort them!” As someone who has what I would consider to be an “above-average” love of babies and children, this encounter alone was what sold me, permanently, on pursuing a position on this unit. A place focused on cardiac care (my favorite body system), but full of babies and children who not only emotionally, but physically needed me to help comfort them and do whatever I could to make them happy? THIS was the nursing that I signed up for!! For me, the joy that I feel from making a small human smile is truly unparalleled. The strength of these little ones is one of the most powerful forms of motivation and inspiration to me…children are our future, and when we invest in their health, we’re investing in a healthier tomorrow for humanity.

While the two RN positions I’ve had so far are quite different on the surface, they are remarkably similar when it comes to my nurse coworkers in both positions. They are truly artists of care. They go above and beyond to incorporate those little humanizing details into their care. Whether it was taking time to sit down and listen to a transplant patient share their frustrations and joys on their health journey, or now taking the time to craft little footprint crafts for parents of babies on our unit with phrases like “Mommy and Daddy, I love you from the bottom of my heart to the tips of my toes!”…the nurses I’ve worked alongside these past two years are the definition of unsung compassionate heroes. They care, so much…and not just about the patients, but about each other too. I have never once, in the past two years, felt like I was “all alone” during a shift. They are ALL the kind of people who notice when you start to pick up your pace a bit walking to a patient’s room, and they instantly offer to jump in and help. (But also, sorry W3 nurses…I just walk really fast everywhere!). They are the kind of people that make sure not only their patients are cared for, but that you and your patients are cared for as well. THIS is the kind of culture we need to encourage among nurses EVERYWHERE…I am so proud to work and have worked beside these exemplary women and men.

This year I have felt the most like the kind of nurse I aspired to be during school: a nurse who works with the team to understand the complex pathophysiology of a disease process and appropriate interventions, while still incorporating those artistic, holistic touches into my care. But I’ll confess…it’s tough to be this nurse. Becoming this kind of nurse, fully, takes time and determination and discipline. And I do have plenty of moments where I feel like I fall short. And the path to becoming this kind of nurse, the nurse whose care manifests the intertwining of science and art…seems daunting.

Throughout the year I’ve shared hints of powerful moments and lessons and reflections from my first year as a pediatric nurse, but two recent patient experiences assured me that here, in this space, I am working at the intersection of science and art.

One was a small baby, who had been in the hospital since the day she was born. Despite months on end of complex interventions, her condition kept worsening. She reached the point where not even the ventilator she depended on was fully effective. As she transitioned to comfort care only during her last days of life, her family’s most important wish was for her to go outside, since she had never experienced the outdoors. Not to try the most cutting-edge interventions, not to try a new medication, just for her to feel the sunshine and breeze on her little face. And her team treated this wish with as much importance as getting a patient to surgery. Everyone pulled together to safely transport her in a little wagon full of pillows and blankets along with her tower of IV pumps, tubes, lines, and ventilator outside to the hospital garden, outfitted in a little sunhat made from string and surgical cloths from the supply room. Pictures were taken, memories were made, and a few days later, her machines were turned off and she passed peacefully.

The most recent was one of the toughest moments for me so far as a nurse: it was a young child I cared for quite frequently during his last month of life. He was known to all the nurses and doctors as a sort of icon of the unit over the years. Despite years of surgeries and interventions, his heart continued to fail, and progressed to multi-organ failure and the need for a Berlin Heart (a total artificial heart). A machine now took over the pumping of his heart’s ventricles; for as long as he was connected to the machine, blood would be pumped to his organs. During his months with not only the Berlin Heart, but a tangle of other drains, wires, and a breathing tube, he surpassed every expectation as far as survival; his little body and spirit were indestructible. However, he suffered a series of acute complications over a weekend, and by the time I returned to work that week, I learned that care would be withdrawn on him the next day.

I can’t believe this, little bug. You survived so much. We would all say “he’s got MORE than 9 lives!” But now you’re telling us you’re ready to be free from all of this…the machines, the medicine…it’s your time. We hear you little bug. Can I come stand by your bedside one last time? Hold your little hand and rub your back like you’d ask me to do so you could go to sleep? I hear them say you’re going to donate your kidneys…that is so special, little bug. You needed life so badly, and yet here you are, giving life to another little one somewhere out there. I’m so proud of you.

I stand outside your room as other nurses come in to send you off to freedom. We gather together in the hall, in quiet solidarity. Your nurse and doctor and donation team gather by your bedside. They have only minutes once everything is off to bring you to surgery, to help you begin your donation journey. They are ready. You are ready. I hear the familiar loud mechanical motor of your Berlin Heart machine, even with your door closed, we could always hear it. It became part of the usual background noise of our unit. The doctor reaches forward, and turns the machine off.

The silence….

…is deafening.

I feel it. We all feel it. The weight of silence. My throat is tight. The tears spill out of my eyes and onto my mask.

The wheels of your bed begin to turn. We line the hall to honor you as you pass by, embarking on your next journey. There is not a dry eye in sight. We find comfort in each other, in knowing how many lives you enriched. You are our hero, little bug. Forever and always.

These moments, these experiences, and so many more from this past year…they resonate with my heart and soul so deeply, with my craving for knowledge, my need for creativity, and with my desire for inspiration.

In this moment, I know I am right where I’m meant to be.

Make it Through the Night

I have worked in two very different areas of nursing now, but both with a surgical emphasis. And I’ve felt in both areas that caring for your first post-operative patient who just underwent surgery that day is almost like a universal “rite of passage”. I currently work in the world of pediatric cardiac critical care, and caring for your first critical post-operative patient is a crucial moment of professional growth as a nurse on my unit. It is a moment that arrives generally after several months of experience on the unit with other patients first, and only once you and your trusted nurse mentors feel you are ready for this next challenge. I won’t go into too much detail here, but the small patients who have just gone through open-heart surgery (which is generally 6+ hours long) are of the highest acuity and critical status on our unit. It can be incredibly overwhelming and difficult for caregivers to see their child hooked up to so many different machines and drains and pumps and monitors, but it is our duty as nurses to try and ease that fear through education, and most importantly, to help families see that beneath all the wires and tubes and heavy sedation, their child is still there, and still needs their love. The following reflections are the result of caring for my first critical pediatric post-open-heart surgery patient on my own. You think you are brave until you experience a baby battling valiantly through the shock of open-heart surgery…THAT to me is one of the many forms of pure bravery.

“Even the darkest night will end and the sun will rise”

-Les Miserables

I arrive at your bedside. Your current nurse is exhausted…from sending you off to surgery, awaiting your return many hours later, from the flurry of activity in your first few hours back in your room…stabilizing you, cleaning you up, organizing the mass of tubes and wires and drains protruding from your tiny body. Explaining to your family that beneath the mass of tubes and wires and drains is THEIR tiny body, their baby.

I see you, caregivers. I see it in your eyes, I hear it in your voices…the worry, the yearning to just be there, wanting to be a part of your baby’s healing journey as soon as possible, but overwhelmed by emotion and uncertainty, no matter how much you’ve prepared for this day. Try to trust us. Try to go and get some rest. Try to sleep. Try to replenish your energy. Take care of YOURSELF, tonight especially. Your baby has been through so much today…but so have you. We realize that. Try and find some peace for tonight, and hear my promise to you, to your baby: This is not just any night, it is the FIRST night, and the first night is going to be difficult, but we will not leave your baby’s side. She will not be alone, brave caregivers. You will not be alone, my brave little one. We are going to make it through the night.

It’s just you and me now, little one. I set to work, organizing, documenting, assessing…no detail is too small to be acknowledged. Temporarily paralyzed and heavily sedated by medication, I look to the nuanced ways your tiny body communicates with me…beneath the veil of medication, I know you are still in there. I know you can still feel pain and fear and discomfort.

Am I hurting you?  Are those little tears I see leaking out from the corners of your eyes? Why aren’t you breathing comfortably anymore? Is it because you don’t like laying on your left side? I know you don’t like it as much as your right side, but we have to try, just for a little while. How about if I move your little arm like this and your little pillow like this? Is that better? And now here comes a dose of extra medicine to ease that extra discomfort.

My goodness, you are so brave, little one.

Between the hours I stare at the monitor screens in your room, vigilantly, as though I am engrossed in a captivating film. I watch the numbers change in real time, watching closely for even the slightest deviation from your baseline, repeating over and over in my head what I will do in each possible scenario that may arise tonight. Planning. Preparing.

Other nurses and doctors float in and out of your room. They ask about you, they stand with me in silence watching the monitors. The solidarity of their presence strengthens me. They offer to relieve me, so even when I temporarily leave your side, you are not alone, little one. Just as I promised.

The hours tick by. I perch on the edge of the armchair in your room to give my aching feet a moment of reprieve. Not even on the chair by the desk just outside your door. What if something happens? It’s too far away…she needs me.

I see your blood pressure drop. One point. Two points. Three points. A new baseline is established. Is this acceptable for her? Will her body tolerate this? I alert the doctor. He arrives at your bedside. We stand together, eyes shifting back and forth, from the monitors, to you. We pause, watching for another change, wondering if we need to intervene. Over and over we do this routine as the hours pass by. You wobble on a tenuous tightrope of physiologic stability. I see you, little one. You are fighting. Fighting through this night so valiantly…you are so very brave.

5 AM. I am exhausted. My head aches from the mental exertion I’ve engaged in all night: making sense of the numbers and the changes and why they’re happening and what it all means for your little body. Reminding myself of your heart’s original physiology, and how exactly it caused you to struggle in those first few days of life, and how exactly your heart has been repaired by skilled hands and sharp minds.

But we’re almost through the night. Morning is coming, at last. You are stabilizing. I pick at and primp and rearrange your tubes and wires and drains, adjusting your position in the crib. A swipe here and a swish there, like a painter touching up their masterpiece. YOU are my masterpiece, little one.

I should sit down. Relax a bit. But I can’t. Not just yet. We’ve almost made it through the night.

The moment is here. The sun has risen. Your new nurse for the day has arrived. To them, you look comfortable, peaceful, stable. There is a sense of calm and transient serenity in your room. But you and I know better, little one. We know what it took to reach the morning. I promised you, little one, that you would not be alone for a moment, did I not?

You are small and you are mighty…the bravest little soul I ever did see. Each night you are in my care, I will marvel at the new strides of recovery and healing you have made…

But for now, in this moment, we have done enough, little one. Together, we made it through the night.

The Art of Nursing

***This essay was selected as the first place finalist in the 2020 Dr. Mary E. Wurzbach Nursing Essay Competition, put on by Eta Pi, the University of Wisconsin Oshkosh chapter of the Sigma Theta Tau International Honor Society of Nursing, and has now been published online HERE: https://hekint.org/2020/07/28/the-art-of-nursing/ ***

When discussing her 1991 suspension installation of debris from an exploded shed, “Cold Dark Matter: An Exploded View”, British artist Cornelia Parker described how she often operates in these frozen moments in time, as depicted in her installation. As an artist of a different medium, an artist of care, this mindset accurately conveys the work we do as nurses. We enter our patients’ lives right at the moment of explosion (illness, injury, recovery from surgery, etc.) and we have the ability to suspend that explosion for a moment in time. To operate within these “frozen moments”, as Ms. Parker described. I can quiet the chaos of the explosion around us, my patients and I, and I can help them focus on the feelings present amidst the chaos. This is how art finds its place in nursing.

I am honored to share that my essay “The Art of Nursing” has been published by Hektoen International, A Journal of Medical Humanities. The entirely-online journal is associated with the Hektoen Institute of Medicine in Chicago, IL. This non-profit organization is dedicated to furthering research and education in healthcare through interventions like research grants, community programs, and Hektoen International. The journal aims to “unite medicine with culture”, and increase awareness and appreciation for the way humanities such as ethics, philosophy, history, writing, and art can influence the way we provide care to patients.

Healthcare students and professionals can submit work to the journal year-round, and the journal works with authors to pair an image of artwork with their piece that represents the themes present within their writing.

For me, Cornelia Parker’s piece “Cold Dark Matter: An Exploded View” was the perfect pairing with my article. Please visit the link provided in this post to read the article on Hektoen International’s site…take some time and immerse yourself in the beautiful way healthcare is represented by art and the works of other authors on the site!

“The Art of Nursing”- CLICK HERE TO READ: https://hekint.org/2020/07/28/the-art-of-nursing/

On Success and Failure

With a new year comes the desire to debut a ~new mood~. We haul out our metaphorical (or sometimes real) vision boards and prepare to concoct the recipe for “the best year yet”. But what does this actually mean? It seems as though our subconscious mindset is that 365 days of nonstop success and accomplishment without a failure or misstep in sight is what should constitute “the best year yet”. By the end of one year and the beginning of another, we often find it all too easy to shake our heads and allow the lows to be louder in our memory of the past and the highs to be all we see in our vision of the future.

Why do we do this? Year after year, it’s the same story as soon as the ball drops.

I was attending a professional development course for new employees at Children’s Wisconsin and out of nowhere, the presentation hit me with a quote that had me, as the kids say (do they?) SHOOK.

“The most effective of all human fears, which often prevents the development of full potential is the fear of failure and the fear of success.”**

Do you ever experience that? Where a statement just hits you right in your ~reflective feels~? Bueller? Anyone? But I digress…I scrambled to scrawl down these words of wisdom, tucking them away for a reflective, rainy day.

So here I am, scalpel out and gloves snapped on, ready to dissect this statement…at the quintessential time of year when the ideas of failure and success are at the forefront of our minds.

First of all, I will be the first to say that I have a very deep rooted, enduring personal connection with what this quote is getting at-it speaks to me on a very deep level. I fear failure like the plague…even though I desperately desire to be successful in whatever I set my mind to. I remember the first time I failed a test…it was like my world came crashing down around me. I was off my pedestal, choking on the bitter taste of humble pie. Up until that point in my educational career, I hadn’t really faltered, much less full on failed. But looking back, perhaps this was because I only put my full effort into endeavors in which I was fairly certain I could attain proficiency, or even excellence.

So what had gone wrong? I considered myself a fairly intelligent person…how had I miscalculated my ability to succeed relatively unscathed so poorly in this class? A class well within the realm of others necessary for my career path, in which I had historically been successful.  A peer asked me then, (meaning well), if I was really sure this was the career/education path I wanted to be on…if I really thought I could do it, if I really thought it would be worth the stress and strife. It was the only time my intended career path had ever been questioned and I remember feeling this “they said I couldn’t, so I did” mentality, burning red hot. I was filled with determination so strong…forgive the melodrama, but in this moment, I knew no matter how ugly or difficult the path to success was, I was going to MAKE IT HAPPEN.

So this quote was rather like a reflective revelation to me. Because I fear failure, I do, therefore, fear success. And I know I’m not the only one.

Much like the chicken and the egg, you can’t have one without the other. This brings up the question, what defines one as a “success”? Looking back on my education, I like to consider success from a practicality standpoint that I did indeed pass my courses, and from a more important “big picture” standpoint that I gained new knowledge and new perspectives that I actively incorporate into my personal and professional life. I’d say I’ve done that. But let me tell you, achieving this educational success was not without failure along the way. Whether it be a less than ideal test score, having difficulty grasping a concept, or feeling generally lost, confused, overwhelmed, or burned out on learning…these are all things that I would classify as feeling like you’re failing. And I’ve experienced all of them…many, many times. And the fact is, they’re staples on the success journey. There’s no taking a shortcut around them. Therefore, if you fear your encounters with failure, you subconsciously fear what you could achieve if you face them head on: success. Just think if I had allowed my deep fear of failure to hold me back…my career as a nurse would quite literally cease to exist. But I didn’t…I crashed headfirst time after time into feelings of failure, clawing my way toward the light, knowing full well that another patch of darkness lay ahead for me to conquer, but moving forward anyway.

Nowadays, this quote’s second meaning speaks to me as well. Much like my previous post about considering the acquisition of knowledge a journey as opposed to a destination, I firmly believe one can say the same about achieving success. I don’t think success is a singular pot of gold at the end of the rainbow; rather, we achieve several successes of different kinds on our journey through life. So I’d say I feel successful in many things I’ve worked toward, and I am still working towards that feeling in other areas. But once we feel success in one area of our lives, perhaps we begin to fear that success, because we fear that a failure could snatch it away from us, and we will cease to be successful. We begin to overthink and worry and work ourselves into disillusioned feelings of unworthiness of the success we have achieved. We feel like impostors, second-guessing ourselves, fragile and insecure in what we have achieved. This, my friends, is called SELF-SABOTAGE. Don’t do it. As someone starting out in a new job, it is vital that I remember this. I cannot be afraid that just because I felt success at points in my previous job that I will not feel it again, just because I’m starting anew. I cannot be afraid of the days when I will undoubtedly feel confused and lost and overwhelmed, because they are necessary to get to the days where I feel bright and strong and successful.

It takes courage to learn. It takes courage to achieve success, no matter how big or small that success may be. We often preach how important it is to “be independent” and “don’t let anyone hold you back”. But I think many of us fall prey to our own doubts (myself included), and we hold ourselves back. Don’t do it. The way to achieve those successes we lust after…is to fail sometimes. #sorrynotsorry. This has been a maddening, often crushing lesson that I am still learning, but I have made it through 100% of my worst days thus far and I still will. And you will too. Don’t just focus on the failure from the past…it was necessary to help you achieve all of your success up to this point…celebrate those! And at the dawn of a new year, remember that for it to be filled with new success, it will also contain some failure. But don’t let that stop you. I certainly won’t.

**Side note, I have scoured the corners of Google for a source for this quote on fearing failure and success and I can’t find its origins…so help a girl out if you know who said it…and please don’t tell the In-Text Citation Police!

Never Stop Learning

Stone Creek Coffee, Wauwatosa, WI

“Never stop learning”. It’s more than just an eye-catching, Instagram-worthy statement mural. It’s something that I, as a nurse, take to heart. This fall I’ve started a new position, transitioning into a new nursing niche. It’s always been my dream to pursue a career in pediatrics, and now that dream is a reality! I’m officially a nurse at Children’s Wisconsin in Milwaukee, a state-of-the-art hospital dedicated entirely to promoting and maintaining the health of children. I’ve joined the team in the Cardiac Intensive Care Unit, where my patients can range from newborn babies to adolescents on the cusp of adulthood. Here, my patients recover from life-saving surgeries to correct complex congenital heart defects, and battle post-surgical complications that threaten to cloud over what should be an active, normal childhood. But despite it all, so many of these children grow and thrive, thanks to skilled healthcare team members carrying out cutting edge medical advancements that have helped Children’s earn national merit and recognition.

Children’s Wisconsin-where “Kids Deserve the Best”!

Does that all sound a bit intimidating? I thought so too…but I’ve always been one to set my sights high and go after a challenge! With this switch in nursing specialty, it feels like I’ve quite literally been thrown back into school, back into the front row of the lecture hall, surrounded by a dizzying array of notes, diagrams, definitions, and policies. It can be easy to get overwhelmed and worry “how will I ever learn it all? When is my deadline to know everything? After a year? Two years?”

While there are basic deadlines by which I need to grasp certain fundamental competencies in my role, there is no deadline in my profession by which I need to know everything. In fact, I’d say with a fair amount of confidence that no nurse knows everything, no matter how long they’ve worked, or how many advanced degrees they have, or how many different nursing specialties they’ve worked in. And that’s the beauty of ~lifelong learning~. As I mentioned in my previous post, this may be a triggering catchphrase to many nurses and nursing students, but to me it’s more of a mindset, one I really do my best to believe in and one we all could, no matter who we are.

Think of it this way, as lifelong learners, we’re actually in a position to take some pressure off ourselves. We don’t need to stress about an impending deadline by which we need to know EVERYTHING…there is no such thing! By shifting our mindset to see that gaining knowledge is an ongoing, lifelong journey rather than a specific, all-or-nothing, set endpoint, I feel like we could develop a deeper appreciation for the things we do know, and an equal appreciation for the fact that we still have questions and things to learn and time to learn them.

You know what happens when you think you know everything? You stop asking questions. Your curiosity fades. You become complacent. Complacency has no place in healthcare…the future of our health and well-being quite literally depends on curiosity and people asking questions and the inherent desire to discover more; how to grow, how to change, how to improve (aka research).

But why should this concept only be centered in healthcare? Shouldn’t it be incorporated into basic, everyday life? I think so. Now I’ll be honest…within the intense environments of school and work, sometimes I just don’t feel like learning. When it’s 5am on the night shift and my brain cells are hanging on by a thread, it’s probably not the best time to initiate intense learning…same as when I had been studying for hours in the library in nursing school…there comes a time when it’s just not practical to learn…your mind does not have to be open for business 24/7. There must be a balance between rest and learning (and those of you who know me from my school days have permission to call me a hypocrite, as I fully admit I was probably too much “study” and not enough “rest”…I may attempt to give sage advice but I’m not perfect, and yes, I do fall off the wagon sometimes and fail to practice what I preach).

But I digress…lifelong learning is about vowing to keep your mind flexible. It’s ok to keep it closed for times of much needed rest, but open it back up again, even when you feel a little hesitant. Curiosity takes courage, and strength, and discipline, and practice. Maybe what we ought to be focusing on is getting better at learning, not just better at knowing.

If you can learn, then you can know, and if you know, then you can teach, and that’s how the cycle keeps on rolling. Teaching is contingent on learning…in order to give knowledge, you need to gain it yourself first. To all my fellow healthcare workers out there, we are all teachers in our own right, (whether we intentionally got an advanced degree in education or not!) and our patients’ levels of knowledge depend on our own. Don’t just learn for yourself, learn for others. Knowledge is power, and it is meant to be shared…keep the cycle of teaching and learning going!

I love to teach…if you know me at all, you know I could talk about patient education for days (I mean, I wrote an entire thesis centered around a new strategy to improve the delivery of patient education, for goodness’ sake!) To me, an intelligent person is not someone who claims to “know everything”, but someone who carries out the learning and teaching cycle; they rest so they can learn, and they learn so they can teach; they keep their mind flexible, and they are content in the fact that knowledge is part of a cycle, gained along a lifelong journey, and is not a set endpoint.

I aspire to be this intelligent person. I aspire to be a great teacher, and so I need to practice being a great learner. I am grateful for the knowledge I have, for my ability to share it, and for the vast amount of knowledge I have yet to obtain. Be relentless in your pursuit of knowledge, and never stop learning.

The First Year

I’ve been working as a Registered Nurse for one year now. One year down in the profession I’ve dreamed of joining since I was a little girl, playing “hospital” with my stuffed animals. During the past year, I completed the nationally recognized and accredited Nurse Residency Program at UW Health University Hospital, on the Abdominal Organ Transplant Unit. UW Health is a renowned academic medical center, but what does this mean? The best way I can describe it is that there is always learning going on…learning and teaching. The UW System in Madison encompasses a school of medicine, school of nursing (both graduate and undergraduate programs), physician’s assistant program, and school of pharmacy, not to mention the large numbers of medical, nurse, and pharmacy residents who may have graduated from other universities around the country (or even around the world!) and come to UW Health to learn and grow with the support of experienced colleagues during their first year(s) of professional practice. On top of students and residents, there are many physicians from far and wide who have come to UW to gain more specialized training through prestigious fellowships, and of course many nationally (and sometimes globally!) recognized attending providers who are rather like unicorns to me-vividly described but rarely encountered, giving my young, eager-to-please heart a rush of excitement when a chance meeting occurs.

UW Health University Hospital

I have always placed high value on both learning and teaching. As Phil Collins sang during Tarzan’s montage transition from boy to man, “in learning you will teach, and in teaching you will learn”. These words were ever so true during my school days…the best way I realized to check if I had really learned something was to teach it, whether through my days as a student tutor or to my friends or out loud, to myself, on a sunny Saturday afternoon in a blissfully empty library #xoxoLibraryGirl. The term “lifelong learning” is basically a triggering catchphrase to pretty much any nurse or nursing student nowadays-while some may deem it a cringey cliché and a “what they want to hear” phrase to drop in an interview, I really do believe in it. The moment you stop learning, you become complacent, and there is no place for complacency in healthcare-there just can’t be. So to me, the appeal of working in a large academic hospital was a culture that encourages and supports learning, improvement, and doesn’t believe in “too many questions”. Surround yourself with those who help you search for answers when you ask questions, not those who bully you into confused silence. Questions are how we learn, and learning is how we can improve. You know why healthcare practices and medicine and science isn’t the exact same as it was 50 years ago? Because someone ASKED QUESTIONS. Thanks to some of the most amazing coworkers, my questions are welcomed and it’s pretty amazing to step back now and realize how much I’ve actually learned during this first year. I can now care for patients straight out of life-changing (and often life-saving) surgeries, I see the joy on a kidney recipient’s face when they hear they don’t need dialysis anymore, or the stunned relief when I tell a pancreas recipient they don’t need to regularly check their blood sugar, or count carbs, or give themselves insulin anymore. I help patients and families navigate the roller coaster this second chance at life sets them on, whether they just received their organ or are experiencing complications years after their surgery.

No matter how little the task, I was low-key intimidated by pretty much everything once I stepped through the door to professional nursing. I had had a fair amount of clinical practice and exposure but when it’s now YOUR job and YOUR license and YOUR patients-reality hits like a brick. Let me tell you, nothing crumbles your confidence from conquering years of rigorous coursework with top academic marks quite like not being able to find the correct button to silence a screaming medical machine alarm while an annoyed patient and family stare daggers into your flustered little soul. But one day (and I can’t tell you exactly when), you suddenly know where the correct buttons are, you can predict which alarm is about to go off and why and what to do about it, and you realize “I don’t have to SEEM smart…I AM smart, gosh darn it!” and at last your practical knowledge and scientific knowledge and interpersonal knowledge coexist in harmony.

…but I’m not quite there yet.

I’ve had a few tastes, a few samples of how sweet this harmony feels, and those moments are precious to me, a new professional nurse with a bit of credibility at last.

Because despite what my insta feed may lead you to believe, it hasn’t all been roses and smiles and delicious picturesque food this year. I moved to a brand new city alone, hours away from all the people I’d grown with up until that point. New place, new career…the independence of adulthood is both liberating and eye opening. Sometimes it’s going on solo day-off adventures and discovering new flavorful cuisine and quaint coffee spots and sometimes its reheating a random assortment of leftovers because you’re too exhausted to cook up a meal that makes sense. Sometimes it’s coming home feeling satisfied and fulfilled from a shift of realizing what a difference you made in a patient’s recovery, and sometimes it’s coming home and realizing you need to shower AND make food and you only have enough energy for one.

We all hear about the dangers of “burnout” in the healthcare field, but it’s not something I expected to come face to face with this soon in my career. I’ll fully admit I felt the subtle tug of burnout at times this year, and it felt like betrayal in a way…how could something I’ve worked so hard and so long for attempt to steal away my inspired outlook this early on? The temptation to become jaded in this profession is stronger than I ever realized. The attitudes of others can be contagious and it is absolutely imperative that you stay above it by any means that you can, at least it is for me

The highs remind you why what you do is worth it, but the lows are where you need to fight. Fight for your reason. If I’ve learned anything from high intensity work, heartbreak, and the general roller coaster ride that is life, you cannot lose your inspiration. My wish for myself and others is to stay inspired, always. And sometimes you will feel so painfully far from your inspiration-I know I have. So reach out. Surround yourself with people who are just as inspired as you aspire to be.

They say nurses save patients, but after this year, I firmly believe that sometimes it’s the patients who save the nurses. Every smile, fleeting “thank you for taking care of me”, or personal story shared with me warmed my soul, filled my heart, and melted away any hurt or exhaustion or frustration or defeat I may have been feeling, if only for a blissful few moments. But even once those moments have passed, they stick with you. I keep them close to my heart for a rainy day, a day when I’m low on inspiration and desperately need to remind myself why I do what I do.

Overall, this year has been about bravery. About facing things I never thought I’d be strong enough to face. I’ve been on this quest for courage and confidence for quite a long time now, gaining steam with each passing year. Setbacks are inevitable, and while they may strike when I least expect them, it will take far more than anyone could fathom to pry my dreams and goals and aspirations from my grasp, no matter how lofty they may seem. Because when I want it, my pursuit is relentless. And I want inspiration. To build and nurture relationships with inspired people and to engage in inspired work. I believe inspiration will lead me to the person I’m meant to become, and that is always worth fighting for. Fear and doubt will always be lurking, attempting to steal away the joy that can be felt from being brave, but I’m trying little by little to live more closely by these words: “Start being brave about everything. Drive out darkness and spread light”.

The fact is, life is short. And we always have a choice, between doubt and confidence. I’m only human, and sometimes I end up choosing doubt. But in the times I’ve chosen confidence in spite of doubt, I’ve been rewarded with some of the most pure happiness I’ve ever known.

So go for it. Speak up. Speak your mind. Go all in. Make it happen. And hold nothing back. Ever.

https://instagram.com/izzy.stj/

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