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Shania Lynn, RN, Voiceactor

The Cure for the Common Read

Hello! My name is Shania and I am a nurse at a rural hospital in Tennessee. I have been a medical-surgical nurse for 5 years and have learned and experienced many blessings and tragedies during my first two years at the bedside. Patient Talk is my public place to voice my emotions after a 12-hour shift with no sugar-coating (while being confidential, of course).

The name “Patient Talk” was created because it is importance to be patient with our patients, even on the hardest days. It is a reminder to be fully present with each patient. Electronic medical records consume most of our day and we quickly fall into the trap of nursing a machine, rather than the human being in the bed.

I will be discussing the patients that have warmed my heart, made me feel like I want to quit my job, and those that remind me of why I have chosen this profession.

I will relay tips to new nursing grads, along with tidbits of knowledge that I have learned during a previous shift.

I will also discuss any relevant topics in nursing, medicine, and healthcare in general as my brain wanders.

Once again, this blog is a safe place to refuel me for the next shift. It is a reminder to have “Patient Talk,” and to remember the reason behind being a nurse. Nursing is the hardest thing I have ever decided to pursue, but it is also the most rewarding decision I have decided to make with my life.

I hope all who read this can celebrate and relate with me in my victories, valleys, and challenges in the life of nursing.

Visit my website: https://shanialynnvo.com/

Until next shift,

Shania

An Actor’s Take on the Clinical Judgement Measurement Model

As an actor discovers and creates a character, they must first answer a series of questions, of which set the stage for the entire performance:

  • Who am I?
  • Who am I talking to?
  • What is my objective?
  • What is my opposing character’s objective?

An actor’s objective is what/how they want to affect their opposing character (the person they are speaking to). An objective is always about the other person and how words are meant to affect them. For example, I recently played an evil History teacher who never reached her goals at her pre-determined milestones. Because of this, I cannot let any of my students achieve their goals, and I make it my life purpose to teach them that the world is against them, so why even try? My objective in this scene is to bring my student to the reality that she will never reach her goals.

Tactics are different methods that are used in conversation, body language, etc. that allow the opposing character to feel a certain way. Tactics are used to achieve the objective. In the above example, I may use guilt to cause my opponent to feel like she doesn’t deserve success. If that doesn’t work, I can evoke fear in her because I know that this is her weakness; I can convince her that her fear will get the best of her, so she should save her effort. Tactics will always tie back to the objective to achieve the desired outcome.

So, how in the world does acting compare to the Clinical Judgement Measurement Model in Nursing??

Well, do the terms objectives and outcomes sound familiar in the Nursing world?

The first step in writing a Next Generation NCLEX (NGN) test item is looking at which content objective needs to be measured. For example, if students are expected to read an EKG, one sample content objective would be to Identify and Measure the following on an EKG tracing: P wave, PR interval, PR segment, QRS complex, QT interval, ST segment, T wave, U wave (if applicable).

The second step involves “Building the Case”. This step includes the creation of learning activities and different teaching methods (tactics) to allow students to achieve the content objective. Students may review a client’s EHR and note an abnormal EKG as they identify and measure the duration of the EKG elements. Students may read in their textbook and/or listen to a lecture on the appropriate values for each element. These class activities are tactics to allow the students to reach the objective.

The final step in creating a NGN test item is to write the question using one of the many new item types. This step is where student outcomes will be evaluated and the instructor will observe if the content objectives were met or were not met and the student requires remediation.

Acting:

Scene Objective=

Tactics=

Outcomes- Did they other person change because of how my words affected them?

Nursing CJMM:

Content Objective

Active learning, classroom activities, case studies, textbook reading, lecture

Evaluate Outcomes= Assess question answers and determine if students met the content objective

The actor’s process may not be so different than the nursing process. When in doubt as a new educator, remember that you have the knowledge and these students do not have the experience that you do. Be confident in your knowledge and be flexible with the attitudes of students to keep them engaged!

Until next shift,

Shania

Nurses do play cards..

In April 2019, a Washington State senator denounced a bill to allow uninterrupted lunch breaks for nurses and stated that nurses “probably play cards for a considerable amount of the day.” Not surprisingly, the senator was faced with much opposition from nurses across the nation, refuting her ignorance and false claims.

After the initial anger from the comments died down, nurses “playing cards” became a joke as memes and apparel were created in reference to the comment.

Nurses are lucky to get a 30 minute lunch break in a 13-hour shift, let alone sitting at the station and playing card games. However, I was laughing at myself during my previous night shift because I did end up playing cards.. Rummy and UNO (in case you’re curious).

I had a patient who was on enhanced safety precautions due to suicidal ideation. She was medically cleared and just waiting for psychiatric placement. She repeatedly said she was just so lonely and asked any staff members to play cards with her.

Typically, requests like this are hard to fill due to short staffing and other duties being priority. I was lucky to actually have some time and it was a “quiet” night shift. We played multiple rounds of cards together throughout the night.

This is patient-centered care. No staff member had to play with her even if they had time. Extra activities and requests such as this are often unable to be completed due to the nature of healthcare. It is moments like playing cards with a patient, braiding their hair, taking a patient down to the lobby to play the piano, etc. that remind us of our why’s of nursing.

No, I did not get into nursing to play cards all day, but the shifts that I can fulfill a patient request, are the shifts that keep me at the bedside.

Until next shift,

Shania

It is my biggest pet peeve.. Why are you calling me?

Conversational. SBAR. Therapeutic. Assertive. Passive. Slurred. Clear. Articulate. Aphasic. These are all words to describe methods and/or characteristics of communication.

Effective communication in Healthcare is crucial, however, what may seem like an elementary skill, communication does not come naturally for many people. Disclaimer…I may be bias as I do speak to myself in a closet for a living (voiceovers), but it is an issue that I have experienced a lot lately.

I have learned that I need to ensure that my students communicate abnormal vital signs. I have observed students completely disregard the patient in the room during a med pass or not address a family member. And then, of course, there is the dread and anxiety of calling a physician for the first time.

Aside from nursing, I have dealt with several different contractors for our one year house inspection and NONE of them have communicated well. Some would show up at our home at 8:00am with no notice. Some would reschedule our date and notify us days later. Some wouldn’t respond for days… I joked to my husband that I would give them all 5 stars if they just communicated appropriately! We need to plan and want to know what is going on!

The parallels in nursing are large. I think of these everyday scenarios and then remember how patients feel when they do not have answers or when family members call during shift change asking for any updates. Early on in nursing, I learned that simply communicating that we are still waiting on MD orders, at least, allows the patient and family to know that they have not been forgotten. Reminding a new nurse that it is necessary to call a physician and that they should never feel belittled or afraid to do so is critical to reduce risk for burnout. Developing assertive communication does take time, but it gets things done!

Until next shift,

Shania

“It will take a year..”

The infamous question from new grads to preceptors is, “How long does it take to know what I am doing?” For many, the answer is one year. Nursing school starts with fundamentals, where students learn how to give a bed bath and safely transfer a patient to the bathroom, to Medical-Surgical Nursing III, where students learn complex disease processes such as Acute Respiratory Distress Syndrome and Shock.

Clinicals aim to transfer the knowledge learned in lecture to practice with real patients. Due to the lack of preceptors, clinical facilities, and strict student guidelines, it is often hard to create a realistic nursing experience as a student. Students often only learn how to care for one patient at a time, and then receive up to 6 patients on a Medical-Surgical floor and are expected to manage their time and priorities.

It takes a year after nursing graduation to really feel confident in our abilities. That year mark is where instead of simply recognizing abnormal assessment findings, we learn to provide recommendations to physicians about a potential intervention.

When I first began teaching one year ago, I was also told to “give it one year.” However, the first year of teaching was way different than a first year of nursing. I know how to be a bedside nurse, but teaching brought on many unique challenges. I feel like I forgot the minute details that we teach and is tested for our complex medical topics. I still study with my students and have started to adapt creative ways to teach content. My stressors as a new grad far outweigh my stressors as a novice instructor. In my first year of teaching, I have improved on exam writing, active teaching strategies, and connecting lecture to clinical practice. But, I still have much to learn just as my students have much to learn on their nursing journeys.

Until next shift,

Shania

From Proficient to Novice

Dr. Patricia Benner created the nursing theory of knowledge progression ranging from novice to expert. She describes what it means to be an expert nurse and the step by step trajectory a typical nursing career follows.

Student nurses are novice nurses. New grads progress to advanced beginners after their preceptorships, orientation, and passing the NCLEX. The beginning stages of this theory revolve around building those initial nursing experiences for each different disease process. At the early stages, nurses are able to recognize abnormal findings, but may not be able to decide the appropriate interventions or recommendations to treat those issues. As they gain more experiences, review order sets, and recognize patterns, the nurse becomes competent. Several more years later, the nurse becomes proficient and can expect order sets for each finding. An expert nurse has many years of wisdom and experience to draw back on. They develop intuition, offer more creativity and alternative solutions, and seamlessly care for the whole person.

When I left the bedside, I classify myself as proficient. 5 years at the bedside allowed me to recognize orders, recommend interventions, and expect outcomes based on selected treatments. However, I am only proficient at the bedside. Once I moved into education full time, I am now a novice educator. I relate so much to my novice students in fears of the unknown and learning to be okay with discomfort.

There is so much to learn in each Individual field of nursing. Lecturing disease processes is so different than practicing it at the bedside.

I am a novice nurse again and that is okay.

Until next shift,

Shania

From Student to Nursing Instructor

In December 2017, I graduated with my AS in Nursing. 5 years later, I am teaching at the same place where I was a student. There are pros and cons of being a young instructor. It is nice to be able to remember how students are feeling at this stage in their nursing career, however, it is difficult for me and students alike to keep the boundary between a friendship vs. a professional student-teacher relationship… especially considering we are either the same age or I am much younger than the students I am teaching.

Teaching content I practice to a student is a lot different than precepting a new grad nurse. What comes naturally now has to be put into words and create a fine balance between explaining in lay man’s terms to keeping medical terminology.

All that being said, I relate to Benner’s theory of nursing competence. As my students travel from novice to beginner to competent nurses, I am traveling that same continuum as an instructor.

What I have learned in my first year of teaching:

  • There are tiers of instructors.. A Nursing Instructor is different than a Professor of Nursing.. there are many years of tenure and expertise to acheive that title
  • All students must be treated equal. This may sound obvious, however this rule applies in situations that you may not realize. One student or one problem that arises can cause policies to be created that may seem harsh or controlling.. (i.e not allowing Zoom links even when sick with Covid, strict uniform guidelines (buttons not zippers), no recording). There is a reason.
  • Accrediting bodies like TJC do not go away
  • If it isn’t documented, it’s not done still applies
  • A 2 hour lecture can take a full 8 hour day to create
  • There is a serious art to test writing- Nursing Process, Clinical Judgement, Maslow’s, distractors.. Oh, my
  • Managing a classroom while lecturing is very challenging.. Remembering what you said, advancing the PPT, checking the Zoom room, answering questions, keeping students engaged
  • I LOVE active learning
  • Incorporating an extra class activity involves many members of faculty
  • What is best for the students is not always what makes them happiest
  • It is okay to not know the answer- Nursing is always changing

I have learned so much already and love my new job. Being a part of a student’s nursing journey is so rewarding.

Until next shift,

Shania

“Your discharge is not priority”..

“Due to short staffing, we are closing early. Sorry for any inconvenience.”

“Please expect longer than usual wait times due to short staffing..”

“Now hiring. $15/hr starting pay.”

These signs and statements look all too familiar within today’s society. The nursing shortage has been ongoing for years and only getting worse. Short staffing at grocery stores or restaurants cause frustration and inconvenience. However, short staffing in healthcare is deadly and only increases the shortage as healthcare workers are overworked and burnt out.

It is really hard to be the nurse that we signed up to be…

  • When we can’t talk to our patients like we would like to and truly listen to them without having 1000 other urgent tasks to complete
  • When we don’t have time to brush our patient’s hair or give them a shower
  • When we don’t catch a dangerous trend in labs or vital signs because we are too busy to think
  • When we make a simple medication error because our phone keeps ringing or call lights are nonstop
  • When we don’t have the compassion we did as a new nurse..

As a nurse, we pledge an oath to do no harm, but it is very difficult when we do not have the resources we need to be successful and advocate for our patients as we should.

What doesn’t make sense either, is that administration views short staffing as doable, giving more and more patients to staff because they have to. But, are these overworked staff receiving additional pay? Most of us are not. The healthcare system does not operate on the usual economical supply and demand system. As demand rises, our pay does not increase.

From a patient standpoint, outcomes and satisfaction suffers. Healthcare worker violence rises and staffing is a major factor. Nurses must prioritize care, especially when having high-acuity loads and no help.

  • We must treat a low blood pressure before performing wound care.
  • We have to prevent a patient from falling before administering your home medication on your own schedule.
  • We will attend to a code before patient teaching.
  • We have to administer scheduled medications and/or pain medications, before printing discharge instructions.

Your discharge is not priority. We are literally saving lives and patients need to realize that a hospital is not a hotel.

I guarantee you, nurses are not just sitting at the station playing cards, drinking tea, or any other outrageous assumption made by the media. We are trying…

Until next shift,

Shania

The Meaning of a Pin

As a student nurse, the one day that you look forward to is even of greater significance than college graduation.. nursing pinning. The nurse’s pin dates back to the early Maltese cross in which a pin was worn meaning a service of Christianity. The servants would care for others with communicable illnesses. Since then, the meaning of the pin has transformed throughout different cultures and programs. Florence Nightingale, the creator of the first structured program for nurses, eventually adopted the pin as a symbol of knowledge, servitude, and compassion for the vulnerable. Today, all nursing programs (and other non-nursing programs) culminate with the ceremony of pinning.

As a practicing RN, we receive different pins to put on our badge. These include acknowledgements such as various awards, employee of the month, degrees, and years of service, among others.

Earlier this month, I received my 5 years of service pin. It feels like I have been a nurse for so much longer, while also feeling like just yesterday I spoke at my own nursing pinning ceremony. In 5 years of graduating with my ASN, I completed a BSN, got trained in chemotherapy and Pediatrics, became certified in Medical-Surgical Nursing and ACLS, worked as a Charge Nurse on weekends and nights during the peak of the Covid-19 pandemic, and now have the greatest honor of teaching last semester nursing students at a community college.

While I receive my 5-year pin, I have the honor of providing the nursing pin to all of my students. And in reminiscence of my own pinning, I recite the nurse’s prayer:

Give us strength and wisdom when others need our touch

A soothing word to speak to us, our hearts yearn for so much

Give us joy and laughter to lift a weary soul

Pour in us compassion to make the broken whole

Give us gentle, healing hands for those placed in our care

A blessing to those who need us, this is our Nurse’s prayer

Until next shift,

Shania

https://pubmed.ncbi.nlm.nih.gov/2694101/#:~:text=The%20nursing%20pin%20is%20a,symbol%20of%20service%20to%20Christianity.

Building a Life you Want

Build a life you want and save for it. This is a FIRE concept in which you can still prepare to be Financially Independent and Retire Early, while also living a life that you desire.

As nurses, we learn to prioritize. We start our day prioritizing as we choose which patient to see first. We prioritize med passes, delegation, admissions, discharges, and every MD order for each patient that we have in our care.

But, we often do not prioritize ourselves. Some of us go with the flow. Some stay in current jobs for years because it is comfortable or familiar. Others go about their daily routines and only imagine pursuing hobbies or passions and never act on them.

I made a difficult decision to leave a job that I helped create for myself because it wasn’t what I thought it would be. I came home frustrated every day for the 6 months I was trying to make it work. I started to realize that the position may not have been a good fit for my strengths. Sitting at a desk all day waiting on the decisions of others was just not a good fit for a Type A personality, who is used to working an active 12-hr bedside nursing shift. I knew I had to make a change for my mental health, especially considering I did not believe the position would improve for my liking. With change, comes difficult conversations.

Intellectually, I knew that for my mental well-being, I had to leave my newly acquired job. I received an opportunity to teach. A position I thought of years before as I was always more textbook smart than I ever was clinically. I took the chance and this is the best career I have ever been in as an RN. I LOVE disease processes. I LOVE encouraging others. I LOVE speaking. All of my loves and strengths seem to be combined into one position that found me in a time I was seriously struggling. All of these loves, plus a schedule that works for family, hobbies, and voiceover 🙂

I would never have found my place as a nurse if I did not listen to myself or take myself as priority. Now, I am looking forward to furthering my education. I am basing my specific program and university off of what will work with my priorities in life: teaching, voiceover, fitness, and family/friends. Rather than sacrificing any of these loves, I will find a program that fits into my current way of living because that is making myself a priority.

Build a life that you want and save for it.

Until next shift,

Shania

It’s okay to take up space

Do you ever say sorry out of habit? “I’m sorry for..”

Making it into the grocery line first

Being in the med room as another nurse walks in

Filing a valid complaint

Asking for a favor

Waking up a doctor for a patient need/concern

I have a habit of apologizing for things that 1.) are not my fault 2.) unintentionally inconveniencing others, 3.) allowing others needs to be greater than my own. In other words, I say “I’m sorry” for things that those words are not even intended for. The word “sorry” stems from a word meaning sorrow or sorrowful. Do I feel sorrow for any of the above scenarios? Of course, not.

While out wedding dress shopping for my sister, my sister was constantly apologizing for bringing more dresses into the dressing room or needing a different size, etc. Finally, the sales associate said, “you need to stop saying, ‘I’m sorry’. I told myself that I need to stop saying that because I am allowed to take up space.”

I am allowed to take up space. We should never let ourselves feel less than others. Apologizing for being a customer doesn’t even make sense! Also, we have learned over the years that empathy is way more affective than sympathy which the words ‘I’m sorry” go with. So, allow yourself to take up space in this world like the billions of other humans that walk the earth.

Until next shift,

Shania