https://medcitynews.com/2021/07/why-the-nursing-profession-is-in-crisis-and-what-we-can-do-to-save-it/

Hi everyone!  I know it’s been a while and I’ve not done a travel assignment in a year and a half, but I wanted to write another blog post to do a pulse check. COVID-19 was rough last year, but right now on the frontlines, despair seems to be reaching a new high.   It’s hard to know how far reaching it is, but when I read articles like the one above and hears whispers from the people around me, I kind of wonder. I love being a nurse so much—but even I don’t like nursing right now.  Maybe I’m not the only one.

There are not enough mindfulness sessions, yoga classes, healthy meals, hours to sleep, water to drink, or exercise routines that are going to make the stress of being short staffed in a critical setting feel OK.  I wouldn’t have to dig deep into the literature to find out that being short staffed and having unrealistic workloads leads to burnout.  So, if you are feeling a bit burned out, it’s not your fault. You haven’t done anything wrong.  Just like when we are playing cards, this not about our lack of compassion or empathy–this is the hand we have been dealt.. 

A LOVE LETTER TO NURSES

So here is my love letter to my fellow nurses, whether you are feeling the burnout or not. Thank you for taking care of strangers and treating them like they were your loved ones. Thank you for your knowledge and expertise that has kept your patients safe in ways they can never understand.  Thank you for every single time you have put aside your own needs for the needs of anther person.  Thank you for caring about your coworkers.  Thank you for working more than you planned to because there don’t seem to be enough nurses in the world right now. Thank you for putting in the energy to deescalate patients (and family members) who are aggressive and verbally abusive.  Thank you for struggling to continue to care for people even as you have struggled to care for yourself. Thank you for the moments when you are faced with more work than can possibly be done well, and you take a breath and dive in. Thank you for precepting new nurses or taking on new roles, even if you may feel like you are new yourself.  Thank you for staying after your shift because you wanted to be sure that your patients were OK. Thank you for all the ways you have said “no” to any of the above, because you knew it wasn’t OK for you and you were prioritizing your own well-being. Thank you for being human, which also means that you don’t have to be limitless or perfect. I know I haven’t been perfect.  But thank you for the work that you have done and continue to do. 

The care you are doing matters SO MUCH, so THANK YOU. And you also matter.  If I was ill or my family was ill, I’d want you to be there.  But I also understand that you don’t have to be there.  Your well-being matters too, and if this job or this profession can’t support your well-being, it’s not OK, and I would support you if you needed a change.  Is the nursing profession in crisis? Maybe? Does it feel like it where you are? I just know we don’t wanna be heroes. We want safe staffing, the resources we need to do a good job for our patients, and enough pay that nurses will stay.

A LOVE LETTER TO EVERYONE ELSE

Hi!  I feel like there are so many people out there I haven’t been able to see or hear from in so long!  Pittsburgh has been HOT and HUMID with thunderstorms every other day and I am personally very ready for fall.  I hope amid the confounding mix of chaos and normalcy, you are doing OK!  I know life isn’t just hard for nurses right now, so I’m also sending some love your way. 

AND FINALLY

I cannot believe it has been a year and a half since I wrapped up in Arizona!  This week I started year two of grad school. Grad school semesters are kind of like travel assignments (they are about the same amount of time) except you pay to do them and they take up all of your free time.  OK… so they are not like travel assignments at all.  Even so, I’m excited (usually) about what I am learning and how it will impact my career. For all of the challenges and the ups and downs, this week has been a good week and I’m thankful to be feeling a little lighter than normal.   

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Here are some bonus poems if you made it this far!  

They Say We Will Emerge Someday

Emerging
From sleepy, sad, safe
Cocoons, or like
A bear from
Hibernation
Longing for sun but
Not ready for the threats–
Outside of closed doors lies
A different interaction with
Despair.
And I realize I forgot
While I was hiding
The danger of
Open spaces.

Nature Poems

Nature poems in the
City chant of sly vermin,
Sneaky city rats.

Withered Rose

Withered Rose
Is unraveling;
A pink
Rose petal
Floats to the Ground.

I love the way
That roses smell,
And I imagine
As this one
Implodes
That it’s fragrance is dispersing,
Billowing out
Like a snuffed candle.

It billows out the way
That smoke disperses,
In tiny trails,
Until you don’t see
Anything
Anymore
Because it is
Everywhere.
It is, after all,
The second law of
Thermodynamics;
Nothing ever really is
Gone.

I know Withered Rose is gone.

And yet,
I know,
It does
Exist.

JUST TO CATCH YOU UP

I’m done travel nursing!  At the end of April my mom came out AZ to help me drive back to PA, and together we tried to be as responsible as possible while still considering I was in 9 different states in 4 days.  It may not have been the trip we originally hoped for—trying to take and spread the least number of germs possible—but it was still an incredible experience to see the landscape shift and change, to cross the Mississippi yet again, and feel the air change from hot and dry to cool and drizzly.  Shout out to my mom for helping me drive, considering the 30 hours of driving necessary to move my life across the US one more time.

MY LIFE NOW

I’m sitting beside my roommate Maggie in my new apartment in Pittsburgh (still waiting for our couch to be delivered) thinking about how I’m going to be working 12 hours in the emergency room tomorrow (starting my third week of orientation).

@ MY HIGH SCHOOL MENTOR

So, it’s the end of an era (and therefore the start of an era).  What does it all mean?  Sometimes when I’m trying to process a time in my life I try to think of what my mentor from high school, Michele, would ask me.  I’m pretty sure she would ask me something like, Holly, how do you think this process has shaped or changed you? And I would start out by saying, Wow!  That is really hard to say!  And then I’d say:

Well, there are definitely some things I’ve learned along the way, logistically.  I’ve learned a lot about Boston, Seattle, and Phoenix.  I’ve learned how to get around them, more or less, and what the surrounding areas have to offer.  I’ve learned that city you live in does change your experience with life in tangible ways—the way you interact with transportation, the people who surround you, the proximity to mountains, the price of housing.

If I still lived in Boston, I’d still be buying from coffee Dunkin’ Donuts at least twice a week, minimum, and I would be drinking in the beautiful spring flowers lining cobblestone roads.  If I was still in Seattle, I’d be contemplating season tickets to Reign FC and the Seattle Sounders (when sports come back, duh) and planning camping trips to the Olympic Peninsula.   If I was still in Phoenix, I’d be either in the AC or the pool right now, learning all kinds of new methods for keeping my car cool(er).

I’ve learned new ways of being a nurse. And everywhere I’ve gone, I’ve found people who I wish I could take with me, people who I miss.

Has this process changed me?  I mean—what does it even mean to change?! Probably?  I hope that I’ve become more self-aware.  More open-minded.  More curious.  More grateful.  More assertive.  More kind.  More decerning when situations call for flexibility or rigidity.  But, I’m not really sure.  I’m not sure because around the times of transition I close myself off a little bit. I’m not sure because it seems like I’m none of those qualities when I am tired all of the time.  And I’m not sure because I think I would be a slightly different person wherever I would end up.  Now that I’ve been in Pittsburgh for three weeks, I’m just starting to dig into who I am going to be now, in this new place, new job, new apartment, with new-old friendships.  And this isn’t a Holly I can just erase in 13 weeks. But figuring who I am now, post-travel nursing adventure, in the midst of learning a job I don’t yet know how to do, is a heavy, probably futile topic that is more complex in a global pandemic kind of world.

So how has this process shaped or changed me?  The best I can hope for is that it has helped me learn how live a life that is curious, kind, and brave.  Time will tell.

I CHOOSE THIS LIFE

I was thinking the other day about what it means for me to choose the life I have.  Obviously, we have limited control, but I think within myself I have found a sense of agency in how I respond to life, and I have found a sense of restless, aimless drifting in how I respond to life.  When I chose to leave Pittsburgh almost a year and a half ago, I felt that my life was happening to me.  Leaving was a way for me to reclaim my life as something I had agency over.  And—I found that agency.  It is no small privilege that I have been able to grasp at a million different worlds and try them on for size.  And I have been able to grow and learn and move in each and every one of them.  At some point along the way, I chose Pittsburgh as my home, these people as my people, and now I get to make that happen.  Going forward, no matter where I am or what I am doing (three months from now, six months from now, a year from now, etc.) can I wake up and choose this life every morning?  And, if so, what are the daily habits and decisions that add up to that kind of living?

I’m feeling some last-blog-for-a-while feelings, which is definitely a certain kind of feeling.  HUGE thank you to those who read my blog and have supported me along the way.  <3.

Hugs from Pittsburgh!

Holly

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I don’t have any pictures this time around, but here are some poems!

Imagining Needles
2/13/2020

Cacti as tall as
Redwood forest trees, and their
Flowers are hammocks

 

Mesa, Arizona
2/13/20

Come to Mesa,
Come to the table,
My family gathers
Here. Amidst cactus
And lime, hot air outside,
We pass the bread, or
A story, instead.
It’s good & it’s kind, &
A way to share
Life. This is (the)
Mesa, my family
Gathers here.

 

Arizona Sunsets
3/18/20

Arizona sunsets
Bleed pink to blue,
Swallowing up
Proud palm trees
Which surrender
To night.

 

COVID Daydreams
3/21/2020

Stuck in my COVID tower,
Naught to do but sing and cook
Like any fairy book.
But–when all is said and done
And my hair tumbles undone–
I’ll tumble to the ground, and
Come what may!
But for today,
Here I stay.
It’s hard to start a fairy tale
From six feet away.

 

On To the Fifth Puzzle
4/16/2020

I don’t think I’m a
Quarter yet done, but it’s
Really hard to say as I
Try to sort the
Colors and note the
Shades and fit
Edges into
Places where
They
Just
Don’t
Fit
And that
Feeling
When they do
Finally
Fit,
And I
Wonder if the
Lonely days and the
Happy days and the
Other days and days and days and days
Add up to what
Kind of picture,
And if it matters
At all, because when the
Picture is complete–
Even if a piece is
Lost–
It’s just
Done
And the point of it all
Is gone.

Sorta weird that no matter where you are… Pittsburgh, Brookline, Cambridge, Waltham, Boston, Seattle, Bellevue, Pheonix, Mesa, Chandler, Tempe, Canton, Columbus, Lancaster, Philadelphia, Austin, Nashville, Harrisonburg, Charlottesville, Chicago, Ann Arbor, etc, etc, etc… we’re all going through this same real weird thing right now.

THIS REALLY WASN’T WHAT I EXPECTED

3/8: Coronavirus first was mentioned in my personal journal, in passing, and I never knew at that point how much was going to change.  

3/9: My Grandma unexpectedly passed away in her sleep.  As a family, we were able to process a bit together and get everything out of her apartment before they completely closed the doors to visitors to her retirement home on 3/14.  

3/12-13: This is around the time when all the events started to suddenly cancel.  My cousins’ children were suddenly mandated home from school, and I had family and friends being told to work from home.  My grandparents in Columbus, OH told me they have strict rules in place at their retirement home. “Flatten the curve” and “social distancing” entered my vocabulary.  I felt a sort of cognitive dissonance, feeling like it was all too drastic (how is this possibly real life?) or not drastic enough (nurses and doctors and respiratory therapists and people in my healthcare family are going to die!) all at the same time.  

3/30: Now, in AZ we are on stay-at-home orders until the end of April.  It seems we are one of the last states to do this, and it seems the AZ governor was somewhat pressured to make this call.

5/2: A future date, and the last date of my contract.  This means the rest of my time in Arizona will be right here, in this house, or at the grocery store or work. My expectations for my time in Arizona are going to have to change.  

If I could have read that timeline in January, I wouldn’t know what to think.  Sounds like the start of a bad sci-fi novel.  

NURSING WAS ALWAYS A DANGEROUS JOB BUT THE PPE SHORTAGE IS DANGEROUS

*Personal Protective Equipment or PPE refers to the masks, googles, gloves and gowns, etc. we wear to prevent getting and spreading infectious diseases

Nursing has always been a dangerous job.  We experience high rates of workplace violence, injury on the job, burnout, etc.  But, even under those conditions, we were guaranteed personal protective equipment (PPE).  At least then, we had the illusion that our health was being protected.  

But there is just not enough PPE on the planet right now, it seems, so we are being asked to forget what we learned about infection control and reuse supplies.  From what I can tell, this is not based on evidence that reusing PPE will prevent the spread of COVID-19, it is based on hope.  Before the shortage, we could have been disciplined for the way we are now being asked to use PPE.  That being said, I’m even not sure where we are in my hospital with PPE right now, much less the nation.  As a staff nurse, I really only have the information I am given and what I see on the news.  

Also, I want to make it clear that I am not working on a COVID-19 unit.  My current unit is an observation unit, and we only have curtains in between our patient beds, so they aren’t putting anyone with even the slightest cough on my unit.  I was even called off this week because our hospital census is low, probably because elective surgeries are canceled and the public is staying away as much as possible.  I feel some cognitive dissonance with that too– I am young and healthy and feel I should be DOING MORE. But at the same time, when I put myself in harm’s way I am also putting my Aunt and Uncle in harm’s way (who I am living with), which I am not going out of my way to do.  I think a lot of healthcare workers are feeling this way, and I know we are not the only ones facing this particular ethical dilemma.  

To all my healthcare worker friends out there fighting the good fight… thank you!

A NOTE ON COMPARATIVE SUFFERING

I am disappointed my time in Arizona is no longer what I intended.  I’m sad my Grandma is gone. I’m disappointed I won’t be seeing my cousins or their kids again while I’m here.  I’m disappointed that I won’t get to do the things I wanted to do or see the places I was still hoping to see. I’m disappointed my friends had to cancel their trips to see me.  I’m disappointed that even as I plan to move back to Pittsburgh, my homecoming will have to be quiet and small and not what I hoped for. Of course, these disappointments truly don’t add up to much in the end, and I still have a LOT to be thankful for.  My disappointments almost seem shameful in light of the suffering of so many other people right now.  

But hear me out: Ignoring my own sadness and disappointment does not move me into more empathy or better action.  While perspective is very important, logically knowing my sadness is less justified than another person’s sadness does not actually help me cope with sadness. And when I cannot cope with sadness, I cannot empathize well with others, either.  Showing myself empathy and caring for my own emotions will help me actually move into space where I can care well for other people and respond to their sadness in helpful ways. 

Because, it’s not about who is suffering the most or who is the most important, it’s the reality that THE WHOLE TIME WE WERE ALL IMPORTANT.  We all matter. It’s not a contest. There is no hierarchy on a person’s worth.  The nurses, the doctors, the respiratory therapists, the patients, the managers, the grocery store workers, your neighbor, your friend, the person you didn’t like, the people you love, WE ALL HAVE ALWAYS MATTERED.  In the hospital, this concept matters: We are to treat EVERY PERSON with dignity no matter who they are or how they came to be with us or what disease they might carry.  

It means that the people who are suffering right now matter, and we should do everything we can to mitigate that suffering.  But it also means that if you are suffering right now (even if that suffering looks different from somebody else’s), that you matter, too.  And if you’re not suffering, that is okay, you also matter. Suffering is not a contest.  Nor is indifference the answer.  Instead of feeling shame, you can let empathy and compassion move you into action (such as staying home, supporting local businesses, calling up someone and asking how they are doing, etc.) that will help the people who are suffering and prevent more suffering.  And somehow, hopefully, sooner than later, we will rise from this, together.  

(THIS podcast about comparative suffering by Brene Brown 15:57-19:10: https://brenebrown.com/podcast/brene-on-comparative-suffering-the-50-50-myth-and-settling-the-ball/.)

 

 

Saw the Columbus Crew play in a pre-season game with Liz (travel friend <3)!  VERY excited for the team they have this season… hope they get to play at some point.

 

Sending lots of virtual hugs from Mesa, AZ.  I’m doing quite well, considering, and hope the same for all of you! 

Oh, and wash your hands! ❤

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Life Update:

I live in Arizona now!  I’m living with my Aunt and Uncle, who flew up to Seattle to help me drive my trusty Toyota Corolla from Seattle to Phoenix.  My Toyota has now driven me along the Pacific Coast, through redwood forests, down through the farms of central California, past the periphery of Los Angles, and through the desert to get me to Mesa, Arizona.

A lot of uncertainty went into the decision to take a position in Phoenix: the pay isn’t as great, learning a new hospital culture is exhausting, the only position I could find was nights, and even though I’ve known my Aunt and Uncle my entire life, I only see them periodically since we live so far away.  I honestly agonized over picking up the phone and asking someone who is generally on the periphery of my life, “Think you’d let me live with you? And think you’d help me drive a 24-hour road trip to make it happen?”  And also—do I really want to start over again?

I’ve been here over three weeks now, and so far, it has been all sunshine and desert flowers.  I love living here, reconnecting with family and getting to know them in new ways.  I hadn’t seen my Grandma in probably twelve years, and now I see her at least once a week!  I’ve been hiking, going on long bike rides with my Uncle, and sitting outside in the sunshine by their pool to read.  So far, pretty great.

Just Your Average Musings on the Human Condition

One of my goals for travel nursing was to take myself out of my normal environment and figure out what was left.  Who am I without the life that has been built around me?  What parts of me are a product of my environment, and what parts of me are, well, me?  Which brings me to tiny houses, nursing tools, and soccer shoes (bear with me).

Tiny Houses (How Does My Home Environment Affect Me)

We’ve been watching Tiny House Nation in the evenings.  I love the idea of tiny homes (typically less than 400 square feet) because they are all about prioritizing.  The people in the show are faced with decisions about what things have to stay, what things are just taking up space, and who they love and how that translates into what they need from their homes.  Since I’ve lived in 6 houses in the last 12 months, I am all on board that the space I live in matters.

Nursing Tools (How Does My Work & Work Culture Affect Me)

The hospital I am working at now seems to use every tool in the trade.  We are given acronyms, and sometimes scripting, to help with every situation: AIDET, Braden, BMAT, HEART, SBAR, CUS, LIFE, RACE, PASS, PDSA, Team STEPP, JHFRAT, etc, etc.  This hospital has a robust policy manual, numerous clinical protocols, and the latest and greatest of clinical technologies.  It all blurs together.  These tools are helpful (especially the clinical ones) because they can provide measurable, safe ways to provide quality care!  Tools help us be better.

But at some point, I have to figure out how to incorporate these tools in a meaningful way. Just like a house doesn’t exist for the sake of itself, nursing tools don’t exist just so we have more tools.  What is the bottom line?  For me, it is my promise to promote health and healing to my patients and the community at large.  Since I believe health is a physical, emotional, spiritual, and social experience, I have to approach the ways I use tools with this in mind.  Sometimes it’s not worth over-thinking—empathizing well and being kind goes a long way in promoting health.

Soccer Shoes (How Do My Things Affect Me)

Last week as I was sitting at a computer completing online modules (including modules teaching the nursing tools referenced above) I keep thinking of this soccer saying: The shoe doesn’t make the player.  Soccer shoes come in all kinds of variety: narrow, wide, as well as numerous materials and colors.  When my young self would agonize about what soccer shoe to purchase, I was inevitably reminded: The shoe doesn’t make the player.  Technique, practice, positioning, field awareness, foot skills, etc. make the player.  However, the shoes do matter in some pretty obvious ways, like if they fit or not, or if they cause blisters.  The shoe doesn’t make the player, but, you do need them to play.

Back to the Human Condition

So how does this all relate?  Well, I’m out here in the Southwest of the United States trying to figure out who I am when you take me out of my environment.  But, it’s not that simple, right?  Perhaps this is just one more continuum, and there is no exact point when I end and my environment starts.  I am always affecting my environment, and vice versa.

So, what does that mean?  Maybe it means I have to put effort into making my home a home.  I affect my home and my home affects me.  It means using nursing tools that are helpful (safe, time-efficient, effective, on mission) and prioritizing less the ones that aren’t.  After all, the tools I use affect my nursing practice, just like my nursing practice affects the ways I use the tools.  It means that my old soccer shoes are enough and the question of ability rests on me.  It means life isn’t about money and having pretty things, but it’s not entirely not about that either.

So how do you figure out what to prioritize, what is enough, and what is merely noise? Who knows!  Maybe it helps to have a general mission for life and work and creating structures in life that fit in that mission.  But really, mostly it’s been a big messy game of guess & check, and some invaluable lessons on how different environments affect me.  I’m simply very thankful for all those who have been there for me as I’ve guessed along.

Enough of that!  Here are some pictures:

Featuring… desert plants!

 

Featuring… hiking! Hopefully, more to come!

Pittsburgh (plane)–> Seattle-(car)-> Pheonix road trip.  We drove past Mt. St. Helens, along the Oregon coast, though some redwood forests, and through central California and eventually into Arizona.  I was very thankful to have help driving!

Hope everyone is well!  Take care!

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And a bonus poem if you made it this far ;).

Morning Coffee

When my world implodes,
Morning Coffee,
Í’ll still wake up for you.
For the science of the hour,
Health food, sinister toxin, 
It doesn’t matter.
If the economy fails,
Should I win the lottery,
No mind that I never play,
We’ll pay it no mind.
Listen,
If he fails to love me,
If a friend moves away,
Wherever I go, 
East coast, west coast,
If I live on my own,
Or surrounded by those for whom
My heart explodes,
That will never change us,
Morning Coffee.
It is no small comfort, 
That life is but a 
Smattering of habits
Which fill up the spaces
Between all of which cannot be controlled.
Even then, faithful life companion,
I am content that
You’ll always find me here, 
Somehow, 
Always,
Morning Coffee.

The Travel Routine

What’s new with me? Well, nothing is new in the sense that everything is still new.  Somehow, even as everything changes, the routine to which it changes starts to feel the same.  

Like at work:

• I will learn so much and it will be both uncomfortable and rewarding
• I expect to be stressed at work for the first three weeks.  Then, after that, something magical happens and the charting gets more comfortable, the processes are more second nature, and I don’t question how (or if) I’m possibly going to get through my workday.
• When I show up on a new unit for the first time (I work on a different unit every day as a float nurse) I expect to assert myself in a room of people who don’t know me, and I expect it to be awkward, and I know by the end of the day it will feel normal.

Like in life:

• I expect to feel nervous the first few times I go to a new grocery store or a new gym, but soon enough I won’t think twice about it.  But, even then, I’ll still need my GPS.
• I’ll have to GPS everything, always, and I’ll miss just knowing where the closest gas station is.
• I know the newness of a new place starts wearing off around week four and I start feeling more lonely, but as I get to know people and find enjoyment in new routines, I know the sense of loneliness improves.

It doesn’t seem to matter that I am aware of my patterns.  I have not yet figured out a way to ~know~ my way out of stress, nervousness, or even homesickness.  The stress of transition is part of the routine, and knowing that the hard parts are also temporary is also a part of the routine.  I wonder if other travelers experience this?  

BUT IT’S NOT all clouds here in the PNW!  Certainly, I have a sense that I’m where I’m supposed to be doing what I’m supposed to do. And I’ll never get sick of Mt. Rainier as a backdrop.  But traveling isn’t the only thing that has a certain routine to it….

 Routinely Learning the Same Lessons

When I was applying to college, I wrote an essay about the tension of deciding what in life was worth holding onto and what in life was worth letting go of.  The essay was titled And Whither Then, I Cannot Say, a way of saying I just don’t know what’s gonna happen.  I realized there was a community that I would dearly miss if I left Canton, OH and I realized that I could learn and grow in meaningful ways if I left. Do I hold onto the community that saw me through childhood and adolescence, or do I let it go and allow those relationships to change?  And truthfully, a bit of that tension still exists.  I still dearly value that community and I am still only ever back to visit.

As I was reflecting on how much the trees in Vancouver reminded me of Rivendell from Lord of the Rings, I remembered the poem that sparked that essay, written by J.R.R. Tolkien.

The road goes ever on and on
Down from the door where it began
Now far ahead the road has gone,
And I must follow, if I can, 
Pursuing it with eager feet,
Until it joins some larger way 
Where many paths and errands meet. 
And whither then? I cannot say.

I wonder if it would be a comfort to me then, knowing nine years later I would still be asking the same questions, feeling the same feelings.  I’m pretty sure seventeen-year-old Holly thought she was doing the angsty work so that twenty-six-year-old Holly wouldn’t have to.  Clearly, that is not the case.  Maybe, instead, I was just learning what it feels like to make adult decisions. What in life is worth holding onto?  What can be let go of? What’s next, if anything?  At times it feels like looking at a blank canvas when I’m not really sure I know how to paint.

Truthfully, this poem is even more relatable to me now as a traveler. On January 13th, eleven months ago, I walked out of my Pittsburgh door in a very different headspace than I am in today.  Since then, I have lived on both extremes of I-90. I have had meaningful interactions with people from different regions, countries, religions, and ideologies. I’ve lived with ten different people and in five different houses/apartments. I’ve negotiated four travel contracts.  And somewhere on that road, I have become myself more than ever before. I have learned more about who I am, what I want, what is important to me, and how to kindly but firmly negotiate for my needs.  I have a few answers and many new questions.  I can’t pretend that I don’t often feel like a weary traveler. But I’m here, now.  Today, the hope I find in this poem is the reminder to pursue the road with eager feet. And what’s next? I cannot say.

Some Seattle highlights:

• The beauty of the PNW is worth bragging about, and the people who live here definitely brag about it
• Saying PNW like a native (as if I even knew PNW meant Pacific Northwest three months ago)
• Reconnecting with college friends: Living with Becca & Jake (& Huck), reconnecting with Marla and Ben 
• The Seattle Sounders won the MLS cup (!!!) and I saw them play twice at home! 
• Went to my first NWSL game and saw Megan Rapinoe and Carli Lloyd in the flesh!!
• A snowy hike in the Cascade Mountains with Marla & company
• First trip to Canada with Lauren, a travel friend ❤
• Learning a new hospital and a new way of serving patients/ a community
• Fall colors for dayzzzz (months!)

^^^Cascade mountain range hike in October featuring fall/ winter hybrid

^^^ Vancouver, Canada ❤

^^^ Capilano Suspension Bridge Park, Vancouver, Canada

^^^ Soccer ❤ ❤ ❤ featuring Jake and Becca (my current roommates), Seattle Sounders, Seattle Reign, and MEGAN RAPINOE

^^^ Hodgepodge of some of the people, places, pups, sights, colors, and foods that I’ve enjoyed the most

Until next time!

Holly

      Puget Sound

      A shimmering Seattle sound
      Backdrop to sleepy, spindly spiders
      And stoic spruce saplings

Seattle & First Impressions

The rumors are true: In Seattle it’s cloudy, rainy, and green.

I was at Lincoln Park today, a city park with tall, beautiful trees and pathways which go right up to the sound.  Signs were posted telling visitors 1.) to just let the seals rest on the beach (they are tired), and please keep your dogs away from them 2.) the clams on this beach aren’t safe to eat, so please don’t and 3.) information on the local orca.  OK.  So, I’m not in Pittsburgh anymore.

I started my new assignment!  Orientations widely vary from hospital to hospital, and I’m getting double the orientation at this hospital and four times a much time classroom/ computer time, so I haven’t even experienced the floor yet.  I’ll be a medical/surgical/telemetry float nurse, meaning I’ll be working on different floors every day depending on where more nurses are needed that day.

It has been great getting to know some of my fellow travel nurses.  There are nurses from Montana, Minnesota, Kentucky, Arizona, Oklahoma, and more.  It’s really fun talking about our different experiences, the different equipment we’ve seen and used, and how policies vary from place to place.  They are all people who I can learn a lot from.

I finished unpacking yesterday.  In a stroke of good fortune, two of my friends from college had a spare room.  I am now living in a home that has a kitchen trash can (not a given, I’ve learned), measuring cups (also, not a given), hospitable roommates, and an adorable dog.  Basically, it’s an excellent situation.  I’m driving to work and live 10 miles from the hospital.  The public transportation seems to be less developed than Boston’s and the parking much more generous, so I’ve been driving a lot.

I arrived a week ago, and it’s all so new.  Honestly, I don’t really know what’s going on around me or what to think. But so far so good!

It’s a Good, Good Life and It’s Enough

Last time I wrote was in July!  I’ll attempt to sum it up:

• Flew to Missoula, Montana for a week to catch up with my friends Mattie and Kara
• Rolled back into my “old life” in Pittsburgh for the month of August and reconnected with some of my favorite people
• Drove with my sister ~3,000 miles from Pittsburgh, PA to Seattle, WA in my humble Toyota Corolla

On the way to Washington, my sister and I saw places so beautiful, I couldn’t have dreamed them up.  As we would rush through (a little tired of sitting, but amazed nonetheless), I would wonder, I know I’m grateful, but am I grateful enough?

On the road out here, my sister and I were talking with some folks at a hotel. When I told them I was going to be in Seattle for three months, they responded, “Only three months?  That’s not enough!”

Even today, walking beside a peaceful shore and between magnificent pines, I feel an urgency inside of me.  One week down, only twelve to go! Am I taking advantage of the mountains, the new sports teams, restaurants, coffee, friends?  Am I doing enough?

Then there are bigger life questions about being enough. Should I be more settled right now?  Should I be somewhere else? Should I get more education? Are the programs I’m looking at the right programs? Should I be saving for a house, a car, some other unknown expense?

Enough, enough.  Be still.  This is a good, good life.  It’s certainly not a perfect life (that might be boring?) but it is certainly enough.  Today I’m grateful for a comfortable home, cool weather, peace and quiet, all the places I’ve seen, all the people I’ve met, dinner plans tonight, this blog and the people who read it, and some hot pumpkin bread.  After all, if today isn’t enough, then nothing ever will be.

Featuring my week in Missoula, Montana & the loveable Mattie and Kara (and Pauli).

Pittsburghhhhhh. It was so good to be home ❤

Highlights of the drive, AKA the Badlands, and Glacier National Park.  A million thanks to my sister for helping me drive this 40-hour road trip!

And Seattle, so far, so green.

Until next time!  ❤

Holly

On nursing

Every time I meet a new person, inevitably my work schedule comes up.  Yes, I am a nurse.  Yes, I work three days a week.  Yes, I only work 36 hours/ week for full-time benefits.  Yes, I work days & nights & weekends & holidays.  Yes, sometimes it’s unbearable.  Yes, sometimes it’s wonderful.  That’s usually where the conversation stops, which is fine.  However, recently I had an experience that made me think about nursing again, a little bit beyond the whacky schedule.

I was assigned a patient (and essentially assigned their large family) recently.  She wasn’t doing well after surgery.  The surgery she needed to survive, but it’s hard to say that this woman will ever get back to her baseline.  So, I just dive in and do the work I’ve been taught.  With some help from another nurse, I change dressings, I check her peripheral IV lines, I get rid of her central line, I hang new tubing for IVs and tube feeds, I label them, I clean the patient, change the sheets, give the medications, answer questions and explain my actions, all while slightly perspiring in a yellow gown I am to wear for contact precautions.

The patient doesn’t speak any English, and honestly, I think our cultures are so different our gestures don’t even communicate a whole lot.  But something about patients like this—I love her.  She is so utterly dependent on my care, and I have learned over the years how to provide that care.  Hours away from those who love me most, I relish the opportunity to be needed and unabashedly care for and about someone.

Then, after several shifts working with this patient, the family gave me a Hallmark card that thanked me for my compassion and knowledge.  I was deeply moved by this.  I was just doing my job, like every day.  I want to say—remember that night I was so tired that I was cranky and abrupt?  When she would moan continuously and I could do nothing?  And, the truth is that I didn’t save this patient.  She didn’t end up getting better.  Yet, I also know I have provided something priceless to this patient and to this family that goes beyond my hourly wage and benefits.  Certainly, vise versa, my interactions with this patient and family have enriched my life and made it better.

I won an award last year for being compassionate, selected as the nurse to represent my entire small, wonderful, community hospital.  I am deeply grateful for this award, but how can I possibly ever live up to such an award?  I am not proud of every shift, every interaction, every situation.  There are weeks where I never hit my stride.  And yet, sometimes people would ask me how I could possibly be so patient.  I don’t think I’m particularly patient, but here a couple of thoughts on why I love nursing (even when I am miserably tired/hungry/desperate to go home) and how I approach the work I do.

First, I truly believe all people are doing their best and thrive when they feel a sense of love and belonging (I’m definitely using Brené Brown language here, would highly recommend).  People need love and belonging, and I believe when these needs are met, their best gets better.  Not just patients, but their families, my coworkers, the doctors/ practioners, our nursing aides, the different therapists (PT/OT/speech), our supervisors, etc.  Of course, our best is always going to fall short sometimes.

Assuming people are doing their best is simply a different way to approach life and conflict.  Turns out, a patient may have a deeper need to feel love and belonging than to take their prescribed furosemide.  And, I don’t assume people are trying to be unkind to me or the people around me, instead, I assume they are either unaware of their actions or something else in their life is eating away at their ability to make a genuine human connection.  They are, after all, just doing their best.

Second, I was taught to approach nursing as a “sacred covenant” I have with my patients, a framework developed by one of my professors.  Simply put, the sacred covenant is the promise (covenant) we have to our patients to do a good job, and the bond between the nurse and patients is special (sacred).  Essentially, nursing is a spiritual practice for me. That does not mean it feels warm and fuzzy, because honestly, it doesn’t.

Nurses have so much power in the care of their patients, even, in fact, the power to save lives.  A lot of the power is not glamorous; it’s timely med administration, maintaining machines that beep and beep and beep, dressing changes, cleaning bodies, people demanding more of you than you can (or even should) give, and being honest when you need help.  Often, saving lives looks more like discontinuing unneeded catheters and performing regular dressing changes than it looks like CPR and IV epinephrine.  Using the power I have as a nurse to do well by my patients gives me a sense of greater purpose and is deeply important to me.

A quick thought: sometimes I think people try to reduce nursing to something less than it is.  Nursing is not fundamentally about patient satisfaction.  Too much emphasis on that is going to lead to burnout, you cannot possibly make all people happy all the time. Nursing is not fundamentally about a paycheck.  Of course, I wouldn’t do this work if I didn’t get paid, but still, something is happening in this interaction that is beyond money.  Finally, nurses are not punching bags for the emotionally unwell or superhumans that can go without food and water.  Our compassion and expertise demand we should receive the same respect and dignity we give to our patients every day, and for compassion to be sustainable there also must be reasonable boundaries.  If our patients get served three meals during our shift, we can demand to have the time to go buy at least one for ourselves.

So what is nursing, then?  It’s about the human connection you have with someone who is vulnerably under your care.  It’s about all the scientifically based interventions we do every day to promote health and wellbeing, whether the patient is appreciative or not. It’s about taking care of the person to the best of your ability AT THAT MOMENT, no matter the outcome.  And, maybe it is a superpower, too.

Life update:

I’m sitting in my room in Pittsburgh, putting off packing for a weeklong vacation to Montana to visit some college friends.  Yesterday was my first full day back, and I thought, Pittsburgh is so empty!  It’s strange to be back, but it’s so, so good.  I’ll be in Pittsburgh all of August!

Heres what I wrote before I left:

My time in Boston is coming to an end.  I’m ready to leave, but I’m also deeply grateful for the time I had here.  I am grateful to my coworkers here, my managers here, the friends I’ve made, the soccer team I had a lot of fun playing with, the neighborhood bar I watched the USWNT games at, and my numerous roommates and neighbors.  There are certain people here I could not have survived without.  Traveling is like the ultimate test of FOMO (fear of missing out).  I’m just on the edge of creating a life and routine here, and every new place you go means there is another place that you are not.  And I’ll miss Bekah like crazy.

That being said—Boston—thank you! Next….

………………………………………………………………………

 

I got to hang out with my parents in Pawtuckaway in NH and see them in their new Aliner/ glamping lifestyle!  Very thankful I got to spend some quality time with them!

Thankful for each and every one of these people!  For beach days in Gloucester, for friends visiting me in Boston, for Tuesday trivia at the Hong Kong, for a friend happy to go to a Boston Red Sox game with me (even though she was already going the next day), and for the endless hospitality from Danielle and her roommates Julie and Muneeb.  Not pictured is my roommate Jaanvi, who kept me saner than she probably realized.

I’ve been in Massachusetts for five months now!  Over time, the flavor of adventure changes.  If you are up for it, here are some thoughts on “adventure” from your friendly neighborhood traveling nurse.

Adventure Is Fleeting

She is the wind that whips through my hair

And she gently whispers,

Calling on me

Tales of being free, of

Letting nothing be

Expected of me.

To the sound of her dizzying songs

I buckle at my knees

Spinning to find her

In troubled seas.

My eyes lift to a blue horizon

Adventure, I call,

To blow away these

Dusty cobwebs

To feel in ways

I’ve forgotten to feel,

But, are you here?

Or are you yet in that seductive

Elsewhere.

With a salty taste I find I’m

Stuck

Nowhere.

Adventure

Someone exclaimed to me recently, “you’re so adventurous!”  Huh, I thought. I don’t feel very adventurous.

Adventure!  It’s a word that has been on my mind for a number of years.  After all, I’m in my twenties!  Aren’t these years supposed to be about adventure?  AM I DOING IT RIGHT?  Adventure is something I idolize and simultaneously am skeptical of, hence the poem above which I wrote circa 2018…. So, what does it even mean to be adventurous?

According to the Merriam Webster dictionary, the definition of adventure is more or less 1.) an undertaking usually involving danger and unknown risks and 2.) an exciting or remarkable experience.

Am I Adventurous: The Adventure Factors in My Life:

An undertaking involving unknown risks (3)

• EVERYTHING is new. Work. Grocery store. Gym. People. Travel. It takes time to figure out what actions produce positive results, so, newness = unknown risks.
• I’ve lived in three different apartments since January and I am learning a thing or two about my boundaries and what is tolerable to live with and what I can adapt to = unknown risks.
• Transitioning from a job where I was very comfortable to a job where I was much less comfortable = unknown risks.

Exciting and remarkable experiences (9)

• I’m following my dreams! I wanted to make a big life change, and I did it.  Cool!
• Living in a wicked, cool city with some wicked history.
• Trying to use wicked correctly in sentences, New England style
• Dunkin Donuts and watching New Englanders inhale iced coffee in the winter
• Lobster. Rolls. &. Cannolis.
• Experiencing the Patriots win the Superbowl while living in Boston (even if I wanted them to lose…)
• Seeing the New England Rev’s (pro soccer) win a game RIGHT AFTER firing their coach! And the $13 tickets were also pretty remarkable….
• Winning a futsal championship
• Running a half marathon in under 2 hours
• Living an hour from the ocean

Total score: 13

Conclusion:

Yeah, I’ll take it!  I am adventurous.  I’ve invited the unknown into my life, and even if I miss my old life sometimes, this life is definitely exciting and remarkable.

Maybe the twenties are about adventure (will reanalyze this in my thirties I’m sure), but adventure should not be misconstrued as a fun-fest.  It’s more like a rite of passage for new adults; risk is inevitable, and hopefully, there are some exciting and remarkable experiences along the way.  Learning how to be a nurse was one of the biggest adventures of my life.  With my current adventure, traveling solo for work, I am learning at rapid-fire pace what I can handle and—honestly—what I cannot handle.  Also, adventure can seem individualistic and self-focused, but learning how to be a part of a community is an adventure unto itself.  That’s an adventure I don’t get to be on right now.  Finally, one of the ways I’m coping with my travel nursing adventure is giving myself a deadline for when I’m going to be done traveling.  Turns out, I need the hope of stability to cope with the change.

As for feeling adventurous?  I’d guess that’s less life circumstance and more a cultivation of curiosity, wonder, and gratitude.   Turns out, moving every three to six months has nothing to do with whether or not my life is adventurous or not. Hmmmmm….

Featuring: Heyyyy springggg!!!

Featuring: Finishing races with pups & friends, a lovely birthday roaming the cemetery with Danielle (morbid, eh?), visits from my friend Carissa,  my sister Emily, and beach days!

Featuring: Donuts, grilled cheese, lobster sandwich, Arabic coffee and cake <3333.

^^On my way to work from my new spot in Cambridge!

Last shift this assignment is 7/18/19!  Here’s to my last month in Boston!

TRANSITIONS

What I love the most about transitions, in life and in work, is the heightened awareness of what is otherwise taken for granted.  This post I’ll talk about my transition to my new nursing position, and the ways I’m noticing transitions in my life being really fulfilling and also really hard.

NURSING… FROM MEDICAL TO SURGICAL

I recently started my second travel assignment on a cardiac surgery unit. I’m still working in Boston, only five stories up from my last assignment.  Since I’m in the same hospital, the charting system is the same, a couple of the faces are familiar, and most of the paperwork was done. The transition should be a breeze.  BUT.  I may have been a little naïve about the transition from medical floor nurse to surgical floor nurse.

Do you remember the scrubs episode where they explain medical vs. surgical?  JD, the protagonist, is on the “medical” side, while his best friend Turk is on the “surgical” side. On the medical side, doctors prescribe medications to fix health problems and on the surgical side, you fix them with a scalpel. If you’d like to see them dance it out: https://www.youtube.com/watch?v=iBcWt407iTE.

During my last assignment, I was on a medical/ telemetry floor that specialized in heart failure.  A lot of these patients have so many chronic issues they DON’T EVEN QUALIFY for surgery.  We treat them with medicine to help the heart failure until the medicine starts to ruin the kidneys and then… well, it’s up to the patient, but the answers aren’t easy.  Many of these people have long hospital stays and end up coming back with the same problem. Each patient, their long list of health problems, and their willingness to put up with hospital shenanigans is different.

All cardiac surgery patients have something in common: MAJOR CARDIAC SURGERY.  A cardiac surgery patient has had their sternum sawed apart, their heart operated on, and their sternum then wired back together.  There are expectations about what should be happening on day 1,2,3,4, etc. out of surgery that makes this type of nursing feel much more methodical.  The methodology of it is growing on me but is a bit of a learning curve considering that I knew none of it before my two days of orientation.

AND THIS: The test of attention is a tool this hospital has nursing staff use to assess each patient daily for increasing confusion.  As part of my physical assessment, I ask the patients to say either the months of the year backward, the days of the week backward, or count backward from 10, depending on their cognitive capacity.  When I ask a medical patient to do this, 9/10 they tell me “I’ve already done this” and it’s often hard to figure out if they CAN’T do it or they just don’t want to.  Surgical patients?  “Decembah, Novembah, Octobah, etc” without being asked twice.  Hmmmm.

FROM BROOKLINE TO NEWTONVILLE

I’m living in Newtonville, exchanging one beautiful, upper-class, Whole Foods infested neighborhood for another one.  I no longer commute by walking, I now take the commuter rail two stops into the city during the week, and will be driving for weekends and night shift.  At the end of May, I will be moving again, this time to Cambridge, which is right in the middle of everything.  This feels like a lot of moving to me, and while I believe it will be worth it, that leads me to…

HOLLY AND TRANSITIONS

This week I got DRENCHED coming home from work TWICE. Both of these days I left the house before 6am and got home close to 9pm, wet and cold, with my raincoat forgotten in Pittsburgh and my umbrella forgotten in Newtonville.  Instead of dishing out an hour worth of wages for an uber (?? is this my Dutch heritage??), I walked the 0.8 mi to the train station in hard, steady, rainfall, with my way-too-long drawstrings painfully hitting my cold legs, and my face turned up to the sky while being pelted by raindrops.  Not exactly what I signed up for.

I also, this week, locked myself out of the house with no shoes, and no promise of my roommate coming home for another four hours. Thankfully, I had my phone and my roommate was able to call me an tell me how to get back in the house, so the episode only lasted a couple minutes.  Still, there was that moment of reckoning when I realized I was stuck with nowhere to go, and with only one person could possibly help me.  The only person who could help me, I had only met two days before.  And what if I hadn’t had my phone?

Mom and Dad, please don’t be scared! I’m really doing well! People who know me well know that I have a tendency to be forgetful; however, something about transitions leaves me especially vulnerable to these bizarre experiences.  After all, neither of those situations would have happened in Pittsburgh.  I’m out here learning a whole new way of doing life, and it’s life-giving and exciting and it’s teaching me to trust myself in a way I never have before, but apparently, it also means getting caught in the rain.   For now, I’m OK with that.

 

 

 

These are each from later on during my first assignment.  The first was taken during a run and features is the Charles River and a pretty sweet view Boston.  The second was taken walking home from nightshift, an absolutely breathtaking moment featuring the firehouse in Brookline that signified I was getting close to home.  The last photo is at the Boston Public Garden, taken two days before I drove back to the Burgh for the week. The grass was FINALLY turning green.

 

Then I got to Pittsburgh after a nine-hour drive to find that SPRING HAD SPRUNG!  Definitely set the mood for a wonderful week.

 

On the way back to Boston I stopped in Newtown, CT to see my Aunt and cousins.  We went to NYC to see a Broadway show and to celebrate my cousins birthday!

 

These photos are from this week, featuring the only decent photo I have of Newtonville so far (it is very beautiful, however) and my fav. English grad student.

Until next time!

 

I have been in Massachusetts for two months now!  In that amount of time, I already feel like I’m settling into a pleasant routine.  It’s amazing how something so new can quickly fade into feeling normal.  But don’t be fooled!  With fresh eyes in a new place, there is a lot to see.

On how to get places:

Transportation in Boston is different than anywhere I have ever lived.  I used to drive and park to get places.  Oh, how things have changed.  For starters, parking is an issue.  To bring it home (pun intended), I pay an extra $8/day to park my car AT MY APARTMENT which is technically in a suburb.  In the city of Pittsburgh, I was paying $20/year.  I have really enjoyed the mile walk to work, but if I wanted to park at work during a weekday shift? That would be $38/day.

I don’t drive a lot because parking is difficult in the city.  Relying on public transportation is very new to me.  Mostly I walk, I take the bus or the subway, or I Lyft or Uber.  As a rule, if it takes 30 minutes or less to walk somewhere, I walk.  If I require a bus or subway, chances are my travels times are at least 45 minutes one way.  For example, on Mondays, I’ve been riding the bus to get to futsal games in Cambridge, MA.  The building is 3.5 miles from my apartment, but from door to door, the travel time is about an hour each way.  Well worth it, by the way.

I remember complaining to my roommate Erin that it feels like I’m walking SO MUCH because it is already half a mile to walk to the bus stop or metro station.  She laughed and said that you get used to it.  She’s right.  Slowly I’m figuring out when to drive/walk/bus/metro/lyft/uber and the half mile to the bus/metro doesn’t feel as long as it used to.

TLDR: If you have any podcasts to recommend as I figure out my way around, please let me know!

On nursing in a new city:

My current placement is on a heart failure/ cardiology unit.  I had three days of orientation which was doable, but difficult in some legitimate and comical ways.

The charting system, how I get and give nurse handoff, where I gather my patient’s medications, how I communicate with doctors, how codes are called, how codes operate, how the cardiac monitoring system works, the IV pumps, how patients are admitted and discharged, codes to the breakroom/ supply room/ med room: all different. How did I learn all of that in three days?  Well, I didn’t. I learned everything I could in three days, and thereafter have continued to ask questions incessantly.

Other differences are more minor, like what things are called.  I came to Boston with a nursing vocabulary from Pittsburgh.  What I call monitor, they call tele; what I call charge nurse, they call resource nurse; what I call patient gown, they call “johnny” (?? also why??); and what I call washcloth, they call facecloth.  All the subtle terminology switches can create some confusion.  I wish you could have seen me running around on day 4 desperately trying to find someone a “facecloth” to have a non-native English speaker hand me a washcloth.

Another dynamic to get used to is that many of the rooms on my floor have two patients in them at a time. This dynamic can create some strange scenarios. Confused patients, manic patients, friendly patients, talkative patients, reclusive patients, patients who speak Russian/Spanish/Polish/ect., patients on bowel prep…, they all get to share their space with a stranger with just a curtain in between.  For all the drawbacks, it’s almost poetic.

TLDR: I really like my assignment.

I’ll be visiting Pittsburgh in April for about a week and then coming back to Boston for my next assignment on a cardiac surgery floor.  If anyone wants to visit, let me know!  As promised, some pictures of my life.

This collage features me being a tourist downtown, Boston Commons in February colors,  a cannoli, a lobster roll, and my reaction to HOW AMAZING lobster rolls are.

This collage features Jamacia Pond, one of my favorite spots, which is just a walk from my apartment.  I’m training for a half marathon, so I run around this pond a lot and snap pictures whenever it strikes me.

This collage features my evolution into the kind of person who takes pictures of their food.

Also, snow.

Until next time,

Holly