Seek, Rather than Avoid

In in the vein of trauma informed thinking, I was discussing with my therapist my worries about being idle.  When I have idle time, the first day is spent adjusting to it, the second day is glorious, and by the end of the third day, I'm starting to feel uncomfortable.  Being still reminds me of places in my life where I was forced to slow down, isolated in my recuperation periods.  

As such, I tend to like being busy--even as a base scaffolding of sorts--as a protective measure.  The gap at the end of nursing school, before orientation began, I wanted to try something different.  My therapist and I discussed that avoiding pain wasn't always as successful as seeking pleasure.  That is to say, trying to force the absence is hard; replacing on the other hand is often a more successful plan.  It was a new perspective on an old concern.  Hell, I hear it works for training animals--replacing a behavior rather than stopping a behavior by, say, teaching a dog to grab a pillow when someone is at the door instead of stopping barking--so why not take advantage of our own wiring?  

This means that I had to manage a couple of steps:  

• Intentionally ask myself what I was feeling in those spaces and allowing myself to feel those spaces
• Ask instead in those spaces what I was looking forward to doing, what I was grateful to have a chance to do

Instead of focusing on existential dread, of worrying about being caught in a swell of emotions, I worked on changing the direction of my thoughts.  It's certainly still a work in progress, yet I can say that there were at least a few afternoons of fun reading and time spent hanging out with Luna that had at least a few degrees less of the typical anxiety.  

"I'm looking forward to swimming a couple of miles a week again," I told myself.  "I'm looking forward to starting my new adventure as an RN," I'd follow.  "And I am allowed to rest in the meanwhile from time to time without feeling guilty," I tell myself somewhat unsuccessfully.  

There's an interesting tension that follows sometimes, in not enjoying my rest "enough" or as efficiently as I "should."  Internalized capitalism, unnecessary self-pressure, a mixture of these and other factors come together into a perfect storm of blah conditioning.  I acknowledge the feelings that are there first, whether or not I understand the root.  The idea is to create a frameshift in how I think about things that I fear.  The impulse is to protect, to guard myself; the proposed change is not to ignore that impulse but instead direct the bulk of my energy toward what I am looking to gain, how I'm looking to grow.  

...so, you know, easy work.

Fledgling Nurse, Part 2

I was asking another new grad the other day what surprised her most in the transition between nursing school and nursing practice.  For some reason, I didn't have my own answer prepared when she reversed the question to me, which means I have specifically paying attention in a few places.  As such, I have been starting to catalogue some of the observations and victories--big or small--that I have noticed along the way.  

Fashionista of the year, yo

Time to deploy the bulleted list!

• My grip strength has gotten a bit better--I can take off the cap of the end of an IV tubing with one hand sometimes, instead of reaching into my pocket to grab out my hemostat (clamp) to quickly twist it off with a tool.  
• I have finally developed the habit of putting on my goggles before going into patient rooms, hooray!  And whenever we're in public and I cross a doorframe, I immediately look for the hand sanitizer as another habit.  
• My short term memory is improving.  Really.  The kinds of pieces that I am remembering between rooms isn't perfect, but I am retaining numbers and which medications my patients are taking when I go to collect them from the right spaces and when I gave X medication to a patient last.  I might do an assessment on a patient in the morning but get pulled in so many different directions that I cannot chart it until four hours later, but I'm retaining parts better than I thought I would and learning what kind of notes I need to take otherwise or normalizing rechecking with a patient when I don't feel certain in my memory.  Yet, I've been startled by how much I do remember, partly as I now have a flow in how I like to do my assessments.  
• I'm allowed to message doctors directly with questions.  It's encouraged, even.  And, achievement unlocked, I have already pissed off a doctor by asking reasonable questions, which means oddly enough that I feel I have "arrived."  
• Sometimes the patients we have on our floor are not in their right minds or are not capable of making their own decisions, for a great number of possible reasons.  This may permanent or temporary.  Trying to explain to someone that is confused why they can't just leave or walk around unescorted does not always go smoothly.  Recently, we had one particular patient that I was wondering if I was going to get shoved or punched by standing between them and the door.  We can try to explain and redirect, but in the end we may need to call for additional hands.  I've been reflecting on a particular experience with this patient and making decisions for what boundaries I will set next time.  
• We have hospice patients on our floor.  Honestly, I've considered going into hospice nursing specifically, so I'm grateful to have some of this experience.  I'm not afraid of grief (familiar with it in my own experiences), and I can push through places where people feel awkward.  I am glad to have dedicated space to listen and simply be present with families as they work through those spaces.   So far, I have been a part of declaring two people dead.  Both of them, however, I did not have much of a chance to meet the family, meaning that I was decidedly more of an "extra" in a pivotal moment of their shared experience.  This was surreal to me in a number of ways.  I felt my role as "accessory" and supported that as well as I could by tending to the physical and encouraging them to take any time they needed to feel what they needed to feel.  It was strange to feel adjacent to death, if that makes sense.  And then I had to turn around and be cheerful in another patient's room and overly polite for the next patient's room based on previous interactions.  There was no time--just turn around and move on, think about it later, maybe.  
• There are a lot of terms that I'm accepting and speaking that I was not so fluent in a year ago.  I might through out "peds" instead of "pediatrics" or look at my notes to see that I've written "20 G R AC, NS @ 80/hr; 22 G L FA, SL" and it makes perfect sense to me.  I mentioned as part of an explanation one day that a patient has the right to leave AMA and forgot that not everyone knows what that acronym means, let alone what some of their hypothetical patient rights might be.  
• I'm starting to find rhythms, find patterns in how I work through my day and what pieces I need to do.  Every day is different, with the various needs that my group of patients that I have.  There's that balance between setting a general pattern in the day and reacting to patient needs that crop up, from trips to the bathroom to major crises.  I come in, check my assignments, start filling out some basics about those patients on paper for my own reference, get report from the night nurse to fill in a lot of important specifics, compare that against both procedures and tasks set in Epic, gather an idea of where to start, and begin on those morning meds after prioritizing accordingly.  Every morning I need to assess my patients, to form my own opinion of how they're doing and what goals we might have for this patient today.  The song is different but the genre is the same.  There are patterns and certain things that need to be done by X point or Y point in the day.  I pick my battles and am finding which ones are worth picking.  
• I am noticing my different feelings of urgency and finding my balances between what needs to be done by X time for Y reason and what is feasible to do--when I have five different people with medications due at nine, I cannot physically be in all places at once.  Inevitably, I will walk into a patient's room for a quick thing and get stuck there for an hour, either because of a series of "well, while you're here..." or needs revealing themselves (e.g. going to deliver an IV medication and finding that their IV doesn't work anymore) or whatever else.  There are guidelines and certain things that must happen at specific times, and there are many things that should happen by a certain time and are going to happen as soon as I can and there are a few things that need to be recorded by the end of the shift (e.g. any patient education components discussed today, which I tend to sprinkle in anywhere).  
• There is so much variety in the patients that we see on our floor.  On the one hand, this can be very intimidating because there isn't a certainty to land into with enough time.  On the other, there is always something new to learn, which I find thrilling.  Additionally, there is freedom in knowing that I won't be able to know everything so I don't have to, which in turn takes the pressure off of trying to know everything.  There is peace in that.

Certainly more to come soon, but that's a happy smattering to start with.  What the biggest surprise will be in another few months time, that'll be an interesting question all over again.

Fledgling Nurse

Whelp, I've been working toward this goal for literal years, walking the path to RN.  Andy and I have been working toward being financially able to make the move, assessing what our best choices were, and determining our most appropriate timings.  It was a lot of calculating, prioritizing, and a fair bit of luck to get to where we were, able to make this kind of leap.  

My view walking into work the other day

And here we are.  This is real.  I have a license and a job in a hospital and a coach and days scheduled and a direct deposit setup completed.  It's strange to me to accept the benefits of the hard work after working toward it for so long.  It's almost like same feeling as a book hangover, that the absence of having something to look forward to, to be working toward, there's a strange void there.  It's time to construct a new goal.  

In the meanwhile, my goal is to absorb as much as I can.  I've learned a LOT as a CNA, regarding how the hospital works in general and how my floor "moves" specifically.  My role and its pace will change--I think probably the most difficult part of that transition might be delegation, figuring out how to best utilize team resources.  

There is so much to learn, but the real trick as I see it is trying to feel out two important things:  my own independence and the balance in transference I feel with my patients.  

Let's dig into those.  

Independence:  I now have the power to administer medications without someone over my shoulder approving them.  There are administrative and procedure powers, sure, but I can give people medications that are within their orders without double-checking each one with another body, allowing me to create a blending between my time schedule,  my judgement, and the verbal contracts I have made with my patients.  I can reach out to their doctor on the patient's behalf with their concerns.  I can ask the client what goals are important to them today and with what I know about their case.  I decide what order to do different tasks.  And yet, there are still places where I need to have my coach present, partly for my own safety and partly as they are gauging where I need additional hands and insight.  This leads to some waiting times, where we have to find a place that lines up between tasks.  In other words, there are places where I am asking a lot of permission that are necessary for a number of reasons, which does then impact how much independence I can grow at once--not a complaint but a recognition of what simply is.  

Transference:  I remember what it was like to be a patient, in very vivid detail in some places and otherwise some important, formative moments.  It is VERY easy for me to see myself in a lot of their situations, to want to fight for them in the way that I wanted people to fight for me.  I now have the power to do some of those facets, but I do not have the time nor resources to be all things to all people.  I can ask the doctor questions; I can encourage the patient to ask questions; I can help connect the patient with different referrals and resources; I cannot, however, take all of their urgency unto myself nor can I be overzealous and take pieces of their autonomy with me.  The solution will be finding balance between hearing the patients' concerns to then turn them into actionable pieces but also not pulling on more empathy than I have available, to ensure that I don't make it personal to me.  I have to be mindful of what and where my boundaries are.  I also need to demonstrate self-compassion in enforcing those boundaries.  

There are many, many other pieces to sort through:  I am finding a groove in some spaces; I am stumbling my way through others; I am adjusting to the crisis that needs addressing, which means I have to re-adjust my whole day; I am providing emotional support, even when I have other tasks that need doing; I am learning that one more thing that was policy that I was hitherto unaware of and adding that to the mental list of things that need attending; I am refining my scripts; I am starting to get to know my teammates.  

And walking around with all of this uncertainty as I do explore these spaces is exhausting and fulfilling and terrifying and encouraging and a number of other adjectives all at once.  

Mindful Exercise

There has been a LOT to process these days.  I'm two and a half weeks deep into my orientation onto the floor now.  Andy's got more than two months under his belt, now, at Rivian, and things are moving incredibly fast in that arena.  Our household is upended in a few ways with these changes, with patterns broken and the discomfort of attempting to reform new ones in the midst of all else, when energy is stretched in new directions and therefore missing in normal spaces.  How we reconnect as household members, how we manage household tasks, how we plan for external connections (spending time with friends and family), how we think about the future, everything has shifted.  

Also, Luna is heartily confused and acting either sullen or clingy as a result, depending on the day.  

At our respective jobs, Andy and I have agreed that we're feeling the weight of uncertainty, that it's difficult to gauge progress so new in these spaces, that there are mistakes and places where our process will be steadily honed, that we are trying to build relationships with team members, and everything hits a bit different as we work through those spaces.  

In preparation for some of these places, I started to design a workout schedule for myself again, specifically getting back into the pool.  I gave up my membership at L.A. Fitness when I started nursing school, figuring I could use the student facilities while I was there...and then there was that whole pandemic thing and I was quite busy in school anyway.  I stuck mostly to Zumba and Yoga from home, and Andy found a Bowflex for a great deal somewhere in the middle there.  But this wasn't a substitute for total immersion.  After I identified the need, I craved that space, teared up at the thought of taking a deep breath, sliding beneath the surface, and exhaling slowly, watching the bubbles rise around my face.  After finals were complete, I set about finding a new gym membership.  

Forever and a year ago, my family went to Four Seasons in town--this steadily became my top choice again, given that any other gym in town only has three lanes open for swimming IF it has a pool at all.  Four Seasons, on the other hand had 200% more, with a six lane pool dedicated to lap swimming alone.  Even at L.A. Fitness, thinking that I would have to depend on someone to understand lane-sharing etiquette was and having to interact with anyone at all when I wanted to simply be was a small but present deterrent.    

So anyway, about swimming.  The South Pool is weirdly nostalgic for me.  I was a part of a swim team there decades ago, I swam there while getting my teaching certificate, and it feels familiar and whole in interesting ways.

The space is designed with intentionality, a standard marking you'll see most anywhere.  The bottom of the pool has a stripe in each lane, so that when you have proper form you can align yourself accordingly, crossed with another black line at both ends to make an elongated capital "i."  The top of the "i" lets you know you've hit the end and the end wall of the pool will also be marked with a line or a plus sign, similarly to help you identify at a glance that you are indeed at the end of the lane.  Above this pool, there are little flags at either end--these are functional and not just for decoration.  The flags and the color of the lane markers change to a solid color at the same place so that someone swimming backstroke can count how many pulls until they reach the wall, to avoid injury or otherwise roll over for a flip-turn at the right moment.  Before a race at a new pool, there will be swimmers testing and recounting what their distance is at this particular pool for exactly this purpose.  I've yet to see a three lane pool bother with these flags, which is problematic because I quite like backstroke and prefer not to worry about smacking into the wall at speed because I misjudged what part of the ceiling was my pretend marker or lost speed too early because I was concerned it was coming up.  

I'm back in the pool now, and I feel a bit more whole for it.  I missed that part of me.  I missed that particular quiet.  To know that I had a space where the only thing I could do for that period of time was be in the water, to not have access to screens, to feel the wake of my own turn, even to shake water out of my ears when I was done.  It was good for my heart in more than one way to get back to lap swimming.

Once I am past the warm-up, I can usually let my mind wander a bit, aside from counting the lengths to ensure I hit my mile.  Recently, I was thinking about the breast stroke.  Breast stroke is an exercise in mindfulness.

Every stroke is made of a kick, a pull, and a glide.  The breast stroke (above) has a very pronounced glide stage.  The timing happens in such a way that the arms are streamlining the body in front, to get the full benefit of the kick, aiming for a balanced between getting the full benefit of the glide and interrupting it for the next pull and kick to go again.  The whole process, though, is initiated by a breath.  The breath is the action that starts the pull; the head is back in the water and realigning for the full force of the kick; the process starts again with the next breath.  Training your breathing is an important part of all swimming--prevents that whole drowning thing--but in the case of breast stroke, the stroke molds more to your breathing rather than the other way around.    

Again, breast stroke is an exercise in mindfulness as much as it is an exercise for the body.  A steady pattern of breathing.  A constant, required rest period in the glide.  General awareness in the alignment of your body for optimum gliding.  Going somewhere simply for the sake of moving and the benefit of one's heart.  It's about being present in the space, watching the bottom stripe of the pool progress forward in the glide stages, glancing up the for end stripe in the breath, and then back to the bottom black stripe, being only where you are if only for that moment.  

Perhaps that was what I needed more than anything, a way that I could only be present in the moment, forced to be free from any outside distractions and only able to quietly entertain my own thoughts for a while.  Silence, accompanied by the occasional song in my head or the sound of water rushing past my ears.  Only me.  Not me and a running YouTube video.  Just me and the water.  

My rotator cuffs are pretty tender and I'm sore in a couple of places today, but I desperately need these spaces of reconnection, which also happens to coincide with excellent cardio activity.  Definitely not back to my more "regular" mile times (when I was going three times a week), but my body is beginning to remember again, remember the space and the practice, embracing those spaces if only for fifty minutes at a time.  

It's a holy place.  It's a place where I do something purely for myself.  It's a place where I'm conditioned to listen to my body and be aware of how it moves in space.  It's exactly what I need these days.