Aloha,
Am just home from the second clinical day in a row for this week, and have only 6 more days (3 weeks) of clinical to do before it’s time for end of semester exams and then summer break……Hallelujah!!
My students are ending their second semester of a four semester Associate Degree Nursing Program. It’s an excellent program with a curriculum that is challenging, evidence-based focused, and patient centered. It is a program that demands students in it and the graduates from it practice within standards of care set by the Board of Nursing for Hawaii, accrediting agencies for nursing programs and for hospitals (NLN, JCAHO), and many professional nursing organizations that set forth standards of care specific to their professional area of practice. So, when patients are taken care of in a hospital, they should be able to expect and receive the best of the current knowledge and skills used by nurses across the nation to help them improve and leave the hospital as soon as possible. That should be a minimum expectation at any hospital facility when someone is a patient. This Hawaii Community College ADN Program (curriculum and faculty who implement that curriculum) does everything it can to ensure that these standards are understood by students and grads, and that they implement the standards throughout the two years as students and then into years of professional employment as RN’s.
I love the students. They are enthusiastic, and caring and compassionate, and sensitive to their patient’s pain, anxiety, fears, needs, and safety. Adhering to these standards reflects those traits which they each bring to the future career of nursing. However, there is always the ensuing element of each student being, technically, a novice and a learner. That means they will require assistance to process and learn techniques and policies or protocols for specific elements in the delivery of care on any assigned unit at any assigned facility. It is then inherent that the professional staff and support staff on these units be open to providing role models to these students, and to take opportunities to instill knowledge gained from their experiences into these future colleagues. Alas, that is not always how the interaction and presence of students on units are perceived by staff members. Today that was brought home to me in a very clear and unambiguous manner…..and by a Certified Nurses’ Aide at that!
I’m not going to go into details about what happened today other than say that in my efforts to follow up on a negative encounter a student had with the aide, this aide was explicit in her declaration of the role she and the other’s that she spoke of in the universal ‘we’ language felt was what they should be doing or rather NOT doing when students were on the floor. She made quite clear that my supervision skills were significantly lacking, and that I didn’t teach in the same way that more established and long standing faculty members did, thus mine was the wrong way to do it. The original trigger had to do with one of those standards and the differing perspectives on how implementation of said standard should be done. Student was chastised for doing it ‘wrong’ and then I was blamed for not teaching the student correctly. OK….ce’st la vive! But then I tried to talk to the aide, and that just blew up in my face. I am very very embarrassed to say that I actually left the unit and cried….I’m sure it’s a hormonal thing, but none the less…..I DO NOT CRY AT WORK….PERIOD!! So what triggered this unprofessional and silly personal reaction to something an aide said??? OK, you asked, and I’ll tell you what I think happened.
My clinical experience in Austin for the last 25 years has been with ACC – ADN students on the general medical-surgical unit at Round Rock Medical Center. I began there when there were less than 50 beds, and have been lucky enough to watch and help it grow to approximately 250 beds today. In that time, I was asked to work some extra time as a nursing supervisor who is the key administrative person in the facility other than the 8-5 M-F that ‘real’ administrators are working. I did that for 10 wonderful years, and gained many personal and professional benefits along the way. Additionally, I was asked to become an inaugural member of the hospital’s Ethics Committee, and when I left the only one of the original members left was the Chaplain who chaired the committee all these years. Lastly, due to the respect of peers on the unit, skills recognized during my stint as weekend or evening nursing supervisor, I was asked by the CEO to join the Board of Trustees, and was then later invited to do a third term because they wanted and needed an RN perspective in Board decisions. That was a total of 9 years on that Board. These and other less prestigious requests for my contributions to committees, continuing education, pre-JCHAO surveys, and staff debriefings were all based upon mutual respect and mutual love of the facility and the quality of care it consistently offers to all patients in it’s area. I treasure those years and the friendships and accomplishments made during that time.
In Hilo, where I have students, I am the newbie on the block. That was a given, and I knew that I would have to earn the respect and trust that I had left at RRMC. But, I have good people skills, and I love nursing. I have respect for each member of the health care team…..a caste system doesn’t help the patient. RN’s need aides to assist with some basic tasks, but RN’s should also do some of these basic tasks when time and situation warrant it. So each helps the other to get the best job possible done for the patient. To that mix you must add additional persons who are not directly giving care to the patients but who support that care…..a unit clerk handling posting of orders, phones, paperwork on admissions and discharges, etc. It also includes the Charge Nurse or on the 7Am to 7 PM shift, the Unit Director. They set the tone, the expectations, the morale level, and the team spirit that is present on any unit. If it isn’t starting at the top, then it’s certainly not present at the bottom…..thus this Unit Director has to be in the know about implied and subtle nuances around them. They need to be the role model for when guests, new employees, students or others are on the unit. That’s how it SHOULD BE. Unfortunately it’s not where I am.
There are exceptions to this sad tale of woe….but they do seem to be the exception. Some of the aides I have been able to win over with my usual style of treating them with respect, thanking them for input and assistance, and just trying to interact as a colleague not some evaluator of their performance. That has paid off with three of them. These three know that if they tell me after a clinical day is over that charting of Vital Signs was not done by student Suzie Student, then I will address it, and it will dealt with in the chart. But, somehow my reverse welcome wagon approach missed the aide I encountered today.
I’m diverging off my point here….why cry? Well, the undertones of questioning my ability as a nursing educator / clinical instructor have been present almost from the beginning. When my students (as second semester students usually do) began to add IV medications to the scope of what they could do in the medication administration skill, I had some catching up to do. Remember, I had only had first semester students for about 15 years now, and therefore had not worked with new equipment and pumps, nor new ways some IV drugs are being dispensed. Now wouldn’t you gain as much as you can from the same lab that the students were taught this topic, and then plan to clarify with staff if you have a question?? Yep, me too. But apparently asking questions was perceived as clear evidence that I was incompetent and therefore should not be there bothering them with my questions. I should come knowing all the answers and only deal with the students. Add to that, many questions came up as students were preparing to give IV meds thus it was added to the growing perception that I am not very smart and that the students were needing the staff to do my job instead of me doing it. The aide today made it very clear that students were not to ask aides or RN’s on the unit ANY QUESTIONS, because they can look in the chart or ask me, the instructor. I should know it or find it in the chart. That includes the location of supplies on the unit, Med Center protocols for Isolation, etc. (Those answers are not in a patient’s chart, by the way.) So, finally the cats out of the bag, the poop is in the bedpan, whatever…… I’m too dumb to work at McDonald’s. Just a last note….when clinical was over, the original student who had the run in with this aide tried to tell this aide thank you for her help and guidance today, and the response was the aide walking away while muttering “whatever”. I don’t think we will win this battle…..my bigger concern is can I win the war?
The Unit Director is less friendly than the staff or aides, gives every impression of being quite ‘put out’ when students are in her station zone to do ANYTHING….yet, charts are there, info on reaching docs are there, and other documents associated with patient information that are not chart based are there. We just have to occasionally go into her area. I do what I can to minimize any contact with this Unit Director, and definitely work to keep the students from irritating her. But, it will not be a 100% effective effort just because of the nature of the hospital unit.
What is inarguably being impacted here is the future replacement of nurses who leave hospital nursing. The average patient care unit job for RN’s is about 10 years. Look around the next time you go to visit someone at the hospital….what is the average age of the nurses working that unit. Older nurses move to areas that are less physically stressful and arduous, like Out Patient Surgery, or clinics or doctor’s offices. We need more nurses even now on patient units like this Medical-Surgical unit, much less needing them in the future. My students are saying to me that they wouldn’t work on this particular Medical Unit (Post-Surgery Unit is a separate unit one floor below us) simply because of this atmosphere of intolerance and apathy about their learning or their desire to join the ranks of these nurses. I find that very sad.
So, I will persevere for three more weeks. If I’m back there next year, I believe I will approach the interactions with staff differently. Being a colleague who just happens to come two mornings a week and work with students instead of doing the patient care myself didn’t work. I’ll just focus on the separation of church and state so to speak…..I’ll deal with student and they deal with each other.
But, then I doubt I can really pull it off…..I too much a people person who generally likes working with health care professionals like me!!
Thanks for letting me vent,
Janene
Showing posts with label Nsg Program. Show all posts
Showing posts with label Nsg Program. Show all posts
Saturday, April 9, 2011
Thursday, August 26, 2010
10 Things I Love About Living in Hilo Hawaii
With all due respect to David Letterman…..
10. Friendly, helpful people who waste no time jumping in to be of assistance to a new comer on the island. I mentioned the fireman and the 7-11 counter guys who helped me when I was lost. When I needed to move into the rental house the handyman, Ed Settle, was able to be quickly recruited to assist me move furniture and boxes. Several pieces were donated or garage-sale priced by Beverly. Ed brought along his son-in-law, Chris, along with a trailer pulled by his truck. Together they loaded a desk, 3 chairs, a 5 drawer dresser, a floor lamp, a glass top patio table with two patio chairs, and a large couch with love seat into the trailer and truck. These were then hauled up the front steps from street level to living room level. Additionally, they moved about 15 heavy boxes of my ‘essential crap’ which had been FedEx’d to Hilo. Thus, now I have all the boxes in the house, and basic furniture that can get me started. The dresser and study desk are especially welcome. All moving done without a scratch or injured back. Two good outcomes if you ask me.
9. Lack of poi, but presence of many new tastes and food combinations. A colleague of mine was eating his lunch yesterday, and he told me he had a burrito. Turns out it was a wheat flour tortilla rolled around strips of heart of palm, chicken sausage link, and shredded cabbage. Uh huh! A Burrito!! I just love it.
8. Guava juice for a breakfast drink. Good thing that I love Pineapples and especially love the juice. It can be mixed with guava juice, orange juice, or all by itself. I keep cans of these mixed variations in my refrigerator and am drinking less Cokes because of the great flavors I can get. This morning it was Guava and Strawberry!! UMMM, GOOD!!
7. Cool temperatures, esp. in evening and at night. I do have a fan at the house, and here in my office for mid-day, but by evening, it’s in the low 70’s or even cooler. During the night, I find I need to pull a light blanket up over the sheet I started with because it has dropped into the 60’s. The radio station, KAPA-FM, said one morning as I was driving to the campus that the day was going to be “a warm one…up to 84”. I just laughed. With my house on a hill, and nothing blocking the wind coming from the east across the Bay and up the hill, I have a wonderful airy living room where I can sit and enjoy the view.
6. Hawaiian wine…..taste of pineapple and other fruits in the wine. There are two vineyards on the Big Island. I’ve only tried one, the Volcano Vineyard, and loved the fruity flavor of their wines. They include fruits not usually found in Napa Valley or French or Italian wines. My favorite had Pineapple and passion fruit as part of the subtle flavor in the white wine I tried. The winery is located near the Volcano National Park, and is open for tours. When you all come to visit, we’ll try to add that into the touring we do.
5. A Community College that talks the talk of a ‘family (ohana)’ relationship with faculty, staff, and students, and actually walks the walk of such a promise. When I showed up for the Fall Full Faculty Meeting led by the Community College Chancellor, Dr. Noreen Yamane, I was given a permanent lei made from a ‘fluffy rope’ in the burgundy of the school colors. That way, I can keep it and wear it when school functions are appropriate for such. The nursing faculty have gone out of their way to be of assistance, and answered questions without frustration. I’m clearly being included in the small group, and was made to feel welcome from the beginning. On day one of faculty prep week, the Nursing Program Director, Dr. Elizabeth Ojilo, took me to lunch. Others have offered to have me follow them in my car as we move from campus to other locations, like the Hilo Medical Center, so that I didn’t get lost. I also have had the nursing program secretary take time out of her busy week prior to students arriving to drive me to the location on the ‘big’ campus for my keys and parking permit, and then give me a driving tour of the Main Campus. This campus includes facilities for both University of Hawaii – Hilo, and the Hawaii Community College. There is overlapping usage of buildings and classrooms, book store, library, gym, etc. It’s a huge campus, and this semester, the Community College enrollment was the largest of the 7 CC’s in the state. That combined with the UH enrollment makes it a great challenge to find parking, but, hey! It’s a gorgeous campus, and people are helpful. The maintenance man, Levi, just returned with a recycle trash can for my office because when he came to empty one earlier today, I told him I didn’t have any trashcan yet and was going to buy one.
4. Flowers, more flowers, fascinating shade trees, greenery of every kind, real bamboo….did I mention flowers? The colors are spectacular. Picture Hibiscus blooms that are 4 inches across in yellow, orange, fuscia, and just plain pink! There are trees here that I don’t know the name of, but they grow out into a huge umbrella shape. They are staggeringly large and beautiful, particularly near the bay. Behind my house is a nice stand of real bamboo. I’m told that bamboo will grow rapidly and spread into other areas if not kept trimmed back. But it is a really unique look that resembles a wall of tall bamboo shoots. If they grow forward and start to enter my kitchen or bedroom, I’ll let you know.
3. A nursing program that while similar to ACC’s curriculum is still very different in the organization, implementation, and emphasis for students. There is a newer model of “SimMan (simulation mannequin)” here, and this model can do many things our model in Austin can’t. The lab set up has an adjacent room with the computer controls for SimMan and the lab coordinator can speak for the mannequin from there. A camera system is also set up so that the SimMan area can be projected to the classroom on the other side of the wall, and then students can watch classmates as they implement a scenario or whatever. It’s a great learning arrangement for them and a creative environment in which faculty can devise new and different learning experiences. Students will also have HCC laptops to use within the lab rooms during appropriate exercises and activities.
2. The view of Hilo Bay from my living room window. The view includes a clear view of the walking bridge across to Coconut Island where only foot traffic is allowed. It’s a small island, and great for picnics, and family outings. On the 4th of July, and New Year’s Eve, they shoot off fireworks from the Island….and I’ll have a ringside view for free!!
1. Did I mention the friendly folks? Actually the entire transition has begun with and at the end of my day still includes these outgoing, strong, happy islanders who want a newcomer to feel welcome and to become at home easily in a place they love. Bev Moodie continues to be my guardian angel. She likes to be the driver, and has spent hours chauffeuring me around so that I learn my way through town, find specific places I needed to get to, was able to shop for furniture and other elements for the house, and, of course, take me to different restaurants all over town. Lastly, when I bought my car from Brian Hamakawa at Hama’aina Nissan, they have a tradition of having each new car owner bang a gong which is in the showroom and came from China. This gong is symphony quality, so it has a great sound. Brian filmed my ‘gonging’ on his I-phone, and we laughed and laughed. It was much much LOUDER than I expected….of course, I took my one and only opportunity to really BANG the thing. The staff came out to watch, and cheered when I hit it. Brian also took a picture of me beside my new car in the lot before I drove off. What a delightful and fun way to celebrate the purchase of my new 2009 PT Cruiser. Ever heard of that kind of celebration or personal pleasure by staff in Texas dealerships?
So, dear friends and family, I continue to learn about my new home, and grow more and more contented with the decision to start this chapter in my life in this relaxed and wondrous setting. The exquisite double rainbows that greeted me on my first night in my new house portents the grace that God granted me in my adventure, and there have been more rainbows almost daily to reinforce His blessings.
With love and aloha to each of you,
Janene
10. Friendly, helpful people who waste no time jumping in to be of assistance to a new comer on the island. I mentioned the fireman and the 7-11 counter guys who helped me when I was lost. When I needed to move into the rental house the handyman, Ed Settle, was able to be quickly recruited to assist me move furniture and boxes. Several pieces were donated or garage-sale priced by Beverly. Ed brought along his son-in-law, Chris, along with a trailer pulled by his truck. Together they loaded a desk, 3 chairs, a 5 drawer dresser, a floor lamp, a glass top patio table with two patio chairs, and a large couch with love seat into the trailer and truck. These were then hauled up the front steps from street level to living room level. Additionally, they moved about 15 heavy boxes of my ‘essential crap’ which had been FedEx’d to Hilo. Thus, now I have all the boxes in the house, and basic furniture that can get me started. The dresser and study desk are especially welcome. All moving done without a scratch or injured back. Two good outcomes if you ask me.
9. Lack of poi, but presence of many new tastes and food combinations. A colleague of mine was eating his lunch yesterday, and he told me he had a burrito. Turns out it was a wheat flour tortilla rolled around strips of heart of palm, chicken sausage link, and shredded cabbage. Uh huh! A Burrito!! I just love it.
8. Guava juice for a breakfast drink. Good thing that I love Pineapples and especially love the juice. It can be mixed with guava juice, orange juice, or all by itself. I keep cans of these mixed variations in my refrigerator and am drinking less Cokes because of the great flavors I can get. This morning it was Guava and Strawberry!! UMMM, GOOD!!
7. Cool temperatures, esp. in evening and at night. I do have a fan at the house, and here in my office for mid-day, but by evening, it’s in the low 70’s or even cooler. During the night, I find I need to pull a light blanket up over the sheet I started with because it has dropped into the 60’s. The radio station, KAPA-FM, said one morning as I was driving to the campus that the day was going to be “a warm one…up to 84”. I just laughed. With my house on a hill, and nothing blocking the wind coming from the east across the Bay and up the hill, I have a wonderful airy living room where I can sit and enjoy the view.
6. Hawaiian wine…..taste of pineapple and other fruits in the wine. There are two vineyards on the Big Island. I’ve only tried one, the Volcano Vineyard, and loved the fruity flavor of their wines. They include fruits not usually found in Napa Valley or French or Italian wines. My favorite had Pineapple and passion fruit as part of the subtle flavor in the white wine I tried. The winery is located near the Volcano National Park, and is open for tours. When you all come to visit, we’ll try to add that into the touring we do.
5. A Community College that talks the talk of a ‘family (ohana)’ relationship with faculty, staff, and students, and actually walks the walk of such a promise. When I showed up for the Fall Full Faculty Meeting led by the Community College Chancellor, Dr. Noreen Yamane, I was given a permanent lei made from a ‘fluffy rope’ in the burgundy of the school colors. That way, I can keep it and wear it when school functions are appropriate for such. The nursing faculty have gone out of their way to be of assistance, and answered questions without frustration. I’m clearly being included in the small group, and was made to feel welcome from the beginning. On day one of faculty prep week, the Nursing Program Director, Dr. Elizabeth Ojilo, took me to lunch. Others have offered to have me follow them in my car as we move from campus to other locations, like the Hilo Medical Center, so that I didn’t get lost. I also have had the nursing program secretary take time out of her busy week prior to students arriving to drive me to the location on the ‘big’ campus for my keys and parking permit, and then give me a driving tour of the Main Campus. This campus includes facilities for both University of Hawaii – Hilo, and the Hawaii Community College. There is overlapping usage of buildings and classrooms, book store, library, gym, etc. It’s a huge campus, and this semester, the Community College enrollment was the largest of the 7 CC’s in the state. That combined with the UH enrollment makes it a great challenge to find parking, but, hey! It’s a gorgeous campus, and people are helpful. The maintenance man, Levi, just returned with a recycle trash can for my office because when he came to empty one earlier today, I told him I didn’t have any trashcan yet and was going to buy one.
4. Flowers, more flowers, fascinating shade trees, greenery of every kind, real bamboo….did I mention flowers? The colors are spectacular. Picture Hibiscus blooms that are 4 inches across in yellow, orange, fuscia, and just plain pink! There are trees here that I don’t know the name of, but they grow out into a huge umbrella shape. They are staggeringly large and beautiful, particularly near the bay. Behind my house is a nice stand of real bamboo. I’m told that bamboo will grow rapidly and spread into other areas if not kept trimmed back. But it is a really unique look that resembles a wall of tall bamboo shoots. If they grow forward and start to enter my kitchen or bedroom, I’ll let you know.
3. A nursing program that while similar to ACC’s curriculum is still very different in the organization, implementation, and emphasis for students. There is a newer model of “SimMan (simulation mannequin)” here, and this model can do many things our model in Austin can’t. The lab set up has an adjacent room with the computer controls for SimMan and the lab coordinator can speak for the mannequin from there. A camera system is also set up so that the SimMan area can be projected to the classroom on the other side of the wall, and then students can watch classmates as they implement a scenario or whatever. It’s a great learning arrangement for them and a creative environment in which faculty can devise new and different learning experiences. Students will also have HCC laptops to use within the lab rooms during appropriate exercises and activities.
2. The view of Hilo Bay from my living room window. The view includes a clear view of the walking bridge across to Coconut Island where only foot traffic is allowed. It’s a small island, and great for picnics, and family outings. On the 4th of July, and New Year’s Eve, they shoot off fireworks from the Island….and I’ll have a ringside view for free!!
1. Did I mention the friendly folks? Actually the entire transition has begun with and at the end of my day still includes these outgoing, strong, happy islanders who want a newcomer to feel welcome and to become at home easily in a place they love. Bev Moodie continues to be my guardian angel. She likes to be the driver, and has spent hours chauffeuring me around so that I learn my way through town, find specific places I needed to get to, was able to shop for furniture and other elements for the house, and, of course, take me to different restaurants all over town. Lastly, when I bought my car from Brian Hamakawa at Hama’aina Nissan, they have a tradition of having each new car owner bang a gong which is in the showroom and came from China. This gong is symphony quality, so it has a great sound. Brian filmed my ‘gonging’ on his I-phone, and we laughed and laughed. It was much much LOUDER than I expected….of course, I took my one and only opportunity to really BANG the thing. The staff came out to watch, and cheered when I hit it. Brian also took a picture of me beside my new car in the lot before I drove off. What a delightful and fun way to celebrate the purchase of my new 2009 PT Cruiser. Ever heard of that kind of celebration or personal pleasure by staff in Texas dealerships?
So, dear friends and family, I continue to learn about my new home, and grow more and more contented with the decision to start this chapter in my life in this relaxed and wondrous setting. The exquisite double rainbows that greeted me on my first night in my new house portents the grace that God granted me in my adventure, and there have been more rainbows almost daily to reinforce His blessings.
With love and aloha to each of you,
Janene
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