Nursing: A Leading Force for Change

Lemme share my essay entry for our Nurse's Day celebration. I have won? No. I'm not bitter. I have listened to the winning essays and I couldn't agree more that they are far better than mine. I just want to give this a chance to be read by many, that is if I have readers out there.

This year's theme. Photo courtesy of CNA

So, here it is.

The cliche change is the only constant thing in this world is very significant in the health care spectrum. And nurses, being the forefront of health care faces a lot of change. As technology advances and the lifestyle and trends develop, the types and severity of illnesses changes as well, making it an everyday challenge for the health care providers to cope up with the implementation of patient care.

Thus enters nursing research. Nursing research has improved and increased tremendously over the last few decades. Nursing researchers plays a major role in the development of how nurses adapt to this rapidly changing world. In this health care arena, researches such as the incidence of health care associated infections in different hospitals at different levels of care further improves nurses' awareness in infection control. Other researches such as improving the quality of life, promoting health and preventing illnesses, patient's safety, wound care and management, end-of-life care, and many other areas play a big impact on performing and implementing health care especially when those researches were applied into practice.

When it comes to innovation, nurses also plays a vital role. Being the forerunners and being always in the patient's bedside, nurses have tremendous appetite for inventions. From improvise splints to big nursing inventions such as the pedi-nebulizer, which acts a pacifier while delivers aerosol to the nostrils of a sick infant and makes every infant nebulization less hassle, and the Nurse's Joey, a 16-pocketed utility tool belt which was designed purposely for nurses in order to deliver and perform patient care, nurses were known to be inventors too. These inventions help not only for the patients and nurses but also for the other health care team members.

Nursing education doesn't stop when you graduated and finished your degree. There are also post graduate courses such as masteral's degree and doctoral's degree. Apart from that, nurses are required to attend seminars and workshops to further enhance their knowledge and skills in delivering health care. These lectures also plays an impact on nursing services, not just earning the required continuing medical education credit hours. And because nursing has a wide scope, nursing specialization is beneficial so that one can focus on the special area you are in.

Because there is nursing education, there should also be nursing educators. Their contribution in the health care arena should never be forgotten. They were the ones who instilled into the minds of the nurses today the importance of quality care to the patients, as well as the skills and knowledge that they have acquired through out their nursing education. They are one of the few people who are responsible for creating excellent, innovative, efficient, and effective nurses.

Without nursing administrators who helps and guides the nurses today, nursing would also be futile. They develop policies and guidelines in performing health care. They lead nurses towards innovation and towards change. They serve as a role model in the health care profession.

There is a nurse leader in every nurse. As situation arises, it's not just the charge nurse or the head nurse who plays the role of a leader. Leadership means making decision and performing it depending on what the situation calls for. Take for example the Filipina nurse Menchu Sanchez who lead doctors and her fellow nurses in transferring twenty sick NICU patients to other hospitals around the city when hurricane Sandy destroyed Langone Medical Center where she is working. When everything went blank, she didn't even thought that her family and her house is being submerged into deep waters, but thought about how they would save the lives of the sick newborns. She led the team using the hospital stairs and guided themselves with the lights of their cellphones. All infants were transferred safely to other hospitals. She was even mentioned in President Obama's state of the nation address, thanking and recognizing her for her great leadership.

Nurses as advocate for health works not alone, but with all the health care members. She works collaboratively and makes every treatment, recovery, and rehabilitation successful.

As we celebrate nurse'd day, we celebrate nurses too... Leading change and advancing health is not that difficult---that is, nurses' way.

Happy Nurses' Day!

Well, that's it. :) 

An Open Letter to A Lost Nephew

Dear baby boy,

I know that you don't know me. I don't know you either. I haven't seen you nor touched you. I only knew about you when my aunt (your aunt grandmother) told me about your mom's pregnancy with you. That was four months ago. I was excited of course. You will be my first nephew. Did you know that I've been long longing for a nephew or a niece? Since my elementary years, I am jealous with my classmates whenever they were talking about their little "pamangkins", how they call them titio and tita, and how they would ask attention from them. But I know it would be impossible if it would be from my brothers and sisters because I am the eldest. And my only hope was your mom. She's my first cousin. We were born eleven months apart, her being the older one. Me and your mom is close. She lived with us during our grades 5 and 6 and we graduated in elementary together.

Before, after your father asked for your mom's hands to your grandma and to your great grandparents, she asked me that I will be the maid of honor on their wedding, and I will be the one who will be in charge of the souvenirs and wedding invitations. I agreed of course. I was even excited, not because I will be wearing gown and heels, but because I know, soon after that, I will have my nephew or niece.

That didn't happened. I was not able to wait for your parent's marriage. I went out of the country to support the schooling of your other aunties and uncles, and you were developed even without their marriage. I admit that at first, I am having difficulty accepting you because your parents aren't married yet. Who wants a child to be born out of wedlock? But I learned to accept you because you're there already. We cannot undo your presence in your mom's womb. The only thing that your aunt grandma wished for during that time is that your parents be married. Yes, the marriage happened two months before you were born. That was a simple civil wedding. No, I was not there. I haven't witnessed your parents exchange their vows, but I have seen their pictures. I have seen how big you've become inside your mom's tummy. You should have seen her carrying you inside her. She seemed like she swallowed a whole basketball. 

Now, you were born. I haven't seen your birth either. I was not there of course. I have learned about your birth from the same aunt who told me about your mom's pregnancy. She texted me while I was sleeping, and the moment I have read her text message, I felt my head became bigger, and my heart started to flutter, and I only managed to say, "what?!?" She said you were born already, and that they brought you home. Not only that, she told me your brain is outside your head. I cannot understand her message at first. I read and reread her message, not only thrice. I don't know how many. I thought my eyes is only failing me because I just came from sleep. But even after reading her message repeatedly, I realized that I've seen the correct words. I replied to her asking what she means, and she just confirmed me my thoughts. You have encephalocele. A congenital disorder with the parts of your brain protruding from your head. I know right at the moment that you will not survive. And I was saddened by that.

I maintained contact with your aunts and aunt grandma, asking about how you are doing and how your mom handles the situation. The next time I know, you were brought back to another hospital. I know that bringing you to any health care facility would only prolong your life to hours if not days. And I am right. After a few hours, I have learned that you left us already.

You only lived for not more than 48 hours. You haven't seen the world, less your mom and dad. You haven't seen how beautiful it is outside your mom's tummy. You haven't seen your cousins aunts and uncles, your grandparents and your great grandparents. You haven't seen the flowers and the rainbows, the green trees and the flowing waters. And maybe you didn't even had the chance to hear your parents say I love you to you. You didn't heard the beep of a car, the rustling of the leaves, your mom didn't had the chance to cuddle you, and your dad have not carried you in his arms longer.

Please don't blame your mom. Don't blame your dad either. You were developed from their love with each other, and never did they thought you will be like that. Nobody is to be blamed here. Don't be like your aunts and uncles on your father's side. They are blaming your mom why you've become like that. Your condition is due to folic acid deficiency, which you have developed while you're on your twenty fifth to twenty sixth day on your mom's womb. She might not even know about your presence in her womb that time. Yes, your condition might not have happened if your mom is well-nourished, but you know our condition, right? How hardly we are working in order for us to fill our stomachs. We're not rich to afford that check ups, and to maintain being healthy. If you will see the condition of life in your mom's place, you will understand what I mean.

They are blaming your mom because according to them, she could have had an ultrasound while she's still pregnant. But what would an ultrasound do with your condition? They would only learn about it earlier. Nothing could change it, even if she had hundreds and thousands of ultrasounds in the world. Learning about it earlier can have only two things, they will be accepting your condition earlier and accept it, or your mom and dad, or your extended family can develop depression earlier. Now, if your mom developed depression while you're still inside her, chances of having her bleed is great, which may harm her life as well. Do you like that also? Please make them understand that. 

You may have not lived longer, but please know that we love you. You have a special place in our hearts. You will always be my first pamangkin that I never had. I know you're better off up there than here on earth. In heaven, you'll be happy. You'll play with the angels even if you haven't had the chance to play with your cousins. Do not worry, we will always be here for your mom. She's strong. She can move on. And your dad's with her too. 

We love you. Remember that.

Love,

Your aunt

Deflated

I cried at work today. Don't raise your eyebrows. I know I shouldn't have done it. But can you blame me if all those emotions have been bottled up and just needs one triggering stimuli to be out? I'm not really a cry baby for crying out loud. Yes, I can easily be affected with different sorts of emotions, but to cry with lots of people around, especially with the most vulnerable patients is definitely not my forte.

Today is different though. This is the first time I shed a tear in front of my patients, take note, it's with an S and in front of my colleagues, and the first time that I've cried due to work.

For almost four years that I have been working as a nurse, not to mention the same almost four years that I have worked as a student nurse, I never complained about the patients given to me. I sometimes might doubt myself if I can handle well the cases given to me especially if it is the first time I'll be handling that case, but after a few mind setting, I will settle for it. It's because for me, the harder the case, the more learning I'll get, and the more I can test myself how effective and efficient nurse I am.

Today is no exception. It was the usual busy day at Female Surgical Ward. Since I am not their regular staff (due to floating system since the hospital renovation started), the Assistant Head Nurse oriented me a bit to the patients I'll be handling even If I had received the endorsement. She assigned six patients to me. Here in this hospital where I am working, that is the maximum number of patients per nurse, No big deal for me. The thing is, two of them are total care patients, both orthopedic cases. As usual, I just agreed after she told me my allocation. She also promised me that I will not be given any admission anymore since I have heavy cases, and even told me that If I'm having difficulty with my patients, I just inform her and she will deload one patient from me. After the allocation, I visited my patients,  took vital signs, and gave the due medications. In between those tasks, I will answer their call bells to give them this and that. In short, I was really busy, plus I have a patient for cataract extraction. She had this eye drops every ten minutes as preparation for her surgery.  So I was coming in and out from one room to another, performing my duties.

While I was busy with my tasks, their Head Nurse called me, and said, "22A (one of my total care ortho patients )is for discharge. The son is here, prepare everything. If the patient is ready, just tell me so that I can call for the EMT and ambulance."  Since I never had the chance to browse her files, I still checked everything then prepared her home medications and arranged for appointment to two clinics as out-patient follow up. During that time, my cataract extraction patient arrived from the recovery room, so I left first the plastic bag with home medications and appointment slips at the nurses' station and received the endorsement from the recovery room nurse who wheeled my patient back to her room.  After receiving the endorsement , settling my patient to her bed and attaching the dynamap to set her vital signs checking every fifteen minutes, I returned to the station and waited for the son to come since the HN told me that the son is present already.  I looked around the station and the ward's vicinity to find the son, but I've only seen one man, the one who accompanies one newly-admitted patient. That's the time I said to myself that instead of being idle while waiting, I will eat a scoop of my lunch first since my stomach is already grumbling from hunger. I am supposed to tell the HN that I am just waiting for the son to come but she is busy talking to somebody, explaining something, so I just told the charge nurse to "please tell her that everything is ready, I'm just waiting for the son to come. These are the home meds and appointment slips. I will just be inside the pantry and eat my lunch. If the son comes, just call me."

Before I went to the pantry, I checked first my post-op patient, and as I returned to the station to go to the pantry, I heard the head nurse say "She's expecting me to do everything for her patient? I'm not the primary nurse", obviously referring to me. Apparently, the charge nurse relayed the wrong message. She told her that I am giving the plastic bag to her (HN). My initial reaction is just to stare at her. Then I told her my real message, and she told me to tell the patient's watcher to call the son. Of course it didn't came into my mind anymore since she told me that the son is in the hospital already. I went back to 22A and told the watcher to call the son. While I was there, 22C, my day 1 post Antero-Posterior repair, whom I removed the vaginal packing previously told me that she's experiencing per vaginal bleeding and she's afraid about it. While I was checking her napkin, tears came out rolling from my eyes. I tried my best not to show it to her. I went out of the bathroom, and dabbed a tissue at my eyes, then I went back to her again and reassured her that it is just normal, while I forced a reassuring smile at her. She might have noticed that I cried and asked me what's the problem. When I answered "none", another flood of tears came out. She even offered me her tissue paper while I'm assisting her to bed.

I went back to the station with bowed head so that they will not see me crying and continued with my tasks without eating my lunch. I came back to 22A to remove her IV fluids and her cannula and I saw the HN changing the arm sling of my patient. While I was removing the cannula, I sobbed while controlling my tears. She might have heard me sniff so she asked me, " Why are you crying?". I said "nothing". Then she told me in front of the patient, "my instructions are clear. I told you to prepare everything and tell me if it's ready so that I can call for the EMT." I just answered her that the charge nurse relayed the wrong message. Then I left her and went to the bathroom again to wipe my tears.

I managed to control my tears after that. But somebody noticed my eyes. And everyone kept asking after that. You know the feeling when you're hurting and all seem very concerned, and your tears won't stop flowing?

Maybe the only thing that I want to point here is she should have not said "she's doing everything for her patient" because I am the one who is at the patient's bedside. I am the one who changed the soiled diaper, I am the one who had difficulty changing the bed linens while the patient is on the bed, I am the one who smelled the urine-soaked diapers and linens, I am the one whom the patient got mad at because I didn't changed her diapers immediately as I was busy, I am the one who strained my back from rolling the patient to sides, I am the one who gave the medicines, the one who checked the vital signs, the one who's doing the nursing assessment and documenting it. And her? She just arranged for the ambulance and EMT and changed the arm sling, and she's doing everything for my patient?

Okay, I might be being childish here, but heck. I was really hurt when after all the things I have done to my patients, she's claiming she did it all. And what's worst,  she did it in front of my colleagues, where everybody heard. I rarely get into shameful situations, and this one didn't only shamed me, it hurt my ego as well.

Still crying.