Love Thy Neighbor: Wear a Mask

Michiganders are now required by Executive Order from Governor Whitmer to wear a mask indoors and in crowded outdoor settings except in certain situations. All workers in indoor businesses should also wear masks and businesses must turn away customers who don’t wear masks.

The Emergency Alert showed up on my phone today at 4:44pm

Our state leader is setting the right example by wearing a mask and is attempting to change the “American culture” of individual freedoms fast. She has to set this executive order to tell everyone the seriousness of this pandemic and what we all must do to combat COVID-19.

Unfortunately our national leader, the president of the United States, does not want to set a good example and has made masks a political movement. It should not be a political movement! Instead, this is truly a public health crisis.

Wearing a mask is a symbol of caring for thy neighbor, anyone you come in contact with. The mask protects the other person from you, just in case you are amongst the 40% of asymptomatic coronavirus carriers.

Being an asymptomatic carrier means that you have no symptoms whatsoever and you still have the virus and can easily spread the virus to others. Currently, the WHO and scientists worldwide tell us the primary way of getting this severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the name of this coronavirus, is by being close to others in less than 6 feet and breathing in their air.

This coronavirus is not going away until a viable vaccine is ready, which is unlikely to happen until next year. We must remain vigilant and always think what we must do to protect our loved ones and those on the front line. Just when Florida and Texas think they are in the clear and open up the country prematurely, now they are paying for it with American lives and wrecking havoc on thousands of families. If Florida was a country, they would be number 4 in the highest number of cases right now.

Love Thy Neighbor: Wear a Mask

This is especially important as a nurse. You must always protect yourself in order to protect and serve others. Encourage those around you to follow good practices.

I have to admit it’s been difficult. I wished for my sister to drive from New York and visit me and my newborn. Unfortunately I had to decline and tell her to visit me next year when we have a vaccine. My newborn is completely vulnerable and I would feel horrible if something happened to him. She had also visited several groups of people in the week leading up to the planned visit and planned to stay in a hotel for a night. It doesn’t help that videos come up that show hotel rooms still not being adequately cleaned even during the pandemic.

What have you done to encourage others to wear a mask? How have you struggled during this pandemic? Let me know in the comments below.

Happy International Nurses’ Day

2020 is also the year of the nurse and midwife as designated by the World Health Organization (WHO) in honor of Florence Nightingale’s 200 year anniversary of her birth.

Florence Nightingale is the pioneer of modern nursing.

It is almost very fitting that this is the year of the nurse and midwife. They are on the frontlines of taking care of patients with COVID-19 and must advocate for not only the patient but also themselves. The protection and safety for themselves is vital for taking care of others.

Unfortunately there are already too many stories of nurses who were not equipped with the appropriate amount of personal protective equipment (PPE) and died because of it. Every hospital system should do everything to support the nurses and anyone on the frontline to get the right PPE. No system should deny the nurses safety and their own judgement on what is required to keep them safe.

As for the midwives, I am proud to say that I choose a midwife to be my primary care provider. Thankfully midwives and the hospital system have a good working relationship and thus many best evidenced based practices are utilized. I’ll go over it in more detail tomorrow. Goodnight for now.

Moving back to Michigan

I moved back to Michigan about a month ago and since then I’ve done a couple of things:

  1. I got a new job
  2. I bought my first home and I’m moved in last week
  3. I attended the AANA (American Association of Nurse Anesthetists) Annual Congress

A lot of big and exciting changes are happening in my life.

Probably one of the hardest things for me to acclimate to a new institution is getting used to new

  • flow (from pre-op, intra-op, to post-op for all different surgeries and procedures),
  • equipment and location of materials,
  • staff (are they seasoned nurses and techs or are they unfamiliar with the preferences of the surgeon),
  • physician anesthesiologists (do they communicate well with you, give pre-medication, follow protocols well, etc) and
  • surgeons (knowing their preferences, speed of surgery, etc).

Sometimes when things don’t flow as well as I’d like, I have to think about the big picture: “did the patient safely go through surgery?” If yes, “what else could I do next time to improve? What did I do well?” I continuously reassess my day. Sometimes I’ll reach out to my colleagues to ask them of their opinion as well.

For now, go blue!

Words Create Reality

Words create thoughts.

Thoughts create reality.

Change your words, change your reality.

Good thing words are free.

In a Ted video, Lera Boroditsky described a tribe that didn’t use the words left and right and rather described direction only in terms of north, south, east, and west. The tribal members were better with a sense of direction compared to anyone else.

In Russian, it’s common to use varying descriptions of the color blue. Whereas in English, we say blue. It is much easier for a Russian to differentiate the different shades of blue compared to an American.

In a book called “Bringing up Bebe,” the American mom says in France, there are descriptors for “a behavior of small annoyance,” which help differentiate small bad behaviors from horrific acts. Because such a word does not exist in English, a kid who doesn’t finish his carrots versus a kid who kicks a dog may be all labeled “bad kids”. It doesn’t help distinguish the level of “badness” and the behavior from the child.

According to the Rich Dad’s Guide to Investing, if you use the words of a rich person, then you will become rich. Gaining a financial education is one of the key factors that will get you there. You gain education through the words you use.

One of the new advances in medicine and nursing that are rocking the world right now is the use of pocket ultrasound. While ultrasound has been available for years, it has remained prohibitively expensive, especially in rural and poor countries. However, the Butterfly IQ has come out, and I believe it will change how people are diagnosed. Some healthcare providers may be reluctant to use it because it was not utilized in their initial training, but as with any advances, it will be imperative to learn new words (and images) and ultrasound education, to fully embrace the new technology and change the way people are diagnosed.

In each field, we use different words to give us more details, and it dictates our thinking. Our thinking turns into action (or inaction), and that becomes our reality. So to become a better anything, you have to learn the words.

That is why if you say you can’t do something, then that is your reality. That is why if you say you do something, then that becomes your reality.

So if you believe you belong in nursing school, then you will do everything you can to get there. If you believe you will become a great nurse anesthetist, then you will find the resources to become one. If you believe that you can make a difference, then you will learn great behaviors from your role models.

Whatever your dreams are, believe in the new words to create a better reality for yourself.

Happy Nurses’ Week 2019

Happy Nurses’ Week.

We are there for patients during their most vulnerable times and we advocate for them when we see something that isn’t quite right.

One of the things that I learned in nursing school is to keep asking questions. After conducting a head to toe assessment, we should ask ourselves: Is there a reason for a certain lab value or condition? Can we correct that? If yes, how (which drug, route, fast or slow; is there evidence-based practice to support it)? When should we re-evaluate our efforts to ensure that it’s improving the patient?


Anyways, a lot has happened since my last post. I’m moving back to Michigan. After practicing out in Northern California as an independent CRNA, I feel that I’ve learned so much in the last year and gained much confidence as well. There are some things that I feel has improved.

  1. The communication among the surgeon and the OR staff. Letting the nurses and the support staff aware of my presence, discussing with the surgeon my anesthetic plan.
  2. Regional anesthesia. While I did perform them in school, the experience I gained while performing them with and without other anesthesia staff has been tremendous. Attending a Maverick regional anesthesia course improved my hand-eye coordination with the needle. Interscalene blocks, TAP blocks, adductor canal blocks…
  3. Ultrasound guided arterial lines. It is the preference for the cardiac anesthesiologists to perform ultrasound guided central lines and arterial lines. So why not make it a standard of care for ultrasound guided arterial lines? Sometimes the ‘feel’ of the pulse is not accurate and a visual of the artery improves the first time success rate even for beginners.
  4. When there’s a sick(er) patient or a patient with a potentially difficult airway, I ask for another CRNA or an anesthesiologist to standby to help me start the case. As a professional, I’m aware of when I need additional help and when I will be able to manage the case on my own.
  5. While the first couple of cases I was a little apprehensive of starting and ending the case of my own (considering that in my training I always had a CRNA and anesthesiologist in the room during those times), I feel much more comfortable with induction and emergences on my own. The positive aspect is that cases tend to start shortly after entering the room so that there is no delay (unlike in a medically directed setting where it may take more time for the anesthesiologist to arrive if s/he is not readily available for whatever reason).
  6. Reducing the amount of opioids used in surgery by utilizing a multimodal analgesia. As you know, the opioid crisis is exactly that – a crisis. There are simply too many people who continue to have post-op pain and require opioids. That is one of the ways that is contributing to the crisis. If we can improve our processes to reduce the amount of opioids during surgery, postoperatively, and utilize other evidence based pain management strategies, then we should all move towards that.

That’s it for now. Until next time.

Nurse Jess in Top 20 Nursing Blogs

Top 20 Nursing Blogs 2018

I received an email about a week ago from Theresa Frost stating that I was on the Top 20 Nursing Blogs list on the Online Nursing Degrees website. I feel honored. But more importantly, I’d like to introduce two other blogs that are great for learning more about CRNAs (certified registered nurse anesthetist).

  • Life as a CRNA – There are some detailed information about what to expect on a day to day basis as a CRNA. There is also some advice for getting into anesthesia school.
  • CRNA Career Guide – It provides a comprehensive guide along with advice from several presidents of state associations of nurse anesthetists.

The Speed of Trust

I recently subscribed to the Blinkist, an app that summarizes nonfiction books and gets to the core of the book. I highly recommend it if you enjoy learning (and being a human, you naturally have curiosities in your life, right?).

One of the books is called the Speed of Trust by Stephen Covey. It tells us that trust affects everything, especially how fast communication and events go. For example, if you trust that the restaurant prepared your food safely, you’ll have no problem eating the food. However, if you had concerns over the food safety, you will hesitate and question the chef before maybe consuming the food (or even throwing it away).

Trust is one of the most powerful forms of motivations and inspiration. People want to be trusted. They respond to trust. They thrive on trust.

You must have self-trust so others can trust you. Because if you don’t trust yourself, then who will?

The way to gain trust in yourself is by following the Four Cores.

Integrity

Integrity is gained by making commitments to yourself and following through on them. Integrity is being honest with yourself. For example, if you tell a patient that you will return to them with information, then do that. If you tell yourself you will go to 50 crunches, 20 squats, 10 burpees, and jog a mile, then commit and do it! If someone blames another person for your mistakes, own up to it and take the blame. If you commit to waking up to the alarm clock and getting to work or school on time, then do it.

Intent

Having positive motives and behaviors will point you towards good intentions. Are you listening or do you just want to “win”? In many circumstances you can increase trust if you have good intentions.

Capabilities

Developing capabilities will improve your confidence. And life is always changing which requires you to keep learning. In the health field, learning what is the latest evidenced based practice and working towards incorporating it in your practice will keep you on the top of your game.

Results

When you build a track record of your results, you build self trust. In the world of anesthesia, you are constantly evaluating your actions– how well did the induction, maintenance, emergence go? How well did the patient do? What could I do differently to improve my results?

 

After developing trust in yourself, you develop trust in others

You develop trust through your actions and your truth. This includes understanding yourself — your strengths and weaknesses, your moods and behaviors, your actions and inactions. By knowing yourself, you can better understand others’ critiques of you and owning it.

You will also demonstrate trust by caring about others. Giving others credit when due. Being thankful for others’ actions. Showing that you are aligned in the same goals.

This will increase your credibility. This is important especially in the healthcare field and in the OR. You trust that the scrub tech stays sterile. You trust that the circulator nurse has the room and everyone responsible ready. You trust that the surgeon is able to safely complete surgery. You trust that the pre-op nurses get an IV and come talk to you if they have any questions. The more you trust yourself and gain trust in others, the faster things move and better the outcome.

With the lack of trust, everything and everyone is questioned. Only more delays occur. And that is why it is so important to gain trust in yourself and in others.

As a side note and reference to what’s going on in the real world…

Christine Blasey Ford showed tremendous courage in speaking out about her experience with Judge Brett Cavanaugh. She was incredibly credible — she had nothing to gain and everything to lose by speaking out, and the fear that her world would shatter and none of it would matter.

On the other hand, Judge Cavanaugh may have been a credible judge with many people who backed him up. He may have had a very credible record and people trusted his judgment. However, I feel that after his hearing, the American people, or at least me, do not feel that he would be impartial. He doesn’t seem like he would have the temperament of a judge. While one hearing doesn’t seem like it should change the fate of this candidate, he is also up for a LIFETIME job as a Supreme Court Justice. In my humble opinion, I believe that there are other candidates who would be better suited for this position. If he is confirmed, I believe that the American people will continue to lose faith in its institutions. Instead of trying to work together, we will continue to divide the nation.

I feel that problem with Judge Cavanaugh is not that he necessarily was a horrible drunk as a teenager and college student, but that he denied it and lied to the Senate. I believe that our principles and values are more important than ‘which party’ sits on the highest courts of our land.

Happy Chinese New Year, the Winter Olympics, and the Florida high school shooting

Happy Chinese New Year!

Ruff. 🐶 I will be spending it on a 12 hour shift.

On the brighter side…

Watching Red Gerard win the first gold for the USA in the snowboarding event was amazing.

After falling in his first two runs down the slopes, he has a near perfect execution and beautiful flips and turns on his snowboard in his final and third run.

It just reminds me that even if you fall, you get back up and you keep pushing to be the best version of yourself. When you do that, you will get better. What can you do to improve? Where are your strengths and weaknesses? What are the steps to get better?

***

On the sadder side…

The Florida high school shooting with 17 dead just makes me so sick. After reading the statistics of mass shootings in the USA in the New York Times, I cannot believe that there’s a mass shooting every day.

I can’t imagine going to school not knowing if I’ll make it out alive that day. It is ridiculous.

If we really care about safety, then we should care about gun safety. It should not be that easy to buy a gun for anyone. Just like you need a license to practice nursing, you should need a license to purchase a gun. The process of getting that license should require safety training, mental status checks, and the requirement to renew the license.

I mean, just to fish professionally, you need a license. To do someone’s hair or nails, you need a license. To buy a gun and be a safe and responsible user, you need to have a license.

I get that the 2nd amendment gives Americans the right to carry a gun, but we also have the right to be safe in our communities and guns are lethal weapons. Especially AK-15s. Why is that kind of gun sold to lay people? What do the gun shop owners expect lay people to do with those guns?

When people own things, they tend to use those things. Those things include guns. This obsession with “our right to gun ownership” needs to let up. We should focus on improving the safety of our neighborhoods by getting guns to licensed personnel.

A gun is not just an object like a TV, or a fishing pole. It is meant to injure or kill living things, including people. It should be treated as such.

I do not want to become numb to the reality of mass shootings. I want the US to be safer than it is now. I do not want to go to a school, a theater, a nightclub, a concert, and worry if my life will be in danger. It should not be that way. We need this to change.

It may involve the government asking for guns to be returned for compensation, and start to enforce gun safety classes (including accuracy target training), assessing mental health and other harmful associations (for example if they are on the no-fly list, terrorist, etc), and require a license, just like you need to drive a car. And like a driver’s license, you will need to renew it, proving that you’ve received updated information. Just like a driver’s license, there should be a gun registration for the gun owner’s license so it is much easier to keep track of how many guns are being sold.

Just like how cars can kill people, the guns’ intention is to kill. Why is it not regulated more?

It is our “right” to drive and it is our right to own a gun. It is also our right to pursue happiness. We can only do that if we feel safe in our communities. And that includes keeping track of gun owners and the type of guns they own.

We need to change America for the better.

Do you agree, disagree? What do you think can improve the gun safety in America so there isn’t a mass shooting everyday in the USA?

Sticking up for yourself

It’s been awhile since I last posted back in August so here it goes.

I graduated, took boards and passed in August. I took a trip to China for my fiancé’s grandpa’s 90th birthday. On the same trip, we went to visit Xian (the terra-cotta warriors!), Taiwan, Osaka, and Tokyo. It was such a great trip to be with my fiancé and visit all these places.

At the end of September, I was getting ready to start working at a hospital. I made the mistake of not asking for a contract before deciding to work there.

Unfortunately, unless a contract is signed, verbal agreements don’t count. I didn’t trust the “man in charge”, especially since he changed the terms only a week before starting work.

At this point, I could’ve started working for him, or leave and stick up for myself.

Fortunately, I was in a position where my family supported my decision and me financially. At this point, I left for California as my fiancé began his schooling at UCSD.

For the next couple of months, it consisted of several interviews and difficult decisions. It also consisted of me actually cooking some food to eat (it had been while!). I finally decided to pull the trigger and move to Northern California.

I started working a couple weeks ago and I’m enjoying it so far. Of course I asked myself, do I still remember everything that I learned? It takes a little time but a lot comes flooding back, even after months of not working.

If it was not for all the support of my family and friends, all the CRNAs and anesthesiologists, all the nurses and support staff, I wouldn’t be where I am today.

Anyways, the biggest takeaway is to stick up for yourself.

Also, happy belated CRNA week. And happy anesthesiologists week. Go team go 🙂