Vasovagal Syncope at a Mass Vaccination Clinic

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I was at a week-long pop-up mass vaccination clinic last month in the parking lot of a sports stadium. We monitored patients for severe allergic and other adverse reactions after administering their vaccine injections. Luckily, we never encountered any patients needing us to treat them with an epi-pen in our tent. However, we did have a patient who fainted almost immediately after receiving their shot. The patient eventually regained consciousness, but not before being attended to by at least five nurses with medics and a doctor along the way. If a patient is going to have an adverse reaction to the vaccine, having one at a mass vaccination clinic prompts attention from an entire team of healthcare professionals!

I had never experienced a person fainting before and it was actually impressive to see so many experienced nurses quickly react and attend to the patient. I didn’t give this particular patient their shot. I didn’t even see the patient faint, since I was opposite end of the tent when it happened. I turned around from where I was and all I saw was a bunch of nurses rushing to care for this patient. Everything happened so quickly. As a new nurse, I want to share what I learned and saw so I don’t forget and can apply it to my own nursing practice!

What is Syncope? What causes it?

Fainting, or syncope, is caused by reduction of blood flow to the brain resulting in a momentarily loss of consciousness. With vasovagal syncope, this can be caused by a sudden drop in blood pressure due to dilation of blood vessels or decreased heartrate. Without knowing this patient’s full medical history, our patient’s syncope was likely an anxiety-provoked reaction to receiving the shot. Some people faint at the sight of blood, pain, or other stressors. It is thought this patient was so anxious about receiving the shot, that the patient fainted and had a vasovagal syncopal episode. I did not follow this patient back to the medic tent where the patient was further monitored and assessed. I also did not administer the shot, interview the patient, or provide the patient with the disclosure statement for verbal consent, so I have no idea if this patient has fainted before. However, what I’ve learned is if a person has a history of fainting, it is recommended for the patient to recognize what provokes the fainting (to avoid or work around triggers) and to also get a medical examination to ensure there are no other health conditions causing syncope. After our patient who fainted, we had a number of patients expressing a history of fainting after vaccinations, so we monitored them more closely and had them sit or lie down after the shot. Luckily, no other patients had a syncopal episode.

A-B-C Prioritization Always Applies

In prioritizing patient care, a nurse assesses a patient and prioritizes airway, breathing, and circulation. This is often referred to as the ABCs.

“A is for airway assessment, observing for airway obstruction which can be seen with a changed sound of voice, “see-saw” respirations, and stridor. B is for breathing assessment, observing for an abnormal respiratory rate, the use of accessory muscles for respiration, and cyanosis. C is for circulation, observing for color of hands and digits, an abnormal capillary refill time, and decreased level of consciousness (LOC). “

Picmonic.com

The patient was sitting when they fainted, and some nurses pulled the patient down from their seated position, in their wheelchair. Other nurses rushed to support the patient’s bottom, legs, and feet. After the event was over, some of the nurses wondered why the patient was pulled down from their wheelchair. After an internet search, I learned one should help a patient lie down and elevate their legs to encourage blood flow to their brain (https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-causes/syc-20350527).

Vasovagal syncope most often occurs when a person is standing or sitting (https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vasovagal-syncope.html). Supporting a patient in the standing or sitting position while they have fainted can prolong their unconsciousness and decreased blood circulation to their brain – their blood will continue to pool in their lower vessels. The nurses pulling the patient down from the seated position were trying to improve circulation. The patient did not have a blocked airway and was able to breathe, but had fainted. The nursing intervention of changing the patient’s position was prioritizing circulation, the “C” part of A-B-C prioritization [Airway – Breathing – Circulation].

Techniques to Regain Consciousness

Because the person fainted, the person was unresponsive to verbal commands or requests. I saw a nurse perform the sternal rub in an attempt to “wake” the patient. Luckily, the patient regained consciousness after laying down and getting the sternal rub. Once the patient recovered from fainting, the patient was frightened and did not seem to understand what had happened. The startled patient grabbed at the nurses’ hats and clothing. It’s normal to be confused after fainting. The patient’s caregiver verbally reassured the patient that they were okay. By the time the patient regained consciousness, the medics from the medical tent had arrived accompanied by monitoring equipment and a doctor. The patient was calmed down and taken to the medic tent for further monitoring and observation.

It was not used, but there were ammonia sticks in our supply bin. These smelling salts can be used on a patient who has fainted, in an attempt to increase oxygenation to the brain. In the British Journal of Sports Medicine article, “Smelling Salts”, the author explains:

“Smelling salts are used to arouse consciousness because the release of ammonia (NH3) gas that accompanies their use irritates the membranes of the nose and lungs, and thereby triggers an inhalation reflex. This reflex alters the pattern of breathing, resulting in improved respiratory flow rates and possibly alertness.”

McCrory, P. (2006)

An experienced nurse shared with me that if the ammonia sticks or smelling salts are unavailable, alcohol wipes can also be used under a patient’s nose in an attempt to startle them into consciousness.

Prevention

If a patient stated they previously fainted after receiving a shot, we monitored that patient closely or had them lay down with medics present. We also monitored patients a little more critically if they had a prior allergic reaction or medical history that would warrant a longer than normal observation time of 15 minutes.

Often, people who experience vasovagal syncope have warning signs that they might faint. Some of the symptoms may include dizziness, nausea, warmth, sweaty palms, or blurred vision. If a patient experiences these symptoms, have them sit or lie down, as needed. If they can’t lie down, they can sit, bend down, and place their head between their legs. Cedars-Sinai’s website also suggests:

“Tensing your arms or crossing your legs can help prevent fainting. Passively raising or propping up your legs in the air can also help.”

Patients who experience vasovagal syncope or who have fainted before should be aware of their triggers so they can avoid them or develop ways to manage their triggers. To reduce the risk of fainting, Cedars-Sinai offers staying away from some triggers such as:

  • Standing for long periods
  • Excess heat
  • Intense emotion, such as fear
  • Intense pain
  • The sight of blood or a needle
  • Prolonged exercise
  • Dehydration
  • Skipping meals

I think the biggest impression left from the experience with the fainting patient was how important teamwork is and how quickly every nearby nurse jumped in to help. As multiple nurses were tending to the patient, other nurses were calling the medics for help. Everything happened and resolved so fast, that I didn’t have an opportunity to support them. I was proud of the nurses and what I saw (and ultimately relieved that I wasn’t the one who gave this patient their vaccine injection). As a new graduate nurse, I wonder if I would have known what to do or have been able to react so swiftly. I know for sure I’d be yelling for help. Now that this has happened, I at least have a sense of what to do, if I ever see a person faint. Hopefully, you do too!

References:

Cedars Sinai. https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vasovagal-syncope.html

Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-causes/syc-20350527

McCrory P. (2006). Smelling salts. British journal of sports medicine40(8), 659–660. https://doi.org/10.1136/bjsm.2006.029710

Picmonic. https://www.picmonic.com/pathways/nursing/courses/standard/professional-standards-of-nursing-8246/prioritizing-care-32342/airway-breathing-circulation-abcs_8453

Why I Blog – Reflections of a Mature/Mom Student Nurse

It is surreal how my and my daughter’s lives have been paralleling one another throughout my nursing journey. When I applied to colleges to complete my nursing pre-requisites, I also submitted preschool applications for my daughter. I was shocked to learn that preschool wait-list applications cost more than college applications. Some preschool application fees/deposits were 1.5 times more than the application fee for our local community college! This week, I had a significant job interview with my top choice employer. In the same afternoon, I received a call to schedule an interview for my daughter for a language-immersion kindergarten. We’re both interviewing for something that sets the foundation and determines how our lives will be for years to come. If I get into my desired new graduate nursing program, I can see myself staying at that hospital until retirement. If she gets into this language-immersion program and accepts the spot, she commits to attending the school for the next six years. 

Most of my other nursing school classmates did not have to contend with commandeering significant change in one’s own life while being responsible for someone else’s life and wellbeing or a family budget. You may be the only parent in your class. Or, like me, you may be older than every student in your classrooms. You are not alone. Other people have been in that situation before or are in that situation currently, perhaps at another school. I write this blog because I want you to know it’s possible to earn a college degree later in life, even with kids. It’s possible to start over with a nursing career, even after a lifetime in another role. Everyone has their unique struggles or responsibilities, and while you might feel alone in yours, know that you are not. There are registered nurses who have had to repeat a semester or more of nursing school. Some nurses I know were pregnant or dealing with a loved one’s death during nursing school. I’ve read stories of students getting cancer treatments during their nursing program or single moms balancing working and nursing school with their family life. If nursing is your calling, you will find your way, as countless others have. 

Your career path may not look like the paths of other nurses or nursing students you currently know. Your burdens or responsibilities may not be the same as your classmates’. For instance, my classmates did not struggle to potty-train their child while studying for finals, as I did. However, I assure you that there is a nurse with a story similar to yours. Whether you are in nursing school or already a nurse, I invite you to share your story. There’s likely something in your nursing journey that others may find relatable or inspiring. A future nurse might need your encouragement.

I blog for the possibility that someone is encouraged by my story. I blog for the person doubting their abilities or overwhelmed by their circumstances. I blog for mature students who might recognize themselves in me. You don’t have to be a blogger to share your story. Other ideas include:

  • Accepting career day invitations for schools.
  • Being a guest speaker for after-school programs.
  • Joining your alumni association mentorship program as a mentor or recruiter for future students.
  • Providing helpful or encouraging feedback to communities for nursing students online.

Thank you for reading my blog and allowing me to share. I find when we share ourselves, it permits others to do the same. Good luck on your journey – and share your story!

Sage Reminders about Moving Forward

I attended a retreat when I was younger where the speaker talked about going on a journey in a car as a metaphor for life. As the driver of your life, you may have a map or route in mind and see the road ahead. Every once in a while, you look at your rearview mirror. While moving forward in life with your plans, it’s worthwhile to reflect periodically and look back at your life, your rearview mirror. However, no one drives a car long-distances by focusing ONLY on the rearview mirror. In the same way, to move forward with life, you cannot be stuck in the past.

As I’ve shared, I’ve been interviewing for new grad nurse positions. Some interviews have gone well, and some have not. I need to look back at my interviews to understand where I can improve and what I did well to move forward in future applications or interviews. However, it doesn’t serve me to beat myself up and ruminate over any mistakes I might have made. I can be overly critical of myself, but that’s crippling and doesn’t help me. It’s important instead to learn from my mistakes and consider what I can do differently the next time I encounter the same scenario. I suppose I needed reminders to not dwell on my shortcomings and be solutions-oriented instead – I have an important interview next week. Throughout this past week, I have noticed messages reminding me about how my focus determines my path.

My first reminder came in a reflection from a 2021 Lenten devotional I’ve been reading, “Embrace This Holy Season” by Joseph F. Sica. In the February 22 entry entitled “Getting Past the Past,” Joseph F. Sica shared:

“When you find yourself being drawn back into the pain and negative experiences, choose to focus on the present—on what is happening right now—and recognize that history is history. To get past your past, you need to accept it as it was and leave it there. Then pay deliberate attention to this moment—a time that’s never been before and is loaded with opportunities and possibilities. All you have to do is seize them.”

He then offers the helpful practice of taping the following quote to a mirror: “Never look back unless you’re planning to go that way.” It reminded me of the retreat speaker sharing the story about driving using one’s rearview mirror. While I wouldn’t suggest NEVER looking back, don’t be fixated on life’s rearview mirror.

My second reminder came in an email from Marie Forleo, an entrepreneur. She was talking about her relationship with her husband and shared the following:

“Human minds are wired to scan for what’s wrong, especially when it comes to our significant other. We criticize, correct, and attempt to control them. We’re quick to judge and point out (either in our head or out loud) what’s not working. My suggestion? Stop that ASAP. Where attention goes, energy flows. Make a commitment to keep looking for what’s right about your partner. Focus on what they did do, who they are as a soul, and what’s wonderful about them — then proactively and verbally acknowledge that to them consistently.”

While Marie Forleo was talking about relationships, her statement about energy going where our attention flows applies to life, in general. We can focus on mistakes we’ve made in the past, our shortcomings, or we can focus on our strengths and continual improvement. As someone starting over in my career, I need to acknowledge when I do things right because it is easy for me to self-criticize when I do something wrong or not exactly how I would have liked. I’m still learning and developing as a novice nurse, and I need to give myself some grace.

Finally, my third reminder came from Brene Brown, a researcher who focuses on shame and vulnerability. She has a podcast and had a guest, Dr. Edith Eger, discuss “Recognizing the Choices and Gifts in Our Lives.” Below is a quote from Dr. Eger that caught my eye while I was on LinkedIn:

I love the concept of finding an arrow and following it. We can’t move forward without an idea of our destination. Otherwise, we’re just wandering. If I make mistakes, after attempting to correct them, I need to know how to prevent them from happening again or improve myself. I’ve lived long enough to come to an understanding that God will present me with the same lesson over and over until I learn from it. Without a path to move forward, we may end up in circles.

Maybe you, too, needed gentle reminders to focus on moving forward. Perhaps you need to acknowledge your gifts and talents instead of dwelling on your shortcomings. Learn from your mistakes and move onward. Envision what you want, be assured of yourself, and head in that direction!

COVID Mass Vaccination Clinic and Lenten Encouragment

This past week was a little whirlwind filled with holidays, starting with Valentine’s Day, followed by President’s Day, Mardi Gras/Fat Tuesday, then Ash Wednesday. I worked the early part of this week at a mass vaccination site in LA County. It was the first time I had the opportunity to administer the COVID vaccine in my job. I was glad to be of service to so many in the community and happy to network with so many nurses.

It was tiring to be out in the sun, on my feet all day, in a stadium parking lot to either observe patients or give vaccines. Despite my achy feet and slight sunburn, I was grateful to contribute to the vaccine clinic. Patients were appreciative to get the vaccine. Amidst the 4,000 people we were vaccinating each day, I saw an old co-worker and friend I hadn’t seen in 3 years since I left my previous career to become a nurse. I took it as assurance that I am where I’m supposed to be, even if I’m still searching for a new grad hospital position. I also met experienced nurses who gave me suggestions and offered help in getting me a hospital job. I took that as a blessing and another sign that I’m where I’m supposed to be. The other nurses and I worked as a team and got to know one another. While supporting the community and each other, we enjoyed the perks of beautiful weather, stadium views over our lunch breaks, and food provided by the event organizers.

Fat Tuesday lunchtime views with my complimentary cheeseburger.

After a long day of work on Wednesday, I attended Ash Wednesday mass virtually at home. Ash Wednesday marks the beginning of the Lenten season. In his homily, my pastor exclaimed, “Don’t let a good pandemic go to waste!” It’s a strange thing to say, perhaps, but it offers guidance. Now, more than ever, we can slow down and not lead such hectic lives. I don’t have the excuses I once had about my pre-pandemic schedule being busy. My family and I can’t go to parties, attractions, museums, restaurants, bars, or friend’s homes like we used to. Instead of running around with our schedules filled, we can choose to spend time in meditation, prayer, or reflection. We can (re-)connect with others and build relationships using the technology available to us. (I’ve recently discovered the app, Marco Polo, and highly recommend it for connecting with others via private video messages)! I want to use this pandemic and Lent to re-focus on my spiritual well-being.

One of the things I’ve decided to do for Lent is to meditate or reflect on scripture each day. Luckily, my church is offering a daily devotional for parishioners to use during Lent, “Embrace This Holy Season” by Joseph Sica. I have enjoyed it so far.

On one of the days I had off from the vaccine clinic, I had my car serviced. I decided to pack my Med-Surge review book with me along with my devotional and bible. (I’m reviewing the Med-Surge book to prepare for an upcoming interview). The bible and “Embrace This Holy Season” were for me to complete my daily Lenten commitment. While the dealership serviced my car, I went for a walk, grabbed a coffee, and found an empty bench for me to study and meditate. I hadn’t taken time for myself like that in a very long time; it was glorious!

When I was a younger adult, I disliked the solemnity of the Lenten season. I appreciated the focus of prayer, fasting, and almsgiving, but it seemed like such a dark time. Now that I’m older, I appreciate the preparation Lent is for Easter. Lent is like a “time-out” for me to focus on my spiritual practices.

The Lenten reflection from Joseph Sica’s book for the day was about being ourselves and loving ourselves. I found it inspiring and a great reminder. I share parts of the reflection here with you, in case you need to read/hear it, too:

Some of you may not be Christian or observe Lent. Regardless, I encourage you to take time for yourself every once in a while for reflection or meditation. Create time for peace and quiet, if you can. Some of you have gratitude journals or practice hygge. This Lent, I commit to daily meditation and reflection. Even if you don’t observe Lent, maybe consider what you can do to make the most out of this pandemic. “Don’t let a good pandemic go to waste!” Can you use this time apart from others to gain clarity? Can you practice self-acceptance and appreciation? I love to hear how others practice self-care or self-love during this pandemic! Good luck on your journey!

Struggling With Boundaries and “No”

I know it’s been a while since I’ve posted. I feel like I’ve been struggling lately and don’t know what words of inspiration to provide. I find myself working when I didn’t plan to work to please my boss. I recognize that consistently not holding the boundaries I set for myself is unhealthy and causes suffering and resentment. Establishing and maintaining boundaries is a skill I have yet to master. I don’t know if I’d even call myself competent.

Sometimes I find myself working extra shifts, not because I want or need to, but because I want to keep my boss happy. I want her to give me a good recommendation when I put her down as a job reference. (I work as a COVID tester but am looking for an acute care RN role). However, when I work extra days to please my boss, it costs me a chance to recharge myself, spend time with family, job search, or blog. For example, even though I said I was unavailable to work the day after my second-dose COVID vaccination, I found myself working when I didn’t plan on it because my boss was short-staffed and begged me to work. My arm was sore, and I was tired and achy, but I had no other symptoms, so I obliged her plea for me to work. I had hoped to be taking it easy at home the day after my vaccination to fill out my daughter’s complicated kindergarten applications and other job applications for myself. Instead, I wore myself out by working the day after my second shot. By the time I got home, I felt so fatigued that all I could do was shower and lie in bed all evening. I couldn’t even pick up my daughter from her preschool; my husband did. My boss asked me to work again the following day (a day I usually have off), and I said I could not; I felt like I was fighting the flu! I found myself to the point of exhaustion before I finally said “No,” to my boss.

Being short-staffed seems to be a common theme no matter where a nurse works. (There are so many memes about this!) I am not a bad employee if I tell my boss I am not working extra days. Saying “No” is a skill I know I must strengthen to maintain the boundaries I set to keep myself healthy and balanced. [Un]Fortunately, it looks like I will have plenty of opportunities to practice saying, “No.”

Before I became a nurse, I was the type to cram a lot into my schedule. I still am this way. Usually, I enjoy it, but sometimes it’s stressful, especially when running late from event to event. However, since marrying my husband and having my daughter, I’ve been conscious of my family’s schedule and try not to burden them with too much activity. A nurse- and mom-friend told me her life coach suggested she schedule no more than three things in a day. I’ve been good with this for my family, but I am trying to uphold this goal for myself. I accomplish goals I set for myself more efficiently, and I am more satisfied and less overwhelmed when I create a manageable schedule.

I still have many goals and lots of things I feel I need to do or accomplish each day. Fortunately, I realize 1) I do not need to do everything all at once, and 2) Some things (like working or blogging) may fall off my schedule to focus on completing other things (like job and kindergarten applications). Honestly, I should make one of my goals to stop being such a people-pleaser, and I would be able to say NO guilt-free and struggle less. I am working on this, so thanks for your patience during my mini-break from blogging the past week!

Vision Boarding in Quarantine

Due to an unexpected quarantine from my daughter’s exposure to a COVID positive person, I found myself stuck at home for two weeks in January with my husband and daughter. Thankfully, all of us remained asymptomatic and tested negative for COVID. However, I adhered to the health recommendations to quarantine, and I did not work or leave the house outside of medical appointments for 14 days. Homebound, I decided to make my 2021 vision board a fun, creative activity I could do with my daughter.  

Below is the result of crafting together that day. 

My vision board / collage
My preschooler’s collage

I tend to be a visual learner and have found vision boards to be powerful tools. I’ve shared this before, but years before I became a mom, I made a vision board about being a parent. My husband and I spent over a year trying to get pregnant before I had a miscarriage. I eventually became pregnant with my daughter almost a year after our loss. It was pretty amazing to look back at that vision board, even though my dream of motherhood took some time to materialize. 

If you want to try your hand at making a vision board, below are some tips:

  1. Review your goals or vision board from the prior year (or semester or quarter). Reflect on what you’ve accomplished and acknowledge your achievements! 
  2. Do you have any remaining goals that will continue into the next year (or another timeframe)? Do you need to remove some obstacles before you’re able to achieve these goals? Consider removal of a barrier to be an initial goal.
  3. Think about your goals for your specified timeframe (year, semester, or quarter). What plans do you have for various areas of your life? You can focus on several areas of your life or many, but here are some to consider: work/career, finances, personal relationships, health/fitness, spirituality/well-being, education & development, rest & relaxation, or hobbies & fun.
  4. Are your goals S.M.A.R.T. ? S = Specific, M = Measurable, A = Achieveable, R = Realistic, T = Time-bound. If not, design them to be S.M.A.R.T.
  5. After you’ve thought about your goals (I also recommend writing them down in a planner or calendar!), gather supplies: paper, scissors, tape, glue, markers, and items with images you can use in your vision board (magazines, calendars, catalogs, or Pinterest photos/pins). 
  6. Start cutting out and collecting images or words that inspire you or remind you of the goals you have set for yourself. 
  7. Get at least one photo of yourself to place on your vision board. I also included pictures of my family in mine.
  8. Assemble your vision board, making sure to include the year or goal timeframe (e.g. Semester I 2021) and a photo of yourself!
  9. Place the vision board in an area you frequently see. I made my 2020 vision board and hung it on the wall by my desktop all last year. I replaced it with my 2021 vision board this month.

Before I made my 2021 vision board, I reviewed my 2020 vision board (per step 1 above). I posted my board last January on my FB and IG pages:

Upon review of last year’s vision board, it was reassuring to see how many things I accomplished or goals I achieved, despite a worldwide pandemic and various stay-at-home orders: 

  • The photo of a mom and her newborn in my vision board was a nod to my much-anticipated maternal newborn and pediatric rotations. I got to attend an emotionally moving c-section birth as part of my maternal newborn clinical rotation last year. My classmate and I witnessed a father cry with overwhelming joy and love for his newborn child – it was so sweet that my classmate and I were both moved to tears. I got to complete my preceptorship in a NICU. I had wonderful experiences during my rotations.
  • I had a bunch of images related to nursing, education, and graduation. I graduated from nursing school with my BSN and passed my NCLEX last year. 
  • I have “RN” and a pile of money on my board. I started my first job as a Registered Nurse before the year ended. 
  • I have travel luggage, a camera, vacation views, and photos of families having fun doing various physical activities on my 2020 board. My family and I managed to squeeze in two family vacations last year – one to Solvang (thanks to a good friend’s timeshare) and another to Bishop (as a result of tagging along on my husband’s business trip). We did not travel the way I originally envisioned after graduation, but my family enjoyed ourselves and explored new places while safely adhering to health orders.
  • I have images from “Hamilton”, the musical. I had tickets to watch the musical in-person with my husband at the Pantages in May. The show was canceled due to the pandemic. Luckily, our theatre tickets were refunded. I had to be satisfied (but “I will never be satisfied!”, a la Angelica Schuyler) watching it on Disney+. A benefit with watching the musical at home is that my daughter gets to enjoy it, too. My daughter periodically requests Alexa to play the songs, particularly the ones sung by any of the Schuyler Sisters.

Before the pandemic, I was excited to be part of the graduating class of perfect vision, 2020. I remember being a total dork and declaring this to my classmates well before the pandemic became a reality. After the pandemic started, I forgot about being part of the class of perfect vision. Earlier this year, however, my church’s mothers’ ministry had a Zoom meeting challenging members to think about how 2020 was the year of perfect vision. It was interesting to consider: I had to be laser-focused in my commitment to my goals to avoid distractions and overcome the obstacles of an unexpected pandemic. And maybe 2020 had me re-focus and let go of attachments and what I thought my life should look like. My family did not travel to other states or countries for vacation as in previous years, but we got to experience adventure and explore new places locally and within the state. My daughter speaks fondly of Solvang as much as she does of Spain (we visited in 2019). Even with letting go of attachments and expectations of what I thought things should be like, I didn’t accomplish all my 2020 goals – I still need to add more physical activity in my life and to declutter my home – but looking at my old vision board, I’m proud of what I’ve accomplished in 2020! Now, onward to 2021!

Curating Friendships: Creating your Support System

Your friends are either a reflection of who you are or who you want to be. Ideal friends help carry you when you’re down and hold you accountable to being the best version of yourself. However, what if your friends doubt your abilities to obtain a nursing degree or succeed at something you desperately desire? I’ve had friends who have been either naysayers or cheerleaders in my life. Over time, I have learned to curate my friendships. After having a family and working full-time or going to school, my time is limited. How and with whom I invest my free time matters to me.

When I started taking my nursing pre-requisites, I had a friend share how her partner questioned my pursuit and wondered if I would go into Nursing. She said she defended me to her partner and responded that he doesn’t know me well enough to know how determined I am. While I appreciated her supporting me, I wondered why she even shared the story with me at all. You may have family or friends in your life who are not supportive or do not understand why you are pursuing a career change or nursing. You may need to limit the time you spend with them to focus on your goals. Limiting time with my friend with the doubting partner was not super intentional for me – I had little free time while I was doing pre-requisites and completing nursing school. I ended up not spending much time with many of my friends outside of school anyway.

Now that I’ve graduated from nursing school, I still don’t get to spend as much time as I wish with friends. Aside from the pandemic, circumstances such as friends becoming parents, moving, or job changes have made it challenging to coordinate schedules. However, I’ve learned I’d rather have a handful of close friends on whom I can rely rather than a ton of acquaintances or shallow friends. My relationships with close friends remain strong despite lapses in connecting with another or physical distance separating us. It doesn’t make sense for me to go out of my way to maintain relationships with people who don’t value me or my friendship or whose motives I question. I already have great friends with whom I do not spend enough time!

I was in a toxic relationship years ago, and a friend exclaimed, “There are so many people in this world! Why are you with someone nice to you only some of the time?” It’s been over 20 years, and that remark has stuck with me and helps guide me. Seriously, why invest time and energy in someone who doesn’t treat you well or support your growth and success? When I was younger, and my self-esteem was lower, I allowed people I thought were my friends to treat me terribly. I accepted friends who would insult and lie to me or were not interested in my wellbeing. They served as obstacles instead of contributors to my success. I am grateful to have grown and matured enough to recognize true friendship and to set better boundaries for myself.

Decades ago, when pursuing my engineering degree, I had a planner with various inspirational quotes listed each week. A quote that stood out for me is from Alice Walker about friends: “No person is your friend who demands your silence or denies your right to grow.” Is someone who is not supportive of your career pursuits denying your right to grow? Have they shared any valid concerns? Or are they just tearing you down? Maybe it’s time to set boundaries and rethink your friendships.

I also like Alice Walker’s quote because it challenges me to evaluate my actions as a friend. In this time of passionate opposing views regarding the pandemic or politics, I’ve questioned if I need to remain friends with a person when I find myself wanting to block a friend or hide their posts from my feed. There should be mutual respect in friendships, and sometimes, I do not respect views expressed by some friends. I’ve wondered about some of my friends on social media, particularly when they don’t seem to be a reflection of who I am or aspire to be. If we were real friends, I would consider having a meaningful dialogue with them instead of silencing them. In the end, given my limited time and energy, I need to decide if the effort to maintain a friendship is worth it.

I remind myself of why we became friends. I consider how surrounding myself with only like-minded individuals furthers the divide I see in this country. So I continue to have friends or family in my social media feed whose political views I disagree with but who wholeheartedly supported me during my life’s milestones and career change. I’d rather be a person who builds bridges than walls. However, there are times when unhealthy, abusive, or toxic friendships must end. I think part of being more mature is developing the wisdom to know how and when to set boundaries.

Surrounding yourself with supportive people and good friends is vital, particularly during challenging or tumultuous times in one’s life. Friends do not always agree with everything you do or say, but they ultimately share your values or interests and respect you or care for your wellbeing. If friends disagree with what you are doing or oppose your pursuits – are their concerns valid? Are they voicing concerns because they care about you? Are they opening up your realm of possibilities, giving you a new perspective, or are they trying to keep you in your place?

One of the big reasons I pursued nursing is because a good friend challenged me. When I got laid off as an engineer and expressed interest in staying in engineering, he told me he’d help me but asked if it’s what I wanted to do with the rest of my life. He asked if I could see myself doing anything else. I took to heart what he asked, and I reflected, prayed, and did a lot of inner searching. His challenge and my resulting self-reflection are what prompted me to finally take action on my career change and go into nursing. I had thought about changing careers nearly a decade before but decided not to pursue it for various reasons. With my friend’s reminder and the new-found freedom I had from getting laid off and getting severance pay, I resurrected my dream to change careers. Good friends don’t always go along with what you say, but they help you be your best by providing a different perspective.

Good friends are there for you, not just in happy or triumphant moments but also in difficult moments. Nursing school brought me to tears more than once, and it helped to have good friends and family around me. When I doubted myself or my abilities, these good friends and family members listened to me and lifted me when I was down. Hopefully, you have good friends in your life. If not, seek out good friends. There is an abundance of people in this world – there is no need to choose friends who do not respect or appreciate you. I wish you good friendships and good luck for this new year!

COVID Crisis and Self-Care

Recently, I decided to cut back on the number of days a week I work. I recognize I’m blessed to have the option to work as many or as few days as a contract RN and COVID tester. Not everyone has the financial ability to work less. I know it’s a privilege to have this flexibility. Because I’ve spent my entire adult life working a minimum of 40 hours per week, I felt obligated to work full-time as a nurse in this pandemic, even though I have a per diem contract position.

Me in my “uniform” during a typical workday.

I found myself exhausted after my five-day-a-week shifts and having to continually re-arrange my family’s schedule. I am a COVID tester for a studio. Due to ever-changing production schedules, I don’t often know what time I am to start work until the night before, and I usually do not know what time the workday will end my day has already begun. My start times last week ranged from 4:30a to 5:30a. My days ended anywhere from 2-4 pm. On days I work, my husband has to juggle conference calls while coordinating preschool dropoffs. If I don’t get out early enough, he also has to squeeze in pickups during his workday.

Besides worrying about my breadwinner husband adjusting his life to accommodate my work schedule, I began to worry about my physical well-being from working so much and being exposed to hundreds of people a week. During the past two weeks, four different nurses I work with called off work due to some illness or another. Other people seemed tenser because they discovered more people in their work or personal life had come down with COVID.

Since Thanksgiving, I get tested for COVID every day I work. I appreciated the daily tests confirming I didn’t have COVID but realized my body was feeling worn out. Even though I’m naturally an extrovert, I didn’t understand how exhausting it can be to serve hundreds of diverse clients every week. My unpredictable work schedule was also adding to my daily stress. One day I was so tired after work, I think I fell asleep on my way home at a stoplight. I know driving drowsy is extremely dangerous – I didn’t realize how tired I was.

One of the nurses I worked with is a retired hospital nurse. She is a seasoned nurse who now works per diem for “fun” during her retirement. She shared that when she was younger, she always volunteered to work overtime. It resulted in her developing hypertension and needing medication. Since then, she has become an advocate for self-care and setting healthy boundaries. In addition to her, I’ve heard similar messages from bloggers I follow: Do not do things out of obligation or because it’s what you think others expect of you. Do what is best for yourself.

Despite my co-worker’s advice, I didn’t consider cutting back on the days I worked until a friend suggested it. During a phone call, she commented on how tired I sounded and heard my increased anxiety about people around me getting sick. After some thought, I requested fewer days from my boss this past Sunday. This week was the first week I didn’t work five days in a row! I felt guilty at first. However, as COVID cases and deaths rise here in Los Angeles, I feel more secure in my decision. I’ve also had more patience and energy for work and home since I’ve had more days to rest this week.

Nurses in hospitals are overwhelmed and have contacted me to let me know all their units are short-staffed. The patient loads are high and over ratio. New grads are getting pulled off orientation to help. As much as I feel like I’m struggling to get a hospital job right now, it seems like a blessing I don’t have one. I’m frustrated and relieved at the same time. I’m glad I get to work as a nurse and contribute somehow, but I’m also thankful that I’m not like my friends and family working in hospitals witnessing the COVID deaths and raging illness. They are frustrated when they see or hear about people not following public health orders to wear masks or avoid social gatherings because they suffer the consequences in a more profound way than the general public.

To all healthcare workers right now, particularly those in hospitals, I am praying for you and grateful for you. I hope you are protected and supported and able to do what you need for self-care. I hope this vaccine is effective and able to remove the burden of worrying about getting COVID or bringing it home to your loved ones. I am doing what I think is best to ensure my family or I do not add to your patient ratios. I’m trying to keep myself safe and healthy so that I may be part of the care team in a hospital someday soon! It took a while to be aware of my own needs, but I have cut back on the days I work for my well-being. For everyone reading this, please practice self-care and keep yourself safe!

COVID Restrictions and Kid-Friendly Resources

Thanks to an upsurge in COVID cases in Southern California, we have new stay-at-home orders in effect starting today. The Health Department does not recommend co-mingling or going to parks with other households. Playgrounds have shut down again. Dining at restaurants – even outdoors – is not allowed. As a parent, it’s sometimes hard to explain the changing rules to my preschooler. I’m a nurse trying to adhere to public health orders, but I’m also a concerned wife, daughter, and mother who wants to protect my family and loved ones from COVID. I found some complimentary child-friendly resources that explain COVID, hand-washing, mask-wearing, and social distancing. I’ve used them with my daughter and thought I’d share them here.

At the beginning of the pandemic, the series of books “A Kids Book About”… offered a free e-book “A Kids Book About Covid-19” by Malia Jones. It is still available for download here: https://akidsbookabout.com/products/a-kids-book-about-covid-19. My daughter and I read the e-book together, which helped her better understand social distancing and hand hygiene. (“A Kids Book About” offers other great books that help discuss complex topics such as death, cancer, and racism with children. I encourage other parents to check out the series)!

Another great book, also free, is “The Inside Book” by Matthew Griffiths. There’s graphics at the back of the book explaining handwashing, mask-wearing, and how to cover a cough or sneeze. This book is offered as a free download in various languages on the author’s website, https://mattcgriffiths.com/. There’s also an animated reading of the book at the same website and on YouTube.

On YouTube, the Dr. Binocs series offered by Peekaboo Kidz helps explain coronavirus and other science-related topics. (I discovered the series when I tried looking for kid-friendly information about pinworms. There was a pinworm outbreak at my daughter’s school a year ago, and I couldn’t find any preschool appropriate resource to explain it to my daughter)!

Life is hard enough to navigate during a pandemic. As a parent, it’s nice to have free tools to explain this pandemic and public health recommendations to my daughter (or younger patients)! I think these free resources above would be great to use for pediatric patient education. If you have other pediatric resources you use, please share! I would love to learn about them! Stay healthy and safe, friends!