Monday, June 30, 2008

Vacation!

Dear Readers,

We will be on vacation from July 1st to July 6th. Thus, Digital Doorway will also have a rest.

Be well, and please stop back next week for the continuing saga.....

Sunday, June 29, 2008

Reflections....

Life moves along a trajectory and it often seems that one is simply along for the ride. However, as powerless as we may sometimes feel vis-a-vis our life's development, I feel certain that I must take full responsibility for how my life has grown and changed. Whether there are unseen forces at play or not, taking responsibility for my life is one way that I empower myself to reflect on the choices that I have made, not to mention the choices before me as I press forward.

Nursing as a career was a conscious choice to work in a field that would provide me with a reliable income while also allowing me to serve others in a soulful way. That ability to serve and give from the heart is, for me, truly at the center of nursing. Even as I begin a process of decreasing the amount of time I spend providing hands-on care (at least temporarily), I remain conscious of the notion that it is the face to face contact that makes my "nurseness" real.

Developing a career as a writer, so far my identity as a nurse is absolutely central to my writing----here on Digital Doorway, on Nurse LinkUp, and in other online venues where I may soon be providing content, articles and blog posts. My life-long desire to be a writer is now manifesting itself through the "filter" of nursing, and my life as a nurse is feeding and abetting my work as a writer. This symbiosis (and may I also say synthesis?) is gratifying and exciting, and while writing becomes more and more central to my life and career, I plan to never lose sight of my very deep-seated need for contact, intimate interaction, and the gifts of the nurse-patient relationship.

This newest manifestation along my career trajectory is keeping me on my toes, and I look forward to watching the progression as things develop and change. Thank you for staying tuned, and thank you for being the eyes and heart on the other side of the computer screen.

Saturday, June 28, 2008

Impermanence

Reflect on this: The realization of impermanence is paradoxically the only thing we can hold on to, perhaps our only lasting possession. It is like the sky, or the earth. No matter how much everything around us may change or collapse, they endure.

Say we go through a shattering emotional crisis . . . our whole life seems to be disintegrating . . . our husband or wife suddenly leaves us without warning. The earth is still there; the sky is still there. Of course, even the earth trembles now and again, just to remind us that we cannot take anything for granted. . . .

---Sogyal Rinpoche

Friday, June 27, 2008

Back in an Old Saddle

Today I began a four-week intensive of covering for vacationing Nurse Practitioners at my old office for 16 to 20 hours each week. While I've been spending a half-day there most weeks---filling med boxes, doing simple home visits, filling insulin syringes---I am now back in the position of Care Manager, albeit temporarily.

My anxiety vis-a-vis this little sojourn has been high, and today was no exception. However, once I was ensconced in that old familiar milieu, surrounded by caring colleagues who I've known for many years, my anxiety melted away and I just got down to the task(s) at hand. Still, I can safely say that being back in this capacity causes me to feel immense gratitude for the opportunity to no longer work full time, and to have left the job of Care Manager behind.

My nursing career is at a new place, with a learning curve at my new hospice position, many writing opportunities (mostly over at Nurse LinkUp), and the ability to pick and choose what I do and when I do it.

So, I'm watching the wheels, and I think I like how they're turning.

Wednesday, June 25, 2008

Nurses' Unseen Work

Please click here to read a brief blog post on Nurse LinkUp about the invisible work behind the work of nursing.

Monday, June 23, 2008

Covering the Uninsured

The numbers of uninsured Americans is a steady and exasperatingly large number, and in this pivotal election year there are still many Americans missing out on important preventive healthcare. Please click here to read my latest article on Nurse LinkUp.

Friday, June 20, 2008

Unions and Confusion

My new per diem position as a hospice nurse with a local visiting nurse agency entails mandatory membership in a union, the first time I have ever needed to join a union. I am woefully unprepared (and ignorant) when it comes to union issues, and I imagine that my education in this area may provide some fodder for writing as time goes on.

Interestingly, the union in my new workplace has been in contract negotiations with my employer for ten months, the last contract expiring in August of 2007. Just yesterday, after a less than a half day of orientation, I was allowed to go home 90 minutes early, and only today I learned that a picket line formed in front of the office not one hour after I had left for home. Was I purposefully sent home so that I wouldn't see the picket line? Did my boss want me to avoid the uncomfortable experience of not knowing whether to join the picket or not? Was it all simply unrelated?

I plan to post about my experiences vis-a-vis working in a "union shop" from time to time, and will probably find this experience quite enlightening. Stay tuned to this labor channel for further contract negotiation updates!

Thursday, June 19, 2008

Mental Health Parity?

Parity for mental health coverage by insurance companies is a goal long out of the reach of most Americans. While both houses of Congress have passed their own versions of the original bill offering such parity, Congress has yet to offer a compromised version of the original legislation.

Please click here to read the rest of my article on Nurse LinkUp.

Wednesday, June 18, 2008

The Gift of Pain

Whatever you do, don’t shut off your pain; accept your pain and remain vulnerable. However desperate you become, accept your pain as it is, because it is in fact trying to hand you a priceless gift: the chance of discovering, through spiritual practice, what lies behind sorrow.

“Grief,” Rumi wrote, “can be the garden of compassion. If you keep your heart open through everything, your pain can become your greatest ally in your life’s search for love and wisdom.”

---Sogyal Rinpoche

Monday, June 16, 2008

Orientation Anxiety

Tomorrow begins my orientation to a new workplace where I will be embarking upon a dual role as a per diem nurse for a hospice team and a palliative care team at a local visiting nurse agency. Being part of a medium-sized local hospital that works under the auspices of a larger multi-state regional consortium of hospitals, I'm not so sure what to expect in terms of bureaucracy and red tape. So far, the Human Resources and Occupational Health offices have been attentive and personable. Only time will tell.

Starting a new position is always potentially fraught with anxiety. Will I look stupid? Will I feel stupid? Will my ignorance be palpably obvious? How long will it take for them to learn what an ignoramus and impostor I am? How long can I delay the day when they discover my utter uselessness? But seriously, starting anew is somewhat stressful, and I simply have to be myself, smile at the right times, take notes (or look like I am), and ask pertinent questions.

Knowing myself fairly well, I am very aware that I have difficulty with facial recognition and name recall. In a new workplace, this is particularly challenging, and I am never sure how I will manage learning all of the names and faces of my new colleagues. Usually, certain names will stick and I'll remember them without effort. Others will simply confound me for weeks or months. From past experience, I know that self-deprecating humor about my failing brain is my best defense, and I can only hope that the people I have trouble recognizing will be forgiving and kind.

At any rate, some change is afoot, with the challenges of newness and novelty. I only hope I will be up to the task.

Saturday, June 14, 2008

Homelessness as a Public Health Issue

To read my recent article on Nurse LinkUp vis-a-vis homelessness and public health, please be so kind as to click here. And thanks!

Thursday, June 12, 2008

Mindfulness Journal: Where is the Present Moment?

My single greatest challenge has nothing to do with earning enough money or getting enough sleep (although those two can doubtless be a challenge!). As I struggle with life-long depression and anxiety, my greatest and most pervasive challenge is living in the present moment.

Anxiety can be debilitating, and when coupled with depression it's a mental health double-whammy, if you will. I find that it's often a full-time job to steer my mind into the present moment, accept that moment for what it is, and keep my mind focused, no matter the distractions of worry and anxiety that beset me.

Some of the greatest yogis, meditators and spiritual teachers in history have spent years grounding themselves in the importance of single-minded focus on the present. These teachers have consistently guided their students to enjoy and revel in the present moment, and to enjoy the peace of mind that is the fruit of that most precious of commodities. The present moment is a commodity, if you will, that we so often fritter away on worry about either the past or the future---or both---and my personal mission is to live more and more of my life right where I find myself.

Racial Disparities in Healthcare: A Follow-Up

My follow-up article on racial disparities in healthcare can be found over at Nurse LinkUp by clicking here. Thanks in advance for giving it a read.

Wednesday, June 11, 2008

School Bus Safety: A Cause for Concern

Please click here to read my newest article on Nurse LinkUp on the subject of school bus safety and the absence of seat-belts on your neighborhood yellow bus.

Monday, June 09, 2008

All in a Day's (Not) Work

What do you do when you receive a verbal offer by telephone of an hourly wage for a new job, and when you arrive to sign papers they've decreased the amount by almost one dollar per hour?

This was the scenario today when I arrived for my pre-employment physical, and the person who made the original offer wasn't even there. So, in lieu of signing the offer letter as requested, I simply wrote that I was not accepting it due to a discrepancy in the agreed-upon amount, and requested a follow-up telephone call. (Mind you, the discrepancy was only 80 cents per hour, but with the price of gas over $4.00 per gallon, 80 cents per hour sure adds up!)

So, the newest job on the horizon just got returned to the proverbial back-burner pending further discussion.

All in a day's (not) work.

Saturday, June 07, 2008

Institutionalized Racism in Healthcare: Alive and Well in America?

A study by The Dartmouth Institute for Health Policy and Clinical Practice once again demonstrates that institutionalized racism is alive and well in the American healthcare system, where African-American diabetics are five times as likely to undergo amputations than their white counterparts. Please click here to read my newest article at Nurse LinkUp.

Friday, June 06, 2008

Nursing and Writing

Since birthing Digital Doorway in 2005, I have found great sustenance and release in writing online. I love the idea of instant publication, the immediate gratification of writing down one's thoughts and then sending them out into the blogosphere instantaneously. Blogging is now an accepted form of communication and instant journalism and I am happy to still be riding that wave. Nursing blogs have proliferated over the last few years, and a list of some of my favorites can be found on the right-hand side of this blog's homepage.

Several writing opportunities have come along due to my involvement in blogging, and I'm happy to report that I will actually have my first piece of writing published in print by Kaplan Publishing at some time in the near future. In a previous post, I notified readers that Kaplan was looking for writing by nurses on particular themes for a series of three non-fiction books by nurses. The first book, which focuses on doctors and nurses, will include my 2500-word essay which cannot be reproduced here due to contractual agreements, so interested parties will need to purchase the book after publication.

Writing is finally becoming a bigger and bigger part of my life, and as I begin to write regularly for Nurse LinkUp, I am casting my eyes around for further work in both print and online media. I am happy to have found a time in my life where I can grow as a writer both professionally and personally, and I welcome any feedback or input vis-a-vis other directions for growth and opportunity.

Wednesday, June 04, 2008

Thinking About Hospice

Contemplating yesterday's post from Sogyal Rinpoche, a Tibetan Buddhist master and teacher, I am considering my new position as a hospice nurse for which I will begin orientation quite soon. Hospice truly is about the alleviation of suffering when curing has ceased and caring holds sway.

As the individual and his or her family make the choice to no longer pursue treatment, the job of hospice is to provide unfettered symptom management and pain relief as the patient moves towards death. Hospice is also about the care of the family and caregivers. Caring for a person who is evolving towards death can be an exhausting and overwhelming experience, and it is the responsibility of the hospice team to ascertain the family's level of coping, working to alleviate their suffering to whatever extent is possible, as well.

With my developing mindfulness practice and increasing interest in Buddhism, I am beginning to see more deeply how hospice work and the care of the dying meshes seamlessly with Buddhist practices in particular and mindfulness in general. Courses such as Naropa Institute's 17-week Contemplative End of Life Care certificate program for health care professionals and Upaya Zen Center's training program in Compassionate End-of-Life Care offer deeper explorations of these connections.

For now, a focus on basic mindfulness and my initial training in hospice care will suffice as I prepare to enter a new phase of professional development as a nurse. While I have unofficially provided hospice care to patients over the years as both a nurse care manager and a visiting nurse, this new opportunity will allow me to truly be part of a comprehensive hospice team, learning from those who have been developing these specific skills for years.

Dying is the last thing we all have to do in this life, and assisting those who are actively engaged in that process is an honor and a privilege. These are skills that I wish to nurture and develop, both personally and professionally, and I am quietly excited to watch as this door of opportunity opens.

Tuesday, June 03, 2008

The Alleviation of Suffering

What is compassion? It is not simply a sense of sympathy or caring for the person suffering, not simply a warmth of heart toward the person before you, or a sharp clarity of recognition of their needs and pain, it is also a sustained and practical determination to do whatever is possible and necessary to help alleviate their suffering.

---Sogyal Rinpoche

Monday, June 02, 2008

Mindfulness Journal: The Unquiet Mind

Sitting quietly and trying to meditate, my mind roars with thoughts.

While going about my usual business, this must be what my mind does all of the time, although I am so busy with the external world that I don't necessarily notice just how wildly raging my thoughts really are.

When my eyes close and my body comes into stillness, I'm shocked by my mind's predilection for staying "mindlessly" engaged with itself, despite the fact that a majority of the thoughts being generated are superfluous and relatively meaningless concerns for the future or the past.

Sitting quietly, no matter the time of day, my mind's ability to simply focus on my breathing is negligible. Pema Chodron says that one must not only cultivate mindfulness and compassion for other sentient beings, one must also cultivate compassion for one's own mind and thoughts. She states that, even during meditation, the thoughts that arise---both negative and positive---need to be seen with compassion and without judgment. One must not even judge one's inability to be non-judgmental.

This mindfulness practice may be the most difficult work in life, but it also seems like the most crucial practice of all.