Who raises a child?

     It’s late at night and my day is winding down. The funny thing is; my heart and my mind are all wound up. My never ending whirl wind of school, work and family/friend commitments couldn’t be piled any higher. However, today was the accumulation of a six month process to become a board member for Cuidando Los Niños (a.k.a. CLN). 

  

It should be explained that this board has some requirements. Attendance at events, participation in committees, volunteer time at the center, involvement in advocacy and outreach as well as a back ground check. There are other points too, but by no means can you show up and expect to be appointed membership. 

When presented the opportunity, I made the time. Moved my working days to weekends, started putting feelers out into the community, donated my time, submitted my back ground check, and during the process become even more excited to join this community. I say community because that is what this is. It is a community of people dedicated to helping children who are experiencing homelessness. CLN helps them meet their developmental milestones so that they can continue to grow, develop and become contributing members of society. Studies have shown that without this, the cycle of homelessness will continue. But CLN doesn’t stop there. They take the whole family and build a plan end the homeless cycle through partnerships within the community.

It makes my heart sing to be involved in something that is bigger than me.  I think that is what deep down my heart wants: contribution to others in a meaningful way.  So as I sit here and ponder tonight I wonder…

Who raises a child?

 Is the role limited to a mother, a father, a grandparent or aunt? What about the sister who raises her siblings or the son who steps forward in the role as provider. There is no one entity that raises a child.  When you think of raising a child as a single individual’s role you fail to see the influences that act upon that child and that family unit.  

Take for instance the school. The school has the principle that provides leadership and fosters diversity which is passed to the teachers. Teachers provide education, nurture, and fosters growth within children often inspiring and encouraging them to grow into their community.

 The school is one part of the community but there are also businesses and other community centers at which children frequent. Imagine the possibilities of influence. For instance camp counselors who inspire imagination and exploration or the business owner who donates his time as a part time league coach. It is the scientist who donates her  time tutoring, or even the  church group who through fund-raising helps to provide shelter, food and clothing to families in need.

Each single individual who enters a community has the ability to influence and sponsor growth within that community.  The ability to donate is not defined by the wallet from which checks can be written. It is defined by the quality of time and mentor ship that is put in to the development of the community that in turn fosters true financial growth and lasting development.

Our communities are not defined by white picket fences or cars polished to pristine shine on the weekends.  Our communities are what we build, through the relationships we develop and the growth we provide.   We all have communities, can you find yours?

Being honored with a position on the board is the green flag to forge ahead in a new civic role full of responsibility, challenges and opportunities. It is by no means a finish line of accomplishment but rather a spark that ignites the personal drive to do more, and be more.  I am more than just a role. I am a role model, a worker and a leader within the community. And at the end of the day, it is the community that raised the family. 

"Yes" moments

Sometimes a long day opens up the mind for contemplation.  I am officially knee deep in my second half of my woman’s health clinical rotation.  I never thought I would enjoy woman’s health, but at times I do. Take this week for example I had the opportunity to call a patient regarding her labs and let her know that her results where normal. I re-enforced the need to eat a well balanced diet and to exercise (something everyone should do) and during the call you could hear the relief in the woman’s voice.  That is when you have that “yes” moment. Helping, giving reassurance, educating and being “there” for your patients, that is what is important. 

In addition to school and working I had the opportunity to attend United Way of NM’s Breakfast event.  Another "yes" moment given to me by my friend Maren. She invited me to the event, and although I thought I was going to hang out and eat breakfast with her, I did enjoy meeting a wealth of individuals in the non-profit community.  You never know who you are going to meet.  It was a great morning, and taught me a lot.  The event ended with a wonderful opportunity and a brief chat with Mayor Berry. 

Now, you may ask why I care to meet Mayor Richard J. Berry?  Well, you see the mayor has an initiative to end homelessness. As some people know I volunteer (and hopefully soon serve on the board) for a non-profit that works towards helping children who are experiencing homelessness. I had to do a quick meet and greet with the Mayor to remind him of the wonderful organization I serve.  Hopefully we can partner to expand and help even more people. But it should be said, in my opinion in order to help someone you should give them the tools for success trough education or opportunities. But what they do with those skills is their own choice. I akin it to the Chinese proverb “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime”.   

So just a small blog today, but long thoughts surround my synapses. I will write more soon…and remember my peers and I are more than JUST any one dimension, one job, or one definition. We ARE nurses.

And now to listen to my new favorite:

Infant Motrin? I think Not

This week I read an article by Novak and Allen: “Prescribing Medications in Pediatrics: Concerns regarding FDA approval and Pharmacokinetics”. The pediatric population is one that I am familiar with and enjoy working with the most. That being said this weekend I was exposed to some other than stellar medical care which made me think about what I would do if the tables where changed.



Brief story: I was working as an agency nurse this weekend in an ED and was asked to give a 10 week old Motrin (weight based dose 5o mg po) due to fever. Motrin is a drug that I have been taught not to give under 6 months of age. So I decided to one assess the patient myself then make a decision on the order. I went into the triage area to find a 10 wk old baby wrapped in numerous blankets. I asked the parents to unwrap the child and have only a light blanket to hold the infant with. I then passed by the triage nurse (engrossed in her computer, charting I am sure) and spoke with the ED MD who had written the order without assessing the child. I asked if he knew that the patient was a 10 wk old child. And he said yes and he felt comfortable giving the medication. I handed him the drug and asked if he wanted to administer it. To which he replied he never does. I explained that the child was wrapped in many blankets and suggested rechecking the temp after being unwrapped and doing a physical assessment and history. I then informed the busy triage engrossed in the computer (still charting I am sure, although she had no patients to triage) that I was not comfortable giving the drug nor would I. I then tried to pull up information regarding Motrin use and infants. As I suspected the FDA has not approved its use for those under age 6 months.

Fast forward to this article. Several key points where discussed. One of the first statements included that “Off-label” use of medications still required rationale scientific theory, sound medical judgment or data from controlled trails. This is of key importance to me. I highly doubt a nurse who is engrossed in her computer did a sound history enough to understand when the patient actually last had Tylenol or thought to unwrap the infant from the many blankets before urging the MD to give her a verbal order, to which she felt too busy to administer herself.

Novak and Allen also point out that although the Harriet Lane book is often differed to for appropriate children dosing, although  some medications described are also not approved by the FDA.

I reviewed my own pediatric dosage handbook by Lexi-comp and again it stated the safety and efficacy had not been established for infants younger than 6 months. Not that this information alone would stop me, but say the infant had an undiagnosed Patent Ductous Arteriousus. The lack of assessment and random administration of a drug without complete history and assessment puts the patient at risk.
At the end of the article this simple statement was made: "prescribing medication to children is one of the most complex and potentially dangerous functions pediatric advance practice nurses perform” (Novak& Allen, 2007, pp.69). I realize that my time on the ED floor is coming to an end, and that I will eventually be on the other side of care. But what seems most important to me is actually assessing the patient and determining the efficacy of treatment. In addition I think referring to professional colleges who have more sage knowledge in specific areas is also important. Never forget your resources. As far as my role currently as an ED nurse, I will continue to question orders I feel where written without precedence and hope that I can teach other nurses who may not be as vocal as I to also use sound judgment and assessment.


Novak, E. & Allen, P.J. (2007). Primary care approaches: prescribing medications in pediatrics: concerns    regarding FDA approval and pharmacokinetics. Pediatric Nursing, 33 (1), 64-70.

Taketomo, C., Hodding, J. & Kraus, D. (2009) Ibuprofen . In Taketomo, C., Hodding, J. & Kraus, D. (Eds.), Pediatric Dosage Handbook (pp. 899-902) Hudson OH: Lexi-comp.

Did I win the hearts and minds?

I wrote this while preparing to leave Iraq after a long year. I re-read it today.

On March 7th 2005 I volunteered to deploy to Iraq. I felt in my heart that it was what I was called to do. It wasn’t my job to defend our country or help another country re-build. My heart called out to me that I need to be in Iraq to take care of soldiers. You see that’s what I do. I am a Nurse. A long time ago I found my profession, which allowed me to care for others, which in turn gave my heart a personal reward of fulfillment. My mind and heart’s only wish was as any Army nurse, to care for and protect soldiers. So for me, my choice did not feel like a heavy burden or pain. I felt excitement and pride, a sense of fulfillment because I had made a choice to be in the Army. A choice I made because I wanted to care for soldiers.


Soldiers, brothers, sisters, family.


In June 2005 a rumor was spread that I would deploy. My excitement was met with mixed trepidation. My family, although proud of all I accomplished, was scared. Fear…I had not felt that emotion until the moment I caught my mother’s eyes. I was immediately torn…serve in what I felt was my duty, but with a strain upon those I loved.


In September 2005 I deployed to New Orleans to help with the Hurricane Katrina aftermath. I had the opportunity to have a taste of what life would be like. I worked in the EMT (Emergency Room) built from a tent at the convention center. I grew to understand and appreciate my co-workers, while having the opportunity to give back to my country and community in some of the most challenging experiences. With that growth and knowledge a glimpse of what was to become the for bearer came..."Politics”.


In Jan of 2006 my close friends and I knew that we would indeed be deploying to Iraq. Our mission was not as we had hoped for; instead we would be taking care of soldiers and Detainees at Abu Ghraib. We were to win the hearts and minds of the masses and reclaim our countries good name, after the negligence of others had tarnished it. I remember leaving my mom at the airport, tears in her eyes. I had caused her pain and now I was to have a mission I dreaded.


A thousand questions pass through your mind and your heart. The “what ifs”, came to life in my dreams. Two wounded...one a US soldier, another a detainee…who do you care for? What if they both have serve wounds? What if you can care for only one? What if one will die? How do you decide? “Remember your ethics training” the empty voice repeats over and over again. “Remember the Geneva Convention, remember the rules of triage” the voice continues. But what about my heart? What if? What if it is me? What if I can’t make that choice? What if I do make that choice? Who will know but me? The truth lies deep inside.

Politics, media, mis-representation, smiles, nods, handshakes, thank you for… yes thank you. We came here to win the hearts and minds. Did we? Twenty four hours into our new lives, “Two marines IED”, my medics voice...breathe in Michelle…breathe out, “you have four inbound, detainees”, breathe in, “Ma’am we have four waiting for sick-call”...breathe out... “Ma’am there’s a call”…breathe Michelle.


I slept the first night with exhaustion. I awoke only once to the sound of Chinooks…more patients I thought. My days seemed to mix. Busy...slow…there was a fair amount of US solider trauma, detainee trauma, aches and pains. No tough choices.


“Smile”, a whisper went into my ear. “Hello Sir”, “Yes”, “We’re good Sir”. Politics, reviews, tours. We closed the infamous Abu Gharib. We moved from one small FOB to a smaller fishbowl, straight in the heart of politics and garrison life. The day we separated from our small home, I felt saddened with the knowledge that I would see fewer and fewer soldiers and more and more politics. It wasn’t just me that felt the change. Almost instantaneously people’s lives were surrounded by “evaluations” and “accomplishments”. With this came a strain of confinement. Winning the hearts and minds became more painful.


Can you give 100% of compassion and care to someone who may have hurt your brother, your sister? Can you do it for one day? How about two days? Ten? How about 150? My friend did. Day in and day out she gave. While I was sheltered in the Emergency Room, I watched as my friend gave and cared. She did it and it hurt. My momentary emergency room triage, evaluation, patch work, was nothing compared to her work. That work changed all of us. We all grew apart and together like an enigma. Pulled at two polar extremes. Our defense at times was to lash out against ourselves. We did it for the anguish, pain, frustration and fatigue we felt. The confusion and strain of our jobs caused a roller coaster of emotions, upsets, and heart aches.

In a job like ours it would be easy to allow the weight of the world, of “politics” to weigh your heart and mind down. “They” say that under stress people band together. We did, my friends and I. We made a mafia of friends. We gave each other strength and encouragement. We found ways to laugh and have fun despite our fishbowl.

The fishbowl, you see, is we now lived. The eyes of the world were on us, even though our neighbors to our left and right had no idea who we were, or what we did. It was this fishbowl that proved to magnify the “politics” that surrounded our job.

Our year is almost complete. Although it sounded like a jail sentence, it was a life experience. We as a collective group watched as mortars flew over our heads and landed 75 meters from our hearts. We felt the sting of “CS” gas, and the scare of M9 rounds clamoring around us. But with that there was more. We learned about the culture in which we were submerged. Both US forces and Iraqi alike. We cared when others might not have. I know now more than my peers will ever learn in their “school books’ and spoon fed educations. A fact that to this day causes me to pause while I listen to them make claims of knowledge and understanding.

I learned also about something others may never truly understand. I learned about Philia, a love for my friends. I love my friends as my brothers and sisters. I understand now, how our lives will forever be intertwined. I also learned how to listen to my own heart and soul. I lived and experienced, I made history. And with all this is the knowledge that by no means did I do any more or any less than my peers. I just simply did.

What lies next in the chapters of my life? The next “what if” to ponder. If there was a word that meant more than a simple “thank-you”, more than gratitude, above the simple and equal to the gratefulness that overfills my heart. I would give it. First to my family, then to my friends. To my co-workers, fellow soldiers, to my brothers and sisters.

It has been five years since that point in my life, and so much has changed. I am forever grateful for my journey. My life constantly gives me the tools to succeed. God, my family, my friends, my mentors and even random

patients teach me every day. And for that I say from my soul, Thank you
~m

Big Steps...

Not for nothing…but it’s been a long three weeks. In the ever evolving world of trying to do too much in too little time I almost hit a high note. Between juggling two of my classes and impending tests for grad school, I grabbed life by the horns and attend my very first ever board meeting for Cuidando los Niños. (Please insert round of applause now)

In the world of being a registered nurse, I have been asked and consequently have started the interview and process of becoming a board member for a non-profit organization. I mean while going to school full time for my masters in Family Practice, and trying to start up my own nursing idea…I decided to stretch myself even more thinly.

Maybe now I should explain why and how for those who like to push themselves too. In our lives we work hard, we make money, build our family and at times we give back to our communities. You see I believe strongly in the principle that it takes a village to raise a child. And I think it is up to you to decide what roles you take in your own community.

For years I have researched and donated what money I could afford to various organizations. Time is something I “never have”. But you see the past year has been one of change. I made a whole new career change, moved back to my home town after a 12 year hiatus, and started grad school. If that wasn’t enough, I realized deep inside myself that I expected more. That expectation involved more of myself and living up to my full potential. And when you put your thought and energy into motion the world starts to open doors.

So let’s rewind six months…

A new friend in the Land of Enchantment invited me to attend a brunch for a non-profit organization. That morning was one I will always remember. I was introduced to an organization that transforms lives of families. It was specifically designed to fight childhood homelessness. The key is helping not only the families with job placement, education, and homes to grow. The key is that families are helped to rebuild themselves, but they are not given a handout. In my mind I equate it to that old saying “you can give a man and fish and feed him for one meal, or teach him to fish and feed him for a lifetime”.

This organization builds people. And even better, helps children grow. When children are homeless they miss those developmental milestones that are essential to their growth. This program is dedicated to helping them achieve those, while also helping their parents grow. Imagine, taking the time, energy and resources to build one family at a time. To take one child who has the cards dealt against them, and giving them a chance for empowerment and growth to their full potential. It is truly inspiring. That morning, after learning about the organization, I felt as though somewhere in the world there was an organization was aligned with my own personal beliefs.

So in the words of Paulo Coelho “When you want something, all the universe conspires in helping you achieve it”. My friend, who introduced me to the organization, took me to the next step and asked me if I would be interested in being a board member. It was like a mentor taking you under their wings and inspiring you to work harder. She set me on a path of giving more and working harder for the next step.

What followed next can only be described as work, uncertainty, and if you can imagine, working harder. I converted my Military Curriculum Vitae into a Civilian Curriculum Vitae, wrote letters of intent, attended lunch meetings and interviews and then it happened. While preparing for a huge test (I am still a full time student and a nurse) I put on my “serious” shoes, grabbed a folder some paper and a pen and headed to my first board meeting.

The meeting is one of three that I will attend, and participate in before hopefully being voted into this great organization. The meeting was nothing short of informative. I felt as though I was learning about life on a whole new level. I left with a whole new laundry list of “to-do” items that I wanted to accomplish. I drove home, did my little woo hoo dance and cuddled up on my bed with my Dalmatian Roxy and…studied. That’s right studied, because at the end of the day I have to be able to achieve in all areas I choose to accomplish.

So, today is Monday and I have now completed two exams, typed up some notes for my team meeting tomorrow and done some research for Cuidando los Niños. The has been long, and I have another long week ahead of me as I dive into more meetings, more studying and prep for women’s health clinical and of course some good ole Emergency Room work. (Oh and I promised my friend I would go running, we have a marathon in 20 days).

Work hard, expect more, find a strong mentor and be more than just anything….

Long break, long thoughts.

This winter break was filled with a “to-do” list that HAD to be completed. I tackled my chores and working with vigor but after a few days I started to feel like as though something was missing. I filled my time with my family, which was a great change. Seeing my family’s faces when they opened their presents and just falling asleep on the couch with them as we watched movies made life easy in a way that makes your heart feel warm. I rang in New Years in Seattle and enjoyed the ability to have Starbucks on every corner! Friends, champagne and great music filled me with renewed laughter, but I still had that feeling in the back of my head and maybe my heart as though there was just a little something missing.

My epiphany came with simple reflection during my long flight back. There are a few things in life that I really enjoy: helping people, mentoring and making connections. With that in mind I decided that we are the creators of our own journeys. If you want more, then it is up to you to achieve more. I want more, and now is my time for action.

Wednesday is my official interview for Cuidando Los Niños (http://clnkids.org/). It is time to take the next step and start to give more to my community. And what is next in the beautiful nursing community that has come to define me? I will continue with this adventure and mental challenge of school, learning and growing into a new nursing profession. There is of course one more step. One that involves intertwining the lives of those that mold me, molds others, and brings them together. It will take work and more mentorship in a new avenue of expertise.

I think each New Year brings with it potential energy. That energy is free flowing and waiting for determination to take hold, utilize and become a mold. The key is that opportunities always await each new chapter in life, so now is time to take action.

FNP

So as of lately I have had some miraculous free time and have been enjoying catching up with friends over drinks and the occasional live sports game. Vino, friends, and sports? Who could ask for anything more? The only difficulty I have run into as of late is the “So are you going to become a doctor?” question.

The scene has been almost the same all four times. Guy comes up to engage himself with my friends and I by asking what we do, etc. Always give the same reply, I work part-time in the Emergency Department and I am a full time student in the Family Nurse Practitioner program.

Inevitably I have to explain what a masters prepared nurse in the Family Nurse Practitioner program does, what we are allowed to do within our scope of practice and my goals. Honestly, I feel sometimes like it is a mini interview, only I am not for hire, and not giving out my number.

So, why do I feel like I have to educate the world on what a Family Nurse Practitioner does and why do men find the need to ask me about becoming a physician? I have no idea, but we should get this straight.

I work with amazing physicians; in fact two have inspired me to want to further my career. That being said, I appreciate the lengths of which they went to school and learned their practice. In my personal education I also have a deeper understanding of the nursing philosophy and want to continue on in the profession I have spent 12 years working in. I will never forget where I came from and yet hope to work hard and achieve more. To this day I stand-up and lobby for registered nurses and I have strong opinions about Nursing Policy and Politics. But I don’t feel like getting beat up for four years then again during an internship to do what I want to do which is own my own practice that works with patients in a holistic manor.

So why does anyone think that I would dedicate two more years of my life, time energy and focus only to turn around and gain 8 more years of let’s face it debt and career change?

When all is said and done, I usually reply “because I love nursing and I want to stay in this field”, it has been met with a nod, um-hm, “really?” and “cool”. And really it all boils down to this .People should do what makes them happy; become engaged in whatever they were called to do. I am not in a competition with any profession or even human being (other than myself, what can I say I like to push myself). Everyone has a place and job in life. The idea is to do it well, and if you don’t like it, move on. There is plenty of inspiration around the world to motivate anyone to change their lot in life.

As for me, I will stick to the mentors of my life: past, present, and future. I will continue to be more than just a nurse, and hopefully open the clinic and still take time each year to pack a backpack and travel to other countries to do what the British call “Pro bono public” and make others smile. And every once in a while drink vino with my friends and laugh at strangers ;)

Check out this website if you like the picture, it is actually a sticker and you can get this and other funstuff here: http://www.cafepress.com/+nurse_sticker,84659190