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I'm A New Nurse - "No Ouchies!"

Our nurse blogger, Marianna Broz, RN is back again with another behind-the-scenes look into her journey as a new nurse in our complex and highly acute world of pediatric medicine.

It's no secret that kids have their own language. They don't simply "go to bed" or "go to the bathroom," they "go night-night" and "go potty." Telling a little one you have to "flush the IV" can get you some strange looks too; they become terrified you're going to give them some sort of  swirly.

So needless to say, it's a constant battle to make sure all lines of communication remain open. Unfortunately, most children are going to associate scrubs with “yucky” medicine and getting poked, so it's no wonder their automatic response when we walk through  the door is not typically pleasant.

The most immediate and effective de-escalation technique I've found thus far, is to literally hold both hands up and repeat "No ouchies!" until they calm down. Once that happens though, you've now entered into the no-ouchie contract, and so help you God if that trust is broken. They watch you diligently as you reach for your stethoscope, making sure there's no funny business.

After they realize no ouchies are intended, it is not uncommon for your patient to now willingly assist in your assessment by moving the stethoscope bell all around. Keep a watchful eye though, as you will end up listening to the bed, the chair, and almost always ending in their mouth. At that point, you just gotta roll with it and politely thank them for their help. At least they calmed down, right?

Though this may be true most of the time, believe it or not the "No ouchies" technique is not infallible (I know, I was shocked, too). One particularly inconsolable patient sticks out in my mind; a young boy who had just gotten a G-tube placed to help him gain weight. Imagine waking up from a very heavy nap one day and having a tube hanging from your belly that all the evil scrub-wearing people are trying to put stuff in. Needless to say, he was not a happy camper. In fact, he wouldn't let anyone go near it without all 4 extremities flailing about, along with an ear-piercing scream. It was horrible.

The day I was assigned to him, I found out  it was time to start using the tube for feeds. I'm pretty sure I remember the hand off nurse chuckling “good luck” to me as she waved goodbye. Awesome. With other patients to care for, I worried how I would manage the additional time necessary to deal with the patient’s active resistance.  So it was time to get creative… and time to ask for help. A vague memory from orientation popped into my head of a group of people trained specifically to help communicate with all types of kids. And so entered Child Life.

Within 10 minutes of just talking to him, our Child Life specialist had discovered my patient's idol and the trick to winning him over: Buzz Lightyear. She quickly returned with one of the biggest Buzz Lightyear stuffed toys I've ever seen, specially equipped with its own G-tube. She proceeded to explain to my patient, using his new favorite toy, how his own G-tube worked. How it would make him grow up to be big and strong, just like Buzz. He listened carefully, and slowly started to compare his tube with Buzz's.

I came in hesitantly after her, ready for the screaming to begin as it was time to start his first feed. To my surprise, he handed me his new toy. "Buzz goes first!" After watching Buzz get a squirt of saline, my patient then turned to me. "Okay, my turn now!" he said as he held  out his tube. I couldn't believe it.

The rest of the day, he was so happy and energetic he wouldn't stay in his room. He would walk around the floor, always dragging his surgery buddy Buzz with him. Sitting on different nurses' laps. Telling his story to anyone that would listen. About how he's going to grow up to be just like Buzz.

And since I have yet to see him back, I'd like to imagine he was right about that.

As you can tell from Marianna's latest post, the transition from student to professional often comes with unexpected challenges. We think she's doing a terrific job, don't you?

She's Gone from Baltimore to Florida - Johns Hopkins All the Way!

Recently I had an opportunity to sit down with Melissa Macogay, RN, who is the Director of the Pediatric Intensive Care Unit (PICU) and Surgical Neuroscience unit here at All Children's Hospital. Her story is unique, in that not only is she responsible for one of the most complex pediatric units in the hospital, but she spent seven years in Baltimore at the Johns Hopkins Hospital as a staff nurse in PICU before joining All Children's.
We discussed a variety of issues ranging from the huge emphasis she places on finding the right team to how that team thrives in the fast-paced PICU environment.

I asked Melissa about the natural stress level that undoubtedly comes with working in a critical care unit which she quickly acknowledged. "The PICU is forever changing, one day you have to care for a child with a neurological condition, and the next day you have a complex trauma patient. You never know what is coming next, which is what we thrive on here. It's non-stop."

This naturally brings up the challenge of finding the right people to work in such a hectic environment but Melissa just smiled and explained her philosophy. "I specifically hire professionals who embrace a true team environment. We know that when we look to our right and look to our left we have colleagues who have made a personal choice to work with our kids. We back each other up no matter what. Yes, we have some of the most advanced technology in the world here, but we have also built a team that is dedicated to the children and each other."

The ability to think critically is an essential part of being a member of our PICU team. Melissa explains it this way, "Lives are at stake, so the ability to think through your options quickly and effectively is a priority. Plus, the rewards of providing this level of care are truly amazing."
As I mentioned, Melissa worked in the PICU at the Johns Hopkins Hospital in Baltimore for seven years. "I left an organization that has so much pride and I wasn't sure if I could find that again. Florida was my destination, but the options to work in pediatric critical care are extremely limited here. When I interviewed at All Children's, I knew that I had found exactly what I was looking for."

Melissa is an excellent example of the type of leadership team we have here on the "South Campus" of Johns Hopkins Medicine. Feel free to reach out to her, or any member of our team to learn more.


Social Media and Your Job Search

We are often asked about the use of social media not only for job seekers, but how it can be used professionally. Let me say this right away...WE LOVE IT! The world has "gone social" and here at All Children's Hospital we are no different. Let me break down some of the ways we have integrated social media tools into our work, and how you can use them to get to know us better.

Check Us Out
If you are new to social media the best thing to do is explore the various channels we use: Facebook, Twitter, Pinterest, as well as our Linkedin careers page. We post jobs, share articles, keep in touch with job seekers, and generally participate in the larger social conversation that is going on 24/7. Feel free to comment or ask questions at anytime.

Get Started
Now that you know where to find us, it's time for you to get in the game! I'm guessing you already have a facebook account, but you may not be on twitter or some of the other sites yet. Now is the perfect time to get started. Jump over to the Twitter home page and set up your account. It only takes a few minutes and will open up the world very differently than your Facebook experience.

Once you are using the tools you will quickly find how effectively they can be used in your professional life. As they say, content is king, and social media is full of content that can be used in every facet of professional life.

We're going to highlight various social media tools in the coming weeks and months so be sure to watch our blog to learn more!


photo credit

Are You Ready For Your Interview?

We receive more than 1,000 job applications each month here at All Children's Hospital/Johns Hopkins Medicine. That is a lot of interest in our organization! For those that receive an interview it can be an exciting and nerve-wracking experience all at the same time. We recommend you focus on your interview preparation to not only help you present yourself in the best possible way, but also to help manage your nerves.

One of the best ways to prepare for your interview is to learn as much as you can about us. We have a wealth of information on our facebook page, the Human Resources website, and our main hospital web site. We are a much more complex organization than most candidates expect. It is essential that each candidate does their best to understand our hospital and the services we provide.

Once you have a general sense of what we are all about, you need to practice. Find a friend, colleague or family member and run through an interview. I know it won't be exactly like the real thing, but it will give you an important confidence boost. Not only will you have put time in getting ready, but you'll also have the advantage of saying your answers out loud before the actual interview. You'll know if you need to make any changes before you come in to meet with one of our recruiters.

Ask Us Too!
Once you are in the interview make sure you ask us plenty of questions. That is a sure fire way to show us that you took the time to learn about us, and that you realize how important the hiring decision is for both you and the hospital. Great questions always make a great impression!

Remember to be prepared for every interview, and good luck!

- Jay

I'm A New Pediatric Nurse!

This week we welcome one of our newest employees, Marianna Broz, RN, to the blog. She is one of our RN Residents, and is going to provide a rare behind-the-scenes view of what it is like to be a new nurse in a complex pediatric hospital. Look for regular updates from Marianna in the weeks and months to come!

Congratulations, you've made it through nursing school! Something we all seriously doubted would happen at one point or another. And so now it's time to start your professional career… the moment we've all been waiting for. So here comes day 1 of my new life as a professional nurse. After all of the exams, clinical hours, and check-offs I now realize: I know nothing. But that's okay, it's actually expected. And thank God it is.

The first week was an overwhelming blur of trying to remember door codes, passwords, colleague names, and locations for everything ever created. Oh, and trying not to run into any more walls (the hallways are deceiving and set up in an oval shape, so walking in a straight line while not paying attention won't do you any favors). It took 3 hits for me to figure that one out.

A new nurse must dance along a very thin line of trying to be competent and knowing when to ask for help. Like the first couple times I received report, I was absolutely convinced it was in another language. I stood there and nodded along, making mental notes to google half of the abbreviations and crazy syndromes I've never heard of.

There are preceptors, floor managers, nurse educators, and residency directors all checking in with us constantly because they know how tough it can be to be so new in a top-notch facility. And though the meetings with all of them are great and helpful, the true support comes from the residency class itself. There are 9 of us; 3 of us will eventually be in Pediatric ICU (including myself), 2 eventually in Cardiovascular ICU, 2 are already in Neonatal ICU and 2 are on the Neurosurgical unit.
All of us are in the same boat, working side by side, experiencing the same events through brand new eyes.

Every Monday we have a 4 hour residency class, and faithfully after each one we all go out to lunch together to "debrief." For at least 2 hours, we all vent and tell stories about how our weeks are going. And if one of us can't make it to lunch or we have a story that just can't wait, there's the group chat: an ongoing conversation of "Oh my God you'll never guess what just happened" moments. Gotta love technology.

As any nurse will tell you, it's very hard to describe the things we deal with to someone who has no idea what it's like. Bad accidents happen to good people. There's touchy subjects like child abuse and neglect. The same kid that makes you laugh all day at work, you'll cry about on your drive home.

But with the support of the people around, it's not hard to see the impact we can make… even after a grueling 12 hour shift.

People always ask why I chose pediatric nursing… My response tends to change after each shift. Sometimes, it's because I get to play at work: Use toys, light up games, talk like Patrick from Spongebob, etc. Sometimes, it's the obvious: Who doesn't want to help a little kid feel better? But after my first couple weeks at All Children's, I found another reason I wasn't expecting: The people around me.

Everyone here has to have some form of a sense of humor to be able to get the job done. To me, there's no quicker way to make a child smile than to make an absolute fool of myself (like arguing with a kindergartner about why Toy Story 3 is better than both 1 and 2. Combined. Times infinity plus one).

So this blog will be dedicated to the good, bad, sad, and absolutely hilarious events that come with being a brand new pediatric nurse. I've been convinced for a while that nursing should be a reality show anyways, so really this is just the beginning.

Look for Marianna's next post in January!