It’s morning huddle. The charge nurse is updating the floor on recent changes, new protocols, and high fall risk patients on the floor. The black circle next to the patient’s name indicates their high fall risk, and suddenly you realize 3 out of your 5 patients are marked with black dots, and the other needs a sitter, but there are none available in the hospital. The sighs fill the nurse’s station. We all know what that means - the tech gets pulled from the floor. The nurses frantically start mentally preparing - finger sticks and assessment done immediately after this huddle, vital signs with medication administration, wound care after lunch. Somewhere between all of this you are suppose to plan for lunch, update the charge nurse, and keep doctors updated with changes throughout the day. Your phone starts vibrating. It’s the resident for one of your patients. “Are you the nurse for patient X?” They know, they just want to confirm. “Yes,” you text back. “The patient’s labs weren’t drawn. I’m not sure why it was ordered an hour ago. I need it NOW”. You review your brain sheets again and see that “difficult stick” was scribbled at the corner of the page by the night nurse. You text them back relaying the information, and still, “I need it NOW”. With the patient load and limited assistance, the unfortunate reality is that “now” tends to be relative. There is so much more than meets the eye. As nurses, our patients are our #1 priority and we will never do anything to delay care. However, there needs to be more situational awareness and grace when it comes to language given to the staff on the floor. They have not walked in your shoes and don’t know the many challenges that are thrown at us. As a new nurse, it can be intimidating to defend yourself and speak up when faced with a miscommunication. Boundaries at work can look and sound different for other people. How can you empower yourself to be an efficient team player while setting important boundaries at work? Be clear in your communication When your workload is overwhelming, it may be difficult to clearly and succinctly describe your current situation. For example, if you have an EKG and troponin draw that needs to be done, but you also have another high fall risk patient that is verbally abusive and trying to leave AMA while simultaneously pulling out their IVs, indicate to the team that you have not forgotten but may need a little more time. Speak up & notify the charge nurse There may be instances where your communication has been crystal clear but the demands are still being pushed. You've clearly described your situation and still getting significant pushed back. You are only one person and can do so much at one time. If for some reason you feel the language being used against you is inappropriate, feel empowered enough to notify your charge nurse. Your charge nurse is another advocate and resource for you on the floor. They will know what the next steps to take and will be an excellent resource for you. Delegate when appropriate There may be times where too much is being asked of you at one time. The field of nursing is a foundationally teamwork-based occupation. When appropriate, ask for help. It may be that you're in a situation that may take longer than anticipated. There are techs, your co-workers, and even the charge nurse that could help you with your tasks. As a nurse, the challenges we face vary day by day. It’s important that we stand our ground, speak up, and empower yourself to use your resources to be the best nurse you can be. “For the sick, it is important to have the best” - Florence Nightingale

It’s 11:30 am. It’s a busy morning - getting patients ready for surgery, replacing IVs for patients that need it, and of course, getting patients their favorite snack - ice. I look down at my checklist and see there’s no pressing task for another 30 minutes except the most tedious of them all -- charting. As I begin to plan out my next few hours, I hear pacing footsteps that are getting faster and faster. I look up to see that it’s the charge nurse walking down the hall with a paper towards ...me. Another admission, I thought to myself. With a worried look on her face, she comes to me with a nurse brain sheet about a new admission but with a twist: they were a PUI (a person under investigation) for COVID19. We both knew what that meant. The technical aspect of COVID admission is a tedious one. When a suspected COV19 patient comes to the hospital, the protocol of the floor changes. The original assignment changes - that nurse assigned to the PUI can’t have any other (non-PUI) patients. They must distribute their original assignment to their colleagues, who already have a lot on their plate. The protective gear changes - its layered gowns, N95s, and iPads for virtual communication. But it’s the emotional aspect that tends to be ignored. There is an exponentially high level of fear, anxiety, and stress that comes with healing the nation during an unprecedented time. For 12 hours a day, nurses are exposed to various infectious diseases, especially those transmitted through blood and/or airborne. We follow protocols that have been thoroughly researched, but COV19 brought with it a fear-inducing element of the unknown, with the nation’s emergency preparedness being challenged day-by-day since March. As the media pushes the sympathetic “healthcare heroes” narrative, there is a heavy price to pay inside the hospital - protective gear shortages, patient influx, all in isolation. I knew that once I was done and the door was closed, the patient was alone. The line of communication is limited. There’s also a layer of sadness - knowing your patients can’t have visitors coiled with limiting patient interaction decreases the line of communication with our patients. Patient experience is at an all-time low, and so is our nurse’s mental health. It takes a special kind of person to be a nurse, one that wants to be part of a person’s healing process. I find the most treasured moments are those at the patient’s bedside, helping patients at their most vulnerable. How do we still treasure those moments while being safe? How do we heal ourselves? Here are some practical tips to better manage the stress amidst COV19: Deep breathing: Studies have shown that increasing deep breathing during times of stress lowers your heart rate, which in turn encourages the nervous system to relax, increasing the sense of calm. Next time you feel stressed, breathe in for 2 seconds and breathe out slowly with pursed lips. Listen to your body and take breaks! You must be an advocate for yourself on the floor. We work strenuous hours, on our feet the majority of the shift. As nurses, we have a way of pushing through the fatigue to become more efficient. If you push yourself too hard to too long, your chance at burnout significantly increases. By taking a break, you are doing what’s best for not only you but your patients. Stay active: As healthcare providers, we are great at giving sound advice to our patients but tend to neglect them for ourselves. Take a nice walk after work. During your breaks, walk off the floor and have lunch in the cafeteria. Phone a friend: In a stressful environment such as the hospital during COVID, it's imperative that you talk to someone about how you’re feeling. Studies have shown that simply talking through negative emotions can significantly help in processing and healing. Talk to a family member or friend - it’s worth your while. Remember, exercise self-compassion. This is not an easy time for anyone, but especially nurses as we are in direct contact with patients every day. Anyone that is going through psychological distress will experience some level of anxiety and stress. Listen to your body and give yourself permission to breathe. “Take rest; a field that has rested gives a bountiful crop. – Ovid”

The clock reads 1:04 am. An elderly woman shuffles around the hospital hallways with a walker, her nurse following closely behind her. “Come on, Mrs. Jane, it's time for you to go to sleep,” she says, blocking her pathway to the elevator while trying to steer her back to her bedroom. “Don’t touch me!” she screams from the top of her lungs, “I don’t need a n**** telling me what to do! How did you even get this job anyway? You can’t afford anything!” Understanding that her dementia talks for her more often than not, does not eliminate the shock that nurses on the floor felt. An aura of sadness, and anger filled the narrow hallway. A multicultural nursing floor, we collectively embodied the feeling, but tried to calmly discuss and de-escalate the topic at hand. “Mrs. Jane,” the charge nurse said while walking next to her, “what you said was not nice and honestly hurtful.” Ignoring to acknowledge the pain she had caused, she continued on her path around the unit, unbothered. I remember standing at the nurse’s station, thinking that unsettling feeling was going to be few and far between. A week later, another incident of subtle racism occurred to my coworker. Another huddle, another unsettling feeling. As an experienced nurse, you see and hear a multitude of comments from patients that are at their most vulnerable. You understand from a nursing lens that people tend to be at their worst during their most emotional states, leaving you to grapple with the weight of their words while simultaneously providing exemplary care; but you are also human. You internalize what is constantly repeated at you. The sentiments of Mrs. Jane are paralleled with that found within the rhetoric during this unprecedented time. This new millennium has brought about two pandemics for the black community- the coronavirus and systemic racism. During the start of the global pandemic - COV19, we saw an international movement for personal protective equipment, and unified protocols to ensure the safety of all citizens. I personally felt the unifying force that came with this unknown virus. It was everything - the news, social media. Health disparities have been well-researched, so it was not surprising that a few months after collecting data that the trends became to emerge - the Black and Latinx communities were disproportionately affected, in large due to having more chronic co-morbidities and decreased access to healthcare. Concurrently, the death of George Floyd and Breonna Taylor has taken the world by storm - pushing people onto the streets to demand justice and fight for policy changes. Too often we are seeing the lives of the Black community taken away from us, and just as often we never have the time to heal from the emotional wounds it brings. But the real question is - what can healthcare providers do about patients like Mrs. Jane? How can we be an agent of change? As healthcare providers, it's our job to not only recognize but take action to better serve our patients. Our duty is to create a better patient-provider relationship that embodies open communication and active listening. Studies have shown that black patients tend to not trust their providers or the medical system due to experiments such as the Tuskegee Experiment, experimentation done on black bodies without consent. By creating this strong bond, we understand the patient’s need holistically, promotes patient engagement, and increases the chance that they will be an active part of their medical plan. "In a World Full of Muffins, Be a Cupcake!" Sheima Gimie BSN,RN Instagram: https://www.instagram.com/gimieabreak/

Did you think nursing school was difficult? Well, guess what is worse, the first year working as a nurse. The obstacles faced by new nurses can be challenging as they enter a new phase in their life. You are no longer the clinical student, under the wing of the clinical instructor. Now you are protecting a license that took hard work, and sleepless nights to get. New nurses often struggle with finding a good preceptor that matches their learning style, and also find it hard to separate their knowledge and experiences from the preceptor assigned who is teaching the new nurse "their way of doing things."Here are some common issues faced by new nurses: Time Management Patient assessment skills Working and collaborating with members of the team Theory to practice gaps Bullying- Heard of the phrase "Nurses eat their young?" Performance anxiety Working Shiftwork Thinking that you have to know everything However, although it can be overwhelming , here are a few tips that can help newbie nurses transition from the role of a student, to a nurse. Find a mentor A mentor plays a vital role in an individual's personal and professional life as they offer support and guidance when dealing with challenging situations. Although finding a good mentor can be challenging at times, do not be afraid of approaching someone that you feel have the your best interest in mind, is proactive, and will provide you with constructive feedback that will help you evolve as a nurse. 2. Be an Advocate for Yourself and your Learning I remember being the new nurse in a medical-surgical department where the average nurse working there had been a nurse for about 10-15 years. I was the "new kid on the block," and trust me they made sure I knew it too. I felt like the outsider, and was viewed as the "know it all" because none of them had a BSN, while I did, or went to a prestigious nursing school (like I did). They felt that I thought I was better than them, and due to this thought process they made it harder for me to learn and get adjusted to being a nurse. In the beginning, it really bothered me how I was treated by those that I thought should set an example of what a nurse should be: caring, willing to teach, empathetic, etc. However, as the time went on I realized that I had to be a self-advocate, and empower myself to ask questions, to face the challenges presented, and be resilient even when the cards dealt were unfair. It came to a point where I had the courage to go to the unit manager, and ask for a different preceptor, as my learning goals did not match with the goals of the preceptor I was assigned to. Yes, I said it "my learning goals." I was not going to allow someone's negative perceptions, affect my ability to care for patients. Is self-advocacy difficult? Yes, it is. However if you don't take control of the situation, and learn self-efficacy and advocacy you will not be able to address issues that affect you in the work environment. What's funny is that I currently teach nursing clinical in this unit, and guess what? Some of the same nurses are still there, and we are friends! 3. Improve Time Management & Organizational Skills I always tell my students that it takes at least a year for a new nurse manage a full patient load, and organize their day. The following are tips that you could use to better manage your time: Delegate (you can't do it all) Do a "To Do List" Create your own patient assignment sheet that gives you a birds eye view of all the patients under your care. Avoid "burn-out-"As a new nurse, your focus should not be on working all of the shifts possible; your focus should on learning your new role . 4. Self-Care is a Necessity You are transitioning from being a student, to caring for patients and their families, so you have to dedicate time to getting enough sleep, eating healthy, and self-meditate. Being a nurse is an extremely emotional, stressful, and challenging job at times, so you have to dedicate time to yourself in order to provide the best of you to your patients. 5. Ask questions There is no such thing as a "stupid question." It is better to ask a question than making a mistake! Your first year out of nursing school comes with it's own learning curve, as every patient and situation is different. Therefore, do not be afraid to reach out to your fellow nurses, mentors, and manager with questions as this will show how important teamwork is to you, and that you value their knowledge. In summary, the transitioning into professional practice is challenging; however, there are strategies you can use to help smooth your transition to practice. “Success is not final, failure is not fatal: it is the courage to continue that counts.” —Winston Churchill

How COVID-19 is compounding the need for reform: Expansion of Social Programs and Universal Healthcare As a citizen of the world, I am dutifully practicing social distancing. As a crohnie, I am hoping that everyone understands the importance of social distancing and the risk to themselves as well as others. As the sibling of a crohnie on immunosuppressants, I will drop kick anyone who sneezes in the general area without covering their mouth. Click here to learn more about social distancing and other recommendations for preventing the spread of infection. While this pandemic is not to be taken lightly and decreasing the spread of infection is the first priority, today, I’m interested in discussing the state of America’s healthcare system and social programs, or lack thereof, that directly impact each citizens’ ability to effectively practice social distancing and America's response to this pandemic. I actually cackled to the point of tears when I read the news of Norway calling on University students to return home from the U.S. citing “poorly developed health services and infrastructure and/or collective infrastructure.” You can be big mad if you want to, but there is truth in that statement. The Beginning. I am not a politician. I do not have inside information concerning the exact nature of the original outbreak in China nor the accuracy of the information relayed to countries around the world regarding infection, hospitalization or mortality rates of COVID-19. What I do know is that three weeks prior to the initial news coverage made available to the general public, several politicians were briefed about COVID-19. In that time, those same politicians sold millions of dollars worth of stock and purchased stocks that were likely to gain valuable in the event of a health crisis (eg. technology companies that could equip hospitals and clinics for telemedicine). That suggests to me that there was significant concern about the potential for widespread infection and mortality. With that in mind, why did the government continue to insist that we were low risk as the outbreak in China gained in severity. Despite brewing concerns about an impending pandemic among government officials, there was no effort on the part of the government to proactively implement protocols to reduce the initial outbreak and subsequent spread of infection in the United States. Who knows? What might have happened if we had implemented social distancing at the time of the COVID-19 briefing? What would the curve look like today? On January 31, a full week after Wuhan announced a quarantine on 11 million people, Trump banned foreign nationals from entering the country ONLY IF they had been to China within the last two weeks. With the first case reported in China in December, it is reasonable to assume that millions of people had already entered the U.S. with active infection or carrier status and that the virus had already begun to disseminate. Not to mention, what if someone had been to China three weeks prior, but had symptoms for the last week. What if they themselves were immune, but were carrying contaminated items. This would have been the time, given the knowledge they had already had and witnessing what had taken place in China, to put the American people on high alert. Re-enforce hygiene practices and begin social distancing to mitigate the spread of infection. Develop testing, stock PPE and ventilators, brief healthcare workers and implement protocols for testing, plans of care and patient education. Instead the government implemented a wait-and-see policy and so began the relentless game of catch up. Patient Zero - Government Response. Many healthcare providers have reported treating an influx of patient with COVID-19 symptoms weeks before the initial case in Washington was confirmed and reported. For the sake of this blog and our collective sanity, we will consider the Washington patient, patient-zero and the first red flag on the government’s radar. In the wake of the first confirmed case in the U.S., the initial response by the state AND the federal government, who had already been briefed, (I must keep hammering this home; it is so important to understand the context that many of these officials had while making decisions) was to reject any idea of an epidemic occurring as had happened in China. There were no protocols put in place to guide healthcare professionals about how to manage suspected COVID-19 patients and there were no preparations to create and distribute tests. Instead the government insisted that the COVID cases would “soon be zero.” NYC and State Response. Today, NYC is regarded as the epicenter of the outbreak in the U.S. with more that 37,000 confirmed COVID-19 cases. This is likely due to the high level of international travel and high population density which increases exposure in NYC and exacerbated the spread of infection. On March 1, the first confirmed case of COVID-19 was reported in NYC and while NYC demographics made it clear the we were a prime candidate for widespread infection, the federal government rejected the WHO's coronavirus tests and continued with business as usual. On January 23rd, thirty-eight days (more than a month), before the first confirmed test in NYC, Wuhan's government officials implemented a complete lockdown, effectively sheltering in place. This lockdown continues today and is projected to end on April 8th. Many have argued that a complete lockdown would not be attainable given the human rights that are afforded to Americans. This may or may not be true, but Americans also weren't given the benefit of full disclosure. They were not briefed as the government officials had been, they were not given the option to socially distance at a time when it may have impacted the initial outbreak. Instead Americans were reprimanded for their indifference, which was only a reflection of what they had originally been told (eg. "it's a political hoax," "it's just like the flu," it's not a big deal for young people"), as government officials desperately tried to rewrite the COVID-19 narrative. Surge In Cases. In response to the rapid spread of infection (indicated by the increase in doctor's visits and symptom reporting) and increasing hospitalizations, New York increased production and access to COVID-19 testing. Additionally, a soft launch of social distancing was implemented in a half-hearted attempt to curb the curve that is quickly surpassing those of Italy and Spain. Quite frankly we sound like a team of out of shape basketball players showing up to a game at half-time, after the opposing team has already scored 50 points, only to suggest that we play defense if we are up to it. In any case, social distancing was the order...well suggestion of the day. If you aren't feeling well, consider staying home. "If you can stay home from work" became university/college closures which heavily influenced the decision to close New York City public schools until further notice. At each stage, New Yorkers scratched their heads in collective confusion and concern. Without paid sick leave or the protection of an official mandate, how could anyone demand to stay home or work remotely without clearance from their employer? Who would ensure that they would not lose their jobs if they were to heed warnings to stay home? The short answer to both questions is: no one. For those who are living paycheck-to-paycheck, losing their job would effectively slick the runway for the boulder they are already struggling to push uphill. That paycheck pays for mortgage/rent, utilities, health insurance, childcare, food, etc. Without any guarantees, New Yorkers were unwilling and unable to risk the employment that provided, directly or indirectly, the very same health insurance that would serve them if they, their spouse/partner, or their children became ill. Paid Sick Leave Around the World. 94% of countries around the world (of high, middle and low-income classification) guarantee paid sick leave through social insurance and/or employer mandate. Globally, 73% of countries guarantee paid leave from the first day of illness. This allows employees to stay home when they are ill and reduce workplace exposure to illness and the spread of infection. In many cases, these policies are not full proof, but compare this to the United States which does not guarantee paid sick leave at all. In the United States, 12 states and the District of Columbia have legislation that guarantees paid sick leave. While some employers may offer paid leave as an additional benefit, financial hardship may influence employers to retract it to preserve their businesses. Furthermore, there are significant discrepancies in paid sick leave based on occupation and income level. 90% of private-sector workers in management, professional and related occupations, such as corporate executives, software engineers, bankers and lawyers (individuals who may have the option to work remotely anyway) have access to paid sick leave. Compare this to 56% of construction workers and 58% of service workers. Let's take a closer look at the paid sick leave being offered: *Barring appropriate documentation* Due to rounding totals may not sum 100% The comprehensive paid sick leave guaranteed in Norway provides more security for workers and normalizes social distancing in the case of everyday viral illness which provides a smoother transition to quarantine in the face of a global pandemic. Universal Healthcare. So what does universal healthcare have to do with COVID-19? When we discuss universal healthcare it is typically in the context of preventative and primary care. Expanding coverage increases primary care access and utilization which leads to better case management and long-term patient health outcomes. For those who are concerned that universal healthcare and a single-payer system would increase wait times for specialists appointments, I'd argue that compared to other high-income countries, our shorter wait times have not improved our mortality or morbidity rates. But how would that make a difference during a pandemic? Universal healthcare cannot prevent the outbreak of a deadly virus, but it can impact access to care. Due to poor or no insurance coverage, those who are acutely and severely ill may be reluctant to seek medical support in anticipation of astronomical medical bills. That means these patients are circulating in general population longer and increasing exposure. In terms of mortality, acutely-severely ill patients are more likely to decompensate. Without the appropriate medical support, (eg. medication, ventilation, etc.) these patients will likely die of COVID-19 complications such as pneumonia and heart failure. Patients that do not require hospitalization, can seek medical counsel and receive patient education about effective hygiene practices, social distancing/quarantining and implement those practices under the guarantee of paid sick leave. Though the stimulus package signed into law this week does cover COVID-19 testing and preventive measures (eg. vaccines) that may decrease susceptibility to COVID-19, it DOES NOT cover COVID-19-related treatment. While we hope that more legislation will be passed to address this glaring problem, this does not alter the current circumstances. Upon discharge from the hospital, underinsured and uninsured persons recovering from COVID-19 will face substantial, if not monumental, financial hardship in the form of medical bills. Medicare For All as A Single-Payer System. In this context, the greatest advantage of a single-payer system is unified financing and governance of the healthcare system. Per person, the United States spends twice as much on healthcare as comparable high-income countries. Despite this fact, the U.S. has fewer hospital beds per capita and rural hospitals deemed unprofitable are closing at an alarming rate. Moreover, there are large regional disparities in the distribution of ICU beds. The United States' current multi-payer system always hospitals with disproportionate funding and profit to outbid others for resources, regardless of need. In 2010, researchers noted: "There is substantial variability in critical care resources across the United States, and a pandemic or disaster affecting a small proportion of the population could quickly exceed critical care capacity in some areas while leaving resources idle in others. This reflects the limitations of a private health system in which planning occurs primarily from the hospital perspective" (Carr, Addyson & Kahn, 2010). You may have also heard that hospitals, and city and state governments are locked in bidding wars for ventilators. This is the direct result of a multi-payer system which leaves each entity to fend for themselves to acquire adequate resources. A single-payer system facilitated by the federal government would ensure the appropriate distribution of these resources as indicated by number of cases, and rates of hospitalizations and mortality. By reforming our healthcare system, we can: (1) eliminate profit-driven sick care (2), reduce healthcare spending (3), decrease health costs for patients (4), improve patient outcomes (5), and support areas with greater need. Hear Me Out. The purpose of this article is to challenge the misconceptions associated with social programming and universal healthcare. These ideologies are often denounced as socialist views that seek to shatter the traditional American capitalist-dream. Consider the benefits we've discussed today and weigh them against any disadvantages of such systems. I will not pretend that these proposals are perfect, but in my eyes there's no contest. To each and every healthcare worker on the frontlines... to every healthcare student volunteering for hotlines or telemedicine... to those producing and donating supplies... to politicians who are actually working for the people to pass comprehensive legislation and save lives... to those abiding by the quarantine and practicing social distancing... to essential workers across industries and to millions more who have offered their time, energy and resources to serve the most vulnerable in our nation, we applaud you. We applaud you. WE APPLAUD YOU. Nuff Love, Amber Emerald from https://waterfallwordsamberemerald.wordpress.com/raindrops/ NYC COVID-19 Response Efforts - Volunteering NYS COVID-19 Volunteer and Donation Assistance Program How to Help and Where to Get Help During the COVID-19 Pandemic

Waterfallwords by Amber Emerald 📷 The Empowered Empath Where to begin. Firstly, this is NOT an expert opinion. I am not trained in psychiatric nursing or psychology. This is purely based on my personal experiences. If you’re reading a blog post about harnessing your emotional energy, I have to assume that you have some history of emotional volatility. So I won’t bother painting the picture of a 7-year-old Amber, who elected to watch cartoons prior to completing her homework, crying in the corner of her room post-“I’m disappointed in your decisions” parent lecture. That image is not particularly important except to note that my anxiety and hypersensitivity were present from an early age. But why? What was the cause of my anxiety and hypersensitivity. Let’s start with my personal theory: The Baby Gets The Bulk I am the youngest of my family. My only sibling is five years my senior. Every family has a hierarchy but in a black, Caribbean family the pecking order is infamously inflexible. (Disclaimer: I adore my family. They are loving and supportive in every way. This is just my truth and I’m certain that this was not a carefully orchestrated plan to guarantee my hypersensitivity). In short, everyone in my house had an opportunity to express their unfiltered opinions, emotions, etc. except for me. As the youngest, I was expected to defer to everyone in my household. I was never the one giving the “I’m disappointed in you” lecture and rarely did I ever get an apology when someone else was in the wrong. I was just expected to take whatever I was dealt. These episodes were infrequent, but they had a substantial impact on my ability to cope with stressors and internal conflict.📷 School was a different story. I was surrounded by my peers and didn’t have to fear the consequences of sharing my honest feelings. I wasn’t running wild and free cursing people or WWE body slamming anyone, but I was comfortable calling out my peers when I felt attacked or belittled. By the time I was in middle school, I was keenly aware of the fact that my hypersensitivity was only a factor in my home.📷 My hypersensitivity also had its repercussions. It was pinpointed as my fatal flaw and so I actively avoided situation (getting into conflict with my sibling or breaking house rules) that would require me to stifle my feelings or opinions (maybe I felt the rules or the treatment was unfair) and subsequently trigger a tearful response. This created tons of anxiety around being “perfect.” If I never messed up, I wouldn’t be lectured (without any space to discuss my motives, feelings, reasoning) I wouldn’t cry in response to the lecture or lay on my bed replaying the scenario (and my opportunity to make a different decision) for hours on end and I wouldn’t be shamed for my “dramatic” reaction. I think we all know how that worked out. Most of my anxiety was related to school since this was the majority of my responsibility as a child. As the expectations surrounding my academic achievements grew, I developed terrible testing anxiety. Any time that I fell short of that mark, that sad little girl would curl up in a ball and feel the weight of the emotions crush her entirely flat. And as infrequent as those moments were, each time brought back memories and emotions of the last. I was compounding my shame. Over the next few years, my family, recognizing my autonomy as an adult, dispensed with the occasional lecture. In fact, they became concerned that I had become obsessive about school and grades and that anxiety would swallow me whole. They were right. I went off to college where my stress and testing anxiety grew exponentially and I became my own enforcer. I was giving myself the disappointed lecture and punishing myself indefinitely for my shortcomings. 📷 What fun… Most available research argues for the opposite. The last born is considered the spoiled slacker who skates by without being held accountable for their actions, existing in staunch contrast to their first born counterpart. The perfectionist approach commonly attributed to the first-born child has been identified as the greatest contributor to anxiety. I suppose there are many last-born outliers. I’d be interested in a study that investigates the contributing factors to last-born outliers and anxiety. So what changed? *ENERGY CONSERVATION. My initial motivation to change my pattern was my Crohn’s disease diagnosis. I was chronically fatigued and falling asleep in the middle of studying on a good day. I did not have the energy to keep beating myself up. Not if I intended to reach my fullest potential. *ANXIOUS NOT CRAZY. I put a word to the feelings that I had. Empath (previously referred to as hypersensitive) and anxiety. The empath in me felt the disappoint that my actions elicited in others and the anxiety was the fear of causing and enduring that pain. I accepted that this was not a defect, but a warning signal from my brain that I was not coping well with the circumstances I was in. Please note that I do not categorize my anxious tendencies as anxiety disorder. Mental health disorders are characterized by an inability to perform daily tasks or function as needed (e.g. panic attacks, unwillingness to leave the house, etc.). I would implore anyone suffering from anxiety disorder to seek professional help. *POSITIVE INNER MONOLOGUE. When I feel myself getting overwhelmed and I can feel the anxiety tie a knot around my heart, I have my inner monologue. I care about me and I can verbalize my feelings clearly to myself and decide on a course of action that brings me peace while still completing the tasks and responsibilities I have as a functioning adult. *FAMILY SUPPORT. As I stated before, at this ripe old age, my family is confident in my morality and work ethic and exists only to uplift and support me. I confide in them often and there is a tremendous sense of peace in having your family validate your feelings and confirm your capabilities. I also found that each person in my home appreciated my willingness to listen without interruption or rebuttal and reciprocate validation. I understood how it felt to be the smallest person in the room and I gave my input in ways that acknowledged the individual’s need to be seen and heard. Acting as emotional support for others made me feel important and taught me how to speak positively to myself. *WHEN TO SAY WHEN. Lastly, and in my opinion most importantly, you must know when to STOP. This applies to schoolwork, to social interaction, to anxiety-inducing activities in general. Of course, as adults, we don’t always have the luxury to remove ourselves from stressful situations, but when you do have the opportunity, take it to resolve inner conflict. Ex: Last week I spent upwards of 18-hours of a single day working on a paper. The paper doesn’t have a hard deadline, but I was determined to enforce my own deadline and finish that night. My eyes and temples were throbbing, my thought processes were slowing to a halt and I could feel the anxiety creeping into my subconscious. “Why can’t I just bang this out? Why can’t I push through it?” The pain in my back was turning to stiffness when I suddenly realized that there was no need for me to push through tonight. I could save the energy for another day. I closed my computer mid-sentence, took a warm shower and watching a Disney movie to fill the nooks and crannies of my brain until sleep took over. I am every bit as ambitious and self-motivated as the next person. For many years, I believed that my anxiety disqualified me as a leader. I see now that my lack of self-care and inflexibility were prohibiting me from utilizing my empathetic nature as a tool to communicate effectively. Let’s analyze some of the benefits of empathy in the professional setting:📷 *DIRECT PATIENT CARE. Establishment of patient-provider trust through patient-centered communication. Patients report warmth and empathy as pivotal criteria for measuring active listening among providers. *GROUP PROJECTS. When polar opposite leadership styles collide, group projects can become stressful. I am fairly adept at accepting criticism especially prior to a final submission. In my view, it’s simply an opportunity to make corrections for a better grade. When I give criticism to someone who identifies (or I identify) as a facilitator, I crank up the emotional intelligence. I know that I should not give criticism without praise if I want this individual to continue to be an effective team member. This article is in part a love letter to myself. With each passing year, I become more accepting of my flaws and I may even convert a few of them to strengths. I hope that you were able to connect with something in this article and begin your own journey to healing and harnessing your power. To my nurses, never lose sight of your empathy; it is the foundation on which our profession is built and gives your expert opinion tremendous credibility in your patient’s eyes. You are your first and last patient so advocate for yourself and your abilities. Nuff Love, Amber Emerald Visit: http://www.dalecarnegiewaynj.com/2012/04/10/define-your-leadership-style-and-tendencies/ to learn more about leadership styles.

On Tuesday July 18th, 2017, I was boarding a plane to the Dominican Republic to be with my grandfather who was not feeling too good. When I arrived, he was in good spirits, and was so happy to see me. On that day, we talked about many things, and one topic in particular was the focus of our conversation. I informed him that I was going to begin my doctoral journey in the following weeks, and he was so happy. The next day I arrived to see him in the hospital, and was not as animated as the day before but who could blame him, I would be this way too if I could not breath normally. The focus that day was to have him transferred to another facility that was able to provide better care, however after many attempts, we were unable to do so as a Doctor would have to accept him, and there was none available. Remember that this was not the USA..we were in another country, with less resources. My grandfather was upset, but eventually calmed down. Well, it was time for my mom and I to go get some rest, and we said goodnight. However, my grandfather hugged my mom and started to cry a little. I did not give that much thought, as I just though that he was just upset from being sick. However, internally I was not happy myself as I practice in the USA, and know what evidence-based practice and protocols are on place for patients with the potential of having a pulmonary embolus. As soon as we got to the house, we were called by one of my uncles stating "both of you need to get here as soon as possible." My gut feeling already told me what had happened, but my heart was in denial. We arrive to the hospital, and my world ended. My grandfather went into cardiac arrest, and was unable to be resuscitated. My dreams, hopes, heart, and everything in between was shattered. It was that moment that I realized the true meaning of pain. The passing of my grandfather took away my motivation to get my doctorate, and I was determined to quit. However, as the weeks passed I kept remembering that conversation my grandfather and I had on July 18th, and it wouldn't go away. It felt like he was trying to tell me "don't stop, I want you to do it." Additionally, the image of my grandfather kept appearing in my thoughts, and it was then that I said, "I am not a quitter, and I need to do this for my Papa." Well, December 5th, 2019, my doctoral journey finished, and tomorrow I prepare to walk on that stage at my commencement and officially be called Doctor! However, today has been an emotional day, as I again remember that July 18th, 2017 conversation, and my grandfathers face.....but something is different. I feel a sense of peace, accomplishment, and relief that I did not quit. I see his face and feel that from wherever he is, he is smiling and so proud. The sad part about all this is that I feel like I am going through the stages of grief all over again. Although I have fulfilled my promise to my Papa, that was the one thing that he focused on the day before his passing. So now what? I feel a sense of loss all over again. Will I never be able to see him in my dreams encouraging me to continue? Am I ever going to see the smile on his face when I first told him, being that now I am done? My Papa was a big part of my upbringing, he was who I consider to be my dad. That closeness is what I am afraid of forgetting. However, as I took out my Doctorate regalia from the clothing bag, in preparation for tomorrow, there was a moment of rejoice and calmness mixed with tears. It was like I felt his presence, and that gave me tranquility. Maybe it was his way of telling me that the new memory I have of him is when I looked at my regalia in disbelief of what I have just achieved? Is grief something that can lasts longer than expected, as we go through situations that give us the need for those that have passed to be present? I don't know the answer, but one thing I am sure of is that my grandfather is proud of me. A picture of my grandparents (my grandmother who I called Mama, died 8/2018).

The increasing clinical nursing demands that students face today, as they move from the classroom to real-life patient care, can be scary for students. Not to mention, how the lack of self-confidence plays a role in self-doubt. As a clinical instructor, I see this everyday where students with the mere thought of asking the patient a question or attempt to go into the patient's room causes a compounding level of anxiety. Should students receive a "self-care" as part of their nursing education? Should more focus be placed on building and promoting the student's self-confidence in order to reduce the possibility of hindering the student's ability to use the newly acquired classroom knowledge into practice? As clinical nursing instructors, we must be cognizant of how the student behaves in the clinical setting, and recognize symptoms that may affect the student's ability to manage different patient situations. In recognizing these symptoms early, we can promptly tackle the problem with uplifting words of encouragement that can help reverse the student's negative perception of the clinical setting, hence allowing confidence to build. It is normal for students to feel nervous, but it is important for them to learn that being confident in the clinical environment is not learned in the classroom, but acquired during the hands-on clinical environment. Clinical instructors can also help build clinical confidence by using different learning strategies, modeling expected behaviors, and guiding the student through a series of patient simulation scenarios that can give the student a bird's eye view of what they may expect. The point is to provide the student with the ability to "preview" behaviors, as this will take away some of the "unknown" that the student is not confident enough to handle. Lundberg, K. (2018). Promoting self-confidence in clinical nursing students. Nurse Educator, 33(2), pp. 88-89.