Clinical Nurse I

I’ve been promoted from Nurse Resident to Clinical Nurse I. All this really means is that I’ve completed a few mandatory assignments and worked as nurse for 6 months. It doesn’t feel like 6 months to me, but the calendar confirms it, so it has been.

How do I like it now, you may ask?  Some of my friends I work with, who are currently in nursing school, occasionally and anxiously ask, “Is being a nurse what you thought it would be? Do you like it”. It’s almost as though they seek to find out if they’re wasting all their time and effort in nursing school, only to realize it’s not all it’s cracked up to be. Or, maybe they seek  comfort and reassurance that they’ve chosen the right profession, when they notice stressed out nurses running around taking care of loads of issues all at one time. The many balls a nurse juggles at one times, can be overwhelming at times.

I’ll tell you how I feel now that I’m on the other side of nursing school, and working as a new nurse for 6 months. The feelings I have for nursing can’t be summed up in one word or sentence though. I could start by using certain words that come to my mind immediately when I think of being a nurse, and they are; rewarding, exciting, challenging, frustrating, frightening, humorous, emotional, soul changing, and it grows one as a person.

It’s rewarding in the sense that everyday I get to care for people in their most vulnerable and low points in life, when they’re sick. I help them recover. Some patients come in with chest pain, and they’re diagnosed with anxiety instead. Their cardiac enzymes come back normal, the EKG and 2D echo show normal heart activity, and these patients  are the ones I discharge within a day. There are patients who come to me with a new stroke, and I spend a lot of time educating them on recovery, lifestyle changes and things to watch out for in the future in order to prevent a future stroke from recurring. I spend time doing neuro checks every 4 hours on these patients, and assess their level of stroke via the NIH Stroke Scale. Then there are those who come to me, who are very sick. I may care for a patient with a new mass on the liver, or it could be a patient who’s abdominal abcess drain is communicating with the bladder, and has now caused a massive infection, leading to sepsis. I may have a patient who’s diagnosed with failure to thrive, with loads of open wounds and cancer. Theses are the patients who take careful monitoring and lots of care. Not only do I care for their illness, dress their wounds, and give medication,  I also try and help them feel comfortable, with the loads of pain they deal with.

Being a nurse is exciting in that I get to see all kinds of new things everyday, and no day is like the day prior or the day after. Being apart of a code should not be exciting, but when you know you’re apart of a team saving a life, you can’t help but feel thrilled. How is it that I get to help in the process of saving lives everyday? It’s an amazing feeling. More often then not, saving lives is a longer process and a little more subtle then jumping  atop the bed and  pounding on the chest of a non responsive patient, while pushing Epi. More often then not, it’s helping the patient who may develop COPD, that he/she must stop smoking. Maybe the nurses constant education and reminders will help that patient finally go after that goal of no smoking. Maybe the kind nurse who didn’t judge the alcoholic who came onto the floor withdrawing from ETOH, can lovingly guide the patient into a better plan for life, and provide the resources for recovery. Perhaps that nurse will help change that person’s life forever, and add years to a life that was headed to an early end. Perhaps the nurses guidance and education on the signs and symptoms of a stroke or heart attack to watch out for, could help a person seek help faster and therefore save a life. Nurses save and help prolong lives, if they take their job seriously, and truly inspire and educate patients. I realize that some people can’t be changed and will never listen to advice, and I can hear some nurses saying, sometimes I wonder why I try, but a nurse should never stop trying. You never know who may listen and be inspired to change. So, nurses save lives in a moments notice by pounding on the chest of a non responsive patient, as well as in those more subtle ways, through education and inspiring healthier lifestyle choices, and education on prevention and when to seek help…..that’s part of saving lives too.

Being a nurse is challenging. The many hats we wear on a shift by shift basis can sometimes be too many. We are the managers of the entire patient load we carry. We have the birds eye view of the patients we care for during every shift. We know that the patients  in room 1 and 3 needs more TLC then the patient’s in room 2, 5 and 4. We have to coordinate the care our patients receive from OT, PT, RT, ST. We talk with doctors about the plan of care, and coordinate services with the case manger. In between passing meds, dressing changes, hanging fluids, discharging and admitting patients, attending to wounds, calling the doctor for status changes in a patient, neuro assessments, starting a new IV, rounds with the doctor and care team, hanging antibiotics, making sure the tech has addressed meal and hygiene needs, that’s when the phone rings off the hook from family members who want updates. The care of the patient who has the most needs takes priority, and the patient who will be “ok” sometimes gets less time. Those who don’t get as much of the nurses time don’t understand the reason they’ve not been attended to as often. They aren’t aware that the patient next door has just received a horrible diagnosis, and the nurse has been tied up with answering questions, holding a hand and generally just being available during a very emotionally fragile time. The nurse has the birds eye view of all her patients.  It’s understandable that the “less attended to” feel frustrated, but the nurse has to make the call on who’s priority  in the limited amount of  time given per shift. There never seems to be enough time to give all patients equal amount of time, due to the nurse patient ratio. This is a complaint of almost every nurse I know. But the nurse knows who needs most attention based on his/her knowledge and his/her birds eye view of all under his/her care. Also, some patients require more because it could mean life or death, if not carefully monitored.

Being a nurse can be frustrating at times. There have been times when I’ve felt all alone. This is rare. There have been times when I’ve felt like I’m drowning, but everyone else on the floor is also grasping for air as they try and stay above water, so I can’t ask for help. There have been occasions (and they are few) in which I’ve chosen to just do a task that I know a tech could help me with, but I know that tech will either give me a hard time about it, or they’ll say comments like “it takes 2 minutes, can’t you just do it”, and I feel as though they feel I’m too good for a certain task. So, I do my tasks and theirs and I either drown, stay an hour past my shift to catch up on charting or fail to give the proper care that only I can give as the nurse to my patients who need it most. Let me be clear, I work with some amazing techs, some who are proactive and I never have to ask for help, but there are occasions when it seems like all I do is ask and ask or remind and remind, or times when I just do the task because I know the tech will give me a hard time or an attitude. That’s frustrating. I’ve been a tech, and I know how physically demanding it can be, and I also know how many calls a tech gets to do this and that. I get it. But, I don’t know you’re in bathing a patient, when I call for help. I’m not with you. Just tell me you’re with someone, but you could help in 5. If you are a nursing student or a new nurse you can read my post on delegation here. Another frustration comes when I can’t get ahold of a doctor, and the family member keeps asking for an update. The patient and family deserve to hear what’s going on, or that their father has a new malignancy. That’s not my job to deliver the news. I feel frustrated when I page and page ad then call the doctor only to find out that they won’t be available until tomorrow. But, I keep the family posted and communicate the best way I know how, to keep these poor people calm and help them deal with their frustration at the lack of information they receive. Again, this is rare, but it happens sometimes.

I feel frightened sometimes, when I realize the weight of the responsibility I hold when it comes to my patients. I don’t take my job lightly. Occasionally I suffer from PTSD, a day or two after a shift, wondering if I missed something, or forgot to chart an important detail,  or when I remember that I forgot to mention an important aspect of care to the oncoming nurse. My mind will occasionally race with loads of flashbacks from a rough shift, in which I think~ I should have done it this way…… or dealt with that situation another way….. or known something so simple…. or responded this way. Why didn’t I know to do it that way or this. 

There are humorous days too. People make me laugh, and there are plenty of interesting patients that keep me and my fellow nurses laughing. There are times when I can’t even believe a patient is saying what they’re saying. The dementia patients say whatever they please, which sends everyone into laughter. Those patients also like to grab, punch and challenge, and at the end of the day, god bless them, they can’t help themselves. The hair, the makeup, the statements, the questions, the farts, the irrational patients and more are enough to keep me entertained all day long.

Nursing can be emotional. There are so many that I become very attached to, and there are times when I have to be apart of delivering bad news. That’s the hardest part of my job. But, I try and stay strong, so that I can be there for the patients and their families in the best way possible. I’ve found that just listening is the key to “being” there. Most of the time, words cannot comfort as well as presence. Holding a hand, being present and a gentle hug can go so far. The emotional end of nursing is not always sad though, because sometimes there are tears of joy, when you get to see a former patient who was once very sick, return to the floor with flowers and cookies to say “thank you”. In my time at Bayfront, I got to witness several trauma victims walk for the first time. One patient, who I became very close with and who lived in the unit for about 4 months, underwent an amputation after a motorcycle crash. Several months after his discharge, he walked onto the unit with his new prosthesis and an invitation to a recovery party that he and his wife were having. It brought tears to my eyes to see him walk, because the only time I knew him was when he was in the hospital bed suffering from pain and sadness over the loss of his leg. The last time I had seen him, he was wheeled off the unit with a long road of recovery and rehab in front of him, and now he returned months later with a smile on his face, a new prosthesis and a load of thanks to those who helped him through his darkest days.

Nursing is soul changing because you realize how precious life is. You appreciate every day. You realize how delicate life can be and how at any moment life can change. You hug the ones you love more. You also deal with the human soul of every patient you come in contact with, and that soul you can make or break. You become a character in the story of the lives in your care. You are the one who can mend a broken heart by the words you speak, and the gentle touch you extend. On the opposite end, and more importantly, you could harm the patient while they’re sick, scared, and sad if you become complacent, rush though a procedure, or aren’t available to listen. I understand nurses get burnt out easily, but if you ever get to that point, then realize it and change, or leave the profession as fast as you can. No patient deserves to be treated like a job or a nuisance, especially when they’re sad, scared and already down. They need a rock…. a support. Connection and caring are as important in the recovery of the patient, as the medications you administer.

Nursing also helps one grow as a person. Not only do I learn something new everyday, because I ask a million questions to the doctors who will appease me, but I’m forced to be professional always. I’m forced to be professional when I speak to family members. I’m forced to confront doctors with concerns. I’ve also learned a thing or two about being prepared when calling a doctor. Recently, a doctor scolded me for not being prepared fully when I paged him about a critical lab value. I was in the middle of five things, and he hadn’t called me back right away… so when he did call, it took me a second to gather my thoughts. He wasn’t happy. But, I pulled on my adult voice, apologized and before I let him hang up on me, I said, “Do not hang up!” I quickly and efficiently spit out a history of my patient, diagnosis, lab values and the reason for my call. At the end of the conversation the doctor apologized and told me I was doing a great job. I stood up for myself, and I also learned to be more prepared when a doctor calls because they are very busy too, and get a million pages in a day. I always admit when I’m wrong and I find it’s the quickest and most efficient way to diffuse any anger or problems when dealing with doctors. As a matter of fact, when I do admit I’m wrong or state that I’m still learning as a new nurse, then I find the doctor will sit and talk with me and educate. Most of them want to teach the eager listener.  Anytime I see a doctor walk into a patients room, I run in after them. I want to hear what they tell the patient, so that we’re all on the same page. The doctor usually appreciates this too because then they don’t have to repeat the plan to me, and if they have orders, I’m there to catch them and implement them immediately.

So there you have it! It’s been a roller coaster of emotions the past 6 months. I’ve had more great days then bad days. Everyday is different then the day before and everyday is a challenge, which is exciting. I’m definitely never bored. I embrace all the emotions I encounter as they come and I continue to grow as a nurse. I feel honored to help save lives, for the opportunities to learn new things everyday, for the chance to hold the hand of a sad patient, for the times I can be there to listen to the frustrated family member, for the wounds I get to dress, for the new skills I learn everyday, for the chance to critically think and notice subtle changes in a patient that needs to be addressed, for the many brilliant people I get to work alongside of everyday, and for the patients who thank me, as their wheeled off the unit after a long hospital stay.

Lorena Webber R.N.

Clinical nurse I

 

 

 

 

 

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