Dirty laundry

As nurses, we have to occasionally wear a mask. No, it’s not always that awful paper inducer of claustrophobia that you find outside of isolation rooms. Nurses have to often mask our emotions for the good of our patients. It is never fair that the family of a dying patient has to console the nurse because she is crying the hardest. It is never right to put the burden of your personal troubles on your patient.  It is never okay to retaliate against the family member who is verbally abusing you, no matter how white-hot your rage burns on the inside. We can’t laugh at the expense of our patients, no matter how weird their genitals look. We have to keep a good poker face, and it takes lots of practice. Early on, I discovered that if I could stay rock solid long enough to slip into the clean linen, that it would be alright. That room became my alter where I’d lay my heavy burdens. If I needed to, I’d drag a buddy in there with me. We’d vent, have a laugh or a cry, and regroup, and be on our way. It’s also a great place to devour that candy bar that’s been riding around in my pocket all day.
I’ve kicked packages of chux against the wall. I’ve spewed profanities into the linen cart. I’ve wiped snot and tears on the white towels. I’ve laughed to tears over severely inappropriate circumstances. I’ve even hidden from disgruntled coworkers and family members, cowering among the clutter. I think it is important to claim a safe place where you can fix your face and pull yourself together. I feel no shame for needing it. It helped me be strong for people who needed me. What better place to air your dirty laundry than the clean linen?

*Side note: Linen rooms, along with med rooms and supply closets are not appropriate places to hide and pass gas. It strictly goes against nurse etiquette.

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Surviving the Novice Nurse

There is this chart that they love to drag out early in our nursing education. It was published by a nursing theorist named Patricia Benner who wrote an entire book on this concept of “novice to expert.” It is plenty interesting if you are into nursing theory. You can take a look at it here.The abbreviated chart looks something like this:

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It is supposed to kind of outline your competency over your nusing career, starting as a student nurse. For some reason it really intimidated me and sticks with me still. I remember thinking “I’ll be taking care of patients for years before I’m even considered a competent nurse?!?” before taking a big hit of Dr Pepper. This is basically what I read:

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I think I’ll publish my version as “The Christmas Tree of Nursing Insecurity. ”

You’ll notice where I put myself.  That is five years after I started nursing school. That is three legal, liscenced years of trying not to kill anybody.
As far as I know, I’ve been successful. But I have to credit the bulk of that success to the more experienced nurses that I’ve leeched onto during my short time in this field. I’d encourage any new grad to seek these nurses out as soon as you can and bond with them. My personal favorite strategy to to find the ones that are a little more tart than the rest. I love an acquired taste. I’ve found if you are willing to work a little to get through the shell of ice, you’ll often find that they are the most authentic, loyal, and wise nurses with the biggest hearts. Do the work, make friends, watch them, and soak in everything.  Listen to their stories, they’ll try to save you from making their mistakes. Laugh with them, they will have a dark sense of humor that you will need to aquire. Thank them when they teach you how to slip on compression stockings without breaking a sweat, or how to keep brittle veins from blowing. They have the tricks to the trade. I’ve often felt like they were the brains and I was the running legs, so we work well together. Nursing is special because even if you do it for 50 years, there will be more to learn. You never stop growing and improving. First, we gain knowledge, then, with experience, judgement. The more we learn the more there is to learn. In fact, I would I would like to respectfully respond to Dr. Benner’s theory with a chart of my own. I present to you,
“Reeves’ Infinite Cone of Nursing Wisdom”

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This leads me to share with you another article of my nurse law. I KNOW LESS THAN I DON’T KNOW.

Where healing ends

Even as an adolescent, I recognized birth as a sacred moment. Perhaps this is why I just knew that I would find my niche, as many students believe, in women’s health. This notion, it turns out, was severely misled, but that is a whole other story for another time.

There is another sacred moment in life, one that isn’t as readily talked about. I’ve never encountered an aspiring nurse who claims end of life care as their specialty of choice. I think there are many reasons for this. Firstly, it doesn’t sound like very cheerful business. Secondly, as far as nursing specialties, it doesn’t sound very glorious. Lastly, we often label our work as a “healing profession” and helping people out the back door of this life doesn’t quite line up with that perception. The fact is, healing is not always the appropriate goal. Please don’t think me heartless or apathetic to the pain of losing loved ones. I know all too well the agony of grieving. The beautiful thing about end of life care is that you are not just treating a patient, you are treating the family and you are treating their loved ones. You provide comfort and dignity. You listen as they reminisce. You laugh with them, you pray with them. It is an extremely intimate process. My hospice rotation yielded some of the most rewarding and spiritual experiences I’ve ever had. I worked some home health, I worked some inpatient. The more I saw, the more I wanted to learn. It was from a dying patient’s care that I adopted my first personal unbreakable law of nursing. My favorite instructor said it as she pulled our whole group into the room. “NO ONE DIES ALONE.” The patient had no relatives. Just us, a group of strangers gathered around their bed. We held their hand, we spoke to them, we wiped their perspiring brow and wetted their drying lips. They say that, as the body shuts down, hearing is the one of the last functions to go. I like to think that is true, and I encourage you to speak, or even to sing to anyone who is “unresponsive.” Do whatever it takes to assure them that they are not alone.
I have never specifically worked in end of life care professionally, but I have, on occasion provided hospice care on my med/surg unit. I have let many things slip and I’ve probably “wasted” time in rooms of the dying that could have been spent tending to other patients. I don’t regret a second of it. We are born once and we die once. Every nurse has a code. “NO ONE DIES ALONE.”

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Sea legs

We learn many lessons from pain, but more effectively, I think from embarassment. Its because embarassment tends to linger longer.
The next rung on the ladder of my nursing education was the hospital. I just knew this is where I would learn “real nurse” work. (That very notion cracks me up by the way,  as I now know that 95% of nursing is customer service.) This is where I was assigned my first inpatient. I was responsible for their assessment, bathing, and any other needs that may arise. I also had a packet of documentation as thick as a T-bone steak to do on them. This thing was nothing if not thorough. Religion, work and travel history, registered voting party, sphincter diameter, favorite restaurant, you name it, it was in there. I spent the first hour poring over my patient’s chart trying to scavenge as much information as possible before meeting them. I had barely found anything before I was torn from the desk and ushered to my assigned room. Apparently we were there to care for patients, not charts. On opening the door, I was greeted by scathing glare of the most miserable soul to inhabit God’s green earth. Picture a dirtier and meaner Ron Jeremy’s fat torso sitting up in a bed from under a pile of blankets and you wouldn’t be far off. The packet of paper in my hand just seemed to get heavier. I after forcing out an introduction I began the tedious chore of interviewing my patient or “collecting objective data” for the sake of my assessment. I would have gladly endured bodily injury if it would have gotten me out of it. Now, what seemed like ten years and a billion sarcastic responses later, it was time for me to lay hand and stethescope to my patient for a head to toe inspection. I shined my little flashlight into his piercing eyes. I auscultated his dramatic and exasperated huffs and curses from all regions of the lungs. I located his heart, though I had my doubts of its existence, and identified both the lub and the dub of it’s pumping. Then, not failing to narrate my care, I told him I would need to throw back his linens to see his feet. Perhaps I should have narrated care before instead of during, because as I yanked the mountain of layers up, he quite clearly let me know that he “don’t have no damn feet.” Sure enough, he was a double above the knee amputee. I returned the blankets to their original state, ran out of the room, and never went back in it.
Truth is, I probably wouldn’t have gotten away with avoiding my only patient all day, but I was admitted to the Emergency Room.
Shortly after completing my “assessment” I was following our instructor around, along with a small group of students to learn something (I’ve no clue what exactly it was) but I do remember interrupting her to say I needed a chair. She looked at me like I was insane and said “I don’t think you’re going to find one.” Black curtains were suddenly being pulled in on my visual field as my knees started to go numb. Soon there was miraculously a chair rolled under my butt and a blood pressure cuff around my arm. I kind of thought I might be dying. It didn’t help that I apparently had no blood pressure. I may have been momentarily relieved that I didn’t have to go back to see my patient,  seeing as how I was dying and all.
Long story short,  was forced to admit myself to the ER to were I became rather angry and pouty because I knew that I now looked like the weakest link in the group, and that I was missing the bulk of a whole day of clinical, and that I would likely have an aweful time playing catch-up. As it turned out, I had just vagaled down and fainted: a phenomenon that I avoided from then on by keeping a granola bar in my pocket. And that is the story of how I barely survived my first day of hospital clinical.

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*Please be aware that any time a patient is mentioned in my stories, I have changed details and often create “composite” scenarios in an effort to protect their privacy and dignity while doing my best to preserve the authenticity of the

experience.

Stepping behind the veil

We were told early on that our journey would not be one that most wouldn’t understand. Stepping into healthcare is stepping through a closed door into a world of both beauty and torment that most aren’t privy to.
It was my day to work in the shower room. I was greeted by middle aged woman with a bubbly disposition. She was a veteran CNA and obviously had wonderful report with her residents. This was also a second if not a third job she worked to support her houshold.
She showed me around the room as it began to fill with steam. She revealed me a tub of body wash, deodorant, and lotions. She explained that she liked to give them a little something special when she could. She winked and I realized she had purchased these things with her own money.
It wasn’t long until the stalls started filling up. I was directed to one and we worked assembly line style. Once you got to me you were already disrobed and ready for washing. The room got hotter and wetter by the minute as I got more somber. There were those with diseases of the mind which had stripped them of their logic and sometimes even their speech. As I washed, I couldn’t escape the notion that their healthy and unaffected self was just under the surface, scratching and begging to be acknowledged, to be valued, and to be loved. There were also those whose ailments were physical. They would often apologize for the burden they believed themselves to be or say nothing at all. they’d just stare at me, eyes begging for any shred of dignity I could offer. Did they know I was nobody? Little more than a stranger off the street who was given some cloths to wash with, I had no credentials and no experience. I felt I was doing these men and women such a disservice with my clumsy hands and terrified expression. I don’t even think I was able to conversate with them as they probably truly needed. I was far too stricken.
That day I left in soggy shoes that I barely noticed. It was my first peek into a world that most are shielded from. I was quite brokenhearted, yes, but it was more pride I felt. Not pride for my performance that day, far from it, but pride in the profession that I had chosen that is filled with people who really want to make a world of difference even in the smallest ways.

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Square peg, round hole

Two and a half years after I saw the lady in the lavender scrubs, I became an official student nurse. My second year of applying won me admittance to the most abusive course of study I could imagine. A small branch of the university,  the nursing department is in a lovely,  but terrifyingly intimidating building. Soon after my arrival, as our instructors began to introduce the world we had stepped into, my attention drifted, as it often does, to my peers. The bulk of them were females very near my age. Most would say that I fit the typical mold of a new nursing student, as there are usually very few males or non-traditionals. I picked up very quickly that I was, however, going to be and outlier when I saw dozens of planners and tabbed notebooks fly out of designer bags every time a professor opened their mouth. My idea of being prepared for class was a pen behind my ear and a 44 oz Diet Dr Pepper in hand. These girls were on their game. Obviously “A” students with a competitive drive and likely some kind of 5-year plan, I was feeling more out of place by the minute. “What in the world am I doing here?” I thought. As the instructors continued to outline the intense two years that laid ahead for those of us who “make it that far” I began to worry about how I would be able to continue to have income. I had always kept an evening job while being in school. “How is this going to work out?” “Who am I?” “How many people are going to die because I have no business in this field?” “I’m going to need more Dr Pepper.”

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The lady in lavender scrubs

Truth be told, I’ve never divulged the details of the day I decided to pursue a nursing career to a single soul. Not a colleague,  not my mother, not even my husband and father of my child have ever heard this story. I always have, and still do adamantly believe that those who are rightfully in nursing are answering a divine calling. Perhaps it is not always immediately recognized as such.
     It must have been December. I was wrapping up my first semester at a four year school for which I had miraculously obtained enough scholarship money to pay tuition. I was groggily trudging across campus to my 8 o’clock, which I’m sure was a basic class chosen by some “advisor” who no doubt couldn’t remember the face of the country girl with no declared major and no direction.   It was cold and I would have liked nothing more than to stay in my cocoon on the top bunk in the tiny dormroom. I’m sure I looked like a walking pile of dirty laundry crunching my way across the frozen lawn, contemplating nothing but my desire to return to bed. Eventually,  I must have gotten tired of staring at my feet (which isn’t a very safe walking habit) so I looked forward. This moment is one burned into my memory. She was a fair bit ahead of me, headed in the opposite direction. She had smooth,  caramel skin and her black hair was pulled back neatly. She had a stethoscope draped around her neck and wore lovely lavender scrubs. The sun casted the warmest orange glow behind her as it began its work of burning off the mist and frost. The lady didn’t appear much older than my eighteen year old self, but there was something different about her face,  a wisdom, it seemed. I don’t know where she was headed, but she definitely knew, she looked so determined. She never so much as glanced my way.
     By the next day, I was no longer an “undeclared major.” I had taken the first step on a journey that would ultimately define me in many ways. Yes, essentially I saw a lady and thought “She’s got it together, I think I’ll go for that.” I don’t know why such a mundane passing of strangers has such an otherworldly effect on my existence. Furthermore, I don’t know why someone in lavender scrubs was doing on campus at 0730. Student nurses wear burgundy and white. Perhaps she had worked a night shift and was furthering her education by day… although her scrubs were rather neat and fresh. Perhaps she worked at the Student Health Clinic, although I’ve never seen them wear scrubs. You can speculate for yourself who or what she was and what her business was that day, I have my own theories.

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