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.
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:
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:
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”
This leads me to share with you another article of my nurse law. I KNOW LESS THAN I DON’T KNOW.
The idea of failure, I think, is pretty well universally feared. For a nurse, failure can have some truly devastating implications. A nurse’s failures can cause pain to others. It can cause death. I believe it took most of the first year to rise above the complete paralyzing grip that the fear of failure had on me as a brand new nurse. It never went completely away, and I pray it doesn’t.
I remember this ritual I had, sitting in my vehicle in front of the small hospital where I worked. I’d pull up around dawn every morning before my shift, kill the engine, and pause. I’d hone in on the song the birds were chiming in the trees, I’d breathe in the smell of bacon as it wafted from the lower level kitchen. I envied whoever was down there. If they should fail their job today, we get burnt bacon. If I should fail, it could end in manslaughter. I really had to just give it to the Big Man, because I knew that I failed daily, and still do. I pray he guides my hands and feet, I pray that He graces me with wisdom and good judgement. I pray for His forgiveness and for the forgiveness of my patients and their loved ones when I fall short. And I have fallen short often. I’ve botched dressing changes and torn skin. I’ve forgotten pain medication and given wrong medication. I’ve over medicated. I’ve missed more IV sticks than I’ve gotten. I’ve let arms swell to twice their size before finding that the IV had infiltrated. I’ve neglected to turn patients and to pull down their stockings, resulting in skin breakdown. I’ve spoken when I shouldn’t and I’ve stayed silent when I should have blown the whistle. I have been the nurse you’ve cursed for leaving your Grandmother’s arms bruised and bleeding. I very nearly once hung the wrong antibiotic on a patient that was severely allergic to that antibiotic. These are the faces that haunt you when the day is done and your head hits the pillow. These failures are hard to live with, but in each there is a lesson. Don’t make the same mistake twice and ask forgiveness when you get the chance. Forgive each other, and most importantly, try to forgive yourself. You do good work. Give it to God. He will see you through.
It is also important not to hide your mistakes. It takes courage to admit them and diligence to correct them. Several times, I’ve recieved the brunt of a particular surgeon’s “wrath” over various mistakes I made. The last time, he gained a great deal of respect from me when he said “You know, I’ve made my share of mistakes, severed ureters, caused bleeds, among other things, but is imperative that we pay attention. We are dealing with people’s lives.” Suddenly, I no longer a surgeon with a “God complex,” but a man who was there” as we all are, striving for excellent patient care. Through the decades he has been practicing medicine, learning from his mistakes. He is proud, but not too proud to be accountable for his errors. I think that is an excellent example for anyone to follow. Seek opportunity for growth and never let fear of failure cripple you.
By the end of my time as a student nurse I had entertained the idea of working in several specialties. Okay, A LOT of specialties. Honestly, I think at some point or another I had decided that every single specialty I rotated through was surely “my calling.” I mentioned that I started out ready to join the world of women’s health, maybe become a nurse practitioner or even a midwife. That is, until I got to my psych clinicals. Psych was so neat and I really enjoyed it maybe that will be it. Oh, hospice and palliative care! That’s it, I belong there! (Rhyme not intended) Surgery, critical care, home health, I can honestly say they all appealed to me for some reason or other. By the last semester of nursing school I was pretty certain that critical care was going to be “the one.” I was all hot to snatch some folks from the jaws of death and it was time to start our three month long preceptorship. I submitted my top three preferences, noting only that I absolutely COULD NOT work overnights because my real actual paying job was a night job and I had to be there. Well, it just so happens that the only ICU slots were over nights, but they had an empty day space in a decent sized emergency department with a very good, seasoned nurse. Now, I’m pretty sure the only time I had spent clinicals in the Emergency Department was on my first day when I ended up being a patient. A little bummed, I told them to go ahead put me in the slot.
I could write a book on my experiences in the ED and my wonderful preceptor who was always so encouraging, kept me laughing, and was way more confident in me than I was. It was there that I learned the beginnings of how to be a nurse, stuff that you will never find in a textbook.
I believe I could have probably built a very fulfilling career starting out in the ER. But, that did not happen either.
Soon, it was time to start submitting job applications. I sent in a few to several different facilities, some were up to an hour commute. As a backup, and not very seriously I might add, I submitted one to our small local hospital. GENERAL NURSING MED/SURG. I was interviewed and offered a position before most of my other prospects even contacted me. Ryan and I crunched the numbers and decided that this would actually be better for our family, even if it wasn’t exactly what I had in mind. Medical surgical nursing was where nurses who aren’t that sharp work. People who just skip through the chaos to collect a paycheck belonged in med/surg in my mind. I wanted to join the elite level of nurses and specialize. It seems so rediculous in hindsight. I even remember clear as day, several professors along the way telling us the exact opposite. At the time, I was certain they were just trying to trick us into being interested. I am so thankful that I started out where I did. I learned so much and formed bonds I’ll have for the rest of my life. I think I thrived off of the variety. It’s rather clear to me now why I could never settle on a specialty. If you like it all, what better a place to work? It’s a riptide, yes, but one to be proud of at the end of the day.
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.”
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.
*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
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.