Becoming a nurse

It’s been one year since I got the results of my NCLEX examination and earned the “RN” after my name. I took the exam on July 18th last year, and when the anniversary of that day rolled around I found myself thinking, “wow, I’ve been a nurse for one year!” It felt strange to think that, though, because I still feel so new. And really, I’ve been at my job now for about 5 months, so I’ve only been working as a nurse for that amount of time. Then again, I graduated with my BSN last May, and my pinning ceremony was last April, so maybe one of those days is the day I actually became a nurse?

Truthfully, I don’t think any one of those anniversaries captures the moment I became a nurse. I can’t think of one day when, all of a sudden, I went from “not a nurse” to “a nurse”. It was a transformation. I’m still transforming. There are still so many things that I need help with at work, so many ways I can feel myself improving and so many more ways that I can continue to improve. Yes, I am a nurse now, but I didn’t become one overnight.

Even with the degree, with the board certification, and with the job, there were moments when I still didn’t feel like a full fledged nurse. Many of my patients during my first month or so on the floor would ask when I was graduating from nursing school. It was frustrating. Between looking young for my age though, and my nervous demeanor, I can understand where my patients were coming from. I can’t remember an exact day when patients stopped asking me that (and every once in a while now, patients still ask how long I’ve been a nurse), but I think finally “appearing nurse-like” is just as important as the day I got a piece of paper with my name with an RN beside it. It’s a growth process, and I’m still growing.

 

A lesson in caring

My orientation is flying by! I can see myself growing a lot as a nurse, but I still have a long way to go. As a new nurse, I feel unsure of myself constantly. I’m constantly looking up medications, triple checking orders, asking other nurses how to do procedures… Heck, half the time I have trouble even finding the right equipment on my own. I come home at night and think of a million things I could have done better, or should have done differently.

“Oh no, I forgot to go reassess her pain after that Vicodin.”
“I probably wouldn’t have sounded so stupid on the phone with the doctor if I’d remembered to pull up his labs first.”
“Did I remember to chart that apple juice in the I&O’s?”

I know I’m providing adequate, safe care for my patients, but sometimes it’s hard not to think that they could be getting more from a more experienced nurse. Seeing how my preceptors manage their time and do everything so easily, it takes a lot to remind myself that these things will come with time. I’m getting better, but I have a long way to go.

I’ve been caring for one particular patient lately, though, who has taught me that sometimes good nursing care goes above and beyond getting everything in on time and efficiently. The actual art of caring for someone is something that can’t be taught in school, and that is every bit as important.

This patient spent close to 4 weeks in the hospital, with a new cancer diagnosis, acute renal failure, pneumonia, thrombocytopenia, anemia, a compression fracture… He came in for what he thought was just an asthma attack. Despite everything that was thrown at him, he carried himself amazingly well and was constantly in extremely high spirits. On several evenings I cared for him, I actually watched as he gave his wife emotional support– her breaking down about an additional complication in his condition, and him consoling her. I was baffled.

There were rare moments when I would see him break, and my heart told me he was surely internalizing more than he was letting on. To some extent, his optimism might have been a brave face he put on to show the world. I saw that mask slip off one night when another nurse and I went to access his newly placed portacath. I saw him wincing as we manipulated the port, and finally he told me the pain was just too much at the fresh site. I got him an order for some IV pain meds, all the while feeling guilty for maybe being too eager to get at that port. When we went in later in the evening, pain meds on board, the nurse who finally did the access was a little less than gentle with the site so I stayed in the room a moment longer to hold his hand, offering what I could.

The following night I found him on my assignment again, and I wondered if he would hold any grudge about the ordeal from the night before. The shift started off normal enough, but after his visitors left and I went in with his evening medications, I asked how he was doing. Again, that mask slipped away for a moment and he admitted he was finally starting to feel worn down by everything he’d been going through.  I stayed and talked for a few minutes, reminding him that he has every right to feel tired– that with everything he had been through, it was okay to give himself a break. He grabbed my hand and said “Today’s been my hardest day yet. You’ve been the highlight of it.”

…I melted. I come home from so many shifts feeling so inadequate– my meds were late, or I forgot to log an I&O, or I forgot to bring that patient the extra blanket she’d asked for. This patient reminded me that sometimes the biggest way to make a difference isn’t through flawless technique, but through genuine care: a hand hold, a conversation, a warm smile. Compassion, encouragement, and hope don’t come in a vial, but they’re some of the most important things a nurse can dispense.

Big changes / Little moments

Well, I’m a little over 1 month into my orientation on the oncology/medical-surgical floor. Each shift has its up’s and down’s, but overall I’m happy with where I am. I love the unit, love the other nurses, love oncology more than I ever thought I would. It’s been a big adjustment, leaping back into the nursing world, and even more so leaping back into adult medicine after doing my final rotations and preceptorship on pediatrics.

Big changes, so what gets me by are the little moments. Particularly during my first handful of shifts, little things would make me stop and realize– I’m a nurse now. Not a student, not a job shadower– an RN. I think scanning my fingerprint into the Pyxis for the first time was when it first hit me. Another time, a nursing student came to me with some questions. It seemed crazy I should be the one to answer her; I was her what seemed like moments ago!

Some of the littlest moments have given me the deepest sense of pride, though. The other night, I was assigned a “difficult” patient– one who had been somewhat negative all day, didn’t seem to want to communicate with his nurse at all. At the start of my shift I had no idea how I was going to get through to him, but each time I went in and made any sort of conversation with him, I made a chip in the ice… And by about halfway through my shift, I even got a smile and a laugh out of him. My next shift, I was assigned a different set of patients but I ran into him while answering a call bell, and he said he was disappointed I wasn’t his nurse. That felt so good!

Other little moments give me a much needed boost to get me through whatever frustrations I’m feeling during a shift. A patient told me he liked when I gave his shots, because they didn’t hurt as badly. Another was surprised to learn I was a new nurse. Another stopped to say goodbye to me on his discharge day– and remembered my name, despite me only caring for him during 2 shifts, almost a week beforehand.

The street goes both ways, of course, and I try to keep that in mind when I’m caring for patients. A little thing like remembering not to put too much ice in a drink, or stopping to chat for a minute, or asking if there’s anything they might need before leaving the room… These can make a difference between a patient having all the required care, and truly feeling cared for. I hope as I get more comfortable as a  nurse, I’ll be able to provide this level of care for all of my patients.
[On a side note, related to my last post a few months ago about my T-cell donation for my bone marrow recipient… I am just as convinced as ever that we are all connected. It’s hard not to think that when your job is to be so closely involved with the physical and emotional aspects of a patient’s life. The donation went well (and you can read about it and any other stem cell/bone marrow/registry/donation topics over on my PBSC donation blog), and now I just need to wait and see if I’ll hear anything about my recipient’s condition. A couple weeks ago I cared for a patient who had recently underwent a stem cell transplant; it felt so rewarding to be able to care for someone “on the other side”, after thinking of my recipient in such abstract terms for so long. Made me think about what kind of care my recipient received; what his nurses were like. I’m sure they were wonderful, and maybe one day I can ask him myself!]

Everything is connected.

I wrote last week about how my experiences with nursing, music, and giving have come to define who I am. The nursing job I am about to begin seems to fit perfectly into the journey I’ve been travelling. The mixed unit will fulfill my love of pediatrics and my passion for oncology nursing that was sparked by my experience with bone marrow donation.

Nursing, music, and donation converged for me on Friday. I spent my morning at the hospital of my soon-to-be employment, filling out paperwork and having a pre-employment health assessment with employee health. I had labs drawn for immunization titers, and got a pretty nasty bruise from the stick. Despite donating blood and platelets several times since last summer, my arm hadn’t looked that beat up since the stem cell donation. The visual reminder made me think of my recipient, and I was actually wondering to myself about how he was doing when a friend texted me a question about the marrow registry.

I was even more surprised when later that afternoon, I got a phone call from the bone marrow registry. It turns out that my marrow has still not become dominant over my recipient’s, and his doctors have requested a T-cell donation. I haven’t been able to find much research on T-cell transfusions for stem cell transplant patients, but from what I have gathered so far it is intended to give my marrow a boost, allowing it to fully engraft and replace his cells. I’ll be getting more information the next time I speak to my advocate.

"everything's a piece of everyone"

And to complete the convergence of my passions, just a few hours after that phone call I was watching Jack’s Mannequin perform in concert. Much of Andrew Mcmahon’s music is influenced by his own battle with cancer, culminating in him receiving a stem cell transplant from his sister. There could not have been a more fitting moment than hearing him sing about “a light in the dark as I search for the resolution” and more, as I said a silent prayer for my recipient!

I am still blown away by how everything seemed to have fallen into place lately for me. If I had gotten the Florida job, doing this donation would be very complicated and maybe not even possible. If I didn’t have Andrew McMahon’s story in mind back when I saw the bone marrow registry’s booth, I may not have thought to have signed up. If I hadn’t done the bone marrow donation, I might still be as hesitant as I had been about working with patients with cancer, and I wouldn’t have known what to say when presented with it during my job interview. Everything is connected.

Who I am & who I will be

If I had to choose an outfit to show people who I am, I think I might wear just what I have on tonight as I sit here trying to keep out the cold: sweatpants with my nursing program’s logo, a band t-shirt, and a sweatshirt from the Be The Match bone marrow registry. These items hardly show any fashion sense, but– along with being cozy and warm– go a long way for defining the major aspects of “me”.

1. Nursing. It’s been 8 months now since I’ve graduated from nursing school. In that time my patience and even my hope has sometimes faltered, but my passion for the field always remained.
2. Music. The art of music brings me peace, and gets me through just about every high and low I encounter. More important is the fact that I can share this love with my friends.
3. Giving. Donating bone marrow this past summer sparked something in me that I am forever grateful for. Realizing the impact of simple actions, recognizing the connection we all share to one another… The experience has changed me forever.

Finding your passions– truly being aware of them, and seeking them out– is what life should be all about. In the recent months, I have become better at recognizing the power of listening to my heart, having faith that if I live to the best of my abilities, good things will happen. When it is meant to be, have faith that all of the pieces will fall into place.

And this has been true for me. I can proudly say that as of last week, I have secured myself a nursing job! The position seems to be just what I need to fulfill my passions. I will be working on a unit with pediatric and adult beds, accepting patients from medicine/surgery as well as oncology. Pediatrics has long been my biggest interest, but I knew that med/surg experience would be useful for the future, and after the bone marrow donation experience my interest in working in oncology skyrocketed. It’s as though it was meant to be.

It’s impossible to know what is truly planned for your life. Literally days before interviewing for this job, I had flown to Florida to interview for a NICU internship. I believed that that could be my destiny, and it sure felt like the pieces were coming together for that opportunity. But God, the Universe, whoever is running this show had a different plan in mind. My trip to Florida wasn’t meant to bring a job offer, it was meant to bring me a fresh perspective. (Plane rides always do that for me). My interview for the internship was meant to help me flesh out my thoughts, perfect my routine, and flush all those interview jitters out of my system.

I know by now that I could very well be wrong about this plan, too, and that in the end even this job offer was just a stepping stone on a greater journey. Even from my window seat on the airplane, I was only able to see as far as my eyes would allow. But it’s exhilerating to be on this journey, and I’m looking forward to bringing my passions along for the ride.

That’s why they say you’re “high”-ered…

Applying for new jobs has far too many similarities to drug addiction, to me:

• I started off pretty slow… Picking through listings and only going for the ones that sounded like my perfectly ideal job. But as the addiction grew, I began to need more and more to feel satisfied with myself.
• It offers a temporary high. I’ll admit that filling in the same old work history and reference contact info is a pain, but I doubt heroin addicts much enjoy the actual needle stick, either. But once I’ve submitted the application, I get a brief sense of hope. I keep going back for that hopeful feeling.
• I’m forever telling myself, “This will be the last one I’ll have to do.” I want so badly to quit.
• But, so far at least, it’s never been the last time. I’ve always needed more. After a few hours– or even a few days of hopeful, patient waiting for any sign of contact from a recruiter– the high wears off. And then the rejection hits, and I’m right back to where I was… Or feeling even worse off.

I came to these conclusions today, at the end of a week that’s been utterly depressing for me. I’m bored, lonely, and restless at home. After a day of feeling especially down in the dumps, I found myself online applying to two more jobs to bring my total for the past two days into the double digits. The “high” isn’t as high anymore, because I’ve all but stopped letting myself get too hopeful about any of these positions. I’ve stopped being selective about what I apply for, too; I have applications out at hospitals and rehab clinics, for pediatrics and for adult medicine, down the road and 1,000 miles away. I’ve posted my resume on so many websites that I’m surprised my name’s not trending on Twitter (yet.). I’ll go almost anywhere and do almost anything to simply be a nurse.

I hope one day (maybe even sometime in the not-so-distant future) I can look back on these angst-ridden, frustrated posts and say how all this paid off in finding a great job at a great hospital where I’m learning a lot and loving life. In the meantime, though… Guess I’ll go get another fix.  ; )

A moment like this

Facebook now enables me to reminisce on even what may have seemed like trivial moments, thanks to its new feature highlighting status updates made on this date one or more years ago. A few weeks ago it was the anniversary of “first day of senior year!!”; more cryptically, the other day marked two years since “:)”. Yesterday I was pleasantly surprised by my status from 2010: “Saw a little baby girl be born today! Love maternity.”

It struck me because this is an anniversary that is actually very significant to someone. For that family– that mom, dad, and brand new little daughter– it is a first birthday celebration! I can still distinctly remember tearing up at the sight of the miracle of birth, watching mom’s face light up as her baby girl was handed to her, watching dad’s giddy smile as he announced the weight. I felt so priviledged to have been a part of it. That is what nursing is about for me, being there in those moments that make all the difference.

There were a lot of those special moment on my maternity rotation, which was one of the things I most enjoyed during that time. I remember helping some new parents give their day old daughter a bath, and having a proud grandfather stop me and ask me to pose for a picture. It was an ordinary nursing task, and yet it was a milestone event.

The moment isn’t always so pronounced; it’s not always a photo opportunity. On one of my overnight shifts during my preceptorship I cared for one family whose infant son had just come from the OR after a repair of a small-type omphalocele. The family was overall quite calm and extremely pleasant, but it was clear that mom was worried about her son’s pain management and recovery from surgery. His NCA pump (nurse-controlled analgesic) allowed for boluses of the pain meds every hour, so every hour there I was giving a bolus and doing a quick assessment: heart rate, respirations, bowel sounds. I think mom slept through maybe two checks. She wasn’t frazzled– just a “how is he doing? You gave the meds, right? Any poop yet?” and then we parted for another sixty minutes.  Around the 0500 check, I walked into the room to find mom already up at his cribside. “I think I heard a toot!” I laughed and checked the diaper. “Someone wants to be off NPO in time for breakfast.”

That was it, a baby fart. But at that moment, to that mother, it was a sign of relief. As I left that morning, she asked me if I would be back for that night’s shift. I think that was the first time I’d been “asked for” by a patient, and I felt so honored that I wished I could have said yes. It didn’t matter that this was my third shift in a week’s time, or that I’d been running most of the night with several busy patients. I wanted to be a part of all that.

Now I just want to be a part of anything nursing related. I’ve had dreams about hospital orientations, job interviews, and patients. I even casually flip through my NCLEX books, just to keep familiar with some of the terms and diagnoses. Last week I applied to volunteer at one of the hospitals like I used to do; if they’re not going to hire me, maybe I’ll at least be able to get myself out of the house and onto a unit, even if it is just to fold laundry or stock bedside tables. I need some more meaningful moments in my life.

RN, BSN… Now what?

It’s been hard for me to write any good nursing blogs lately, because I’ve been having trouble really feeling like a nurse. It’s been nearly three months since I graduated from nursing school, and just about one month since I passed the NCLEX-RN. I have earned the right to add “RN, BSN” at the end of my name; I just haven’t been able to find a place to write it yet.

I haven’t written much about my post-graduate life yet, though. On July 18th, I sat for the boards. It was a nerve-wracking experience, but I went into it more confidently than I thought I would. After weeks of studying, it all came down to 75 questions. I hadn’t told anyone I was taking the exam that day because I didn’t want to be constantly reminded of it, but I was very relieved to run into a classmate as I finished. It was nice to have someone to vent with! I spent the rest of that afternoon wandering the city with some headphones on– my coping method of choice that got me through many a stressful time in nursing school.

While my professors all seemed to emphasize the NCLEX as the hurdle that all nurses must face, I’ve found the job hunt to be much more daunting. The most frustrating thing in the world is finding the ideal position and then reaching the bottom of the job description, where it inevitably reads (almost always bolded, underlined, and sometimes CAPITALIZED): “New grads will not be considered.”

I understand the hospitals’ rationale for not wanting me (and I say “me” because it always feels personal when I see that phrase). New graduate nurses require more training, longer orientation, and a willing preceptor; we are more likely to make mistakes as we grow; and after all that there is still the chance we won’t stay in that position very long. But it feels as though no place wants me. I have applied to close to 30 positions, and have gotten only one interview– a phone interview, which went very well except for the fact that the hospital “doesn’t have any positions available for new graduates at this time”.

I miss feeling like a nurse. I miss G-tubes and tracheostomies and figuring out I’s & O’s. I miss being up before sunrise for early morning clinicals, and I miss watching the sleeping city outside the windows on overnight shifts. Even more than anything, I miss the patients.

I miss the patients, their stories, and what I was able to learn from each of them. I’ve decided that, in the absense of any present nursing experiences I may be having, I will use this blog to try to capture some of the lessons I learned from some of the patients I encountered during nursing school. All of the names, ages, and identifiable traits will be changed for everyone’s privacy. I just want to capture the essence of some of these experiences. As I continue trying to move forward, it might be worthwhile to take a look back.

The Boy Who Lived

“Scars can come in handy. I have one myself above my
left knee that is a perfect map of the London Underground.”

–Albus Dumbledore, Harry Potter & the Sorcerer’s Stone

Well, there’s no sense hiding it: I’m a bit of a Harry Potter geek. To prepare for yesterday’s release of the final movie installment, I took it upon myself to reread all seven of the books over the past four weeks. It was a lot of pages to read in a fairly short timeframe. It all cumulated in my reading of over 600 pages yesterday, followed by seeing the movie late last night. In addition, with the boards looming ever nearer, I’ve been doing at least 100 review questions every day, and going over topics that I want to refresh on (seriously, renal stuff just won’t stick in my brain.). Between Harry and the NCLEX, my days became a blur of hippogriffs, glomerulonephritis, electrolyte imbalances, and horcruxes. I once caught myself mentally scolding Madame Pomfrey for “not using therapeutic communication” with her spell-stricken patients.

I grew up with the Harry Potter series– I read the first book when I was 11 years old, graduated high school as the seventh one came out, and now here I am freshly graduated from college as the final movie premiered. Reading it this time around, though, I had a different perspective. I was looking for closure– both for the characters and myself– and rather than reading it with the eagerness of an 11 year old seeking a story, I was reading it for broader meanings. I was relating to it in a new way.

In the series, Harry Potter’s scar serves as a physical proof of what he survived, a symbol of his mother’s protection, and a reminder of what he had to do. Scars are proof that struggles leave marks. Whether the mark comes from a fall off a bike, a surgery, or a failed Killing Curse from a dark wizard… Scars are proof that a person has lived through something. They represent healing, protection from further harm. The tissue hardens but the wound closes. And once a scar is there, it is up to the person to decide whether to be ashamed or proud of the mark.

In nursing we see scars a lot. Patients sometimes need help coming to terms with a fresh scar; others collect them as testaments to their past. I had a patient once show me her scar running the length of her back, from a previous spinal fusion to treat scoliosis. She was happy with the mark, she said, because it gave her the chance to share her story with anyone who might question her about it. This summer I’ve acquired some scars of my own– much smaller ones, really only noticeable if pointed out– but I like seeing them. They dot my left arm, “track marks” from the stem cell donation I made for a patient with non-Hodgkin’s lymphoma through the national bone marrow registry. I love them for the story they tell, and for the chance they give me to spread the word about being a donor. For me they are a sign of healing that runs much deeper than the IV access sites; the process reshaped how I think about a lot of things.

Like the Dumbledore quote above states, scars can serve a variety of purposes for different people. We cannot separate ourselves from our past; it becomes a part of us and shapes who we will become. Perhaps not as literally as in Dumbledore’s case, these scars do serve as a guide for our future. How we interpret that guidance is still up to us, and I hope to be able to use mine in a way that will help my future patients write their own story through their scars.

Take a deep breath…

I saved the e-mail my professor sent my first clinical group on the night before our very first clinical on the rehabilitation floor at our nearby hospital. It was about two and  a half years ago, spring of my sophomore year of nursing school. We’d built up to that day with endless hours in the simulation labs, practicing taking blood pressures on one another and giving gel pads injections of normal saline. But that e-mail was preparing us for the the BIG day– the day we would have real patients, with real diagnoses, on a real hospital unit, needing real nursing care. With some simple directions for where to park and how to get to the hospital’s Dunkin Donuts, the e-mail was brief. Still, the professor managed to write one simple phrase three times in that e-mail: take a deep breath.

We tell that to people all the time. In nursing, we remind our patients to take a deep breath for all sorts of reasons. We say it while listening to lung sounds, calming anxieties, preparing for a procedure. Beyond the physiological explanation for why any of this gets done, though, there is something about this phrase that brings reassurance. There is comfort in the idea that taking even one moment to focus on something as simple as breathing can make a difficult situation seem more manageable.

It’s been over two years since I’ve needed any of the information conveyed in that e-mail. Working a sphygmomanometer is no longer a daunting task; the idea of giving a bed bath no longer gives me palpitations; and I can easily get you to not only that one hospital’s Dunkin Donuts but to every DD and Starbucks within a mile’s radius of any hospital I’ve spent hours in. In four years of nursing school, I’ve learned how to calculate IV drip rates, how to read EKG strips, how to apply a wet-to-dry dressing, and how to tell crackles from wheezes from rhonchi from stridor. The hundreds of hours I’ve spent in clinical rotations and on my senior preceptorship have taught me even more finer points: how to do 4:00am vitals on a sleeping toddler without waking him or his nervous parents, how to teach a nervous mother about caring for her brand new baby girl, how to track down an Arabic translator before the end of the day shift, how NOT to unclamp a G-tube before disconnecting it. Yet still– and especially now that I’m facing taking the NCLEX, finding a job, and potentially moving far from home– I think that the most important advice I’ve gotten so far has been simply, “take a deep breath”.