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.

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.