Thursday, September 14, 2006

So you're a nurse. Now what?

I got a request for a post about role confusion (that awful feeling that comes from being a new nurse), and it sounded like a good idea. The transition from student to preceptored nurse isn't as hard as you'd think; you still have to show up on time for various classes and lectures, you still have somebody following you around, you still feel like there's some leeway for mistakes.

Coming off a preceptorship, though, is a whole 'nother deal. All of a sudden, you're a Nurse. But you don't feel like one; instead, you feel like some shmuck that's been picked up off the street and dumped into scrubs. Things seem really, really hard--even simple things, like a focused assessment of a patient.

Here's what I learned when I was a new, nervous nurse, then:

1. You will not kill anybody.

Unless you do something spectacularly idiotic, which is very very very rare, you will not kill anyone. You have people looking out for you--this is true throughout your nursing career--and every action you're expected to take has gone through a number of people more experienced than you.

2. Remember the First Rule Of Nursing: If you have to jack with it, it's wrong.

That one little rule will save you every time. Hospital and clinic work has been streamlined and perfected over the years so that it's practically tired-new-nurse proof. Therefore, if you find yourself having to improvise or make things up to get something done, take a good look at what you're doing. The likelihood is that you're either doing the right thing wrong or the wrong thing altogether.

3. If you do screw up, report it immediately.

Nobody is going to fire you, yell at you, or make you feel like an idiot. (Chances are, you'll do that last one to yourself.) Everybody, even Super Nurse Extraordinaire, makes mistakes every day. That's why we have procedures in place to, say, double-check settings on pumps and so on. If you screw up, it's important to report it so you can have help figuring out *why* you screwed up, and how to manage the situation in the future.

4. Ask questions.

Everybody asks questions, including Super Nurse Extraordinaire. Most of us ask them constantly. We all double-check each other, help each other out with weird titrations, give second opinions on whether or not that patient is more or less gorked than the day before. Your colleagues are part of a team that includes doctors and other nurses and X-ray techs and respiratory folks. Ask 'em all questions. If anybody tries to make you feel stupid, respond politely and be effusively thankful. That'll embarrass them no end.

5. Honesty is the best policy.

If a patient asks you how long you've been a nurse, *be honest*. You're not fooling anybody. If you don't know something, *say so*, then vow to find out the answer. This, too, happens every day.

6. But don't volunteer information.

I say this not because patients are stupid or mean. I say this because if you give somebody too much information, it can be truly overwhelming. Stick to answering the questions you get asked, like "How long until I can shampoo?" or "When will my stitches come out?" Don't go into a dissertation on possible side effects that only occur in 0.1% of the population. This is a lesson I learned the hard, hard way.

7. Fake it.

Act confident and friendly, even if fear makes you want to throw up and pass out. Eventually you will feel confident and friendly. In the meantime, nobody else will have to deal with your vomit or prone body.

8. Going home in tears is not necessarily a bad sign.

You will be so overwhelmed, stressed out, and exhausted that you will occasionally sag against the wall of the elevator and weep. This is a normal part of the stress that comes with being a nurse. It becomes less frequent as you learn more. It's okay. Here, have a cookie.

9. People will occasionally do mean things or get inappropriate with you.

Wackos can smell a new nurse. I got odd suggestions, inappropriate physical contact, and outright bullying more in the first six months I was a nurse than I have in the following three-and-a-half years. Be patient. Eventually you will develop that Nurse Callus that allows you to see the loonies coming and deal with them. In the meantime, lean on your charge nurse and your colleagues to help you get out of rooms unscathed. And if you're getting consistently shitty assignments with a higher-than-normal proportion of weirdos, complain. It's not fair to saddle the newbie with all of the nutjobs.

10. You will, someday, feel like a nurse.

I remember when that happened. I had had a day during which I had made only a couple of minor mistakes, caught them before they'd done any harm, and had caught a problem before it developed into something severe. Further, I had had time to pee and eat and actually take *time* with my patients.

That didn't happen until I'd been a nurse for more than a year--maybe even more than two. I don't remember the exact date, but I do remember the feeling. It was though I had finally gotten the hang of swimming with the current.

This will happen to you, too. I can't stress that strongly enough. Nursing is a constant learning process. You feel off-balance every day of your professional life, and there's always something you don't know. Nevertheless, there will come a day when you realize that you're looking ahead of what's immediately in front of you, and when care plans finally begin to make sense. You'll build on skills you already have when it comes time to learn something new. Yeah, you'll fuck up royally the next day and go home in tears, but you'll have had that one day when you can say, honestly, 'I am a nurse.'

And then, a few years down the line, you'll be chatting with a notoriously hardassed doctor and apologize for doing something dumb, like calling her at 3 am, and she'll say, "Y'know, if it comes from a good nurse, I don't really mind it when I get called at 3 am." And she'll smile, and you'll know that Good Nurse = You.


Janet said...

Excellent post, Jo! I wish someone had said these things to me when I was new. You should submit this to Grand Rounds or Change of Shift.

annie said...


This is the best advice you could ever give a person....


Anonymous said...

I'm a student nurse about to go into my second week of a prac stint in a busy hospital and this post has made me feel so much better about my place in the world.
Thank you

annelynn said...

Thank you thank you thank you. A thousand times and also a double serving of poutine for you!

I am printing this out. Thank you.

Anonymous said...

Very well done! Please consider submitting this to a nursing journal - it deserves much wider readership!

oncRN said...

this was brilliant and true and real. it took me back to my early days reading this. thanks for a great post.

Alaska Mona Lisa said...

I had my first break down with tears the other day during a visit with the DON, after just talking to my direct supervisor. I'm a new- nurse and on-call and there is much to learn. After that talk with DON, I think I need to settle into one place and become really good and really comfortable with the patient population, the docs and the routine.

Thanks for the advise.

Cassondra said...

HI. I found your post about surviving nursing school from a google search. I am 38 right now--I have always wanted to be a nurse, but I put it off for years. I have an 18 year old, a 9 year old, and a 17 month old and am married. I am intending to start school in the fall (2009). How difficult is this going to be for me? I am nervous about it--change is not easy for me.