Wednesday, April 18, 2007

Gosh, look at the time.

It's spring, the loveliest time of the year!

Those of you who are about to graduate from nursing school will no doubt have noticed that it's staying light later in the day, although other details might've escaped your notice. Since it's spring, it's time for the periodic Tips From Nurse Jo For New Grads...

1. The first rule of nursing is (sing it, everybody!): "If You Have To Jack With It, It's Wrong." Remember that when you have to connect tab A to slot B through connector C and widget D. If something doesn't come together in an idiot-proof way, be it lab results or equipment, take another look at it and figure out what's wrong.

2. You will not kill anybody. I promise. You will still pray, as I did, every single day that you won't kill somebody, but you won't. There are people looking out for you.

Which brings me to

3. If you've somehow landed in a hospital where the nurses are horrible, you can always leave and find a new GN internship. Don't feel like you have to put up with abuse in order to pay your dues or make it as a nurse.

Mother Jones has a big discussion on the backbiting and cattiness in the nursing profession. Honestly? If nursing is the cattiest, bitchiest profession you've been in, you've obviously never spent even five minutes in community or college theater (but that's sort of beside the point).

The point is that there are plenty of nurses out there who aren't looking for a GN to chew on. There are lots of internship programs dedicated to educating you, making you a confident and competent practitioner, and plenty of folks like me who love to teach and are proud of you for what you've done.

If you end up in one of the other sorts of internships, don't take the abuse. You can always walk.

Speaking of walking, there's

4. Do not be afraid to leave a room or the nurse's station if somebody is abusing you. That goes for patients and double for doctors.

When you're a new nurse, everydamnthing is so overwhelming that, even if you've dealt successfully with crises before, you tend to cave. Remember that walking away is often the best way--and sometimes the only way--to deal with shouting nutjobs. Yes, I've turned on my heel and walked away from patients, family members, and doctors. As I've gained more experience, I've had to do so fewer and fewer times, but it's still a valuable skill to have.

5. Shoes, scrubs, and fiber are the three most important components of daily life for a new nurse. Make sure your shoes are good and sturdy, be certain your scrubs won't fall down if you have to book it down the hall, and eat your veggies. Taking care of your body and making sure that your clothing is worry-proof isn't selfish; it allows you to concentrate on your job.

6. Don't lend your stethoscope to a resident unless you're absolutely sure you'll see her in the next ten minutes.

7. The volume of shit a patient can produce in one shift is inversely proportional to their level of consciousness.

8. Other nurses and doctors (didja notice? I said "other nurses! You're a nurse! Hooray!) are there to have their brains picked. Ask questions. Ask for help. Don't turn down help if it's offered. Don't be afraid of looking silly; we all look silly on a daily basis (or oftener, if you're me). And don't underestimate the knowledge base of the transporters, patient care aides, radiology guys, and pharmacists. Pester everyone, absorb information like a sponge, and sort it out later.

9. Being a nurse is much, much easier than being a nursing student.

10. Eventually, I promise, you will feel like a nurse. It might take a couple of years, but it will happen. The flow won't come immediately; you'll feel completely at sea for the first several months. Someday, though, you'll be wandering down the hall and be hit with the realization that you actually saw a patient and planned her care and thought through her case in a second-nature sort of way. You will suddenly realize what all that studying was for. You'll understand how all the pieces of a problem come together and what to do about some of them. You'll feel a glow of accomplishment and a surge in confidence.

And then your patient will go into respiratory distress, or you'll realize you've made a whopping med error, or you'll spill spaghetti on your pants. But for one shining moment, you'll feel good about what you're doing.

Hold on to that. Spilling spaghetti on pants, tragically, does not get any less frequent with experience, but the feeling that you're doing good comes more often.


#1 Dinosaur said...

An amazing amount of that excellent advice applies to new docs as well. Though at first, residency is harder than studenthood. Other than that, everything is spot on. Especially the spaghetti.

susan said...

well said!
the only thing i would add is that you will find yourself assessing people when you are in the mall or walking down the street. thinking like a nurse will become so much a part of you, you will do it automatically.
welcome to the unique, wonderful world of a nurse!

shrimplate said...

I love working with students and newbies. Today we had IVP Labetolol, sinking an NG tube, and peritoneal dialysis among "student firsts."


Magpie N. said...

I can't wait! I'm downloading this post and saving under Things to Remember. Thanks for writing it.

sn moxie said...

jo, as always your advice and wisdom are much appreciated. i will definitely try to keep these in mind. what i don't know outweighs so much of what i do know, sometimes it hard to believe.

shrimplate said...

And another thing- don't even *put down your stethoscope* withing 10 meters of the nearest resident. They are like black holes that hoover up Littmans.

Birdy said...

I love your Words of Jo Wisdom. You should start an advice column. Seriously.