Sunday, July 01, 2007

About a hundred posts per year.

This week is the fifth anniversary of my passing the NCLEX and being a newly minted, official RN.

If I had to break things down, I'd say this: the last four years have been the absolute best of my life. The fifth year, the first year I was a nurse, was tough--but still good.

When you're brand-new, you're still in that headspace from school--the one that makes you not want to make a mistake, ever. Ever. It's the mindset that tells you that no learning curve is too steep, no responsibility too big for you--you just have to get in there and do it. It's the same mindset that led me to be certain that I couldn't cut it as a nurse, that I'd surely kill somebody before the shift was out, that sent me (the dubious agnostic) into the chapel every morning before my shift to pray please God please, if you're up there, let me do well today.

After that first year (listen up, new nurses!) things don't exactly get easier, but you develop a routine and a flow. Bobbles that might throw you off for an hour or two get easier to handle. You develop a sixth sense for IV bags, so you can change them before they're empty. You develop the same feeling for fevers, so you can tell when somebody's actually sick or when they just haven't been walking as much as they should. You make up your own shortcuts--and I don't mean that in a bad way--that work better than formalized routines.

After the first year, your feet hurt less, because you've discovered good shoes. You know that going without lunch won't kill you. You've figured out how to manage a fluid rotation (peeing and drinking water) in thirty seconds or less.

During the second year, you find that other nurses will sometimes ask you questions. Certain things get to be routine, like starting IVs or managing minor crises. Bad things bother you less. You redefine "good outcome".

During the third year, you hit your stride in other areas. People calling you "nurse" no longer feels weird. The crazies don't seem to seek you out like they used to. You can see problems developing a long way away, and you finally have the wherewithal to avert crises. Care plans, those things you struggled with in school, finally make sense. More than that, you're making them up in your own head without any problem.

During the fourth year, things really seem to start coming together. You've got your routine down to where it feels natural. Your reports are short, sweet, and hit the high points. You know the guys in Radiology by name. You're finally good at making a bed with a person in it. You can see a patient in a holistic way, rather than as a bunch of problems and potential problems in isolation. You know which size of filter mask fits you. You know what size sterile gloves all your residents wear.

Now I'm in my fifth year. I find that people call me for tough IV starts (zut alors!) and for tough catheter and NG tube insertions. (Everybody has a schtick; mine is catheters and NGs.) Newer nurses ask me for advice. Older nurses bounce ideas and problems off of me. I've learned that leaning on other people and asking questions is a good and honorable thing. The residents and attendings respect me, and I've learned not to be afraid of them.

I've learned the value of teamwork and of occasionally staying late. I know how to fix, jimmy, or jury-rig almost every piece of equipment on the floor. I know where we keep the molasses, and I know where the bodies are buried.

A whole bunch of people I cared for are dead now, most of 'em from what they came in for, some of 'em from other things. More are still alive and doing well. Some have come back to visit. A few people I've worked with are dead for various reasons. Most are fine. We've been short-staffed, overstaffed, bizarrely staffed, staffed with floaters, agencies, and nurses so old they walk around with oxygen backpacks on. We've won awards as a floor. I've won a couple on my own merits, a fact which still baffles me.

I am five years older. I have grey hair now. I'm thirty pounds heavier. My feet hurt sometimes, and I've developed some odd varicosities in my ankles. I used to be intimidated and awed by those no-bullshit nurses who would get straight to the point and tell you something *once*; now I'm one of them. I can change a dressing, calm a fever, stop bleeding, resucitate a dying person. My sleep habits have completely changed. I can and will eat food from vending machines without complaint or adverse effects.

And after five years, when the nice man from the mortgage company asked me what I did for a living, I said, "I'm a nurse." And grinned.


Penny said...

"You've figured out how to manage a fluid rotation (peeing and drinking water) in thirty seconds or less."

Oh, hell, I got that part down PAT. I can pee, get water, grab copy off the printer and be back where I need to be in less than two minutes. So...I got THAT going for me.

Friend Pens, completely freaking out about Case Study #2, which contains such gems as, "Succinylcholine binds to Ach receptors at the motor end plate. Explain the mechanism by which it could produce muscle relaxation."

shrimplate said...

The mpst trusted profession, according to Gallup polls.

anne said...

Thank you, Jo. Huge, huge thank you.

Four semesters to go.

Congratulations on your fifth year! I've enjoyed your writing for about three of those years - even before I started nursing school. You certainly have my admiration, both for your nursing skills, and for your writing.


shrimplate said...

Except for my typing skilss.


Magpie N. said...

Happy anniversary, Jo. You're an inspiration.

Alijor said...

Hey. That really, really is. Beautiful.

Happy Anniversary!
Cheers, Alijor.

GingerJar said...

Have been reading your blogs for about 3 or 4 years or so and could have sworn you had at least 20 years under your belt. I have 18 mo as LVN and 5 yrs as RN, and even with my better skills I still pray every day that my patient's all live though the night, so I can hand them off ... intact... to day shift....even if they are DNR's and taking their last breath.

Shelly said...

Just what I needed to hear. Tomorrow is the 3rd day of my first week of being a "real nurse".

Nurse Bear said...

Six months in, myself. I'm framing this and putting it up on my wall.

Do me a favor in five years and give me a heads up on years Five through Ten, hey? (;

pixelrn said...

Love this post! I've just entered year three and can't wait to hit year 5.