Wednesday, May 27, 2009

Everybody has it that bad. I promise.

A colleague-shaped blur went past me this week and resolved itself, once I caught up to it, as Marcia, one of the new nurses on our floor. She just got out of her internship and has been looking a bit white around the eyeballs lately.

"What's up?" I asked. "D'you need any help with anything?" 
"No..." she replied, "It's just one of those learning experience kind of days."

Ooooohhhh yeah. I remember those days. Sometimes (meaning about three shifts out of five) I still have them. There is nothing worse than being a new nurse and having Learning Experiences every. damn. day. you work.

Because, no matter how hard you try, you still feel like either an asshole or an idiot (or both) by about noon. This is common, and it's caused by the fact that you think you've actually learned something in nursing school. 

Not that I'm bagging on nursing school. It's like this: You learn all this very useful information, and all these valuable facts, but you don't--you *can't*--learn how to put them into practice until you've been, well, *practicing* for a while. Coming out of nursing school and expecting to have a handle on being a nurse is a lot like taking driver's ed without ever getting into a car, then expecting to be able to handle rush-hour traffic. On a different planet. With totally different physical laws.

Part of the problem, I think, is that you're trying to put things that you learned in a static fashion into practice in motion. I know that's a weird way to look at it, but bear with me. When you're in nursing school, you get a case study or a scenario to work with, and you can go through it step by step in a logical fashion.  You're sitting down, what you're working on is the only thing you have to deal with. Once you get out onto the floor, though, you have that scenario *and* about fourteen other things--literally--happening at the same time, and you have to keep track of all of them, and call bells are going off, and people are falling over in the bathroom, and you're running down the hall. 

Not only does your brain have to get good at sorting, discarding, and shoving things into medium-term memory, but you have to do it all on the run and while paranoid. 

This is why new nurses have breakdowns, start drinking, and think about going back to banking.

The good news is that things do get better. I don't know how it happens, but somehow your brain gets good at remembering five or six things for an hour or two, ranking those things in order of importance automatically, and then (most important) discarding them once you've dealt with whatever they are. Thinking back, it took about six months for that to start happening for me, and another year for it to get really good. Now I can go to the grocery store without a list and not forget anything. It's a good skill to have.

Also, you get used to thinking on your feet. It'll get to the point eventually that it'll be hard for you to really grasp a new concept without being in motion as you learn it. There's some neurological basis for that, but I'm down two Hop Head Reds at the moment and can't remember what it is. Anyway, you'll get so used to learning and coping while on the fly that it'll seem weird to discuss a problem with a doc if you're standing still.

And finally, you'll lose your pride. I don't mean that in a negative way: you don't turn into some sort of snivelling creature who winces any time anybody corrects you. I mean that you realize that mistakes happen multiple times a day, and catching and correcting them before they do harm is the important thing. You'll also learn that nobody knows everything, and even experienced nurses screw up in impressive, mind-boggling ways. Your ego learns to lie down and take a nap while you're at work, and mistakes quit seeming so damn personal.

Listen: I screw up at least six times in a shift, every shift. Most of the time, thanks to experience, I catch those screwups before they head out the door. Sometimes, I manage something so amazing that it qualifies as a Learning Experience, Nuclear Grade--and I've been doing this full-time, in one specialty, since 2002. Thankfully, my pride doesn't take a hit (or not much of one) every time that happens, because I've learned that I'm not the only one.

There are also things that I still do not know. Some of them are very basic; others are kind of arcane. I ask a lot of questions (one of the docs has nicknamed me the Elephant's Child) and do a lot of reading and try to get in on cool bedside procedures when I can. Those habits are among the most valuable you can develop as a new nurse. Not only do they mean you'll never stop learning, but an honest curiosity about things will put you in good stead with doctors and other nurses who like to teach and learn themselves.

Eventually it will all come together. You'll look up one day and realize you've filled out your chart's checkboxes in three minutes, your patients are all medicated and comfortable, and you actually have time to pee. Six months later you'll have time for lunch. Two years later you'll have enough downtime to fill in a couple of boxes on a crossword. More than that, you'll be able to form a synthesis with speed and accuracy and keep a dozen metaphorical balls in the air without flipping out.

Getting there sucks. The nightmares suck, the fear that you're going to hurt somebody really sucks, and the anxiety is awful. But it all does ease out over time. 

New nurses, listen up: Cut yourself some slack. Be easy on yourself when you look stupid, as you most certainly will. Don't expect to be an instant expert, or even instantly competent at everything. Recognize that you have strengths and play to those. Recognize your weaknesses, too, and learn how to hedge around them and how to compensate.

And for God's sake, don't go back to banking. We need you here with us. I am glad and proud and tickled to death to be working with you, because you teach me so much. You also remind me why the heck I got into this business. So thank you.

And if you need some help, don't hesitate to ask. We've got twelve hours, after all.

10 comments:

08armydoc said...

Amen Sistah.

This could be written for interns, as well. Even at the end of my first year of internal med, I feel like an idiot with the power to write prescriptions.... Then I realize where I've come in a year. Most of it's just come from the magical "experience" or reading, but some of it's come from making mistakes or getting my butt kicked - nothing quite focuses your learning while getting some hide taken off in front of everyone.... Even if you know the topic, sometimes the words don't come out right, and you still sound like an idiot.

So, now that the new interns are coming in, I have a little pep talk sketched out in my head: You aren't expected to know everything, just how to figure it out, or ask where to find it. Work hard and keep moving forward. Trust yourself. Trust your nurses. Thank your nurses. And as the surgeons say: eat when you can, sleep when you can and don't mess with the pancreas.

Catherine said...

I really hope the same process happens with newly minted docs as well. For my sake, and yours.

Love your blog, finally delurked to comment as this post totally hit home.

Anonymous said...

i am a long time lurker, have never commented on this - or any other! - blog. but i have to say, what you've described here is the same exact path we residents take through our training.

we come out of med school knowing next to nothing - if we're lucky, we knew what we wanted to do during school and could focus on that - but usually not. but we did lots and lots of work in front of textbooks and on exams - "you get a case study or a scenario to work with, and you can go through it step by step in a logical fashion. You're sitting down, what you're working on is the only thing you have to deal with."

then you hit intern year, and suddenly, you're "the doctor." i think it took me at least six months to even turn around when someone addressed me as "Dr." i think i was lucky that i knew how much the nurses around me had to teach and help me. i cannot imagine working their job, with a new group of assholes showing up every July...

and that's what some of us are - assholes, pure and simple. but some of us are actually learning, growing, stretching...

what hit me most about your post was the idea that "your brain gets good at remembering five or six things for an hour or two, ranking those things in order of importance automatically, and then (most important) discarding them once you've dealt with whatever they are." this is exactly what has gone on in my brain over the past 2 years, and yes, i can now go to the store w/o a list.

and this is me: "It'll get to the point eventually that it'll be hard for you to really grasp a new concept without being in motion as you learn it."

and this: "You'll also learn that nobody knows everything, and even experienced [doctors] screw up in impressive, mind-boggling ways. Your ego learns to lie down and take a nap while you're at work, and mistakes quit seeming so damn personal."

and this: "There are also things that I still do not know. Some of them are very basic; others are kind of arcane. I ask a lot of questions."

we are not so dissimilar, new nurses and new doctors. so why the disconnect? if we can all acknowledge that we're all here for the same reason - to learn how to do our jobs, and to do as much good as possible, with as little harm - can't we meet in the middle? with the greater good as our goal?

this, Head Nurse, is in now way a comment on your (most excellent) blog, nor on the way you treat your residents - to each according to their assholery, as they deserve - but your post really struck a chord with me. i thank you for considering this (Nimbus Old Monkeyshine-influenced) comment. please feel free to delete this last paragraph as you see fit

- 2nd year resident

Anonymous said...

I can't say "thank you" enough.

I am a brand new nurse - and I feel stupid every minute of every day. I have three other degrees besides by BSN, I did well in nursing school, and I work hard. I'm not sure any of that matters. Yet.

I freely acknowledge that I don't know much, that I'm new. And thank God, I've run into wonderful nurses and some pretty terrific doctors. They are helping me through the blindness, the uncertainty.

Yes, I've run into some jerks that are doctors and nurses. I try not to take it personally and most of the time, I don't. And then I remind myself that I don't want to wind up like them and I try to treat others with respect and kindness, no matter what their role is.

It's just all so hard. So perplexing and complicated. Too many times every day, I have say, "I don't know," "I'm not sure," and the inevitable, "Let me find out for you." All of which takes me so long to find out.

I look forward to being two years down the road, when I can turn to someone new and say, "Here. Let me help you."

AzRN said...

i would also add: find a mentor to trust and stay out of the way of the toxic folks on your unit. i have been a rn for 16 years and i still have those days :D. it all makes it worthwhile when you catch something everyone else missed.

Aura said...

I love this post. It is so comforting to me as a student with 6 months left until graduation and currently on a clinical placement on a very busy ward. It's a relief to know that everyone goes through this. You would think a lot of nurses forget this as they expect me to be at full RN level with my time management. It's a work in progress!

FYI - I quoted and linked this post on http://allnurses.com/nurses-disabilities-forum/getting-hired-adhd-398575.html

Thanks Head Nurse. Keep the wisdom coming.

Anonymous said...

Great post. And I agree with AzRN: Find that mentor. I am so lucky as a newbie to have an enthusiastic nursing supervisor who, 20 years in, still loves what she does. Around 3 o'clock this morning, after my latest "learning experience," she volunteered some of her best missteps as a new grad, including the IV that she inserted with the cath tip pointing down to the fingers. She assures me that yes, in fact, there is hope for me. I really appreciate her perspective as well as her comment that I will succeed because I have good coping skills. Which is a good thing when, as Head Nurse notes, every damn day (hour?)is a learning experience. Find that mentor, learn from him or her, and let them know how much you appreciate them.

Anonymous said...

A late comment - Thank you thank you thank you. I am two weeks away from finishing my final preceptorship and I feel like a moron so much of the time. It is so good to know that it isn't just me. Now to actually find a way to forgive myself for these percieved shortcomings and keep moving!

Anonymous said...

I can't thank you enough. I'm sitting at my computer, bawling at this blog entry, because it addresses so many of the fears and downright torments I've had since beginning my new job as a nurse less than 2 months ago. I'm terrorfied and everyday I go home obsessing on fears that I've made a massive mistake. I don't know what else to say other than, thank you again.

Anonymous said...

Thank you so much..I almost cried reading this article. No one has summed up the new RN experience like you have. All I can say is that I appreciate you and your experiences so much. Thank you.