Starting over maybe isn't so bad after all.

Yeah, well, parts of it aren't so bad.

Relearning acid-base balances and hemodynamics and learning about Swans and pressor drips? That kinda sucks. But other parts? Not so bad.

I was thinking yesterday (which is why you smelled smoke) that the best thing about being an established nurse moving from one place to another is this: I already have people's confidence. I don't have to prove myself to anybody; they all know me already.

That doesn't mean that I'm gonna get all puffed up and forget to read my charts, but it does mean that I don't have to go through that awful eight-to-twelve month period that new nurses have to go through, when everybody including you is trying to decide if you really ought to be doing this in the first place. That's already done. Everyone I work with knows what I can do and knows that I don't, say, panic over nothing.

The flip side of that, of course, is that they also remember every screwup I've had in the last seven years. Which, surprisingly, is actually a positive thing. If Resident A or Nurse X remembers that I'm a little goofy about lab results, they'll be watching too, for the patient's sake. It's nice to have people at your back that know all the bad things about you; it means they don't panic unnecessarily.

And, of course, there's the beauty of knowing your own ignorance. When I first started nursing, every day was fraught with peril because I simply didn't know what I didn't know. Now I do: I know nothing at all about cardiovascular stuff, because a) I was asleep that day in school, and b) I haven't used it in umpteen years. I know nothing about complex neck dissections, open sternums, open bellies, or fresh amputations. I know next to nothing about new neobladders, ileal conduits, pulmonary edema, and free flaps that have just been placed. Although it doesn't sound like it, that helps narrow down what I have to woodshed.

And finally, there's the whole neuro side of what I'm doing. It amazed me to find that I know more--a *lot* more--about how brain injuries affect function than some of the CCU nurses do. That's because I've been working with people who are already on the way to recovering. If you have a left parietal bleed, for instance, it's not logical to expect that the CCU nurse will know that that'll likely translate to you ignoring your right arm. She or he has been too busy keeping your ass alive to worry about what you'll do later. It *is* logical to expect that I'll know it, since I've been getting those folks with bleeds ready for rehab for years and years. That helps a lot with family and patient education. It's nice, too, that I can warn them what to expect when they get to the floor and what they'll do in neuro rehab.

So, yeah. So far, so good. This week will bring rotations in the CVCCU, which fills me with terror. I don't know that I can keep six or eight drips straight in my head (which, I guess, is why you write things down) and I'm still not clear on how or why a balloon pump is a great idea, but I guess I'll find out.

Maybe this won't be so bad after all.