Saturday, August 23, 2008

Ah, the shock of role transition.

Somebody, I don't remember who now, with a glass of wine in me, asked what I would say to the newbies who are having the SHOCK of ROLE TRANSITION as they go from being a student to being a new grad/new nurse/newbie.

Honestly? All I remember from the first months of nursing practice is this: I prayed every day that I wouldn't kill somebody, and I felt horribly alone.

Both those feelings, it turns out, were bogus. Like, "Boh-oh-oh-oh-oh-oh-GUS!!" the way Tom and Ray say it on "Car Talk". Bogus, like we never imagined it could be in the 80's. Bogus, like carob is to chocolate, or Cool Whip is to whipped cream.

Being a newbie is *hard*. It's almost as hard as nursing school in that the amount of information you have to absorb is huge; it's just more focused. Being a newbie is scary, in that you don't really know what you're doing yet. Being a newbie is frustrating, in that you know some things you're being asked to do are wrong and stupid, but you don't know how to communicate that to more experienced nurses and doctors yet.

The thing to remember is this: If you're a newbie in a precepted program, you have somebody following you every step of the way, making sure you don't screw up. Nobody is going to let you kill a patient. And even if you come close, we're not going to let the worst happen. *Everybody*, from pharmacists to physical therapists to the other nurses, is looking over your shoulder--not to catch you in mistakes, but to make sure you feel confident enough to make decisions on your own and yet stop you if they're the wrong ones.

As for not knowing what you're doing, the honest truth is that a lot of times I don't know what I'm doing either, and I've been doing this for six years. As in, this specific thing, and nothing else. And I *still* run into stuff that flummoxes or stumps me. There are always people around that know more than you, and who won't make fun of you if you ask very basic questions. The trick to being comfortable as a nurse is not in learning everything; it's in getting rid of your ego so you can admit comfortably what you don't know.

And, finally, frustration. I have a story to tell about this particular problem:

Years ago, when I was still being precepted, I had a patient admitted with fulminant meningitis. It could've killed her; it's considered a huge huge huge fucking run around with your hair afire emergency. 

The very moment she was admitted was the moment that our computerized drug distribution system went down. Pharmacy was totally unable to fill any orders, since they didn't have access to anybody's allergies or tolerances or drug levels or *anything*. So, because I was a newbie, my patient with fulminant meningitis went for six hours without her first dose of antibiotics. I gave myself an ulcer in the meantime, trying to do things by the book.

I will never stop being grateful to her doctor. Rather than call me out on the floor and ream me a new one, as he had every right to do, he took me aside and explained what the problem was, and asked me why the patient hadn't gotten her meds. I explained as best I could, suddenly not 31 any longer but 10, stuttering and tearful and ashamed, and he was firm but kind. No harm had come to the patient, but he was unhappy with the level of care. He offered to go to bat for me and get the drugs from pharmacy himself--not in an "I'll go down there and kick their asses" sort of way, but in a "maybe they don't understand how serious this is" way. 

The thing I learned from that awful experience was this: No matter how set the procedures and protocols are, you can always do an end run around them. Sometimes it means finding a sympathetic doctor or pharmacist to write you an order or float you the first dose of meds. Sometimes it means going down to the kitchen to talk to the folks there about what, exactly, "halal" means. If it can be done, you can find a way to do it. The best thing to do is to set up a reputation for being pleasant, creative, and a little stupid right at the start, so when you start doing imaginative things to get your patient good care, people shrug and say, "What the hell, it's only Jo."

The upshot of all this lecturing is this: Good nurses remember, if not the details, at least the general outlines of being a newbie. They will help you out. Glom onto them like death, and do not let them go. I have a mentor at work, and you should too. Don't fret about feeling like an idiot; other people do every day, too, and you'll develop a callus against that sort of self-consciousness. And don't forget: At some point, someday, you'll find that you're finally swimming with the current rather than struggling to stay afloat, and you'll feel like a Nurse. Finally. And you'll grin like an idiot, and go on to make a stupid mistake, and realize that that's what the profession is all about. 


Anonymous said...

I'm a new nurse who reads your blog regularly, and the short de-lurking comment I planned on leaving turned into something much bigger that I posted instead on my site. Thanks for a encouraging post.

GingerJar said...

Sometimes we all feel like new nurses. When I first started there was a statue in the courtyard that I walked by that had an angel with it's arm around a little boy and it's wing kinda wrapped around him. Every day I would start praying at the angel and not stop till I reached my unit. My mantra....Please keep all my patients alive, amen, Please keep all my patients alive, amen....over and over.

I have been training a new nurse now for 1 1/2 years and it starting to drive me crazy....she has absolutely zero matter how I've tried to empower her. Does that mean I've failed as a mentor....??? I blog about it...well too much I guess. I've actually been challenged to study up and re-investigate things I "know" where do I know it from. If I could just give her knowledge from osmosis I would!

Kind of Blank said...

Thank you so much for this post--I live every day in terror of killing someone. On one hand, that feeling gives me a healthy respect for the job, and on the other hand, it can be paralyzing. I guess the key is in find the balance. Anyway, it makes me feel better to know that I'm expected to be a dumbass for a while.

Anonymous said...

LOL. You should write the advice book for nurses, Jo. Loved the advice about being pleasant and stupid. That's me.

I had a pt fire me once during orientation. I hadn't done clinicals at my hospital and was unfamiliar with the brands of equipment so my preceptor was showing me what to do with this particular NG tube. The pt screamed at me that I didn't know what I was doing. I voluntarily reassigned myself but my self esteem was in the toilet. Now. after my 1st year os nursing I fein confidence, no matter what.

RehabNurse said...

Yes, I love the advice.

I've never felt like blubbering in public yet, but it can get hard when you have a doc who thinks you're just getting in the way as you tell him one of his anemic patients is still bleeding out his Foley.

This happened to me today. I've been out of school just 14 months and I still have a knack for getting in the way...when I'm worried a patient will go down without some help.

It is so great to have a mentor...mine went in with me to get the doc to send our guy for further evaluation in another unit...pronto.

Sometimes it just takes two (or more nurses) to get the doc to change his/her mind!

head chef said...

wow, you're reaching a ton o' folks out there. Keep it up.

Anonymous said...

great advice. All of the things that you've said applies to me. It's like you can read my mind. Lmao.

Kim said...

Hello - I'm a new visitor, just sneaking around looking at nurse blogs. But In just a few posts you've mentioned several of my favorite things, including Bill Bryson and Car Talk, so I thought I would say Hi!

I'm not a nurse yet, but pulling together my pre-reqs for nursing school. I hope to enter in 2009 or 2010. Your posts about nursing have me very excited.