Monday, February 09, 2009

In which Jo answers questions posed by a semi-anonymous reader.

A couple of weeks ago (or a little more), I got a very nice email from a young man (God, I love being able to say that) who had some questions about nursing and about the blog. He'd read a bit and was interested in learning about stuff I don't necessarily mention here. With his permission (Hi, Chris!), I have excerpted some of his questions and my answers. I think this might be for a class of some sort; Chris, I hope you get a decent grade on your paper.*

You sound sometimes like you really hate your job.

Honey, *everybody* sounds like they hate their job sometimes. I don't. I get frustrated and angry sometimes--not with patients, but with manglement and doctors and sometimes family members--but I love what I do. It's like a cocktail party, but with more blood.

What's the thing that pisses you off about nursing the most?

On a micro level, it's the lack of positive reinforcement I get from my bosses. Yes, I have more than one, and yes, they all suck at telling you you're doing a good job. Fuck up on your charting and you get an immediate email and a correctional meeting; manage to get a hostile family member to calm the hell down and get on board with a plan of care and you hear nothing. My bosses, for the most part, suck rocks. That's discouraging, but not enough that I'm gonna find another job. (I originally typed "mob" for "job", and that's about right.)

On a macro level, it's the "Dare To Care" stereotype of nurses and nursing. If you've read back over the last year or so, you've seen how I yammer on about being a scientist first and a warm, fuzzy person second. One interesting thing that illustrates what I mean: we had a doc write for QID (four-times daily) massages for a patient. Uh...I can't *do* QID, thirty-minute massages. Leaving out that I don't have the training, I have four or five other patients who are, you know, in varying stages of critical. We had to do some hasty education with that doc.

What's the one thing about your job you like best?

Making a difference, as hokey as that sounds. If I'm able to touch a patient with my bare hands when I know they haven't been touched by anybody without gloves in a week, I know it'll make both of us feel better. I love being able to relieve pain and alleviate fear. I love being able to educate. I love being able to learn, most of all--and I learn things from my patients every day. I know more now about structural engineering, how to manage Crohn's disease, Asian art, nonstochastic physics, politics, and being a rodeo clown than I ever imagined I would know.

The patients are the absolute best part of my job, hands and spines and brain pans down.

You sound like you work for Dr. House. Is everything always so complex at your job?

No. I write about the cool stuff; the stuff people might not have heard about before. Lumbar surgery and neck surgery aren't all that interesting. Lumbar surgery on an 800-pound patient is more interesting. Brain worms are *way* more interesting even than that. 

Plus, I do work at a research hospital. We see shit every day that most nurses never see in a lifetime. I Googled a diagnosis that a patient of mine had once and got 35 results. So the stories about CJD or crazy-ass neuroleptic syndromes or conversion disorder might make it on to the blog most often, but they're probably only about 40% of what I do. The other 60% is plain old boring ordinary craniotomies and lumbar laminectomies.

LVN or RN?

Based on my experience, I'd have to say go for the RN. That'll differ from place to place, of course, but Texas is moving away from using LVNs as primary caregivers. Big County Hospital now, in fact, requires that all entry-level nurses have a BSN. 

There's a joke: "What's the difference between an LVN and an RN? About ten thousand dollars a year." That's *kinda* true, and *kinda* not. A lot of the things I do an LVN could do as well or better. Some things, though, LVNs can't do because of the guidelines set out by our state board. For instance, while they can intervene to fix a problem, they can't assess the patient--either baseline or in response to their fix. Now, most places you'll find LVNs acting basically as an RN, doing assessments and whatnot, but they're not *technically* supposed to. 

It's a silly distinction on a lot of levels. Unfortunately, the way things are here, you're pretty much locked into working either at a long-term-care place or overnights with shitty staffing in a hospital if you're an LVN. You have a lot more freedom as an RN.

So, yeah: RN. The choice between a two-year and a four-year degree is a whole 'nother ball of brain worms, though.

What one piece of advice would you give somebody starting nursing school or starting a nursing career?

Find a mentor. Do it as fast as you can, and lean on that person for support throughout your schooling or the first few years of your career. It makes a huge difference.

My mentor in nursing school was one of my instructors. She was, hands down, the best teacher I have ever had in any subject in any school I've attended. Luckily, she was both an active nurse and my clinical instructor, so I got to see a real pro in action during clinicals.

The thing that impressed me most about her, and what made me want to be like her, was her combination of dignity and warmth. When she dealt with doctors, she had their respect. She stood very straight and was extremely professional--almost like something out of an old movie, but without the "Yes, Doctor" subservience. She knew her worth and the worth of her work.

And with patients, she was amazing. She was the person who taught me how to approach people first thing during the shift. She would walk into the room, introduce herself before she approached the bed, and then make the person in the bed or the chair her *total* focus for five or six or ten minutes. Sometimes she'd just rest a hand on their arm while they talked to her; other times, she'd fix some seemingly-minor (but huge to the patient) problem right away, without waiting. In that small space of time, she established a rapport with the patient that let her give really good care, because the patient knew she wasn't going to get distracted or screw them over by being in a hurry.

I learned more from just watching her in one semester than I did the first three years I was nursing. She was the best.

Hm. Maybe I ought to drop her an email and let her know all this. I doubt she'd remember me, but it's nice to hear when you've made a difference.

Any other questions you want answered? Post 'em here or drop me a line.

*Dude: Edit out the word "fuck", okay?


Unknown said...

I'm a new nursing student, and I happened upon your blog and had had HAD to follow it. Love what you write! Interesting, Educational, and side-splitting funny too. Good combo.

RehabNurse said...

Yes, jo, yes! I totally agree with the mentor part.

I have a couple and I talk to them frequently--one's an old school RN and the other is a PhD RN. Surprisingly, they're neighbors and each other's best fan club.

It really is pretty cocktail party at work...only on our unit, it involves more excrement than blood!