Wednesday, June 09, 2010

Okay, so you've been a nurse for a year or what?

Julie and I were sitting in the monitoring room the other morning before report, just enjoying the glamorous and exciting life of the nurse, when she made a comment that I remember making:

"I've been a nurse for a year, and I am so burned out. I can't wait until I actually know something."

(Now, before any of you older nurses snicker over the "burned out" part, think back: remember how it felt to be overwhelmed all the time? Yeah. Like that.)

I think everybody feels that way after the first year, and then again after the second. Not to give you false hope, or anything, but after the second year of practice, nursing gets a whole lot easier. The question of *why* it's so hard the first two years, though, is something that it might help to understand. Heck, it might keep you from flinging yourself in front of a fast-moving laundry cart, even.

The first year of nursing is a combination of one part sheer terror and two parts cluelessness. It doesn't matter how well you did in class with pathophysiology or nursing diagnosis; things are much, much different when seen in 3D. Looking at a lab report with wonky numbers and figuring out what's going on in the classroom is miles away from looking at the same numbers at the nurses' station as call bells are going off, doctors are rounding, and your patient has sixteen other things going on that distract you from those numbers. I like the simile that another colleague of mine came up with: Nursing school is like learning to put together a jigsaw puzzle of a cathedral, while practice is like being handed a bunch of stone blocks and being told to build that church.

"Burned out" isn't really the right term for it. Most of us still want to come to work, and most of us aren't especially depressed by our choice of career. It's more like your brain feels full all the time, and you never really get a chance to integrate things. You *know* you're learning stuff, but it's either not really sticking (even though it is), or things are happening so fast that you have a hard time with recall (even though you don't).

Plus, you keep feeling like you're totally ignorant. (You're not.) Again, it's that jigsaw puzzle versus cathedral-building thing: you have all the information you need, but it's hard to put it together on the fly.

And, if all of that weren't enough, you're refining your routine and your time management and the way you deal with people and doctors and other staff members and learning who to call in the pharmacy when the dadratted drug machine won't dispense and what to eat and what to stay away from in the cafeteria and where the best bathrooms are and.....*whew*.

The good news is that the feeling of being constantly overwhelmed goes away. The bad news is that it's replaced, during the second year, with "is this all there is?"

There's a good reason for *that*, too. During the second year of practice--and keep in mind that these timetables are fairly arbitrary and mostly based on my own experience--you've got the basics covered. You can make a bed with a person in it, you can lever a body up off the floor without hurting yourself or them. A crazy-low potassium or calcium level won't make you panic, and you know who to call at 3 am for those problems.

The trouble is that you're....well, you're kind of disappointed. Things seem a little dull.

That feeling passes, too. It's there because you've absorbed all the things you need to do your job *efficiently*, but you're not quite to the comprehensive detail-management, weird-complication-anticipating point. That comes during the middle or end of the second year, and things therefore suddenly get much more interesting.

The biggest change in my practice between years two and three was this: I began to be able to see, sometimes even days in advance, what might go wrong with a patient. My care up to that point had been competent, but shallow. After two-and-a-half years, it deepened, as everything that I knew and everything that I could imagine anticipating came together in a cohesive whole.

The human brain recognizes patterns. Part of the brain's development is the ability to recognize patterns *as part of a whole picture*. That's what happens during years two and three: the big stone blocks you've piled up begin to resemble a cathedral, because you're able to stand back and see the whole damn thing.

So hang in there. Don't feel like you're the Lone Ranger on this one--believe me, going from expert in one part of nursing to novice in another brings those feelings right back. If you're feeling overwhelmed still, remind yourself to look back in a year more and see how things have changed.

Because your brain will catch up and your practice *will* change. The stuff you need to avoid in the cafeteria, though? That stays the same.


Anonymous said...

This makes me feel better! It already feels overwhelming! Currently a 2nd year nursing student, one year to go and I'll be in the workforce :)


bobbie said...

EXCELLENT advice!!!

Susan said...

This is where I am right now! I've gotten over the "OMG I HAVE TO HANG BLOOD" freakouts and it's onto the "but what REALLY is going on with my patients" thoughts. I rocked patho and pharm and "critical care" in nursing school, but sitting with a multiple choice test is a bit different than calling the doctor...especially the one who always says, "Huh? Don't bother me!"

I sure hope it gets better after two years because although it did get MUCH better after a year, I still have friends who tell me, "Why do you work at a job that makes you cry?" While all my nursing friends say, "Oh don't worry, it's totally normal to cry." What an odd profession...

Justine Zoeller said...

I needed to read this so badly this morning. Thank you, thank you, thank you. Last night one of the surgeons asked charge to change the assignment so I would have his patient instead of a float (6 year experienced CCU) nurse. I wanted to say, "seriously? Don't you know I've beem a nurse for like, a minute??". I know so much more than I did 8 months ago, but what scares me is what I don't know that I don't know. And that it takes me so much longer to do almost everything.
Every day I see myself getting better, and then learning even more things I don't know. Ugh.

Anyway. Today I am especiAlly glad to hear it won't always be like this.

woolywoman said...

Good advice. Is your arm/back/neck all better?

I think of it as moving from reacting to things to anticipating the near future, to anticipating the middle future. Kind of like when you drive somewhere new. First time, you're all about the map and the directions, second time you have the directions, and eventually you find yourself goin different ways to improve the route.

Abilene Rob said...

Thanks, Jo.

You rock socks, as always.

RehabNurse said...

Totally agree with the pattern matching. I did pattern matching in previous jobs, but no one died if I goofed.

I'm feeling more astute as I go along, but I always ask another nurse or I query the doc if I need to do so.

It does get better, it just seems like it takes forever.

If you really love what you do, get certified in your area. This requires spending time learning more in a less hectic environment. It helped me feel more confident in my job, because I got exposed to more than what I normally do.

Brad said...

What a brilliant post. Thank you.

Nurse Corrie said...

I just threw myself a 2 year post-NCLEX party... and I agree with everything you said. This week I found myself calling doctors about problems that hadn't quite happened yet, because I now know enough to see it coming. I like that. The ability to be proactive feels amazing, and yet at the same time I know there is so much more to learn. It will be interesting to see where I am a year from now.

Robert said...

Ugh, I want to play with blocks instead of puzzles already!!

Lioness said...

Bless you. No, BLESS YOU! I am going through exactly that as a starting vet, I can't understand how anyone - colleagues and owners - can entrust these pets' lives to me, I absolutely feel like I know nothing, certainly not enough not to kill them! It is overwhelming and terrifying, sometimes to the point where I'm convinced it'll never change and I'll forever feel inadequate.

I'll hold on to your post then, for sanity.