Tuesday, May 31, 2011

Congratulations, new graduates! You'll be fine.


You won't kill anybody.

No, I mean it. Seriously. Just remember Jo's First Rule of Nursing:

If you have to fuck with it, it's wrong.

This was brought home to me in a big way just yesterday, when I had a patient with one of those don't-stop-it-or-they'll-die drips. The pharmacy sent a bag with a certain concentration of drug, and that matched the doctor's order, but the pump....was fucked. I couldn't make the drug dosage on the order match the drip rate in the pump's library, no matter how much I fucked with it.

So I stopped. Because fucking with it until you can't remember exactly how you got to where you are means it's wrong. I got another pump, with a different drug library, and I reprogrammed that pump, and everything was fine and dandy.

Advice for the new nurse, graduate nurse, or intern, gleaned from five minutes' worth of actually paying attention over the last decade:

1. Do not freak the fuck out.

There will be time to learn everything you need to know. There will be people who are willing to answer your questions, and people who will have your back (even if you don't know it at the time) and people on whom you can call when things hit the fan. You are not doing this on your own. Everybody has been where you are; sometimes we feel like we're right there with you once again.

2. Actually killing somebody means that a lot of things have gone wrong.

Therefore, it's extremely difficult. With any medication or procedure or what-have-you, there is a string of quality-assurance checks that happen that are meant to ensure that you, New Nurse, will not make a mistake. Trust the procedure, but verify. Which brings us to:

3. Be sure to ask for help or advice when you're not feeling confident.

I ask for help every damn day, and I have been doing one thing for eight years. How many of you have done one thing for eight years? Show of hands?

Yeah. That's what I thought.

The point here is that the human body, even independent of doctors' orders, can do crazy shit with very little warning. Don't bully on through if you don't feel good about it. It's worth it to look like an idiot, or to take the extra five minutes to verify a policy or drug dosage.

4. This ain't no party; this ain't no disco; this sure as hell ain't no fucking Grey's Anatomy.

Don't sleep with your coworkers.

I don't care how cute that nurse is: you're asking for trouble if you have a horizontal relationship. Ditto the resident, the intern, the attending, the other nurse's boyfriend. Just don't. If you must have a relationship with another nurse--a decision which might lead to endless arguments about who had the worse code that day--make it a nurse you don't work with directly.

I, and your other coworkers, thank you.

For this one, Rob, I'm looking at you:

5. Don't work too hard.

There is time. Coco Chanel said that there was time for love and time for work, and no time for anything else. If you adhere to that philosophy, you'll be a crappy, burnt-out nurse in no time. I know you have loans to pay off and an electricity bill that's two months overdue, but you can't kill yourself the first six months out of school. Any knowledge or insight you gain will be overwhelmed by stress hormones.

Take some time to rediscover what you loved before you started drinking from the firehose that is nursing school. Remember what it's like to wake up in the morning (or evening) with nothing to do all day (or night). Read for pleasure. Go catch a movie. Spend a couple of hours doing nothing but daydreaming and petting the dog. It'll not only help you stay healthy, it'll make your brain more able to retain information, true fact!

You're done. You've walked the stage, you're about to take the NCLEX (and you'll pass, I swear), you're getting ready to start a hell of an adventure.

Congratulations! And I look forward to working with you.


bobbie said...

I echo what Jo has said...
I've been doing this for 30+ years, and I STILL ask for help...

Just DO eeet!!!

And remember to breathe ~

Lynda Halliger Otvos (Lynda M O) said...

What a wonderful testament to the job nursing is; you all deserve to be lauded from the rafters and loved from the feet up !~!! Bless you all, new nurses, older nurses, experienced nurses, retired nurses, nursing profs.

Urbie said...

Heh... that sounds remarkably similar to the approach a new tax preparer needs to have... except that nobody dies when we screw up! :-D


Mr. C. said...

Thanks for your insight Jo. To all the new grads out there, (especially my own) good luck!! Welcome to the most trusted profession. We ask that you help us maintain and strengthen our profession.
She is right, freaking out does not help. We have all been there, done that. There is lots of wisdom on this blog.
To those of you who will soon be training our newbies, please do not "eat them". They want to do a good job, and they will in time. Be patient with them. They may be watching your back one day.

Callie Ann said...

This is such a breath of fresh air. Thank you for everything you've said and for giving us "new nurses" some hope. I may or may not read this fifteen more times before I become a real nurse, just for encouragement. :)

RehabNurse said...

Yes, breathe. Breathing is so important.

This is the beginning, hopefully, of a long, productive career.

Go out and enjoy!

Rosanna said...

So----(and this is entirely infeasible, Jo, but just *fun* to think about!!)----if you'd combine your 5/3/10 and 5/31/11 blog entries about "Advice For The New Nurse, Graduate Nurse, Or Intern," INTO ONE; then ............ (like the silk SURVIVAL MAPS of Europe, that the WWII U.S. Navy pilots sewed into the linings of their bomber jackets to use, when downed, to navigate their way back to the safety of the Allied troops, the map surplus of which was later actually used TO LINE bomber-style jackets) ............ some intrepid entrepreneurial soul could have *your* "Survival Advice For The New Nurse, Graduate Nurse, Or Intern" PRINTED ON either the lining of a bomber-style jacket and/or the lining of a jersey knit cardigan............ i.e., both for "newbies."

Then, during that first year and a half of a newbie's finally being "in the job"............ when THE STRESS (*clearing throat*) is a little "high"............ all ya'd hafta do is............ DASH TO the Break Room/your locker/the Staff Coat Rack............ and **Q.U.I.C.K.-R.E.A.D.** N.U.R.S.E. J.O.'S. A.D.V.I.C.E. on (the lining of) your jacket or cardigan, (haha)!!

nurse emilie said...

Thank you Jo! All so true. I always ask my preceptor questions if Im not sure as one thing I wanna be sure of is that Im a safe nurse. Thanks for the fabulous advice for us newbie chickens! :-)

Brian said...

I've been telling Jo's First Rule to my classmates. I originally saw it about a year ago, when I started in school, and in clinicals it probably saved a few of us from mistakes. So thanks for that!

Also thanks for the reminder not to freak out. I got my ATT this afternoon, and I'm taking NCLEX on Monday. I will spend the next few days buried in my study materials but I'm going to be calm about it. :)

Meghan said...

Thanks for this post, Jo! My classmates and I are taking the NCLEX in two weeks. I forwarded this post on to them and they (and I) really appreciate it!

Cartoon Characters said...

For myself: 35 years of asking for advice and counting.

You don't stop doing it.

If you do - you are hooped, because there is always something that will come up that is *new* or *different*

Beana said...

As a newly graduated nurse, I love this! Thank you!

shrimplate said...

There are days at work when I realize that every other nurse there is somebody that I myself precepted when they first came to the job.

Now they don't *need* me, but I like to pretend that they do. (Wink!)

The Wordmonger said...

I will graduate in 1 year! This helps me see the light at the end of the tunnel!

Alexis said...

Thanks for this! I just finshed my first semester of nursing school and I'm already overwhelmed. This should be itneresting.

Abilene Rob said...

You always know how to make a fella blush.

(By the by: the next few weeks are all about balance for me. I put in the last few weeks so I won't have to work until I pass my boards. I'll be studying, of course, but I will also exercise and sleep and read blogs and fix my plumbing and wash my poor dog and get a handle on my life again. Breathing is nice. I forgot what it's like to draw a deep breath without feeling guilty about squandering all the time it takes to fully expand my lungs.)

micheal shaw said...

thank you it helped to know that it isn't as scary as some of seniors told me it is

KC said...

thank you for this!!!!!