Tuesday, December 20, 2011

Question From A Young Nurse: But What About The Feelings?

A Young Nurse asked Auntie Jo for advice this week. Poor, deluded Young Nurse.

Our correspondent asked this: "What do I do when a doctor or older nurse snickers at an answer I give to a question, or takes me aside later and tells me that I should've done something different? I have six patients, and I'm new to the night shift. I can't keep everything straight all the time. I want to kill them. What should I do?"

Dear Young Nurse,

We were all there, once. Those of us who got over it became the sort of nurse that your Auntie Jo is. Right now, I have a cat rubbing on my shoulder, a cold beer to the right of the keyboard, a happy dog frolicking in the back yard, and a list of men who want to be seen with me.

Those of us who didn't get over it became the doctor and nurse you're working with.

Practically, what you can do is this: Do what residents do. At the start of your shift, make out index cards that have each patient's name on them in big, bold lettering, so you can't miss it. On those cards, write the essential lab results and neuro/cardio/gastric/renal changes the patients have during the shift. Update them as you need to. That way, if you're ever caught out by a question, you can yank your index cards out of your pocket (be sure to wear scrubs with pockets at the waist) and answer the question quickly.

Doctors *love* it when you do things that they did as residents. It makes them feel very smart, and they will treat you better as a result.

As for the nurse: be humble. Shrug things off with a "Well, I'm still learning. Someday I'll have all that stuff on the tip of my tongue, like you do!" Make sure your back is turned when you roll your eyes. Mean nurses love that sort of thing, even as it makes them wonder if they're really *that* decent of people (answer: No, you're not, and you're going straight to a flaming-hot Hell when you die).

But what about the feelings?

It is hard, and I acknowledge that it's hard, not to reach out gently and wrap your scrawny little hands around somebody's neck. As The Bloggess once said, "A hug is just a strangle you haven't finished yet." I would suggest that you find a nice, private place to feel those feelings.

Feeling something like rage or disappointment doesn't mean you have to act on it. It just means that you've opened the door marked "RAGE" or "DISAPPOINTMENT" and have gone in and browsed through the goods on offer. It's best to do it in private so you're not interrupted. Rage, rage, against the asshole nurse or doctor who decided to get his or her rocks off by humiliating you. Then set it aside.

Resolve that next time you'll be so bulletproof that you'll embarrass them without meaning to. Resolve that next time you'll have the perfect l'esprit d'escalier and won't forget to say something like "up yours, motherfucker" when it's warranted.

Resolve--and this is both the most difficult and most important thing--that you won't let this make you think less of yourself or your practice. Some people are just assholes. Instead of bundling the urge to finish the hug up inside yourself, practice letting it out in the car.

All you can do is the best you can do. Be prepared, be on point, and if things don't go your way, don't fret: you've done your best. Believe it or not, your best doesn't have to be perfect. This is a twenty-four hour a day job. Self-doubt is a killer, because the minute you doubt yourself, you start doubting that little voice in your gut that tells you something ain't right.

If all else fails, Talisker. It's a good Scotch for beginners.


Nurse Philosopher said...

"If all else fails, Talisker. It's a good Scotch for beginners."

Perfect, Head Nurse. Iiii LOVE it!

Come to think of it, there are a few nurses walking about with quite high self-opinions in partial result of compliments I gave out, in just the way you suggest.

They came to see me as the kind of nurse who, although not as swift and astute as they, could at least appreciate perfection in my betters. After many wagon loads of that horse dung, they let me alone. Which was nice because you know thumbscrews are never available when you need them.

Avalon said...

Great post. I just graduated with my BSN, waiting to take my NCLEX. I have had experiences with my preceptor in clinical that had an attitude and was sort of cold-hearted. Your advice is SPOT ON. Thank you so much.

bobbie said...

From another long-time nurse ~ ditto what Auntie Jo says...


Go home, and practice extreme self care...

Val said...

Thank you sooo much for this entry. I am in nursing school and have really been wondering how I am going to deal with the authoritarian complex that some doctors and nurses seem to air in front of students and "baby nurses". It pisses me off, but i suppose all in due time i will be through that stage of everyone nitpicking at me...since eventually I'll know better! I'm just afraid one day I'll bitch-slap someone in the meantime! Ah!

The Keyes Family said...

Thanks for this blog. Its right on the nose. I'm headed into work and bound to see one of those "asshole" doctors today so even though I may not be prepared for the stupid question he asks and already knows the answer to... I won't hug him so tight he can't breathe today! Thanks

Olio said...

Another thank you. Two and half years out from graduation and still unemployed (with the exception of a couple of seasonal gigs), I've met the breed of nurse described by the young nurse; unfortunately some of these were instructors in my nursing program. I hope someday to actually work as a nurse and to be in a position to mentor a young nurse.

JA-RN said...

And remember how their comments made you feel,so you don't do the same to some other new nurse down the line.

snarkygurl said...

Thank you, thank you, thank you. I'm not a nurse (and I'm VERY thankful that there are people like you who are willing to take on that kind of responsibility), but this is exactly what I needed to hear. Recently the need to bitch-slap or introduce lazy-ass coworkers to the training bat have been coming more and more frequently, and the frustration/rage is becoming more difficult to manage internally each time. I'm going to try your advice because I'm rapidly running out of non-violent options...and I'd really like to stay employed.

Scrub Ninja said...

Good taste. Talisker has been at the top of my scotch list since long before I started nursing school. :)

Anonymous said...

Sadly, as an experienced nurse, I see this stuff happen way too much and not just with new nurses. Why do nurses eat their young (and their not so young)?

Anonymous said...

As an OR nurse, one of the first things I was told is that there will be yelling in some cases. Sometimes the yelling is directed at you, the nurse, but really it is just the surgeon venting his/her anger at the CASE and not you personally.


If it is something you did wrong, or didn't know, simply tell the doc/nurse, "Okay, now I know and I will not do it/ask again."

Show them you acknowledge the situation as a learning opporunity, that you learned what you needed to, and that you will show this learned knowledge again in the future.

Sometimes docs/older nurses forget that they were young and inexperienced once, too even though they act like they came out of the womb knowing how to do everything. Brush it off and just go on your way.

Rosanna said...

For those poor Young Nurses............ (who, despite very HONESTLY doing the best they can do, either *already* think less of themselves; OR are *starting* to think less of themselves)............ Nurse Jo's advice here is maybe, i.e., from my Retired RN's perspective............ the most useful, *R.E.A.L.*-LIFE advice you'll ever get, you know!!

Experienced nurses all know that there are *nice* ways to help a Young Nurse learn how to give good Patient Care; and then............ (bearing the same-exact Good Nursing Practice information)............ there are also very *insensitive* ways to convey that same-exact information to a Young Nurse, too. After EVERY SINGLE mean, snobby, snotty, snickering, coldhearted, condescending, authoritarian, and/or totally NON-empathetic comment or rebuke that a Young Nurse might receive from "certain" older, more experienced nurses, or from "certain" doctors, a Young Nurse can just *V.O.W.*~~(facetiously in blood, haha!!)~~to "NEVER--EVER--NEVER BE LIKE THAT"............ i.e., when *you're* then an older, more experienced nurse *yourself* (on-your-Floor/in-your-Unit)!!

VOW~~to yourself!!~~to *S.O.M.E.D.A.Y.* be that older, more experienced nurse, (who just might also be a little bit heavier, with graying hair underneath your hair color!!)............ who has genuinely *Kind, Understanding Eyes*............ and who has *A Heart That Can Remember*----(i.e., like Auntie Jo's heart can remember)----the uncalled-for workplace hurts that she herself felt as a Young Nurse, too.

Someday, just~~(very-DETERMINEDLY!!)~~*B.E.* that older, more experienced nurse about whom Younger Nurses will say, "Even though she/he's OLD and has been here for a REALLY long time, we know that we can always go to HER/HIM with our questions or problems because *S.H.E.*/*H.E.*............ won't bite our heads off!!" (Haha!!)

RehabRN said...


I don't visit the Rage door anymore. I've taken up aerobic kickboxing.

Nothing like imagining that idiots head right in the way of your foot as you kick.

Just don't fall and break your arm while drunk like the Slug did. Unless, of course, you need a great excuse to miss work for a couple of months.

Anonymous said...

Great post! Stop the vicious cycle of "picklefaces" in healthcare. Seen this happen before in my CCU - I didn't think we'd ever see the light without cleaning house and starting all over again. Sad.

Stay positive:)

joy said...

Ah, the term you are searching for is...bullying. Yes, that doctor and that nurse are bullys. They may not steal your lunch money but they're trying to make you feel small and helpless and cringe-y (is that a word, but you get what I mean). When you realize that's what's up with this interaction you gain a little control. The notecards are a good touch, though. It distances you from their personal attack and might actually work....sometimes. As long as you keep in mind what is really going on in this interaction.

Unknown said...

Awesome post, not just for nursing, but for annoying coworkers in general :)

shrimplate said...

I officially invite to come work with me. I will precept you and protect you from "situations" and the sort of people who create these.

Really. We'll have fun.

Brooke @ United Anesthesia said...

I love that you just lay it out and don't beat around the bush. I think this can apply to all working careers and not just nurses. Any time you go into a new job people always think they are better and will call you out on the things you do wrong..I personally always shrug it off and just keep trying to learn. Most of the people that want to critic you are the same ones that won't take time to teach you the right way.

disorderlycna said...

Note cards - brilliant! I am so doing this at clinicals this term. Thank you!

Scrubs - Tara Harkins said...

It's hard being the newbie in scrubs, but you gave the perfect advice. Good luck!!!

Anonymous said...

Nurses are a special breed of people. You have to have a passion to be a nurse.

Anonymous said...

As a nurse who just hit her 6 month mark, I couldn't agree with you more! CONFIDENCE! All young nurses need to have it. Also, couple that with a smile and the bullies will slowly disappear. Kill 'em with kindness.

Now if only I could stop the patients from acting like jerks, I'd be perfect.

Linda Carole Bloom said...

Great post! Not only new nurses get bullied. My reply when being bullied is Thank you for letting me know/your advice/etc. Walk away. If your pts are breathing at the end of the shift, you done good. When you are in charge give the bully the pt with explosive diarrhea.
If you are nice to the orientee and give her a great experience AND your department hires her, she will always be there for you - to help you change the pt with explosive diarrhea.