Day One as an RN: The Blue and the Green

WOW!

Where do I even begin??  My first nursing shift was today......7 am feels like it happened five years ago!

So much to say, I guess best place to start is the beginning?


So 7 am. I was as nervous as a jumping jelly bean. But at the same time.....kind of calm. Does that make sense? Nervous because I was starting a brand new, huge, important job. But calm because I was in a familiar setting with people that love me, and I kind of knew what was ahead of me. I was ready for the day. Thanks to my incessant and annoyyyying adhd, I just really wanted to get OUT there and start doing something. Getting report is essential, and great, but I'd so much rather just get out on the floor and go see my patients with the night nurse rather than sit at a table far away. The nurses on my floor used to walk & talk but we seem to be straying away from that thanks to hippaa (privacy laws). So now we give reports in little hushed corners where no extendable ears are listening (supposedly).

So first things first, I got acquainted with my preceptor and we sort of laid out the ground rules and what not. Today was strictly  (supposed) to be an *observation* day. Remember that, lol.

After that we got right into assessing our patients, one by one (we had four to begin with). Well, my preceptor quickly realized I was not about to just stand there all day and so she let me listen ( to bodyish sounds), assess, chart, etc. Then came time for meds. Normal meds. Since the med system at my hospital is something I'm totally new too, this took some time to get used to. As an aide, I was pretty much familiar with most everything else nurses do (like IVs), but meds and the medselect system was kind of foreign.

But then the "plan" went out the window. And soon after is when I learned that plans are great in nursing, but last for about five minutes before everything gets uprooted and changes again. One of our patients started having intense chest pain, so that took priority above everything else, even though we had all our meds laid out and ready to go on someone else. So that required a full asseessment, a stat EKG, doctor phone calls, labs, etc. After all that settled, we went back to those original meds for about five minutes before one of our other patients (psych) pulled out his NGtube (really not good) so we had to go rush and reinsert that. We got temporary placement, but when it came time to give him his meds through the NG tube, it was clogged and we couldnt unclog it and therefore we got to reinsert a new one.

So, phew!

After that we went back to the routine meds, and by this point she decided I had picked up fast enough that she let me draw up my own meds to give. Woo! So the rest of the day was a collection of lots of meds, working with a lot of IV's, charting (a lot), and reassessing. I learned a lot more about prioritization, and learned that there is just SO MUCH to do. 12 hours seems like such a long shift, but I'm starting to realize that its not even enough time to realistically do it all! Yes you have to always attend to the emergencies first, and then after that attend to stat orders, medicines, assessments, etc, but if you leave patient communication on the backburner or turning them every two hours, then that will slowly creep on you and it will soon become your worst enemy if you don't attend to it first in the beginning. So Nursing is a game of knowing how to do it all, at the right time. I get that now. I just have to perfect it.


So, whats with my title? Well, I've changed colors. Aides wear teal green throughout my hospital and now I'm wearing royal blue, along with all my other nurses. Its funny- All day I got a lot of confusing stares-even from the cafeteria workers and housekeepers- that I was "in a new color".  Sidenote: As much as I love the thought of self expression and coming to work in whateverhellscrubsyouwant, I do enjoy being able to go to the cafeteria and know where someoone works and what they do based on the exact color they wear. What do you think? End sidenote. lol.

Anyway, since I haven't been to work in like an entire month as an aide (thanks to NCLEX and the law), there have been a couple new hires (aides). And when I had some down time today (my preceptor went to lunch), I made some rounds in the hallway on everyones patients and went in and helped a couple people to the bathroom, answered a couple bells, etc.  Well, you should have seen the look on one of the new aides face when she saw me in the room, helping one of her patients. She doesn't know me and all that ran through her mind was, a nurse is helping me? Fo realz? It was quite comical.  Even some of my closer friends that are aides, I can tell they see my blue now and I can read their thoughts. I can practically read it in their eyes, hoping I don't become "one of them". One of those nurses that doesn't help, that is bossy and "too good" to clean out a bedpan, too good to help out wherever its needed. All I want to do is prove to my friends that just because I wear blue now doesn't mean the past five years as an aide hasn't taught me anything. Those five years are the entire backbone for the nurse I am today. I would *never* be where I am today without the experience, and without those friends to get me through. To get each other through.


But it is hard, separating myself from that role. Despite me wanting to prove I am not "that nurse", doesn't mean that I don't have a whole new set of responsbilities now that need serious attention. Sometimes you just have to delegate, and I see that now too. Thats where excellent communication comes in and treating your aides right and they will treat you right! :) But even just instinct. THe sound of a call bell- I still automatically start walking towards it. The sound of an emergency bell still makes me want to run. Today I felt like a bad person because I was giving meds instead of helping whoever was trying to get out of bed when the emergency bell went off and the aides were busy. I remember those days. Its hard going from being responsible for the entire floor to only responsible for 4 of those people on that floor of 30. Its a lot different.

I have full intentions on telling my aide(s) every day how much I appreciate their help. To say thank you for every thing they do and take nothing for granted, ever. I will never delegate a task that I could just as easily do if I am not swamped with charting, meds, ivs, etc. I will ask them with respect to help me with something rather than tell them to do something for me. I think every nurse should be an aide first! I really do though.


So by the end of the day today, my preceptor discussed with me how she was superbly impressed with my knowledge base (trust me, I was suprised too), my instincts, memory and bedside manner. So, yay! So her and my educator decided I was ready to move along to the next step: my first official patient comes wednesday! I make the decisions and guide the care, give the meds, chart and assess, all under (a lot) of guidance from my preceptor. Woo! It felt AWESOME to be able to explain to patients (finally!!!) why they are going for a test, or why their lab values or up, or why they can't have a regular diet, etc. I've been so tired of saying, "I don't know. Let me get your nurse."  Now I feel like everything makes sense!!!

I think I am most scared of: calling and bothering doctors (they always seem so bothered when you call), and putting in my first IV. Yikes.

Also, by midday today I wanted so badly to just practice what she kept teaching me. I just wanted to grab it and do it myself! So thats a good sign. At least i'm not afraid to do things. I remember in clinical I thought it was the end of the world if I had a patient with a piggyback, because I was afraid of it. Now I find it exciting! But then I finally DO get in the spotlight and asked to do something and then all the confidence leaves and suddenly I doubt all my actions because I am just so deathly afraid to do something wrong.


At this point, its all about finding my own "system". What works for me? What charting system, what assessing system, what medication system works best for me? How should I organize/plan my day? So it will take learning from a couple different nurses to find out which techniques I want to take from who and mold myself from that.


Well, thank you for reading this far. Really! Even if none of you made it this far, I'm glad I have this all in written form because in twenty years I will read this entry, my first day of nursing, and I will laugh myself silly most likely. Oh how things will change! But I can't wait :-) Let life begin!



Love you all,

<3 A Writer in a Nurse's Body

The Many Me's of Future Me

Right now, It is February.

I graduate in May. Early, May.

I take the NCLEX in June, most likely.

It is really, really, really time to start thinking about real and actual and concrete options for the next step in my life. I firmly choose not to say "the rest of my life" because I honestly don't have the commitment for that, unless I end up really, really, really liking my job... which, would be great.

I am really scared.

There are SO MANY CHOICES. I want to do a lot of different jobs. (In Nursing). But the nursing community *tends* to prefer you to choose a "line" of nursing work, rather than try a bunch of different things. OF course, some nurses disregard that advice and dart from working in a NICU to working in a doctors office...But most nurses follow a chain, or line. For example: Start out as EMT Nurse, go to ER nurse, go to ER chief  nurse, go to flight/transport nurse, go to...something crazy. Emergency has a TON of crazy options.

I honestly feel like I am in high school again, and I am changing my mind every single week  on what type of nursing I want to do.

There are four "paths" I can see myself following.

1) Labor and Delivery: I say this because I came into this Nursing program with L&D deadset in my goals- I desperately wanted  to be an L&D nurse and nothing else. Well, that has changed over the last three years, but recently I have been reconsidering that as a strong possibility. Will I be a midwife, as originally planned? Probably not. Is learning how to deliver a baby an amazing skill to possess, in any situation, for the rest of your life, in and out of the hospital? Yes. Will I like working on an L&D floor? Probably.

2) Floor Nurse. Regardless of this is on Med/Surg, or Oncology, or telemetry, or wherever...I think I would like being a floor nurse. Even if it is "at the bottom of the nurse chain" as far as nurse positions go, I would feel OK there. Once I got in my comfortable "been on the job for awhile" shoes. This reflects two parts of me. The part that wants to just be alone and come to my job, do really good work, and go home. It also reflects the part that desperately wants to make a set of nurse-friends on a floor that I can trust and rely on and laugh with, a lot. I want that. I want both parts. There are two nurses on my current floor that always work together and they always are making each other (and everyone else) laugh, and always have each others backs. I want that. But at the same time I feel that being on the floor promotes independence, if you so desire. I see a lot of nurses on my floor that are plenty sociable with the other nurses, (as I would be), but they stick to themselves and get their own work done. I can see myself being either.

I know, that as a floor nurse, I would be the best that I possibly knew how to ever do. I have a lot of Med/Surg experience. All I need perfection on is the actual "Nursing skills" (i.e. IV's, wounds, foleys, talking to doctors, reading doctors writing, calling doctors, giving meds, etc.). I have the "compassion" down and the Therapeutic communication down. the Caring. I'm working on my critical thinking and physical assessment skills. They will come. As a floor nurse, I would put every thing I have learned over the past 5 1/2 years as an aide and past 3 years as a student nurse and put it into giving every single one of my patients all of my attention and doing everything I can for them. That, I can't wait for. I always try to do that now, on my job, but it is very hard to do when you have 30 patients. I look forward to managing 6-10 patients (even though that is still a lot of work).

Units I would Like:
-pediatrics
-telemetry (maybe)
-adolescent
-burn unit?

3) Emergency.

I never thought I would ever be putting emergency as a third option in my future. And its true...I'm not normally a fan of the emergency room. I never, ever came into this program ever expecting to like emergency nursing. However, it all started when I realized bigger goals that I had required emergency room nurse experience. (flight nurse, NASA, etc). At first I said- Okay, fine. So much for those goals. But after revisiting the idea a couple times, and actually spending a clinical day in the E.R., I wouldn't shoot the idea down completely....

this is why: (another part of me)- hence the blog title-
1) I like to work fast. I like having a TON of things on my mind to do. I like feeling scatterbrained. Not all the time, of course, but I like being busy. It makes me feel important, and needed. Like I am doing really important work. I like the thought of climbing up on a stretcher on my 14th hour of work and doing CPR. I like being so busy that I forget to even eat. Thanks to my ADD, I like having something to do every five seconds.
2) Patients are on a high turnover. This is a disadvantage and advantage- dis because if you like them, you can't connect with them, you can't get to know them. The most you can do is leave a lasting impression on them to help represent your hospital and move on to the next patient. Advantage because if you don't like the patient...well, they are in someone else's hands pretty soon. I would be seeing a lot more than 6-10 a day. But for shorter periods of time. ER nurses need excellent critical thinking skills, and need to be fast. Excellent instincts....Can I do that, though?

4) Holistic Nursing-
Okay. This is funny. A couple of months ago I was in an extreme holistic phase. I wanted to treat myself holistically and the rest of the world. I was obsessed. Have a headache? Take this herb. I wanted to focus on nutrition. This all sounds lovely, but pretty much means I would have to be a nurse practitioner. There are a *couple* other options with holistic nursing...but, I'm just not sure. I don't think I want to land in an NP position. But then again I once said I never wanted to do ER nursing. I still like nutritional healing. But I have lost a *lot * of faith in the whole shebang because all of my personal treatments for my own health failed, and I am back to square one- despite making a lot of dietary changes. And I can't afford to make an appt to actually see the HNP to discuss what else I could do...and then she would prescribe a lot of things, and thats a lot more $$, and I just don't know. Its complicated. So, Holistic nursing is still a possibility. But I'm thinking....less of a possibility than it once was.

Okay. This is a long post. But I got a lot of important thinking done. Tomorrow, or Sunday, look for Part 2: Actual Options, not Pathways. I.e.-Getting Specific. I also will talk about the student nursing convention I just got back from (I learned a LOT!!!) and update you on my new york times mission. But its late and this is long enough for tonight. Thank you for reading..

With immense amounts of love,

~ A Writer in a Nurse's Body

P.S.-

Things I could NEVER see myself working in ( I say this now, to document it!)
- Intensive Care Unit of any kind
- Psychiatric
- Oncology


PSS- THis actually isn't that long of a post. I thought I typed a lot longer. But I did a lot of thinking, so it counts as a long post. :)