Life in the Middle Lane

Hello lovely, lovely readers! You are lovely because you still read this blog, even though I never post as much as I should! I really do always have a lot to say, just never the time, or balls, to actually say it.

I write this blog today because I've just about exactly hit my "Two Years" Nurse Anniversary. This is a definite bittersweet anniversary/year.

Lets discuss.

It is sweet because, hell, I've been a nurse for two years! I've SURVIVED! If I can survive this long, chances are I'll survive the entire career. I've made it past that point where I doubt myself every minute of every shift. I've made it past the point where my coworkers doubt me every minute of every shift. (Now only some coworkers do, lol). No really though, in all seriousness, I've been on two very autonomous, heart-wrenching (literal and figurative), fast-paced hospital nursing units now, and I can proudly say I've seen and done a lot in those two years where I legit feel comfortable with my knowledge base now. So much so in fact that I'm craving more knowledge. 


This is also the problem, knowledge. Now, roll with me guys. Does it make sense at all, if I tell you that despite what I just said above, hitting the two-year mark also means I'm hitting the "I've been a nurse for two years and I still don't know what the hell I'm doing" mark? I know you're confused but let me (try) to explain. Despite having a wide array of skills and a comfortable knowledge base that has grown in these two years, there is still so much I don't know. And I understand that nurses feel like that after fifty years of nursing, too. There's always going to be something new or confusing. I know enough now where my unit seems to think I'm charge-nurse quality and I'm frequently elected charge nurse to this telemetry unit, where I'm in charge of 2-6 nurses and 14-36 patients at a time. And yet when I am in charge, there are still so many times I run into a new situation that I don't have an answer to. And those times, I have nurses that need those answers from me, like I needed from my superiors back when I first started. And that's batshit crazy.

It's just, nurses are required to know the entire body system. Even though I work on a telemetry cardiac-focused care floor, the heart can affect many other organs and I must be prepared to handle anything. And there's so much to know and remember I don't think I'll have it all down by the time I'm retired, but I'll always be trying. I want to be the nurse that knows everything, that can help everyone, my staff and my patients. I want to always have an answer. But as the saying goes, the nurse that knows everything can be the most dangerous. So I have to be patient with myself. I have to accept the fact that it's okay to not know everything. But I'm finally at the point where at least I know a lot of things.

So that's where I am now. But looking towards the future, I'm still at a loss. I don't want to become stagnant In my position, I want to keep growing. I talk to my patients in their 80's that tell me they worked the same job for 50 years and I can't even fathom that. I know that generation workforce is entirely different than the one today. Not only could I not last 50 years in this position, but I feel almost pressured to move on. Like good nurses are supposed to keep growing, keep changing, keep moving to different units so their knowledge base becomes even more diverse and themselves more experienced. Like If I stayed on this unit for 10 years and did nothing else, I would feel like nothing. Like I'm taking my life nowhere, In no direction.

So now that I've hit that two year mark where I feel slightly confident in my skills, I feel that pressure that I need to do something else with those skills. I've recently successfully passed ACLS, which stands for Advanced Cardiovascular Life Support, which is a major step up from only being allowed to do compressions and airway support with just a BLS (Basic Life Support) Certification. Now with ACLS I can direct and lead a code blue in an emergency situation, even without a doctor being present. I can push life-saving medications into a patient during, just before or just after a code. I can participate in advanced airway management techniques now. So this has quenched my thirst for more self-evolution and knowledge, but only temporarily so.

So where does that put me now? Well, I want to go back to school. Not only because I just actually really do like school, but because that's the ticket to advancing my career. The only major problem is, what career?  Applying for a masters in nursing is like a senior in high school that is trying to pick a career out of all the choices in the world again. Yes I am trying to advance my career in nursing, but in what route? There are so many choices and routes that I could potentially see myself being successful in, but how do I know which one I actually will be happy in? I can't get a degree in everything (as much as I'd like to), so I have to be sure.

I've debated starting to a local program near me that is for a "Nurse Executive" degree, basically a dual-degree of MSN/MBA. It would take forever and be super expensive but would put me down the road of maybe eventually being very high up in the hospital administration pool one day. But as high-paying, important and as cool as that is, is that really what I want? To leave the patient bedside? To lose what it really is to be a nurse? To hold someone's hand and tell them they are not alone and will be okay? To instead be in an office making and revising policies, firing and hiring people and enforcing rules? Is that what I want? I don't know yet.

I've also been interested in the future of nursing informatics, but I would also completely lose the bedside nursing aspect there, too. With a degree in there I could help formulate programs and design new computer charting for nurses. I've also fantasized about working in epidemiology, where I could easily travel and investigate new diseases around the world and help stop or control them.  I'm also very interested in the route of emergency nursing, where that would keep me at the patient bedside, but in a totally different manner. I'm slightly interested in ER nursing, but even more interested in field nursing, but even that has many different routes. I could do pre-hospital nursing (riding with ambulances providing pre-hospital care), or I could go completely crazy and apply to be in a disaster relief system to travel to new disaster areas and help triage (that really is crazy I don't think I'd actually do that). I'd miss my kittens too much. ;-)

But can you see how overwhelming this could be? That is the blessing and the curse of nursing. Just because you're in nursing as your one career, does not make you limited. I can still pretty much do anything I want and that scares the shit out of me.

So that's where I am. I know a lot but am craving to know more. I've been a nurse for two years and don't know where I'll spend the next 30 years. So (too) many options.


I just try and like....meditate, and try and picture myself in the future, what am I doing and am I happy? And I just can't see it. I guess that's because I can't tell the future....makes sense I guess.



Anyway, with love.....


~WNB





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EKGing it up!

So, a lot has happened lately!

FIRST OFF, I got the job! Woot! I officially start there on Monday, it is a med/surg position still, which is great because I need my two years and I like the constant variety... However it will be a weekend night position. What's that? You basically strike a deal with the devil and agree you will be there 2 nights, every single weekend except TWO per the entire year...but that's it. You get off 5 days per week, work the weekends and get paid more. I see it as a win!

But anyway, at this new hospital I will be responsible for my own EKG readings. For my non-medical readers, an EKG is a test involving 12 little stickers or "leads" that are placed on your chest, legs and arms to monitor the amount of electricity through your body conducted by your heart, which is displayed on a strip piece of paper and we can see the type of rhythm your heart is making. By knowing this rhythm, we know what's wrong with your heart and what part of your heart isn't working.

So! Here I am, a one-year RN going from a med/surg unit where I never had to worry (much) about heart rhythms to a unit where I will be responsible for my own. Yikes! I skip completely over the unit where they have techs to watch the monitors and tell you what they mean. *sigh*

The first time I floated down to that unit, my cardiology unit in my hospital here, I first asked my old preceptor, "do you have any really important advice to give that I should know about cardiology?"

She looked at me very seriously as she nodded, got a piece of paper out and drew this:



As she drew that line she said, "if you see this, it's not good."

Of course she was kidding. Well, sort of kidding. Partially kidding. Only in the aspect where every nurse (or really anyone every that's watched a medical show on tv in general) knows that a flat line is never good. So that pro founding bit of advice wasn't exactly that helpful.

But I learned quickly. And whatever you don't know in nursing, you quickly get someone that does know.

But being that I have the type of brain that loves to do math, figure out mysteries, do busiwork, etc., I found that I fell in love with trying to figure out each rhythm. It was like a puzzle.

I finally finished the class and all of the sudden I feel 200% more competent as an RN. No more constant dread that I can't competently take care of cardiac patients. I can look at the tele monitor now and understand who is in critical condition, when to call the doctor, what to do about certain rhythms. It feels amazing to connect those synapses in your brain when things coming together, applying knowledge you gathered in nursing school to knowledge you learned on the field to knowledge you regain after like this, on top of the clinical knowledge.

For example when I came on shift recently, I looked at my patient on the monitor. I had asked the nurse taking care of him prior what rhythm was his normal, and they had trouble reading it so they had to move his room to better wireless area. So I was the first to read his rhythm. I looked at it and right away thought, "that's a.fib". My heart threw a PVC (haha), and I thought "shit! My patients in a. Fib!" but then I remembered the basics. 1) assess my patient. 2) assess the heart rate (is the heart able to accommodate or control the a fib? 3) does the patient have a known history of the a.fib? 4) does be doctor know about the a.fib happening on this hospital stay?

Luckily, they were all in my favor. My patient was not symptomatic. His heart rate was under control. He had a history of the a.fib, and the doctor already knew because they saw it during surgery earlier that hospital stay. So all I had to do was continue to monitor my patient, monitor the heart rate, make sure it doesn't enter an uncontrolled rhythm. The reason I bore you with this story is to show you (or myself ) that before this class, I would have freaked out if my patient was in a. Fib because that's a scary term and I wouldn't know the difference of good or bad a.fib....but now, I am competent enough to understand the heart enough to see that rhythm on the monitor and not have to 1) initially freak out 2) enter a bout of colitis because I would be stressed all shift about it until my patient went normal sinus (the normal heart rhythm).

With every bout of learning I learn, I love nursing more and more. The days I hate nursing are the days I feel incompetent. Those are the days I feel stressed. I don't mind having a completely shitty, busy as all hell day, whatever bring it on. But the minute I feel like I aren't good enough to care for my patient, that's when I feel that I hate nursing and can't wait for my shift to end. But when I feel like I can take care of my patients no matter what and can help other nurses even, I love my job. I love being able to feel confident. It's empowering and it makes me want to learn more, more, more. Soon I will be taking an ACLS class, which would further my certification to enable me to take care of more critical patients. During code-blue situations I would be able to push life-saving drugs into patients. I can work in the ICU or the ER with this certification. So, that's pretty cool and up and coming.

I finally have fully functioning power back and at least 134,342,114 posts ready to write, so look forward to that! Hopefully I still have readers =)

Love you all, thanks for reading.


~WNB.