What I think New Nurses Need in the Work Field!

First and foremost (as I’ve begun to come out of my writers block), I’d like to say it has certainly been quite awhile since I’ve written a post and so I think this topic is rather suitable since I’ve progressed at my work place. As other new nurses have also.

Let me just start by saying this is only my opinion! I am sure there is plenty more a new nurse needs but these are what I found in myself and I believe they can help other new nurses.

1. Confidence

       I purposely put this one first because I think it is the most important. One of the first compliments that I received from a lot of my patients and the nurses training me was that I was confident in what I did. Now I’m not saying act like you know what you are doing or be over confident… no thats not the solution. When I say confidence, I mean hold your head up high, greet everyone with a smile and mostly talk to your patients beyond what you were intending on speaking to them about. It lets them know you actually care and aren’t just there to do your job. To explain a little further, don’t just go into your patients room to do a single task and leave. Every visit you should be collecting some sort of information from your patient and their surroundings; it becomes vital later on, when you have to put the whole picture together. Nursing school teaches us to look at things bit by bit and thats only because we are building up to a whole different perspective, THIS is when that perspective will develop. Being narrow-minded will not work here, the more you open up the more you will see and learn.

If you have the confidence, it will help prevent you from being overly flustered. It becomes important to take things one at a time because overthinking and jumping ahead will only mix you up more and you do not need that especially when you are pressed for time. Now there will always be times when your priorities will change and you have to change gears; I’ll explain this later on. Many times a patient will tell you something and you will not have a way to respond and guess what?!! That is perfectly OKAY! We don’t always have to have an answer to everything; sometimes its good to use your senses and listen.

2. Know your stuff!!

      One thing should be clear; nursing is not the profession where we can say …”thank god, I don’t have to look at books again”. Uhmm, huge sorry for you because if you want to be a good nurse and be on top of your game then that is one of the things you will do! Human brains don’t have the ability to remember every single thing we have learned (unless we are Rainman) and I know I’m not. Looking back to your nursing school notes or even doing more research IS NOT I repeat IS NOT going to make you look stupid. People often thing of it as a weakness, that you have to refer to notes again and I think its sad that they think that. Reinforcing something is a strong trait and I back it up.

Knowing drugs… first your not a pharmacist… let them do their job! Nurses and drugs are a complicated relationship. You will always learn them when you are working, they are not something you need to know immediately off the top of your head! This is something I wouldn’t stress about because if you don’t know it then look it up but please don’t guess. Most importantly, nurses should know signs and symptoms of disease processes and drugs more. Because we are the ones present 24/7 and we are the ones picking things up on patients. Skills get stronger as you work but it doesn’t mean you should have an excuse to know nothing! Look at the acuity of your floor; look at what occurs most in what patient population. Focus more on that, it will help you branch out later on.

3. Learn to ask questions and utilize all of your resources

     One word: PRIORITIZE. The way you can do this is by asking questions when you don’t know something, instead of standing there and wondering what could be. Utilize your resources people!! Use the senior nurses, use the COW (computer on wheels), use the protocols at the nurses station and read the policies if you are second guessing yourself. All of this leads you to help prioritize. At first I had trouble with this when I started work and that is fine because you pick up on “how to” once you work more. Its expected of a new nurse and it is okay, please don’t feel down or upset because you believe you should know everything.

In one of the previous sections I mentioned how priorities change. And they change quickly! At one point you will be calling pharmacy to send up an antibiotic because its due at 10:00 and they haven’t yet and btw its 10:15, at the same time you’ll find out your patients blood sugar is 40mg/dL. Things like this is what I mean when I say your priorities change immediately. After all those nursing school exams and NCLEX questions, prioritizing should be easier in terms of filtering out who needs to be seen first and what you need to do. What I do is: once I get all my information on my assignments; I have started to ask myself who is more acute?! Who has more of a chance of going downhill? At that point you will definitely have your answer. If you have two at the same level; break it down further.

At some point people will expect you to think ahead and anticipate a certain situation. You can’t delay this! Its important to learn what you need and when. For example; you get a patient with end stage COPD, who cannot breathe unless they sit up, who has a productive wet cough. What do you need before your patient gets on your floor and is under your care?!!! These are the types of questions you need to ask yourself.

           You’d need to grab suction equipment, oxygen lines, non-rebreathers, and an ambu bag. Keep a dynamap near by b/c you’ll need vitals.

4. A calm approach to everything!

       This one is harder to grasp, especially because it depends on our personality and everyday demeanor. But it is certainly good to get practice in so you can have a sturdy foundation. Hold your ground no matter what!!! Take a few seconds and breathe deeply because most of the time you can’t speed something up that isn’t under your control. Doctors will ask you a million times if the patient pooped or something or if they coughed up a sputum. No your not going to force your patient to poop or push them to cough. It will happen… unless they have a severe bowl obstruction or something then, relax. Freaking out makes things worse and you definitely don’t want your patient to see you like that because guess what?!! They will freak out too.. they depend on you for care, if caretaker flips out, patient flips out.

5. Don’t be afraid of doctors!

    I come to think of everyone as working together. If you have a question, ask them while they are on the floor. It gets getting used to calling or paging a doctor. Importantly, your job is to look at the orders… do they make sense? A lot of the times docs can easily overlook what your goal as a nurse is to prevent & it happens, they have their plate full too, but thats why you are there as a fail safe mechanism ….** NERD ALERT**  Which cardiac rhythm is also known as a fail safe … to my nurses out there.. – Junctional Escape. : )

6. Lastly, a positive attitude and don’t forget to reward yourself

      Being negative Nancy isn’t going to get you anywhere. I know, it sucks… you deserve to have one bad day because anything and everything happened at home between you and your mother or you and your boyfriend had the most horrible argument. This is where being selfless comes in. Keep reminding yourself that for the next 8-12 hours, you are devoting all of your time to your patients. This is where you leave your problems at the door. A positive outlook will not only guide you to do good things for your patient but also make your patient happy every time you see them. Sometimes its easy to forget that your patients are going through a hard time too and only they know what type of hell they are experiencing, but it helps me to remind myself every now and then. I sometimes like to think of what my patient has as something I would have; it puts it into perspective… because even you don’t want to feel like they are, so why treat them like they don’t matter. Make them feel important, make them feel cared for. Reward yourself, everyday and every week! You deserve it. You work in a fog all day and only stay on one path. Its tough to not lose focus and stay motivated. Unfortunately, we don’t have that options to come back and do it tomorrow. Here and now… here and now. So, get that massage, spend that extra cash, go to dinner with a hot date, go to the beach and relax with your girlfriends. You need the balance with this type of work and kudos to you for graduating nursing school…. the real fun is only now starting!

** One awesome piece of advice I received from one of the nurses that was training me was…. “As a nurse, you do everyones job; it doesn’t matter if you have assistants to do something, you be your own assistant”. And she was right. There will be more than one time where you will be searching through the halls for someone to help you or to get a support to clean a patient up. You will waste more time looking then actually doing. Do it yourself. Please don’t be the nurse that says “well thats not what I do” … actually it is because your job is to care for your patient. If you don’t want to lay in a pile of your poop for more than 20 minutes then I’m pretty sure your patient doesn’t either. The floor I work on does vital signs every 4 hours; its a cardiac floor. This task is the job of the nursing assistant or support as we say. I do my own. A. I get to include it apart of my assessment and I get to check up on my patient (which you should be doing periodically btw). B. the assistant can get to other work that needs to be done.

This was just a compilation of what I thought was important because this is everything that I do and everything that I am growing stronger in. Of course, there will be qualities specific to the nurse and that is just as important. Nursing is the most selfless profession I know, giving your time to a group of patients who are strangers is the most respectful thing one can do. Pushing aside your feelings for once and thinking about anothers’ is vital here.

Goodluck to the nurses who just graduated … good luck on the NCLEX and the job search. You got this, never fall back because you will never realize how great you can be.  😉

Hope this helped for those who need it!! Peace Out !!! – TP

 

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Nursing isn’t what it used to be; Working can’t change me.

 

I know its been awhile since I’ve written a post, but between recovering from a tonsillectomy and starting my first nursing job; I’ve been rather busy and plus I needed the time to gather my thoughts!

First, let me start by letting those of you who are not in the nursing field know that, nursing school and work in the field are two separate things. This might be true for quite a few fields, as we all learn to accommodate to the work environment but here is why nursing really sticks out like a sore thumb.

In nursing school we learn to be the patients backbone. Most patients are in a hospital nowadays because they are incredibly sick; hospitals these days are not keeping patients over night for simple post -op recoveries, they send them to nursing/rehab centers to recover, which is what scares me. In school we are taught to look at the patients perspective, to understand how they feel and what they are going through. To me, that is what a nurse is. We become advocates for the patients, we are their support system.

Now this is where things get tricky….; during my first few weeks, I was handling 15-30 patients on a single cart (med cart). And here are the rules:

1. Finish your med pass by noon (you start at 8am) + blood sugars and insulin

2. Answer doc questions; drop everything you are doing and get them the information they need

3. Stop what you are doing if there is a temp higher than 99 F or if someone is in pain

4. No electronic medical records; so make sure you remember to sign out the narcotics from their cardex. The count should not be off or your ass is on the line.

5. Gather vitals on who needs them.

6. Check off everything in the med book.

7. Know who takes their meds crushed or whole. (Crushing meds takes another 2 mins)

8. Find your patients if they are not in their rooms…. this requires an awfully fast walk to the other side of the building.

9. Finish morning med pass and start 2pm pass and hopefully finish by change of shift, which is at 3pm

10. Chart notes on your patients, do a monthly note, take off doc orders, fax pharmacy new med orders, report to the next nurse.

You get the point, I’m making here right? Now I am not complaining because this is the job I chose, my point here is that where do I have room to sit for 2 minutes and talk to my patient to see how they are doing? The truth is, you don’t have that time. The reason I chose nursing and the reason I actually fell in love with the profession during school was because I was able to uncover who I really was. All my life, I have seen myself tend to peoples feelings, putting myself behind them and I am okay with that. It is how I was built and it is how I am wired. But in the field where I cannot be who I want to be and I cannot give my patients the attention they need, how could I be the nurse I want to be?

I have met some extraordinary nurses while at my work place and they have years of experience. I have been told, once you figure out your routine and nook, you will be fine. Unfortunately, upon observing other nurses, I see them doing what the nursing field isn’t anymore. I encouraged one of my co-workers to further his/her degree, I saw their work ethic and I was amazed at how efficiently they dotted their I’s and crossed their T’s. They said “honestly, even though I wanted to, I wouldn’t do nursing again because nursing isn’t what it is used to be anymore”. As a new graduate I have quickly realized that.

I think I am more angry if anything at the system. I went to school in New England, where a nurses patient load did not exceed more than 5 patients. Here in NJ, it is 15-30 (in a rehab center) (7+in a hospital). I am the one these patients rely on throughout the time I am there to survive and to pick up on minor problems. If a patient is crying (even if I am told “oh she/he cries all the time”), I want to be there to comfort them, at the time they are feeling hurt and confused, so why not offer what I have? The answer is, “I can’t stick around sir and or madam because truthfully, I have 17 other patients just like you, to take care of and give medications to on time”. I mean, what kind of system is this?

I saw good nurses and bad nurses throughout my time in school. I vowed to myself that I do not want to become that cold nurse that ignores her patients because she needs to finish a med pass or write a couple words in a chart. I fear that most of the nurses that I am working with have changed. I do not want it to happen to me. I stuck with nursing because I became a shadow for someone in dire need of help, if my shadow can’t stick around what good am i? I refuse to be the one who is in and out with a paper cup of meds  and yet that is all I find myself doing because I am rushing to move on to the next patient all the while triple checking my meds because I cannot make a mistake.

The list I wrote, looks simple to the untrained eye. But if you look at it, as everything being done in a cluster or some what simultaneously, the picture might become clearer. Being a nurse is hard work and I don’t say that lightly.

I would’t be a nurse if I did not pay attention to my patients, if I did not speak to them or have a simple conversation, if I didn’t do them little favors etc. I owe my professors the most gracious thanks because through them I learned to go the extra mile. Through them I learned I should listen to my patients speak for two minutes because that is what they need to do; they need to communicate. Most of my patients spend their time alone in a room or doing activities. The individuals who are alone, just want to have someone to talk to; after all no one wants to be alone.

I recognize that I am still being a nurse while I work. I give meds, monitor conditions, change dressings etc. What I am really upset at is that there is no room for therapeutic communication, which is something I believe it truly helpful to someone who is healing. The power of communication itself is such a grand opportunity, it should be woven into all walks of life.

So, what am I doing about this? I think, slowly during my day at work I am trying to integrate my own practice into something that is so set in stone. I am noticing, that it does set me behind schedule but only by 15 -20 minutes. Now, in nursing world thats like one hour… but I’ve received more information out of my patients through talking to them then by just walking in and out of their rooms. I am better able to control their pain because I ask them if they are in pain and how much and where it is hurting. I try to clean up what I can while I am doing their meds. The  nursing assistants are just as busy as the nurses but I only wish that some could be more attentive. After all, no one wants to sit in a wet brief with food all over their face, I am sure you wouldn’t, I wouldn’t either. I am only standing up for what I believe in, whether it be quietly and on my own. I am one of the youngest and most inexperienced nurses in the field but I know what I have been taught and what I believe in should also be considered in the care of patients. I know I am doing the right thing for myself because when I am done talking to my patients, they thank me for listening, or give me a smile even if they are having an awful morning. Think about how many times you have had an awful day, where you wanted to quit…. then think about how many people you resided to… quite a few huh?! Now think, these patients do not have that. Some don’t even have a family to turn to, better yet friends.

So then, why not do what we can for people who cannot even raise their hands due to paralysis or because they forgot how to go to the bathroom due to Alzheimer’s?!

I am incredibly grateful that I became a nurse, I owe it to the family members that helped guide me in the direction and to the nursing school I attended and of course myself because I believe being a nurse not only includes what you learned to do in school but who you are as a person. I hope for change to occur, I know it is impossible to completely recreate something that is set in stone, but if us nurses are really in it for the patients & their happiness then bringing change little by little can’t be that difficult.

I will continue to work the way I was trained. Of course, I have remained fair to both systems presented to me, but I cannot stand for poor nursing just because your 9ams are behind schedule. I tried following the nurses’ lead…. the guilt of not reaching out to my patients came at me like a speeding 16 wheeler. I hated it.

As I may have mentioned before, I plan to go into humanitarian aide work. I want to travel to countries that do not have the proper medical means to survive. It is my ultimate dream and I plan on carrying it out 100%, I want to live in a country for a few months to become a part of a culture that is foreign to me. No matter where I am in the world, the greatest good I can do is helping another human being (and animals but thats a topic for another post 🙂 )  There is no such greater gratitude than the one you experience after you help heal someone and that is all I need.

“Sure, I’m for helping the elderly, I’m going to be old myself some day” – Lillian Carter

– TP ❤