Not Nurse Ratched

One of my patients said that to me last night, and I said, “Well, thank you. I would hope that all nurse were caring people!” He looked at me as though I were a very dim bulb and said, “You must be new.”

I am. Still, I’ve been working as an RN for just shy of 3 months and now and then feel as though my feet are under me. I’ve barely scratched the surface, and that’s a good thing—one reason I was attracted to nursing is that you never stop learning. But I’ve scratched it enough that I feel increasingly competent at basic plus some critical care, and that is making everyone’s life easier. It is chokingly terrifying to feel afraid and unsure almost all the time, and I’ve whittled that down to maybe half the time. I’m so blessed to work with nurses who happily answer questions, give advice, and actually lay eyes on my patients if I need an experienced opinion. (“My patient looks funny. His vitals are fine and he isn’t in pain, and my assessments are negative, but he doesn’t look right to me….”)

I was even impressed with myself once last week because I did not think there was any chance I would be able to handle my night: acuity-wise or time managment–wise, either one, but I did. I had jacked-up paperwork to start out with (messy med recs, you name it…eg, “So WHAT do I give him tonight?”), one pretty sick patient and two might-be-sick-any-time patients, and an admission on a vasoactive drip who required high-level care. I thought I’d be there until 10AM. I did ask for help with vitals and a few other tasks (we don’t have aides), but I put my head down, kept breathing, and did the next right thing, and I got through it. More to the point, so did my patients, and I left at 7:45. I cried in the car, but that’s beside the point. The point is that I learned a lot, I provided appropriate care even though it strained my abilities to, apparently, a breaking point, and the next time that happens I’ll do even better.

Although apparently that load violated our acuity level and it’s not likely to happen again. One problem with being new is that I feel overwhelmed all the time, so I don’t know when to complain about my workload!

I’ve cried only the once, and I often leave feeling pretty good, so I’d say overall the whole job thing is successful. My patients more often than not tell me how much they appreciate how well I take care of them, and I am getting a metric buttload of critical care experience for free and for fun, as they say. I am, however, physically exhausted, so I will take my leave of the blogosphere for now and, uh, move over to Twitter for a while…

I had a string of three shifts this week, and the first one was so awful it pretty much ruined the next two because I never quite recovered. At least the fates (and charge nurses) smiled upon me so that I didn’t have three bad ones. It was just that I started out with a discharge and and admission right off the bat, which isn’t a particularly good plan to begin with—and the discharge had a million meds to reconcile, and the admission was a direct with no orders and was having an MI when EMS ran down the hall with him. And was a hard stick. I never caught up with myself. I wanted to cry. In the midst of all that a doc snuck in, wrote orders, and stuck the chart back in the rack so I didn’t notice said orders until about 3 AM, and this required that I then wake up a second doc to confirm doc #1’s orders. Needless to say, doc #2 was not in the NNR fan club. I had other nurses helping me with the admission so it wasn’t like I was out on a plank, and I never feel as though I do not have backup. I just almost always feel as though I’m barely managing to keep my head above water, and it. Is. Exhausting.

Speaking of exhausting, I also just found out that I’m not paid for 30 minutes each shift because they think I’m actually sitting down and taking that time as a break, when in fact I never have time to do that, so I’m working 30 minutes for free every night. This makes me feel that I should make a point of doing nothing for 30 minutes every night—I’m disinclined to work for free, and it would be better for my mental and physical health and general outlook if I, you know, engaged in minimal self-care. At the time I think, “I’d rather use this time to catch up. Just a few more tasks and I’ll be caught up.” The reality is probably that I’m not ever going to be caught up whether I take a break or not, so I should take time to eat and rest a bit, thus giving myself a fighting chance of maintaining health and sanity.

I keep telling myself that each shift should theoretically be easier because each time I encounter a situation I’m more likely to have seen it before. The second hectic admission is not as difficult as the first hectic admission. The second deteriorating patient is not as terrifying as the first deteriorating patient. The second angry, screaming doctor is not as terrifying as the first—ah, er, actually that one’s not true. I’m also starting to vaguely develop a routine, although I’m finding that routines are more difficult in critical care than on a med-surg floor because the patients don’t cooperate with my scheduling needs as well. I’m learning to be more adaptable and prioritize (eg, yes, I’m supposed to have vitals and second assessments done at 2 AM, but given my need to stay with my patient whose SpO2 won’t climb above 82%, tonight they will be done by 3:30 AM instead, and it will probably all be good). I don’t have an aide, and I cannot be in four places at the same time and am trying to live with that. Stuff gets done and charted late. Meds are given late. And it’s usually not important in the grand scheme of things.

I’m just not naturally given to letting things slide, accepting less-than-perfection, or forgiving myself for mistakes. But my natural personality traits are not going to allow survival in this field. I am getting a crash course in flexibility, and it’s frustrating. Did I mention it’s frustrating? I just have to have some faith that I’ll find balance in here somewhere.