Placing IVs in Babies

NICU nurses in my hospital are responsible for putting IVs in our neonatal patients. We don’t have an IV team to do it for us, and often, our nurses are called to other units when other units have difficulty putting IVs in babies. Regardless, IV placement is an essential nursing skill, and putting IVs in infants is different than putting IVs in adults. For adults, I can usually see or palpate (feel) veins. For babies, it can be difficult to see veins, and I’ve never been able to palpate them. It had been a while since I placed an IV in a baby, so I asked and volunteered to do it for a colleague needing to replace an IV in her patient on my last shift.

Photo by Isaac Hermar on Pexels.com

I placed the IV in the patient, but not without almost giving myself a needle stick (I dropped the needle, and it rolled away from me before I could retract it) and having some blood splash from quickly releasing a used hub on a bedside table. I’ve never come close to giving myself a needle stick, nor have I created such a mess from attempting to place an IV. Senior nurses were present to help me hold down the baby and hold up a vein finder. I felt like I was fumbling through the process with an audience. I hadn’t worked with these nurses before to place an IV because I was still new to the night shift. And while I eventually got the IV in, I felt foolish with how long it took and how I splashed blood on the table. I’m embarrassed that this is the first impression I’ve given these nurses on my IV skills. In a way, however, it was confirmation that I needed the practice.

While I was placing the IV on my colleague’s patient, the IV on my patient stopped working and needed replacement. As soon as I placed the IV on my colleague’s patient, I hurried to my patient’s isolette. I attempted to put a new IV on my patient, got it during my second attempt (the vein blew during the first attempt), but then accidentally pulled out the catheter as I tried to remove the tape and Tegaderm to retape the IV. It had stopped flushing smoothly, and the other nurse and I thought we could retape it to prevent it from getting kinked or occluded. As a guideline, a different nurse should take over the IV placement after two unsuccessful attempts. I stopped with further IV attempts on my patient beyond my two tries but got the lesson to remove tape individually so as not to pull out an entire catheter when retaping. (I had initially tried pulling off the tape before the Tegaderm, but it was hard to separate it from the Tegaderm). My colleagues eventually got a new IV in my patient. I appreciate the teamwork, but I still feel embarrassed by how I kept “messing up.”

I wanted IV practice on my last shift, and the universe gave me multiple chances! As humbling as my previous shift was, I realize the only way to improve my nursing skills is with experience and practicing essential skills: I will be more consistent and successful at putting in IVs only by putting in more IVs. Luckily, NICU nurses support each other and help and assist one another during IV placements. However, there are times when the unit is busy, and nurses may not always be available to help each other. I want to feel more confident with doing IV placement alone. I will have to request to do IVs whenever there is a chance.

Sometimes, it feels weird to be older and yet so new in work experience. I must remind myself and give myself the grace that I am still relatively new to my profession. There’s a lot I’m still learning to do that senior nurses do effortlessly and automatically. And even the most experienced nurses make mistakes or are sometimes unable to get an IV placed on the first try. I can’t expect perfection, but I can at least aim for improvement.

Missing My PPE – the realities of being a working parent and night-shift nurse

I came home from my shift this morning and had a strange moment feeling lost without my hospital PPE in my own home. Before I could even shower, I had to take on the dreaded parenting task of cleaning up my child’s vomit. My daughter wasn’t feeling well, so she decided to stay home from school during the intended morning drop-off and vomited in her car seat before returning home. In an instant, I wished I had access to everything I would have had at work.

Photo by EVG Kowalievska on Pexels.com

Luckily, my daughter took it in stride and was patient while I searched for gloves and wipes to clean up the vomit. I was still wearing my scrubs but wished I also had access to a gown and toothpaste sandwiched between two surgical masks (a trick I learned in dealing with malodorous tasks or patients). I tried not to make faces as I collected and cleaned up the mess. In the hospital, I could’ve hidden my face behind [two] masks to obscure any traces of disgust. This morning, I hope I showed concern and care for my daughter over being grossed out while I wiped off her partially digested breakfast from her body and car seat.

I briefly wondered why this seemed harder than work. I clean up vomit and poo as part of my job, but an infant vomiting breast milk or formula is very different than an elementary student throwing up solid food. When a NICU baby vomits, it’s rarely due to the stomach flu or communicable illness. When my school-age child vomits, I wonder and hope I don’t catch what she has. Cleaning up and wiping down a plastic bassinet or hospital crib is much simpler than washing a car seat. I also don’t have access to a hospital laundry bin at home. It is much more convenient for someone else to collect and wash soiled materials I place in a blue plastic bag than for my husband and me to clean and hand-wash clothing and a car seat drenched in vomit.

My daughter is doing better, thank goodness. I’m feeding her lunch while I type this (and hoping she keeps it down). My husband and I get to figure out how to care for her the rest of the day while I’m supposed to be sleeping, and he’s supposed to be working. Ahhh – the realities of being a working parent and night-shift nurse. Here’s to hoping my daughter continues to feel better and that my husband and I don’t get sick!

What I Wish I Knew As a New Mom about Feeding my Newborn – and what I try teaching as a NICU nurse

When I had my baby, my husband and I struggled to feed our newborn. I wanted to breastfeed my baby exclusively, but she would not breastfeed well. Influenced by various sources and committed to breastfeeding, I refused to pump or bottle-feed my baby while in the hospital. My baby and I roomed in together while I tried to breastfeed. My husband recalls having to travel with my baby somewhere for light therapy. I vaguely remember this too, but I was tired, delirious from lack of sleep, and recovering from a C-section. I only remember sleeping while my husband and baby were out of the room. In retrospect, my baby most likely went to the NICU because she was jaundiced. She may have been there for only a few hours because I remember waking when my baby and husband returned from wherever they went. Thankfully, the hospital did not admit my baby to the NICU, and we could leave the hospital together. However, our struggles to feed our newborn continued when we got home. Looking back at our experience as new parents, I wish I had known some things about feeding our baby that I know now as an experienced mom and NICU nurse.

Photo by Helena Jankoviu010dovu00e1 Kovu00e1u010dovu00e1 on Pexels.com

Fed is Best

As a NICU nurse, I see term or late pre-term infants (born at 34-37 weeks gestation) who come to our NICU for hypoglycemia (low blood sugar) or hyperbilirubinemia (seen as jaundice/yellowish skin). Often, these term babies come to our unit because they are not eating well. For some babies, parents refuse to feed baby formula while postpartum, and the mom may not have established her breastmilk supply yet. This description reflected us as newborn parents and a likely reason why my baby needed phototherapy.

A build-up of bilirubin in a baby’s body can cause jaundice. Bilirubin is usually processed by the liver and leaves the body as waste. A newborn’s liver may not yet efficiently function, but the baby should be eating/drinking something to produce waste and encourage processing out bilirubin. A newborn baby drinking breastmilk or formula helps curtail jaundice. If a baby is not feeding well or is still jaundiced despite attempted feedings, however, hospitals can treat elevated bilirubin levels (hyperbilirubinemia) through light phototherapy.

Jaundice is normal in newborns, but the hospital monitors bilirubin levels and treats when levels rise above certain thresholds. If the baby’s bilirubin is too high, brain damage can occur. In our hospital, if a postpartum baby needs phototherapy, the baby is admitted to the NICU. Phototherapy in the NICU only happens after multiple attempted feedings and when bilirubin levels exceed treatment thresholds.

Frequent feedings are how parents can reduce bilirubin levels in otherwise healthy babies (and hopefully prevent hyperbilirubinemia that requires NICU care). However, frequent feedings can also help prevent another common condition in our NICU: hypoglycemia, or low blood sugar. If an otherwise healthy baby born to a non-diabetic mom takes enough breastmilk or formula, the baby can usually avoid hypoglycemia. However, if the baby is unable to feed adequately, the baby can develop low blood sugar.

Before a baby goes to the NICU for hypoglycemia treatment and monitoring, the mother and the postpartum staff will attempt to feed the baby. If the mother consents, the baby can be offered formula. If bottle-feeding is still insufficient, a sugar gel is given to the baby orally. The postpartum unit will attempt several feeding and sugar gel administrations before the baby goes to the NICU. If the NICU admits a baby for hypoglycemia, we will place an IV to deliver sugar to the baby as IV fluids. Once the sugar levels in the baby are sufficient, and the baby is drinking adequately, we can reduce the IV fluids and eventually remove IV fluids if the baby can orally consume the needed calories and fluids while maintaining healthy blood sugar and hydration. In the NICU, we try feeding our babies breastmilk if it’s available and not contraindicated (i.e., substance-abusing mother). If breastmilk is unavailable and we need to feed a baby orally, we will give provider-ordered formula to our babies.

For babies admitted for hyperbilirubinemia or hypoglycemia, I sometimes hear the baby barely drank anything because the baby was unable to breastfeed from a mom who wanted only to breastfeed exclusively. Before doctors send the baby to the NICU, the nurses can offer the baby formula if the mom consents or requests it. However, by this time, the baby may have worn themselves out or be too tired to drink from the bottle. It makes me and other NICU nurses wonder, “If the parent or nurses fed the baby from the bottle sooner, would the baby still need to go to the NICU? Is the mother promptly informed of her options if her milk supply hasn’t come in or the baby cannot latch or breastfeed?”

While I’m glad my husband got to go with my baby and accompany her for phototherapy, I would have preferred that my baby not leave my postpartum room at all for treatment or tests. To prevent my daughter from needing to leave our room, I would have pumped sooner to encourage my milk supply and produce milk that my husband or I could bottle-feed my baby. We did not learn until weeks later that my daughter was tongue- and lip-tied, which may have initially made it difficult for her to breastfeed. From my perspective, it’s better to feed a newborn some formula to keep the baby with mom and out of the NICU than to rely solely on breastmilk that may not be available yet or difficult for the baby to access.

Pumping is Okay

I was offered to pump in the hospital but refused, thinking I would breastfeed. My doula recommended not to pump until after the first month, so I tried holding off on pumping in an attempt to have my baby latch, help establish our breastfeeding rhythm, and set my breastmilk supply.

I didn’t want to feed her from a bottle because I didn’t want to cause nipple confusion and have my baby prefer the bottle over breastfeeding. When we got home, I thought I was doing okay breastfeeding, but when we brought our baby to her 1-week checkup, she wasn’t gaining enough weight. We brought her to her 2-week checkup, and her pediatrician still didn’t think she was gaining enough. My daughter fell in the 2nd percentile on the growth chart. (I did not discover until months later that my husband and his siblings were so small as newborns they were not even on the growth chart). We were strongly encouraged to start bottle feeding her formula.

Wrought with guilt, we decided to feed her some formula, and I began to pump. By this time, I had developed mastitis (Mastitis is a painful infection in the breast caused by bacteria introduced by breastfeeding. It also caused me to have body aches, a high fever, and chills. Imagine dealing with this while trying to care for a newborn!) My supply was woefully insufficient, and most of my daughter’s caloric intake was formula once I started to pump while battling mastitis.

Formula is Okay

It is okay to use formula if you are not producing breast milk or enough breast milk/colostrum to feed your baby. I wanted to exclusively breastfeed because I learned about the benefits of breastfeeding and how it’s the best, natural, and easiest way to feed my baby. It’s great for baby bonding and helps provide passive immunity to the baby. However, I got mastitis TWICE within the first month or so of my daughter’s life. We also learned my daughter was tongue-tied, making it difficult for my daughter to breastfeed. Not until later did I meet other mothers who breastfed AND bottle-fed their babies or moms who exclusively pumped. (Moms who exclusively pump only feed their babies breastmilk from a bottle). Had I not been so attached to exclusively breastfeeding, I could have adapted and explored these other options earlier as a new parent.

Do What’s Best for You and Your Family

Aside from taking antibiotics, the way to clear a mastitis infection from the breast is by breastfeeding or pumping. My daughter preferred the bottle by this time, so I relied on pumping to clear my infection. Pumping (and antibiotics) eventually relieved the pain and released the mastitis in my breasts, but the repeated infections impacted my supply. Encouraged by my doula, I remember three days where I spent about 9 hours pumping (diligently pumping 45 minutes every 2 hours, per her recommendation) only to produce about 1 ounce of breastmilk daily. I was so exhausted and upset by the results of my efforts. I also felt cut off from my daughter while I pumped (Because I couldn’t figure out how to safely hold her with all the pumping tubes hanging from my body, my husband or parents would take her while I pumped). After the three days dedicated to pumping round-the-clock, I decided it was not worth it to continue to pump. It was more important for me to be with my baby than to try giving her my pumped breastmilk.

I still held out hope for breastfeeding. Once my infection cleared, I tried to breastfeed my daughter using an SNS (supplemental nursing system – a tube placed on the breast but connected to a bottle to measure and ensure the baby has adequate intake). She was already used to the bottle nipple and did not take to the SNS. I attempted multiple times, but she would refuse to feed through the SNS, and I would end up with formula spilling all over my chest.

I share a bit of my breastfeeding journey to emphasize that there are many ways to feed and nourish a baby. In the end, so long as the baby is healthy and safe, parents decide what works best for them and their family. The caregivers’ mental health and well-being are as important as the baby’s. The way you choose to care for your baby may not resemble how other families do things, and that’s okay. I was ashamed for not breastfeeding my daughter for as long and in the way I hoped, but I felt my attachment to breastfeeding distanced my baby from me and caused so much anxiety and distress. Parents should not be ashamed of doing what is best for them and their families.

In the NICU, I meet moms who feel nervous they cannot directly breastfeed, yet they can pump and produce enough breastmilk to meet their baby’s needs. I meet parents who are ashamed they don’t have a separate nursery for their baby. We live in Los Angeles – not every family can afford to pay for a home with different bedrooms for each of their children! Many of our parents rely on WIC because they can’t afford to purchase formula. Getting formula from WIC is better than diluting formula or not feeding the baby enough nutritious calories. I try to assure the parents I see they can do what works for their family – it doesn’t need to match other families.

I felt defeated when I finally gave up pumping and breastfeeding. I wish I gave myself a little grace as a newborn mom and wasn’t so hard on myself. I felt so much grief over my inability to mother and feed my child as I thought I should that it made me feel inadequate as a mom. I was separated from my baby while I pumped, trying to salvage any breastmilk I had. I cried every day when I was pumping or trying to breastfeed. Ultimately, I fed my baby adequately, thanks to formula, and my child is now a healthy school-age girl. She still falls on the low end of the growth chart, but her father and I are not tall, so my daughter’s standard is the tenth percentile or less.

As I reflect on my experience as a new mom, I hope to impart grace and support to other new parents now that I’m a NICU nurse. If a caregiver is feeding their baby adequately, caring for and bonding with them, and keeping them safe, I want them to know they are doing a great job! I also want them to know it’s okay to make adjustments as needed or change their minds about how they want to do things. Parents can adapt their plans according to the family’s needs.

I originally wrote this post to give insight on how to lower the likelihood of hyperbilirubinemia or hypoglycemia (and admission to the NICU) through frequent feedings. If this information helps reduce NICU admissions and prolong in-room bonding between caregiver and baby, I would be ecstatic. Ultimately, I hope this post reassures parents (and serves as a reminder to myself) that there are many ways to care for a baby. There are no perfect parents; there are no perfect children. We’re just doing our best with the information and resources we have. Good luck to you on your journey!

Sweet Gestures

Every once in a while, NICU families will bring treats or food for the nurses as a thank you. It’s [literally] such a sweet gesture. This past week, a family brought in fancy doughnuts, and they were the prettiest doughnuts I had seen, so I took a picture.

Fancy doughnuts given to the NICU from one of our patient’s families. (Tastes as good as it looks – I had the Nutella cronut on the bottom right and it was amazing)!

However, the sweetest gesture I wanted to remember from this past week was not what we received as nurses but what one family did for another family in the NICU. Due to supply chain shortages, our unit has run short on nursing bottles and caps and can’t give as many away to our patients’ families. Moms use these bottles to pump and store breastmilk for their babies to use while in the NICU. When our supply is limited, we recommend that families purchase and use milk storage bags as an alternative to the storage bottles.

One family overheard another talking about how it’s been hard to find the milk storage bags and how expensive they can be. The parents talked to the other parents and offered to bring them a box of bags. They brought them a box the next day. It was such a sweet thing to witness NICU families supporting other NICU families. Having a baby in the NICU can be challenging, so seeing our patients’ families support one another is reassuring that people can still be kind and thoughtful even when faced with difficult situations.

I have one more thing I want to remember/share from working this past Father’s Day weekend. (I hope everyone had a Happy Father’s Day – I’ll celebrate it late with my father and husband this week). I typically see mothers in the NICU more than I see fathers. Lately, I’ve seen a lot of dads visit with moms. In particular, one father of twin patients has been visiting and caring for his babies more frequently than the mother. The dad lets the twins’ mom continue to rest and recover while he travels to the hospital to bond with his babies. We didn’t make Father’s Day cards for the dads as we did for the moms of our babies for Mother’s Day. However, I hope the dads realize what a difference they are making by being in their child’s life and supporting their child’s mom. I know there are cultures where mothers are primarily responsible for parenting and the domestic duties of diapering or feeding a child. However, it’s been refreshing to see so many fathers involved in caring for their babies in our NICU.

I hope you can draw inspiration from the sweet moments you encounter in your work or training. Did you witness anything that inspired you this past week? Feel free to share in the comments!

Reflection for the Week of 22-May-2022

As a mother of a school-aged child, the mass shooting at a Texas school earlier this week impacted me. I felt a mixture of grief, anger, and helplessness. Like other parents, I dropped off my child at school the next day, holding them tight as we hugged goodbye before the school day. It’s devastating to consider the victim’s families said goodbye to their loved ones the morning before without knowing it would be their last.

On a nursing community page, fellow nurses asked what they could do to support the healthcare workers caring for the mass shooting victims. I’m a neonatal and pediatric nurse and always find it difficult to see children suffering in a hospital due to the brutality or neglect of adults. It’s inevitable to encounter child abuse cases in my line of work, but dealing with the mass murder of children is unfathomable. I became emotional as I imagined trying to care for the victims and facing so many deaths at once.

I’m so tired of mourning, crying, and feeling helpless. I pray but cannot accept that it’s now the responsibility of parents to search for bullet-proof backpacks or for kids to know where to hide or how to play dead to protect themselves from an active shooter. We have to do better for our children. We need to act and demand action from our leaders.

I have always believed that one cannot complain about issues if you’re unwilling to do something about them or propose solutions. One way to start taking action is to consider donating to Everytown for Gun Safety at everytown.org. I have contributed to the organization based on the guidance of other mothers and family members I trust. Other mothers I know have chosen to participate in their Moms Demand Action groups; I hope to join them.

Have a peaceful week – and if you are not at peace, may your internal discord inspire you to act and make positive life-giving changes. Take care and good luck on your journey.

Mother’s Day in the NICU

Mother’s Day coincided with my 3rd consecutive day working in the hospital. I get pretty exhausted after three-in-a-row shifts, even working on dayshift. Knowing how tired I get, my husband thoughtfully ordered food for us to have dinner at home last night. After dinner, I finally opened my daughter’s Mother’s Day card/gift she made at her school. (She’s been eager to have me open it since she brought it home on Friday – I insisted on waiting until Mother’s Day)

A portrait – part of my daughter’s Mother’s Day gift

My shift was hectic yesterday, but I didn’t mind working on Mother’s Day in the NICU. For our babies who have parents that visit them, I get to be there to comfort and support the parents and to celebrate the mothers on their special day. Some parents have difficulty being separated from their babies while their babies heal or recover in the NICU, especially on days like Mothers Day. NICU nurses often provide emotional support and assurance for patients’ caregivers. Some parents don’t yet feel comfortable handling or caring for their babies. As nurses, we educate and guide caregivers in their new roles.

All the NICU nurses made Mother’s Day cards using our babies’ various handprints or footprints on Saturday. I don’t usually have much downtime to craft cards for parents, but I enjoyed making memorable print keepsakes for our patients and their caregivers. Some of our babies have no parents visiting them and are awaiting placement in foster care or adoption. We still made Mother’s Day cards for them – their future families may appreciate their teeny baby prints!

Until this past weekend, I’d never seen these cards or prints on our unit. At my children’s hospital preceptorship in nursing school, I often saw footprint cards made by nurses in the NICU. However, those patients were at higher acuity, so 1) had longer stays and 2) had 1:1 nurse-to-patient ratios. Still, I want to try making more of these cards for our NICU babies in the future. It’s a great souvenir for caregivers, and it allows me to practice my beginner calligraphy skills!

Since I worked on Mother’s Day, my family decided to celebrate Mother’s Day with my parents on Tuesday, May 10, when my Mexican friends celebrate Mother’s Day / Dia de la Madre. (Cultural Awareness Tip: El Salvador and Guatemala also celebrate their Mother’s Day on May 10). We have many patients from immigrant families at work, so I told some nurses to keep displaying their Mother’s Day cards/signs until Tuesday.

Wherever or whenever you happen to celebrate it, I hope you have (or had) a “Happy Mother’s Day”!

What Nursing School Did Not Teach Me About Nursing, Part 3: Physical Endurance & Self-Defense

Nursing can be very physically demanding – many patients require assistance turning, lifting, or moving body parts or equipment. I attended a safe-patient handling workshop offered by Daniel Tiano, a physical therapist whose goal is to “enable healthcare workers to fulfill their vocation without being held back by pain and injuries.” He compared nurses to endurance athletes, constantly lifting, turning, pushing, and pulling hundreds of pounds over a 12-hour shift. While I work primarily with neonates now that I’m a NICU nurse, I can still get floated to pediatric or post-partum wards and handle heavy patients. Pediatric patients are not always light, easy-to-handle patients. I’ve cared for adolescents over 80 kg and adults (18-25 years old) in pediatric units.

Photo by Andrea Piacquadio on Pexels.com

I must handle my patients carefully to avoid ergonomic injuries, even with babies. [Tips: Raise and lower beds or cribs to prevent back strain! Get assistance when lifting patients, and use lifting tools!] I know from experience that I can hurt more than just my back when caring for babies. As a new mom, I developed tendonitis because I held my newborn with my wrists bent. My baby wasn’t heavy to carry, but I still injured myself. My tendonitis pain went away after treatment and physical therapy. I’m more conscious now and deliberate about holding babies with my wrists straight!

Aside from modifying my behaviors to make sure I don’t cause myself injury, I have to be alert to other people’s behaviors. Patients (or their families) can have behavioral issues and be violent. As a nurse, I have to be careful that certain patients do not harm my co-workers or myself. Unfortunately, one of my teenage patients attacked her sitter/nursing assistant during one of my recent shifts. A nurse must continually assess their patient and environment to keep not only their patients safe but themselves safe, too.

Some patients (or their visitors) have mental health or drug use issues that make them unstable. Other patients may have temporary delirium due to infection or illness, causing verbally or physically abusive behavior that they usually would not have. I have cared for patients that have tried to hit, kick, or bite me or have yelled, cursed at me, and called me names. This danger doesn’t exist only in adult units. My NICU colleague had a teenage patient throw a monitor at her when she floated to the Pediatric unit. Honestly, I have more physical and personal safety considerations each day in my nursing job than in my previous career. I think that says a lot considering I was a certified Hazardous Waste Operator (HAZWOP) who periodically cleaned up hazardous material spills while I was an engineer!

Anyone working in hospitality or customer service is probably used to dealing with all kinds of people. My former preceptor used to be a restaurant server, and she said it helped prepare her for dealing with all types of patients in nursing. However, nursing is very different from what I was used to in my prior career. I never felt unsafe or in danger of other people when I was at work. I worked in a secured facility for over 18 years – people from the street couldn’t walk in, and we didn’t serve the public at my site.

In contrast, when you work in a hospital, you see all kinds of people, and often, people are emotional, in unresolved suffering and pain, or the most unstable they have ever been. It’s a ripe environment for people to lash out, potentially violently. Healthcare workers encounter violent behavior so often that facilities often require their employees to get certification in Management of Assaultive Behavior (MAB). As a NICU nurse, I haven’t encountered violent parents (hopefully, this NEVER happens). Still, I have observed emotional and angry parents with whom I must be careful and anticipate volatile behavior.

Bedside nursing is a physically demanding job. A nurse should exercise, eat energizing foods, and get enough rest to stay healthy and physically well. That applies to ANYONE. However, a nurse must also act like an endurance athlete and self-defense master. Aside from the typical actions to stay physically well or safe, nurses must be aware of body mechanics and constantly read behavioral cues from others. Thankfully, I’ve been safe and injury-free so far, but I’m still trying to figure out how to be more healthy, so I have the stamina and longevity to be a bedside nurse. I’m on a journey and will continue to share. Stay tuned for the next part of my novice nurse series, where I discuss handling my emotions as a new nurse.

What Nursing School Did Not Teach Me About Nursing, Part 2: Mentality and Mindset Challenges as a Novice Nurse

Welcome to Part 2 from a series of posts about what I learned as a new nurse and the demands of nursing.

It took a while for me to transition into nursing and adjust to my newfound career and job expectations. After working over eighteen years with the same company in a consumer products/manufacturing setting, I grew accustomed to a certain rhythm in my job as an engineer/scientist. I was a salaried employee in my previous career as an engineer and never needed to clock in or out. Some days could be stressful when I was an engineer, but mainly, I could set my day-to-day schedule. I didn’t have a required shift to start by six or seven each morning. I would have project deadlines to meet, but they didn’t necessarily dictate what I did every hour of each workday. I could go to the bathroom when I pleased or schedule my lunch to eat with friends. I had a lunch squad. If I was behind with my schedule, I could stay late. When I wasn’t periodically supporting shift work in the manufacturing plant, I started my days mostly between 8a and 9a and ended around 6:30p – 8p. Each workday as an engineer, I did not have to consider getting my work assignments from a prior shift, passing work along, getting and giving shift reports, nor did I need someone to take over my work during my bathroom or meal breaks.

I work in a hospital now, so my shifts as a nurse are dictated each day. Sometimes, there’s no time for me to pee, drink, or eat as a nurse. I eventually get to do these things, but not necessarily when I want. Hourly tasks (assessments, med passes, labs, and patient ADLs) dictate each workday. My patients and their needs and orders direct my priorities for each day. I have no lunch squad. I can’t go on meal breaks with my co-workers because they need to cover my patients when I go on break. Sometimes, the charge nurse makes me go on my snack and meal breaks when I am not ready to ensure proper coverage. If I think things are a little slow or I have some downtime, that’s when admission or some unexpected event likely occurs. (This is why you never use the “Q” word – “quiet” – to describe the environment or shift around nurses – you jinx them into having a chaotic shift later).

I’ve learned it’s better to accomplish tasks early rather than on-time because one emergency or tricky issue can cause a delay to an entire planned schedule that was once “on time.” For example, when I was in Med-Surge, I had to do unscheduled sacral wound dressing changes for an incontinent, primarily immobile, continuously stooling patient. Each time I’d get help to turn and lift the patient, clean them, replace their diaper and linens, and do the dressing change, the patient would soil themselves and their new dressing. These kinds of time-consuming, unplanned activities aren’t limited to adult patients. More recently, when I was floating to our Pediatric ward, an ostomy bag for a hyperactive non-compliant preschool patient kept leaking and needed continual replacement. The patient would purposely peel off their ostomy bag and then resist having it changed. Even though the patient was a preschooler, one person needed to help hold down the patient and keep the patient still to allow another person to replace the ostomy bag. Such unplanned activities take time and can cause delays in other scheduled tasks. I was used to addressing shifting priorities and non-compliances as an engineer, but I never had hourly assignments that could jeopardize people’s health if completed late or improperly.

Photo by Cedric Fauntleroy on Pexels.com

It was hard for me to account for unexpected, unscheduled tasks as a new grad nurse. It can still be frustrating, but I feel I’m not as flustered, and it doesn’t have to thwart the rest of my day. I have learned to do things as early as possible to leave room for the unexpected. My last NICU preceptor also encouraged me to accomplish tasks as soon as possible to be available to help other nurses. Thankfully, nurses in my department jump in and help one another. However, my preceptor warned they may not be as willing to help me if I’m always busy and unable to help them when they need assistance. As I shared, some activities require coordination of availabilities and assistance from other nurses or nursing attendants. I want to be a team player that others can count on for help. Accomplishing tasks early not only makes my life easier, preparing for the unexpected, but it also allows me to help others with their patients or tasks. However, even when I am able and want to accomplish tasks before they are due, I can’t always do this. For instance, I must still ensure meds are given in an appropriate timeframe and not too early to avoid overdosing patients.

Critical thinking and mental alertness cannot be lax as a nurse. (This is also how I justify my caffeine intake). At best, a nurse’s mistakes may cause inconvenience; at worst, permanent injury or death. Any mistake I made as a process engineer could cost hundreds of thousands of dollars, but it would never cause bodily harm or death. There was a lot of oversight, approvals, and quality control with my work as an engineer. I feel like there are fewer checks and balances for nurses for the tasks they complete.

A nurse performs activities based on orders and nursing judgment. There is no constant oversight or approval process when a nurse administers many medications or completes orders. In contrast to process engineering mistakes, a medication error can kill. Not reporting critical labs or assessment findings can cause delays in treatment or interventions. I can’t consult with a weekly project team if I’m behind on my nursing tasks. I have to figure out who to ask for help to catch up with my work or quickly judge if it’s acceptable to be late, reschedule a task, or if I need to escalate issues. Aside from impacting patient care, nursing mistakes and errors can threaten nursing licenses. When I made mistakes as an engineer, I may have received criticism and a poor performance rating, but I never worried that I’d lose my ability to work as an engineer.

Given the pressure and expectations of nursing, my anxiety levels are higher than when I was an engineer or scientist. Some stress is healthy and helps keep my patients and me safe by forcing me to focus, ask for help, or take time with unfamiliar tasks or medications. However, until I became a nurse, I never realized how common it was for nurses to have or develop hypertension, anxiety, or depression. I’ve heeded the warnings of veteran nurses who advised me not to take overtime if I don’t need it, lest I end up with hypertension, like them.

I did not switch careers only to develop medical issues from my job. It’s one thing to manage high blood pressure, generalized anxiety disorder, post-traumatic stress disorder, or major depressive disorder, but it’s another to develop these conditions because of one’s job. Nurses need healthy coping mechanisms, as stated in my last post. I respect that sometimes it’s not enough to have healthy coping mechanisms or rely on comfort wisdom; various conditions require medication. However, Kelsey Rowell, RN Career Coach and founder of @wholelifenurse shared recently on her Instagram, “If your nursing job is requiring you to go on or increase your medication to support your mental health, that is your sign to find a new job, take a break, or do something else.” I wholeheartedly agree with her statement. Since I’ve switched to NICU nursing, my anxiety levels are lower than when I was a Float nurse for adults. Part of that may be due to having more experience or not working the night shift for the moment, but I think my decreased stress is also because NICU nursing is a better fit for me. There are so many opportunities within nursing that if a particular job is causing medical or mental health issues, try changing your nursing job!

What’s also relieved some of the new grad anxiety and pressure is recognizing that nursing is a practice. With more time and experience, I can improve my nursing practice. With more exposure to various units or patients, I learn what I like or dislike about specific nursing roles and can set my boundaries and determine my career goals. With more experience, certain medications or typical treatments will become more familiar. I will more easily recognize the signs or symptoms of conditions I regularly encounter. I can determine which skills are essential to master for various units or roles. (Tip: time management is a critical skill, no matter where you work as a nurse)

I have accepted that I’m imperfect and will make mistakes. Even veteran nurses make mistakes. When making mistakes, it’s essential to be transparent to a charge nurse or provider to correct errors or get help and alignment to move forward. Mistakes can serve as lessons. I’ve made mistakes in my engineering and nursing career that I know I will not make again because I never want to feel as compromised or ashamed as when I made the mistakes.

I want to prevent making mistakes that injure or permanently damage patients. One of my NICU preceptors said to accept that I will make mistakes but to spend time making sure I don’t make medication errors. If I spend more time evaluating an unfamiliar medication, dosage, or route, I accept that I will appear slow because of my uncertainty. I will ask for help or clarification. I will move more slowly and risk falling behind on my tasks rather than harmfully administering medication.

ANY new job or career produces increased stress and mental challenges. Some level of discomfort is healthy and helps us to learn and grow. It takes time to learn the protocols or processes of a new organization or unit. No one is perfect, and we all make mistakes. Sometimes, you understand how to be more efficient or effective by making mistakes or witnessing them. It takes time to learn who to ask for help, what requires escalation, and the chain of command. Over time, we know the methods of communication our co-workers, bosses, or patients/clients prefer. Skills cannot improve until you’ve practiced and done them many times. Understanding all this and having the mindset that I’m still learning (“I’m developing, not deficient!“) has helped relieve some of my new grad/novice nurse anxiety.

I hope this post gave some insight into the mental challenges of nursing and the mindset one has to have to thrive as a novice nurse. If you have any advice on how to handle the pressures of nursing or the mental challenges, please share! Thanks for reading! My next posts in this novice nurse series will discuss how I address the physical and emotional challenges of being a nurse.

What Nursing School Did Not Teach Me About Nursing, Part 1: Time vs. Energy

Aside from an abundance of job opportunities, one of the things that attracted me to nursing was the schedule. Typically, nurses who work 12-hour shifts in hospitals work only three days a week. It seemed ideal to have four days off weekly to have more time with my family. I felt I could manage to work obligatory weekends and holidays when I already had worked weekends and holidays in my previous career as an engineer. I was used to working 12+ hour days as an engineer and would periodically do shift work, working overnight. When I wasn’t doing shift work, I would work weekdays, but work would follow me home, or I’d be on-call 24/7. I could work long hours and focus my energy on launching a product, completing a project, or passing an audit. I learned how to be a hard worker and resilient to get through challenging work assignments or situations in my previous life as a chemical engineer. However, I don’t think I’ve ever had to work as hard as an engineer on a day-to-day basis as I do each shift as a nurse.

Nursing takes a lot out of me. At the end of a shift, it’s common to be mentally, physically, and emotionally drained. Maybe it’s because I’m older, but I genuinely feel the work and energy required for nursing does not compare to when I was an engineer.

I came across a Business Insider article citing well-paying low-stress jobs. Nursing is nowhere on that list. Is it ironic that chemical engineers top the list at number 2? I chose to leave a relatively low-stress job and transitioned into one of the most stressful professions. Additionally, I became a nurse in the middle of a frickin’ pandemic!

While I do not have to work four days out of a week, it takes a lot more time to recover my energy from working nursing shifts than when I was an engineer. Also, when I worked night shifts as a nurse, the entire next day/night off would be a complete wash – I’d spend my day off napping, recuperating, and re-adjusting to my family’s schedule while still feeling like a zombie. Sometimes I’d need two days before I could feel fully functional and alert during the day and meaningfully interact with my family and friends. Just as I’d start to adjust, I’d have to work a block of night shifts and begin my cycle over again. I’m currently working day shifts, but I sometimes still need a whole day to recuperate after working. I have to be aware of my body’s needs and rest on days off, even when I have every urge to pack my schedule with outings and activities. I want to take advantage of my extra days off but recognize I need to spend some of that time relaxing or recovering. I might have the time to do something, but do I have the energy?

Photo by Anastasiya Vragova on Pexels.com

Admittedly, I never worried about having the energy to do something when I was younger. I kept a packed schedule – even on weeknights after work. (I think I also was more tolerant of toxic relationships and hostile work environments and did not realize how draining those could be). Maybe I seemingly had more energy because I was single and didn’t have family committments or time to devote to a spouse or children. It’s possible I had way more energy – or I just felt that way – because I could sleep in when I needed. (I’m a parent to a kindergartener; it’s been years since I slept in late). Now that I’m older, not getting enough rest impacts me more. Or maybe I’m simply more aware of my body’s needs than when I was younger.

Being self-aware helps me determine how to restore my energy. For instance, I’m an extrovert and need to connect and interact with people for my well-being. My introverted husband needs the opposite. Earlier in our relationship, I realized that going from party to party would make him miserable, while I would be happy and energized from the social interactions. As a result, I’m more selective with our social commitments.

When figuring out what to do on my days off, an essential question is: “Do I have the energy?” If not, what do I need to do to regain my energy? One of the ways I recover is by spending time with friends. I try to include social activities on my weekly calendar, even if it’s over Zoom. I did this throughout my pre-requisites and nursing school as well. Because I’m an extrovert, social interactions are crucial to maintaining my sanity and happiness. I felt dates with my friends or family were especially important during nursing school when my schedule would be packed with classes, clinicals, and studying. These dates could be simple lunch outings, coffee/tea, seeing a movie with my husband, or Zoom calls (critically needed during pandemic surges and lockdowns). I needed to make sure I had something social in my weekly schedule to feel balanced. I mentioned it before in other posts, but it helps to know what brings you comfort. I didn’t learn this in school – time and life experience have taught me “comfort wisdom” (a la Brene Brown). Have you developed healthy coping mechanisms? What do you enjoy as stress relief? Nursing school is stressful, but working as a nurse is even more so. Build a foundation of healthy responses to stress before or during nursing school to combat the stress and anxiety that frequently accompanies working nurses.

While being a nurse can be draining at times, I honestly love it. I can feel tired and overwhelmed, but there are moments where I’m interacting with patients and at peace and content with making a difference in someone’s life. People going into nursing naturally want to help people, but they need to understand how demanding nursing can be. Until I started working as a nurse, I don’t think I realized just how stressful a job nursing could be. Prospective and new nurses need to understand what they can do to protect and restore themselves to continue in this rewarding profession. I have so much to share about this topic that I thought I would make this and the next several posts about addressing the mental, physical, and emotional demands of being a nurse. I want to candidly share what it’s like for me and what I do to try and guard myself against being drained or burnt out. And yes, unfortunately, burnout can happen to early-career nurses, too, not just veteran nurses.

I hope what I’ve shared – and what I plan to share – is helpful and provides some honest insight – see you in my next post on this series!