The Mature Student 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!

Sasquatch Scavenger Hunt: Nursing Teaching Moments

Yesterday, I took my daughter, my best friend from nursing school, and her daughters to South Coast Botanic Garden. Due to the COVID surge, our school district had halted school for the rest of the week – not even resorting to online learning. We thought it’d be nice to take our girls to explore and appreciate the garden, work in some outdoor physical activity, and keep them off screens. While we were there, we discovered the garden had a Bigfoot Scavenger hunt. Visitors are encouraged to find Sasquatch evidence by exploring various sites using clues and then recording your findings in a nature journal, a pamphlet they pass out to guests to draw what they see.

My friend’s youngest daughter was determined to see Sasquatch’s Lair before leaving the garden. We were on our way out when we discovered Sasquatch’s secret hideaway. It ignited excitement in my daughter and her friend that we continued to see all the other Sasquatch evidence throughout the garden and solve all the other clues. There were five scavenger hunt stops: Sasquatch’s Lair, Sasquatch Scat, Clump of Fur, Foot Prints, and Sasquatch Food Cache. We found all the stops and saw all the clues. My daughter and her friend were satisfied to find all the evidence, and I was just happy to spend time with my friend and get 10,000+ steps in my day.

Today, my kindergartener excitedly told my mom, “I saw where Sasquatch lived and saw what he ate! We even looked for Sasquatch POO! – Yeah, based off his poo, he’s CONSTIPATED!” My mom started laughing, and I couldn’t help but laugh myself. When we had found the Sasquatch Scat, they mainly were a pile of brown-colored balls. In Nursing School, we learned about the Bristol Stool Chart – a visual and numerical chart used to describe people’s bowel movements, from constipation to diarrhea. Separate hard lumps (or balls) indicate Type 1 stool, which is a sign of constipation. When we saw the scat, my friend jokingly commented that Sasquatch must be constipated. My daughter remembered this and was proud to share her discovery with my mom. She may not be in school right now, but I guess my daughter is still learning something!

What my daughter recorded in her nature journal

My daughter’s drawing most closely resembles Type 1 Stool, a sign of constipation. Poor Sasquatch could probably use more fiber and water in their diet.
Bristol Stool Chart Image Source: https://www.webmd.com/digestive-disorders/poop-chart-bristol-stool-scale

Caffeine + Viagra

The Privilege of Being Old

If I’m honest, I feel weary about being an older, second-career nurse from time to time. I think about how my high school or college classmates (from my first degree) are well-established in their careers. Yet, here I am, starting over with little to no experience in the nursing field. I don’t have the same energy as when I was a teen or in my twenties, where I could seem to function on 4 or 5 hours of sleep or pull overnighters. I would be able to make up any sleep debt by sleeping in on the weekends. Now, as a middle-aged adult, I find it difficult to sleep in as a parent to a kindergartner, and I feel fatigued when I do not have more than an average of 6 hours of sleep. It takes longer for me to recover my energy when I sleep poorly. My eyesight is changing where it’s more challenging to read small letters and numbers. I feel weakness, aches, and pains in my body that I associated with “old people” problems when I was younger. These moments make me realize how I’m getting old and experiencing the physiological changes with growing older. Sometimes, it’s discouraging. Ultimately, though, it’s a blessing that I have this opportunity to discover a job I love later in my life. It is a privilege that I can be older and try something new.

This sentiment hit me this week when I discovered my dear cousin had died. After working all weekend, my eldest cousin called me on Monday before lunch to share the tragic news. Our cousin died suddenly in a car accident. Her injuries were so severe that she passed quickly; there was no time to visit her or for family members to say goodbye. The first phone call the hospital made to the family was to share the news she was gone. She was only 37 years old. She had three kids, older siblings, and her parents are still alive.

Even though she was a grown woman, I think of my cousin as my baby cousin. She’s the youngest of my cousins on my dad’s side. I spent an entire summer in California with her family when I was in middle school, and she was only 5 or 6 years old. Since I am an only child, my baby cousin became my little sister that summer. I last saw my cousin in 2018 during a family reunion in Washington, but my fondest memories were when she was a child. It has been difficult for me to look at my daughter and not think of my cousin this past week. My daughter is the same age my cousin was when I spent the summer with her. My daughter even shares the haircut my cousin had in kindergarten.

I think about how wrong and unfair it is that my baby cousin has died. It is unnatural that the youngest of my cousins die before even my uncles, aunts, or older cousins. There was no illness or anticipatory grief to prepare us for this sudden loss. I may have concerns about growing older, but my cousin won’t get the chance to experience life in her 40s or beyond. My uncle and aunt are going through the worst loss I feel anyone can have, the loss of a child. My cousin’s children will not get to have their mother in their lives as they become adults. I’ve been grieving, but my heart also aches for the rest of her family. It’s all so tragic and sudden that it’s, at times, surreal. I take comfort in the fact that she spent time with her family the night before her accident and her last social media post was about how she was in a good place in her life.

My blog posts have been sad lately, but I am sharing an honest reflection of my life and current happenings. Thank you for your continued interest and reading. Despite the heaviness, my ultimate goal with this blog is to motivate others: If you think you’re too old to make a career change or discover a new passion, you’re not. Like my baby cousin, some people will not get the opportunity to live as long to be considered “old.” Some people do not get to live long enough to try having multiple careers. It is a privilege to be old. As challenging as it is to accept the physiological changes of aging, it is a blessing to add years to my life. To grow old is to gain more experience, to be able to start over or try something new, and to build and share memories with loved ones.

Embrace growing older and the opportunities it provides you, but please also remember to embrace and spend time with those you love.

Rest in Peace, Baby Cousin. I’m grateful for our time together. I love and miss you. Love, Ate.

Why I Cried At Work

I spent last Friday morning at work crying. I was in my new job at my new hospital and in training. The training I took Friday morning was a mandatory two-hour computer-based session about the Commercial Sexual Exploitation of Children or CSEC. I cried with the testimonials and the trauma described by survivors and experts in the field. I felt a combination of rage and helplessness while I watched and listened to the videos. Luckily, I was in an area where no one else was sitting around me, so I felt I could express my grief and despair without too much concern.

I think this is part of what scares me about being a pediatric nurse. I worry if I can emotionally regulate myself when working with abused or neglected children. I also wonder and hope I can recognize and report abuse should I ever encounter an abuse victim. As difficult as it was, I appreciated completing the training and felt it was valuable. As a nurse, I am a mandatory reporter and must report child abuse when I suspect it. However, I think the general population should also take the introductory training about the Commercial Sexual Exploitation of Children to increase awareness, recognize and reduce risks, and maybe correct misconceptions about victims.

It is unlikely that the public would voluntarily take a two-hour training about the Sexual Exploitation of Children. Despite this, I hope to educate my readers and others who come across my blog or social media posts, because I think it’s important and is something I can easily do to help victims of CSEC. Some of the things I learned from the training are found below:

I can cry and grieve for these children, but I also want to take action. Let me know if you learned anything new from this post or if you found it helpful. I’m also curious to learn and hear from others about ways they support victims of the commercial sexual exploitation of children.

Major Update: I Quit My Job!

I have not posted in a while because I have been busy with some life changes. I recently resigned from my new grad RN job and accepted an offer to work at another hospital. What could have possibly taken me away from my #1 choice hospital and my highly pursued new grad program? A spot in my dream unit, the NICU!

It was tough for me to leave my program since I felt like the people were supportive overall. I truly appreciated the environment, community, and staff. I was learning a lot and growing as a nurse. However, my experience as a new grad RN working in the Float pool with adult patients also affirmed that my ultimate goal is to work with babies in a NICU.

My hospital has a NICU, which was a big reason I applied to their new grad program – I had hopes to move into their NICU eventually, especially after having a NICU preceptorship during nursing school. However, after working as a resident, I learned that the NICU at the hospital where I was employed does not accept inexperienced NICU nurses. The NICU manager recommended I apply to an L&D fellowship after my Float Pool residency, and maybe I could transfer to the NICU afterward. That would mean the earliest I could go to our NICU would be 2023, and that’s with the caveat that I would get accepted into a competitive year-long L&D fellowship. I would be competing with other nurses whose ultimate goal is to be an L&D nurse and other more experienced nurses previously rejected from the L&D fellowship.

After learning all this, I had the opportunity to interview during a mass hiring event for another hospital. The hospital already had my application from earlier in the year, one of the 70+ positions I applied to before starting my new grad program. I shared I only wanted NICU positions – there was no other reason I’d leave my new grad program since it was a great program in a good hospital. I interviewed with the NICU manager at the new hospital via MS Teams in between scheduled night shifts. At the end of the interview, she shared she’d like to hire me. I gave my job three weeks’ notice once I passed the background check and received a target start date. I started orientation for my nightshift NICU position at the new hospital on Oct. 1, last Friday.

I know it’s customary to give two weeks’ notice, but I felt obligated to give my old hospital three weeks. I ended up working four more shifts than if I had only given two weeks’ notice. During those four shifts, I had the most brutal shift I’ve had since coming off preceptorship and working solo. If I had left sooner, I could have saved myself from experiencing the most horrendous shift I’ve had so far. Luckily, my last shift was smooth and helped build my confidence after feeling torn down and broken from the week before – I met my patient’s needs promptly, charted everything on time, gave good shift reports, and my patients had no incidents. At my last job, I ended on a good note and had valuable learning experiences. My horrible shift in the week leading to my final shift taught me that when I’m overwhelmed, not only should I delegate, I should escalate to the charge nurse or nurse leaders. I will remember how awful my experience was on that shift to remind me in my nursing practice: “When Overwhelmed, Delegate + Escalate!”

I will remember this lesson as I start my new job. I am excited to have the opportunity to be in a NICU again. The children’s hospital where I precepted during nursing school opened its new grad program about a month after starting my previous job. Various cohort-mates encouraged me to apply, but I decided I needed to give my program and hospital a fair chance. I passed the opportunity to apply to the children’s hospital NICU new grad program before learning that my hospital would not hire me into their NICU for at least two more years. I don’t regret not applying to that NICU program because I’m grateful for my experience and feel more confident as a nurse because of what I’ve learned working with adults. I gave my program a chance and put forth my best effort, and concluded that I wasn’t willing to wait years to reach my goal to be a NICU nurse.

The earnest pursuit of career goals is somewhat new to me. For years, I didn’t know what I wanted. I knew that I was comfortable but not necessarily excited or passionate about my previous career as an engineer/scientist. During performance reviews, I would dread when my manager would ask what 5-year plan was because I wasn’t inspired by what was around me. I didn’t want my manager’s job, and other than becoming more skilled, building my expertise, and gaining more leadership experience, I wasn’t sure what else to say. Now, it’s nice to have a goal (dayshift NICU nurse) and work towards it.

It’s still a little terrifying:
“What if I don’t like it?”
“What if the staff is mean at the new hospital?”
“What if it’s not what I thought?”
“What if I’m not good at it?”
“What if I can’t handle the long commute?”
“What if I can’t last long enough on nightshift to make it to dayshift?”

Sometimes, you don’t know if you’re going to like something or will be able to handle it until you give it a try. I also have to be open to the possibility of failure or making mistakes with this new job – it’s those moments where real growth occurs, however. That’s how I became a better engineer or scientist. I made a mistake and remembered not to do it again. It’s like doing something wrong a couple of times before you figure out how to do it right, or in the most efficient way.

I think a terrifying part of being a novice nurse is mistakes in healthcare can have a profound and permanent impact on a patient and patient’s family. If I made a mistake as an engineer or scientist, many processes and people were in place that ensured no one would get hurt or injured. Delays or mistakes I made may cost hundreds of thousands of dollars, but they would never hurt someone. As a nurse, I no longer have that sense of security or protection. It’s anxiety-provoking. I’ve met many nurses with high blood pressure, anxiety, or depression due to the stresses of this profession. I don’t want to develop health issues because of my chosen career. I went into this profession to help people, so I try focusing on how I can help or improve care vs. contemplating the many ways I can injure someone or how someone may injure me (a genuine consideration with adult patients).

I’m still a recent grad with less than a year of acute care experience and still developing. Fortunately, my employer views me as a new grad and is willing to train me as a NICU nurse. I consider my new position as an opportunity to learn, grow, and be a better nurse. I’m going to try to focus on that and becoming the best NICU nurse I can be. Wish me luck!

Persistence with the Night Shift

I’m still trying to manage my life working the night shift while parenting a young child. While I wish I could engage more with my daughter, I’m grateful that she and my husband are close because of their time together without me. I wish I could give my husband more breaks from caring for our daughter solo. Unfortunately, I can’t participate in family activities like back-to-school nights or family dinners when I work. Truthfully, even when I do NOT work, I’m still exhausted from working night shifts; I can’t participate as much as I want with family activities, even on days off.

It’s a lot of effort for me to focus and maintain my clarity with sleep deprivation. When I started the night shift, I had difficulty sleeping during the day between my shifts and trouble staying alert during my shifts. I’m three months into working nights (7p-7:30a), and I can sleep about 5 hours between night shifts compared to the 3 or 4 I would get before. I am also more alert and have more stamina to last me throughout my shifts compared to three months ago. However, I now have difficulty sleeping at night on my nights off. (It was 2:30 on Monday morning when I started to write this blog post because I couldn’t sleep and wasn’t tired).

Photo by SHVETS production on Pexels.com

Here is how my day(s) off went after my last shift Friday night:

8:30 a – Come home from work Saturday morning, still stressed after a rough night shift – the third of three-in-a-row.

11 a – After showering, eating, and replaying my night in my head, I finally fall asleep – and miss out on my family’s Saturday brunch outing spontaneously scheduled with a friend that morning.

3:30 p – I wake up later than my 1p target. I feel too tired and groggy to join my husband and daughter for their afternoon pool-time.

7ish p – We have dinner delivered because I’m too tired to help prepare anything.

10 p – Husband wakes me on the couch since I fell asleep somehow. He convinces me to move to our bedroom.

2:30 a – Wake up and have trouble going back to sleep.

4:00 a – Take melatonin, hoping it will help me sleep

6:07a – The time on my clock that I remember seeing before falling asleep

7:35 a – The time I woke up when my daughter turned on all our lights and insisted on noisily searching our room for her lost unicorn.

My husband and I spent the rest of my second day off of work taking our daughter to gymnastics, having family brunch, going to church, and visiting a family friend in the afternoon and again for dinner. I briefly fell asleep sometime in the afternoon after reading with my daughter in her bedroom – before my husband woke me so we could go for the afternoon visit with a family friend. I try to enjoy days off with my family but often feel like a zombie days after I work.

When I work, I’m unable to attain the recommended 7-8 hours of sleep. I don’t think I’ve made up for the sleep debt I’ve incurred and am unsure when, if, or how I’ll make up for it. My sleep schedule is entirely abnormal, and I’m often tired. I schedule myself to sleep during certain times, but my body does not comply. I’ll fall asleep during the day between shifts hoping to sleep 6-7 hours but will often wake up after 4-5 hours. I have blackout curtains, use earplugs, play beach waves as ambient noise, spray lavender mist on my pillows and bedding, and wear a travel eye mask to help me sleep.

Travel Sleep Mask, Lavendar Spray, and Ear Plugs – standard parts of my daytime sleep routine

I don’t have television in my bedroom, and I take all phones out of the room when I sleep. I sleep for longer durations when I eat before going to bed in the morning, take melatonin, and supplement with tart cherry concentrate (which helps regulate melatonin levels). I set my alarm as late as possible before work and try not to look at my clock or phone until that alarm has gone off, even if I am awake and lying in bed for hours. I meditate or pray in bed to relax and attempt to fall asleep again if I wake up before the alarm activates. To stay awake while working, I drink caffeine but avoid it after 2a during my shifts and on days when I’m not working.

I’m not fond of the idea of having to medicate my body to either sleep or stay alert. In reality, though, I live in a caffeinated culture. Coffee and tea helped me survive nursing school. They also helped me in my first job as a nurse working swabbing shifts before 5:30a. Many people I know consume caffeine daily to be alert or as part of their morning ritual, and they are not nurses, nor do they work night shifts. Maybe I should accept that caffeine (and melatonin) are part of my weekly routine as a night shift nurse.

To try weaning off some of the caffeine, I’ve tried replacing some of my coffee intake with cacao. It has helped me during the early morning hours at work (when I think it’s too late to consume more caffeine), keeping me up without giving me jitters or hand tremors. My nursing school best friend turned me onto a brand, Crio Bru. According to Crio Bru:

“Brewed cacao is 99.9% caffeine free, but contains theobromine, a naturally occurring stimulant found in cacao that can be longer lasting, milder, and more pleasant than caffeine.”
-Crio Bru (https://criobru.com/pages/crio-bru-brewed-cacao)

It’s roasted cacao nibs that brew just like coffee, but there’s no caffeine. I like to make Crio Bru drink in a french press and keep it sugar-free.

I’ve also discovered a sugar-free cacao powder by ChocoVivo that doesn’t require a french press to prepare (https://chocovivo.com/collections/cacao/products/100-cacao-full-spectrum-cacao-powder). The hot chocolate from ChocoVivo has a thicker consistency since the cacao is not getting filtered out and is reminiscent of the hot chocolate I had with churros in Spain. It’s like drinking a dark chocolate bar. I sometimes like to add a little cinnamon to it.

I’ve been trying various techniques and methods to sleep or stay awake, stubbornly trying to make night shift work, because I eventually want to move out of my current position working with adults and work in a Neonatal Intensive Care Unit (NICU). I explored switching to dayshift when I met nurses from day shift in my cohort who wanted to work nights. However, I stopped pursuing dayshift with my manager when 1) the dayshift nurses changed their minds about working nights, and 2) I realized working the night shift was more aligned with my long-term goal to work in a NICU.

Because NICU is a specialty that people do not often leave, it is rare for any new NICU nurse to start work during the dayshift. One NICU nurse shared it takes ten years to switch to dayshift in her hospital because people never leave. I have no desire to work nights for ten years, but I am willing to work a couple of years on the night shift to work and gain experience in my dream unit. I know of a hospital in the area that supposedly has their NICU nurses move to the day shift in about 2-3 years, so my goal to to work there eventually. While I’m still adapting to working the night shift, I hope to adjust and thrive in a NICU. I’m using the time in my new grad program to adjust to the night shift, so I hopefully don’t have to struggle so much by the time I land in a NICU. I am making sacrifices now in order to reach my long-term goal to become a dayshift NICU nurse. Right now, the only way I know to get to days in a NICU is to start on nights. Hence, I continue to fight and search for ways to make night shift work for me and my family.

I would love to hear about your sleep hygiene habits and any tips for sleeping. Do you have rituals for bedtime or starting your day (or night)? What are your sleep routines? How do other parents of young children manage night shifts or graveyard shifts? What do you do to ensure you have sufficient energy while you work?

Lessons Without My Preceptor

I have been working without my preceptor since the beginning of August, or for about three weeks. I’m lucky to work in a place that values teamwork and helping one another because other nurses have helped or guided me on almost every shift since I’ve been off preceptorship. One of the biggest things I’ve learned and the best advice I’ve received as a new grad is to ASK FOR HELP.

I have no problem asking for help or clarification when I am unsure how to do something. However, I get flustered when asking someone to do things for me when I think I can or should do such things for myself or my patient. At some point in my shifts, I may start falling behind, or the unexpected happens; if I want to stay on track or not be completely off-schedule, I must ask for and accept help and support. Other nurses have started IVs or completed bladder scans at the end of my shift for me, so I can finish passing meds or complete tasks for my other patients. While uncomfortable for me, I’ve learned to ask for help and accept the support and generosity of others. (Note to self: Never mess with a funky IV contraption that ED set up – it’s probably the only way they got it to work. Trying to “fix” it just before shift change can mess it up and cause you to lose IV access, requiring a new IV start as you scramble to do morning meds).

I’m on an exponential learning curve and make mistakes. Each week, I discover new ways of doing things inefficiently, incorrectly, or in ways that doctors, patients, or my manager do not prefer. [Un]fortunately, I am learning through experience and by doing. I make mistakes or feel so uncomfortable or irritated with my performance that I must consider various ways to improve or avoid making mistakes in the future to feel competent and more confident about my work.

Communication

Photo by Tima Miroshnichenko on Pexels.com

I’m still learning how various doctors want to communicate with nurses during the night shift. Some doctors prefer secure chat, while others only want phone calls. I’ve learned preference, of course, because I’ve utilized the opposite method of communication to what some doctors wish to use. Meanwhile, my manager advised only calling doctors in an email that I didn’t read until days after sending numerous notifications to doctors via secure chat. (I now try to be more diligent about checking my work email). Ultimately, if I need to urgently communicate with a doctor about a patient condition or issue, I will use whatever method allows me to get a hold of them. I’ve also learned that it’s better for a doctor to be upset because I communicated something they thought unimportant instead of not sharing a potential issue with a doctor. Also, I need to document every attempt at trying to reach a doctor. I had a doctor upset with me for contacting him so late in the evening, even though I called his answering service multiple times, hours earlier.

Compare and Despair

To be clear, my leadership or staff have not shamed me for my shortcomings. My leaders have been genuinely supportive and offer non-discriminatory methods of correction. I don’t feel singled out by my mistakes, and I know I’m not alone when I speak to others in my cohort. However, I measure my success by using others’ progress as my ruler. For example, one of my cohort-mates calmly activated and engaged in rapid response for one of his patients on only his fourth day without a preceptor. He received accolades from the leadership team, and our manager shared his praise with the rest of our cohort. I was so impressed and in awe by what my colleague faced and how he acted in crisis.

In comparison, during my second week, one of my patients fell. I was getting the patient’s medication in the med room when the fall occurred. Falls require an incident report and are a pretty big deal for hospitals. Thankfully, my patient did not get injured and was apologetic for the fall. I felt embarrassed and ashamed for having an incident and kept replaying the scenario and trying to understand what I could have done differently or how much worse it could have been. I have been vigilant with my patients’ bed alarms and documenting their fall education since that event.

Discovering What I Don’t Know

I have done things in less than ideal ways and made mistakes and will likely make more mistakes. However, instead of dwelling on my mistakes, I can focus on continual improvement. Am I learning from my past actions or others’ mistakes? Can I figure out how to minimize the chances for errors or prevent making the same mistakes again? Can I improve on my processes or methods? As a new nurse, I have so much room for improvement and growth. I don’t even know what I don’t know, and I keep discovering this each week.

I recently learned that I needed to administer or waste narcotics within a specific time from retrieving the medication(s) from our Omnicell. For the past three months, I dispensed and gave narcotic drugs while likely exceeding this time limit because I hadn’t known this guideline existed. I had no idea until a nurse on the floor mentioned it to me this month, and my manager emailed the team after his periodic department audit. Now that I know about this limit, I try to avoid other tasks after pulling a narcotic that may prevent me from immediately administering the medication to the patient.

Moving Forward

As I’ve shared in previous posts, I’m still adjusting to working nights and have had difficulty sleeping. I think it’s also because I’ve developed stress-induced insomnia: I replay how my shifts went and how I could have done better. I can beat myself up about things I didn’t know or events I wished I had handled differently, or I can use these experiences as lessons and move forward.

I write this blog to help others and because it allows me to process my experiences as a new nurse. It’s a way to release the ideas in my head so they don’t ruminate in my mind. My blog is also a reminder to focus on neutral or positive thoughts for self-encouragement and coaching. I consider how I would talk to a friend if they were experiencing what I was experiencing.

If you are a new nurse with anxiety before/during/after your shifts or beat yourself up over your mistakes, I am with you. Without realizing it, I survived the last night shift I had without caffeine; I think my stress response kicked in, and I was running on adrenaline. (Also, a unit secretary pointed out I was having hand tremors with the amount of caffeine I was consuming, so I’ve been trying to reduce my caffeine intake). I’m still figuring out the best ways to relieve my stress and practice self-care, just as I’m learning how to be the best nurse I can be. Besides lowering my caffeine intake, I try movement (yoga or hiking), meditating, blogging/journaling, or confiding in other nurses. It doesn’t matter how old, young, experienced, or inexperienced you are – there’s always room for growth and self-discovery.

This blog chronicles my nursing journey and serves as a journal of sorts, but I share my life to support and encourage others’ success and progress, too! I would love to hear from you: How do you give yourself grace while developing and growing? How do you move forward from mistakes? How do you practice self-care? For ideas, check out the past IG post I had about the Alphabet of Coping Mechanisms: https://www.instagram.com/p/B3uuR4ynB_9/

Staying Organized: Brains and Checklists

On my first day in Nursing Fundamentals Clinical, my instructor shared a typical schedule to follow when we’re on the floor and the expected flow of the day. My instructor explained how the nurse has to keep organized to ensure the nurse properly assesses each patient, gives medications on time, takes vital signs as needed, provides education, addresses orders, and documents care. One of my classmates asked how a nurse keeps track of everything, and my instructor responded, “Oh, I use my brain.”

My classmates looked at one another, perplexed. I wondered, “How will I hold all that information and remember everything I have to do in my brain?!?” Only later, with some further explanation from my instructor, did we realize the “brain” on which she was relying to stay organized is a document and not an organ in her body.

A nurse’s “brain” is a document that helps a nurse stay organized and allows the nurse to take notes for shift handoffs, doctor’s reports, or assessments. A nurse can also use a brain to track: treatment or surgery, when to give medications or perform additional tasks, inputs, and outputs, progression of care, or the completion of orders. Of course, the nurse documents care within a patient’s chart. However, a nurse’s “brain” serves as a mini notepad or planner for the nurse between charting.

In nursing school, I was exposed to and used various types of brains. There are numerous templates for brains available, and some are even free. During nursing school, I liked trying the brains offered by nursing.com. (With a subscription, the website provides a brainsheet database of 33 different brains, some focused on specialties like ICU, Peds, or L&D). Often, units in hospitals print specific brains for staff to use. However, it is the nurse’s preference that determines the brain a nurse uses. For instance, my preceptor never uses the unit’s pre-printed brains and writes out her brain every time she shifts. While nurses are not required to use a brain, I don’t believe I’ve ever met a nurse who doesn’t use one.

After attempting to use multiple brains, I decided to design my own. Some brains don’t have enough space, are not organized the way I want, or do not capture the information I need. As a new grad nurse, I find it difficult to track the completion of required charting or documentation unless I note it in my brain. No generic brain template is going to capture the documentation unique to my unit.

As I imagined what I wanted to include in the brain I was designing for myself, I read the book “The Checklist Manifesto: How to Get Things Right” by Atul Gawande. My husband received it as a gift, and he recommended the book to me. He thought it would interest me since the author was a surgeon exploring ways to make surgeries safer. The author worked with the World Health Organization (WHO) to develop a checklist to use for surgeries, to prevent errors (and ultimately, injuries or deaths due to preventable mistakes). It was a quick and fascinating read. He explored how other industries such as construction or airlines use checklists. As in surgery, errors in those industries can be fatal. At its worst, errors in construction or flying planes can be catastrophic and result in mass casualties. Yet, such errors are rare compared to mistakes in surgery. The book discusses how he and others developed a worldwide surgical checklist for WHO and what resulted. The author also shares when checklists are inappropriate and offers tips on developing them, even down to what font one should use. I enjoyed reading the book – it was a nice break from studying or reviewing nursing-related topics, yet I felt it was helpful to me as a nurse.

Considering what I learned from Atul Gawande, I placed a documentation checklist onto my brain template. Since I’ve set the documentation checklist in my brain, I’ve been more efficient in my charting. I can ensure I’ve completed the charting documentation for each patient without spending extra time combing through various sections of a patient’s chart to verify completion multiple times. My preceptor does not have to stay over later to complete missing documentation for our patients as she did earlier during my orientation and training. My checklist lets me know what I’ve done and what’s still missing during my shift. I know I’ve become more proficient at time management since starting orientation, but having the checklist helps me keep organized and manage my time. Plus, as a checklist gal, it feels satisfying when I cross off all the boxes in my checklist by the end of the shift.

The documentation checklist I added to my nursing brain

Are there checklists you use day to day that help you in your personal life or your work? Or, are there brains you’ve used that you like? I’d love to hear and learn what works for others!

Reminder From My Preschool Graduate

My daughter graduated from preschool last week. During her graduation ceremony, she wore a cap and cape. Instead of the traditional cap and gown, she and her classmates wore capes displaying their chosen super-power. My daughter’s chosen super-power: “I CAN DO HARD THINGS.” The next day, she started her summer camp at a different school. Her best friend from preschool is not attending the same summer program, nor will she follow my daughter to kindergarten. I was probably more emotional about my daughter moving into a different environment after two years with the same preschool teachers and classmates. Despite the mixed feelings I had, my daughter had a seamless transition. She was sad to leave her best friend and other classmates but genuinely happy and excited to be in a new space and meet new friends. My daughter shed no tears about the transition (unlike me). I agree; my daughter can do hard things.

My daughter is a big reason I push myself and powered through to pursue nursing as a second career. I wanted her to know it’s never too late to pursue your dreams and that it’s okay to struggle. When she is frustrated at not doing things perfectly or independently immediately, I remind her that she can do hard things. I allow her to work a bit and put forth the effort to try things on her own. I don’t swoop in to save her or fix things right away.

A recent example of this is when my daughter tried opening a package. She wanted me to open a snack pack for her, but I said she could do it. She then tried once and asked me to open it. Again, I said she could do it. She tried again and became frustrated that she couldn’t do it. I talked her through how she could try holding it a particular way to make it easier to open. She still struggled. I began to wonder if she had enough grip strength. I still cheered her on. She eventually opened the package herself. She was proud of herself. So was I.

Sometimes things take hard work and practice before we become good at something. As a new grad nurse, I identify with this. I do not feel confident or even competent some nights. I thank God that I still have a preceptor. However, it won’t be long before I’m on my own. I know I’m capable, but I doubt my ability to do things all on time or wonder how I’d handle a demanding patient-load independently.

I understand it can take a year or two before some new grads begin to feel confident or secure in their competence. I am anxious about cutting the cord, having my assignments, and nursing solo. But I know I can do hard things. I have done hard things and can continue to do hard things.

Growth and development come from discomfort and pushing our limits. Getting better at something won’t come from doing what feels easy. Like my daughter, I’m going through a transition. I’m in a new environment with new people and doing unfamiliar things (compared to when I was an engineer with 18+ years of experience in the same company and people who knew me).

Sometimes, I have to remind myself what I teach my daughter. It might be good for me not to have a preceptor to “save” me next month, just as I don’t keep my daughter from a bit of struggle. I know it won’t be without hard work, but hopefully, I can be proud of myself as an independent nurse. Maybe you’re like me and need the reminder, too: “YOU CAN DO HARD THINGS!”