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.

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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

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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.

From a poster in one of our break rooms

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.

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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/

COVID Mass Vaccination Clinic and Lenten Encouragment

This past week was a little whirlwind filled with holidays, starting with Valentine’s Day, followed by President’s Day, Mardi Gras/Fat Tuesday, then Ash Wednesday. I worked the early part of this week at a mass vaccination site in LA County. It was the first time I had the opportunity to administer the COVID vaccine in my job. I was glad to be of service to so many in the community and happy to network with so many nurses.

It was tiring to be out in the sun, on my feet all day, in a stadium parking lot to either observe patients or give vaccines. Despite my achy feet and slight sunburn, I was grateful to contribute to the vaccine clinic. Patients were appreciative to get the vaccine. Amidst the 4,000 people we were vaccinating each day, I saw an old co-worker and friend I hadn’t seen in 3 years since I left my previous career to become a nurse. I took it as assurance that I am where I’m supposed to be, even if I’m still searching for a new grad hospital position. I also met experienced nurses who gave me suggestions and offered help in getting me a hospital job. I took that as a blessing and another sign that I’m where I’m supposed to be. The other nurses and I worked as a team and got to know one another. While supporting the community and each other, we enjoyed the perks of beautiful weather, stadium views over our lunch breaks, and food provided by the event organizers.

Fat Tuesday lunchtime views with my complimentary cheeseburger.

After a long day of work on Wednesday, I attended Ash Wednesday mass virtually at home. Ash Wednesday marks the beginning of the Lenten season. In his homily, my pastor exclaimed, “Don’t let a good pandemic go to waste!” It’s a strange thing to say, perhaps, but it offers guidance. Now, more than ever, we can slow down and not lead such hectic lives. I don’t have the excuses I once had about my pre-pandemic schedule being busy. My family and I can’t go to parties, attractions, museums, restaurants, bars, or friend’s homes like we used to. Instead of running around with our schedules filled, we can choose to spend time in meditation, prayer, or reflection. We can (re-)connect with others and build relationships using the technology available to us. (I’ve recently discovered the app, Marco Polo, and highly recommend it for connecting with others via private video messages)! I want to use this pandemic and Lent to re-focus on my spiritual well-being.

One of the things I’ve decided to do for Lent is to meditate or reflect on scripture each day. Luckily, my church is offering a daily devotional for parishioners to use during Lent, “Embrace This Holy Season” by Joseph Sica. I have enjoyed it so far.

On one of the days I had off from the vaccine clinic, I had my car serviced. I decided to pack my Med-Surge review book with me along with my devotional and bible. (I’m reviewing the Med-Surge book to prepare for an upcoming interview). The bible and “Embrace This Holy Season” were for me to complete my daily Lenten commitment. While the dealership serviced my car, I went for a walk, grabbed a coffee, and found an empty bench for me to study and meditate. I hadn’t taken time for myself like that in a very long time; it was glorious!

When I was a younger adult, I disliked the solemnity of the Lenten season. I appreciated the focus of prayer, fasting, and almsgiving, but it seemed like such a dark time. Now that I’m older, I appreciate the preparation Lent is for Easter. Lent is like a “time-out” for me to focus on my spiritual practices.

The Lenten reflection from Joseph Sica’s book for the day was about being ourselves and loving ourselves. I found it inspiring and a great reminder. I share parts of the reflection here with you, in case you need to read/hear it, too:

Some of you may not be Christian or observe Lent. Regardless, I encourage you to take time for yourself every once in a while for reflection or meditation. Create time for peace and quiet, if you can. Some of you have gratitude journals or practice hygge. This Lent, I commit to daily meditation and reflection. Even if you don’t observe Lent, maybe consider what you can do to make the most out of this pandemic. “Don’t let a good pandemic go to waste!” Can you use this time apart from others to gain clarity? Can you practice self-acceptance and appreciation? I love to hear how others practice self-care or self-love during this pandemic! Good luck on your journey!

COVID Crisis and Self-Care

Recently, I decided to cut back on the number of days a week I work. I recognize I’m blessed to have the option to work as many or as few days as a contract RN and COVID tester. Not everyone has the financial ability to work less. I know it’s a privilege to have this flexibility. Because I’ve spent my entire adult life working a minimum of 40 hours per week, I felt obligated to work full-time as a nurse in this pandemic, even though I have a per diem contract position.

Me in my “uniform” during a typical workday.

I found myself exhausted after my five-day-a-week shifts and having to continually re-arrange my family’s schedule. I am a COVID tester for a studio. Due to ever-changing production schedules, I don’t often know what time I am to start work until the night before, and I usually do not know what time the workday will end my day has already begun. My start times last week ranged from 4:30a to 5:30a. My days ended anywhere from 2-4 pm. On days I work, my husband has to juggle conference calls while coordinating preschool dropoffs. If I don’t get out early enough, he also has to squeeze in pickups during his workday.

Besides worrying about my breadwinner husband adjusting his life to accommodate my work schedule, I began to worry about my physical well-being from working so much and being exposed to hundreds of people a week. During the past two weeks, four different nurses I work with called off work due to some illness or another. Other people seemed tenser because they discovered more people in their work or personal life had come down with COVID.

Since Thanksgiving, I get tested for COVID every day I work. I appreciated the daily tests confirming I didn’t have COVID but realized my body was feeling worn out. Even though I’m naturally an extrovert, I didn’t understand how exhausting it can be to serve hundreds of diverse clients every week. My unpredictable work schedule was also adding to my daily stress. One day I was so tired after work, I think I fell asleep on my way home at a stoplight. I know driving drowsy is extremely dangerous – I didn’t realize how tired I was.

One of the nurses I worked with is a retired hospital nurse. She is a seasoned nurse who now works per diem for “fun” during her retirement. She shared that when she was younger, she always volunteered to work overtime. It resulted in her developing hypertension and needing medication. Since then, she has become an advocate for self-care and setting healthy boundaries. In addition to her, I’ve heard similar messages from bloggers I follow: Do not do things out of obligation or because it’s what you think others expect of you. Do what is best for yourself.

Despite my co-worker’s advice, I didn’t consider cutting back on the days I worked until a friend suggested it. During a phone call, she commented on how tired I sounded and heard my increased anxiety about people around me getting sick. After some thought, I requested fewer days from my boss this past Sunday. This week was the first week I didn’t work five days in a row! I felt guilty at first. However, as COVID cases and deaths rise here in Los Angeles, I feel more secure in my decision. I’ve also had more patience and energy for work and home since I’ve had more days to rest this week.

Nurses in hospitals are overwhelmed and have contacted me to let me know all their units are short-staffed. The patient loads are high and over ratio. New grads are getting pulled off orientation to help. As much as I feel like I’m struggling to get a hospital job right now, it seems like a blessing I don’t have one. I’m frustrated and relieved at the same time. I’m glad I get to work as a nurse and contribute somehow, but I’m also thankful that I’m not like my friends and family working in hospitals witnessing the COVID deaths and raging illness. They are frustrated when they see or hear about people not following public health orders to wear masks or avoid social gatherings because they suffer the consequences in a more profound way than the general public.

To all healthcare workers right now, particularly those in hospitals, I am praying for you and grateful for you. I hope you are protected and supported and able to do what you need for self-care. I hope this vaccine is effective and able to remove the burden of worrying about getting COVID or bringing it home to your loved ones. I am doing what I think is best to ensure my family or I do not add to your patient ratios. I’m trying to keep myself safe and healthy so that I may be part of the care team in a hospital someday soon! It took a while to be aware of my own needs, but I have cut back on the days I work for my well-being. For everyone reading this, please practice self-care and keep yourself safe!

What I Learned at Preschool

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I attended my first parent-teacher conference this week for my preschool daughter.  I had wrapped up my final exams just two days before.  While my own grades were still unknown, my husband and I learned about my toddler’s progress and “grades”.  We got a snapshot of where she was as far as cognitive skills, emotional development, gross motor/fine motor, and social skills. My daughter’s ratings were “P”, “B”, or “D” for her various skills.

I asked the teacher, “What do the letters mean?”

She replied “P is for proficient.  B is for building”. 

I then inquired, “Is D for deficient?”

She said with a laugh, “No, D is for developing.” 

In a prior Facebook and Instagram post, I shared how a professor described my “deficiency” after a clinical simulation and provided solely negative feedback to me.  I was unexpectedly triggered by my own insecurities at my daughter’s preschool review, thinking “D” meant “deficient” for areas where she could use more work.  Instead, the areas where she could improve are ones in which she is still “developing”.  What if I gave myself the grace and focused on how I am still developing?  What if I transformed “deficient” to “developing?”  Stating, “I’m developing a skill” elicits a very different response and attitude from, “I’m deficient in a skill.” 

What if I transformed ‘deficient’ to ‘developing’? Stating, “I’m developing a skill,” elicits a very different response and attitude from, “I’m deficient in a skill.”

The Mature Student Nurse

I got emotional during the conference and started to cry. I cried at the recognition of myself in my daughter.  I cried about projecting myself on her progress and development.  In a moment, I felt my issues had me resigned to suck at parenting.  The traits and behaviors I notice in myself that I try to “fix” or change show up strongly in my daughter: stubbornness, perfectionism, and inflexibility.

  • She may give up on doing something if she notices she is not doing it perfectly.
    • She was doing a cutting exercise with scissors but just gave up and decided not to do it because she saw she wasn’t exactly following the cutting line.
    • I have multiple calligraphy sets that I don’t use because I get discouraged with how my writing ends up looking – even though I know the whole point is to practice.
  • She can be very driven and direct herself, but so much so where she does not welcome working in teams.
    • She loves working on puzzles by herself, but she gets upset when her classmates try to join her.
    • I sometimes find it challenging working on group projects. I dread them at times. 
  • She can fixate on things and become emotionally derailed if things do not go as she planned.
    • She melts down over clothing. 
    • I go into panic mode over a bad test grade.
  • She gets an all-or-nothing attitude.
    • She was supposed to draw a picture of herself.  She started, but was unhappy with how it turned out. She erased the image and tried to re-draw the picture, but never finished.
    • Because I want to do things perfectly, I can take a long time doing things or worse, I won’t do it at all.

I realize my daughter will naturally take on her parents’ traits – good AND bad, whether we purposefully do this or not.  How can I expect her to act differently when I do not know how to do this for myself?  How can I give her tools I do not have?  To an extent, I realize my stubbornness and perfectionism has served me well and allowed me to get into a very competitive nursing program.  However, I also recognize where it has not served me. 

I’ve heard the saying, “the enemy of great is good enough,” but I know my issue can be summarized as “perfection is the enemy of good enough.”  I can get overwhelmed or paralyzed from not being able to do things perfectly or exactly the way I think I should.  Comically, I now recognize that my perfectionism is what had me put so much pressure on myself as a parent that I was driven to tears at my daughter’s parent-teacher conference. 

I would not want to label my daughter as “deficient,” so why am I so quick to label myself this way?  My daughter is DEVELOPING. So am I. 

The acknowledgement that I am still developing is a gift and empowering.  I can work with that.  If I want my daughter to know that it is okay to make mistakes and pursue projects imperfectly, I need to demonstrate that.  Before I can change my behavior, I need to notice it.  I see how my behavior impacts my life (and my daughter’s). I can do something about it now that I recognize it.  I am figuring it out as I go along. I feel lost at times and may not make the best choices, but I’m trying – I am still developing.