I have faced tough days as a student, mom, or nurse…Beyond prayer, music helps restore me and surrender my circumstances to God. What restores you? What do you do to bring peace or rebuild your confidence when you face uncertainty, have no control, or have had a rough day?
St. Augustine said, “Those who sing pray twice.” I love to sing, and music helps inspire me. Personally, songs from church help bring me peace. Below is the link to my Spotify playlist of songs that I listen to or sing to motivate me on tough days. May it inspire or encourage you.
They say when you begin a journey (or a big project) to start with the end in mind. Before I even switched careers, I did an online job search for the job I wanted. This preliminary job search helped direct and guide what I did to prepare me for my career change.
Do this before you pursue a bunch of training and education for a career change. Look at what your dream job requires. An old co-worker of mine became a nurse while she was working full-time and tried to apply to her dream job with a government organization. Unfortunately, she wasn’t qualified because her program was not accredited. She shared how her entire motivation to become a nurse was to work for this employer, and how devastating it was to discover that she couldn’t even apply to the organization.
To be honest, I *still* search for other jobs to this day to motivate me in getting the training, certifications, or experience I need for my next possible position.
If you are a career switcher, what advice do you have for people considering changing careers? Share in the comments below!
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.
It’s the time of year when many students are getting acceptance letters to nursing schools, and I’ve seen posts on discussion boards asking for advice on choosing a nursing school. Since I lived in an area where there were many Nursing school options, I had to filter through and determine which programs were the best fit for my family and me. In this post, I offer advice on what to consider when choosing nursing schools and insight into how I chose my nursing program.
Accreditation & BRN Approval
First and foremost, ensure the programs you are applying to are accredited and approved by the Board of Registered Nursing. In the US, you can visit your state’s Board of Nursing “Education” section to search the list of approved nursing programs. The BRN divides the list of programs by pre-licensure programs (LPN, ADN, BSN, and entry-level Master’s of Nursing program) and advanced practice programs. If you’re even wondering which schools offer nursing programs, the BRN list is an excellent overview of approved programs in your state.
You do not want to spend tuition and time at an institution that the BRN hasn’t approved because you won’t be able to sit for your licensure exam (NCLEX). The BRN will list programs with full and conditional approvals. Consider how a conditional approval may affect you if, for some reason, the BRN removes their program approval before you graduate. Can you ask the school or program why they received conditional approval and what they are doing to ensure full approval? I shied away from newer programs and didn’t apply to conditionally approved ones. I sought only fully approved and established programs because I didn’t want to take my chances with enrolling in a conditionally approved program or a program that could easily dissolve.
NCLEX Pass Rates
While visiting your state’s Board of Registered Nursing website, search for NCLEX pass rates (For California, where I obtained my degree and license, the website is https://www.rn.ca.gov/education/passrates.shtml). The pass rates provide a sense if the program you’re applying to adequately prepares its students for the NCLEX, the exam required to earn a registered nurse license.
Consider on-time graduation rates for your potential schools/programs. Per the amended Higher Education Act (HEA) of 1965, colleges must publish information regarding graduation rates, retention rates, and student diversity.1 Due to the National Center for Education Statistics (NCES) definitions, graduation rates for people with second degrees or who have already attended other postsecondary schools aren’t necessarily part of a school’s published on-time graduation rates.2 However, whether you are pursuing Nursing as a second or first degree, I think graduation rates are something to consider and request from your potential school or nursing program. If your nursing program does not readily share graduation rates, you can also view graduation rates at the following NCES website: https://nces.ed.gov/collegenavigator/.
Graduation rates are essential to consider to manage your expectations. If you’re choosing a nursing program because it’s shorter than others, but their on-time graduation rate is 50% or less, you run a 50% or greater chance of spending more money and extending the amount of time to earn your degree to get your nursing license. There is a private, for-profit university known for not having a waitlist for their nursing program here in Southern California, so many students apply and attend. They can start nursing school quickly instead of getting waitlisted or possibly rejected from other less expensive, competitive programs. The program is over $100,000 for the projected three years it takes to get a BSN from this for-profit, private university. The three years are appealing over traditional four-year bachelor programs despite the cost. However, the for-profit university’s on-time graduation rate is as low as 38% for their Los Angeles campus. When talking to nursing alumni from this university, many agree that it’s easy to get held back a semester and that the program can take longer than expected. However, the additional cost and time are worth it for program graduates because it was an avenue to get their nursing degree when other options were limited.
I’m not saying to shun schools with low graduation rates. Consider graduation rates, so you know what to expect. It’s better to be aware of potential costs up-front than to be surprised when you need to spend more time and money than what the program advertised.
An obvious consideration when applying to schools is tuition. How much of a student loan will you need to attend school, or can you avoid taking a loan? For what kinds of financial aid are you eligible? (Second-degree holders do not qualify for pell grants). Can you afford private schools? Public schools are far more affordable but can also be more competitive.
Do you have grades, work, or volunteer experience that make you a competitive candidate? Do you need to repeat pre-requisite courses to increase your GPA and become a more desirable applicant? The extra time to repeat pre-requisites might be worth it if it saves you tens of thousands of dollars in tuition fees. (CAUTION: Be careful with re-taking courses or exams because some schools only accept a certain amount of repeats or will only accept a repeated course or entrance exam like the TEAS if it’s after or within a specific timeframe).
The duration of the program is an important consideration. If you’re not working while going to school, that extra time in school is potential income lost. It is ACTUAL income lost for people with a prior career like me. Like most people looking to switch careers, I wanted an accelerated program to work as quickly as possible in my newly chosen profession. I didn’t want to be in school for four years to switch careers. Since I already had a bachelor’s degree, I was eligible to apply to accelerated Bachelor’s of Science in Nursing (ABSN) programs. In my area, these ABSN programs range from 12-24 months.
Consider the location of your nursing school. Are the programs to which you’re applying local? Will you need to spend an hour or more commuting to school? Some of my classmates moved from one part of Los Angeles to another part of Los Angeles to avoid traffic that would add to their commute. Can you carpool with someone to allow you to take the carpool lanes and make your commute more bearable? Other cohort mates moved across the country to attend our ABSN program. All the nursing schools I applied to were within a reasonable drive from my home.
The school I chose happened to be the farthest from my house. When I started nursing school, I was lucky enough to discover one of my cohort-mates lived in my neighborhood, so we agreed to carpool. She became one of my best friends, and we used the carpool time to study and quiz each other (or vent about our lives as the only moms in the program).
If you can, try to find out where the schools do their clinicals. You can ask the program staff or alumni. Doing clinicals at hospitals or areas you wish to work offers excellent exposure to potential employers. The pandemic limited clinical rotations, so the recent years’ clinicals may not represent what is typically provided in a nursing program. However, you know a program is decent if they were able to send their students to good clinical locations amidst a pandemic. Also, keep in mind the places of clinicals may add time to your usual commute to school, and some may occur during the evening or night shift. Knowing this information upfront helps manage expectations.
Impressions of Alumni & Working Nurses
Talk to alumni about the programs you’re considering. Some questions you could ask:
Do they recommend going there?
Did alumni feel adequately prepared by their program?
How long did it take to graduate?
How much did it cost them vs. the advertised tuition?
What attracted them to their program?
What do they feel were the pros and cons of their program?
Talk to working nurses you trust and respect. How is working with new grads from particular schools or programs? Do some nurses seem better prepared than others? What are working nurses’ impressions of students from that school/program when they do clinicals? Do they have program recommendations? Would they recommend their alma mater?
As I shared in a prior post, I networked with others before I applied to ABSN programs and before I accepted the offer to attend my school. Talking to others about the various schools assured me that the schools I applied to were a good fit for me. My top choice school would change from time to time, but all schools I applied to were great options for my family and me.
After working hard to make sure I’d be a competitive nursing school applicant and getting straight A’s on all my pre-requisites, I got accepted into three ABSN programs lasting 12 months, 15 months, and 24 months. The cheapest program was the 15-month program from a public university, while the 12-month program at a private university was more than twice the cost of the 15-month program and the most expensive, by far. The 24-month program tuition was slightly higher than the 15-month program but had the longest duration. I chose the 15-month program to save money and time and figured the additional three months it would take to earn my degree over the 12-month program would be worth my sanity. Additionally, the 12-month program had much lower NCLEX pass rates, making my choice even more straightforward.
Although this post was prompted by someone considering nursing school offers, ideally, all the above considerations would be made BEFORE applying to nursing programs. Whether you’re sifting through nursing school offers or selecting which schools to send applications to, I hope this post helped. Please share in the comments below if you have other considerations or advice to contribute when selecting a nursing program. Thank you for reading, and good luck on your journey!
Per the National Center for Education Statistics, “The overall graduation rate is also known as the “Student Right to Know” or IPEDS graduation rate. It tracks the progress of students who began their studies as full-time, first-time degree- or certificate-seeking students to see if they completed a degree or received a certificate within 150% of “normal time” for completing the program.”
The National Center for Education Statistics (NCES) notes that “students who have already attended another postsecondary institution, or who began their studies on a part-time basis, are not tracked for this rate.”
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)
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”!
As a follow-up to my blog post last week, I thought I’d share some general tips and questions to consider when networking with others if you’re interested in switching careers. Scroll through the slides below for my tips!
Do you have any additional tips for networking or questions to ask others when considering a career change? Drop a comment below if you have something to share that you found helpful for you!
A friend recently asked me how I switched careers as a working mom. She was considering switching careers, so she wanted to know about some of my steps before becoming a nurse after years of working as an engineer. Some advice I gave her:
Talk to others in your profession of interest.
Ask them about their experience, challenges with their work, how they like their jobs, and their favorite part of their work.
Inquire about the education or training they completed to get where they are and how they got their job.
Before entering nursing school, I did these things to get an idea of what nursing was like and what I needed to do to become a nurse. To put it simply, I networked.
Build on your connections: Talk to Others You Know.
I talked to all the nurses and people in healthcare I knew. I had a couple of cousins who were nurses. Aside from periodically picking their brains at family gatherings, I asked if we could meet for lunch to discuss nursing. I asked them what they liked and disliked about nursing. I learned how they chose and got accepted to their nursing school and how long it took them to complete their programs. They shared how expensive their tuition was. I asked their impression of the various programs and the graduates their hospitals tend to hire.
If I had any nurse acquaintances, I tried interviewing them, too. I reached out to nurses I met from my mom’s club and nurses I knew from church. I offered to have coffee with them to discuss nursing. I had an old friend from college who had a friend that went through an ABSN program, and I asked my friend if I could reach out to her. My friend put us in touch, and I was able to ask her questions about her accelerated nursing program. I reached out to EVERYONE I knew who could give me some perspective on the nursing profession or nursing school.
Form Connections: Talk to Others You Don’t Know.
I even reached out to nurses I didn’t know at all. I joined a MeetUp for nurses. I explained my interest in nursing and my desire to meet more working nurses. When I’d go to my personal doctor’s appointments, I’d talk to MA’s, phlebotomists, and nurses and ask them how they like their job, what training they went through, and if they had advice for aspiring nurses. I even reached out to a nurse in my neighborhood’s Facebook Buy Nothing group. She graduated from a nursing program to which I was applying. I eventually became friends with her and was able to request her to review one of my nursing school application essays. (Sidenote: When I experienced my first death after a code blue, my nurse friend from church recommended I view a TED Talk given by a nurse about grief. The TED talk speaker turned out to be my neighbor/friend from my Buy Nothing group!)
Strengthen Your Connections: Continue to Network.
All nurses and even non-nurses I approached to discuss healthcare and nursing were supportive of me. All were willing to answer my questions. As I started to meet more nurses or people in healthcare, I felt I was getting a more accurate picture of Nursing.
I first heard the brutal truth about nurse burnout during my second Nurse MeetUp event. The host of the MeetUp, Cara Lunsford, didn’t want to scare or discourage me, but she also wanted to acknowledge the challenges nurses face and support working nurses. Until that meetup, I didn’t realize the nursing shortage wasn’t just that not enough people were entering nursing school. Cara shared that a lack of nurses also exists because many nurses leave the profession. The MeetUp was a nurses’ week event, and Cara’s company, Holliblu, hosted a free screening of the 2014 documentary, “The American Nurse.” I thought it was excellent exposure to various facets of nursing and the potential challenges I would face as a nurse. Since then, now that the world has experienced the COVID pandemic, I think more people are aware of nurses’ working conditions and burnout. My continuation to network emphasized that it’s good to learn as much as you can about your area of interest – the good, the bad, the ugly – before deciding whether or not it’s for you.
Join Professional Organizations or Online Groups
After meeting with my nurse friend from church, she suggested I join a professional nursing organization’s Facebook group. She was part of a local chapter of the American Association of Critical-Care Nurses (AACN). I asked to be part of the Facebook group before I was even in nursing school. Because I was part of the Facebook group, I learned about and attended a sponsored event with AACN during nursing school, even though I wasn’t an official AACN member. I spoke with critical care nurses who provided unsolicited but valuable advice on where NOT to work after graduating from nursing school. Eventually, I became a paid member of AACN as a nursing student. (Hint: Membership fees are cheaper if you join professional organizations while still a student. Also, professional memberships are good to put on your resume as you apply to new grad jobs.)
Before I became a nurse, I tried immersing myself in the working environment of a nurse. I reached out to a former co-worker and fellow engineer who volunteered at a hospital before she joined a full-time MBA/MPH program. Her volunteer program, COPE Health Scholars, seemed rigorous and offered excellent training. It was more than simply pushing patients in their wheelchairs or bringing them water. Volunteers took vitals, assisted CNAs with patient activities of daily living, and participated in codes, as allowed by their certifications. I learned about the program through her, and I applied. I passed the rigorous application process and training and got accepted into the COPE Health Scholars program while working as an engineer. I volunteered throughout my pre-requisites, nursing school applications, and until my ABSN program started. I met many more nurses and worked with patients in various units. The program further cemented my desire to become a nurse, gave me valuable clinical experience, and helped with my nursing school applications. Perhaps even more beneficial for a handful of other volunteers, the program helped them recognize that healthcare was not for them.
Return the Favor: Give Back
Seize networking opportunities, but don’t be an opportunist. When networking, it’s not just about what you can take from others. If you want to build relationships and good faith, offer something in return. Share your wealth with others. Your wealth is not just monetary wealth – you have skills, time, knowledge, experience, connections, and resources. Some examples of how I tried to reciprocate with others I networked with:
I offered to buy lunch or coffee for nurses who agreed to meet with me.
When my entrepreneurial MeetUp host inquired about corporate sponsorship or contacts, I gave as much insight as possible about the company that employed me as an engineer. Even though my work experience was in the consumer products sector, my former employer led a campaign to support nurses and the nursing profession.
I signed up to volunteer at AACN community service events and got some of my nursing school classmates to join me. (AACN eventually canceled these Spring 2020 community service opportunities due to the pandemic).
When another mom’s club member approached me to explore nursing as a career change, I readily met with her during a study break.
I put my friend, who is exploring a career change, in touch with the one person I knew who worked in her field of interest.
I have to admit I always found the term “networking” intimidating, but it’s something I had done before changing careers without realizing it. I hope what I’ve written provides examples of how you can network – or connect with others – to explore a second career. I’d love to hear about ways you network, what’s worked/didn’t work, and what you thought was helpful! Good luck on your journey!
Nursing requires emotional regulation in a way that engineering never demanded. If an engineering project experienced delays in my former consumer products and manufacturing career, I could have a lot of anguish, and managers may be upset. Still, such delays generally wouldn’t impact someone’s activities of daily living, quality of life, or health and well-being. There are a lot of passionate reactions when a family member expects to take their loved one home from the hospital but cannot for whatever reason. When there are unexpected treatments, tests, or further monitoring patients must undergo, people get frustrated, particularly when they feel their health issues are unresolved or worsening. The family members or patients express their frustrations with their nurses. I try my best that my patients or families feel heard or understood, but sometimes, a healthcare worker’s efforts are not enough or provide little comfort.
I’ve witnessed codes ending in unexpected deaths, and I still have to be present and care for other patients while surviving family members grieve. I’ve dealt with emotionally unstable, angry, or stressed-out patients and family members. Patients have attempted to hit me or have cussed me out. I don’t take it personally, but I sometimes fear for my safety. I feel like these instances of feeling unsafe have drastically dropped since I started working in the NICU. However, I still float to the PICU or Pediatric units. During my orientation in the Pediatric ward, a 4-year-old patient tried to bite me when another nurse and I tried to change his ostomy bag. Shortly after my cross-training to the Pediatric unit, I had a Pediatric teenage patient attack her sitter. These instances are further reminders of why I chose to work in the NICU over other units. But witnessing these events made me realize that it’s not helpful to react emotionally to dysregulated patients. I’ve seen healthcare workers respond angrily, and it does nothing to help de-escalate situations.
Aside from navigating emotional pitfalls with my patients or their family members, I’ve had to figure out how to deal with specific staff and co-workers. I have had to learn who and how to ask for help or get people to do their jobs so I can do mine to ensure my patients are getting appropriate care. Certified Nurse Assistants (CNAs) typically support registered nurses (RNs) by performing activities of daily living for a patient, taking vital signs, or acting as sitters. RNs are responsible for ensuring the CNAs work is documented and must oversee and support the CNAs work. As a new grad, I’ve had to correct a grumpy CNA about proper hand hygiene or continuously remind a CNA to document their work in the patient’s chart. I like that I don’t have to worry about this in the NICU. In the NICU, we have no CNAs. I appreciate this versus negotiating or constantly confronting an uncooperative CNA to do work or documentation. Don’t get me wrong, just as with any role (Charge nurse, RN, Doctor, etc.), some CNAs are incredible, but some are not. I like having one less variable to deal with during my shifts.
I think it’s good to get a sense of your limitations and your ability to regulate yourself emotionally. I love babies and children, but I chose to work in NICU and not focus on Pediatrics for the genuine concern of being unable to regulate myself emotionally with pediatric patients. Anyone I’ve personally known who’s had a baby in the NICU has had their child leave and carry out healthy lives. My daughter will never be at risk of being in the NICU – she’s way past that stage. However, when I find myself in pediatrics, I see patients there that could be my child – some are there due to some freak accident or unknown illness. One of the most recent times I was in the PICU, a toddler or preschooler was getting intubated on the other side of the unit – I started to tear up as the patient was wailing and crying, “Mama” while their mother held them to prepare for the procedure. I was grateful this wasn’t my patient and tried to distract myself from their cries and their distressed parents by focusing on my patient.
It’s good to see parents involved with their children’s care, but other pediatric patients are there because of abuse by family members and adults. Some of the children’s social situations are sad. I can’t dwell too much on this as I care for my patients, and I try to give the child the best care I can while they’re my patient. I try to develop a trusting relationship with patients (or family members) by promptly communicating with them and responding to their needs. For abused patients, I sometimes tell myself, “This child’s life before they arrived at the hospital may not have been so great, but I can care for them and provide some stability and safety while they’re under my care.”
Complex social problems can also occur with our neonatal patients. I see my fair share of neonatal patients in our NICU because of maternal drug use – some mothers are remorseful of their actions and are in rehab programs, while others have no desire to quit using. Sometimes it’s hard for the moms to see their inconsolable babies withdrawing and know their baby is struggling because of their drug use during pregnancy. Some babies go home with their families despite drug use, and others do not. Either way, as a nurse, I try to support the caregivers taking the babies home and educate them on how to care for their babies. I’m responsible for the care of my patient while they’re in the hospital, but I also want to support their caregivers and give them confidence in being able to care for their babies (or children) when they leave.
I’ve never had a job that demanded so much of me every day. Nursing can be mentally, physically, and emotionally draining. Until I became a nurse, I don’t think I realized the impact nursing has on a person holistically. I like helping people, I like that I can do that as my job, and I want to be able to do that for a long time. I always heard about the nursing shortage but never really considered that what was contributing to that was nursing burnout and nurses leaving the profession until I started pursuing nursing as a second career. It’s essential to be aware of the typical challenges nurses face to determine how you will guard yourself and strategies for longevity in the profession. I hope this series of posts helps provide insight into what it’s like as a novice nurse and some of the things I do to keep myself connected to the things I love about Nursing. Good luck! If any other nurses out there have other advice to share, I’d love to hear it!
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.
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.
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.
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.