Six Months In

Just realized I've been WORKING as a nurse for six months. Crazy, how time flies!

The most common question that I've gotten over the past six months is "So are you loving nursing?" It's a really tough question, 1) because the asker really wants to believe that I do and 2) I really want to say yes, but I can't.  I'm too new and too inexperienced to say I love it. I usually reply "I have good days and I have bad days." I think I'll start to enjoy it more when I stop feeling anxious before my first shift. First shifts of the week are always hard because I'm getting all new patients. Day 2 and 3, I'm a bit more relaxed because I've already cared for several of my patients for at least one night and know their routines and behaviors.

Night shift isn't so bad. It's the sleeping during the day part. haha!  Actually MOST of the time I get at least five-six hours after my shifts, but after a particularly hard shift, I often can't sleep more than a few hours because I wake up and my mind starts thinking about work and it's hard to go back to sleep. It's those times that I wish I had some good sleeping meds. Ambien\helps me get to sleep, not stay asleep (when I actually take it!).  But honestly, I have no desire to work day shift at a hospital. On dayshift, the number of people on the unit seems to double at times with doctors, physical therapy, respiratory therapy, case management,administration, pharmacists, and of course, family and visitors! Plus patients often are coming and going from tests and procedures or are discharged or admitted. Night shift is generally much calmer! Don't get me wrong, it can still be busy-- there are nights when I don't get to sit down (except for my 30 minute lunch). What I like is that the night shift nurses really help each other out. Our busy times wax and wane, so as available, we can help each other out. I'm so new that I still ask a ton of questions or need help with something something I've not done before or done only a couple times (blood warmer, feeding pump, wound care, etc...) and it would be hard on day shift to get help. I'm not sure how new nurses cope on day-shift. Perhaps they just learn faster because they see more and are forced to figure it out. But I'm not wired for it - at least in the hospital environment. Certainly I'd prefer to work when the majority work and to sleep when the majority sleeps, but for now night shift is where I need to be (and it pays more). When life circumstances change (like going back to school), I'll have to rethink things, and maybe by then I'll be ready to move into a different type of nursing that will be more accomodating to a personal life. Twelve hours shifts are tough too, but I DO love that I only work three days a week!

I've been a complete slacker getting to the gym. After completing my three work days, I'm usually so exhausted and it's tough to get motivated to leave the house. Previously I found that I was most successful in getting to the gym when I went right before or right after work or school. But on the days that I'm working I don't want to go to the gym after my shift b/c I'm dead tired and just want to go to bed. And if I go to the gym before my shift, then I will end up not getting enough sleep. So that leaves my days off...and I don't have a regular routine for those days. Maybe that's what I need to figure out.

My goal this year is to do one creative project a month. So far I'm ahead. My January project was Pinterest inspired. When I was in Liberia, I saved a few bottle caps from the soft drinks. Liberia has it's own Coca-Cola bottling company, so all the caps have the price in Liberian dollars on them. Anyways, I turned them into refrigerator magnets by gluing craft magnets inside. I love them. Then the same weekend, I made what I hoped was going to be a case/tote for my new laptop which is super thin...but the tote is HUGE and was actually designed to hold a sleeve (from same pattern package) for the laptop. So I have this nice, new homemade tote and still nothing to hold/protect my laptop! Oh well, at least I don't need to carry my laptop to work or school these days. Guess I should pay more attention to actual dimensions than to what the photo on the pattern package looks like! Ha! So I guess my next creative project should be to make the sleeve and HOPE that it works, but the tote was soooo much work that I'm a little worn out and might have to push the sleeve to spring.  Other things I want to sew this year include: seatbelt covers, hairbands, flat sheet into fitted sheet, and maybe another totebag. Not sure about after that. Perhaps I'll re-learn to crochet. I did a little in highschool, but I've forgotten anything I learned. I tried knitting and that was a disaster. Perhaps I could try it again, but it's hard to get psyched up when "casting on" defeated me the first time.

Well, I probably should be thinking about going to bed as I'm back to work tomorrow. Somehow I was scheduled for four days in a row. Can't remember if I've worked four in a row before. This past week I worked two shifts and they were pretty miserable/crazy. So I'm hoping this weekend is much calmer!

Time and Patience

Today I stopped by my nursing school to drop off a couple things and as luck would have it there was a faculty meeting and so I waited a bit and got to see a handful of my instructors and the program director. It was really good to see them!  They asked about where I was and how I was adjusting. It made miss having people in my life that care about my success. The faculty do care, despite what students think.

There are days when I wish I was back in school and enjoying the slower pace and low pressure environment. I am far happier on night shift because things are a bit less hectic and whirlwind. I've had a couple doozy nights. On night shift, we are pretty much non-stop between 7 and 11p but after that the work ebbs and flows depending on our patient load, acuity and any admissions, but usually there's another nurse that can come help when needed. There are still plenty of things I have not seen before or dealt with. In those instances, I HAVE to find help. Last night I administered blood and it was my first time. I printed out the hospital policy and procedure and with help and coaching from my Charge Nurse, things went well. Last week I had my first NG tube-fed patient that required me to do flushes and meds according to hospital policy. Every week there's something new to learn. Obviously learning is good, but I really hate asking for help (but of course I do). It's inexperience, and I hate it. One of the instructors that I saw today said that it's usually at 9 months where you start feeling a bit more confident and less insecure.  Guess I need to start another countdown timer.

Those who know me know that I don't lack self-confidence or strength. I am strong. I am confident. I just HATE feeling out of control. And honestly, that's probably the hardest thing for me as a new nurse. I have NO actual control over my patients and what happens next. I can certainly plan how I will go about my shift, but hypoglycemia, fever, arrhythmias, delirium, vomiting, chest pain, stroke, bleeding, and pain can totally disrupt those plans and I must respond accordingly while also still managing to get everything done that I must get done. I will become more proficient - more efficient. But it will take time and practice. So daily I am practicing patience with myself and others. 

The BEST part of my job is the opportunity to make a difference for a patient. Just this week I had a patient who was having trouble sleeping because of his shortness of breath combined with claustrophobia. He was a handful at night as he was uncomfortable and needed to move around but was not physically strong enough to move himself safely. He rotated from in the bed, to side of the bed, to the chair and back around and around.  At one point he said, "I'm sorry that I keep calling and needing your help... can you tell me why is it harder to breath when I'm laying in bed and a bit easier when I'm sitting on the side of the bed?" So while he was sitting on the side of the bed, I just sat down on the stool and sat with him and took the opportunity to spend time with him and explain how positioning makes a difference for people with heart failure and/or COPD. He was so grateful for my explanation. No one had ever validated his feelings or explained this in a way that helped him understand. Fortunately, I was finally able to get him some medication ordered that took the edge off his anxiety and shortness of breath so that he could sleep. In the morning I came by to check on him before I left for the day and he said "I want you to know that I really appreciate you taking the time to  explain things and your help last night. Thank you." Yes, he was a lot of work for three nights, but it's so satisfying to come alongside a patient who is really struggling and to not only help them with their physical needs, but to also see the light bulb go off after providing just a little bit of education about their situation. 

When I look to the future, I don't see myself doing bedside care for the long-term, but rather I see myself in a patient education role or working in a clinic where I can spend more time with patients. Perhaps a cardiac device clinic? I think I'd be happier in a position that is a bit more predictable, consistent and is less "in the moment" acute care.  But who knows - maybe with time and increased experience, I will grow to love bedside care such that I can't imagine being anywhere else. Time. And. Patience. Oh joy!

Missed Me?

Yeh, well, returning to work full-time has certainly reduced my leisure time. And working twelve hour shifts has certainly taking some getting used to. Last week I switched over to nights and tonight is my last shift on official orientation. I still have so much to learn and there are plenty of things that I haven't seen before that I will need assistance with.

Last weekend I officially moved in to my new apartment. Well, I'm not exactly moved INTO my apartment as there are boxes and piles of stuff that I need to find homes for. I still have flower pots outdoors and a few things in the garage at my previous location, but the homeowners are not chasing me out - yet. It's nice to be in my own place and allowed to decorate and organize as like. But I have too much stuff and yet it's hard to let go of perfectly good stuff knowing that ONE DAY I might want it!

Two weekends ago I flew to Michigan for the 20th highschool reunion for the school I attended through 9th grade. Since I was in touch with most of former classmates they invited me to attend even though I didn't graduate from there. It was really great to go back and catch up with those friends!  A week from tomorrow I will drive down to South Carolina to attend my actual 20th highschool reunion. I've been to SC within the past five years and have seen a few classmates during those visits, but I haven't seen the majority of my graduating class since our 15th-- which was before my trip to Liberia (I think). My night shift brain is kinda unreliable with that sort of information. While I'm looking forward to my SC trip, I will be glad to have my big travel plans and events (moving!) out of the way for a while. I'm ready for normal for a while.

I will eventually get around to writing about my orientation in a very general way. Eventually. Won't promise when! :)

Until next time.

RN Orientation: Week Four

Well, I'm already half over with week five and I realized I have not posted on week four!

I'm doing a bit better with packing sufficient food and taking breaks to eat. I've tried a few protein shakes (soy, whey, other) with mixed results. I've started packing two hard-cooked eggs which are quick and easy to eat (if I peel the night before). And I'll eat one mid-morning and another mid-afternoon. I also made a batch of peanut butter balls (PB, honey, powdered milk) and they've been tasty treat that I look forward to. I think part of my issue of feeling tired and hypoglycemic is partly being dehydrated, so I'm trying to make more of an effort to drink more water throughout the day with a goal of drinking 16 oz in the morning before work and 16 oz at lunch and 16 oz on my way home. It hasn't worked out completely that way, but I when I have consumed more water, I have felt better. Of course more water means more trips to the bathroom - which often feel like a luxury to a day-shift nurse!

There are certainly moments where I feel completely overwhelmed and clueless as to what to do or what's expected. I was an excellent student but it doesn't mean that I retained it all (disease processes, meds, heart rhythms, etc...) And here I am learning so much at one time, that I feel like I'm not retaining it very well. But with practice comes familiarity.

In school I never got to insert an IV in a live person (only fake arms) and within the last week I've had two opportunities to insert them but b/c of various circumstances I didn't get to... But chances are I would not have been successful anyways as BOTH patients were elderly and ended up being VERY difficult sticks...even for the experienced nurses (requiring several attempts). My time will come!

In a few weeks I will be caring for three patients "independently" with my preceptor as backup. I'm a bit nervous about this as every day I'm experiencing all sorts of new scenarios with each patient I'm assigned. And while I feel comfortable with certain aspects of patient care and assessments, the other aspects such as calling docs, IV therapy, patient teaching, answering patient questions, knowing protocols for post-procedures and other scenarios (stroke, chest pain etc...), well, they are a bit more intimidating. Everyone says I'm doing well, but yet I have a lurking fear that I just have everyone fooled. But I KNOW that I will rise to every opportunity. Every new RN has strengths and weaknesses and deals with feelings of insecurity and feeling stupid. But we all have to start somewhere. Everyone has been so nice and supportive and encouraging -- it's my own insecurity that makes my sleep a bit restless and not restful.

I'll write again in a few days with update on this week (week five) and some things I'm looking forward to that are not work-related.

Bad Dream

Last night I had my first dream related to starting my new job. You know...those dreams where everything is crazy and goes unbelievably wrong and when you wake up you are sooo relieved that it was just a dream. For me, throughout my dream I was in a state of frustration, stress, embarrassment and completely overwhelmed. When I woke up, I was so relieved that it was not real and started processing through all the problems encountered in my dream and how I should've handled them or how I could've prevented the problem in the first place. For example....in my dream, I had multiple patients (five?) in one room and I had an elderly patient who was peeing endlessly and consuming all my time as I repeatedly tried to clean her up! Hello??? Why the heck did no one think to put a brief on her? And because of this I had not gotten any vitals on any of my patients and not a single assessment either! In my dream I was glued to this patient and stressed out about not getting to my other patients. Ack!

This afternoon I was telling a friend from nursing school about the dream, and she laughed when I told her that I reviewed everything that went wrong in my dream. She said... "It's like you were evaluating your nursing interventions!"  Yeah, what interventions?!?! hahah!  But it's true- I was using the nursing process in my dreams (albeit mostly unsuccessful), but especially after I woke up when I starting thinking through all the things I could've/should've done instead. I guess I learned something in school!

So there you have it... I guess I'm experiencing some anxiety about starting my first RN job. I guess I should be prepared for some more crazy dreams in the coming days, weeks and months. So not fun.