Saturday, October 23, 2010

A real sharing and a choice!

The shift began with the news we had a nurse call off and each of us would be carrying extra patients. The nurse before me left 8 infiltrated IV’s and an open wound that had not been repacked since 11:30 am, plus three other treatments that were not done at all. It was going to be a long night.

A few hours into the shift, I found myself sitting in a pool of urine with my left shoe hardly on and my right knee smeared with feces. I was on a hospital floor with my 82 year old patient, Molly*; my arms were curled around her and I was rocking her back and forth. Molly was crying and I had tears running down my cheeks. I had frightened her when I pulled her off of the bedside commode as I entered the room responding to a code that had been called on her. When I lifted her up her arrhythmic heart beat converted to a normal rhythm. It was a false alarm triggered by her excessive straining. In the rush of everyone entering the room, the bedside commode got knock over and thus the reason Molly and I were sitting in urine. Molly’s tears were from fear, but mine were from exhaustion. This was the third “code” called on my unit and my patients this evening and it was only 8:03pm.

After I got Molly back in bed, I took a minute to change my clothes and as I was in the lounge I thought, "is this what it is going to be like all the time?" Will I ever get comfortable at what I do?" I sat down, cried for a minute, then got back up and went to the unit.

This was my first job as an RN and I was in my eighth (8) week. My orientation was five (5) days long. On the first day, I did paperwork and watched safety videos. The next three (3) days I shadowed another RN. On the last day, I observed activities in the ER. After my orientation, I was assigned to the Med/Surg Unit and given a full load of patients on the first day.

All I ever wanted to be was a nurse but tonight I was wondering if I had chosen the wrong field. I doubted if I had what it took to make it as an RN. At home that evening, I played the shift over and over in my mind. I needed to assess my actions. Why did I respond the way I did? Why did I cry? I tried not to be too hard on myself, but the bottom line was if I did not want a repeat of tonight then I had to make a change. As I reviewed, it came down to one major issue: I doubted my clinical abilities. I was uptight because I was afraid I would not know what to do in an emergency. I had to find away to increase my faith in myself.

I had read a story written by Walter Cronkite where he shared that he learned early on that in order to be a success you needed to be prepared. He said for every story he expected to cover, he thoroughly researched all the available material regarding the event, the background, and the major persons involved. He went on to say he did not design plans or labor-saving machinery that might permit him to skip this essential step to doing his job to the absolute limit of his ability. His motto was: There are no shortcuts to perfection.

“Reading a book is never enough to make a difference in your life. What has the potential to make you better is your response.” John Maxwell

I figured if Walter Cronkite had to keep studying and preparing for his commentaries all of his career, perhaps that is what I was missing. I quit preparing when I finished my nursing boards. The next day I arrived at work a half hour early. I did not clock in because I was there to prepare! I brought with me several index cards and a small notepad, both of which could fit into my uniform pocket. I picked up my assignment and went to the patient kardexes. I searched each kardex for treatments, medications, procedures and unusual occurrences. If I found something I did not know or understand, I went wherever I needed to go to learn what I needed to know to do it right. I wrote procedures step by step on the index cards and then I attached them to the kardexes. If there was a medication that could cause a certain reaction I was not familiar with I wrote that on an index card and attached it to the med sheet. I was getting prepared.

For the next few weeks on my breaks, I wrote signs and symptoms and complications that could occur on the type of patients that were admitted on our unit. On one side of the index cards, I wrote the diagnoses and on the other side I wrote the signs and symptoms and complications. It was a great learning tool. I brought in a recipe box and stored my index cards by diagnoses in the box and put it at the nurse’s station. I started making care plans for the typical diagnosis we admitted, this way when a patient was admitted I could pull one of my pre-made care plans and tweak it to fit the current patient’s condition.

I found by taking these preparatory steps I was reeducating myself and building my belief in my clinical abilities. I was no longer frightened of what a shift might bring; I was now looking forward to each shift as a growth opportunity. What really took me by surprise was in a short period of time, I noticed the other nurses on the unit referring to my index cards and using my pre-made care plans. I was no longer just helping myself; I was now helping my team mates.

Lesson learned:

1. Make a decision - stay or go
2. Look around and take a hard look at what is happening.
3. Ask yourself, what part of this situation do I own? What part can be changed? What part do I have to let go because I do
not have the power to change it?
4. Do something

I had two choices:

I could blame others for my issues – after all the “other” nurses did not do their jobs completely – the “other” nurses did not run to help me and ease my burden – I did not get “enough” of an orientation – it was the hospital’s “fault” etc, etc, etc. - they, they, they, --- in other words I could take the “victim” route


I could come up with solutions and climb over my stumbling blocks to victory. Take ownership and make a difference in my life.

To no surprise, I stayed in Nursing. Did I have other nights that were worst than this one, absolutely. Did I cry again, yes I did! However, my behavior changed and again and again I found solutions and moved on.

* Molly is a fictitious name to protect the true patient
** the year is 1985 prior to package care plans and computers at the nurse’s station