Friday, May 10, 2013

Dear New Grad...

Happy Nurse's Week!

Yes, the e-cards circulating on Facebook appropriately laud and encourage all of us nurses.  Like anyone who does or does not like their job, we work hard, see the best of the best and the worst of the worst, have stinky hours sometimes, and bear an enormous burden of responsibility.  The expertise of an experienced nurse is quite literally what can save your life.  But today I want to address a group of nurses who are quite possibly the hardest workers and who will face the toughest challenge this year:

New grads.

Over the past few years, as I've significantly scaled back my hours and sort of tabled a profession that I fiercely love and would love to grow in again at some point, the Lord has dropped in my lap some unexpected opportunities to mentor and encourage nursing students or new grads.  Whether it's a mock interview, meeting for coffee, or even being connected for a quick email to answer some questions but never meeting in person, these opportunities are a treasure.  Being a new grad is no joke. Especially in the current economy. When I was a new grad, hospitals snatched us up by the dozen, often before we even graduated; you slid straight from finals to orientation within a week.  It's not that way today, when hundreds or thousands of applicants may vie for one nursing position.  Being a new grad is an overwhelming, exhilarating, exasperating, amazing experience.

So, I would like to post some encouragement for you, new grad.  A lot of this could probably apply to anyone in a new position; but I do think that the experience of being a brand new nurse is its own animal.  I'm not trying to come off like I'm some spectacular know-it-all nurse; but there ARE some things that I wish someone would have told me before I stepped into that first job.  So, here's the summary of the past few years of mentoring some of the most hopeful, bright, and talented people I've encountered...who, by the way, did end up getting amazing jobs and are thriving.  So, nervous or discouraged new grad, it can be done. ;)

Dear. New. Grad....

Welcome to nursing, congrats, etc etc.  Let me dive right in.

If there's one thing I wish someone would have gently reminded me, it's that your work isn't be graded anymore, so-to-speak.  The research you seek out, the interventions you come up with, the care plans you write - yes, the whole of your work will likely be evaluated on an annual basis, but as a rule, your consistent source of feedback isn't there anymore.  I was used to professors applauding my words, my papers, my exams, and my efforts - and that's what pushes you through school. The A or the C- lets you know where you stand.  You won't really get that in your job.  Admittedly, many hospitals have excellent orientation programs that offer excellent mentorship, but once you're off orientation, you might not hear much about the great job you're doing.  Sometimes all you'll get is negative feedback - and if you don't get ANY feedback, it may mean that you're doing great.  I know this probably comes off as pretentious or fluffy, but when I look back at the number of days I came home from work and flung myself on the bed in tears, I realize now that it was because no one was patting me on the back and telling me that I was at least on track....and I desperately, desperately wanted to know that I was at least on track.  So you might not get that feedback.  And that's okay.  Keep putting one foot in front of the other.

You will pass boards.  I know some *incredible* nurses who had to take them two or three times.  Yes, a horrifying thought. -But- one, two, twelve years's really not much more than a blip on the radar.

When you interview, be prepared to answer the simple question, "So tell me about yourself." I've had a lot of interviews between being a traveler and simply moving around quite a bit in a few-year span, and this was almost always the first 'question.'  It sounds simple enough, but when you're nervous and dressed in your best and trying to put on your best face, just being asked to tell someone about yourself suddenly feels like a very loaded question. And when I've done mock interviews, it's where most people flub, blush, look at the ground, "er" and "um" a lot, and finally choke out a not-terribly-confident response about how they have a few siblings and like to knit or run.  So think about how you'd respond!  Then practice sitting up straight, looking that manager in the eye and saying, "I'd love to!" and tell them where you're from, a thing or two that you like to do, why you became a nurse, and perhaps what brought you to this current interview.  Or something like that.

You will make mistakes.  One night when I was a new grad, I received an order to give a patient 1 to 4 mg of dilaudid IV push as needed for pain.  She rated her pain as a "10."  SO, I gave her 4mg, the maximum dose.  She was the size of Thumbelina.  Four milligrams was WAY too much.  PRAISE THE LORD she needed oral potassium, and when the LPN went in to wake her up to give it to her, that's when we found that she had a respiratory rate of 4.  You know that sternal rub they teach you in school?  It works really well when you do it REALLY HARD.  A quick dose of narcan and she was (painfully) wide awake and breathing just fine.  The outcome could have been terrible and I wouldn't be writing this today.  The doctor was like, "Um, I meant for that to be titrated."  Yup.  Now when my patient rates their pain as a "10" I start out lower than the lowest dose.  The point is, you learn from your mistakes and you never make them again, guaranteed.  No one flunked me, yelled at me, or fired me.  The rest of my shift went fine.  It's okay.  Expect it and don't beat yourself up over it.

You will never be your own island.  Yes, when you study for your boards, you really do feel like if you don't know every. little. thing. about every disease, every organ, every medication, every single one of Erickson's stages and Maslow's Hierarchy of Needs, you will most certainly kill everyone in your reach.  But that's simply not true.  You will always, always be surrounded - or at least accompanied somewhat - by other people.  When things go down, other nurses are there.  When you have a question, there's someone to ask.  You will never find yourself alone without another soul for miles and miles with a patient who is dying on the spot.  There WAS the one time when I worked in a very large NICU that someone handed me the admission pager so they could run down to grab something to eat.  They swore that the 26-week triplets who were on the board weren't doing anything anytime soon.  Well blast it, labor and delivery hit that pager about ten minutes later, and those 26-week triplets were about to come out.  Problem was, they paged it incorrectly, so all of the other people with pagers (like the nurse practitioners who were also on their break) would likely look at the page and ignore it.  I showed up alone, at a c-section for 26-week triplets! when I should have had nine other people with me, and about soiled my drawers on the spot.  BUT!  at what felt like the last possible second, the rest of the team showed up and I nearly collapsed with relief.  And now in retrospect, no way would they have just started the surgery and handed three extreme preemies to one nurse.  But at the time, it sure felt like that's what was about to happen.

You may not land your dream job right away.  You've always dreamed of being a pediatric or labor and delivery nurse.  What's available is dialysis, renal, or the neuro step-down unit.  Take those jobs. Attack them with gusto.  The pediatric and L&D job will open up at some point, but if you turn down the other opportunities along the way, you may be looking and unemployed for a loooooong time.  And, you may find that you actually enjoy setting up peritoneal dialysis.  Who knows.  I did the traditional 1-2 years of med/surg - and I know that that is met with groans of great reluctance.  But dang, those med/surg nurses have to know their stuff...about a LOT of meds, a LOT of diagnoses, a LOT of age groups.  I learned that I loved working with the elderly.  You're doing everything from changing bed pans to giving blood transfusions to taking care of all manner of post-surgicals.  You learn to hustle your bustle.  In a good way. If you have an opportunity to do med-surg or any form of ICU, take it.  Right now doing anything for one or two or three years sounds like a lifetime, but it's literally the tiniest fraction of your career, but will pay dividends in the long run as far as experience is concerned.  You will get your dream job at some point, I can nearly guarantee it.

Be open to going someplace else.  I heard a few years back that Missoula, Montana was the place to go to find great nursing positions.  A big university town with a decent-sized hospital.  But yeah, it's in the mountains pretty far out there.  Take those jobs.  Make them the springboard for where you want to go next.  You want to be a travel nurse?  You need at least a few years of experience...BUT - pick a great place to start out, and begin your adventure that way.

Now, when you do land that job....

Have big ears, and ask a lot of questions.  Listen to other nurses and how they answer patients' questions.  You'll learn a ton.

No task is beneath you.   Sadly, I'm surprised by the number of BSN students who are less than enthused about filling a patient's water, changing linens, walking a patient, or (gasp) changing a bedpan or taking the to the bathroom.  I've even heard one or two of them say, "Oh, we don't need to do that...when we start working, that's what the unit assistants do."

*scoreboard buzzer.* 

No task, no matter how small, is beneath you.  Filling water umpteen times for your patients during your shift is a nursing intervention and an opportunity to teach about hydration, edema, keeping secretions thin, preventing a bladder infection, healing from surgery, you name it.  The contents of a bedpan will tell you much about your patient's current status.  Rubbing lotion on a bed-weary back will clue you into a whole lot about your patient's skin integrity.  You won't have time to do many of these tasks and they will need to be delegated...but they certainly come with the territory AND your degree.

Keep your patho book.  And your diagnostic lab manual.  That just goes without saying.

Yes, you will write care plans for the rest of your career.  Sorry!

Learn how to be a great teacher.  One of the biggest roles you will have as a nurse is to educate, educate, educate your patients.  I worked nights for a few years as a newbie.  I always felt out of the loop on the night shift, because you don't see the docs and social workers and everyone making their rounds during the day, so you don't hear firsthand what's going on, and the report you received from the off-going nurse may have had some holes (it's hard to remember every detail at the end of 12hrs).  So I started off going straight to the progress notes and the most recent orders, and used those as part of my teaching.  A) It helps you know what the doc said or has in mind about this patient, and B) you start to become familiar with the dubious scribbling handwriting of each doc, another bonus.  Then I could go in a patient's room and confidently say, "Here's what the plan is" (within reason...obviously you're not going to march in and say, "Did you know that your doctor wrote that your prognosis is very poor?"), go over their latest orders, use that as an opportunity to reinforce new med education, etc.  Then, as you do your assessment, use that as a teaching tool - as you're auscultating lungs, review the importance of C&DB.  When you listen to bowel sounds, reinforce the importance of ambulation and hydration.  And on and on through your whole assessment.  Boom.  You've now looked at the chart, checked the orders, done your assessment, AND can fill out your education record, all in one fell swoop. :)

All of that stuff your profs hammered into you about evidence-based glad.  You will never get away from needing to know the most recent research.

All that stuff you learned about culture...yep, you'll be glad you know about that too.  And while I'm at it, if you have the opportunity to learn Spanish....yeah.  My Spanish looks like a vaudeville comedy act.  So much for minoring in French.

And finally...

Plug into a good church or community.  It's easy to let your new career consume you.  But you need to keep your faith afloat, you need accountability when you start getting crass and judgmental, and you need a life outside of work.  Because work will get your number and will take as much from you as you are willing to give...and then some.  I let church fall to the wayside for a season (it was really hard on an inconsistent night schedule), and I wasn't a pretty sight emotionally.  Make it a huge priority.

And so, dear new grad, you are welcomed into a new world of odd schedules, working weekends and holidays, and amassing some great stories.  It's also a world full of some of the most incredible, sharp, intelligent, motivated and talented people you'll ever meet.  Congratulations - your education hasn't been completed, it's only just begun. ;)

Sunday, February 24, 2013

Choking on Words

These are the most ordinary pictures in the world, but they were taken on a terribly extraordinary day: December 14th, 2012.  The day the Sandy Hook shooting occurred.  I'm not normally given to emotional reactions to the news, but I think it was a day that every person - and certainly every parent - suffocated in horrified possibility.  I took these pictures just a couple hours after hearing of the events, just to feel the weight of this thing called normal that those parents haven't grasped since their babies were silenced.

I've been writing blog posts in my mind every day since, and time and toddler and baby steal my opportunities.  Or it's just too big and too much to speak to.  But I'm choking on words that beg to be written - so tonight I choose words over sleep.

My heart is beyond heavy tonight.  The weight of heavy discussions and questions this week press on me.  The cracking of a precious mother's heart in grief over a fractured relationship with her child presses on me.  The bitter rage of a mother who unexpectedly lost her toddler - a mother I don't even know, but social media is weird like that - presses on me.  Seeing how tender my own son's heart is.  All of it.  It is so easy to ask.... long, O Lord?  How long?

Our days, they are so fleeting.  Oh Lord, teach us to number our days, that we may gain a heart of wisdom.

Several weeks ago a dear woman at church testified to the anxiety that has crippled her for years, confined her to her bed some days.  She was loathe to speak of the time it took from her children, and for her children to have to see her walk that road.  The fear that something - that huge unknown - would happen, and she wouldn't be there for her children, was unbearable.  And it locked her in and owned her.

Today this tiny minute of a woman stood before us, testifying again - this time of her release from her self-inflicted captivity.  The joy, the freedom that has finally settled upon her.

But her freedom did not come in a way that you may expect....

She is staring her worst fear in the eye, confirmed without expectation only a few weeks ago.  In just as many weeks, she may very well be standing in front of her Lord and Savior, and her good work here will be finished.

But we do not grieve as though we have no hope.

Like Paul, she rejoices BECAUSE of her chains, not in spite of them.  The worst has happened.  She no longer has to worry.  It came to close her in, but thanks be to a perfect Savior who already conquered death, who is her final hope and plea.  Cancer may take her brain and her body, but her joy and hope rest in the One who created her brain and body, who never topples off his throne wondering what will happen next.

Friends, I don't know what I would do if I didn't have the promises of our God.  I can't bear up the burdens of the people around me without knowing that they ultimately aren't mine to bear.  If I didn't have Christ to fall upon I would be *nothing.*  NOTHING.  A crushed, wrecked pile of ash.  I would not be able to handle the news on days like December 14th.  I could not bear the heartache of a devastated mother.  I just could....not.  My marriage would be a disaster and my parenting a joke.

Oh, I long for the freedom that this dear woman is experiencing right now.  The Proverbs 31 woman laughs at the days to come because no fear stands by her shoulder.  Do you laugh at the days to come?  No matter what they may bring?

I guess I really have no point in this post except to say...all of our days are few. We have no guarantee that our families will be safe, our health will be secured, our children will make wise choices, our worst fears won't happen.  But thanks be to God who is on the same throne He was on the day His Son died.  We do not have to live as though we have no hope.  There is still freedom and life to be found in our worst fear coming true, even.

I need to go to bed.  I still feel burdened.  And like I wrote a blog post that has no real point to it...but I will wake up tomorrow morning reminded that this IS the day the Lord has made and I WILL rejoice and be glad in it.  I will clean my house and feed my babies and be grateful - so grateful - that it is another normal day.

Look carefully then how you walk, not as unwise but as wise, making the best use of the time....Ephesians 5:15-16)