Entering My 18th Month of Bedside Nursing...What I Have Learned.

Lev, MSN, RN, NP

I look back at the past year and half plus and I can hardly believe I am here. I sometimes wish I was still back in school under the watchful eye of a clinical instructor or preceptor, with time to fully review charts and have hour long conversations with my patients, to be able to watch and not have to do. But, alas, those times are behind me and I am a nurse with a degree and a license. I have grown, in good ways I believe, and a lot of it can be attributed to the job, I think.

I have seen humanity. Not the full extent of it, but a lot of it. I have seen a lot of diversity. I have learned that there is something to be learned from everyone, from all cultures, and from all generations. I have learned that smiles go very far and mutual respect is paramount to a nurse and patient relationship. I have learned to set boundaries. A firm yet gentle hand keeps your patients safe, eating properly, exercising lungs and legs, and complying with medications and treatments. Did I mention respect? Respect goes a long way.

I have seen people ruin their lives. What are the biggest culprits? Alcohol, drug abuse, and noncompliance with diabetes treatment plans. The 42 year old whose mental status reminded me of someone with moderate dementia because of alcohol induced encephalopathy; her speech permanently slurred and gait permanently unsteady. The 25 year old non compliant type one diabetic, who kept having runs of ventricular tachycardia and who is already a dialysis patient, yet insisted on KFC for lunch and refused to self administer insulin. He'll be dead by the time he's 40. That was the thought that floated to my mind.

I have learned the importance of teamwork. No man is an island. We need one another and this is especially the case in nursing. I am one of those people who had a hard time delegating. I want to do it all myself. I want to know it was done and it was done well. I forced myself to delegate and now I delegate to the techs without batting an eyelash. Be good to your techs and they will be good to you. I'm still protective over my nursing only duties and I still like doing it myself, but I'm learning. Because you just have to. There's no other way to survive. There are simply not enough hours in the day to do all that is expected of us. Sometimes things have to be left for the next shift, and that's ok.

For those nurses who work with psychiatric patients and love what they do, all my hats go off to you. Working with psychiatric patients has been one of the most draining aspects of my job. Setting firm boundaries, as mentioned is very important. I've found that being able to manipulate the manipulator works as well. Setting deals works. Making contracts works. Fortunately, I've been able to implement some of the strategies I learned as a student with moderately good results. I can manage a psychiatric patient in an acute care setting. I can keep them safe and the staff free from harm. However, this all comes at a cost of feeling exceptionally mentally and emotionally drained, so that is why my hats are off to my psychiatric nurse colleagues.

Nursing has taught me how to laugh at life. My already dark sided humor has become more enhanced and embellished. There is too much sadness out there in the world and a lot of it comes with people to the hospital. Humor is a coping mechanism that has become a trademark for nursing. As a nurse, you must depersonalize suffering, while having compassion or at least feigning it. Being a nurse gives you a unique perspective into another person's psyche. You get to know your patients in a way people they see every day may never know them. The nurse and patient relationship is superficial, but deep at the same time. It's very hard to describe.

I have learned how to extend myself in ways I never thought possible. To truly put others' needs first. To forgo your nutritional needs so others can eat. I can do this but I don't think this is necessarily a good thing. The world needs nurses who are healthy to help people be healthier. I am working on making sure to take my breaks and really sit down and let the documentation rest for half an hour. Unfortunately, it seems there more focus on the documentation and not enough focus on the care that is actually being performed and then documented. For the safety of our patients, this has to be turned around.

I have learned to say no. I said 'No' to working a 4^th day one week, because, as I told my boss, "My mental health is important to me." It seems my comment has not affected his general impression of my skills as a nurse. I am learning to say no to patient demands for action right then and there. "Action right then and there" generally means: stop the important nursing task you are doing and go into waitress mode. I am learning how to work my way around giving into every single one of their customer service requests, especially when they are not to their benefit. I truly think that the new customer service focus is enabling patients to take advantage of their care providers and is actually detrimental to patient safety and progress.

I have also learned the importance of lifelong education and oh, how humbling it can be. No matter how much you know there is always someone who knows more than you do and you may be surprised at who that someone is. An open mind and an open heart go a long way when you're a nurse. When you view yourself as an educated professional and integral part of the healthcare team you won't feel intimidated. You can question orders and ask for interventions without feeling like you're bothering someone. Physicians are our colleagues, not our bosses.

Nursing has taught me a lot, yet I still jaded. I am getting tired. I can't stay at the bedside as an RN forever. I am passed the honeymoon phase and am finally fairly comfortable in my practice. I hope to move from acute to critical care, get several years of ICU experience under my belt, and perhaps apply to nurse practitioner school. Somewhere along the way, I would like to work ED, IR, PACU, vascular access, and in a clinic. In nursing there is always something new.

Entering My 18th Month of Bedside Nursing...What I Have Learned.

About Lev, MSN, RN, NP

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