Tips On How To Transition From Studentnursworld To Realnurseworld

mother/babyRN, RN

Tips On The Transition from Studentnursewold to Realnurseworld

Almost thirty years following the nerve wracking September morning I entered nursing school, I am often reminded of the first lecture and introduction. That's because it was the day I knew I wouldn't quit whatever the circumstances. I would love to share that it was because I absolutely knew that nursing was the field for me, or that nursing was in my blood.

Quite frankly, just after the instructor introduced herself and covered the pertinent facts and history of both nursing and the school (New England Deaconess Hospital School of Nursing), she also asked us to look to either side of us and memorize the faces of our new classmates because at least half of them wouldn't be present at graduation. Some would quit voluntarily and some would be asked to leave. Immediately, I felt my heart begin to race. It suddenly occurred to me that this was serious business and all other things aside with my competitive nature stoked, there was no way I was quitting. A challenge had been issued and I believed I was up to the task, if for no other reason that I wanted to be right and in charge...Well, my dad always did say that I had to have the last word.

Since that time I have faced funny, frightening, fuzzy and fantastic circumstances in my bumpy journey from Studentnurseworld to Realnurseworld. Even the ones that convinced me I either couldn't or did not want to continue on the trek somehow propelled me even further forward. There are myriads of chasms between Studentnurseworld and Realnurseworld, whatever area eventually chosen, and following are some of my own personal excursions and observations.

Destination first assignment in Studentnurseworld.

1. Learn the language of the place.

This is a hairy big deal. Most people on the outside refer to bodily functions and appendages, as well, what they are. In studentnurseworld you are taught that asking someone if they tooted or farted is just not acceptable. You must discover if they passed flatus. And not only that; you are asked and even expected to buck whatever social graces you grew up with, to ask the question in the first place. Once you discover the pathophysiology as to why the question must be asked, for the true Studentnurseworld resident, both the questions and the reasons behind them become fascinating. There is something kind of cool about having permission to go home and talk grossly to your family as a school assignment. Calling my brothers "gonads" was quite satisfying until one of them decided to look up the word and told my mother. That was not one of my best days.

"Singultus" and "eructate" sound terrible and provocatively so. Following the gonad incident at home, I threw these words into the mix. That elicited another visit by mom, who burst into laughter when I explained that the words referred to hiccups and burping. It was another little victory and an affirmation that nursing school was probably the right place for me.

2. Accept your limitations and make friends with people smarter than you.

Studentnurseworld residents are exceedingly smart. Of course, this means that you are too but do not always feel this way. Once you figure out that many of your peers are loftily above you in the brains department, align yourself quickly with them. They can help you! Of course, you are ethically and morally bound to be honest in procuring and securing their friendships, but an alliance at the top of the intelligence chain can only help you when it comes to classes, clinical and homework.

If you just can't grasp Chemistry it does not hurt if your next door neighbor is a whiz at the subject and both willing and able to share his or her knowledge and expertise. That, after all, is what a good nurse is all about. Helping people is a good thing.

That said, I would like to take the opportunity to thank my dear friend Claire who did not have the money to become a brain surgeon as she originally desired, but spent countless hours with me discussing subjects as diverse as neurosynapses and osmotic gradients in order to get me through more than one tough tutorial.

3. If an instructor singles you out and asks you some question that you have not had any time or opportunity to research, DO NOT PANIC!

OK, you can panic a little. But during my time in studentnurseworld it eventually occurred to me that even if gifted with the most amazing brain on earth, I couldn't possibly retain every single tidbit of information.

I learned that particular lesson when my ICU instructor asked me to stand up in front of our clinical group and the observing staff (some smirking some horrified) and trace a drop of blood through the human body. After a second or two of shock and extreme performance anxiety, I managed to badly muddle through a scaled down version of what actually occurs, and silently vowed to study hematology (in my "spare" time), and become an expert.

I slunk back to the dorm and burst into tears. No amount of emotional support from my roomie was able to console me. By the time I arrived at our next clinical day I believed I was ready for anything I was asked. By then I didn't only know about factor eight and coagulation; I had memorized all the clotting factors and how they worked. Not only could I trace a drop of blood through the human body, I could recite its components and intelligently discuss blood types.

Confident, since messing up in my previous embarrassing episode meant I was a target for the instructor, I practically dared her to quiz me. Her question to me was to explain the causes, discovery and treatment of someone with pseudo cholinesterase deficiency. All I can say to that is while it wasn't pretty; the experience did something to foster my interest in learning new things.

Something I DEFINITELY learned in Studentnurseworld is that one cannot know everything and a smart resident will admit it. In my next rotation in PACU, the instructor took me aside (again in front of everyone-that somehow must be a rite of passage in Studentnurseworld), turned the back of the recovery notes over and asked me to explain the why and how of every drug given pre/peri and postoperatively to my assigned patient. This time I was ready. I said, "I don't know."

The instructor stared at me for what seemed like forever (during which time my heart felt like it would burst from my body and explode), smiled and said, "Well class, lets talk about it." We all learned a lot that day and I learned that if you don't know, sometimes the best thing you can do is just say so.

4. ALWAYS stow some sweats next to your bed in the event of an unscheduled fire alarm.

I learned this the hard way at three in the morning when the lights started flashing and the sirens sounded. I had just gotten to sleep after a grueling study session and believed for a split second that aliens (from outer space), were attacking. Clad only in underwear, I followed my roommate out the emergency doors and onto the very public Jamaica Way in Boston. Let's just say the general public and the firemen were extremely entertained and even distracted by our attire. To my knowledge I was NEVER in the streets of Boston in my underwear again....

5. Very important. If you have a roommate with a significant Other, knock first.

Enough said.

6. During times when you are supposed to be studying or writing papers, take your breaks by going around and checking who is ahead or behind you in the way of completion of the assignment.

One interesting concept of Studentnurseworld is for some reason, when you find another resident on par or behind you in the assignment, you somehow feel relieved and even better. Never understood that one logically, but it always calmed me just the same.

7. Make friends with the upperclassmen.

They will watch out for you and show you the ropes. Of course, they have been there longer than you have so know a lot of the ropes are frayed, if you know what I mean....So, if you can see past their complaints, they can be very helpful and a lot of fun. Try to be helpful and available to the lower classmen and women, who like you, will be fresh, innocent and ignorant of the true qualities of Studentnurseworld. Be kind. They might work for you someday. Conversely, YOU might be working for them.

8. Try as they might to deny this fact, every instructor has his or her favorites.

You can discover that very quickly if you are astute (use those fledgling assessment skills). Hang with that person. They know they are the favorite and their ego may be such that they enjoy the status and will include you. By osmosis (see, I DID study), the instructor should be kinder to you. If not, as in my case once or twice, the favored one will go to bat for you and tell the instructor what a wonderful person you are. This makes life much easier in a world where life is tough and fast paced. If, by some amazing coincidence it is YOU who are the favorite, share your good fortune and be accepting and nice to your classmates. They need you.....Believe me, they do. You will be rewarded with a great reputation, many friends and a revered place in Realnurseworld.

9. I would encourage you to relax but I personally found that to be impossible the entire time I was there.

Except during what minimal sleep I had which, as I mentioned, was often interrupted with early morning FIRE ALARMS!

10. Get super friendly with the student librarian.

He or she holds the keys to the library, which is a place where you will be spending a great majority of your time prepping for clinical and school assignments. This is especially useful if the librarian is going through the same clinical or discussion group as you because he or she can tell you not only where the materials are located, but even save them for you so they aren't all checked out during the vast influx of students running late on their assignments. This particular tip saved me more than once. Whew. I still shudder when I think of those times had I not been tight with the librarian. It would have been ugly.

11. Practice being a patient advocate.

In the beginning, Studentnurseworld residents are lets just say, a bit awestruck and possibly even fearful of the hospital staff. If you feel that way, imagine how a patient feels.

Take the opportunity to learn to be a patient advocate in tiny little steps. For example, I was assigned to a patient with brittle diabetes who had been admitted for treatment of a nasty ulcer on her foot. The Deaconess had their own team of "foot nurses" and they were kind and caring. During the several days I was assigned to the patient, there was one resident who visited her, pretty much ignored her questions and ripped the dressing down to check it, leaving her in tears and in pain with overwhelming dread at the thought of his return.

The patient was legally blind and essentially helpless. The resident was an arrogant blunderbuss and the staff said nothing. I noticed that whenever he came to see and ignore this patient, he sat down next to her on the bed and spoke to her (and the rest of us) in a condescending manner that curled my toenails every time.

I noticed this doc always wore corduroys and was extremely into himself and his appearance and it occurred to me that we might be able to covertly teach him a lesson, or at least make both of us feel better.

I sprinkled powder on the bed after giving the patient her bed bath. When I say sprinkled, I guess I really mean dumped. In came the resident. He tore off the dressing and sat on the bed for his usual one sided conversation. When he stood up his beloved trousers were covered with powder. He glared at me with eyes that could pierce a steel wall, but I smiled and shrugged. "Sorry", I said, "I'm just a student."

The patient hugged me close and thanked me. While I wouldn't sanction that as a frequent intervention, in Studentnurseworld, where one really has no standing, sometimes patient advocacy goes beyond words and confrontation. All I know is that this guy was kinder to my patient and hopefully to others after that episode. Plus, I got a hug from a dear lady who, if only covertly, I fought for. What a great feeling. I was hooked.

Studentnurseworld is not a democracy. Trust me, you either follow the rules or you are expelled. At the very least any attempt at mutiny or change is often met head on by opposition. That sort of situation is usually headed by the dreaded "instructor." These are often wonderful people charged with molding the student nurse and preparing him or her for the transition into Realnurseworld. Not an easy task. Trust me, I know.

The first word I learned during my stint in Studentnurseworld was "homeostasis." (The ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes). I thought that was a great word. It made such sense.

What I didn't know was just how impossible a sense of homeostasis would be. Forget any sort of physiological equilibrium in Studentnurseworld. You are always fatigued and grumpy. Just when you think you have mastered something in the way of information or treatment, something else is tossed into your path. Though I never found any official bylaws of the place, I can assure you that my memory of Studentnurseworld is full of bumps and thumps.

OR rotation (recall tracing the drop of blood through the body). Same instructor was involved. One of the last things I remember her telling me was to NEVER stand in front of the OR doors. "NEVER EVER EVER do that," she insisted. There is a perfectly good reason for that, by the way, as I discovered roughly twenty minutes following her caution. Sigh....

If one stands in front of the OR doors, there is the almost certain likelihood that someone will open them without warning and the unsuspecting student nurse will go flying into the sterile field, which really (and trust me on this) REALLY screws up the plans of the day.

Also, on the subject of the operating room, if some doctor looks over at you and curtly states, "Pinch my nose," he does not mean it literally. He simply means to tighten his mask by squeezing the wire thing near the nose. Hey, what did I know? You can imagine I was not that instructor's favorite student and the end to that 18 week rotation could not come fast enough for me or her.

Concerning the transition from Studentnurseworld to Realnurseworld, one fact holds true over time. THE TWO PLACES ARE TOTALLY AND COMPLETELY DIFFERENT. You will discover early on that everything you learned in Studentnurseworld does not necessarily apply in Realnurseworld. At least, not the way you were taught. There is bound to be a captivating moment when you realize you have truly made the journey from one world to the other, and it is rarely planned or expected.

For me it was the middle of a night shift. I was on a medical surgical floor and terrified. I was in charge of two hallways of the vast floor with a robust Jamaican woman named Norma. Norma had been a nursing assistant on the unit for over twenty years.

I was the charge nurse and had been on the unit about twenty minutes.

Norma had seen them come and seen them go. She glared at me. I stared at her. It was at that moment I figured out who was REALLY in charge and said simply, "Norma," "I know that I am supposed to be in charge of you but I have no idea whatsoever what I am supposed to be doing and I am scared down to my toes." Suddenly, a crack in the staid demeanor and a wisp of a smile. "Let's go" she said and off we went to start my career in nursing. Norma took great care of me and saved my butt more than once.

I remember that she never called me by my first name. I was simply "girl" to her. It was then I realized who was truly in charge. Make friends with the nursing assistants, ward clerks and anyone else who is in the trenches. You will need them more than they will need you.

Around that same time frame I was walking down the dark hallway checking IVs when I noticed a cardiac monitor in one of the rooms. We weren't supposed to have them on the regular floor but some residents did their own thing.

Embryo nurse me didn't know enough to speak up and challenge the rule breaker so the monitor stayed. I recall that I recognized exactly one rhythm that soon after exiting Studentnurseworld. VTACH had appealed to my artistic side because of the symmetry and beauty of the rhythm.

Of course, when I passed by the illegal monitor in the hallway and discovered the patient was in VTACH, I immediately began to sprint down the hall to get the nurse. About half way down the hallway, I stopped suddenly and realized for the first time that CRAP, I WAS the nurse. There will always be those moments in nursing that are cemented into your brain. After that episode I wasn't afraid to call doctors. Those who yelled at me screaming if I knew what time it was were equally lambasted and put in their place.

You have to make adjustments from Studentnurseworld to Realnurseworld. For instance, when you are a student you are drilled in the art of orienting people to reality. It's good for them. It's soothing. It is NOT always the best thing to do and they do NOT tell you that in Studentnurseworld. So, upon entering Realnurseworld and encountering confused patients, one thing becomes crystal clear. It only takes one confused patient to disrupt a unit and drive you to tears.

Take the sweet elderly woman whom I nicknamed Houdini for her legendary skills of getting free of posey restraints. All night long she insisted there was a dog in her room. All night long I barely saved her from falling out of bed, retied her restraints, redressed her and yes, oriented her back to reality. Except for the dog she was concerned about, she was really quite pleasant, but at three am when I discovered her naked and once again, unrestrained standing in bed to get away from the puppy, I took a deep breath, briefly examined my conscience and called the imaginary dog out from under the bed. My confused lady slept for the rest of the night and I learned a valuable lesson about Realnurseworld. Sometimes you have to reshape the rules and think outside the box. I still feel a little guilty about that one.

There are too many moments and times for me to talk about at length, but I would like to share that for me both in Studentnurseworld and Realnurseworld, advocating for patients and families should always be at the top of your to do list. It is not always easy but it is rewarding. All too often you have to take risks that make your tummy hurt. People will be upset. People will be angry. People will challenge you. People will respect you.

Sharon was a twenty three year old woman who gave birth to her first baby by C-section. She just didn't recover well. Her temp was elevated and she was fatigued. No one could figure out what was going on and she eventually withdrew. She didn't want to see her baby. Her blood work was off and she didn't get any better. She complained of pain that wouldn't go away. Her doctors and nurses began to doubt her complaints.

Eventually a cardiologist determined she had a lowered ejection fraction. She was placed on heparin. She remained on her PCA and barely glanced at us when we entered her room. I was convinced she was going to die, and she made the trip up and down to ICU more than once. One morning I closed the door to her room. She looked away from me. "Sharon", I said softly, knowing my job would be on the line if anyone knew what I was about to say. Won't you at least talk with me? She stared at the ceiling but said nothing, the only evidence that she had heard me a huge tear that rolled down her cheek.

"OK," I said, "I'm just going to talk and you don't have to." "I need you to call your boyfriend and have him come in her to insist that you be transferred to Boston." "We need to find out what is going on and you need to find the strength to insist." She said nothing but more tears flowed.

The next morning was busy so I volunteered to stay and keep her as my patient. It occurred to me that she was a hairstylist and hadn't been well enough to shower or have her hair washed, so I arranged to wash her hair.

"You are afraid you're going to die aren't you Sharon?" I asked the question softly but didn't wait for a reply. "I think you are refusing to see your baby because you are afraid if you die you and he will be too attached." She looked at me and burst into tears. "That is exactly it," she sobbed, her shoulders heaving in the midst of my hug. "I'll fight for you." Was the only reply I could muster. And I did fight. It got to the point that another nurse approached the doctor and insisted that he listen to me.

Sharon was shipped to Boston later that afternoon and it was determined she had a massive infection caused by a giant abscess behind her uterus. She had to have a hysterectomy and according to the receiving doctors, was twenty four hours from death. I didn't think I would ever see her again, but she came up to our unit a year or so later with her little boy and boyfriend.

It was then I knew I would fight for patients who can't or won't fight, and it was only one of so many lessons I was blessed with on the way to and through Studentnurseworld and Realnurseworld.

To those of you currently struggling in Studentnurseworld, aside from some of the advice I have offered, be extremely GRATEFUL you live in the time of the internet and computers and be even more grateful that you can, will and do make a difference. And oh yes, welcome to REALNURSEWORLD. It's a heck of a ride but it is always an adventure!

Written by Martha, RN (formerly stumbling SN)02/08