Still Raw: Six Months After Graduation. Five Months After Employment.

ixchel

A few months ago, I wrote an article that basically expressed my shock at the first weeks on my first nursing job. (It's called "Raw: two months after graduation, one month after employment", if you are curious.) I wanted to share how life has been since then.

I've been on the job for about 5 months now. My orientation ended about two months ago, and I'm honestly so glad for it. It's not that I don't feel like I have a lot to learn - definitely I have way more to gain before I feel confident. After having two back to back preceptors who were terrible leaders and teachers, it was a huge sigh of relief to be cut loose from them. I still struggle with the second one I had. She is terrible at communication, did her best to make me feel as small as possible, and regularly enjoyed the unit gossip and drama. She hovered. Not during patient care (at those times, she was usually unable to be found, and if I did find her, she would remind me that I need to learn how to do things by myself), but when I'd talk to other people. It didn't matter if it was patient care related or not. She literally forbade me from speaking to other people. It's was awkward at best, infuriating and distracting at worst. So if you ask me if felt I was ready to get off orientation when I did, yes, I was, but not for the reasons I should have been.

So what's changed since then? Well, a lot, really, but not everything. I still feel the shock of the first year. You know - the one that probably led to this "First Year" forum being created in the first place. But I am better at what I do. I'm not quite as slow as molasses anymore. That's been a huge victory for me, actually. While I haven't been successful yet at real-time charting for assessments, I've been getting closer to it. Getting in assessments and notes before 2200 meds has been a massive win for Team Newbie Ixchel. I'll be honest - I won't get in my whole patient group, usually, but getting in most? Total victory.

I can get through a shift. The whole thing. I'm not falling all over myself. And I've been reaching a point where I can often give report without reading like a zombie off my report sheet. The other day, I gave a bedside report with a complex patient and hovering Grandma in the room (no notes!), and I nailed every last bit of it. On top of that, I impressed Grandma because she knew I listened to her, and she demanded she get me back my next shift because she knew I paid attention to detail. Made me feel like a rock star!

So what's still making me feel raw? A few things really.

I'm still feeling the sting of the reality of nursing being harder than the expectation of nursing. I'm still pretty angry about that, actually, and the more time I have to think about it, the worse it gets. Four years of education almost scratched the surface. At first, I would think about this and say to myself, "it's not like nursing programs could really do anything any differently."

Actually, yes they could. It is ridiculous to pretend clinicals actually give a student an impression of what nursing is. It is nuts to me that assigning massive volumes of studying and careplanning simultaneously is supposed to introduce us to time management skills necessary for success in real world nursing. How about instead of stressing students out by over extending them, give them time to focus on one type of thing at a time. I wish I had had the ability to focus on the theory content more without being distracted by careplanning. How about sticking theory up front, and clinicals in the end, so that we can actually build a more solid foundation?

And stop pretending that nursing is filled with unicorns and glitter! Do you know how much I wish I could sit and hold the hand of every nervous patient and soothe their fears? I hate that I can't! Nursing school convinces us that that gets to be part of the job description regularly, for as much time as we want. So we are left feeling short when we find ourselves unable to do that.

Clinicals are perhaps a good experience in making students less afraid of patients, and on rare occasion a new skill might be learned, but they generally set up the expectation that those days are actually what nursing is. Seriously, wouldn't it be fun to have one patient and just do total care for that one patient? OMG. lol Imagine it!

Any student reading this, mark my words - you are being lied to in school, and you are being distracted in ways that are supposed to be teaching you time management, but the time management skills you are learning now have nothing to do with the time management skills you will need. Instead, they are distracting your attention away from the things you will later wish you did most, like read your textbooks. Man, I wish I read my textbooks. I still can, of course, but between kids and work, it hasn't been possible yet. Don't ditch your textbooks, friends. Maybe you'll find better time than I have.

Another thing that has me raw is staffing. Okay, yes, you can google and find this crap anywhere, but lets face it - staffing is ridiculous. I was told my floor would be 4:1, and yet, I'd say half my shifts are 5:1, and charge nurses seem to have decided the time for gentle patient assignments for Newbie Ixchel is over. I get it - they need to be fair to the other nurses and not dump a harder load on them just to ease mine. But I'll honestly admit I've had a few shifts that have completely plowed me over with patient complexity. Only one of those has left me genuinely afraid that I couldn't handle the condition of a couple of my patients. But then I've had others where the night charge nurse recognized my group should be broken up because it was just too heavy, but then the day charge nurse would say, "Oh, hey, ixchel had those 4 or 5 last night, lets give them back to her even though she'll be in each room for so long there is no way she'll get a single thing done on time, let alone clock out within an hour of when her shift should end." (Okay, not literally, but good grief.) And on nights, we seem to be chronically under staffed. No one will take overtime to cover shortages. We've had giant staff changes, especially on my unit. The way they did the schedule had to change, but they realized that 6 weeks after it should have happened. So there are many shifts short by one nurse. Hence, the ongoing 5:1 issue that might end mid December. Might.

So basically? I'm tired. Always tired. I'm disconnected from my kids and hubs because I am at work. Which, honestly, I signed up for this so I'll move past that. But it feels terrible because if I were happier leaving work, I wouldn't mind being so tired and rundown outside of work. Night shift suits me so very well. I do see my family more than I did on days. The easier shifts with higher pay can't be scoffed at either. I really thought I would hate nights. But, I don't. I just wish I were happier leaving them.

It's not all bad, thankfully. I feel the most pride when I'm pushed the hardest and I succeed. I had one night in particular (the one I mentioned I was genuinely afraid during), where I totally nailed it. It was a night with two patients on their way to crashing, while I did all the normal routine with 3 other patients. And I got every last detail right. It was success. It was a win. Maybe a small victory, but mine.

What I want is to not be new anymore. I want to get past this part. But I need this part to get past this part. So I'm pushing forward. It's demanding more of me, and as much as this makes me a masochist, I like that. Without that, I wouldn't feel satisfied.

My favorite thing I've learned? Nurses are the hospital. Before I worked in one, I thought doctors were the hospital. Now, I know and it fills me with pride. The observation of the nurse as it is reported can be the difference between a good outcome and a bad one. A nurse trusting their instincts can be the difference between life and death. I had the most amazing opportunity to witness this in action. Our hospitalists aren't used to suddenly crashing patients. When a patient has a steady and predictable decline, they get shipped off to the ICU for the intensivist. But a suddenly crashing patient doesn't happen often away from the ED MD or ICU, so when there is a crash in the middle of the night, it can be scary. I watched a nurse take charge of a situation, snap a doctor into action mode (this poor MD was a deer in the headlights), and she stayed strong in her advocacy for the patient in the face of the RT and the ICU charge nurse trying to talk her down. It certainly didn't help the patient to have them arguing, of course, but she stood her ground and the patient didn't die that night because of it. If the nurse yielded to RT and didn't get the MD to act, that would have had a very different ending. Night shift is amazingly empowering because you see more directly the individual impact you have when the additional staffing isn't available and there is only one MD on. Our role is amazing.

I haven't really said any single thing that hasn't been made the subject lines of so many threads in this place. I haven't said anything new. Goodness knows I've read all of this time and time again, but reading it certainly hasn't given the reality any amount of justice because I really felt like I was some kind of special snowflake. And eleventy dozen nursing students might stumble onto this post and say to themselves, "wow, nursing is my destiny and I'll never let it get me down!" The higher you think you are, my friends, the further you have to fall. Stay humble, and know that this is hard. I'm pretty sure it gets a lot better, but it's hard.

So now I sit here and look at my calendar. I see this month I have very, very few days off due to staff meetings and education things. I'm so worn out. I'm tired, desperately. I'm frustrated that this isn't easier. (Yeah, I just admitted that.) I do still have days when I remember that retail management or bartending is still an option. I've never in my life worked so hard. But you know what? I'm sticking it out. And I'm going to be amazing.

Still Raw: Six Months After Graduation. Five Months After Employment.

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