An Introvert's Guide To Nursing

SoldierNurse22, BSN, RN

In the hustle and bustle of morning shift change on the busy GI/GU unit, I stuck close to my preceptor, watching it all with wonder and more than a little bit of fear. I took report as best I could, checked my sheet against the assignment board, and took a deep, terrified breath as I followed my preceptor into our first patient's room, and another day of discoveries and interactions began anew.

My Introduction

Hi. I'm SoldierNurse and I'm an introvert, but you wouldn't know it to look at me. Not while I'm at work, anyway. You see, it's been nearly four years since I was that scared nursing student described in the short narrative above, and I've come a long ways since then. As the topic of introversion and the common challenges ascribed thereto have been discussed frequently on AN in the past several months, this article is intended to be a guide to encourage and inform the shy and interpersonally-challenged as they push their way through nursing school and their first years of practice.

The Bad

Let's start with what people tend to notice first about us introverts: the perceived limitations we bring into practice that come molecularly fused to our personalities. I'd be doing you a disservice if I lied, so I won't--there are drawbacks to be an introvert and a nurse...just like there are drawbacks to be an extrovert and a nurse. The key for both the introvert and extrovert is to find those factors that may inhibit you and target them for improvement. In this section, I'll address the major issues that most people worry about when they think about introversion and nursing.

I'm Really, Really Shy

It should go without saying that crippling shyness could be a limiting factor in your practice. Nurses interact with people in a wide range of social settings all day long. If you experience a certain amount of discomfort in unfamiliar, new or challenging social situations, nursing could be painful for you, especially as you first step into patient interaction, particularly in nursing school.

I'm a Student; What Do I Know?

Honestly, not a whole lot. With that said, it's understandable that you're going to feel some anxiety as you start to interact with patients and you realize exactly how little you know. If we introverts are forced to talk to people in the first place, we prefer to come armed to the teeth with expertise, but nursing isn't going to be like that. You really want to give your patient/preceptor/coworker a confident, honest reply, but what do you do when you simply don't know?

I Only Tend To See My Faults

Let's face it: we introverts can be very, very critical, and usually, we're most critical of ourselves. That doesn't tend to help a sometimes innate lack of confidence, and the harsh inner voice that's constantly criticizing our every little move can be a real inhibition to practice and improvement therein. Constructive criticism is one thing. Constant condemnation is quite another.

I'm Not Good at This

One of the introvert's favorite tricks is to tear oneself down even when they're trying as hard as they can and are perhaps even on par or above those in their class. If your basic nurse is a Type-A overachieving show horse, then introverts with a critical inner voice are the racehorses of the pasture. It's surprisingly easy to jump into something new, struggle to keep up with an incredible knowledge burden and blame yourself as you fight your way through a high-paced learning process. The trick is allowing yourself the time you need to learn and learn it right, and that means accepting that you're not going to be proficient at this right away.

People Think I'm Unfriendly

Use whatever word you want, but we quiet ones tend to get a bad rap. We won't come up and greet you like an extrovert. If you're anything like me, then you tend to enjoy watching social situations before entering them, and only if you absolutely must. It's the same reason some people don't like cats--we introverts can be kind of aloof. As such, people may perceive that we're cold fish, and it's absolutely true that your patients, coworkers, bosses and potential employers will treat you differently if they don't get the right vibes off your handshake or smile. Your body language and tone of voice are essential pieces to your nursing practice that you cannot afford to ignore.

I Hate to Bother You

Hand-in-hand with being quiet is not wanting to be a nuisance. While this can be a very useful skill, it can also limit one in nursing as nursing is still a trade that is largely learned from other nurses. It's one of the many reasons that preceptors are essential in making a competent nurse. Human-to-human interaction doesn't end with a patient, and if you're not confident enough to approach your preceptor with questions, you're going to have problems.

I Can't Stand Conflict

If you don't like dealing with people on a regular basis, the idea of facing interpersonal conflict has the ring of a nightmare. However, anywhere that you have people working together in any field, there is bound to be conflict. The trick is to learn how to anticipate, dissipate and resolve conflict before it gets out of control.

Story Time with SoldierNurse: Part I

I tried to smile convincingly, but I already didn't like what I was seeing with this patient. She had been chatting nicely with the receptionist, but she shut down immediately when she saw me approach with the chart. Was there something wrong with my hair? Was I not smiling widely enough? Great, now I'm smiling too widely. Add some Bozo The Clown hair and I'll fit right in under the big top next time the circus hits town.

"Hi, Mrs. Jones. How are you today?" I ask, mustering my best happy face.

"I'm OK." She replies, eyeing me curiously.

OK, I saw that. I know I saw that. Is it me or her? My last patient was fine! Does my breath smell funky? Am I even close enough for her to notice my breath? Whatever, I'm neck-deep in this now, I decide and press on.

I get her weight and height and take her to the treatment room, trying to make conversation, but my patient's lips are locked tighter than a drum. Maybe I'm losing my touch. I was doing so well with that other patient. Is it possible to lose one's mojo in less than 30 minutes? Ugh, I need to get my head in the game or I'm going to miss this IV stick--and then what will she think?

The rest of the appointment goes awkwardly, despite my best efforts to establish rapport with the patient. When she leaves after her treatment completes, I feel unsatisfied and concerned for the next time we meet. Does she trust me? Will she tell me if something's wrong? What could I have done better? What the heck is my problem?

The Good

All right, enough with the bad stuff. Believe it or not, you as an introvert do bring certain strengths to the table. While it's often undervalued, many introverts come pre-equipped with certain skills that are great assets when it comes to dealing with other people.

I Don't Speak, Therefore I Listen

Anyone who's spent any time in nursing school knows the incredible value of listening to the patient. One of the complaints I hear most often about providers of all levels is that we don't really grasp what the patient is trying to tell us. As an introvert, you're probably naturally inclined to clam up and let someone else do the talking. Sharpen your listening skills and enjoy the effortless rapport that forms when a patient realizes that you're honestly interested in hearing what they have to say, not just telling them what you think or what to do.

The Devil's In the Details

Riding on the coattails of active listening is asking pertinent, thorough questions in one's assessment. When you're really concentrating on understanding what the patient is trying to say, you have the unique ability--and often ample time--to absorb, process and form relevant, significant questions to follow-up on the patient's concerns. This leads to a concise, complete view of the patient clinically and also lends itself to building rapport.

The Constable's Responstable

In following with not drawing attention to oneself, introverts are often timely, rule-abiding folks who like to avoid the embarrassment of being late/wrong/negligent and the consequences associated with those infractions. Employers, coworkers and patients tend to enjoy punctuality and the (at times) intense level of responsibility that is innate to many introverts. Capitalize on that. Where you may struggle in interpersonal interactions, this side of your personality will show folks that you really do care.

An Ounce of Prevention

Introverts tend to be very thoughtful, and often, that thoughtfulness can help a nurse to recognize problems or issues before they arise. If you're looking ahead and you see a problem, whether that be in a patient's plan of care or your personal study plan, act on it. If your gut is telling you that something's wrong with your patient, don't be afraid to speak up and ask questions of your preceptor/fellow nurses. If something is in fact wrong, then kudos to you for seeing it! You're developing as a nurse. If something isn't wrong, then you got an answer and clarification that will help form your critical thinking skills and add to your knowledge base. Lesson learned.

An Instinctive Understanding

Many introverts are so in-tune with their own feelings that they're often very sensitive to the feelings of others. Personally, I tend to enjoy people-watching from dark corners and safe distances, and while some may see this tendency as creepy, this can develop one's ability to notice and interpret a myriad of clues as to the mood and behavior of other people. If you play this talent right, you can use that ability to understand how a patient is feeling, allowing you to better relate to them and earn their trust. If a patient is irritable, give them the space they need to vent their feelings. If a patient is upset, do your best to understand why without pressuring them. Reassure them by conveying that you empathize with their situation. Being understood is a basic desire of the human experience, and the healthcare setting is certainly no exception.

The Queen of Charting

Personally, I am very comfortable with the written word, and many introverts may find that they feel the same way. I have earned a reputation in several facilities as the Queen of Charting as I can write a veritable book about a questionable interaction/treatment that's as legally airtight as anything a neurotic lawyer off his anxiolytics could ever cough up. If you find that you're also a bedfellow with a pen/typewriter/computer/chisel and slate, use those skills to augment your nursing practice and improve your documentation by providing professionally-worded, thorough, objective narratives when necessary. You really never can tell when this will help you--or your patient--in the future.

Story Time with SoldierNurse: Part II

We had been warned about our patient. My preceptor, a seasoned, energetic CNA, charged into the room to face the man who lived in legend on the 4th floor ortho unit. She fought with him from the second she crossed the threshold and ended up leaving frustrated, the linens unchanged and her moody patient unwashed.

An hour later when she had cooled off, she asked if I'd go back into his room and see if our irritable patient would consent to a bath now. Though I was undeniably intimidated by the show of temper I had witnessed a little earlier, I did as she asked, almost literally shaking in my Dankos as I walked into room 20.

I was only eighteen, a new EMT-B who had been hired on as a PCT in a mid-sized urban hospital, and incredibly inexperienced when it came to patient care. When I entered his room, his eyes settled harshly on me. I knew I was asking to get burned, but something instinctive in the pit of my stomach insisted that I speak despite that fear.

"Mr. Jones, I'm SoldierNurse. I'm a tech working with Jane today. I'm sorry that you're upset, Mr. Jones, but we're only trying to help you. What can I do to make this better?" I asked genuinely.

That moment stretched in a stunned silence. His jaw tightened, his brow drew down harshly, and I steeled myself against the verbal lashing that most of the other CNAs and nurses on the ward had received from this patient. But just as he looked ready to unleash the storm, his expression broke and he shook his head, gazing down sadly at his sheets.

"I'm sorry, SoldierNurse. I don't mean to act like I do."

After I picked my jaw up off the floor, we had a half-hour conversation, the patient doing the majority of the talking. Turns out, the scruffy, angry man in the bed was a CEO of a major corporation, accustomed to giving the orders and not receiving them. But now, in pain and in a hospital bed, unable to care for himself and being told what to do by professionals half his age, he found himself disabled, dependent, and afraid. Anger-fueled attempts to control the staff were his reflexive attempts at re-establishing control over a situation that was unfamiliar and frightening, even at the age of sixty-two.

"I know this is difficult for you, but believe me when I say that we're all just trying to help you. It's clear that some of the staff have rubbed you the wrong way, but if you let us help you, you'll recover faster. We'll get you back to who you were before all this happened."

A moment passed as he processed my words. "Then I suppose you'd better get the wash basin, young lady." He said, a smile breaking across his face.

The Way Ahead

Whew! Take a deep breath--you made it to the best section! Below, I'll describe a few techniques that have worked for me personally in my ever-evolving career as a professional nurse. Please note that these solutions require dedication and, above all, practice. That means frequently inserting yourself into that uncomfortable situation and learning to deal with it. Hey, I said you could do it. I didn't say it'd be easy.

Patience, Patients and Preceptors

No matter how much you want to be, you're not going to jump into this field as an expert. There's simply too much to learn. Allow yourself the room to learn, to experience, and to grow as a professional. Learn how to tell your preceptors and your patients, "I don't know, but I'll look it up and get back to you". There's no shame in not knowing. And instead of feeling embarrassed when you have to look something up or ask what you feel is a stupid question, look at it this way: next time, you'll know, and it'll be one less question you have to ask!

Fake It Til You Make It

This phrase comes straight from the lips of the preceptor who guided my through my senior practicum. To clarify, this doesn't mean that you ought to lie or pretend you know how to do something when you don't. The idea here is to feign confidence until you actually have it. This allows your patient to relax, and believe me, you won't help yourself by making your patient nervous by explaining to them just how inexperienced you are with starting IVs. As always, be honest, but be confident, even if you have to fake it at first.

Ask, Ask Again

Didn't get it the first time? Better ask again. Swallow your pride, march up to that nurse who's been wearing whites since you were a twinkle in your father's eye, and ask again. This not only reinforces the right way to do things, but it also saves your patients from potential error. And I really don't care if you think your preceptor might tear your head off if you ask for clarification/instruction about how to prime an IV line one more time; better that you be headless than your patient be in danger. They're a preceptor and you have every right to ask questions. That's quite literally what they're there for. If you feel uncomfortable doing as much, then it may be time to talk to the right authorities about securing a different preceptor.

No Offense

Let's face it--you're an introvert. The first person you look to for a cause of trouble is likely yourself, especially in a situation that's unfamiliar to you, even if you know it probably wasn't your fault. But if you worry yourself over every little interaction, every curious inflection in your boss's tone and every questionable piece of body language you encounter, you'll drive yourself crazy and probably destroy your confidence in the process. You're learning, so give yourself permission to be a learner. If people have a problem with you asking questions when you need to, that's their issue. You have your practice, your license and your patients to worry about.

I Think I Can

You know that situation that freaks you out the most? The one you can't stop obsessing over? Time to redirect that energy into something useful. Put yourself in that situation and think about what you'd do. A patient becomes angry with you and starts to cuss. A family member makes a scene at the front desk. Your coworker angrily accuses you of something you didn't do. A doctor on a caffeine binge tries to pick a fight with you at the nurse's station. What do you say? How do you react? Try to prepare yourself with a calm response and a controlled reaction before the chaos inevitably hits. You may be surprised how well you handle the heat when you've got a script already prepared in your head.

The Value of Experience

If you're looking to gain some confidence before you enter practice as a nurse, consider working as an EMT/CNA/PCT. The exposure to the hospital setting, the ability to watch nurses practice at a close proximity and the interactions with patients can grease the wheels for you when you become a student and a new nurse. I can personally vouch for this method's effectiveness when it comes to developing a certain level of ease with interpersonal interactions within a hospital.

Lock It Up

A familiar Army term, I'd apply the above saying to your emotions. As a general rule, introverts tend to be less outwardly emotional, but I've noticed over the years that the one thing that can make me lose that natural cool that keeps my reflexive responses in the deep freeze is rudeness, lying and outright disrespect.

If someone really steps on your feelings--a patient calls you a couple choice names, a family member questions your competence, a preceptor says something derogatory, a doctor tells you where to go--then you'd better lock it up. Do not reaction in anger or sadness or fear. Whatever you do, do not cry. Walk away if you must, but if you stay to engage your attacker, learn how to rein in your emotions and respond like a professional. When the situation is over and you're somewhere safe and private (see: NOT the elevator on the way to your car or Facebook/Twitter/etc), THEN you may feel free to cry/vent to your cat/cuss in the shower. But whatever you do, when you're in the moment, don't let them see you sweat.

Practice Makes Confidence

It's the situation you avoid the most, and it's staring you in the face. Despite that gnawing anxiety in the pit of your stomach, jump off your butt and do it. Face that fear head-on and learn through taking the bull by the horns. Of course, the risk is always that it may not turn out as you'd like. What would you do differently? Perhaps you handled it better than you thought. What'd you do right? Do what you do best and evaluate yourself and how you acted/what you said. It's only through this process that anything ever improves, but you must first be willing to challenge yourself by tackling your fear. Don't be afraid to jump into the ring.

Conclusion: Nurse Face

That's what I call it: my Nurse Face. She's the social, professional persona that I wear while at work. Nurse Face is the end result of that practice and confidence you're striving to build. Eventually, you'll hit your stride and find a grove in which you're comfortable, and that's who you'll be as a professional. Not only does Nurse Face allow you to function in the workplace, it also protects who you really are--your true personality--from the harsh realities of a job where you'll encounter often less-than-pleasant people all day long.

All that said, that isn't to say you won't have difficult days even when you find your feet in this profession. That isn't to say that you won't feel at times as if your Nurse Face has failed you or that you just can't seem to get it right. After all, you're only human. To quote a famous playwright, "If you prick us, do we not bleed? If you tickle us, do we not laugh? If you poison us, do we not die? And if you wrong us, shall we not seek revenge?".

Just because you're a nurse doesn't mean you're invincible, and you oughtn't expect yourself to be. Stand up for yourself, do not abide abuse, and do not allow it to happen to others. Above all, keep in mind that nursing as an introvert is far from impossible, and contrary to popular belief, you have valuable skills and insights to bring into practice. Give yourself the alone time you need to recharge, don't be too hard on yourself, and practice, practice, practice.

Chin up, introverts. We need you out here!

MY DISCLAIMERS

Please note that this article is geared toward students and new nurses involved in direct patient care and may not apply equally to every nurse everywhere who ever existed across the board.

In addition, this article contains broad generalizations and personal observations about introverts that indeed will not apply to equally to all introverts everywhere. That being said, please cherry-pick this article and apply solutions liberally to yourself as you see fit.

I have nothing personal against extroverts and do not intend any portion of this article to imply that extroverts are lesser or inferior beings--merely strange, peculiar--albeit often lovable--ones who introverts frequently have difficulty understanding. If you're an extrovert and offended, write your own article! I'm sure the other extroverts will appreciate it and I as an introvert would be happy to try to better understand a vastly different way of seeing and experiencing life.

**Details of the stories told in this article have been changed to protect the identities of patients and coworkers.**