How Do Nurses Do It?

[KnitWitch, ASN, RN]

I'm in my first semester of clinical courses (after working on getting accepted to my ASN nursing program for a year and a half). Right now we're in a transitional care unit that deals with patients in orthopedic rehab after joint replacement surgery. I really love what I do -- I get out of bed at 4:30am once a week to get to my clinical on time and I love it. I couldn't do it if I didn't love it. But this past Monday I just struggled.

It wasn't a bad day. Nothing went wrong. Meds were passed on time, patients were up, fed, dressed and out to PT on time, everything worked. But for the life of me I could not find my stride on the floor. Everything was a struggle. Getting vitals, motivating patients, dealing with PT... everything that came so easily in past weeks I had to fight tooth and nail for on Monday.

It didn't help listening to the nurses give report in the morning. How do they KNOW all those things? How do they keep track and know what's important and what isn't? How do they remember the significant findings versus the typical patient complaints? My mind just boggled, both during report and talking to the nurses as I shadowed them on the floor. I feel like my brain will never be able to keep up. I feel like I will never be able to keep up. And this is just on TCU. I had aspirations or working ER or Trauma some day but if I can't get my head around a unit as straightforward as the TCU how I can ever hope for something more high-pressure?

Don't get me wrong -- I'm by no means ready to quit nursing. I still love it, every minute of it, even the minutes filled with poo, non-compliant patients and difficult MDs & administrators. I just don't know how or if I'll ever be good enough to really focus on the areas I want to focus on and work with the ease and grace of the nurses I'm working under right now.

Advice, tips, and cheering up is most appreciated right now.

[jnick31]

Practice, practice... and more practice. Some days are a sprint, some days are a jog, but one day we will be the ones student nurses are posting things like this about.

[llg, PhD, RN]

jnick31 is right. Practice, practice, practice. No one is capable of doing those things in the beginning. It takes months and years of practice to develop the knowledge and skills you are trying to acquire. You are just at the beginning of your journey. It's a long road ... try to enjoy the trip along the way.

[TheGuestNurse]

One day at a time.

The rewards are subtle but worth it.

As far as knowing what is important, well that just comes with time. You will slowly develope an intuition about things and your nurse spidey sense will take control in situations when needed.

Just breath, do your best, and know that there will be a day soon when things, at least most of them, make more sense and are more fluid.

Time and patience will aid you in your understanding. You're desire to get it now will make you a better nurse. I had no idea what it was I was even tryig to get until I was 6 months out o school, so really you are ahead of the game.

[Music in My Heart]

I'm a firm believer in the general notion of biorhythm and psycorhythm. Sometimes, we're just not hitting on all cylinders - despite being well rested, well hydrated, and well nourished.

I had just such a shift last week. For some reason I was just in a funk and having trouble remembering and processing... There's no clear reason for it, it just happens.

It's for that reason that we strive to develop robust systems which minimize the potential for errors.

To quote the Shirelles: "Mama said there'll be days like this, There'll be days like this my Mama said"

or to quote Stevie Nicks: "Sometimes it's a b***ch, sometimes it's a breeze"

[dan1100rt]

I graduated about a year ago and have been working for nine months. I had some students on our floor yesterday and it made me remember how much I liked this forum when I was a student.

What you're probably seeing in the nurses on the TCU that seem to do everything with ease is the result of experience and comfort that develops over time. I didn't experience a sudden "click" but I did find that with around three months on the job I was able to remember more basics (for example critical lab values or good/bad vital signs) which freed my brain up to develop those instincts regarding patient care. It's never a breeze, but it most certainly gets easier. I am astounded at what I am able to do with less than a year of experience and even more astounded about two weeks ago when other nurses started to ask me for advice.

Those shifts when nothing works do come up. Yesterday I had an unsteady encephalopathic patient on a bed alarm who got out of bed 37 times during the shift (an average of every 20 minutes). I got through the day, all four of my patients were assessed, were safe, got their meds, got to their therapy sessions, and I even discharged one and admitted another ... and I got everything charted and reported to the next shift. I would not have been able to handle this day six months ago.

Also remember, your charge nurses and more experienced nurses are always there to support you (maybe not all of them - you'll also develop an instinct about whom to ask and when). No one came out of school knowing everything and EVERYONE will encounter something they don't know.