Ideals vs Reality for the Aspiring Nurse

IHeartPeds87 · Dec 1, 2009

I'm not a nurse so I can't "answer" your post. However, as an aspiring nurse I have often wondered the same thing. I can tell you, the more I've worked in health care settings, the more "hardened" i've become. The trick is to loose your naivety without losing your compassion, which trust me is possible (as evidenced by nurses/health care staff that have been working for a long time and still do their work in a manner that I truly respect). It is difficult though, and not everyone is cut out for it....see nursing burn out!

I encourage you to read the book "Just a Nurse." I remember there were two stories in their, back to back, about two nurses who took opposing sides on the same issue. It was about a patient who was in immense amounts of pain, and a nurse who purposely took a long time to code him because she wanted to let him die and how that nurse ended up being prosecuted as murderer. The next story was about a nurse who answered the page of a similar patient right away and did everything in her power...much to the disrespect of other nurses on the floor who had a general understanding amongst themselves that they weren't gonna heroically try to save this poor man who was in soo much pain. IT was really, really interesting to see both points of view on the same topic, and how the nurses who acted oppositely were both chastised because it is, after all, an ethical dileemna and I couldn't decide who I agreed with.

nyteshade, BSN · Dec 1, 2009

I could think of many, many difficult situations you will wade in...if not be in over your head...The fact of the matter is that you are there to provide support, comfort, and skill. You must try to remain objective, and educate your patients as much as possible. You'd be surprised at little they know regarding their own care. If at any point in your career, you encounter something you will not take part in because it contradicts your values, speak up. Try to get another assignment. Nurses can be so selfless, they forget this. You will learn there is a fine line between compassion and emotional involvement.

shoegalRN, RN · Dec 1, 2009

I had a hard dose of reality when I had to withdraw care on a pt. I had to call the time of death, as well as be there for the family, as well as do post mortum care on the pt, as well as call the transplant network, as well as call the morgue and fill out tons and tons of paperwork.

Before I became a nurse, I would have thought to do everything possible to save the pt because I believe in miracles. However, once I became a nurse, I understand that despite every measure taken to save a life, sometimes, it's out of our control. I would much rather see someone die with dignity than die in pain.

Becoming a nurse, I realized just how much I DONT know. And yes, my ethics have changed a bit. However, I'm still compassionate. I have decided if I ever lose my compassion, it's time to get out of nursing.

Ivanna_Nurse, BSN, RN · Dec 1, 2009

I thought that I was going to make a huge impact... be the best nurse, patients squeaky clean, linens pristine and fresh. Be at the bedside, and do the education that I feel every patient deserves. Feel like I made a difference.

I thought I would have time to have lunch, void and time to chart.. I thought that I would have time to sit and go through my patient charts, read all the HP's and consult notes. I just knew I was going to be the best patient advocate and make sure I collaborated with the docs to get my patients the care/treatments/meds they need.

Then reality came... my bright shiny visions were overcast by a cloud, then another and another. Under the gray gloom, I felt like a *bad* nurse... and in the beginning I was rather depressed about all of it.

I wasn't the *best* nurse. I was frazzled, and had no time management. I was constantly pulled from the bedside by paper work and forms and charting and other things. I hardly ever had lunch, and when I did, I'd almost feel bad... because I should be doing something for my patients.

I've always worked ICU, I always will. The longer Im in, and the more experience I get, I see that it's not me, Im not a *bad* nurse. Just trapped by the paper work and the crummy staffing and the family demands.

I still have shiny visions, but they have changed alot in the last three years...

~Ivanna

Rabid Response · Dec 2, 2009

When I was a nursing student I never had a bad thought about a patient! I felt nothing but compassion for everyone. Last night I had a patient who had two speeds--obtunded or obnoxious. All night he was barely responsive as I poured fluids and blood products into him in an attempt to get his pressures up. At about 5am he opened his eyes and started yelling at me. Apparently he had passed out while watching some game on tv during evening shift, and he thought that I had turned the tv off so he missed the end of it. I reoriented him, but once he was no longer confused he was even more obnoxious. Every other word out of his mouth was a cuss word. He roared orders and swung at me. He was furious about being NPO, about the volume control on the tv, about having to wait 10 minutes to be hauled up in the bed due to the fact that he weighed 300 pounds and I couldn't do it without help. Three years ago, I would have knocked myself out trying to understand his angst and his needs. I would have spent half a precious hour trying to fiddle with the tv remote even after he flung it at my head. Last night I just put on my blank face, complete with professional half smile and continued hanging blood and meds as if nobody was cussing at me. I don't think I'm burning out; I've just come to the realization that I can't please everybody and that's okay as long as I'm polite, professional, and do my best job.

sunnycalifRN · Dec 2, 2009

I am wondering if there are any experinced nurses who entered the medical field with high ideals only to discover that they were a bit disillusioned and nieve. For example, when you first began, did you have specific ideas about ethical issues, equality, fairness etc. that were markedly changed by experience?
As a student learning about ethics, specifically "slow code," I am deeply disturbed by the issue. However, reading about individual cases I realize that I have never had to recessitate a very frail 90yr patient whose sternum was crushed beneath my hands, and who, if survived would have to suffer the pain of those injuries. I am nieve of the situation because I have never experienced it, and so should not orient my feelings so strongly against it.
What other situations do you find that a new nurse is emotionally unprepared for and can you give any advise to the student to prepare for such events. Do many aspire to become a nurse because of the deep emotional root to care for people but in practice become hardened a bit? Im just feeling like I need a hard dose of reality in the heart department. Thanks!

Does your nursing program have you read any of Echo Heron's books? We read her books, Intensive Care: The Story of a Nurse and Tending Lives: Nurses on the Medical Front. She was an ICU nurse in the San Francisco Bay area for many years and she "tells it like it is".

Many of my classmates said "she's exaggerating" or "stretching the truth" but, not so.

PostOpPrincess, BSN, RN · Dec 2, 2009

I have found new nurses very judgemental of medical people who don't outwardly show "concern" or "cry" at a drop of a hat or are very "matter-of-fact."

I guess the best thing to know that everyone copes and deals with things differently.

Don't make assumptions.

questionsforall · Dec 2, 2009

First, I thought that all nurses were really cared about their patients and were nurses because they truly cared about people (I found out that there are nurses that are in in only for the money and they actually hate people and these are the nurses you should avoid).

I never imagined that one of my patients or their families would ever be upset with me if I did everything right (even if I responded to them the way the book told me to respond), but sometimes we are the ones that they are angry with because we are the ones that are constantly there.

One thing that did hold true: A nurse can heal with a touch, sometimes all we can do is hold a patients hand or just listen, but as we learned in nursing school this sometimes is the best treatment.

Student2Registered · Dec 2, 2009

Well, I have found that I am so busy that I don't have time to care for the "whole patient". That saddens me. When someone is crying and every part of my inner nurse wants to sit down and be there for her/him but the clock ticking on the wall is haunting me because I have meds to pass. There are a few others but overall I absolutely love nursing and it is turning out to be mostly what I have expected it to be.

DLS_PMHNP, MSN, RN, NP · Dec 2, 2009

I have found new nurses very judgemental of medical people who don't outwardly show "concern" or "cry" at a drop of a hat or are very "matter-of-fact."
I guess the best thing to know that everyone copes and deals with things differently.
Don't make assumptions.

Jo, I couldn't agree more.

I am not one to freely show emotions, good or bad, so unfortunately some have labeled me as "cold". Not the case at all.

You are right- people should NOT make assumptions

sistasoul · Dec 2, 2009

I thought that I was going to make a huge impact... be the best nurse, patients squeaky clean, linens pristine and fresh. Be at the bedside, and do the education that I feel every patient deserves. Feel like I made a difference.
I thought I would have time to have lunch, void and time to chart.. I thought that I would have time to sit and go through my patient charts, read all the HP's and consult notes. I just knew I was going to be the best patient advocate and make sure I collaborated with the docs to get my patients the care/treatments/meds they need.
Then reality came... my bright shiny visions were overcast by a cloud, then another and another. Under the gray gloom, I felt like a *bad* nurse... and in the beginning I was rather depressed about all of it.
I wasn't the *best* nurse. I was frazzled, and had no time management. I was constantly pulled from the bedside by paper work and forms and charting and other things. I hardly ever had lunch, and when I did, I'd almost feel bad... because I should be doing something for my patients.
I've always worked ICU, I always will. The longer Im in, and the more experience I get, I see that it's not me, Im not a *bad* nurse. Just trapped by the paper work and the crummy staffing and the family demands.
I still have shiny visions, but they have changed alot in the last three years...
~Ivanna

I love your post Ivanna. I have been off of orientation now for 7 months as a new RN. I too, feel like a "bad nurse" because I cannot do everything I want to do for my patients. I am constantly pulled away from the bedside too by many things. My time management skills are not the best and I too am frazzled and have been able to take a legitimate lunch once since I have been an RN. I am so glad you posted this because I now realize the problem is the "system". It is broken. I am not a "bad" nurse either.