The Nursing Experience: Defining Moments That Change Us

Powerful experiences in nursing can change our careers for the better or drive us out completely. We have to advocate for ourselves if we want to change the profession for current and future nurses.

The Nursing Experience: Defining Moments That Change Us

Virtually every nurse has a story about a patient or family encounter that has changed them or their role in nursing forever. I’ve had many memorable encounters over the years, but one changed my career trajectory more than any other.

I was working on the labor and delivery unit on the night shift of a small rural hospital and caring for “Nancy” who was high risk due to various co-morbidities. Nancy was attended by her family physician who had delivered her other two children and she declined to transfer to a tertiary facility to remain near her home, attended by her long-time physician.

This was Nancy’s third pregnancy and was unplanned. Her last child was born 18 years earlier and she was concerned about the prospect of starting over in motherhood. Nancy was 42 years old, with two prior c-sections and a history of chronic conditions that put her and her baby at risk. She was 35.5 weeks gestation and was being monitored in the hospital due to a non-reactive fetal non-stress test. The plan was to get her to 36 weeks and deliver by repeat cesarean section.

At the beginning of my shift, her fetal monitor tracing was within normal limits, but with a decrease from her admission baseline rate of 130 down to 115. Her physician made the last rounds and reassured both me and Nancy that she could make it to 36 weeks, just two days away.

As the night wore on, Nancy’s fetal heart rate pattern became more concerning. After several calls to the physician, around 3:00 AM, he made the decision to move her c-section to that day at 7:00 AM, still hours away. That morning, while preparing Nancy for surgery, her fetal heart rate changed dramatically. There was a rapid deceleration to 60 beats per minute, and then nothing - no sound, no tracing. I called for help, readjusted the monitor, and tried to reassure Nancy, but I believe we both knew it was too late. The charge nurse made the calls to activate the emergency c-section protocol and Nancy was wheeled on her bed to the OR suite.

The OR team and physician quickly assembled and within 30 minutes a baby boy was delivered with no heartbeat and no respirations. Labor nurses in this hospital also served as the nursery team (there was no NICU) and we began neonatal resuscitation. The pediatrician on call soon arrived and the resuscitation attempt continued to no avail. My colleagues and I were shaken, yet each of us went to a separate area to chart the events of the recent hours, not knowing what else to do or how to comfort each other.

I walked out of the hospital that morning into what otherwise would have been a beautiful sunrise on a normal day. This day was not normal and made me reconsider if I could continue being a nurse after such a loss. The infant was found to have cardiac anomalies and likely would not have survived even in the best of circumstances, but I felt such guilt. This guilt is common among nurses after a patient death, but often we carry on as if we are unaffected, just doing what we were trained to do.

I returned to my role at the hospital after a couple of days off (staffing shortages, you know) while pursuing an advanced degree in nursing leadership. I found my passion for promoting safe care for obstetric patients and newborns and decreasing maternal mortality and morbidity across the nation. Over many years, I lost other patients, both mothers and newborns, but I learned how to use my experience to advance safety in maternal care and find meaning in my work.

These recent months of the Covid-19 pandemic have shined a harsh light on the toll that the work can take on a nurse’s emotional state. We have seen many leave the profession, unable or unwilling to carry on through one more heart-wrenching 13-hour shift. The pandemic nurse has not only been the caregiver of dying patients, but also the substitute family of those patients when their family members couldn’t be present with them. They have carried the weight of sometimes several deaths in an average work week, all while pretending to be strong and carry on with business as usual. Despite the accolades in the media and the community as “health care heroes” or “superheroes in scrubs”, they didn’t feel much like heroes - more like wounded soldiers with no respite from the war. 

The current nationwide nursing shortage will only grow worse over the next decade as nurses leave the profession, fewer students sign up for nursing programs, and fewer nurse educators are available to teach those who do. What will happen when the great migration has ended, and our numbers have dwindled to even more unsafe nurse-to-patient ratios? It’s time for a very close look at how the current healthcare system is designed and the role of the nurses within it who are exhausted, strained and disillusioned. Nurses need more than cookies, balloons, and even incentive bonuses to carry them through. They want to feel valued and validated every day and it starts by being accepted as full partners on the decision-making team, not as martyrs working in silent drudgery. Only when we present ourselves as healthcare leaders can we expect others to view us as such and to claim our seat at the table. We have specialized knowledge and skills - may we use our collective voice and advocate for ourselves as passionately as we do for our patients. Our future depends on nurses stepping up, speaking up, and leading the way for those who follow.

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Tina Hayes

About Tina Hayes, MSN, RN

Tina Hayes has 19 years experience and specializes in Obstetrics.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

A very well written post. I have experienced a few moments, or shifts, in my career that I feel will stay with me in a stronger way than the others. Unfortunately, they all involve patient deaths and in at least a small way each changed me as a person and a nurse. 

Inequity in compensation is rampant in almost every industry, those that do the work are rarely recognized in the way that the corporate leaders are. I hope for nurses that there is a change in the industry, especially with value being attributed to those that try to make a positive impact in their place of work. Maybe this pandemic will bring about some positive changes, so at least something good can come out of it. 

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I feel like these devastating situations touch us in ways that are undefinable and become part of our DNA. 

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Specializes in Obstetrics, Simulation Education.

That's a great way to put it! Thank you for your comment.

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Specializes in Critical Care.

Great post. It took me a while to accept that those I have been with when they passed on (too many to remember) and the host of emotions that come with them, isn't something I can "recover" from, it is a part of me. Emotions randomly surface. I remember a face or a family member. You just have to feel what emotions come, accept them, and move on with your day. No one who isn't a nurse can understand what it is like. 

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Specializes in Obstetrics, Simulation Education.

I agree. The experience always stays with you, even if you don't realize it. Memories come back at the strangest times. Thank you for commenting.

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I don't want to be too specific.

One patient will always be with me.  She was very young and suffered horribly before she mercifully passed.  Her suffering was incomprehensible to me.  I just didn't understand why this innocent child had to endure such horror. 

So I ran away from that setting and decided to seek work in a different area, which I did love and toward which I was leaning anyway.  The foregoing just sealed the deal for me.

I still don't understand suffering, except that I believe that we live in a world full of sadness and sorrow and unavoidable suffering, and that God is in charge.  I have learned that Him being in charge is enough for me.

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Specializes in Obstetrics, Simulation Education.

Very well stated and I agree! Thank you for your comment.

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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

One such moment for me was a cardiac surg case where the pt had a massive substernal fungal infection. It had already eroded the aorta once, resulting in big bleeding and a fast trip to the OR for repair, but there was really no way to fix the underlying mess. It was dreadful.

Then a week or so later the bleeding began again; the pt was terrified, blood pouring out of the wound. The surgeon bent over the bed, spoke calmly and quietly, told the pt not to worry, we’d have the OR ready immediately. He called for the charge nurse, told her to call the OR, and to bring him 20 mg of morphine. She brought it, he gave it push, and then, when the pt lost consciousness, said, “Cancel the OR.” It didn’t take long for it to end. 

It was a heartbreaking demonstration of mercy I have never forgotten. 

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Specializes in Obstetrics, Simulation Education.

Oh my...that is heartbreaking. I'm thankful that you had a merciful doctor. That would definitely be a life changing experience for any nurse. Thank you for sharing your story.

Tina

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Specializes in Geriatrics, Dialysis.

The patient that changed my career trajectory is not a tragic death, thank goodness. As far as I know this gentleman is still alive and well.

The situation with him that caused me to make a drastic career change was no fault of his but was the fault of how management responded.   It's been awhile now so if any of my former co-workers read this and figure out who I am I guess I really don't care. This is a bit wordy so sorry in advance. 

I worked in LTC for my entire career up to this point, 25 years worth and all in the same place. I truly expected that facility to be the place I retired from someday. Co-workers would even occasionally joke that they expected one day I would pass my last med there and the next day I'd be admitted as a resident.

This elderly resident with moderate dementia one day accused a CNA of inappropriately touching him. While we were all certain no such thing had happened and thankfully there was another staff member in the room at the time that could confirm nothing inappropriate had happened the correct investigatory steps must still be followed so I charted the incident and initiated the investigation as required. 

I did this not only because it was required of me but also to protect the staff moving forward. What would happen to the poor CNA providing care the next time he made such an accusation and there was no second staff member in the room that could stand as witness? These kinds of accusations could ruin a career.  Even during my initial staff interviews it came out that this resident had made several accusatory statements while residing on a different wing that were never officially reported or followed up on which put staff at risk, the CNA's that knew this history always tried to double up during his care to protect themselves even though this resident was never care planned for two staff at all times. 

Management chewed me up and spit me out.  I had actually charted pretty much word for word  what the unit manager wanted me to chart, even having the charting reviewed by her before hitting enter to make sure it was worded well. As horribly as the DON and administrator spoke to me I can only imagine the dressing down the poor unit manager got as I did nothing during the entire process without running it past her first. 

I knew the steps to take and followed them to the letter. I had what I thought was a great relationship with the DON and administrator and was seriously shocked almost speechless at their anger. I'd never been so thoroughly yelled at in 25 years there and this happened for doing my job properly?  I made my point extremely clear to both the DON and the administrator that I was only doing my job as their own policies and procedures required and charted everything as the unit manager directed so what exactly did they did expect me to do differently?  

They offered a very insincere apology and dropped the write-up they were threatening me with but for me that was the straw that broke the proverbial camel's back. I thought about it and decided that was enough for me to leave. I started putting in applications the next week.  I accepted a job in dialysis which was a huge career pivot for me after 25 years in LTC.  When I put in my notice  the DON and administrator had the nerve to be shocked that I was leaving. 

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Specializes in Obstetrics, Simulation Education.

It's terrible that this happened to you after so many years of loyal service. Unfortunately, this kind of experience can cause some to leave the profession altogether, so kudos to you for preserving yourself and your dignity and leaving that situation, not nursing. Thank you for sharing your story.

Tina

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