This for those of you members of allnurses.com who have hinted, believed, insinuated or baldly stated that I don't remember what it's like to be a new grad, that I always thought I knew everything, that I have ever actually known everything or that nurses eat their young. Believe me, if I'm still around after the rough start I had, nurses don't eat their young.
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I remember being a new graduate -- in fact sometimes I still wake up in the middle of the night remembering something I screwed up in my formative years as a nurse. I wasn't the best new nurse to ever rock the telemetry unit -- I wasn't even an adequate new nurse. I was the first BSN graduate ever hired by the small community hospital where I got my start in nursing. In those days, the debate wasn't ADN vs. BSN vs. MSN; it was BSN vs. Diploma graduates, and the Diploma nurses were winning. The hospital (which we shall call "goat lick community hospital" or GLCH) had their own Diploma program, and most of the nurses hired were their own diploma graduates. Diploma students got about 24 hours of clinical a week, working three 8-hour shifts. I had 8 hours of clinical a week -- two hours to go through a patient chart and come up with a care plan, then 6 hours with the patient the following day. Consequently, there were a few things I hadn't learned when I graduated from school and started my first job. Ok, the things I didn't know could -- and will one day -- fill a book; the things I did know could probably fit on the head of a pin.
The good people at GLCH hired me because a seminar at the nearby large university teaching hospital had convinced the head nurse of the telemetry unit that BSN nurses were the wave of the future. She was about the age I am now and counting the days until her eventual retirement -- about like I am now, and I think she believed that she'd be passing the torch to a BSN nurse. She picked me out of all the potential employees because, as she told me later, "you've always worked." I worked all through high school and all through college, sometimes two and three jobs at a time. She chose me because she liked my work ethic. (or maybe it was just that there really was a nursing shortage in those days.) Unfortunately, once hired, no one knew what to actually do with me. The Diploma nurses came already oriented and ready to just jump in and do the job, but not only did I not know where the transfusion forms were kept or what they looked like, I didn't even know we needed transfusion forms. Not only did I have no idea where the foley catheters were kept, I had only the vaguest idea of what to do with one. And, IM injections used to make me literally sick to my stomach. Even drawing one up was enough to send me running to the bathroom to barf, have diarrhea or both.
There was no such thing as a preceptor at GLCH in those days, and it never occurred to me to ask about an orientation in my interview. (did I mention that I was clueless?) After my first day on the unit, a good part of which I spent in the bathroom crying, the charge nurse and team leaders correctly deduced that I wasn't going to be an independent practitioner right out of the box. If ever. Never having needed to orient a new nurse before (the Diploma graduates came already oriented!) They had not the slightest idea what to do with me. My second day on the unit, I was handed a list of room numbers and pointed toward the standing scale. My job was to weigh everyone on the list. The nurse's aides (as we called them then) were thrilled -- that had been their job and they were ecstatic to get out of it. It was a couple of weeks before I mastered that job and was given something more advanced to do.
The first time I went to place a foley catheter in a male, I couldn't find his member. (I'm still not sure they didn't choose that patient for my first foley deliberately.) The man had figured out a way to essentially push his member into his abdomen to hide it. After looking for the member for several minutes to no avail, I gave up and went and got the seasoned nurse to tell her that Mr. B didn't have a member. She was muttering as she led me back down the hall to flip back the sheets where, magically, Mr. B.'s member had reappeared. I did get the foley placed, but I was sweating mightily the entire time.
Most of what I learned, I learned from the experienced nurse's aides and the crusty old LPNs. It was Sandra who taught me how to clean up poop without getting it all over my (bare) hands, how to assist a patient from bed to chair, and how to whip out fifteen baths and bed changes on a Saturday morning. And, it was Gertrude who taught me how to give an IM injection without GI decompensation (mine), how to place a nasogastric tube and how to pass meds on 15 patients on a Monday morning without giving Mrs. T's meds to Mrs. I or Mrs. G's digoxin when her heart rate was only 48. Emma taught me how to hang blood without drenching myself. Nancy taught me that a patient who says they're going to die tonight just might no matter how stable they look, and Horty taught me (by bad example) to look at my patient lest I hang and IV on a dead lady.
I hated nursing in those first two years; hated it so badly I'd cry all the way to work and then cry all the way home. Had it not been for the fact that I had education loans to pay back and a husband to support, I would have quit and gone off to waitressing or wedding photography or something --- anything else. At the end of my first year, I won the prize for "most improved new graduate of the year," which was laughable because I still hadn't caught up to the Diploma grads who started a year after me. Two decades later, when GLCH closed it's doors for the last time, they were still telling stories about my mishaps to reassure new grads that they couldn't possibly be the worst nurse to ever start on the telemetry unit.
I suspect that one of the reasons I'm such a popular preceptor these days is that there isn't much a new nurse could do wrong that I haven't already done, witnessed or heard about -- but mostly done. And, because I not only admit to it, but tell stories about it. I remember what it was like to be a new grad -- to feel stupid and useless and to not know what to do with myself to be either helpful or out of the way of those who were actually doing something. I remember what it was like to be tongue tied when I tried to ask a doctor for an order or explain their treatment plan to a patient. I remember what it was like to be ridiculed for being stupid because I had done some really stupid things. I remember what it was like to worship the experienced nurse and doubt that I could ever manage to achieve the heights of knowledge she had. I remember being terrified I was going to make an awful mistake and hurt somebody. I remember fumbling with a foley, mishaps with the med pass and "failures in communication." But, I lived through it, learned from it and am still at the bedside after over three decades. Now I'm one of those crusty old nurses . . . just counting the days until I can retire and trying to teach the newbies what I had to learn from bitter experience.
