New Nurse Insanity Interview

Our first installment of this series talks to an RN who blogs at New Nurse Insanity: The Adolescent Years using the pen name Shrtstormtrooper. Her bio states: “I’m in my mid twenties, love Jesus, and have no verbal filter. I’ve been a nurse for a little over two years, and it’s amazing how much I’ve learned in such a short time – and even more amazing how much I still need to learn! At any rate, I’m loving my job and loving the learning. Life is good.”

The bold statements are taken directly from her posted works, followed by our questions and her responses.

What I enjoy most about the ER is that we can fix people in one visit. Have you been interested in exploring any other departments yet, or does the ER provide you with the ideal balance of challenge and reward? What is your least favorite aspect of the ER?

So far, I am very happy working in the ER. My attention span is fairly short, so I love the aspect of triaging a patient, taking care of them for a few hours, and then either sending them home or to a different area in the hospital. During my nursing school clinicals, I had one patient for almost an entire semester – it was nice for about three clinical days, and then I was sick of seeing the same patient, same chart, same stuff. Working ER allows me to always have different patients (and a huge variety of problems, from trauma to cardiac to GI to surgical stuff).

I also really love not knowing what sort of shift I will have. If I worked on the ortho floor, I know that all of my patients are some sort of bone problem which can get kinda boring. With the ER, I never know what will roll through the doors until a few minutes before they come in. Sometimes we even have something crazy like a stabbing victim walk into the ambulance bay and start banging on the doors, or a woman roll in the front door two minutes from giving birth. It keeps me on my toes, and I always have to push myself to learn a lot of information about a huge variety of stuff.

I suppose this love for variety and the unknown ties into my least favorite aspect too – I strongly dislike the frequent flyer people. Some of them I can understand. Those who have no money and no primary care doc, and no social support system, they truly view us as their only way to health care and so we see them often. These people I don’t judge their misuse of the ER. The ones I dislike, however, are those who just abuse the system. They come for their narc fix, are rude and hateful and abusive to staff and we can’t throw them out or WE are the ones who are wrong. I hate having to smile through my teeth and tolerate this blatant abuse of resources, money, staff, and time. I hate that we have people who come to the ER 28 times a year for vague complaints and who know how to work the system to get what they want. I hate that dealing with these people takes away my time and mental attention from those who are very sick. I just don’t like it…but that is part of the ER package, and the cons of dealing with these people are far outweighed by the pros of the ER in general.

Plus…I just enjoy the general ridiculousness of it all. The docs I get to laugh and joke with, the absurd complaints from patients, the dark humor of the other nurses, and the overall camaraderie with the staff. They really are my second family now.

Having just taken a Spanish for Nursing class, and still feeling Spanishly Dumb, I really, really wish I was bilingual. This seems to imply that you’d suggest nursing students take advantage of learning another language while still in school, correct? Does being bilingual open new doors professionally, or does it simply make patient care scenarios easier, and more complete?

Oh, I wish I were bilingual. I would definitely suggest that students take advantage of any second-language opportunity. Do it now while you can! Being bilingual is advantageous for so many reasons in the hospital setting. The region where I work has a large number of Hispanic and French Creole people, and few of our staff members speak these languages – I find it unfair to these people that I, as a healthcare professional, sometimes can’t accurately assess them or treat them because I don’t know the extent of their complaint due to language barriers. Even using the language line is a poor substitute to open and easy dialogue.

In addition to making patient care easier and more beneficial to the patients, it’s also great from an employer’s point of view. My boss flat out stated he positively views bilingual staff members, and being bilingual will definitely give applicants a leg up in hiring.

Sometimes, though, I feel like I don’t quite get the opportunity to interact with patients on a basic level…. I am glad for this slow night, for the chance to be able to be there for someone. I didn’t need nursing school to do what I did. What are some of the things that you think made you strong here, in providing emotional support – ideas that may not be common among all nursing students?

Follow your gut instinct. If you think someone needs comforting, they do. If they need someone to listen for an extra minute, do it. If someone is hesitant, ask what you can do to make them feel more confident. Offer an extra pillow.

I find that the best way to do this without being cynical or condescending is to look at the patient as if they are a beloved family member. They deserve the best care because that is what you would expect for your family. These patients are scared and hurting and overwhelmed – you have the chance to alleviate some of these feelings, so take advantage of that!

I don’t think my nursing school did a great job on balancing the technical aspects of nursing with the emotional ones. They either focused solely on book knowledge or tried to justify emotions with all sorts of studies and journal articles and grief models. All this stuff is nice to know in the back of your head, but kind of useless when you’re facing someone who needs your comfort. Just use your common sense and treat them like you want to be treated. Golden Rule for the win, I guess.

When you have 26 hours of school work to do in 24 hours of the day, something has to get cut. For me, it was exercise. I swore to myself that when I got my RN and a job, I would start working out again. So here I am, almost two years into my nursing career. And I haven’t worked out more than a dozen times. Are there other things that you swore would happen when you got a job as an RN (looking at it wishfully from your student-shoes), that are not happening, or really (with the vantage point of experience) now kind of silly?

Ha, I swore when I had a job and income that I would buy as many fun shoes as I wanted…which I have proudly accomplished! On a more serious note though, I promised myself that I would be able to better balance a personal life with work life after graduation. Nursing school was so intense that I rarely did things just to relax, and I didn’t want my post grad real life to be that stressful. I promised that I would always be balanced, and not spend so much time at work that I forgot to enjoy life.

There really isn’t much that I have failed to have happen so far – I am a very laid back person who doesn’t wish for much on a grand scale, but I’m also driven for what I do want. Now that my life isn’t so hectic from nursing school, the few things I do want, I have the time to accomplish them.

Perhaps the only thing so far that I still wish I could accomplish is the goal of traveling. I went into nursing partly because it was a portable profession, and I very much want to see the world. I’m not in a panicked hurry yet, but I would like to do accomplish this sometime.

I’ve only been a nurse for less than two years, but already the number of times I’ve been verbally assaulted has been too many to count. Physically assaulted? Also quite a few. It’s not acceptable to press charges, since I should have “talked the patient down.” When does it become acceptable to press charges, or consider yourself affronted as a nurse?

In the eyes of management, it’s never acceptable to press charges. We are there to help the patient, not make things worse. Unfortunately, this is so far removed from the rest of all professional careers that many of us nurses are fed up. Why should I bother to put my ass on the line to take care of people if I’m going to be blamed for the times when a patient is just out of line? I can understand a demented patient lashing out, or a person with meningitis acting out of the ordinary, but the drunk idiot who spits in my face and tries to hit me? Not okay. You make the decision to drink or get high or just generally be an ass, you should be held accountable to that.

I was sitting in triage the other night, and the other nurse and I were discussing the lack of bulletproof glass at the window. “How long before they make this glass bulletproof,” I asked. She replied, “only after someone gets shot.” Sadly, it’s true.

If I could give any advice to incoming nurses, it would be to start becoming active in the ANA or unit-specific associations, and know what the legislation is. Know what the laws are, and start early with making it known to the public that abuse will not be tolerated. If enough nurses take this stance, we’ll slowly be able to change the current attitude towards our profession.

I saw you leave this world, and I was so busy saving you that I forgot to be there for you. I don’t think there was anything we could have done different medically. You were going to die, and I couldn’t have stopped that. But I should have helped you die with more dignity, and I failed. Is there anything you can offer to nursing students as things you’ve seen that help people to die with more dignity – things a nurse might affect, but aren’t really taught in class?

Class will teach you the five stages of grief, and how to document in a SOAP or SBAR note, and how to watch for a reaction to blood products, and know that a patient needs this drug and not that one, but they can’t teach you how to be ready for death. It comes down to this: everyone dies at some point. All you can do as a nurse and as a person is to understand that you play a part in their life. Make that part count. If you were dying, what would you want someone to do? Of course you want them to be sound in their medical knowledge, but you want them to care.

I think that as long as you truly care and never allow yourself to become flippant about death, you will find a way to show your care in small ways. While I try to keep my emotions under control, I attempt to always be aware of what my patient or their family might be feeling. Be it pain, anxiety, sadness, or resignation, I watch for it. Sometimes, all it takes is acknowledging that yes, things do suck right now – but you are there for them.

All this advice is well and good, but really I’m just one person who has one way of attempting to show dignity. Everyone will have different ways. Like I said before though, you need to make sure you care if you want to do this job. The minute you realize you don’t actually care about the emotional status of a patient…you need reevaluate your career path.

Because no matter how highly administration might think of me, and trust me with orientees, the real measure of a good nurse is whether or not I can take my uncertainties or deficiencies and learn, improve, and use that new information to take better care of my patients. Accepting deficiencies as bridges to lessons, especially as a new nurse, must be difficult – are there any pointers you learned that could potentially help an aspiring nurse in recognizing/appreciating these moments in this positive manner?

Just know a few things: First, every single student and new grad feels the same way you do – scared and trying to hide it or at least not be reduced to a blubbering mess. If they deny it, they’re lying.  Second, the staff knows you don’t know everything, and most of them are willing to help you learn. If they critique you or offer to show you something or even just spout off random knowledge, soak it up. It’s a learning opportunity. Third, know that you start off knowing very little. Even if you’re great in classes, book knowledge and real-life hospital knowledge are very different. So even if you think you know something, ask questions about it. Ask the staff why. Ask the doctor why. If you’re embarrassed, preface it with, “I’m new and just want to get your opinion on this.” No one will ridicule you for that. In fact, if you don’t ask questions and start off being unsure, the staff will definitely view you as arrogant and dangerous. So don’t be like that. Lastly, everyone has a learning curve. You’re not alone in that.

(On one year anniversary) Sometimes it’s been kinda overwhelming. To go from student to new grad orientee to shiny new nurse in the space of six months…there are days where I just shake my head and wonder how I got through it. When I signed up for this career, I knew it was what I wanted to do. But still, I was most definitely not prepared for most of it. If you could go back now and better prepare the younger you for what is coming, what would you say?

This is a hard one. I honestly think there is nothing that anyone would have been able to say to me to adequately “prepare” me for the emotional aspects of my job. Really, what can you say to someone to prepare them to watch someone die, or comfort a family who just suffered a tragic loss? There is no class available to truly teach this stuff; experience is the only thing that will show you how.

Instead, I would tell my nursing school self this: no matter how hard it seems, you will get through it. You’ve made the decision to become a nurse because you want to help people and that decision alone means you have the strength to be the nurse you imagined. It will just take time. And of course, follow your instincts when you give comfort. They are usually right.

This goes for the mechanical stuff as well – you might not know the ins and outs of how to do procedures yet but you will learn in time. One suggestion though: get a job as a CNA or patient care tech before or during nursing school summer break. If your program has an internship, sell (or promise) your first-born child to get into the internship. You’ll learn more in that 8-week program than you will in a whole semester in terms of the reality of nursing. It will most definitely help your comfort level too.

She mentioned how a lot of her nurses had been crusty and mean and impatient, but that I had been very pleasant and willing to listen to her complaints. I thanked her, then jokingly replied that I haven’t been a nurse long enough to be heartless yet. She says, “you nurses never lose your hearts, you just learn to protect them better.” How have you learned to better protect your heart since becoming a practicing nurse? Any tips for nursing students on how to do this effectively?

Mostly I am able to deal with sad stuff because while it is emotionally hard, these people are complete strangers. I’m able to distance myself from it because I don’t know their history, I don’t know their life stories, and I find that by not letting myself know these things, I am able to view the patient as a medical problem to be fixed, and the families as extra people who come as part of the package deal. This seems kind of harsh, but it works for me. I still am affected emotionally, but I’m able to keep it in check when I need to. I guess my method of not letting myself know a patients’ life story lends well to the ER, since you get to know more about a patient if you take care of them on the inpatient floors for many days in a row – another reason why I prefer the ER.

I have also found that a lot of things that happen in the ER weigh on me even after my shift is over, and I didn’t have any idea how to handle that. I was talking about this with one of my charge nurses and she told me to go home, make a cup of tea, and cry my eyes out. I did and felt so much better. I think the take home point is that emotions can be held in check, but you can’t discount them completely. These situations are sad and tragic and any normal person would cry – so be a normal person and cry!

It’s been almost six months since I’ve been off orientation and I still sometimes wonder what I’m doing here. While I’ve become competent in the small things, the big things still make me think, “there’s no way I’m allowed to do this!” As time passes, do these thoughts tend to become smaller and less frequent, or have they remained relatively constant or actually increased in any way for you? What specific things help to make this feeling diminish?

Honestly, the more I learn about being a nurse, the more I realize how little I actually know. It’s humbling. I don’t feel so overwhelmed every shift with the small stuff which is due to me just generally knowing more information than I did when I started, but I still every single day have to question myself and double check information and look up meds and re-read stuff about disease processes. If anything, I have the thoughts of inadequacy even more now because I am no longer a brand new nurse and I feel like I should know this stuff. If I don’t know something, I almost sometimes feel guilty. So I make sure I fix those feelings every time they pop up.

I can do the mechanical processes without much thought now; trach suctioning, obtaining a nasal washing sample, starting IVs, getting EKGs…this stuff is easy now, but it’s not what makes a good nurse. The critical thinking, assessing, and ability to look at someone and just know they are sick – doing these things well make a good nurse. I’m getting better at this stuff but I’ll never be perfect. Thus I will always strive to be improving. I’ve been told that the day I feel completely comfortable is the day I should get out of nursing because I’ve become dangerous. This thought is always in the back of my mind, and is a very effective motivator for keeping on my toes.

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Thanks for sharing the insights, Shrtstormtrooper! You can read more of her work on her blog: New Nurse Insanity: The Adolescent Years

Join us tomorrow for the next installment of this series, as we talk to rehabRN, a nurse who specializes in rehabilitative care.