“Do not fear going forward slowly; fear only to stand still.”– Chinese Proverb
“The journey of a thousand miles begins with a single step.” – Lao Tzu
Tomorrow morning, at about 5:45, I’ll wake up and go through a mental checklist.
- Brush my teeth, wash my face, comb my hair.
- Pick out a pair of matching or complementary scrubs.
- Make sure my pockets are filled with my penlight, pen, and scissors.
- Pack my wallet, inhaler, folders, jacket, and lunch into my backpack.
- Double check to make sure I haven’t forgotten my badge or stethoscope.
- Wake him up and make his breakfast drinks and make sure he has a lunch to take.
We’ll leave the house at about 6:20 and get to the hospital by 6:30. We’ll eat breakfast together, because otherwise my nerves would get the better of me and I wouldn’t have a meal until after 1:00 PM. I’ll show my employee badge and get a discount. It will still feel incredibly weird to sit in the cafeteria with other employees while I nibble at some bacon and half-listen to the morning news. I’ll say, “I don’t know why I’m so nervous.”
He’ll say, “Neither do I. Just take a deep breath and do it. Nothing bad happened on any of your other shifts. You’ll be fine. Eat some more of your eggs.”
Maybe I will and maybe I won’t. But I will walk upstairs at around 6:53. I’ll clock in.
It will be the fourth day of my hospital preceptor period. I get ten weeks and have finished the first, which means I only get another twenty-one days. Twenty-one days to become more comfortable with the thought of being entrusted with the care of five to six patients. Right now, the thought still makes me feel sorta sick to my stomach.
Like I pounded down a few mixed drinks and then hopped on a roller-coaster.
The first three days didn’t go badly. On the first day, which was meant to be strictly observational, I ended up starting to help Nikki (my preceptor) pass out medications. I got to see her do some charting. I met several of the doctors on the unit and a lot of the day shift nurses and techs. I also met the supply guy, a woman from an oxygen company, and a case manager. No one died and I left feeling tired, but optimistic.
On my second day, Nikki had me do the majority of the medication passes and I only made two mistakes (she didn’t consider them mistakes, but called them part of the learning process). The first was pretty comical – I accidentally broke a saline flush by pulling to plunger out . . . thus dousing myself and the floor. The second made me feel a bit like an idiot – I didn’t recognize that a patient’s diastolic BP measurement was too low for me to give him his dose of amlodipine . . . Nikki pointedly asked me to double check it and I realized my near-mistake. She later explained that it probably wouldn’t have had a negative impact, but she wanted to make sure I was being mindful. Again, no one died, but I left feeling overly emotional and a bit defeated.
On my third day, it was a struggle to make myself go in. I was tired and worried about what was going to be asked of me. I was afraid of making more mistakes and of making Nikki think I’m not competent. Once I was on the unit and moving, things got a bit easier. I had two patients assigned to me by Nikki after we took shift report – both of whom I’d met and helped take care of the previous day and both of whom had assured me that they think I’ll be a great nurse. I didn’t want to disappoint. Nikki had me pass out morning medications again, then I performed assessments and charted on both of “my” patients. By the end of the day, we’d discharged both of them, plus two others, and we’d gotten two new patients in. The day was packed and it didn’t leave much time for nerves.
Now, having time to reflect some, I realize that I’ve done/learned quite a bit in just the past three shifts I’ve worked. I learned how to work the medication dispensary machines and where to find the most commonly used supplies. I have memorized the names of the nurses and techs and doctors I’ve met. I can now call the telemetry office for updates on my patients’ hearts. I know how to chart the assessments that are due each shift (full body, pain level, safety concerns, teaching, and plan of care). I got to see both admissions and discharges (though I don’t think I could do either successfully). I learned the difference between a conditional and an unconditional discharge. I figured out how to navigate from the cafeteria to the unit using the employee halls and elevators.
I also got to watch the insertion of both a Foley catheter and the straight-cath procedure. I saw a port de-accessed and learned a lot about how chemo-therapy is administered. I realized that even nurses who have been nurses for months and years still ask other nurses for help and advice. I witnessed Nikki and another nurse comfort a woman who was hallucinating snakes and bugs by hiding her IV pole, bedding, and remote in the bathroom after “killing” them. I talked with her distraught husband and he showed me pictures of their grandchildren.
Sitting here, I can remember the names of all of the patients I’ve seen thus far. I can think about their stories, their families, and their conditions. I am awed by their resilience and their optimism. I feel guilty for being nervous about taking care of them. I want to be the best I can, for them, but I also have to allow for the fact that I’m a brand new nurse. I am trying to learn how to help them all. I keep apologizing for being slow, but Nikki says I’m doing just fine and not to rush.
There are a couple of things in particular that I want to learn tomorrow.
I need to learn about the compression stockings that the patients have as part of their VTE prophylaxis. I’ve never really seen the stockings before and wouldn’t know how to set them up if I saw them. I know that all patients are meant to have them, or else be getting blood thinners. I know the theory behind them, but nothing else.
I also want to ask about the parameters for blood pressure meds. I know that 105/59 is too low to administer amlodapine, plus Lasix and Entresto. I don’t; however, know what the actual cut-off numbers are or if there is some sort of magic list I can reference.
I want to get more familiar with putting in orders through the computer system. I know the basics of it, but not the details. There’s a button for orders, you search by provider, you enter the type of order (usually telephone or written), you search for the right order from a list of hundreds, you select it, and then it’s approved . . . but there are also protocol orders that can be entered without having a provider’s direct instruction. And some orders are generated automatically upon admission. It’s sorta overwhelming.
Despite my anxiety over all of tomorrow’s unknowns, I’m going to try to take my advice and just take it one task at a time. I’m going to try to be less critical of myself and more open to trying new things. I’m going to strive to be less distressed in the event I do mess something up or ask a silly question or need to be shown how to do something again.
And tomorrow, when I get home from the shift (which is, in theory only twelve hours long, but in actuality is about 12.5 hours long), I will make another post and see where I’m at. And then, the next day, I’ll go back again and hopefully learn more and do more.