Thursday, May 30, 2013

New grads Pt. III: Doing It

Day's going to come when you've passed your NCLEX, and gotten your first job. Sooner than you think. Once again, congratulations, and welcome to the major league.

If you thought you learned a lot before, try not to get your pants twisted too tight, but you ain't seen nothing yet. You're about to get the biggest education of your life, starting on Day One. It ends when you retire.

All your time in school, your prestigious diploma, and even that shiny new license after passing your boards document to any who care to admire them is that you are, now, certified by the state in which you live to be at least minimally qualified to do basic nursing, to the point that it's highly unlikely you'll kill anyone out of sheer ignorance, 80% of the time. And that's all it means, until you learn a whole lot more.

All three of the little epistles in this series are because all of you really are the future of nursing. I want you to succeed. Despite what you think, or how it may feel on some craptastic days (nights!), especially some in your very-near future, so do about 99% of your colleagues and co-workers.

So continuing in the spirit it's intended, a few final pointers as your embark upon the ultimate learning experience.

The aim of the exercise is helping people heal.
It's not getting you a bigger paycheck, lots of new friends, a date, a mate, or new toys. It isn't about stroking the doctors' egos, making your charge nurses happy, or being your co-workers' bitch. It's not even about making you better at what you do. All of those things will happen, if you do your part, and over time, more of the good ones than the bad ones. But the main one is that patients come first.

You're going to learn to hold your pee. Yes, literally. You're going to lose sleep, skip meals, stay late. You're going to be frustrated, offended, insulted, belittled, cursed, patronized, accused, and very likely even assaulted. Sometimes, all in the same day. It's a cruel world, and we're working at the nasty end of the stick. You will feel, and sometimes actually be, overwhelmed, helpless, angry, up to your eyeballs in other people's pee, poo, blood, and other body fluids that you'd really rather not care to acquaint yourself with, even by accident.

And you'll still be expected to do your job to the best of your ability, all day, every shift, forever. Welcome to the world of every one of your fellow nurses, and most of your coworkers. This is why it's called work. As Super Chicken reminded Fred, "You knew the job was tough when you took it."

The payoff, when you overcome all those additional hurdles, is that you'll get a lot of the other benefits this job isn't about. Which is still ancillary to the biggest payoff of all: your patients will get better in direct proportion to how well you do your job. And sometimes, they may, on occasion, say "Thank you."


People will bombard you with stuff verbally. Patients, coworkers, supervisors, families, bystanders, and busybodies. So unless you're deaf, it isn't going to be a quiet day, most any day. (And that's probably the last time you'll mention the "Q-word" within sight of your job, unless you want to find a voodoo doll with a remarkable resemblance to you, except full of pins, nailed to the staff lounge bulletin board.)

You're going to have to learn to hear it all, and separate the important stuff from the cacophony of background noise. Including from ringing phones and the callers they bring, overhead pages, dinging clanging buzzing PITA alarms, whining family members, and uncorralled children.

The biggest tip I can give is that when somebody who knows more than you tells you something, pay attention to them. It could be a doctor, another nurse, or the tech who's trying to tell you something. I repeat, pay attention to them. Listen to what they're trying to tell you. Remember that when you're just starting out, everybody knows more than you.

You've doubtless heard the phrase, "Nurses eat their young."
Uh, not so much.
There are a few soulless evil burnt-out bastards out there, and you'll learn who they are.
But mostly, nobody goes out of their way to set you up to fail, unless you go out of your way to ignore them when they try to help. Then, they'll happily watch you get crushed.
Some of them, nurses, doctors, techs, supervisors, patients, family members, and whoever else, have utterly abysmal people-skills, yet still have the patient's well-being and you doing your best well in mind. But every fish in the ocean isn't a shark, and every person you work with isn't a heartless jackhole.
Every one of YOU, however, are utter newbies, so until you aren't one, pay attention to the people who have been where you are, and know.
Grow a thicker skin if need be, and hear what they're saying to you.

The one time it's okay to run your mouth instead of your ears, when you're new, is asking.
Not questioning adversarially, but asking for information. How to do stuff, where things are, what the procedure is, the protocol, and ten million other things that you didn't have to know as a student. Because now, it's your deal.

A nurse is a computer with legs and arms.

If you're asking things, everyone knows you're thinking.
If you're asking the right things, you're thinking well.

It's also okay to ask for help. There are, of course, some unwritten rules.
Don't ask me to do something you can do yourself.
Don't ask me to give you information you could have gotten without asking. I'll tell you where to find it, and you can go look it up. If I don't know, I'll go with you, and then next time, we'll both know.
Don't ask for someone to do something like start a tough IV, or do an opposite gender cath for patient comfort, without doing something for them while they're busy doing your work.
Don't ask me how to do the same thing three times in the same week. Once is info, twice is reinforcement, and three times is you're an idiot.
Don't ask for help unless you give it at least as freely, if not more so.
Don't ask for information and then ignore it.

I, and we, all of us, want you to be the brightest and best nurse you can be, because we're going to need your help, and no one likes co-workers from the short bus. The only thing better than having a shift full of coworkers from top to bottom on the "A" team, is realizing you're on it, and earned your place there. Work with us, and we'll work with you. Screw us, and we'll screw you. Drag us down, and we'll carry you until you either learn to carry yourself, or we decide it's time to thin the herd. Believe me when I tell you that you don't want to see the bus from the underside.

You may be that one-in-a-million nurse who'll work at the same hospital from now until Social Security kicks in. But probably not. So get used to being the new kid on the first day of school, throughout your career. You'll change shifts, jobs, workplaces, and specialties, pretty much non-stop.

To survive and thrive that level of constant change, you're going to need at least a few people you trust.

You need at least one co-worker who's at your level, to tell you when your perceptions are dead-on, or if you're missing the forest for the trees. You're not everywhere, and neither are they, so other perspectives are going to help you fine tune your radar. And they have to be someone who you know has your back come hell or high water, like you have theirs.

You need someone at work that's older/smarter/more experienced, who you can go to for help, for wisdom and counsel, and to be a big brother/big sister/aunt/uncle. They will save your day, your career, and your sanity. Take your time, but when you think you've got one, hang on to them until hell freezes over, even if you move five states away. (In which case, find another one there, too.)

Have people who don't do anything remotely related to medical care. Someone who's a friend, who can tell you when you're not being you, or when you're in a bad place, bad mood, or bad job, without it being someone you might see at a staff meeting.

And take care of your relationships with significant others, spouses, kids, parents, and the rest of your family. They won't want to hear your awful hospital tales - that's what your co-worker friends are for. (Or, here's an idea, your blog!)

Love your family, be dedicated to your profession, loyal to your friends, a rock to your coworkers and colleagues, and a godsend to your patients.

And enjoy going to work. But don't love your job, because it'll never love you back.
Just get it done right.

You want to get to where work is work, and life outside is life outside. Both are important, for your patients, and your own sanity. Remember, no one's dying words were ever "If only I'd spent more time at work".

Do that, and before you know it, you'll be the one breaking in the rookies, and good at it.

1 comment:

  1. I just wanted to say "thanks". I've probably read this post at least three times. I am an RN in a new job in LTC, and being new is indeed hard. I was just encouraged today by one in management that they know some people are talking bad about me, but to pay them no mind. Ha! I didn't even know I had enemies yet! I've only worked there like 11 days! I am just going to concentrate on giving the best care that I can be so that my patients can get well. And I will remember that work is work and home is home. Sigh. I'll get there. This post helps my perspective.