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You’ll know you’re a nurse when ...

by Chris G. Alumbaugh

I’ve been an RN for three years and continue to marvel at the fact that I’m truly living a dream. I wanted to be a nurse for as long as I can remember. My mother recorded in my childhood journal that, at age 3, I announced, “I’m going to be a nurse when I grow up!” When I was 7 and Mom was recuperating after surgery, she wrote, “Chrissie has been taking such good care of me, even helping me out of bed. She still says she wants to be a nurse some day.”

Well, 33 years after high school, I made it. In May 2002, I graduated from Baker University School of Nursing with a BSN. The icing on the cake was my induction into the Honor Society of Nursing, Sigma Theta Tau International and receipt of the student recognition scholarship. I knew the honor society existed but didn’t dare to think I’d be included in this group. I attended the 37th Biennial Convention in Toronto and was amazed at the company I was in—nursing leaders from all over the world.

After one year of nursing practice, I was asked to share my thoughts and experiences with new graduates and their families at our chapter’s induction ceremony. Here are some of my thoughts on “my first year as an RN”:

After surveying many nurses, I have discovered that most of them do remember embarrassing and poignant events that took place in their first year of practice, no matter how long ago it was.

There are the things that a new nurse is most afraid of: Your first “Code Blue,” the first time a patient falls out of bed and you hear that “klunk” and just know it is a head hitting the tile floor, the dreaded medication error that we all make at some time, deciding whether or not to call a physician at 3 o’clock in the morning, a patient dying.

The first time a patient became unresponsive was during my first week on the night shift. Just as I made my way around the end of the bed to stand next to this swaying man, he keeled over, head first. I swear I heard the voice of a former clinical instructor say, “Don’t let his head hit the floor!” So I slipped under him, scooping his very large body up in my arms as we both slowly slid to the floor. We landed with his head in my lap and me sitting in a pool of his urine, and I had my answer to “What will I do if ... ?”

Some things will surprise you in that first year: The high patient-to-nurse ratio, the vast amount of documentation required to cover your shift adequately, and how hard it is to master the skill of time management. You’ll be amazed at how much you learn in one year—and how fast that year passes.

My fellow graduates and I were told it could take a year to feel comfortable and confident working independently. We thought, “A year? That sounds like an eternity!” But here it is, a year later, and by most accounts, we do face each shift with the confidence that a) we know how to care for each patient, and b) we know whom to ask for help or advice when needed.

Still, there’s the discrepancy between “knowledge” and “application” of information. We were taught to double-check that clamp on the nozzle to a Foley catheter bag, right? Well, one sure-fire way to remember that is to have to mop up urine that has poured onto the floor and has run under the bed into your patient’s slippers!

One RN told me, “It can’t be said enough that every mistake you make does make you a better nurse ... if you learn from it!” She told how one night her post-heart surgery patient began having chest pain, similar to what he had experienced prior to surgery. She knew the patient was on a nitroglycerin drip, so she checked him over, asking a dozen questions and racking her brain as to why his pain had returned. Finally, she checked the IV pump and found it had shut off, but the alarm hadn’t sounded. Thus the chest pain resumed. She always checks the pumps now.

And there are things we simply cannot be prepared for, like the vast amount of responsibility we have as RNs, or the high stress level at which we must work. No amount of study and no student clinicals prepare you for the first time you step out onto the unit as a “real” RN. Equipment is either being improved or breaking down.

Policies and procedures are continually being revised, just when you become comfortable with “the way we always do it.” We may imagine that we are emotionally prepared for anything, but just wait for the first Code you experience, or the first time you have to put that lady with dementia into soft restraints to keep her from pulling out her IV and taking off her oxygen mask.

Finding humor in otherwise sad, scary, embarrassing, traumatic or intense situations is sometimes a must, such as when your patient receives one soft-bland-diet tray too many and the food becomes an abstract painting on the wall; when you find yourself answering a confused patient in her own gibberish just to soothe her, and you fear the nonsense you’ve spoken came far too easily; or when your patient appears stark naked in a hallway full of visitors, asking for a drink of water, as if at home in his own kitchen.

Teaching patients isn’t easy when you’re trying to hold in laughter. One nurse, after observing a patient carefully placing a capsule into his ear, realized she should have said, “You take this antibiotic by mouth for your ear infection.”

The work we do can be overwhelming. Sometimes, you just have to take a few minutes in the staff lounge with another nurse to share a bizarre situation or a weird moment with a patient, or to laugh—or cry—at the grotesqueness or tragedy of what you just went through.

But what cannot be emphasized enough is that it should be done in the appropriate setting. I have cringed in an elevator or in the hall to hear names and personal details tossed out for just anyone to hear. We are guardians, not only of our patients’ health and safety, but of their confidences and privacy as well.

There are also miraculous, touching and downright heart-wrenching moments. You will witness the joy of birth and the heartache that accompanies caring for patients for whom all hope of real healing is exhausted. You’ll sense the depth of grief in a parent at the loss of a child and the isolation of those who are all alone in life—or in a world of their own because of dementia or schizophrenia.

But when such a patient suddenly looks you in the eye and you know he understood you for a brief moment, or when she reaches for or actually kisses your hand and says, “Thank you for your kindness” or “I love you, dear,” that’s when you will be filled with wonder at the path you have chosen.

In my opinion, those Johnson & Johnson TV and print ads hit the nail on the head. Nurses do dare to care. We care about all people—the lovable and unlovable alike; those who appreciate our help and those who don’t, or can’t; those whose disease or physical condition would cause the average person to turn his eyes away. But nurses don’t look away. Why? It’s what nurses do. We make a difference.

We do what it takes to make a patient’s lips change from mottled blue to pink again with CPR. We realize by what she says and how she says it that a patient intends to kill herself. Then we help her decide to turn over the pills she’s been hoarding and make her feel good about it.

When you are ready—emotionally and clinically—circumstances will present themselves so you can do what needs to be done. Recently, I had the same six patients for three nights. One, with dementia, required nearly constant surveillance just to keep him in his room with his clothes on and his IV and catheter in. Around 2 a.m., another patient began to decline rapidly. By 5 a.m., he was showing signs of active dying. When the time came for his nurse to get another patient ready for surgery that morning, I told her I’d stay with this dying man until his granddaughter could get there.

I watched as the classic signs of his body shutting down unfolded before me—all the things we had studied in class and that I’d read about in research journals on death and dying. Then, almost instinctively, I did what needed to be done. I held his hand and spoke to him softly, saying, “You’re not alone” and stroked his forehead as he gradually drifted away.

I consider that night a gift—from me to a man I didn’t know, but with whom I shared his last few hours, and to me from a man who not only shared my father’s first name, but who allowed me to repay a debt to the nurse who had stayed with my dad five years before when he took his last breath.

I stayed past shift change that morning because I wanted to tell this woman that her grandfather had not been alone, that he had died peacefully and that he had even smiled twice as I assured him that, if he was ready, it was OK to go.

What’s the bottom line? You must be able and willing to find humor in nursing. Let evidence-based practice be something you do, not just something you pretended to understand and agreed with to get through a nursing course. And compassion and respect for your patients and their families must be foremost in your mind.

Without these things, your heart may break with sadness, you’ll miss the foundation of 21st-century nursing, and you may even lose faith in human nature. But if you can laugh at yourself, laugh with others at themselves and strive for—then cherish—those moments when you know you’ve made a difference, you’ll know you’re a nurse. RNL

Chris G. Alumbaugh, RN, BSN, is a staff nurse on the cardiac/telemetry unit at Stormont-Vail HealthCare, a regional medical center in Topeka, Kan.