The Intensive Art

I made the realization today that I have surpassed that mystical milestone that all RNs struggle to reach. That is, I have been out of school and working for just over one year. Everything you read, and everyone you talk to all agree that the first year is the toughest for new nurses.

I must admit, even though I felt that simply not being a student anymore was fantastic, having a year under my belt feels even better. In fact, I feel much better than when I graduated. It would seem, as per what I wrote here, that I didn’t feel all that much of anything on my last day!

“My last shift as a nursing student is Friday 23:15 to 07:30, then I report to work at 07:15 Monday for my first shift as a paid, full-fledged nurse. It really doesn’t seem as exciting as it sounds. I have been working almost full time as a nurse since May. Sometimes it was paid, sometimes it was as a student. In the end, Monday will just feel like another day with pretty much nothing different.”

I thought I would mark my first year out of school with a reflection on nursing practice itself. I noticed that whenever nurses on my unit gather around the water cooler (or in our case, the clean supply room–typically near the ostomy supply section while trying to find the last flange in a very specific size) we have very intense conversations about nursing as a career.

Of particular interest is the idea that the quality of nursing as a career is often gauged by whether or not one would recommend nursing as a career to their children or friends. I wanted to share some of my reasons why I would recommend becoming a registered nurse, and some reasons why I wouldn’t recommend becoming a registered nurse.

I’ll start with the reason’s I would NOT recommend becoming a Registered Nurse. These are in no particular order:

1. Earning a Bachelor’s of Nursing is incredibly harder than earning degrees in other faculties. Being a nursing student is an experience that non-nurses can never understand.

2. The pay is not reflective of our job. I know many will argue, but I fully believe this to be true. In only a couple years, many people that graduated with degrees in management or engineering beside me will be making double (or more) of what I make. My entire family works for large downtown companies with education equal or less than mine. I’m tired of hearing about their $360 an hour pay, three day work-weeks, eight weeks of vacation, and $25,000 Christmas bonuses. No, I’m not making this up.

3. Patients are NOT usually fun or interesting to talk to. If you’re a people-person when you start out, you may start hating people sooner than later. What they don’t tell you in school is that an unbelievably large amount of patients are rude, mean, bossy, needy, selfish. On top of that, you’re lucky if they aren’t physically and/or verbally abusive. Families are worse! One would expect more “thank-yous” than actually occur.

4. Argue with me if you would like, but coworkers in this industry are the worst to work with! I have worked in a vast array of environments, and nothing compares to the hospital. Everyone from doctors, nurses, lab techs, porters, administrators etc. are all cranky and burnt out. Not many days go by without an “encounter” with a coworker (I’m not talking about me, of course! I’m sweet and innocent and everyone loves me!!! hehehehe)

5. Bad stress. There is so much negative, harmful stress that results from being a Registered Nurse. Most of this (in my own theory), results from a complete lack of control. Everyone from administrators, doctors, patients, family, dieticians, etc. have the ability to make a decision and implement this decision. However, nurses are at the complete mercy of those around them. If a doctor wants a 24 hour urine sample on a confused incontinent patient, or an administrator wants you to have two extra patients that are out of your scope of practice, or the dietician wants you to weigh your 400# quadriplegic before commencing TPN, the RN is forced to comply. It doesn’t matter if the RN has two coding patients when these orders come in…they MUST be done STAT!

6. I personally (I don’t know about others) have become numb to other people’s issues. I’m surrounded by 41 patients every day with large cancers that have needed massive complex surgeries. Many of them are palliative, in excruciating pain, and are covered in wounds, drains, and sometimes sores. When someone I know/love has a medical issue, I find it hard to feel emotions for them. I think this stems from having to put up emotional barriers all day long to such incredibly difficult situations. Otherwise, I would be an emotional mess all the time. This wall spills over into real life. Although, whenever one of my patient crashes, I always seem to break into tears on the way home once the adrenaline has subsided.

7. Patients/public have no idea the skill and knowledge it takes to be a registered nurse. You hear comments like, “It can’t be that hard, don’t you just follow whatever the doctor says?” or “Aren’t you kind of like a waiter? You just bring the patient what he needs and stuff?” Yes, real examples.

8. You are ALWAYS busy as a nurse and rarely have time to rest and enjoy the day. This would be alright, except that most of the items that keep you busy are tedious, routine, basic tasks. Many shifts can go by without something exciting happening.

9. Working holidays.

OK! That’s enough of the bad. There is a lot of bad points to being a Registered Nurse. However, there are also many many good points to this crazy job we do.

1. There is always something new and fascinating to learn. Just the other day we had a patient with a factor VII deficiency. A hematologist gave an impromptu lecture on just exactly what this meant for this patient. Most people that go into nursing crave new knowledge like oxygen. Trivia buffs make great nurses!

2. When a day is exciting, it’s REALLY exciting! I went into nursing thinking that every day would be action-packed and full of adrenaline. It didn’t quite turn out like I thought, but there are still enough of these exciting times to keep me going. These challenges keep nursing endlessly fascinating and fresh.

3. Example: a patient’s ostomy bag fills up faster than expected and falls off in the middle of the night. The patient awakens to a bed/gown/body/head full of poo. To me, a normal night as I redo the ostomy, but for the patient, it’s a heroic endeavor of the nurse who spent an hour cleaning them up–and they continually thank you for your actions and even write you a card when they’re discharged.

4. Example: a patient that you absolutely can’t stand is going to a nursing home after several months of inappropriate residency on an acute surgical unit. Everyone on the unit is incredibly happy and can’t wait. However, you realize that after many weeks, you are the only nurse on the unit that has created a special bond with this patient. You sit down with the patient as she cries out her fears about leaving the hospital. You realize that you’re going to miss her and wish she wasn’t leaving. You think about visiting her in her nursing home–but realize that it’s probably crossing some line. There’s a special bond that can happen between patient/nurses that just can’t be put into words.

5. When there’s a medical emergency at the grocery store, you can part a crowd quicker than Moses and the red sea. All you have to do is shout, “It’s OK, I’m a Registered Nurse!” Everyone will gasp with joy and let you through.

6. There is a bond between health care workers that is incredible. Much like cops or war vets, health care workers go through many difficult situations together that outsiders just wouldn’t understand. As such, a special bond develops that allows for many laughs and interesting conversations. Just look at all the medical blogs out there!

7. Because Nursing School is so hard, there is a special bond between those who have made it through. My Grandmother was a nurse. I hadn’t seen her in years, but when I did we gabbed and gabbed about nursing school (I was still in school at the time). We laughed about what was new and what hadn’t changed. I had never felt closer to her!

8. There are endless variations in career paths. Even though it’s hard to get bored, if you do get bored or simply need a change, it’s no problem! There’s almost TOO many things to choose between.

9. Registered Nurses are well-respected and trusted.

10. You get to be crafty! I swear! Just try and put a vac dressing on a complex tunneling wound, or hook tubes up to drains that don’t attach. Martha would be proud!

11. Wearing scrubs. Need I say more?

12. You have the power to soothe pain and discomfort.

13. You get to say cool things like, “I’m legally allowed to dispense narcotics,” or when somebody claims something untrue about health and says, “but THEY say it’s true,” you get to say, “I AM ‘they’ and I’m telling you it’s not true.”

14. You get to put needles into skin, muscles and VEINS! How cool is THAT!?

15. When you DO feel like you have no control, it feels incredible to stand up to those around you with power. When your advocacy for yourself or patient is effective–you feel like a million bucks!

Anyway, that’s my list. Some of the items are dead serious while others are light-hearted. They are all based on actual experiences and thoughts. The most important piece of this entire list: I think that the good FAR outweighs the bad. But, then again, it depends which day you ask me!

I would like to challenge everyone else to make a list of reasons they would/wouldn’t recommend nursing/medicine/paramedic etc. as a career.

Nurse Sean

This entry was posted on Thursday, December 13th, 2007 at 01:28 and is filed under Musings. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.