You Know You’re an ER Nurse When…

  1.  You can’t walk around town without seeing your frequent flyer drunk/homeless clientele panhandling/getting arrested/participating in other questionable activities…

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    See you in two hours bob when you are “found passed out in park” …again

  2.   You are not shocked at all to hear that your patient with the black eyes who got the shit beat out of them was  just “minding their own business”

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    could’ve had me fooled

  3.  your patients mistake you for a flight attendant/waitress/maid…
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    Yeah Susan, I’ll get right on that, after I finish doing CPR on Mr. B over here.

     

  4.  When you think anyone who isn’t on a critical drip or on a vent is “fine”…

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    go home

  5. You have perfected the art of listening to a patient describe what is “accidentally stuck in my vagina/rectum” without making a facial expression…

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    and how did you say it got up there? OH you fell…

  6. When you are more afraid of bed bugs than TB and MRSA…
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    brb going to douse myself in bleach in the decon room

     

  7.  You can talk about room 8’s profuse diarrhea , the maggots crawling out of room 24’s leg wound and the homeless pt’s trench foot all while simultaneously eating your dinner like it aint no thing…

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    i’ll have some fries with that

  8.  You are banned from talking about anything work related at family/holiday dinners because last year you made everyone throw up and aunt Jane almost passed out

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    “what ? we all poop, its normal you guys”- me trying to rationalize my topic of choice

  9.  You are wish ther was such thing as nebulized/aerosolized Ativan

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    *dreams of peaceful waiting room and happy patients*

  10. You know what a B52 is…

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    no caption necessary

  11. Your patient in triage doesn’t want to wait  and threatens to leave and “call an ambulance and  so I can get right in to a room”…

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    great idea carol no one has thought of that before. also surpise, you’re still going to triage

  12.  You would rather take care of a coding patient than a cyclical vomiter…
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    *literally finds anything else to do besides take care of cyclical vomiter*

     

  13.  “Stop doing drugs”, “Stop drinking alcohol”, “Make better choices” are all legitimate d/c instructions

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  14.  You are constantly  checking out random people’s veins everywhere you go & mentally choosing what size IV you’d use

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  15.  You’ve had a patient walk into triage/come in by ambulance with multiple suitcases/luggage bags in tow

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    “better bring all these bags in case Im admitted”

  16.  You are angry for no reason, have zero form of emotion and tell the most vile stories and jokes without blinking an eye

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  17.  Your normally noncompliant diabetic patient requests food/a sandwich because ” I am diabetic and I haven’t eaten”

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    interesting how you don’t check your blood sugars regularly or take your insulin but let me stop everything I am doing to make sure you get a sandwich for all that insulin you did NOT take.

  18.  When you’re assessing the level of orientation of a patient and you aren’t even sure of the answer

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    wait it’s Tuesday,right?

  19.  when you are in triage and ask the AOx3 patient who ambulated in with soda &chips in hand what their emergency is and wait for them to put on the theatrics…

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    “pt states he literally can’t even”

  20. When your patient doesn’t want to be discharged for whatever reason (doesn’t want to d/c to jail, wants more pain medication, a warm bed to sleep in…etc) and drops the SI bomb

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    drunkacidal is a real thing

  21.  You know that LOL means little old lady

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    arriving by ambulance , ETA 5 min to room 5: LOL FDGB

And finally, You know you are an ED nurse when you put up with all of this, and keep coming back to work because you love your job & can’t imagine doing anything else.

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But honestly, the list goes on and on. What are some other reasons you know you are an ED nurse? Comment to share! 

**disclaimer: ED nurses are subject to some of the weirdest, most bizzare, emotionally upsetting, physically exhausting scenarios you could ever imagine. This post is meant to be something that ED nurses can relate to and laugh over, in order to cope with some of the craziness we deal with. This post in no way is meant to be rude, or hurtful to any group(s)of people– it is only meant to be satirical and something us ED nurses can laugh and bond over after a crazy day/week/month/etc.

 

 

 

Thank a Nurse

Nursing is such an incredible, empowering, inspiring profession, but at the same time it can be overwhelming, depressing, and anxiety provoking- anyone who is/has been a nurse can attest to that. As nurses, we are fortunate enough to be able to touch the lives of so many , and many at their most vulnerable times. Yet because of this dichotomy, we are entrusted with a large amount of responsibilities, which can be overwhelming. With increasing censuses, patient acuity, and seemingly endless charting/documenting requirements, I sometimes feel like I am not able to be the best nurse I can be. I feel restricted by these things, and at times I even question myself “Did I do anything today to really help someone, or did I just do the bare minimum?”.  Personally I find that it can be tough to cope as a nurse in this environment- we want to provide the best care and we strive for excellence, but sometimes we feel we simply cannot meet the demands.  We often leave work burnt-out, sad, stressed, tired, and  all the while wondering if all of our hard, demanding, physically and emotionally exhausting work has just gone unnoticed. Then we may start to question ourselves as nurses. Is this why I went in to nursing, to feel like I can’t keep up, and to feel underappreciated?  Then, someone (anyone!) says “thank you” and for a small fleeting minute, the weight of everything else is lifted. It rejuvenates you. Crazy how two small words can mean the world sometimes, especially when we are feeling beat down and overworked.

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a little humor but I can relate!

To preface things, I guess I should clarify that as nurses, we do not do what we do just so we can have someone say thank you to us in return, because that is just not how it works. But, a small thank you goes a long way — whether it’s from management, coworkers, a patient and/or their family. Sometimes it’s the moments like these that help to remind us why we do what we do and inspire to keep doing. Whether or not we are thanked, we will keep doing our jobs (and we will be damn good at it because we are nurses, but I digress).

Anyways, I have a little thank you story that I would like to share. I had a complicated patient a while back, during a really busy shift, with constant admissions and discharges in the higher acuity section of the emergency department. The patient was maybe in her sixth decade of life, chronically sick with cancer and was brought in due to an acute issue that the cancer was obviously not helping with. She was weak, in pain and frail. Her husband was at the bedside the entire time and  was very involved in her care. He was quite doting and asked a lot of questions, and provided a lot of the crucial aspects of the history of present illness – which is not unsurprising or unexpected in this type of situation. I even remember that he knew how to deal with her complex GJ-tube that she had (also not uncommon, it always amazes me what family members take on in order to care for heir loved ones these days). He stated that he often has to troubleshoot it because it gets clogged, or clamped down,  and he was trying to explain to me all the steps he normally takes.  While I am the first to admit that I am in no way an expert or genius with all the different types of tubes and equipment people may come in with, I still wanted to give it a try, because how hard could it really be, right?  After several minutes of tinkering with the tube to no avail, I ran out to ask another coworker for some assistance. When I came back in with a coworker, we both worked on troubleshooting the tube without obvious success. Meanwhile the patient’s husband had been chiming in, telling us what we were doing wrong, and letting us know what we had to do. I could tell that he appeared to get slightly agitated/frustrated when he felt like we were not listening to him. When my coworker left, the patient’s husband vented to me and said “I am sorry to get snappy but I really just didn’t like how she didn’t want to listen to anything I had say. It’s like she didn’t want me to bother her ego. It’s not like I don’t deal with this every day. I know what I am doing”. This was a little uncomfortable for me (I am sure it might have shown in my face) because I did not want to put down my coworker, but I too felt like maybe she brushed him off a little bit and at the very least, I  wanted to let him know I heard his concerns. I apologized and asked him to show me again step by step what he normally does for his wife’s tube. I said something along the lines of “sometimes we forget that you guys are actually the experts with these things most of the time and that we can ask you for help”.  As I continued to work on the tube, the husband, patient and I had a candid conversation about this and how frustrating it must be for the patient/family to feel like they are not being listened to because we (nurses/staff) are just running through the motions doing tasks. We eventually fixed the problem with the tube, at least for the time being, and the patient’s husband and the patient herself thanked me for my patience and for listening to them. In the moment it felt weird being thanked for this.  I told them they in no way had to thank me, that I was just doing my job. He told me that “even though 4 out of 5 nurses would rush through things , not taking the time to sit and listen, it was the one that actually does, that makes a difference . We always remember the ones like you, thank you”. This really stuck with me. I was so appreciative of their gratitude.  The patient was eventually admitted to a medicine floor, and my time as her nurse had ended . The next day I arrived to work and was told there was something for me at the secretary’s desk. To my surprise, there was a bag of chocolates and a card written out to me- the card read as follows:

“Dear Hannah… I know you were upset with me last night, but nothing I said was directed at you. We think you are a super professional nurse. We wish they could all be like you. We have seen the best like you, and we have seen the worst. Thanks for being so nice”.

I was delighted to have a personalized thank you card from this family, especially because I took a lot of my time trying to sit and listen to them when it was really busy and I felt like I had thousand other things to do. But I was also slightly taken aback that he thought he upset me. I didn’t want him to have to apologize for me when he was only advocating for his wife/loved one when he felt like no one was listening to him regarding the care of her GJ tube. But overall it was very heartwarming and gratifying to get this thank you card from him and his wife. Unfortunately, I later found out that the patient became septic and was transferred to the ICU earlier that day where she later passed away. Even though his wife was so sick , her husband took the time to write me this note and thank me on behalf of her and him. I was so touched, and still am.

We have the amazing ability to make a difference to people during a fragile time for them. There is no way we can remember ALL of our patients- usually we seem to remember the ones where something drastic, sad or crazy happened- but we have to keep in mind that they will likely remember their experience with us. Trust me, people will let you know when they have had a bad health care experience, they are usually not shy about this. I like to tell them that I am sorry they have had a bad experience in the past and let them know that I am going to try do my best to make it so that their next experience is maybe not so anxiety provoking or maybe not so negative in their mind. Sometimes, just acknowledging their concerns and sitting in listening for a few minutes (which seems like an eternity when you feel like you have 100 other things to do) goes a long way for patients/families. And maybe, just maybe they will thank you for listening to them.

Many times at work, I am juggling anywhere from  3-7+ patients in the emergency department, meaning their acuity can range anything from non-urgent to life-threatening. Ideally, if there are higher acuity patients in my assignment the ratio is better, but that is not always the case because things are ever-evolving in the emergency department. At any given time however, the constants are still the same: patients are requiring assessments, IV placement/bloodwork, pain management, medication administration, assistance with activities of daily living (ie: getting up to the bathroom or commode), patient education, food/drink, documentation (a whole other beast)…etc. So there are days when I am literally running  around from one room to another, trying to get all the needed tasks done, all the while, feeling slightly dejected that I am not spending as much time listening/talking to my patients as much as I would like to. I try my best to try to give all my patients my full  attention and try to present myself as though I am not rushed,  (even though in the back of my head I already have a mental checklist of the next 5 things I need to do as soon as I can leave the room) because that is what I would want for my loved one if they were the patient. But the sad reality is, that doesn’t always happen and I know that the majority of the time some patients get put on the back burner while I attend to someone who may be “more sick” or someone who more often than not, may be making more of a scene (overuse of the call bell, yelling out and disrupting staff and other patients, using obscene language , etc). This constant chaos leaves me feeling really burnt out and frustrated, but also makes me feel that I am not always doing a good job at my job (major sad face here).

Recently however, I had a few patients/family members acknowledge how busy the department was, and how busy I was running from room to room and despite all of that , they thanked me. Even though I felt like I didn’t necessarily do much for them to warrant being “thanked” for, I was elated, shocked, taken aback. These two small words went such a long way and were so gratifying to me, especially at a time where I was stretched thin and probably didn’t/couldn’t provide the best, most thorough nursing care ever. Moments like these inspire me to not give up hope and they remind me of why I became a nurse! (Am I the only one who gets over excited,happy, emotional when a patient/family member thanks me?)

And finally, this one sums it up perfectly — This gentleman came in to triage,  sat down complained of chest pain and was going through the triage process when he slumped over and became unresponsive and pulseless. He was quickly rushed back to a room and CPR was initiated. He received 1 shock for V tach and compressions were resumed while we attempted to get access in him for meds. As I was putting in the IV I felt his leg move and alerted the team- hes alert, hes awake!!! He started to move all extremities and then he was able to start talking to us. It was an amazing and satisfying feeling when you can revive someone like that. We quickly carted him off to the cardiac cath lab …and he ended up doing well and is now home recovering! He sent us this lovely card after the fact:

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We Really Have the Best Jobs (info covered to protect privacy)

The fact of the matter is, we do have amazing jobs. We save lives. We get to be part of miracles like this. We don’t always get thanked, but when we do, it makes it all that much more beautiful.

XOXO,
Hannah

Food for thought: Think about a time a coworker thanked you for something you did, and think about how it made you feel. I know I am genuinely so appreciative of this, because I know we all are feeling the weight of patient census and acuity. I know that personally, when I have been thanked, it has gone a long way in my mind. I try to be mindful and thank my coworkers when I get the chance, because we are all bogged down and overwhelmed at times and we often forget to let each other know that we appreciate each other and recognize how hard we all work on a daily basis. It fosters an environment of caring- which is what we should all be about. Lets start the cycle of taking care of ourselves and one another, and appreciating and recognizing each other for all our hard work. Before you call out your fellow nurse on “why haven’t you done this or that” while getting/giving report, stop yourself and put yourself in their shoes– You don’t know what else they had to deal with on their shift.  Be appreciative of what they have done (versus what they haven’t done) and say thank you for that. Kindness and gratitude go a long way.  Thank your coworkers for coming in to work and putting their patients first, despite dealing with their families, personal issues, own crises. We all have lives outside of work, and sometimes we forget that. Thank them for coming in and doing their best they can to be a part of the team with you- recognizing that they may have left all their troubles at the door in order to do so. Don’t wait until shit hits the fan or some big/remarkable case happens to thank your coworkers (we are often good at thanking each other and recognizing each others’ hard work during extreme situations like codes, traumas, etc..) but sometimes we forget to say thank you to our coworkers in less “obvious” situations.  Thanks to all my amazing coworkers, who not only deal with my annoying/complaining ass,  but inspire me to be better every day. I love you all.

Advice to My Younger Self as a New Nurse: What I Know Now

I was recently thinking back on all the things I have learned over my past three and a half years as a nurse & it’s a lot. Most of it, I didn’t even learn in nursing school. In fact, most of it was learned in real life practice. Through my mistakes and successes, the good days and the bad, I became a nurse. 

I thought it would be interesting to write a blog post on advice that I wish I could tell myself as a new nurse, now that I know what it is like. Anyone who is a nurse (also applicable to several other professions) can attest that starting out as a brand new nurse is overwhelming, daunting and challenging. I remember knowing that I learned all of this information in school but it was so different trying to translate everything in practice somehow. It was like I had a big arrow pointed at me that said “NEWBIE NURSE” and I felt insecure in my abilities to be a nurse for a long time. It definitely took a while to become comfortable with my role and my knowledge, and to feel like I was a nurse, not just someone pretending to be one. I remember getting a lot of advice from fellow nurses and friends at the time about how to cope with this transition.

I wish I was able to give myself back then advice from myself now, knowing what I know now. I would tell myself that it is going to be okay- that you know what you are doing more than you think. That a gentle nurses touch can go a long way, and active listening can make any patient feel like a PERSON, not just a patient. That silence is sometimes a good and necessary thing. That your instinct is sometimes more powerful than anything you may have learned in a book, lecture or conference. And that you WILL grow as a nurse, it will become more natural, and you will be confident in your nursing abilities one day. That it is always okay to ask questions, no matter how stupid or crazy you think it is. No one is going to fault you for asking questions, seeking answers and furthering your education. That is the beauty of nursing, it can open many doors for you, if you let it.

I asked a bunch of my nurse friends and colleagues to help pitch in with their advice they would give their younger selves and the results were beyond amazing and powerful. Not only do I think they are a good guide for new nurses, but also serve to be true for any nurse, experienced or not.

Advice to your Younger Self as a Newer Nurse:

  • If you don’t know, just ASK. There’s no way anyone can possibly remember everything from nursing school- plus every hospital/unit is a little different. Also, don’t feel like an idiot for not knowing! “Veteran” nurses will be happy that you’re attempting to do things right. (I personally recommend complimenting them on how knowledgable they are before asking them my question- everyone loves a compliment!)
  • Asking questions does not make you dumb! Ask ask ask! Ask things you don’t know, ask things you think you may know but want a second opinion. Ask anyone. Ask doctors ask nurse practitioners ask respiratory therapists, physical therapists, anyone and everyone. The more you know, the more confident you will become.
  • Never stop asking questions!
  • Stay calm, think before you speak and listen!
  • If you’re unsure of something– seek out experienced nurse for some feedback and advice. No question is a dumb question.
  • Go with your gut… If you feel like something’s wrong with your patient there usually is. Nurses intuition is a real thing.
  • Join a military branch, become an officer with goal of retiring from the military. Excellent benefits for rest of life, health etc.
  • Nobody loves staying in the hospital so be extra sensitive to the emotional piece. Patients and families might not be themselves when they are flooded with worries/fears. Be kind, be understanding and you’ll be more resilient.
  • Listen. I mean, really listen. Hear what people are saying without the words. Everyone has a different story and you are only seeing a tiny snapshot of their life. Don’t judge. Instead listen. Listen to their bodies. Listen to their tone. Listen to their eyes and their face. They say so much more than what you ask.
  • Nursing gives you the opportunity to explore your interests, you can’t possibly have covered all the different types of patients to care for in nursing school (elderly, med surg, cardiac, cancer, pedi, mother baby, ICU, surgical,neurological) take a chance that something you haven’t experienced yet might be your true passion. And don’t be afraid to change it up and learn nursing in different settings, the hospital is not for everyone. Take advantage of the fact your license allows you to be a lifetime student, constantly learning.
  • Always remember you were once a student…so when you have an opportunity to mentor a new nurse…think of what your mentor did to help you…and do the same. Not only will you help someone else but you will grow in the process
  • After a few years of consulting – An easy one is to put your cell phones away. Be present. Make sure your attention is on the patient and your fellow staff members. Save the face-spacing to break time. Healthcare is personal, important and intimate, treat it that way.
  • Make a mental list of things you can “fix”and things you can’t! Some things can’t be fixed, and some things just shouldn’t be! Learning that lesson helped me prioritize my care and keep my sanity in the ICU. And advocate for your patients, even when it’s not easy to do so!
  • Never be afraid to ask questions… take those patients that scare you the most… be forgiving, 1) towards others, we haven’t walked in their shoes, no matter how much we THINK we know about them, and 2) towards yourself, cut yourself some slack, do your very best always, and if you weren’t as successful with something as you had hoped, scrutinize, learn, then move on. … and always listen to your gut!
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Nurse humor

What advice would you give to your younger self as a new nurse? Or what advice would you give to any new nurse?

xo

Hannah

(Special thank you to all you awesome nurse friends who posted  in response to my question-prompt on my facebook page that helped to contribute to this post! You know who you are!)

 

18 Important, Career-Saving Things I’ve Learned In My Two-And-A-Half Years Of Being A Nurse

Thought Catalog posted one of my first and favorite blog posts!

Thought Catalog

Shutterstock / Minerva StudioShutterstock / Minerva Studio

It’s truly amazing how quickly time flies by. It feels like just yesterday when I barfed in the bathroom of the building I took the NCLEX in only to find out three days later I passed the exam, becoming an official “registered nurse.” Me, Hannah Josephson, RN.

That was two-and-a-half years ago now, but who’s counting? Compared to many nurses, that’s just a blink of an eye, I am still a “new” nurse and I still have many years of nursing ahead of me. I know that. But I also know that there is a wealth of knowledge I’ve gained in these past 30 months. Here’s what I have learned and these are my advice to you.

1. Get a good pair of shoes.

Let me tell you, you will be on your feet more than you will be off of them, and one of the…

View original post 3,493 more words

Shots Fired at Brigham and Women’s Hospital in Boston

Click for news article

Shots Fired at Brigham And Women’s Hospital

I woke up today (after sleeping from last night’s shift) to several text messages and calls from worried friends and family about this horrible situation. Luckily, I am fine and was not there, but this tragedy just reminds us that there are bad people out there. It is so sad that a place where people go to heal and cling on to life was targeted for such a heinous crime and that the people who work diligently to help heal and nurse those sick & vulnerable people back to health are targets for this sort of violence. I’ll be heading into work in an hour and half with my head high; this situation could have been a lot worse and I applaud all the brave people there who helped to diffuse the situation. Lets just hope and pray that this type of violence stops here.

17 Things Almost every RN can Surely Relate To

If you’re a nurse- regardless of what your specialty is- I am sure you will be able to relate to some of these! Again, I can’t emphasize how much that I love my job and my patients but sometimes nursing can be so difficult that we need to have an outlet for little humor to make it all balance out. Do you agree?

1. Having a patient on precautions and feeling convinced that you now have MRSA/C-diff

2. The moment that super overbearing and annoying family member leaves

3. The patient is smiling and moving around in bed but when asked to rate her pain she says 9/10 after pushing on her belly.

4. Those awkward times when you’re not sure if you actually have free time or you’re just forgetting something.

5.Whenever a patient says “Well I read on the internet/wedMD…”

6. When you hear the IV pump start alarming as soon as you get back to the nurses station.

7. Care plans…

8. When your rude and verbally abusive patient threatens to sign an AMA

9.  You finally help to get your patient to fall asleep around 5 am only for them to be woken up by all the med students and residents an hour later… #nightshiftproblems

10. Your family and friends tell you EVERYTHING (I mean no holding back) about themselves in hopes you can diagnose them. “I know this may be TMI but…”

11. When someone says “you’re soooo smart” &  asks why you didn’t go to med school and become a doctor.

You’ve got some nerve…

12. Leaving work and always awkwardly saying “have a good night… I mean, sleep”

I really can’t be sure what day of the week it is

13.  It doesn’t matter if you are running around sweating for the entire 12 hours, somehow your hands will ALWAYS be ice cold.

14.  When your non-healthcare friends think that you get to take naps/sleep during the night shift…

15. The patient who is so complicated &needy who monopolizes your time thus making you feel like you didn’t provide optimal care to your other patients (who happen to be nice and normal).

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16. How I feel at the end of my 3 12’s :

17. Me giving report off on all my train-wreck patients …

But at the end of the day, even on the toughest days, even on the verge of tears, even when I say “I can’t do this”… I find the strength inside that I can do it, and I can do it with passion. I wouldn’t trade my job or my experiences for anything in the world.

A question I’ve gotten has been, “if you won the lottery, would you quit your job?”. I mean this is tempting and all but I didn’t go to school for nothing, and I am not continuing to go to school for nothing. I love what I do and it is a huge part of my life. Yeah they say we “make decent money”, but are nurses nurses for the money? I like to think it’s deeper than that!

What do you guys think? Would you quit your job if you won the lottery? Can you relate to this blog posting whether or not you are a nurse or work in another field?

Thanks for reading!

What I Have Learned in my Two and a Half Years of Being a Nurse

It’s truly amazing how quickly time flies by, it feels like just yesterday I barfed in the bathroom of the building I took the NCLEX in only to find out three days later that I passed and was an official “registered nurse”. Hannah Josephson, RN. Wow that sounds so cool I said, and off I was to my first job, as a new graduate nurse just like that. That was two and a half years ago now, but who’s counting? Compared to many nurses, this is just a blink of an eye, I am still a new nurse and I still have many years of nursing ahead of me and I know that. But what I also know, is that there is a wealth of knowledge that I have gained in just these past 30 months. So here it goes, here is what I have learned and this is my advice to you…

1. Get a good pair of shoes: Let me tell you, you will be on your feet more than you will be off of them, and one of the most important things you can do for yourself is get a pair of truly comfortable shoes. Don’t get dansko clogs just because “every nurse has them” if they are not comfortable to you. If you aren’t wearing the right shoes, your feet will hurt, your back will hurt, heck your whole body will hurt. Find something that you feel comfortable walking miles around in, because you likely will be walking miles per shift (wear a pedometer I dare you). See what your hospital/floor policy is, but if you can wear a pair of comfortable sneakers, that may be your best bet. I personally like the XP Danskos because I feel they have a little extra padding, plus they give me some height so I don’t look as short, but honestly after a few hours, my arches hurt, my back hurts and I have probably rolled my ankle at LEAST 10 times (seriously, I cant be the only one who does this right?).

2. Don’t show up on time, show up early. When you are first starting out, you will be so overwhelmed just going to work, especially when you are off of orientation. I remember some days I was so scared and nervous to go in that I would think to myself “well it wouldn’t be so bad if I slipped and fell down these icy stairs, that way I would miss work”. It’s embarrassing, but it is true and I know other new nurses who felt the same way as me. It is scary because as a nurse you assume so much responsibility, literally peoples’ lives are in YOUR hands. As a new nurse, this responsibility plus all the other things you are supposed to remember become a huge burden. Make sure you take the extra time to show up early for work. I’m not saying an hour early but like 15-20 minutes early so that you can settle yourself down, get your assignment, organize yourself and at least try to relax before you find yourself feeling rushed to take report. Trust me, I used to only give myself 5 minutes to get ready before a shift and I would feel so frazzled, unprepared, unorganized and anxious which is not a good or safe way to start a shift. It is worth the extra 20 minutes of your time for your sanity and your patient’s safety.

3. You are NOT the only nurse working. ASK FOR HELP. Seriously, I think I still have an issue with this one. In nursing school, they talk about delegation and delegating this or that and asking for help, but in clinical rotations during nursing school they make you do everything. Somehow this instills into our brains that we, as nurses, must. do. everything. NO, it is not humanly possible. Asking for help doesn’t mean that you aren’t capable of doing something, and any good nurse/colleague/co-worker will understand that and even appreciate you for realizing the need to ask for help. If it is something that can be delegated to an aide, delegate it to them- after all that is their job! I used to be paranoid that if I asked for help from an aide that they would dislike me for using them or that they wouldn’t get the job done as quickly as I could… but I soon came to find out that when done correctly, delegating can be a huge huge help with my workflow. A lot of times other nurses will not come forward and offer help because they assume that you will ask if you need it, so never be afraid to ask for help, ever. And when someone asks you for help, return the favor if you can.

4. You are NOT a computer. I repeat, you are not a computer or robot. You do not have to memorize every single thing you learned in nursing school. You are not expected to know every single lab value range, or medication name/dosage/indication, it is not humanly possible. LOOK THINGS UP. SO many errors happen when people take random guesses or don’t ask a question when they are unsure of something. If you are unfamiliar with a medication, look it up, ask someone, call the pharmacy. Use your resources!  There are so many of them. I will never pretend that I know what something is if I don’t because a) I don’t want to look stupid if asked to explain b) I could do serious harm to someone if I did. I know I am not some einstein genius, and I am not required to be. As a nurse I need to use my critical thinking skills to solve problems and evaluate and intervene when necessary. If you are unsure of an order, question that order. If you are unsure of anything, question it. Because in the end, do you want to be the nurse who overlooked something because you thought you knew it or do you want to be the nurse that catches the medication error that saves a patient’s life?

5. Follow your gut. I know they say this a lot in nursing school, and it really did take some time for this to become a thing for me (like probably within the past 6 months). Once you start to get into the groove of things, you just know certain things. If you have a bad feeling about something, something just doesn’t add up or seem right, let someone know. It could be the charge nurse, another nurse on the unit, a physician or pharmacist, just let someone know your concern, and back up your concern. I work in maternity, and I can’t tell you how many times I have had a hunch or bad feeling about something and had people respond “its fine, dont worry” and then it ends up not being fine. Don’t back down if you truly believe something is going on. Trust your gut, trust your patient. I had a woman recently who was status post magnesium for 24 hours after delivering her baby for severe preeclampsia. When I assumed care of her, she was on a 400mg BID dose of a blood pressure medication ,Labetolol. In report that I received, she was doing much better, feeling better, having no symptoms and her BPs were stabilizing. When I actually SAW the patient, it was a different story. She was sweating in bed, holding her hand to head complaining of the worst headache of her life, dizziness and shortness of breath. Immediately I elevated her head of the bed and took her vital signs. All of which were normal (including her O2 sat) minus her BP which was 140s/80s. The MD was notified and satisfied with BP but wanted a repeat, which ended up being around the same if not higher and the patient was still not feeling well. I felt like I was “bothering” the doctor for keeping her posted on the play-by-play of this patient, but looking back I don’t regret it for a minute because this patient was really deteriorating right before me and needed more intense monitoring than what could have been done on our floor. Long story short, she ended up being transferred to another floor where she received loads and loads of IV blood pressure medication to help stabilize her blood pressures. When I heard how much medication she had gotten on the other floor, I just KNEW that this would be the case from the first moment I saw her in bed, she just looked awful. I remember I even suggested to the MD that this patient may need more monitoring than we can offer, but the suggestion was politely declined at the time. I did not stop contacting this doctor with all the details because I had this gut feeling that something needed to be done with this patient, and I am really glad that I handled it the way I did because I hate to think of what could have happened if it had gone unnoticed throughout the night- she could have had a seizure, thrown a clot, had a stroke or MI…. This is just one example, there are so so so many. follow your gut. If you are wrong, you’ve probably done no harm but be extra cautious, but if you are right, you’re doing your job.

6. You may get eaten alive by some older nurses but you cannot take it personally. For some reason, nurses like to “eat their young”. I don’t know if it is for the sheer fact that they don’t remember what it was like when they were new, or if it is a secret nursing hazing ritual, but you will come across some nurses who will just try to bully you around and scare you. Please try not to let it get to you. Just do your job, be a good nurse, and that alone should prove your competency. Easier said than done, but don’t feed into this mentality, and don’t treat the new nurses after you like this. I always offer a helping hand and advice because I remember being in those shoes not too long ago and I wished that I had someone that I could go to for advice.

7.  Bring snacks. You may not always get a full lunch break, but that doesn’t mean you should not eat. Nursing is hard labor and you will be running around for hours at a time before sitting down. A lot of time, nurses go without getting a proper lunch break, I can attest to this. Bring granola bars, yogurt, a water bottle, anything really to munch on when you get a chance because if you don’t get to take your lunch, you may get cranky or even feel sick/lightheaded/nauseous.  At the very least, drink water. I’m still very bad at this.. I sometimes don’t sit down for hours to have a sip of water or a snack, but make it habit, sometimes you have to put yourself first. You can’t take care of someone else if you can’t take care of yourself first. Oh and don’t forget to pee! Seriously, you’ll get a UTI if you hold it in all shift. You make your patients void, so practice what you preach!!

8. Document document document. I remember a professor I had in undergrad say “If it isn’t documented, you didn’t do it“. Nursing can be so fast paced that it is easy to forget some things, or something may seem more important than something else. Or maybe you thought that baby’s respiratory rate was 77 but you don’t want to document that because then you have to recheck it in an hour and it was probably a mistake right? WRONG. document it, recheck it. It could be nothing, but it could be something. what if you found out that baby started grunting/flaring/retracting and became apneic on the next shift and had to go to the NICU because nobody had noticed ( errhm documented) that the baby was tachypneic. Again just an example. Somethings do NOT get documented (ie: “husband is a pain in the ass”), hahaha, but that goes without saying. There are some things that get passed along in nurse-to-nurse report, but remember, this can lead to error, misunderstanding, and may forget to get passed on again. Make sure you document everything thoroughly, objectively and as brief as possible. I always think to myself, If this had to go to court, how would it look? Document what you are concerned about, document your intervention, document who you made aware, document their reaction. Because in the end, it is your license to protect, and your patient’s lives in your hands. Nursing bears a huge responsibility.

9. You will go home and stress about all the things “you may have forgotten”. trust me this is NORMAL. I used to call my floor and ask to speak with nurse X or nurse Y and make sure that I documented this or signed off that…etc. Talk about paranoia. This can seriously drive you crazy. There would be times I couldn’t sleep at night because I was just trying to remember if I did everything right at work and if I documented it all, if there was ANYTHING I forgot. It is normal in the beginining but try not to make a habit out of it, that is no way to live. Eventually, you have to leave work at work or you will burn yourself out HARD and fast. Trust me, if something was missed or you forgot to document that oxycodone, someone will call you. It is totally normal to be hard on yourself, and alot of that makes for a good nurse, but when you take it to straight panic level, you may have a lot bigger of a problem on your hands than you thought.

10. Not every patient is going to love you, even though you want them to. Even though you may have done SO much for them, and felt like you were the best possible nurse, you are not guaranteed that your patient will be outright loving of you or grateful for you. This is the hard part because a lot of us nurses are overachievers and strive for excellence and thrive off of being a patient’s “favorite nurse”. There really is nothing like building a good repoire with a patient and feeling like you made a difference in their hospital stay, but that is not always the case. Humans are interesting in that we all experience things differently, we all have different stressors and things going on, we all experience pain and joy and love in different ways. You cannot take it personally if a patient doesn’t seem to love you as their nurse, you just can’t. I have spent so much time wondering “why don’t they like me, I have been so nice?”. Well, because to them, I am part of a negative experience for them, where they are in pain and not feeling well and they don’t want to do small talk, they want to be alone. Some people are not lovey-dovey, some people are not as grateful… that is just life. Just go into it telling yourself that you are going to be the best nurse that you can be no matter what. We don’t really know what is going on in each of our patients lives or what is going through each and every one of their minds. And quite frankly, our jobs are to help them heal, not to become their friends. I personally feel like I have connected with so many of my patients and I have felt their gratitude, kindness and companionship, but there are some patients where no matter what, I can’t seem to connect. I have learned to just let it go. As long as I am providing the best care that I can and attending to that patient’s needs, I cannot be selfish and insist to myself that I am their favorite nurse.

11. Don’t overshare personal stories with patients. I have heard some nurses share some real personal stories with their patients. It’s okay to be personable with your patients, but take it with a grain of salt, use your judgement. Don’t say anything that will hinder your patient’s trust in you and don’t make it about YOU, because the patient is the patient at the end of the day, and they want/need it to be about them.

12. Don’t assume anything. Pretty obvious one here. If an emergency bell is going off, don’t just assume someone has gone to answer it, take responsibility. If a patient is walking around clueless in the hall, don’t just ignore them and assume they will make it back to where they came from. Be helpful, don’t assume, ask questions.

13. Don’t forget to say goodbye to your patients at the end of your shift. I mean, I think this is just common courtesy here. I can’t believe that some nurses just leave without telling their patient that their shift is ending/asking if they need anything in the mean time. Just make it a habit to go say goodbye. I spoke with a nurse who told me she used to feel awkward doing this, but once she started, she couldn’t imagine not saying goodbye to her patients. I really didn’t know that people struggled with this until I started my most recent travel assignment. Obviously, don’t wake the patient up if they are sleeping, but I think in general, it is courteous and kind to say goodbye to your patient after spending a solid 8-12 hours with them.

14. Don’t pick up too much OT. It may be tempting, especially at first to make all that extra money, but don’t overdo it. You will learn to resent your job, resent wanting to go into work and you will become burnt out. You will feel like a zombie/robot that is just on repeat mode and you will make mistakes. Realize when you get to the point that you dread going into work, because at that point it’s safe to say you are probably burnt out or well on your way to getting there.

15. Don’t talk smack about your co-workers. It isn’t nice, it helps noone, it doesn’t create a conducive work environment. We aren’t in middle school, we are all professionals and should support a professional, judgement-free work environment. I don’t want to find out someone is talking behind my back, that is hurtful. If I have done something to bother someone, I would rather them come to me directly. Take that into your practice. If it bothers you that Nurse A always does xyz, take it up with Nurse A, don’t go telling everyone else about it- that is gossip. It will get back to Nurse A, it will cause office drama, and really, who wants that? Just be kind.

16. Be thankful. Sometimes I complain about my job, but at the end of the day I am thankful that I have a job- a job that I love, a well respected and well paying job. I get to do my job with passion,  work with amazing people and help build families and learn something new every single day. How many people can say that?

17. You will make some of your best friends/lifelong friends ever at your job. Or as I like to call them, my work wives. These are my people, they have my back & I love knowing that when I get to go into work, I get to spend time with them.  They help support me when I am down, help me laugh when I am sad, help me bear the weight of a heavy assignment and much more. They are my friends outside of work too, which is equally as important. I love my work wives and wouldn’t be able to do my job without them!

some of my work wives & I (Sarah, you are here in spirit I promise!)

18. DO USE caution with social media! This is a really important one. In this day and age, everyone is connected to their phones which are connected to twitter, instagram, facebook,etc but it is important that as a nurse you leave all that behind. It is not wise to post about patients or your day at work, even if you are leaving out “identifying factors” because someone is bound to see it, someone could get offended, it could get to management. Is that one post really worth risking your job? I have been astounded at what some people do on social media- I have seen people take photos of babies/patients and post them- THIS IS AGAINST THE LAW, you will get in trouble. Just be smart about it. I have posted before things like ” Rough day at work, I am thankful for all of my awesome coworkers”- I think that is fine, and I think you have to use your judgement because it could easily not be fine. Don’t post about how you don’t like your coworkers, or how your assignment was awful, or how unsafe staffing was (if this is the case, take it up in the appropriate outlet, not on social media, if a patient sees this it could open a can of worms). Don’t post things that you are doing if you call out of work! common sense people… I mean I really have seen it all and it amazes me what some people think is okay to post on social media. Is a like or a comment worth it that much that you risk your job to post it? Also, use caution when adding patients as friends on social media sites- this one is a touchy subject. I have a couple of really close patients that I had for extended periods of time that I added/accepted only after I was done caring for them, and I am able to keep up with their growing miracle babies and help give them words of encouragement. Again, I think this is okay, but it is a slippery slop and you have to be really careful with social media in this day and age!

Does anyone have some words of wisdom/advice that they would like to share?