Reality Shock is Settling In…

Sorting through the mess of accumulated crap residing in my basement, I recently stumbled across a long forgotten article that was given to me in my orientation packet when I started my current job. My first “real job” as a registered nurse. The article was about the reality shock that new grads go through in their first year out of nursing school and how it follows the same pattern of grieving, and in many ways I think I’m starting to agree with that based on my own experiences. My first year as a nurse is about 75% over, as it is March and I will have been with my employer for a year as of June 23. And let me tell you, the crazy roller coaster ride that began with the stress-packed interviews and the near 7 month long orientation process has not slowed down since completing my perioperative internship program in January. I’ve been on my own as a full-fledged (or fledgling) nurse for two months now and I realize more everyday how much more I have to grow and figure out.

One of the biggest changes about being on my own is, naturally, being more accountable for the events that occur in the rooms I work in and for my performance. There’s a lot of stress that comes with that, and fellow staff members are not slow to judge and gossip about how you’re doing. Despite the strain, I’ve been fortunate to be very supported by my loving boyfriend and ever encouraging mom, and I haven’t lost my confidence. That’s the trick: no matter how beat down the situations around you in the OR may make you feel, you CANNOT let it get inside your head. It’s a test of mental stamina. Those who can find a way not to take gossip, verbal abuse from surgeons, mind games, or organizational bull and still maintain their sanity, integrity, and dignity are the ones who are going to last. More importantly, I’ve come to appreciate even more what a steep learning curve there is when with nearly every move you make, a patient’s life hangs in the balance. It means HUGE responsibility and it is not a path for the faint of heart, that’s for sure.

Being off orientation also changes some of the ways I look at my internship process now. While I was an intern, I felt protected and always had Belinda (my nurse educator) to go to. Although I know I am always free to turn to her even now for help, advice, or commiseration, I feel awkward doing so anymore because she has new interns to focus on. And although my opinion of her and of the training she provided us with remains high, I can now see her without the rose-colored glasses that I wore as a naive intern and I can appreciate some of the criticism that other staffers voice about her. A lot of that is idle talk and some is actually quite nasty, however, I do agree that in some instances Belinda could have protected us more or better prepared us for some of the situations we would face when we were set loose. I am reminded of Melissa, an intern who started in the group that followed Esther and myself, and how she was effectively driven out of the OR by derisive preceptors and poor managerial support. Although I know Belinda stepped in to address those issues on several occasions, could she have prevented Melissa’s eventual transfer to a different unit? Or did she lack the ability to better handle the situation due to personal faults or her own lack of managerial backup? If she could have scrubbed in with us for even one day each per month, or just been with us in the rooms for any duration of time longer than the few moments that she would poke her head in our rooms, I feel she would have been able to appreciate our strengths more and to have identified our weaknesses and skill areas in need of improvement. Unfortunately I think this was impossible due to other obligations thrust upon her by the hospital, which routinely pulled Belinda away from the OR and from much desired meetings and face-to-face time with the interns. Nobody’s perfect anyway, and it’s very common knowledge in our work environment that we need a structural overhaul after so many years without a stable management base.

I’ve also learned that when it comes to working in my hospital, you must be nice to everyone but don’t trust a soul. The person who may be friendly and encouraging to your face may just be the one who trashes you behind your back and talks negatively about you to your supervisors in order to either make themselves feel important or to get ahead in some way. As with many nursing work environments, ours is full of whispers, gossip, secrets, judgments, and cliques. The same goes not only for coworkers, but for supervisors as well. My nurse manager creates an environment of intimidation and negativity in our workplace, where positive remarks are limited to yellow comment cards submitted from one staff member to another (commonly a friend) at the weekly staff meetings but where criticism and fear of wrongdoing are rampant on a daily basis. It seems that every minor error or lack of knowledge is deemed a “terminable” offense. His attitude and cold demeanor have instilled in me a distrust in my ability to report grievances or safety concerns that I witness in the workplace for fear of being seen as a complainer or a trouble-maker. This is not a healthy or constructive work environment. More than anything, I just want to fly under the radar unnoticed by him so that I do not have to be in his presence.

He started working at our hospital just weeks before I came off orientation. At a warning meeting with he and the assistant manager, which was being held for an unintended scheduling error of mine, I felt like I was trapped in a tug of war between the old manager (now long gone) and this new one. Really, I felt like I was on the witness stand being attacked by a hungry prosecutor. He asked “how attached” was I to my new shift, which is an off-shift from 9am-9:30pm. I responded that I liked it very much and felt that it is a great learning opportunity, since I get to see lots of different surgeries and expand my ability to think quickly on my feet while doing breaks and lunches on the first half of my shift, but that I also get the experience of running my own room when 3pm rolls around and I relieve the day shift staff in rooms that are still running. I also get more experience with Level cases and with traumas on this shift.

I was assigned this shift by the old manager. She asked what my preference was for scheduling after orientation, and I honestly answered that I would prefer to work three 12 hour shifts per week rather than continue on day shift five days per week as I had been doing while on orientation. I had worked 12’s as a med-surg tech for two years in college and was eager to get off the five day a week routine, especially given that I am in a distance relationship and travel the hour long distance back and forth several times a month. She informed me that doing three 12’s after orientation was acceptable and that they had a staffing shortage between 3-7pm, therefore she would be assigning me to the 9a-9:30p off-shift so that I could fill that void. As I have since learned, traditionally everyone who graduated from my perioperative internship program had been required to continue on day shift (7a-3:30p) for the first six months that they were working solo. I also learned that some of my coworkers wanted the shift I was placed on and were (understandably) pissed when the newbie fresh off of orientation was given it instead. However, I was assigned my 9a-9:30p shift for fulfill a need, not because I was aimed at devilishly thwarting anybody else’s goals or desires.

That being said, my new manager was blunt in his explanation that he does not like having me on this shift. Belinda had been more polite, but equally expressive that she deemed it a bad idea based on her perception of how much backup I would have to call on if need be. The new manager, in his cold way, gave me the distinct impression that he would be monitoring me very closely to look for even the slightest slip-up so that he could yank me back to doing day shift five days a week and strip me of my 3 day a week 12 hour shifts. However, he did not forcibly take me off the 9a-9:30p shift, which leads me to believe that unless I do seriously mess up and give him a valid excuse, he is perhaps not able to override my current assignment without my consent. Talk about adding on the pressure when you’re already nervous anyway about being on your own!

I truly feel that I’ve been doing well though, and perhaps even exceeding a few people’s expectations – including my own. Last week I was stocking case carts for the next day when around 4:30pm we had a Level 1 emergency craniotomy roll into the OR from the ER. Two other nurses and I immediately flew into action, hauling the neuro trauma cart into a room and rapidly organizing our supplies. One of the nurses told me to scrub in since he’d never even seen this type of case before and had no idea how to scrub it, even though he had been working there much longer than me. I was nervous but felt up for the challenge, and knew that I was competent enough to do the job as well as anyone else around me. The surgeon was a bear to work with and by the end of my shift I was shaking from hunger and exhaustion, but I did a good job and the patient did very well. The nurse who was circulating in my room did something afterward I don’t think I’ll ever forget. The surgeon was yelling during the case and threatening to send a vicious email to our boss about how frustrated he was with delays – such as a drill not working or a bone cement not being what he wanted – all of which he blamed on me. The circulating nurse went to our nurse manager the next day and told him directly what a good job I had done, how professional I had been under pressure, and how she did not think that she (as a 15 year veteran of such tense situations) could have handled the surgeon’s behavior with the patience and level-headed-ness that I did. There aren’t that many people who will speak up for you like that in this business, and I’ll always be grateful for her for it.

Speaking of surgeons, part of my reality shock has been coming to accept that the doctor’s are a hospitals “cash cows,” not nurses or anybody else. Patients come to see doctors, not nurses or auxiliary staff or administrators. So hospitals work very hard to accommodate even the most sexist, racist, abusive doctors and particularly surgeons in order to keep the money flowing. Surgeons can get pretty bad, even to the point of throwing sharp objects in the operating suite. I’ve read some forum postings on Allnurses.com about how some hospitals have forms that staff can complete online or on paper to report such bad behaviors from doctors. I wonder, why don’t we? In an instance of irony after feeling somewhat harassed by the surgeon in my craniotomy case on Tuesday, the emphasis of our Thursday staff meeting was about that very issue. When I asked the workplace diversity specialist about documenting surgeon aggression and abuse, she really didn’t offer me much hope or advice other than to repeatedly chastise them in the moment. There is probably some validity to that suggestion, yet in some circumstances I would question whether being confrontational during a heated moment when a surgeon is already flying off the handle while a patient lies under their aggravated hands is really such a good idea.

In some situations I have spoken up though. There is a young surgeon who is in her first year on her own. It’s sort of like we are paralleled in where we stand in our respective professions – both fresh off training and being watched closely. She takes pictures of everything she does and is very conscious of her surgical start and stop times, as these are reviewed for the entire first year as a new attending. On two previous occasions I had been circulating in this surgeon’s room and at the end of the cases, she had gone to the computer where I had the nursing documentation program open on the screen and she had adjusted the end time for the surgery to trim off a few minutes, in essence making her look better in the eyes of the review board. The first two times I simply went back into the system after taking the patient to recovery and corrected the times to match what anesthesia had rightly deemed them to be. The third time that this happened, however, I calmly walked over and informed the surgeon that the computerized nursing document was a legal document and that it was inappropriate for her to touch it, just as it would be inappropriate for me to do anything to the charting she is responsible for completing. She blew up at me and threw a hissy fit, even cursing at one point, which I reported to my shift supervisor. It was later addressed by the nurse manager and seems to be resolved, yet that experience served as an important reminder to me that what I do and what I chart is a legal obligation to be truthful. My documentation can protect the surgical team and myself if, for any reason, we were ever brought to court to defend our actions. It can also protect the patient in case there was ever a recall on a type of surgical implant or if a medication error was made. Therefore it’s important not only morally and ethically, but legally, to report the truth and do be cautious with my paperwork.

Sometimes it’s the surgeons who make an impression on you, other times it’s the surgery itself and the questions if raises in your mind. There is one patient in his mid-twenties who has been to our OR several times in the past few weeks for excisions and debridements to his massive burns, which he inflicted on himself with a gasoline fire in an attempt to commit suicide. This poor troubled young man must have had his reasons for not wanting to live, and instead of respecting his wishes, we are keeping him alive on a ventilator and putting him through even more pain in our attempts to heal him. Burns are one of the worst kinds of injuries to recover from, as the surgical recovery process is intensely painful, takes many visits to the OR, and is inflicted on the patient many times over in order to remove dead tissue which could get infected and to prevent skin and muscle contractures. In burn victims, the team in the OR must cause more pain in order to properly care for the patient, but it disturbs a nurse’s mind to realize that in order to help her patient she must first hurt him. That is the opposite of how we normally think – “first, do no harm.” It’s also difficult when you have a case such as this one where you find yourself wishing that this patient had been successful in his suicide attempt, simply because then he would not have to deal with the pain that follows.

Such situations also make me question the economical impact on that patient’s family, and on the health care system. Money does not stop us from providing the utmost quality of care to any trauma victim that rolls through our doors, but I do sometimes wonder why we struggle (sometimes in vain) to save patients like this who may not even want to be saved. And speaking of socio-economical impact leads into another case that made me consider it as well, and which makes me a strong advocate for family planning. With so many unplanned or unwanted pregnancies, which could have been prevented with better education, why isn’t family planning more heavily emphasized in our society? I was in the room for an abortion about a month ago. The woman was a heroin addict with a history of rebound even after many cycles of rehab, has had 5 previous abortions, and 5 living children who had mental health deficits from her drug abuse and who are wards of the state due to her inability to care for them. Although I am pro-choice,  nobody actually wants to be there when an abortion is performed. It is significantly unpleasant. In cases like this though, I wonder, why was this woman not sterilized after the first or second abortion? How do we prevent situations like this from arising in the first place? Once a child is here, I support the idea that the government must help provide for those children if their parents cannot or are unfit to, but some such children perhaps should not have been conceived in the first place. For future generations who must pay the taxes to support these children and who must share the limited resources available on our planet, I am a strong advocate for family planning and birth control options.

On a brighter note, I was very interested to be at work one night recently when a patient was being brought to the OR for organ harvesting. This patient had had an aneurysm and was brain dead, his heart and body being kept alive only through mechanical ventilation. The family wanted to respect his wishes to donate his organs, so Living Legacy was called in and it was arranged. It was sad, of course, but so interesting from a nursing standpoint. What an amazing gift to give from one life that is ending in order to reinvigorate another life! Shunts were put into the abdominal cavity via either side of the groin area so that cold fluids could flood the peritoneum and keep the organs chilled immediately following cardiac death. It was an unusual harvesting in that the family did not say goodbye to the patient in the ICU; they wanted to be present when cardiac death occurred after the endotracheal tube was removed and the vent had stopped breathing for him. So the family was there after he had been prepped and draped, his wife holding his hand and blowing him a final goodbye kiss after the monitors stopped beeping. It was so tragically beautiful, and she was grateful to be able to fulfill his final wishes and have a peaceful parting. I will always be so thankful that both of the first two patients whom I have witnessed dying both had  lived full, long lives and that their families were at peace when the time came. I have been very fortunate not to have been traumatized yet by witnessing any violent or unexpected deaths during my young nursing career.

The Next Step

It’s been six and a half months since I started my first professional nursing job in the OR, and I’m finally about to finish my long orientation period. I have one more week to go and then I won’t be a nurse intern any longer, but a regular staff nurse. I was bummed this week because I got a cold and had to call out sick on my last regular day of the internship, but it’s nice to actually be able to do that now since a few months ago I wasn’t allowed to use any of my PTO at all.

I had a “wow” moment this week. At first everything in the OR was exciting and every surgery I saw was interesting and amazing to me, but after awhile you start to see the same thing over and over, and between the different surgical services you start to see similarities and things aren’t quite as exhilarating anymore. Still interesting, but no longer a novelty. This week I got to scrub in on my first thoracic surgery though – a lung lobectomy. It was incredible the way the doctor assessed his location among the ribs and how he accessed the lung. It was eye opening to see the black spots and damage caused by the patient’s years of smoking. I love seeing and learning about new surgical procedures.

I’ve come to realize that there are some pros and cons of working in a Level 2 trauma center versus a Level 1 hospital. For example, a pro is definitely scheduling – because we are smaller and have big neighboring Level 1 hospitals, we don’t have to be as heavily staffed on nights, weekends, and holidays, meaning that I get more of those times off without having to request them. A con that our hospital doesn’t do cardiac surgery or transplants, and thoracic surgery is very few and far between.

It has also been interesting to sense how my role among my coworkers is changing as I near the end of my internship. My more experienced coworkers have started to realize that I’m almost done with orientation and are treating me more like equals. The newer interns seem to look up to me and I find myself looking out for them too, as soon of our scrub techs (one in particular) seem to be against them. My nurse educator and I have begun communicating on a more personal level at times, while at the same time she treats me as a equal professionally. This in particular means a lot to me because I am young and fresh out of school still, so to be recognized and treated as  a bonafide professional is very appreciated since I see myself in that light.

I will miss Esther after this transition…she’s been with me on every step of this journey and has become quite a friend and confidante at work. Now our schedules will be different and we won’t have the same time together as before. As interns, we had lots of meetings and conferences that we attended together, whereas now we won’t have those as much anymore. There will still be Thursday morning staff meetings and perhaps we’ll go to some Dysrhymthmia or ACLS courses together, but I will miss seeing Esther and the other interns regularly at our 2:00pm meetings with Belinda.

We had an undergraduate student in our room on Wednesday, and I found that I really enjoyed being the one who got to explain everything to her. When you come into the OR for the first time, I know it can be so disorienting. There are so many machines and people that it’s hard to know what all of them are there for. And to be the one who was knowledgeable for once! What a nice feeling.

Now that I will be on my own without a preceptor by my side, I will be responsible for everything. There is always a safety net in that you can call the front desk and the charge nurse can rush in and help if things get bad in your room, but hopefully I won’t need to do that. I feel ready to try this on my own. It will be strange though, because for the past 6 months I’ve been oriented to the day shift 7am-3:30pm Monday through Friday, but now my schedule is changing. I will be working three 12 hour shifts a week, from 9am to 9:30pm. This has some great benefits in my opinion. Those are great hours for a 12 hour shift, and I would naturally be awake during those hours anyway (versus 7am, which is too early and not natural for me). It will give me more days off per week, meaning more 3 and 4 day weekends to spend at home with my family & friends. Coming in at 9am is considered an off-shift, and in our OR the off-shift employees always get first or second dibs on signing up for the upcoming schedule, whereas regular-shift staff get to sign up on a rotating basis after the ortho & off-shift teams. It could be difficult at first though, because I will be coming in to cover people’s 15-minute morning breaks and then their 30 or 45-minute lunch breaks (depending on the day). This will mean I’m not in one room or even in one role (scrubbing or circulating) continuously throughout the day but instead jumping between many different surgeries. That could be good, getting to see lots of different things…or it could just feel chaotic and crazy. But at least if I’m covering a room and things get bad, I’m kind of guarunteed to be out of there in 45 minutes or less, haha!

Normally I’d be typing something lame in the trend of “wow, it’s been a long time since I wrote on here!” But no, I refuse to allow myself to get into this pathetic habit of apologizing to the unknown internet audience abyss every time I feel like writing on this blog after taking a multi-month hiatus. I’m a busy girl people, deal with it.

So…wow though, a lot has changed. I’ll start with my personal life and then wrap back around to this whole nursing thing that I do. Things in New City are still foreign and weird compared to my cozy little suburban enclave that I’m accustomed to, yet strangely I find myself feeling more at ease here these days. Suppose that happens after being somewhere for so many months. It’s been…just about 6 months now that I’ve been renting this room in this skinny little house. I miss windows. I miss grass. I miss not feeling claustrophobic in my own space. But most of all, more than ANYTHING, I miss having a guaranteed place to park when I come home at night. Never again shall I take that for granted, EVER.

It’s not all bad though, and the stress of living here has admittedly decreased since Laura signed the lease. My former roomie, Megan, whom I’ve always been rather estranged to due to our 12 year age difference and the fact that she practically lives with her boyfriend two blocks away, is moving out this weekend to live with said boyfriend. Thus I went through a very stressful/frantic time period not long ago when I was trying desperately to figure out how to find someone to take over her part of the lease (she’d been subletting from me) since there’s no way I can afford this place on my own while still maintaining any semblance of my standard quality of life (which is not extravagent by any means). So via a mutual friend from college who lives one neighborhood over, I was introduced to Laura and now she’s moving in once Megan is out.

Although I am not the one moving and although I won’t be here for any of the moving out/moving in process thanks to the Thanksgiving holiday (of which I truly am VERY thankful indeed), I am surprised to find that it is still a lot of work on my part to facilitate this exchanging of roommates. They don’t know each other, so I’m playing middleman between the two in order to accommodate each girl’s needs with their moving process. This includes working out when Megan will be totally clear of the house so that Laura can move in. This is tricky for me because I feel I must still be welcoming to Megan at the house and sensitive to the fact that she has paid to be here through the end of the month, but that I must also juggle the reality that Laura must be completely moved out of her old place and into ours before December 1st. All of this is complicated by the fact that Megan and I have very different work schedules and she rarely ever comes by the house to see the notes I leave her or the bills she needs to pay or the forms I need her to sign for us to switch the cable out of her name. So although the major stress of finding a new roommate is over, I am still feeling the stress of the situation and just want it to be all over with.

I am also unsure how things will be in the house once Laura is here. She made me nervous last night when she came to leave the security deposit money for Megan because she had to sit there and figure out her finances for 20 minutes in order to be able to write the checks. Perhaps I am just more sensitive and private about my finances, but it made me uncomfortable to sit with this girl I don’t know that well who is moving into my house and will be sharing half of the household bills while she demonstrated financial dishevelment. If she’s having money issues, I don’t want to know about it. Just figure it out before we hang out and handle it on your own time.

Speaking of hanging out, we have hung out on several occasions and get along well, however I am not used to having a roommate who is around a lot or who wants to hang out. My previous roommates, even in college, were not very social and didn’t want to hang out very much, but Laura seems like she’s a bit more of a partier and someone who will want to come home and do stuff together. It sounds great in some ways, but it also sounds kind of…exhausting. I guess I’ve gotten comfortable with a quiet house and being by myself a lot in the evenings. Regardless of that, I am looking forward to this new experience! Once the move is all settled, that is…It will be very weird to come home December 1st after Thanksgiving at home and to walk into my house with all new furniture all of a sudden.

I can’t wait for Thanksgiving. I have not had 4 days off in a row since before I started my job on June 23 of this year. There is also a possibility that I may get 4 days off in a row for Christmas, although that is unsure as of yet. I like my job, but I do need time away sometimes. This week was admittedly better than last week (which was hell), and I can tell that I’m doing well in my nurse internship. Esther and I will come off of orientation on January 19, 2009 – FINALLY! After that we will be full-fledged OR nurses flying solo without preceptors and we will finally be able to self-schedule our shifts. I hope that I can do 12 hour shifts since that would give me more opportunities to be flexible with my visits home.

Since starting in June, we have been rotating through all of the surgical services offered at our hospital – two weeks circulating in each, then two weeks scrubbing in each. This arrangement has afforded me invaluable training in scrubbing, which as I’m told by more experienced OR nurses is hard to obtain as an OR nurse. The surgical services that I’ve been through so far are: General, Vascular & Eyes, Orthopedics, GU/GYN, and right now I’m in Plastics & Burns. Next I have Neuro, and then I’m done!

Yesterday was my first look at a really bad burn (greater than 70% of the body) and I think it was pretty much the most horrific thing I have ever seen in my entire life. Charred flesh, muscle, tendon, bone…I was literally standing next to the bed thinking “I’m looking at a corpse.” And sure enough, that poor man died later that day. Nursing can present you with strange emotions though. When I heard today that my patient from that case had passed away, I was relieved and grateful. I felt that it was more merciful that he had died then than living even a moment longer in the shape his body was in and the pain he must have felt. You never expect to be thankful that someone had died though, especially as a nurse who’s goal in life is to save and improve lives, however I’m finding that sometimes the kindest thing you can do for a patient is to let them go.

This has made me very passionate about the importance of everyone making their wishes known in case of a health emergency such as this poor man’s. Everyone should make a serious consideration of what kind of life saving measures they would wish to have made in their behalf should something happen to them and their family have to make those horrible calls. At least if the family knows what you wanted and did not want, they can feel at peace in making those hard decisions in a moment of extreme emotional turmoil and pain. Issues like organ donation, DNR orders, living wills, advanced directives…I could really be an advocate for these things.

My experiences in nursing, and particularly now that I’m in the OR on a daily basis, have also made me feel strongly about the importance of blood donation. As nurses, we hear/see/feel the blood shortages when they occur. It can be very frightening to know that if you use up what you have for a patient, there may not be more available when it’s needed. For this reason, I went yesterday to the Blood Drive being held on my hospital’s campus and tried to donate. Sadly I was turned away for a hemoglobin that was just shy of their desired level, but I’m proud that I tried. In college I would go every other month with a girlfriend and became a Blood Bank member. Even got a neat little certificate when I reached the 1 Gallon donation mark. So if you can give, please – GIVE.

Anyway, I’ll get off my soapbox now. Going back to my nurse internship training now. In September we had 4 new nurse interns start. This is the group that Esther and I were originally scheduled to begin with, however when nurse recruitment gave us all the option of starting in June instead, we were the only 2 that accepted that option. And now I’m even more glad that I did! Even though we were still cramming for our nursing boards while starting the new job, Esther and I had a smoother start in the nurse internship program than the new 4 people have had.

When we started, we were the only 2 new people on staff who were being oriented and precepted on a daily basis. For the 4 new nurses, however, they entered our OR during a time when there’s me & Esther, the 4 of them, 3 new scrub techs, 2 scrub students, and 2 new “experienced” OR nurses (who suck). So that’s 13 new people who are all orienting at the same time, and the OR staff is completely overwhelmed. When Esther & I started, our preceptors were patient and gentle with us and our lack of knowledge. The 4 new nurse interns have essentially been thrown to the wolves though since the staff is tired of having to train new people constantly while not receiving additional pay for it.

Also, when I started Belinda the Educator was new and had more free time to spend with Esther and I to direct our placements and our education. Now that she is in the thick of things with her role, she is often pulled away from the OR for meetings and education training programs, leaving the new interns with very few people to turn to for help when things go badly. Belinda is trying the best she can to provide them with the experiences they need and to pair them with preceptors who are members of the permanent OR staff (rather than travelers or people fresh off orientation themselves), but there are so few people on our permanent staff right now (helloooo nursing shortage!) that it is very difficult for her in addition to the other responsibilities the hospital administration has placed on her shoulders.

I am grateful that although it was hectic when I started in June since we didn’t have our educator for the first month, we still had a smooth start and positive first exposures to our surgical service rotations. It’s painful to watch the 4 new interns struggle while getting started in the current negative atmosphere that has pervaded our OR due to higher case loads, more staffing problems, and higher stress levels throughout. Despite these challenges, I would have to say that they are all doing remarkably well overall. When Belinda and the 6 of us nurse interns meet to discuss everything, it often ends up being more of a group therapy session than a debriefing or opportunity to learn from each other’s surgical experiences. It’s organized chaos in the OR, that’s for sure.

I know that at most other hospitals, nurses in the OR do much more circulating than scrubbing, but I really enjoy scrubbing because I learn more about the surgical procedure since I’m actively taking part in what is happening and it requires me to pay attention to what is happening. I also like scrubbing because you get to know the surgeons better and because you have complete control over the back table. I guess that’s part of my territorial control freak coming out, but I like having a space that is just mine to manage, whereas when you circulate you are often running around like a chicken with its head cut off trying to get everything done around the surgical field.

Knowing how to scrub for any kind of case will make me very marketable whenever I decide to leave my current hospital, which is excellent because although it’s a good place to be and very highly respected, I want to go back home. The big hospital that I used to work at has 26 operating rooms and does open heart surgery, which would be great experience in comparison to the mere 10 operating rooms that I’m floated between currently (which don’t do any cardio-thoracic surgery at all). Once I move back, I know I will appreciate my hometown in a way I never did before after having this time away. Everyone who’s ever been away from home will tell you that, and it’s true. There are many wondrous, beautiful, amazing places in this world, but like Dorothy said in the Wizard of Oz – there’s no place like home.

When I do move home, I think I will remain in the OR for another year. I’m still up in the air about whether to do this or whether I should try to go straight into an ICU setting since I need critical care experience in order to apply to CRNA programs, but since moving home (by which I mean, moving back in with my parents for a few months prior to the next step) will be tumultuous enough, I think I should stick with OR jobs for awhile. That way I at least will have a clue what I’m doing when I go to a new hospital while I’m in the midst of my rather big personal life transition. Plus that way OR nursing will truly be cemented in my head so that if I leave it and then decided later in life to return, I will know what to expect and how to do the job basics. Good plan.

Playing Catch-Up…Like a True Nurse

Whew! It’s been awhile since I’ve sat down and typed up a storm on here. Weird thing just happened when I tried to come to the site though. This site, MY site, is www.nursingchronicles.wordpress.com. I forgot to give credit to my awesome host WordPress however and just typed in www. nursingchronicles.com, and up popped a site that looks almost IDENTICAL to mine that someone had created & made two posts on in the fall of ‘07! I swear I had no clue that site was out there and the insane similarities of our sites names & appearances was a complete freak of nature coincidence!!

Anyway, it’s been a busy month since I last posted. I studied my little heart out for NCLEX and finally tested on July 21, 2008. It was a Monday at 12 noon. That weekend one of my uncle’s & his family were in town, along with my parents, so thankfully that forced me to relax from studying and enjoy their presence. I made a concerted effort to be all “zen” about my NCLEX preparation because I knew I’d been studying like mad, but the morning of the exam I was so nervous. I sat outside the test center in my car, called my mom almost crying, and told myself a million times that I was ready and more than “minimally competent,” which is what NCLEX tests for as a nurse.

The whole testing process makes you feel like some kind of secret agent entering a locked down area. You give your ID & Authorization to Test (ATT) letter to the girl at the counter, sign a waiver, and put everything you have in a locker. You are then fingerprinted at least twice before entering the actual testing room and have your picture taken, which is guaranteed to be one of the worst pictures ever snapped of you because you’re practically hyperventilating at that point. This tiny lady with a Russian accent then fingerprinted me again and walked me to my assigned computer, equipped with ear plugs and the most uncomfortable chair imaginable. At home I would just spread out, get comfy, and take practice test question in my underwear at my computer, but if I’d known that chair at the testing site was going to be so darn uncomfortable I would have practiced while sitting on a hard wooden straight backed chair to get used to the experience.

After a quick tutorial on how to use the computer (what is the mouse? where is the enter key?) the questions that would decide my entire future began popping up on the screen. This test really was critical to the continuation of my happy life flow that I’ve established here in New City, because if I’d failed NCLEX I could potentially have lost my job, or at least been demoted with a wicked pay cut. The gist of this test is that you get a minimum of 75 questions & a maximum of 265, and of those questions 15 of them are just being trialed and don’t count towards your score. You can pass or fail at any number of questions. So when I got to question 75 and the questions kept on coming, I was freaked at first but then decided to try to get comfy in that awful chair because I figured I was going to be there for the long haul. Around question 95 though (I’m not sure of the exact number), the screen just went blank. BLANK. It was terrifying. My jaw dropped and I realized I was done.

I left the test center as fast as humanly possible and called my mom. It was like I was in a state of shock, realizing that I was done studying for this thing. The way I described how I felt to people was: “I don’t feel like I failed, but I don’t feel like I passed either.” It’s like you don’t want to say you think you passed because you’re almost too scared to say it out loud for fear that you might jinx it. Two days later the other intern and I checked on the testing center’s website to see if we could pay the $8 to see our results early, and it let us. Paying $8 was completely worth it to find out our test results a few days early. I would have paid even more because the days spent waiting after the exam was even worse that the anticipation of taking it. At that point it’s just out of your hands and there’s nothing else you can do about it.

Thankfully, after checking the website constantly like maniacs for two days, we were authorized to pay and see our results. And there is was…”PASS.” We had both passed!!! Massive relief, oh man. Thankfully we found this out together and at the end of the workday, because after we found out we couldn’t settle down. We were skipping and running to our cars just laughing and screaming like idiots, we were just so happy! It’s a wonder that security didn’t stop us. Once I got in my car, I called my mom and she pulled my dad in on a 3-way conference call, so that I could tell them together. I sat there on the phone for half and hour crying and laughing with joy. Relief was definitely the best way to describe it.

So there you have it! I am an official Registered Nurse – and as of today it even says so on my work badge. Plus my pay raise goes into effect this week, yay! It’s a little tough after taking boards to be so excited and free and still have to wait and watch as your other nursing graduate friends continue to stress over their upcoming exam, but so far I don’t know anyone who has failed. We must be smart after all. It’s also weird after coming home from work everyday and studying for at least an hour per night to leave work and realize you have a whole evening now to do whatever you feel like.

And what did I feel like doing in my newfound free time? Karate, duh! Well it’s “duh” if you know me. I’ve done Kenpo Karate for 4 years and when I moved an hour away from home, I told myself that my reward for passing NCLEX (besides keeping my job and having income) would be to go find a new karate school in my new city. Thankfully I had brought directions with me to two karate schools on the day that I took boards, because otherwise I wouldn’t have known what else to do with myself during that stressful time after boards when you’re awaiting your test results. I found a school that seems awesome and I’ve been going there for two weeks now. Between karate 2-3 nights a week, that tango class I payed for (which I’m glad is almost over cuz I’ve decided tango’s not really my thing…I like salsa better), having friends & family visit on the weekends, going home on weekends, and trying to establish a social life here in my new town, I’ve been pretty busy! There have also been lots of little loose ends to tie up in regards to my move – such as car registration in my new state, transferring accounts with banks & insurance, and finding new health care providers – which have taken up time too. Hence the lack of blogging for your unimaginable enjoyment…although I doubt anyone actually takes the time to peruse my endless rambles on here, and if you do, I’m not sure whether I should be thanking you and applauding your interest or trying to help you determine a more constructive way to utilize your apparent excess of free time.

Speaking of which, the reason I write this blog is not so much for the benefit of anyone else out there, but more so because I think that I might find it amusing to look back at when I’m old and gray, or when I’ve become an experienced nurse who re-reads her initial nursing follies and enjoys them as a laugh with her super cool nurse friends. It’s also really cathartic and helpful in working through some of the experiences that I have and will encounter. If, however, there is somebody about to graduate from nursing school who’s moving away from home to start their first real nursing job in an OR who has stumbled upon my blog and finds that it strikes a chord with what they’re thinking/feeling/experiencing, then by all means I’m glad you’ve found me as your kindred spirit – and rock on! OR nursing, woo!

Hmm…big things that have happened at work in the past month…a lot. The other intern & I finally met our Educator, which was a big deal because she essentially runs our lives until mid-January (when our 6 month internship ends & we will start circulating/scrubbing on our own). I was relieved that our Educator is exactly the way she is – confident, approachable, knowledgeable, and fair. We have post-conferences nearly everyday with her for an hour to discuss how our cases went that day and what we learned. She assigns us our cases for the next day and we do a bit of research on them at night using the huge stack of textbooks she’s loaning us. At first I was peeved at this concept because I felt like this is a job, not school, but I guess when you’re a professional, that line can become very blurred because in something like health care, you will always be a student. You will always learn something new every single day because the cases, technology, and policies change. And I want to push myself to excel as a nurse so that someday I can go back and further my education, so I guess it’s also good that these assignments kind of keep me in that mindset.

Our Educator also holds lab with us about once a week, which is very helpful. Our hospital is in the process of building four new OR’s. One of them is already finished but hasn’t received it occupancy approval yet for patient use, so we use that space to learn how to position patients & operate the beds, practice prepping patients (in this case, each other), and getting used to the equipment and how it works. Lucky us to have a brand new, state-of-the-art OR just sitting there unused for us to play in!

These labs sometimes cause me to feel pretty conflicted though. In the name of educating the other intern and myself, our Educator obtains lots of equipment and items that are one-time use disposables. Yesterday in lab we were practicing the correct way to scrub and gown, as well as how to properly toss sterile items from their packaging onto the sterile field. The equipment we use/waste exercising these important principles costs an extraordinary amount of money. One sheet of Ioban, which is impregnated with betadine solution and basically looks like a big sheet of brown sterile sticky paper, for example, costs $1000. That’s INSANE. And we just opened it up and threw it away. I wouldn’t consider myself a green-activist and I’m bad about recycling here in the city, but I do have a conscience and I do try my best when I can to be good to the earth. I also think about the economy and the outrageous expenses that are incurred upon our patients when they walk in our hospital doors. But working somewhere like the OR, it’s necessary to use one-time-use disposable equipment due to the extreme importance of sterility and infection control. Sterlizing stuff is not a cheap process. Plus a lot of the equipment we use is highly specialized and can be hard to come by, which makes it all very expensive. The money that passes through the OR – any OR, anywhere – just boggles my mind. It’s not something I really anticipated as an issue that I would encounter and feel conflicted about when I entered my nursing career. All I can do is try my best to be mindful of what I use and not to waste anything unnecessarily, for both the sake of the environment and the economy.

Well now that it’s August and we’ve been working for almost two full months, it’s a strange thought that in September there will be a whole batch of new OR interns coming in. I’m so used to telling people “I’m one of the new OR interns” that I’ll have to change that, because I won’t be one of the new ones anymore. I’ll be more experienced than these other new people, haha! That’s a funny thought because I still have sooo much to learn. I’ve been told that there are 3 of them coming and that they are all new nursing school graduates also, so maybe it will be an opportunity to make some new friends. Wow…this paragraph had the word “new” in it a ridiculous number of times.

Anyway, even though I’ve technically been working now for 7 weeks, I’ve only actually been in the operating rooms themselves for 2 weeks. Last week we started orienting to the circulating role in the General Surgery service (with some random other cases mixed in). So far I’ve seen several gastric bypasses, a spinal fusion, some cholecystectomies (gallbladder removals), and lots of other surgeries too. After awhile it gets hard to remember all the operations you’ve been a part of because it’s just like any other job once you get used to it, at least in the sense that at first every surgery you see is a big deal to you, but after awhile it’s just the norm and not every case is quite as memorable as the first few you ever saw. Working in the OR can be a very serious place and you don’t often get to know your patient very well, but today I had a really awesome lady coming in for a hysterectomy. I love funny old women. In pre-op, this woman gave us a big box of chocolates. Then after we’d put her to sleep on the operating table and lifted her gown up to prep her abdomen for the procedure, we all just cracked up because this dear old lady had placed 5 smiley face stickers on her stomach along with a taped-on note thanking us for taking care of her and wishing us luck with the operation. It’s patients like that who make you stop and smile that really make me love this job.

It’s not always fun though. There was one case that kind of got to me in particular, and it took me by surprise. I had a six year old patient getting her tonsils, adenoids, and frenulum removed. She was the first child I had observed undergoing surgery. I’d seen a tonsillectomy during my junior year of nursing school and it was no big deal then, and even when I had my own tonsils removed in December ‘07 it wasn’t a big deal to me going into surgery. But after the surgery, I had pain like I’d never experienced because it’s such a highly vascularized area and I was old for the procedure. So watching this little girl get that same surgery done and remembering my own experience and how grueling the recovery was, it really got to me. By the time they were waking her up from anesthesia and she was kicking, crying, and screaming, I had to leave the room because otherwise I was about to pass out. My vision got dim and my knees got weak. It was embarrassing to me because it was so unexpected and seemed so ridiculous for me to react that way especially when I’d seen the procedure done before, but I guess it just happens sometimes when you don’t think it will. I think it just hit me hard because unlike other surgeries I see everyday, I had actually had that one and knew the pain that I associated with it in my mind, and I had trouble dissociating my experience with what I anticipated that child was going to feel afterwards. Hopefully it won’t happen again, but at some point in a job like this I think something is going to get to everyone eventually and you have to take a step back for a minute.

Looking ahead, next week we’ll scrub in on General Surgery cases all week, which I’m really looking forward to. Maybe I’ve explained this before, but in the OR different kinds of procedures fall under different “services,” which are kind of like sub-specialty areas in OR nursing. There’s the GYN/GU service (gynecology & genito-urinary), the ENT service (ear/eyes/nose/throats), the Plastics service (burns & plastic surgery), the Vascular service, the Neurology service, etc. In General Surgery, it’s basically surgeries that deal with the abdomen. Like if you’re getting a colectomy (removal of part of your colon/bowel) or a gastric bypass…those would fall under General Surgery.

I don’t mean to demean anyone who does know what I’m talking about, but I figure some of this stuff might not be common knowledge to non-medical people, so I’m trying to do a fair job of interpreting our jargon into layman’s terms. When I mention “scrubbing” for a “case,” “scrubbing” is when you wash your hands really well at that big sink like they do on TV and then you come in the OR and put a sterile gown and sterile gloves on. A “case” is just whatever surgery you’re doing. As a nurse who’s scrubbed into a case you’re the person passing instruments from the back table to the surgeons/fellows/residents/interns who are actually performing the surgery.

There’s also confusion about who these doctor people are that sometimes just randomly show up at your surgery or at your bedside when you’re a patient in the hospital. Let me try to break it down for you, as best as I can. First they go to undergrad and get whatever degree they think will help them get into med school. Then they go to med school, during which time you may see them around the hospital observing. Lots of times, these clueless med students come into our OR and look helplessly to us nurses for direction, and being the nice people we are, we sometimes choose to accommodate them (other times, it’s only because we have to). After they graduate from med school, they are MD’s. But don’t be fooled! Just because it says “MD” on their name tag does not necessarily mean that they are fully trained. Often, far from it. Because after med school, these newbie doctors still have a long road ahead of them. They generally go through 4 years of post-grad training, and during that time they are sometimes classified as “PGY1, PGY2, PGY3, or PGY4.” This stands for Post-Grad Year such & such. A PGY1 – that is, someone who is in their first year out of med school – is called an Intern. After a year as an intern, they become Residents during PGY2-4. Following their residency, doctors may become a Fellow. Fellows are training for a medical or surgical specialty, such as neurosurgery, for example. A fellowship can last several years. And if they’re lucky, maybe these long-suffering doctors will be full-fledged Attendings (a.k.a., the doctor in charge of all the other less trained doctors) by the time they’re 40. See why I didn’t want to be a doctor?

Alright, enough blogging for today.

Week 2 Wrap-Up

As of today I have officially lived in my New City for 2 whole weeks. It’s kind of strange being a young single twenty-something woman leaving the place you’ve lived your entire life and establishing a new life in a different state, completely independent of loved ones and all the acquaintances you’re used to seeing on a regular basis. It’s been unbelievable how well it’s all falling into place somehow.

It’s not that I’ve never lived on my own before. I spent 3 years of college in the dorms and had an apartment, so I’m used to having a roommate and taking care of my own domestic needs and responsibilities. I even turned out to be a really tidy person despite being a slob when I was a kid. I guess that bad habit turned around freshman year of college when my roommate and I agreed to have our room be a showroom for campus tours -which required us to keep our room immaculate – in exchange for $250 per semester. Managing bills and finances aren’t an issue for me either, although I’m really needing my paychecks to start rolling in for this new job!

I guess I’m just reflecting on all the phone calls, letters, emails, faxes, and other communications I’ve been able to get worked out in such a short period of time. Practically just two months ago I didn’t even have a job, and in that time I’ve totally established myself here in New City with my new job at New Hospital! Things I had to set up:

- Looked on craigslist.com, contacted lots of people, saw lots of places, settled on one

- Signed a lease, did some background checks on my private landlord, settled initial payments

- Set up new bank account, 403(b) retirement savings account, pension

- Got a new driver’s license for my new state (giving up my old one was tough)

- Update my address with all the businesses and people who need it

- Set up my benefits, find new doctors

- Register my car

- Transfer my insurance policies

My moving day was no piece of cake either. That morning when my brother and I went to pick up our rental truck we got the run around at 2 different locations before we finally got our reserved vehicle, and then while driving it off the lot my brother side-swiped my car and wrecked the bumper. We persevered though and picked up the two guys helping me move and got everything packed up. As we turned onto my new street in New City (more than an hour from home), however, I realized I had forgotten my new house keys. Agh! Thankfully my landlord came after an hour or so and let me borrow his copy of the keys. After everything was moved in, we headed back home and I was exhausted. Yet right before I was about to pass out and go to bed, a pipe burst in the bathroom of my apartment. It was a really bad moving day, to say the least! But now it’s my war story and thankfully it’s all behind me.

It’s strange also being so young and completely financially independent from my parents. I think I may be the first of all my friends who are my age to do so. It’s typical these days for a majority of Americans to move home after college to save money and to remain dependent on their parents for at least a few years, if not into their thirties. I’m part of the minority who are living on their own, have their own benefits, are paying all of their own bills, and like it that way. It’s a little scary though because you sort of feel like that safety net has been pulled away somewhat. I joked with my Mom the other day that I feel like I graduated college and immediately morphed into a 30 year old woman.

I also think it’s interesting to consider that of all my close friends who I’ve known since high school or earlier, I’m the only one who did not pursue a liberal arts education. All of the friends whom I still close to got degrees in subjects like English, History, and Religious Studies. I got a history minor, but not because I intended to, it just worked out that way. My Dad remarked that my career choice may have been the wisest and most lucrative, however I truly admire my friends for pursuing their heart’s interest because that’s what I feel like I did too. Maybe my heart’s just more logical and financially minded…who knows.

Anyway, with all the stresses and chaos of my recent move it seems almost unfair that I’m also studying hardcore for NCLEX as well. Today may mark 2 weeks since I moved here, but tomorrow marks 2 weeks until my test date. I rode out this afternoon and investigated the location where my entire future will be determined…not too bad, I suppose. It was a three-story brick building situated deep within a “business park” and took about 25 minutes to get to from my house. I am now one step more prepared for handling my anxiety on test day. Now I must obtain layered clothing, a water bottle, tissues, Aspirin, a snack, and soothing music for the drive over. These are my weapons to prepare for this battle day. That plus the hours of studying I’ve been putting in. It’s unnerving that my boss knows when I’m testing and that the results are posted publicly on the State Board of Nursing website. This means that she may know before I do whether I passed or failed. Very unnerving indeed.

That’s enough about my personal life for one post! This blog is supposed to be about my experiences at my first job as a nursing graduate working in the operating room. It’ll be nice when I finally get to the operating room…for the last two weeks I’ve only been there once, and I won’t be there again for at least another two weeks. During my second week as an operating room nurse intern I had three days at consortium, another day of general nurse orientation at New Hospital, and got Friday off for Independence Day. Wednesday marked the halfway point of our 6-day consortium classes and we had a quiz. Happily I received a 98% on that and also did very well on the pharmacology quiz that was given Thursday at orientation.

Consortium has been interesting and very educational. We discussed things like legal/ethical/financial considerations, anesthesia, positioning, and how to perform counts in the OR. It gives me a lot to think about and thank goodness I’m actually enjoying it like I thought I would, because it would suck to get this far and realize that OR nursing wasn’t for me! Honestly I do wonder if I will start to miss the patient contact that you get working on regular nursing units, but I think the trade-off and satisfaction of not having to deal with the call bells and patients who drive you up the wall will override the memories of the few nice patients who actually realize and appreciate how much you do for them.

That’s part of the reason I chose the OR. There are a lot of really good reasons that I wanted to go into the OR. I like how clean and precise you have to be, I like how technical it is, I like the team approach, I like that I get to advocate for my patients in a very real way, I like that I’m part of team that is drastically improving lives on a daily case-by-case basis, and I like that I get to focus on just one patient at a time. Those are the good reasons that I wanted this job, and they were the reasons I mentioned on job interviews.

What I didn’t mention was some of the less respectable reasons that I wanted to go into the OR. I was tired of having too many patients who worked me to death, I was tired of call bells and cleaning up incontinence all day every day, and I was tired of psychotic or ornery patients. I was excited by that thought of just one patient at a time. And that patient is unconscious! They even get catheterized in many cases and have been fasting (NPO), so there’s a minimized chance that I will be required to clean up urine or feces. I’m a fan of that idea. Much like an ICU setting, the OR is also a very controlled environment. It may not be the healthiest thing for a control freak like I tend to be sometimes, but it is very fitting to my work personality. Yet at the same time, most people who work in the OR tend to have a sense of irreverence and fun about them, so although the utmost care and caution are taken in every case, it can still be a very enjoyable workplace.

I foresaw that as an OR nurse, I can write my own ticket. It’s a specialized field of nursing that you can’t just walk right into like you might be able to in an area like med-surg, so I’m more valued in some arenas. I foresaw that I can work in hospitals working every shift (days/evenings/nights) and make a higher salary there while I’m young, then when I’m older and have children I can go work in an outpatient surgi-center and work an 8-5 schedule. Or I can work per diem or just weekends. You don’t have that same kind of control over your time and work locations when you’re a med-surg nurse because that’s a type of nursing that is only done in hospitals. You don’t do med-surg nursing on an outpatient basis – that’s what they call home health care.

Getting back to the past week and the consortium, the only lecture that made me start to feel decidedly overwhelmed was the introduction to surgical instrumentation. There is clearly a LOT to learn.
We’ll get a running start on that education this week because for the next 5 days, the other intern and I will be cleaning, sterilizing, and packaging surgical instruments in Central Sterile Processing. It will be a good experience for us to see another area of the surgical process that is critical and often overlooked, however I’m not looking forward to using the autoclaves. At consortium, when we learned about sterilization and autoclaving materials it was just about the most boring discussion I have ever sat through. Hopefully the real thing will be more captivating.

A Parting Thought: More than anything else that I learned at consortium this past week, I was amazed by a single fact. One bronchoscope – the small telescopic instrument that is used to inspect a person’s airway – costs more than my car. Wow.

Week 1 Wrap-Up

I mentioned that I make a lot of lists, and today I organized the huge running to-do list I keep on my computer desktop. Now that I’ve started this blog about my nursing experiences, I also started a list about some things I may want to write about on here. This sounds really OCD, doesn’t it? *Sigh* oh well. My lists keep my scatter-brained head in line and help me get things done.

My first post was massive. This one will be shorter (at least by a little, promise).

The OR internship that I was accepted into at New Hospital requires that you attend a consortium. This is basically a bunch of classes that introduces you to the major principles and practices that are implemented daily in every OR, and our consortium started on Friday. Before this, all the new employees at New Hospital had to go to 2 days of general job orientation, on Wednesday I shadowed and observed nephrectomies all day (kidney or kidney tumor removals), and Thursday all the new nurses had computer training & more orientation. After all that general orientation it was nice to finally get down to some specific training that related to my purpose: to become a super awesome OR nurse.

So Day 1 at consortium: Learned about “surgical conscience” (always put the patient first). Learned about the electronic surgical unit (ESU), or Bovie, which lets surgeons cauterize and cut during surgery but are also the single greatest fire source in the OR. Learned about how the OR is set up and why, along with some key terms and names of supplies.

A few gripes. Perhaps it’s because I am a young new nurse and because nursing is not a second career for me, but I get very annoyed when other new nurses (or just nurses new to my field of nursing) come to orientations and meetings like this and talk talk talk. In that kind of setting I just want to get through the educational material and get out so I can go home, but these folks seem to see it as their personal opportunity to share stories and reminisce. To me, it’s quite frustrating and their contributions rarely seem to be of value to the lecture. Another thing: It was so cold in that room. I understand keeping the OR cold to decrease the spread of infection, but I don’t get why every lecture room that I go in has to be freezing. The place we went was very accomodating though – lots of free food. You will quickly learn that in the nursing world, food is abundant. Everybody gives us food. It’s great, unless you’re on a diet.

As in most classes, no matter how riveting the speaker is, sometimes you get tired or your mind wanders. During Day 1 of the consortium my mind wandered towards the differences between Hometown Hospital and New Hospital, and I came to recognize that most of these differences were based on each institution’s judgment calls about where to best use their budget. They are two very different hospitals – one is suburban, one is urban. They’re in different states with different laws, regulations, standards, and public expectations and attitudes.

Before I accepted the OR internship position at New Hospital, I had interviewed at several others. Maybe 4 or 5. Each of those interviews was for the same type of position in the different OR internship programs at these various hospitals, and each interview required that I come on a second day for what is called a “shadow” or “share” day. This is when you basically come in, change into their OR attire, stand in the corner and watch OR procedures all day. The purpose of this is to prove that you can handle the sights, sounds, and smells of the OR atmosphere without getting scared, passing out, or vomiting (all very frowned upon, naturally).

As a result of doing so many of these shadowing days while trying to land a job, I got to see a wide variety of OR arrangements and supplies. While I was shadowing at work on Wednesday of this week, I couldn’t help but think about some of the things that were blatantly absent in New Hospital’s OR. My observations of what was missing (don’t hate on me for not knowing the correct terms):

- Sponge counter bags

- Surgical helmets to which facial shields attach

- Electronic boards in the OR, PACU, & family waiting area that denotes where & in what stage of the surgical process a patient is in

- Re-usable sharps containers

- An OR-specific pharmacy

Other things throughout New Hospital that caught my attention:

- There’s no swipe-in, swipe-out system for attendance & time clocking

- Can’t dial 911 directly during emergencies, must dial a non-intuitive internal system number

- Use of disposable blue chucks instead of re-usable pink pads for incontinence

- Not a smoke-free campus

Now the reason that this doesn’t fluster or upset me is because of what I mentioned before about allocating the budget. By the way, as a new grad I felt that this was a rather astute observation on my behalf. For example, New Hospital may not have some of the things in that list, but the money that those items would have cost was instead spent on purchasing state-of-the-art robotic surgical technology which will better serve our patients. I’m okay with that. I must say also that New Hospital has the best customer service and employee satisfaction that I’ve witnessed anywhere.

My mind decided to wander to other things as well during class. Primarily, I thought about how cool it was that I’m getting paid to learn. It’s like the Pleasantville version of college. I also thought about how I’m proud to be entering the nursing profession early in life with a Bachelor’s degree. Once in awhile I’ll run into someone who’s looking into attending nursing school and they will ask me – “Should I go to a 2-year Associate’s Degree (ASN) program or a 4-year Bachelor’s Degree (BSN) program?” Well, that depends on you. If you have any inclination that someday you may want to further your nursing education and go beyond being an RN, such as entering management or teaching, you will need your Bachelor’s Degree in nursing anyway. If you know that all you want is to be an RN for the rest of your days, an Associate’s Degree will do you just fine. Both programs will get you an RN license (if you pass boards).

My experience has shown, however, that most people who enter an Associate’s Degree nursing program end up taking 4 years to graduate anyway though because they have to wait for clinical spots, whereas Bachelor’s Degree programs rarely seem to have that same struggle. I don’t know if it’s because of the different connections the schools around my area had with the local hospitals, but it seemed like a shame to have spend the same amount of time in an Associate’s program as the people who went to the 4-year Bachelor’s program and not get the same diploma. At many hospitals there’s a pay difference that favors BSN graduates over ASN graduates, and most hospitals nationwide are pushing ASN’s to get their BSN anyway. Some places won’t even hire ASN grads.

If you’re one of those people (as I was) who think of nursing as a job that sticks you by the patient bedsides for the rest of your life, allow me to change your perspective. This may be particularly of interest to anyone who’s in that position of trying to determine if all they’re going to need is their Associate’s in nursing or if they should dive into a Bachelor’s track program (my preference, if you couldn’t already tell). In my Book of Lists, this list is titled “Nursing Career Options…For in case I ever get burned out.” I’m sure there’s more that I have down because nursing is such an incredibly varied profession. Below is my compilation of the many amazing things you can do and become as a Registered Nurse:

- Bedside Nursing (Med-Surg, Pediatrics, L&D, Psych, etc.)

- Specialize in one of those areas

- Surgical Nursing (Working in the OR like me, where patients are asleep & catheterized so they won’t make a mess on you, yay!) in a hospital or outpatient surgical center

- Become a Nurse Practicioner (many states allow you great autonomy, even prescriptive authority)

- Become a Legal Nurse Consultant or an Expert Witness (if  you’re interested in nursing and law)

- Work for a pharmaceutical company either as a sales rep or working with research participants

- Can work in many settings (Hospital, community clinic, private doctor’s office, etc.)

- Work for National Institutes of Health or other government agencies

- Work for a professional nursing organization (such as the American Nurse’s Association, Sigma Theta Tau, etc.)

- Become a college nursing professor (my long-term hope) or part-time clinical instructor

- School nursing

- Nurse at summer camps, resorts, and cruise lines

- Travel nursing

- Work in nursing administration/management

- Become a nurse researcher

- Work in public health nursing (lobbying for health issues, etc.)

- Instruct NCLEX review courses

- And much, much more! (cheesy, I know)

Another thing I thought about during the consortium lectures which hadn’t struck me before was the realization that as a new nurse graduate, this may be the last time in my career in which I am so generalized in my nursing knowledge. This is a good thing, because it’s good to specialize and to focus in on one particular discipline of nursing in order to best serve my patients, but it’s also a bad or sad thing because I’m worried I will lose some of the knowledge that comes so easily to me right now once I’m not using it on a regular basis.

Right now I’m definitely using all of my cumulative nursing knowledge on a daily basis because I am studying to take NCLEX. This is my nursing licensing board exam and it’s coming up soon. I’ve taken the Kaplan course and that has definitely been helpful (free advertising for ya Kaplan, congrats), but naturally I’m still anxious. This test determines a few things: if I get to become a nurse, if I get to keep my job, if I have a livelihood… oh and just about everything else I have planned out for my future. I’m confident that I will pass, it’s just that at this point I want it to be over and done with.

PS – Please don’t think that I’m a slacker who didn’t pay attention at all during my consortium classes. I really did! Most of the time

First Post

One day, I will be old. And perhaps my children will wonder what my youth was like. Okay well maybe they won’t care, but hopefully somebody will be and/or is currently interested. In an effort to remember what it was like to be a new nursing graduate moving to the big city, and maybe to help ease (or increase, who knows) the fears of others following in my footsteps, I have decided to start writing this blog. Plus I’m selfish and want to write it down because it can be cathartic in times of stress. Whatever, it helps.

I should probably start off with some background information about myself (the author). When I was in high school, I was determined to bust out of my regular surroundings and not end up like so many others in my position who had ended up going to the University right down the street from our high school. It’s not like ours was a small town necessarily, but it certainly felt that way. There was a real “everybody knows everybody” feel to life. But wouldn’t you know that during my sophomore year of high school, my audacious mother (love you!) decided to get a job at that exact University which was down the street from my high school, and that her new job offered me free college tuition? How dare they! Of course, I’m just kidding about being upset and I’m thrilled Mom got that job. It was actually fantastic news for both her, myself, & our family. It did, however, pretty much seal the deal that I was going to be going to the university which I had convinced myself was not for me.

Later I figured out how juvenile my whole perspective on that whole situation was. Thankfully, I was smart enough even back then to realize that nobody in their right mind turns down free college tuition and I applied early decision to the University. That done, it was time to figure out what major I wanted to declare. Now when you’re a senior in high school, it can be quite daunting to look at a list of options and say “That right there, that’s what I want to do for the next 40+ years of my life!” So being the logical person I am, I made a list. I make lots of lists. To do lists, shopping lists, life goal lists…I literally have a journal that is designated just for list-making. What a personality quirk, geeze. Anyway, I made a list about what I wanted and what I liked.

Number One: I like helping people. All through high school I was a member of the Key Club, which is basically a junior Kiwanis Club, and did lots of volunteer work through that organization. So I had that down.

Number Two: I like science. I’m not particularly gifted at it, in fact I hated chemistry and physics, but I had a biology teacher who pushed me to love that and to enjoy the challenge of it, so science was in.

Number Three: Job security and decent pay are a must. After seeing my Dad go through the hardship and heartbreak of being laid-off while I was young and the strain it put my parents under to provide for our family, I knew that I wanted a job that would give me independence, autonomy, and a guaranteed paycheck.

This all considered, I looked through the University’s catalog of majors and came up with nursing. I didn’t consider the fact that this would involve handling a lot of blood, guts, and grossness. I certainly didn’t realize that my decision would lead me into a part-time job during college in which I would be directly responsible for cleaning up incontinence (that’s the nice word for it). Yet it worked for me. Every nursing course I took confirmed more in my heart and mind that this was the profession I was meant for. I can tell my family and friends stories that make them want to hurl, I can eat ice cream while watching someone’s arm get sewn back together (my brother’s motorcycle accident in ‘06), and I have a fairly decent understanding of many general mishaps that can happen with your body. It’s fun times, man.

Nursing school was an amazing experience. We had some of the best professors you could ask for. Our simulation labs were large, well-run, and supplied with cool mannequins that pooped, peed, died, and even gave birth. We had clinicals all over the place and left with some crazy stories about patients, situations we faced, and our instructors. I studied abroad twice – working with AIDS orphans in South Africa my sophomore year and then doing sun safety & skin cancer research on the beaches of Australia during my junior year. Best of all was the bonds of friendship that formed between us nursing girls. It’s kind of like an exclusive club to be a nursing student, you have to be in it to understand it. Your other college friends have no clue what you’re studying or doing most of the time, but they know it’s hard and that you’re going to get a job before they do. But at the same time, you’re not isolated from the rest of the campus community. No way…us nursing girls like getting out there and mixing it up.

Despite my juvenile desires to reject this university that was just down the street from my high school, in the end I am so thankful that I went there. It allowed me to save money, stay close to home while still growing in my independence (living on campus & then in an apartment), do laundry and get great home-cooked meals at home (thanks Mom & Dad!), visit my Mom at her office on campus whenever I needed a hug or encouragement, and I got to stay close to my high school girl friends while also branching out and embracing college life. There is nothing I feel like I missed out on in college, which is a pretty great thing.

Okay now I’ll get into a little bit about how I got to be where I am right now. So while I was at the University, a lot of us nursing students worked as nursing assistants (techs) at a local hospital. I’ll call this Hometown Hospital. Hometown Hospital had a heavy role in most of our clinical learning experiences, lots of our professors worked there per diem, and it was the kind of situation where it’s just sort of assumed that most – or at least a lot – of the new graduates from our nursing program would end up working there. That’s kind of the reason why this hospital and my university get along so well – it’s a healthy reciprocal business arrangement for both institutions. I should mention that this is also the hospital where I was born, the hospital where I had been a patient, and the hospital where (just like in high school) I was DETERMINED not to work. It’s not like it was a bad place, that’s not it at all. Hometown Hospital afforded me huge educational benefits as a tech that you just don’t get out of nursing school alone, and it had done great things for my family’s health. The reason I was determined not to end up there was that just like back in high school, I felt like I was destined for bigger and better things. Kind of uppity, I know. There you have it though. I didn’t want to feel pigeon-holed.

I knew all of this well before my graduation from nursing school. About halfway through senior year of college you start applying to jobs and figuring out what you want to do with your life after graduation (the entrance into adulthood – eek!). This time it wasn’t quite as simple as making a list. We’d had plenty of clinical experiences to help guide our decisions about what area of nursing we wanted to pursue, so I tried to think about which one had been the most interesting and exciting to me.

Med-surg: Tired of it, been teching there for 2 years.

Pediatrics: Never baby-sat, not good with children (although I like them and want some!). Also requires dealing with anxious freaking-out parents…not my cup of tea.

Labor & Delivery: Gross & miraculous at the same time, but devastating to all parties involved if anything goes wrong. Too upsetting, no thanks.

Psychiatry: Depressing/frustrating/eternal uphill struggle. No.

Community Health: Not hands-on or clinical enough for me.

Emergency Room: Too much craziness & stress.

Critical Care (ICU’s, etc.): Perhaps…

Operating room: Bingo!

I never had a clinical in the operating room (OR), but I had had several field experiences and seen some procedures. Overall, I liked it! I liked the teamwork I saw, the technicality, the sterile field, the ability to hugely impact somebody’s life in a positive way in just a matter of hours, and the mystery of “What do they do behind those closed doors?!” It was appealing. But how do you get there?

This led to my job search for a spot in an operating room. In recent years many hospitals have developed “nurse internships” for new nursing graduates as a means to train new RN’s for specialty nursing positions. This is good for me because that’s how I ended up getting my job. These nurse internship programs are expensive for hospitals to run, but it’s beneficial to them long-term because nurse grads are indoctrinated right out of school with their specific practices and policies, plus they tend to have good nurse retention rates. All of these things are important in a world where nurses are in high demand and short supply, particularly nurses who are specially trained to hold positions in areas like the ER, ICU, or OR. Areas that are not generally considered nursing specialties include med-surg and the like, however it’s my opinion that pretty much every area of nursing is specialized and unique. After awhile it can be very difficult for a nurse familiar with one area of nursing to switch to another area, and attempting to make such a switch (known as” getting pulled” to a different unit or area) may be downright dangerous for patients unless that nurse is provided with a thorough update and review about nursing practices in that different area.

Back to Hometown Hospital. This hospital had one of these nursing internships, in fact they had several of them, one for each specialty nursing area. Although I was *determined* not to end up there, I applied to their OR internship. I also applied to lots of others in 4 different states, but in the end it came down to Hometown Hospital and one other. The other hospital was just over an hour away in a different state, and is pretty well known and respected throughout the medical community and the nation. I will call this hospital New Hospital.

I had anguished over my efforts to get a job before graduation because early in the spring semester of senior year, it seemed like all of my friends and fellow nursing majors were signing on for jobs well before I even had an offer on the table. I kept reminding myself that it was taking longer because I was applying for competitive nursing internship positions rather than regular floor jobs, but it’s an understatement to say I was worried. Finally during the first week of May, just weeks before graduation, I got the two job offers I had been waiting for – nursing internship positions in the Operating Rooms of both Hometown Hospital and New Hospital. Now I was faced with a daunting decision: Stay at the Hometown Hospital you know and are comfortable at, or leave everything you know and take a leap of faith by moving away to work at this other well-renowned New Hospital? In the end I guess it’s a good thing my Mom got that job at the university down the street and that I stayed in my hometown for college, because that experience (although I loved it) of not stepping out of my comfort zone pushed me this time to take that leap of faith. I accepted the position at New Hospital. Everything happens for a reason.

New Hospital carries some weight when you tell people you work there. I gotta say, I enjoyed telling people and especially my extended family members, that I was headed there. I’m still proud of it. I’m still getting used to it! This has been my first week there and already I can tell it was a good thing for me. The people are so friendly and nice, as are the facilities. Getting here, however, was not without it challenges.

I found out on May 1st that I had gotten the job. Ecstatic! My original start date was September 15 or something, and I was planning on keeping my tech job at Hometown Hospital for the summer. Had no idea at that point what to do about my apartment since my roommate was moving out and I didn’t want to pay the rent alone. Also had no idea what I was going to do all summer about health insurance, as my parent’s insurance company was dropping my coverage the day after my college graduation (how nice of them). On May 13th, however, I received a call from my nurse recruited at New Hospital informing me that “Surprise and good news! We have reviewed our budget, made some changes, and would like to offer you a revised start date of June 23!” I was floored. This was amazing news – I wouldn’t be bored all summer, I’d have a real nursing job and be cool like my other nursing girl friends, wouldn’t have to worry about rent & insurance – but oh…wow, June 23? Um…that’s only 5 weeks away. So I tell her “Sure, I don’t know how, but I’ll be there!”

Haha this started a whirlwind of action. It was only a month and a halve ago but I sit here today wondering how in the world I pulled it off. That afternoon, I dropped everything (including schoolwork) and hopped on craigslist.com. Five days later my Mom and I drove out to the city where New Hospital is located and checked out at least 7 or 8 different places to live. I settled on the second to last; a row-home with an older nurse (whom I did not know) who works at New Hospital’s affiliate location that was 2 blocks from some night-life, 5 blocks from the water. Nice place with cheap rent too, for a city! I signed the lease less than 10 days after accepting the new start date. Can you say “hectic?”

And now I’m here! In the meantime between getting that epic phone call and starting work this Monday, I finished clinicals, graduated from college, moved out of my apartment into my new house, hugged my life in hometown goodbye, and did LOTS of research and made LOTS of lists to help manage my entry into this new, unknown life. I’d be lying if I said I acted all smooth and cool about it. At times I felt like someone was going to have to drag me to my new city kicking and screaming. Honestly, I had a lot of anxiety about leaving home. I never knew I was such an emotional person! Everyone told me “You’ll be fine, it’s only an hour away from home” but having never lived away from my friends and family before, or anywhere other than my hometown, moving (especially doing it alone) was a little traumatic. They also told me this would be a huge learning experience for me, and they were right. It’s been less than a week and I already feel like I’ve learned a lot about myself, not to mention the stuff I’m learning at work!

Now that I am working full-time, it’s gotten a lot better. I have a direction and a purpose in life, people expecting great things from me, and I am expecting even better things of myself. I thrive on productivity and goals. Leave me with nothing to work for and I’m a sad sack. So no more crying spells, at least not for now. I’m too busy! The OR internship that I am doing at New Hospital involves extensive training and orientation, including a huge class that spans several days and is held cooperatively with many other medical institutions to train their new OR nurses as well. That starts tomorrow morning and will cover information given to me in the biggest three-ring binder I have ever laid eyes on.

I’m also busy learning my way around New Hospital and around my new city. Today I found the employee gym and was excited to see that it has a large, empty, mirrored workout room designed for aerobics classes. I’m not much for aerobics classes but a space like that is perfect for me to practice my karate skills, techniques, and kata. I have done kenpo karate for 4 years now, which was another thing that made it so emotional and hard to leave my hometown. My karate school and all the people there holds a very dear place in my heart, and I was truly heartbroken to leave them.

There are some kenpo karate schools in my new city, as you would expect, but I’m taking awhile off from karate or from looking for a new school right now while I study for my nursing boards. Talk about stress. New job, new city, new residence, plus the most important test of my life all rolled into a short period of time. I won’t say the exact date when I’m testing, but I took the Kaplan prep course and am feeling fairly ready. I’ve got a few weeks to go still. Karate is my motivating force – well, along with the desire to keep my fancy new nursing job! – because I’ve decided that once I get my RN, then I will allow myself to go find my new karate school. It’s my reward system for myself, yay!

Well I think that’s plenty for this post. Wonder if anyone will read it or find it interesting. Doesn’t matter too much, it’s mostly for me anyway! If you do read it, feel free to give me encouragement or happy thoughts for my continuing journey into the nursing profession and into adulthood. Just keep it PG, kids.

PS – If it seems like I’m being vague, it’s on purpose. I don’t want to mention names of any particular institutions and risk getting sued someday if they don’t like what I say on here. I kind of like not going to court or jail…maybe that’s just me! Hence the nicknames.