Then Wednesday night hit.  It was the beginning of a 24-hour period that had my adrenaline in overdrive.  One thing after another kept happening, and I was at my wits end by Thursday night.

Here is a brief overview:

The camp pastor fell on a horseshoe stake and injured his leg.

A 12-year-old boy fell off a 10-foot platform face first.

A 10-year-old boy was brought in on a back board after injuring his neck inner-tubing.

Another 10-year-old boy fell and injured his arm and ended up in the ER.

Now, between these injuries were several bee stings, a sprained ankle, a minor eye injury, and all the minor stuff mentioned above.  Those were easily dealt with and forgotten moments after they happened (for me, if not the patients).

It was the others that had me reeling a bit.  Three of them I was alerted to before I saw the victim.  The fourth happened in front of me.  I watched the fall through the lens of my camera.

In each case, my stomached dropped.  Remember, I’m a Family Practice nurse, NOT an ER nurse.  It’s amazing what comes to your mind when everyone is looking to you to deal with an injury.  Honestly, after the “Oh crap” thought left my head, I went into an immediate prayer.  It went something like this: “God, please help me to be sufficient for this situation.”  Short and sweet. 

I was completely aware that I might not have the experience needed to care for the injured party, but I was all they had in that moment.

I am smart enough to know that my very first responsibility is to remain calm.  If I don’t, no one else will either.  It’s all an act, of course, but they don’t have to know that.  Beyond that, I just start doing whatever comes naturally (or supernaturally in some cases).  I take control, ask questions, and pretend they are in extremely capable hands as I start attending to whatever need they have.

If you’ve been reading this blog for a while, you may remember that my first camp nurse experience didn’t go so well.  Actually 99% of it went fine.  It was the 1% named Tony that was the killer.  Tony was electrocuted by a fan in the camp kitchen and died.  He was 17.  I did everything I knew to do, but he died anyway.

We all face situations as nurses where we aren’t sure our abilities will be enough.  Where we don’t know if we know enough.  Where we feel insufficient.  Sometimes, in fact, it’s the truth.  But more than likely, we have everything we need to do the right thing for the patient.  Tony died because he was electrocuted, not because I did anything wrong.

And our patients deserve our confidence.   What could be worse than feeling terrible and have the person who’s supposed to be taking care of you acting like they don’t know if they can?  Talk about adding insult to injury!

So the next time you have to do something you aren’t sure you can,  fake it.  Even if you have to get some help, ask for it in the most confident tone you can muster.  You are a professional.  Other people assume you’re qualified.  Act like you are.  And if you’re still a little uncertain, you can always try my approach and pray.  Who wouldn’t want to believe there is a higher power who can bridge the gap between what they have and what they need?

I, on the other hand, am not panicked.  I am annoyed.  The phones of every doctor’s office in the country, and possibly a few other countries, are ringing off the hook.  Every person with a fever, every kid with a cough, every kid who sat next to a kid with a cough: They are all worried to death (or at least their mothers are) and looking to the medical profession for answers.

Unfortunately, the answers I want to provide are sarcastic.  “Do you know how many people die of influenza every year in the US?  36,000!  And do you know how many have died of H1N1 flu in the US so far?  One!  That’s how many.  So go home and take some Advil, get some rest, and drink plenty of fluids.  Trust me, the chances are pretty good that you’ll live.”

Fortunately for my patients, I never actually say what I think.  It doesn’t actually matter what I think.  What matters is that people are scared.  My job is to care for them.  In part, that’s relieving those fears, but it’s never dismissing them.  The term pandemic is scary.  It causes a low-level hysteria that rapidly grows into a high-level hysteria as news pundits discuss it day after day.  I can share my personal opinion with friends, but not with my patients.  I have to handle each person and each concern like it matters to me.

My best friend is an advice nurse in California.  She told me yesterday that they have received thousands of calls in the last couple weeks about the Swine flu.  The other day they were 6 1/2 hours behind on answering calls.  Of course, people were calling with “normal” stuff, too.  They also had to wait to be called back because of the flu calls.  It’s completely overwhelming.  But one call at a time, they go through the protocol, giving advice, making appointments as needed, and talking people off the ledge.

I guess what I’m saying is that it’s okay to feel frustrated about stuff like this, it’s just not okay to show it.  At least not to our patients.  They deserve to feel like their illness, real or perceived, is important to the ones they have entrusted themselves to.

First, I was put in a room with 3^rd-year med students, which was great because I introduced myself and got to chat with them about their program.

Then I waited over an hour for someone to acknowledge me.  (I was escorted to the room, so it was known I was present).  Other nursing students did this same thing through the semester, so it’s not like I was the first one.

Finally, the MD came in. We all stood up, and he introduced himself, shook hands with the med students, and ignored me.  I was very upset by this, so I forced my hand out at him and introduced myself.

Then the MD told some H&P about a patient, mocked them with the door open, called out individually to med students to follow him-and did not provide me directions.  So, I made the best of it and knocked on patients’ doors, introduced myself, and asked if I could observe the visit.  This allowed me time to talk to patients and get information.

Then the docs walked in, did their exams, and left.

I know how to measure a fundus, use a Doppler, and take H&P.  Whoopie!  I was pregnant before, so this was not an educational experience for me.

Also, I was very insulted by the MD’s attitude.  He is supposed to be a professional.  He made it quite clear I was not welcome-even before he met me.  He was also unprepared.  He told every patient he had no idea what labs were drawn, what the results were, or what meds they were taking. I could not imagine this person as my MD!

For the first time since I was in nursing school, I felt out of place, insulted, and even embarrassed to be in the nursing field.  After that clinical visit, I found out that other students were treated this way.  I made a complaint to my instructor and received no feedback.

I am sure not all doctors are like this, but I recommend reading The Intern Blues instead of following some jerk around if you want to know what doctors do.  As for them knowing about what nurses do, they don’t care as long as they don’t have to do it.

Generally, though, when I make mistakes, I realize I have the best intentions and am able to forgive myself.

But there was one mistake I made in nursing school I can’t get over. I was one of the few nursing students that had been a CNA before school, working at a nursing home for two years. During our first year, I had a post-op hip patient. We were responsible for oral meds and ADL’s at this time. This patient needed to have a BM so I asked the new-grad nurse taking care of her how she had been using the bathroom. She handed me a bedpan (I didn’t know what a fractured bedpan was).

I asked if I needed to help the patient, and she told me the patient had been helping turn herself. So I went in the room and the patient asked me if I should get some help. I had heard this comment a lot at the nursing home, and said my usual joke: “I’m short, but I’m stout.”

I may have pre-planned for this patient, but I did not think about making sure there was a hip abductor between her legs. The patient rolled over with my help and did well, but had some discomfort. I thought this was normal, but after I put the bedpan under her and we rolled her back to her back, she was crying in pain. I ran to get the experienced nurse for help. She came immediately.

After we had the patient comfortable, the experienced nurse told me what I did wrong and what could have happened (how her new hip prosthesis could pop out). She asked me not to take care of that patient anymore. I agreed, but still went into the patient’s room to own up to what I did.  She didn’t say much.

I also told my instructor, who tried to make me feel better. But I couldn’t stop crying. I just can’t get over it because I always wonder if I was trying to impress someone. (Who knows – maybe I was trying to prove something to myself.) I was always told how good of a caretaker I was. I never considered how cautious I should be.

I know what I did was wrong-and I just can’t stop thinking about the pain that woman was in. I still cry about it now.

It won’t stop me from trying to be the best nurse I can, but GOD I wish I could take it back!

1) Always be the needy one. If you’re always the one needing help with getting everything done and never offer to help someone else, the other nurses will eventually resent you.  Now, that doesn’t happen right away. New grads will always need help, and that’s fine.  But as soon as you have a spare minute, don’t keep it to yourself; offer it to someone else who may need a hand.

2) Don’t own up to a mistake. If you mess up, AND YOU WILL, confess the problem before someone else brings it up.  A good learner recognizes a mistake and takes responsibility for it before it’s called to their attention.

3) Get involved in the drama. Once you’re in, you’re in, and it’s very hard to extricate yourself.  Just try to avoid getting involved in whatever soap opera of the month is taking place.  Don’t comment on it.  Don’t ask questions about it.  Don’t go to lunch with the people involved in it.

4) Externalize. Do you know the kind of people I’m talking about?  The kind who always blame all their problems on everyone else.  They never take responsibility for their own stuff, be it time management issues (”I got caught by a train!” “So-and-So needed help, so I couldn’t get my meds passed on time”)  or relational issues (”The charge nurse has it in for me,” “The PCTs are never helpful with my patients!”), or nursing skills (”That’s not how I was taught by my preceptor,” “The patient wouldn’t let me”).  Just be responsible for your own actions, behaviors, and words.

5) Talk about other staff behind their backs. Do I really need to say anything about this?  It will ALWAYS come back to bite you.  Just don’t do it!

6) Cop an attitude. As a new grad, you need to be confident yet humble.  Nobody likes a newbie who thinks they know everything.  In fact, nobody likes a seasoned nurse who thinks they know everything either.  Acting like you’re better, smarter, prettier, or anything else that ends in “er” is just plain annoying and will put you on the hit list.

7) Stop learning. This is as much about you as those you work with.  It’s not good all the way around.  You’ll stop liking what you do if it gets boring.  And it will if you stop learning.  Always be on the lookout for new things to learn.  Read the journals, take classes, volunteer for committees, ask the docs questions.  It will not only make you a better nurse, it will make both your job and you more interesting!

Now, I’m sure there are a hundred more ways to ruin a job; these are just the first I thought of.  What are some others?  Do you know from experience?  Personally, I’m trying out number seven at the moment.  I haven’t stretched my brain at work in a long time, and my love for the job is waning.  Frankly, I’m bored.  I’ll let you know how I work this one out.

In the meantime, fill me in on your ideas of ways to ruin your job.

The day didn’t start out great—-and soon got worse.

That day I asked the hospital cleaning crew to mop up some fresh vomit. “We don’t clean up body fluids,” she replied. I tried to borrow her mop to clean it up myself.

“You’re not allowed to use my equipment. You’re not trained. It’s company rules!” So I went to the cleaning cupboard to get some equipment to clean the mess myself. But it was locked and the cleaner wouldn’t open it for me. I ended up using a towel to clean up the vomit.

Then a patient slipped from his chair, and I found him sitting on the floor… asleep. I tried to find a nurse to help me sit him up, but couldn’t find one in the immediate area. I asked the cleaner to help me sit him up.

“We’re not trained to do that. It’s against company policy.”

My anger swelled. “I don’t give a damn what your company policy is. Show some bloody compassion and get over here and help me.” My appeal worked, as we helped the patient up off the floor.

Where were the other nurses? I wondered.

When I think of this type of sagging medical care in hospitals, I think back to Mr. Smith. His breakfast tray was always left out of reach. I’d come over from my side of the ward (I didn’t have the time, but I did when I could) just to feed him. Every day he got weaker, more dehydrated. The infection spread throughout his lungs. He just stopped breathing one day. If he wasn’t left in bed or in a chair all the time, maybe he wouldn’t have died. If there were enough physical bodies to just get him going, I’m sure he would have made it.

Managers and government people are always trying to find ways to improve hospitals. They set goals, devise plans, install new systems, but they never work.

Frankly, I think we just need more bodies to do the basic work of a nurse–which is simply to care.

Is anyone out there listening? Do you agree? I’m not the brightest or the most knowledgeable. I just want a chance to be heard. And I think I can make a difference. I think you—a new nurse—can make a difference, too.

One month at the PICU, I’m so tired. It’s been the kind of month that keeps you up all night. If you finally get to sleep, you wake up from a disturbing dream.

You smile and joke the whole day at work, but subconsciously you’re bleeding from the gut. And there are no sutures to keep the wound closed. Really, there is no time for that. There is no time to wallow in pain and grief for the patient you just lost–because another sick kid is being wheeled in from the ER.

You gulp back the lump in your throat and blink away the tears. The heart has to stay intact. If it doesn’t, everything else will fall apart.

Sometimes I wish I could just not show up at work. But I know I can’t, and I won’t. They need someone to be there for them. Someone to wipe away the crusted blood from their young skin; someone to remove the tubes from their mouth; someone to wrap them up; someone to help their parents through the whole process of death because they are too emotionally shaken to do it by themselves.

They need someone who cares, even if it hurts. Showing up and being there—it’s the least we can do.

Here’s the thing about seasons. They come and they go. That’s important to remember. Especially the going part. Some feel like the new birth of Spring, and some feel like the death of Winter. Either way, you have to remember to enjoy the good, and keep hoping through the bad. Both will turn into a new season in time.

If you’re a student, it may feel like the studying will never end. If you’re a new grad, it may feel like you’ll never get the hang of this new career. If you’ve been working for 30 years, it may feel like retirement will never come. Stop waiting. Enjoy what you’ve got. It will be gone before you know it.

As I remember it, college was the most fun of all the difficult things I’ve done. Lots of friends, lots of entertainment, lots of ….

Those first hospital jobs scared the crap out of me, but I had more free time and spending money than I’ve ever had since.

Now I’m 20 some years into a Family Practice career. I can do it with my eyes closed, but every time I go to work, something good happens. A great conversation with a patient or colleague, holding a baby, chatting with an old man who doesn’t have anyone to listen to him. I leave loving my job every day. Mostly.

When my first child was born, I was ecstatic but exhausted. I never slept. I thought he would spontaneously combust if I let him cry. He was also a terrible nurser, so he didn’t gain weight. That only added to the stress.

When he was about two weeks old, a friend said, “Don’t worry, he’ll turn a corner when he’s six weeks, and it will get much easier.” She thought that would encourage me. Instead it made me cry. I was SURE I would not live to see six weeks.

Twelve and a half years out, I can tell you I did survive. I even occasionally tell new moms that their little screamer will turn the corner at six weeks. But I always add how that statement made me feel.

What season of nursing are you in? What do you love about it? What do you not love about it? What advice are you giving about the last season you were in? That’s the other thing about seasons. There is always someone else in the last one and the next one.

We all have things that freak us out a little. In the nursing profession it ranges from doing a new procedure, to working with a doc who intimidates you, to having to speak with a patient or their family about life-changing events.

When you’re in school or as a new nurse, the new stuff comes at you fast and furiously. Every time you turn around you’re having to do something you’ve never done before. To make it worse, someone’s standing over your shoulder watching and it’s likely to hurt the person you do it to. It’s amazing any of us take on that challenge. We don’t even have a sandy beach waiting for us on the other end!

What we do get out of it is satisfaction of a job well done (eventually, anyway) and another fear conquered. Just in time to face the next one.

Really, facing our fears is just a part of life, no matter what kind of job you have. Our fears vary. So do the ways we face them. I’m not afraid to fly, but I am afraid of heights. Xanax and wine would not be a good combination for me, however. I’d fall off a cliff for sure!

I’m also afraid of making phone calls to patients with test results. I don’t really understand myself. I spend as much time as I can looking up information so I don’t sound like an idiot once I have them on the line. I make a couple other “easy” calls then bite the bullet and make the dreaded one.

It’s never as bad as I think it’s going to be, but there’s always that potential. When I was first learning procedures, I would visualize what I was going to do, pretend I was confident, and say a prayer.

What are some of your fears in nursing? More importantly, what are the ways you deal with them? Maybe we can help each other out with some new ideas about how to face anxiety. I’m getting on a plane in the morning. My newest fear is that I won’t have time to stop for coffee before I board.