NursingZen

I’m about to round the corner on year one as an acute care RN … and I like it … I’m pretty sure.

It sounds strange, but it’s not always easy for me to tell if I’m enjoying bedside nursing because of the many frustrations with the hospital system, the challenges with management and co-workers, and the aspects of the job that are physically taxing or routine. So, in an attempt to assess my level of enjoyment and fulfillment with bedside nursing, in the past few months I’ve been asking myself these questions:

How do you feel in the following situations?
– When you don’t feel like going to work, how do you feel once you get to work?
– How do you feel one hour after you get off a shift?

You see, once in a while we all dread going to work, but how often that happens and how you feel once you’re there can give insight into whether the job or place is a right fit. I have a friend who dreads every single shift. I’m sure she’s conscientious at work, but she admits she’s always thinking about the end of the shift and going home. After work, she’s always exhausted and relieved to be done. She has survived a year, but she doesn’t intend to make it two.

In contrast, I’ve noticed that even when I’m dragging my feet to work, as soon as I step on to the floor and start getting report, I feel a burst of energy and excitement (good ole’ adrenaline). As soon as I lay eyes on my patients and start talking to them, I become completely tuned in and forget about everything outside the hospital for the next eight hours. After work, once I’ve unwinded at home, I’m eager to look up information I didn’t understand during the shift.

These must be signs that I’m currently doing the right thing in the right place, right?

Does anyone else out there run mini-mentals on one’s self?

I know, I wrote hardly a word about Year 1 of my Master’s of Nursing program at UCSF last year, and suddenly it’s Year 2. That’s because I was taking a few unexciting, required, graduate courses (theory, research methods, other intro classes) while juggling life as a new grad nurse in both a hospital and a community clinic. Obviously, school became a third priority.

   This year should be a different story. This year it’s all about the core Nurse Practitioner coursework and clinical residencies.

Today was the first day of class and I felt as giddy as I did on the first days of elementary and high schools. Today a detailed, well-written syllabus and my brand-spanking new Advanced Health Assessment textbook were a joy to behold and read…

And after many doubts and much back and forth in the past year, I’m happy with my decision to do the Master’s program over three years instead of two. I feel I have a more well-rounded life than if I were to be a student only. Although the nursing school officially discourages students from veering off the prescribed three-year MEPN-Master’s path and the two-year Master’s path, the Adult Nurse Practitioner faculty has been understanding and supportive of students who need to make changes along the way. I have been one lucky duck and cannot wait to get cracking!

Recently I read a nursing blog post by a prolific nurse blogger, The Intensive Art, who, like me, hadn’t written for months and who admitted that he simply had lost the drive to blog. That’s how I had been feeling since April. And yet, since April, not a week has gone by when I haven’t thought to myself: ‘Man, I feel so bad that I’m not writing anything. Why am I not writing?’

And my answer to the question was one of my greatest fears: Maybe I’m becoming an uncreative, unreflective, dull, self-absorbed, regimented nurse zombie.

Indeed, I think I went there. I think I became so tired and overwhelmed – and so intent on not being tired and overwhelmed – that I just disappeared into my work and my regimen/routine, and thereby had no energy to reflect and share.

I also felt uninspired to blog because around May it struck me that my unit sees the same types of patients every day, most of the assessments I do are repeated patient after patient, and many tasks can be routine. For example, get medications (usually a beta blocker, proton pump inhibitor, anticoagulant, and diuretic), check meds, explain/administer meds, repeat. Pull femoral arterial sheath, hold pressure, check pulse, check vitals, assess groin site/dressing, repeat.

On the one hand, I was delighted that I’d become comfortable enough with my job to consider some things “routine.” On the other hand, I began to worry that I was getting sucked into a task-oriented mindset. Although as a novice I know it’s natural to be task-oriented, I could see how easy it is for tired nurses to have only enough energy to complete their tasks and nothing left to take on challenges and continuously seek knowledge and professional growth. I could see that the path of least resistance was that of following routines.

For a couple months, I found myself teetering at the precipice of a dreary and boring nursing career. This scared me back to my senses. Since July, I’ve pulled back from the cliff and have been running the other way. For example, instead of being bored by the medications that I have to pull over and over again, I take extra time to learn and remember new things about the meds. Instead of viewing a sheath pull as a boring, time-consuming task, I experiment with methods to make the procedure more pleasant for the patient and less tiring for my arms and back. Most important, I remind myself that pulling a sheath out of someone’s femoral artery is never boring — vigilance is key to avoiding a multitude of potential complications.

A book that I recommend for new and growing nurses is Patricia Benner’s “From Novice to Expert: Excellence and Power in Clinical Practice.” It comforted me when I read it as a new grad last year because it normalized the incompetency I felt. It comforted me this summer when I worried about being consumed by tasks and routines.