My Bones are Weary

It's been one of those days (or nights). You hit the floor running and even had to stay late to catch up on charting. You never once had time for a lunch break, much less a bathroom break. You had three total-care patients with extensive dressing changes, two patients in severe pain, and one patient who could not stop vomiting, regardless of how many antiemetics you gave her. You finally made it home and all you want to do is use the bathroom and go to bed. But the kids and husband (or wife) are wanting to spend time with you. Do you, A) tell them you are too tired and fall over into your luxurious bed, or B) push yourself to spend some much-needed time with the family?

This is a question that many nurses (and nursing students) are having to ask themselves. With the onslaught of higher acuity patients, nurses are becoming more and more tired at work. One recent study found that more and more med-surg nurses are not as happy with their jobs as they were 10 years ago. Why is that?

Sicker Patients

The patients we are seeing in the hospitals are much sicker than in the past. People are waiting until they are deathly ill before they see a doctor due to the rising health care costs. Also, they are being discharged earlier, so there is an increased need for patient teaching in a short period of time.

Money is Tight

Money is tighter, so hospitals are forced to slack off on the amount of nurses on each unit. Even having one less nurse per shift can cause the amount of work to be done to increase for those left behind. I remember some years ago, when I worked on a med-surg floor. We were all scurrying around, trying to get everything done. We were all sweating, turning patients, cleaning patients, giving meds, giving patients cold washcloths, cleaning bed pans. We all finally got to sit down to chart and the CNO came around. She said that since we weren't doing anything, one of us would have to go home. We tried to tell her that we couldn't manage, but all she saw was us sitting down. One nurse had to go home and we would have to take up the slack. None of us sat down for the rest of the shift, which caused us all to stay late to finish up charting...which caused us all to have overtime. Was that overtime less than what the other nurse would have been paid, had she been able to stay? I don't know the answer to that, but I can tell you that our morale was zapped. We were unhappy campers.

More Demanding Patients?

Patients are becoming more and more savvy. That is a good thing. They know more about their health issues than ever before. However, some of these patients feel as though they should be treated like they are guests in a hotel. Is that so wrong? Maybe...maybe not. Patients do deserve to be treated well, with kindness and respect. So when you follow a nurse who hasn't been all that respectful and kind, the patients can already be in an uproar when you come onto your shift. It seems like an endless cycle. When I come across an angry patient, I try not to become discouraged. I see it as a challenge. Can I get this patient settled and happy before the end of my shift? If I can do that, I will have done my job.

All of these things, and more, all lead up to some very tired nurses. So what is the solution? Nurses should start thinking about the upcoming shift more. When you use the last of an item, replace it immediately. If you write on the last line of the nurse's notes, put in a new sheet. Keep your patients happy so the next nurse isn't land-blasted.

Another thing you can do is work in teams. Teamwork is so helpful on a med-surg floor because you can all share the work. When it is time to go bathe patients, get a cart ready with everything you will need and park it outside of the patient's room. Everyone can get in there, clean up the patient and the room, including placing new linens on the bed, in less than 10 minutes. Move on to the next patient, and before you know it, everything will be done.

When you work in teams, you begin to read each others' minds. I have had some great teams in the past, and I keep reinforcing teamwork with all of my students. Don't ever say you won't help someone, because you may be the one needing help someday. It MUST be a give-take relationship. If everyone gives, then no one has to feel guilty about taking from time to time. Just don't be the one who is always taking and never giving. Anger can grow quickly!

Start out your shift with a smile on your face. This may sometimes feel impossible, but studies have shown that if you force yourself to smile, your brain is tricked into thinking you're happy. In recent years, I have never seen more scowls as I have when I walked onto a med-surg floor. However, I smile at everyone, and before I know it, others are smiling back at me. Are smiles contagious? I don't know the answer to that, but I do know that one can certainly affect the moods of others...so why not have a positive effect?

Don't forget about your family or yourself. You give yourself over to your patients every day you are at work. But don't forget that you have a loving family at home. Make just a small effort to spend time with them. It doesn't have to be anything big. Come home, take some ibuprofen, and allow yourself to relax. Having a supportive family is crucial, but they won't be supportive if you always come home in a negative mood. Leave your work woes at work, and turn that smile on again when you walk through your door. You never know...you just might brighten your family's day as well.

Friends for Life, and Life as a Nurse

I've given out some tips in my previous posts, so I thought it was time to add something a little fun. This time, I thought I would talk a little bit about the friends you can make while in nursing school and some thoughts I have about being a nurse.

Friends for Life

Nursing school is a rough time. You are always under a ton of stress, you have very little spare time, and it seems like there is ALWAYS a test. However, your classmates know exactly what you're going through. You probably spend more time with them than you do your family at times. You start to have those "inside" jokes...jokes only you and your classmates know about and think are funny. One little note here...nursing students and nurses have to laugh about some things, even if they don't seem funny to anyone else. This is because if they didn't laugh, they would cry, and they would probably fall apart at the seams. But I digress. It is because of the close proximity to others in these stressful situations that many students find themselves in new friendships. Friendships that can be closer than any other friendship previously. That isn't always the case, but I have two very close friends that I met during college. One I met in my pre-req classes for nursing school. We still see each other every day - we work together at the university. She left to go to another nursing school, but we still went to nursing school "together". We are best friends, and she was my maid of honor at my wedding. Another friend has moved to another state, but I still think of her as one of my very best friends. So cherish those moments with your nursing school buddies. You may just get a lifetime friend ( or many) out of it!

Life as a Nurse

When I graduated, I was scared to death. I felt like I was on a tightrope without a net...and I have NO grace! I just knew that I would fall to my death. But I didn't. I had a wonderful preceptor, and she took me under her wing. She understood what it was like to be brand new and string-free (no instructor there to save me). I was doubtful of my skills. But I had the book-smarts, so I began working on honing my skills. Before long, I was the one everyone was calling to start those difficult IVs. Now, IVs, NG tubes, and Foleys are my favorite things to insert. I know that may sound weird, but I see them as a challenge. I absolutely LOVE using sterile technique to dress a CVL. I don't get to do these things much anymore since I don't work outside of education, but now I get to help my students hone THEIR skills.

One of the things I was most afraid of was taking care of a patient who had something I knew little or nothing about. Yes, we covered so many topics in nursing school that I thought my brain would explode, but what about those disease processes we didn't cover? So, I brought my books with me to work, namely my Taber's Medical Cyclopedia and my med-surg book, so that I could look things up if I needed to. It turned out that I used them very frequently. Later, I didn't need my med-surg book as much anymore, but I used that Taber's nearly every time I was at work. I was always running across new terminology, or I saw something that I had never seen before. Now, with smartphones so popular, one can look up almost anything. There are even applications specific to nursing. One of my favorites is the Taber's app. Another is the RNotes app. I also have a drug guide on my phone. It's much easier to carry a phone than a ton of books. I just have to be careful not to whip my phone out in front of everyone, because looking up something looks suspiciously like I'm texting, and that just doesn't look very professional.

One of my most memorable moments was when I was still very new to nursing. I was working on a med-surg floor, but the ER nurse wanted to turn me into a savvy ER nurse. So I bit. She would call me if she needed extra help in the ER, and I would come running after I made sure my patients were okay and someone could watch them for me. One night, the ER nurse called me and said she needed me right away. I ran to the ER to find the nurse and the paramedic from the local ambulance company in with a small girl who was actively seizing. The ER nurse said, "Hurry, I need an IV in this girl so we can give her some meds. They weren't able to get one on the ambulance because she hasn't quit seizing and she's so strong one person can't hold her arm still." I panicked. How was I going to do it if the paramedic couldn't do it? The nurse and the medic patiently and gently held the girl's arm steady for me (well, as steady as they could). I hesitated. The ER nurse said, "Don't think, just DO IT!" I took a deep breath, steadied my own shaking hand, and stuck the IV in. Blood return! YES! I threaded the IV, taped it down quickly, and we pushed her meds. I nearly passed out. I was so relieved that I hadn't hurt the little girl, and that I had gotten the IV on the first stick! The adrenaline rush was amazing. That was when I knew for sure I wanted to work the ER, and I knew I was meant for nursing.

Another story comes to mind. Again, I was working a med-surg floor, different hospital. I was caring for an elderly woman who had just had open heart surgery a few weeks previously. She was very demanding, and I could never please her. I kept doing whatever I could to appease her, but it just didn't seem like enough. I would listen to her complaints patiently, and then basically bend over backwards just so she would stop scowling. I had her for a few nights in a row, so I was worn out! I got to know her family, and the woman had quit complaining quite so much, but she still kept me on my toes. One night, she told me she was dying. Her vitals had been stable, her cardiac strips had been normal. There was nothing I could see that would make me believe this woman was dying! I tried to comfort her the best I could by listening to her and holding her hand. She told me that she was going to try to get some sleep. As soon as I walked out of her room, the telemetry room, which was right around the corner, went crazy with alarms. I didn't even look to see whose monitor it was. I ran right back into my patient's room. She was coding. We worked on her for about an hour, desperately trying to revive her, without results. The family was called in, and the doctor and I went out to see them. The family was heartbroken. The daughter asked me if she could speak to me privately. Oh no! Was she angry about the way her mother had been treated? Had I not done enough? I was sure I had ransacked every closet for extra pillows, but maybe....

The daughter and I sat down. She said, "I just wanted to tell you that mother thought the world of you." Heart...in my throat. "She told me over and over again how much you cared for her and how much you did. I know she can be a little difficult sometimes, and I just wanted to thank you for taking such good care of her. You were her angel, and I know she was in caring hands because you were her nurse." Okay. At this point, you would have thought that Ol' Faithful had started up. I began crying and I couldn't stop. Usually I have pretty good control until I am away from the family. But at this point, I had invested so much of myself in this one patient, and I had felt like I had been a huge disappointment. Now I was finding out otherwise. I tried to pull myself together. I thanked the daughter profusely for telling me that, and I told her how much that meant to me. That moment sealed the deal for me. I knew I was put on this Earth to comfort people, no matter what. When I went to work from then on, I told myself that if I just made one person's day a little brighter, then I had done my job. I went on to make a lot of people's lives brighter by living by that credo. Now I try to instill that into my students.

You're probably thinking, "But why don't you still work in the hospital instead of teaching? You can't comfort patients if you're teaching." Well, now I can comfort my students...and I can teach them how to comfort others. I can affect so many more lives this way! And...when a student has a patient who needs that extra TLC, I warm my hands up, go in the room with the student, and we comfort our patient.

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Being a Nursing Student

When I am advising a potential nursing student, I often get the question, "So what can I expect when I am a nursing student?" This is a difficult question to answer. Many times, it is only after a student has been accepted into the program and in the thick of it, that the realization of what nursing school entails hits the student like a brick...or a ton of bricks! While I am sure that talking about what it is like to be a nursing student isn't just like "being there", I feel like I need to shed some light on the subject...even if it's for the sake of the nursing student's family members (I told you!!!).

Nursing School is HARD!

Nursing school was the hardest thing I ever had to do...and I've been to graduate school! Grad school was a piece of cake compared to my undergraduate studies. In grad school, I made a 4.0. In my undergrad...well, I was lucky that I made B's and C's. It takes dedication, time, effort, loyalty, ingenuity, strength, courage, love, and patience. It takes all of that and then even more. Nursing school requires that students give more than and work harder than they have ever given before. I have had students who have fought in a WAR say that nursing school was harder than being in Iraq or Afghanistan. One student was even shot during war, and he felt that the skills check off during the first semester was tougher than that. Now THAT'S saying something. I mean...really let that sink in for a moment...wow.

Nursing School Requires Family Support

Being a nursing student means having minimal luxury time. That being said, family members really have to pitch in if the student is to be successful. Sometimes family members do not understand this. If you are a family member of a nursing student reading this, please....I beg of you...support the nursing student as much as humanly possible. The nursing student is working on little sleep, probably a ton of sugar and caffeine, and has the lives of his or her patients in hand. Only once you're in nursing school can you understand the depth and brevity of this. A nurse has the weight of the world on his or her shoulders. So much responsibility, so little time...

Nursing School Requires Time

Time is an issue for nursing students. That is probably the understatement of the decade...or millennium, for that matter. Nursing students have to figure out how to read 100+ pages each week, do homework, get prepared for clinicals, take care of family, cook, clean, etc. It is tough, but manageable with a plan. It is wise to get the entire family in on the plan, so that everyone has a duty. The nursing student shouldn't have to worry about every single house matter that arises. A little (or a lot) of sacrifice (on the part of the nursing student and the support system) is needed for nursing student success.

Nursing School Requires Patience

Nursing students often feel overwhelmed. When I've asked students the exact reasons they feel overwhelmed, I've been told, "I feel like I need to know everything right at the beginning." While this isn't 100% accurate, it has a certain truth to it. If we haven't gone over congestive heart failure (CHF) in class, but you are taking care of a CHF patient, you are expected to know about that disease process in order to care for that patient. However, your instructors do not expect you to be an expert. They are well aware of when you will learn that information. So be patient. Don't freak out because you haven't yet learned about diabetes. If you had to know everything the first week of school, we would NEVER have any nursing students. Everyone would run away screaming and crying. Yes, do your very best...and even better. But don't stress over not knowing everything. You have years and years and years to learn...and you still won't learn it all. So don't get worked up about it.

Nursing School Requires Determination

I have told many nursing students that if they want it bad enough, they will sacrifice until they have it. I don't mean sacrificing a marriage or kids. I mean sacrificing fun times. I didn't have a life when I was in nursing school, and neither will you, most likely. I don't know of many people who do have a life during nursing school! The "nursing school no social life" memes are some of my favorites because they invoke *fond* memories of my own time in school.

If you do have a life, you may not do so well in nursing school, or you may not pass boards. Nursing school requires more than just being smart. You have to memorize and then apply what you know. Most students are used to memorizing...but the application is what's so difficult. How will this information help you to take care of your patient? THAT is the question.

Nursing School Requires Passion

If a student doesn't have a passion for learning, or a passion for helping people, nursing school will be even harder. Some people get into nursing for the money. Yes, while there is money in nursing, remember that RN does NOT stand for "rich nurse". One has to really love caring for people in order to make a life-long career out of nursing. Otherwise, burnout is always right around the corner.

My advice? If nursing is worth it to you, do the best you can. Make those sacrifices for two years (plus or minus). If it is not worth it, don't waste your time and effort. Best wishes to all of you!