I can’t stress how difficult the transition is from a student nurse to a professional nurse.
I even had experience as a CNA, EMT and LPN and nothing could have prepared me for the culture shock that was working on my own taking patients as a registered nurse for the first time.
It is well documented how tumultuous the first year it is for new nursing graduates.
The average nurse turnover rate (how many nurses in a particular unit/department/hospital that seek a new nursing position elsewhere) in an average year was 16% in 2015.
New grads have twice the turnover rate at 30% in the first year as a new nurse graduate and a whopping 57% in their second year as a new grad.
This can be chalked up to a variety of factors including heavy workloads, disillusionment of the profession, crazy hours/schedules, insufficient time spent with patients, or seeking a more challenging work environment.
I was a part of this statistic leaving my first RN position after 9 months to seek a more challenging work environment after nailing down the basic/fundamentals in a general med/surg/ER rotation position. I wanted to work full time ER, the opportunity presented itself.
I felt HORRIBLE leaving after they had invested so much time and training in me. They paid for me to take classes like:
To the nurse who just made their first medication error: I know what you’re feeling.
Your stomach is in your throat. Your eyes are burning with tears. Your heart is racing as you skim back through the MAR over and over again trying to figure out what could have gone wrong.
I know what you’re thinking
I’m a failure. I’m not a good nurse. This isn’t the right profession for me. I could have hurt my patient. What if something bad happens to my patient. What if I get fired. What if I lose my license. What if my reputation is ruined. What if I get yelled at. I should have checked one more time. I’m stupid. I’m worthless. I’m not ready to be a nurse.
Stop. Take a breath.
I remember my very first medication error. I was a new baby RN barely on my sea legs a few weeks after I turned 20.
The medication order: Azithromycin 500 mg IVPB every 24 hours
I gave Azithromycin 500 mg IVPB which is what my MAR prompted me to do when I came on night shift. Little did I know, the patient was transitioned from observation to acute care that afternoon. To do so, the patient was discharged from the observation visit and admitted under an acute visit. Azithromycin was already administered just hours before but the medications administered under the observation visit weren’t visible to me in the new acute chart. As the doctor put in orders (to be continued from the previous chart) it came up as DUE. A seasoned nurse would have looked back at the observation chart to make sure it wasn’t given twice. I was simply doing what my MAR prompted me to do without question. I didn’t ask WHY (rookie mistake in hindsight, but if you don’t know you should be looking for something, how do you know where to look?)
I didn’t even know I made an error at first. The two other nurses I was working with were acting strangely that night. There was a lot of whispering. Around 0400 they presented me with a neatly written and well thought out event report and explained they had written me up for my medication error HOURS after the IV medication had been infused.
I felt betrayed and confused and mortified. I felt like I was going to throw up. Were they talking about me all night? Why didn’t they tell me sooner when they noticed it? Do they think I’m a bad nurse bound to make a mistake? Why were they checking up on me to begin with? Is my patient going to be okay? I need to go see my patient. Does my patient know I’m a failure? Will they ask me to leave the room? Will they ask for a new nurse? How am I going to tell them I overdosed them on their antibiotic?
Rest assured, it all turned out just fine. My patient was fine. I sincerely question the way the medication error was brought to my attention but that’s a story for another day.
I had to tell the doctor. His response was, “Well, that isn’t what I intended but I guess we can’t change it now.” Whew.
I had to review the event thoroughly with my boss. He told me something I’ve repeated to my coworkers and nursing students time and time again.
Everyone. Makes. Medication. Errors. EVERYONE.
If you have never made a medication error, you will and you’ve likely not been in bedside nursing for very long or you’re straight up lying.
One more time for the people in the back, EVERYONE HAS OR WILL MAKE A MEDICATION ERROR.
Welcome to the club! It is almost a rite of passage!
Here’s the kicker you guys, YOU WILL MAKE ANOTHER MEDICATION ERROR.
Yup. That sucks doesn’t it. But that’s life. We are humans. We are not perfect and we will screw up again. The goal is not to make the same mistake twice. I can bet you won’t.
So, to the new nurse (or the old nurse) who just made their first medication error:
You are a good nurse. You are not a failure. You are cut out for nursing. You are learning. You will grow from this.
Stop. Take a deep breath. Take a minute. Take five minutes if you can. Show yourself some grace and read Friday’s blog post on the actual steps to take after a medication error.
I’ve gotten so many comments from readers about what a wonderful nurse I am and how I’m so caring and compassionate but I’m telling you:
I used to be a bad nurse.
Have you ever worked with someone who was grumpy all the time? Someone who was dismissive?
You could tell they hated their job and they were so unhappy. They came off as rude and hurried. Their heart wasn’t in the right place anymore.
Well…that was me.
I’m sure you’ve heard of burnout. Burnout has recently been recognized as an actual medical diagnosis as burnout syndrome. I wanted to include this chart to clearly differentiate between compassion fatigue and burnout. I was 100% on the burnout side of life.
I want you to ask yourself these questions:
Are you spiritually, emotionally or physically exhausted?
Do you have a positive outlook on your future at your current job?
Do you feel like you see the good in people or give them the benefit of the doubt?
Are you suspicious of your coworkers? Are you afraid they are gossiping about you or have ill intentions?
Is it difficult to concentrate at your work?
Are you as productive as you could be at work?
Do you question your capability to complete your tasks at work?
Do you suffer from chronic headaches or abdominal pain?
Are you sick all the time for no apparent reason?
Do you dread going to work?
THIS. WAS. MY. LIFE.
My documentation wasn’t thorough. I had a negative attitude. I didn’t always show empathy for my patients. I was cited for coming off as rude to other departments and in a hurry and talking too fast. I acted like a know it all.
I was of the mindset “I’ll say it how it is.” One of the new ER nurses told me one day, “You just really have no filter do you?”
I thought everyone hated me. I thought everyone thought I was stupid. I knew I wasn’t good enough. I’m sure everyone was gossiping about me. I was at such a deep dark point in my life that Fall. I wasn’t happy.
I had withdrawn from my coworkers and my friends because I was so sure that they didn’t want to hear about my life or talk to me. I didn’t want to annoy them with my stupidity.
My mind was a battlefield. I was constantly hating myself for the way I looked. I was constantly telling myself I was stupid or I wasn’t good enough. My mind was like a broken record playing this mantra over and over again:
“Why set goals when you can’t achieve them? You’re so dumb. Everyone is watching you. They are gossiping about you. They think you are dumb too. They can tell you’ve gained weight. They can tell your scrubs are tighter. They don’t trust you. They think you’re a bad nurse. They think you talk too much. Stop talking about yourself. No one cares. You look like SHREK. Just go to work and do your job and go home. They don’t like you here. They don’t want to work with you. I feel bad they have to look at me all day.”
My supervisor approached me. She knew I wasn’t operating at my full potential. Other departments were complaining about my negative attitude. My heart broke. I had never gotten a negative review in my life. I’m telling you guys, I had NO idea how bad I was. I spiraled.
In hindsight, I am SO SO thankful that my supervisor came to me. I knew that I wasn’t well but I didn’t know it was effecting my work, my attitude, my work environment, and relationships with my coworkers. I didn’t know how obvious it was to everyone else how miserable I was.
If you knew me during this time, you probably didn’t like me. I’m sorry. I know that my burnout damaged my reputation. I still hear about how far I’ve come and how I used to be very rude. I know I offended people. I know that I wasn’t well liked and I want you to know that I’m sorry and I’m better now. But I also want you to know that this could happen to you too.
I enrolled in therapy in November of 2017. I have been attending ever since to address my deeply rooted body image issues and my need to be perfect. In other words, I am a recovering perfectionist. I am a recovering workaholic. This and my undiagnosed social anxiety put me at an extremely high risk to fall into the burnout trap. I have learned my triggers. I have learned effective coping mechanisms. I know how to recognize burnout in myself. I know how to recognize it in my coworkers and friends.
I want you to know I’m still at the same job and I love it. I want you to know that I was the one putting the pressure on myself. I want you to know that while I was working 60 hour work weeks, I was the one who picked up the hours. I want you to know that if you recognize yourself in this blog post that there is hope.
It was NOT easy. It was hard work. It took time to make progress. Every day was a battle. Every day I was working harder to improve myself as a wife, nurse, and mother. Part of that came in the form of self development. Here are a few things that have played a role in my transformation:
Brene Brown’s The Gift of Imperfection: This book needs to be read by EVERYONE but most importantly it needs to be read by recovering perfectionists. I have read all of Brene’s Books but THIS ONE really hit home and I highly recommend you check it out.
Sarah Knight’s Get your Shit Together: This was a basic introduction for me on working to maintain a work life balance. I remember listening to this on the plane to see my brother in Houston Texas in October of 2017. I was so desperate to feel like I had some part of my life together. Like I said, this book isn’t nearly as “in depth” but it is a basic introduction to getting your life back on the right track.
Here are a few mantras that I recite to myself to cope with day to day work stress that have helped tremendously:
Everyone is welcome.
We are all God’s children.
Will this matter in 5 years?
What is the kind choice?
What is my goal?
You don’t know the whole story.
You don’t know what they are going through behind someone else’s closed doors.
Productive Days I learned that a HUGE part of my problems were trying to find a work life balance. I would come home on my 1-2 days off during the week and just sleep. I was so exhausted I never felt fully accomplished at home or at work. I started putting together the beginnings of my “productive day” that I refer to often on this blog. Read more on that here:
Seeking professional help: I also highly recommend counseling. I LOVE going to see my therapist. She is so kind. I’ve been so fortunate that I have never paid a bill for one therapy session due to some AWESOME insurance. I have come so far, I rarely talk about my anxiety or my body issues anymore when we have sessions but it still feels so good to have a third party listen in and offer perspective.
So what is my goal with this post? I know that as you are reading you are thinking of someone. Maybe it is a coworker, a supervisor, a friend, a daughter or husband. Do you know someone in your life that is burnt out? Is their toxic behavior effecting your life or work environment? THEY. MIGHT. NOT. KNOW. Just like me.
It may be time to have an honest conversation with them or refer them to your company’s employee assistance program. It may be time to send them this blog post and see if it helps them recognize these feelings within themselves.
I was so upset with my supervisor when she first came to me. She was describing me in a way I wouldn’t have recognized. I was mortified. But that conversation changed my life in so many ways. I will always be grateful for her honesty and her professionalism. Maybe you need to be that person for someone.
I’m so glad to meet you. SINCERELY. I firmly believe I am meeting a group of lifelong friends today. I look forward to becoming your mentor and colleague.
I hope when you’re struggling you hear my voice in the back of your head reminding you to use your nursing judgement.
I hope when I have to give you some negative feedback you can understand it is only because I want the best for you and your patients. It’s better to learn as the student than to learn as the nurse.
I hope you are patient with me. There are so many of you and just one of me. I want to give you all of the knowledge I can. Please know I’m trying.
I hope you are patient with yourself. I wasn’t strong like this when I started out, none of us were. You’ll struggle. Embrace it. Most of all learn from it. Give yourself the time to grow into the nurse you want to be. It doesn’t happen overnight.
I hope you give it your best effort. I know sometimes it feels like you’re “working for free” but I challenge you to challenge yourself when you aren’t feeling challenged. Ask for a heftier patient assignment. Volunteer to assist with an admission.
I hope you are forgiving of your classmates. Nursing school is such a stressful time for everyone. Emotions run high and you never know who is at their breaking point. Please be forgiving of them. Please understand what they are going through.
I hope you think of me every time a beta blocker makes you LOL or when you give Lovenox, low molecular weight heparin, in the love handles. (my former students should understand that joke)
I hope you remember what this feels like when you’re nervous and new and green. I hope you are patient with nursing students when it is your turn to be the expert.
I hope you can build your confidence. I hope that when you have a bad day or when someone makes you feel small or someone makes you feel like you aren’t cut out for nursing you won’t believe them. I hope you know you are made for more and that you are enough.
I hope you are learning to understand and not learning to pass the test. There will come a day when you catch something everyone else missed or you save someone’s life with the information you’re working so hard to understand.
More than anything, I hope you appreciate the struggle. One day you’ll look back at how far you’ve come. I hope you can appreciate how much you’ve grown. I hope you can draw strength from your weaknesses. I hope you can remember how scary this all feels right now and be proud of the nurse you’ve become.
How many times do we hear that phrase “above and beyond?”
ALL. THE. TIME.
I hear it in award speeches, I hear it in those cheesy AIDET classes we have to take, I even hear it in interviews.
“Describe a time you went ‘above and beyond’ the call of duty for your patient?”
What is your above and beyond?
My dad died from lung cancer on June 2nd 2019. He had a long 129 days from diagnosis until his death. He spent most of his time in and out of hospitals.
My dad was a pretty gruff guy. He wasn’t one to show much appreciation or affection. He really avoided the doctor at all costs prior to those final months.
His first hospital stay was following a failed attempt to remove a 4 inch tumor from his right lung. It didn’t work. They sewed him back up.
His second hospital stay was following a fracture of his C2 vertebrae. He was leaning back in his recliner. He spent a week in the hospital.
His third and fourth hospital stays were a week long each. We thought he had radiation pneumonitis. He didn’t. He was dying. We didn’t know yet.
Throughout the hospital stays, my parents had picked out their favorite nurses.
Lauren was my dad’s nurse when he broke his neck. Dad was on the medical oncology floor which was a really busy floor. Lauren’s phone was constantly ringing. I knew she had her hands full. Yet all I heard about was how smart Lauren was. I was so excited to meet her because I’d heard such high praises.
I spent two days with my dad in the hospital. I met Lauren. Don’t get me wrong, Lauren was a fine nurse but she didn’t have the superpowers my mom and dad had described. In their eyes, she was “above and beyond.” My mom went as far as to write a letter to make sure she was recognized for her efforts.
Do you know what Lauren did?
Lauren listened. She sat down, she talked to dad, and she actually listened. More than that, before she responded, she thought.
Dad always commented on that. He said he could “see her wheels turning.”
When the strongest pain medications weren’t touching his pain, she listened. She sat down, talked to dad, and she actually listened.
When he had concerns about his new feeding tube, she listened.
Lauren worked on a busy floor. Lauren wasn’t always on time with her medications and assessments. She was already preforgiven because Dad knew whens she got to him, she would listen.
That’s it guys. That’s the BIG SECRET to getting all those fancy nursing recognition awards: LISTENING.
I have bent over backwards and sideways four ways to Sunday for patients.
I have bought people the giant packs of depends, I’ve paid for people’s taxi’s, I gave a patient a ride home or to their hotel on several occasions. I have literally saved lives. I went and bought a family member of a dying resident cheese curds after work and brought them back to her. I went in on my day off to be with an old man with no family so he wouldn’t die alone.
All of these grand gestures may get me into heaven one day but do I listen to my patients?
Do I make sure they feel like more than just a task I need to complete?
Do I see beyond the tubes and wires and remember they are a human?
Do I sit down on their bed and look them in the eye?
Am I listening to respond or am I listening to understand?
In a world of screens and monitors and technology I challenge you to disconnect and reconnect.
In closing, my fellow nursing friends, I challenge you to rethink your above and beyond.
Have you seen these posts running around Facebook? These fear mongering posts about “DON’T KISS MY BABY!!” And then pictures of severely ill children in the pediatric ICU?
These posts drive me nuts.
This is not one of those posts.
RSV is a virus. It stands for respiratory syncytial virus. Most kids do really well with it and don’t need to be hospitalized. There are a few kids who need extra support like breathing treatments or steroids. There are a few more kids who unfortunately cannot tolerate RSV at all and it can become deadly. These kids are usually immunocompromised to begin with or have reactive airway disease already as a child or a preemie baby.
The older you get the more tolerant you are to RSV. In fact, a myth is that adults and older children don’t get RSV. That’s not true. We do get RSV but it’s just a cold for us. OR we’ve already been exposed as a kid and we are tolerant to the virus. We can still pass it on to others though.
RSV IS a virus. There is not a cure or treatment for it. We only treat the symptoms or “symptomatic and supportive care.” If they need rehydration we give fluids. If they need oxygen we give oxygen.
The only reason we really test kids for RSV is to rule out bacterial causes of fever and illness. For example, if we just assume a fever is caused by RSV we could be missing a urinary tract infection or strep throat which ARE treatable with antibiotics. Also, it helps us identify those kids who might need extra help fighting the virus.
Here’s what gets my goat. Influenza is also a virus. Kids can also get influenza. Influenza can be just as dangerous to babies. Influenza can put kids in the ICU too. Influenza kills people. BUT YOU CAN VACCINATE AGAINST INFLUENZA!! And the same people who are all like “DON’T KISS MY BABY!” Some probably didn’t get their flu shot either.
Here’s also what drives me bananas. RSV does not live on the lips and faces of well meaning relatives. Weirdo Great Aunt Becky isn’t trying to give your kid RSV when she kisses your baby.
The baby is more likely to get RSV and all other viruses from the shopping cart you didn’t clean off.
The baby is more likely to get RSV from childcare or their toddler cousin.
The baby is more likely to get RSV from going in public.
The baby is more likely to get RSV from the doctors office.
The baby is more likely to get RSV from YOU NOT WASHING YOUR HANDS and kissing YOUR OWN BABY!
But they are also equally as likely to get any other virus from anywhere else viruses live.
Also – I don’t want to brush past that. Do you think great Aunt Becky is the only one with RSV living on her lips just waiting to give your newborn the kiss of death? NO! Do you kiss your newborn? Like everyday? Like multiple times a day? YES YOU DO! More likely to catch something from you. Just being honest.
So get your flu shot. Wash you hands. Stay home during flu season. Quit passing the baby around the room at winter get togethers. Don’t let them suck on the shopping cart. Wash your hands some more. Expect your kid to get an insane amount of viruses and runny noses and coughs between November and May. Take kids to get their flu shot. Immunize your kids.
If your kid gets RSV, don’t panic. MOST KIDS DO JUST FINE without hospitalization. My son has tested positive for RSV twice and influenza twice. He did fine at home all four times and proceeded to give it to our entire family.
And to Great Aunt Becky – don’t kiss babies. Not only because you could potentially give them a virus but also because THATS WEIRD TO KISS OTHER PEOPLES BABIES. Full stop.