Fledgling Nurse, Part 2

I was asking another new grad the other day what surprised her most in the transition between nursing school and nursing practice.  For some reason, I didn't have my own answer prepared when she reversed the question to me, which means I have specifically paying attention in a few places.  As such, I have been starting to catalogue some of the observations and victories--big or small--that I have noticed along the way.  

Fashionista of the year, yo

Time to deploy the bulleted list!

• My grip strength has gotten a bit better--I can take off the cap of the end of an IV tubing with one hand sometimes, instead of reaching into my pocket to grab out my hemostat (clamp) to quickly twist it off with a tool.  
• I have finally developed the habit of putting on my goggles before going into patient rooms, hooray!  And whenever we're in public and I cross a doorframe, I immediately look for the hand sanitizer as another habit.  
• My short term memory is improving.  Really.  The kinds of pieces that I am remembering between rooms isn't perfect, but I am retaining numbers and which medications my patients are taking when I go to collect them from the right spaces and when I gave X medication to a patient last.  I might do an assessment on a patient in the morning but get pulled in so many different directions that I cannot chart it until four hours later, but I'm retaining parts better than I thought I would and learning what kind of notes I need to take otherwise or normalizing rechecking with a patient when I don't feel certain in my memory.  Yet, I've been startled by how much I do remember, partly as I now have a flow in how I like to do my assessments.  
• I'm allowed to message doctors directly with questions.  It's encouraged, even.  And, achievement unlocked, I have already pissed off a doctor by asking reasonable questions, which means oddly enough that I feel I have "arrived."  
• Sometimes the patients we have on our floor are not in their right minds or are not capable of making their own decisions, for a great number of possible reasons.  This may permanent or temporary.  Trying to explain to someone that is confused why they can't just leave or walk around unescorted does not always go smoothly.  Recently, we had one particular patient that I was wondering if I was going to get shoved or punched by standing between them and the door.  We can try to explain and redirect, but in the end we may need to call for additional hands.  I've been reflecting on a particular experience with this patient and making decisions for what boundaries I will set next time.  
• We have hospice patients on our floor.  Honestly, I've considered going into hospice nursing specifically, so I'm grateful to have some of this experience.  I'm not afraid of grief (familiar with it in my own experiences), and I can push through places where people feel awkward.  I am glad to have dedicated space to listen and simply be present with families as they work through those spaces.   So far, I have been a part of declaring two people dead.  Both of them, however, I did not have much of a chance to meet the family, meaning that I was decidedly more of an "extra" in a pivotal moment of their shared experience.  This was surreal to me in a number of ways.  I felt my role as "accessory" and supported that as well as I could by tending to the physical and encouraging them to take any time they needed to feel what they needed to feel.  It was strange to feel adjacent to death, if that makes sense.  And then I had to turn around and be cheerful in another patient's room and overly polite for the next patient's room based on previous interactions.  There was no time--just turn around and move on, think about it later, maybe.  
• There are a lot of terms that I'm accepting and speaking that I was not so fluent in a year ago.  I might through out "peds" instead of "pediatrics" or look at my notes to see that I've written "20 G R AC, NS @ 80/hr; 22 G L FA, SL" and it makes perfect sense to me.  I mentioned as part of an explanation one day that a patient has the right to leave AMA and forgot that not everyone knows what that acronym means, let alone what some of their hypothetical patient rights might be.  
• I'm starting to find rhythms, find patterns in how I work through my day and what pieces I need to do.  Every day is different, with the various needs that my group of patients that I have.  There's that balance between setting a general pattern in the day and reacting to patient needs that crop up, from trips to the bathroom to major crises.  I come in, check my assignments, start filling out some basics about those patients on paper for my own reference, get report from the night nurse to fill in a lot of important specifics, compare that against both procedures and tasks set in Epic, gather an idea of where to start, and begin on those morning meds after prioritizing accordingly.  Every morning I need to assess my patients, to form my own opinion of how they're doing and what goals we might have for this patient today.  The song is different but the genre is the same.  There are patterns and certain things that need to be done by X point or Y point in the day.  I pick my battles and am finding which ones are worth picking.  
• I am noticing my different feelings of urgency and finding my balances between what needs to be done by X time for Y reason and what is feasible to do--when I have five different people with medications due at nine, I cannot physically be in all places at once.  Inevitably, I will walk into a patient's room for a quick thing and get stuck there for an hour, either because of a series of "well, while you're here..." or needs revealing themselves (e.g. going to deliver an IV medication and finding that their IV doesn't work anymore) or whatever else.  There are guidelines and certain things that must happen at specific times, and there are many things that should happen by a certain time and are going to happen as soon as I can and there are a few things that need to be recorded by the end of the shift (e.g. any patient education components discussed today, which I tend to sprinkle in anywhere).  
• There is so much variety in the patients that we see on our floor.  On the one hand, this can be very intimidating because there isn't a certainty to land into with enough time.  On the other, there is always something new to learn, which I find thrilling.  Additionally, there is freedom in knowing that I won't be able to know everything so I don't have to, which in turn takes the pressure off of trying to know everything.  There is peace in that.

Certainly more to come soon, but that's a happy smattering to start with.  What the biggest surprise will be in another few months time, that'll be an interesting question all over again.