‘Sadistic’ may be the most appropriate term to describe what it’s like to look back on the many many hours, days… even years invested in pursuit of a dream, while at the same time trying to wrap your head around the immense chasm of understanding, knowledge, and experience needed yet still. Nursing school and long term goals definitely fall under this umbrella.
At this point in my nursing journey I am metaphorically out of the harbor and out to sea. I am too far away from the shore to turn around even if I wanted to, but I also have no idea when the next time I will see land will be. I catch occasional little mirages of land, oases found in clinical rotations and class, which in real life equate to ideas, thoughts and action aligning. But all too often those moments are fleeting. In the next instant we’ve moved on to the next wave of material in class, or I don’t have a good answer or idea to why something is happening with a patient or case study, or I am botching some simple part of a procedure for the seventh time like setting down and contaminating a 10 mL flush to be split over the SAS on an IV push. Maybe that’s why they teach us to use two flushes in nursing school. (See that was a little oasis a ha moment right there just writing this.) *Non-healthcare provider readers, sorry to get technical there, if you’d like to understand what I’m talking about, check out the italic paragraph at the end for an explanation. That all might be a little dramatic, but at the very least, it’s a strange feeling to be caught somewhere in between still feeling so so far away from realizing a dream, and simultaneously reflecting on just how far you’ve come since taking the first steps towards a lofty goal. Today as I sat in this helicopter I couldn’t help but think about how far away from simply becoming an RN I sometimes feel, which makes complete sense because becoming an RN is not simple or easy. Over the last 5 months, as I have charted a course into the deeper waters of nursing, I’ve gained a better understanding of the complexities, challenges, and sheer cache of knowledge needed to excel as an RN, and it is overwhelming at times. The idea that I could literally save lives and have the knowledge to make split second life or death decisions on behalf of another person as an ICU and flight nurse someday is so weighty it seems almost unreal. It is a lot to take in knowing that landing back on dry land as an RN could merely be an island stopover on the way to solid footing as a critical care nurse. This idea could be teased out even further by visualizing flight nursing as merely just another island on the perilous "knowledge" sea crossing to becoming a nurse anesthetist. From where I stand now the scale and magnitude of these goals are bigger than I ever imagined. This is not to say or imply that lofty goals beyond the RN aren’t worthwhile or unattainable. They’re simply just very hard to conceptualize or be concerned about in relationship to the challenge at hand, which is learning and preparing for the NCLEX to earn RN after my name. The only answer I’ve come up with to overcoming seemingly insurmountable grandiose plans and ambitions has to be keeping the big picture or perspective simmering on the back burner while turning the heat up on the critical mix of ingredients up front. For a while in my nursing program I had left the steering and command of my ship of learning in the hands of more seasoned nurses and educators in both the clinical and classroom experience, which is completely understandable given my general lack of experience in this field. However over the last couple weeks of clinical rotations, I’ve had an epiphany that at this stage in the journey I actually do have some good ideas about how to care for people, and I have enough knowledge to make (or humbly offer up) suggestions regarding patient care with nurses I work and learn with. I can ‘turn the heat up’ and accelerate my learning by taking the rudder and steering my own learning when possible. Ways I’ve realized to accomplish this include spending more time considering the patient’s needs, spending more time personally educating patients regarding therapies and drugs, and even better, coming up with and sharing my own ideas about plan of care for a patient, including drug and therapy suggestions, questions, and concerns with the nurse I am working with. Unfortunately it is far too easy to settle into a passive clinical experience as a wallflower tethered to a more experienced nurse. It’s too easy to fall into the trap that they have more experience and defer to just watching them work and trying to learn by osmosis, or remaining closed mouthed and silent with thoughts and ideas because “they know better than us”. I’m sure everyone in my cohort has seen a nurse they are working with do something inappropriate or not by the book at this point. Do they really know better (or at least practice better) than us all the time? The answer is clearly no. Nursing is a contact sport, and when we choose passiveness, we ultimately are shying away from an optimized, active and engaged learning experience. We can watch other nurses operate, plan, assess and push meds all day, but until we actually attempt to initiate ideas and plans of care we are selling ourselves short by missing out on opportunities to critically think through care we are providing. Another strategy I have come to love this semester is asking ‘Why?’ about everything. Why does a particular pathology manifest with xyz signs and symptoms? Why is the patient on this drug? Why are these side effects associated with this drug or treatment? Why are we providing a particular course of treatment? Why? Why? Why? Asking these questions force us to think critically and make big picture connections instead of relying on and memorizing a million one-off facts. Putting these habits into play can be hard, but trying to regularly will allow us to develop routine that turns the heat up on current tasks at hand and promotes the ability to work more effectively, critically and confidently. The goal for us is to see the little steps we are taking moving us closer to our ultimate ambitions, whatever they may be. When we can note these small island mirages and oases we gain confidence in our skills and abilities and move a positive cycle forward. We can then occasionally find ways to ‘sample’ our simmering long-term plan to make sure that goal is still appealing and applicable. This might involve networking and talking with professionals in a career or specialty you are interested in or capitalizing on opportunities to experience other units or jobs and understand how each position requires different personality and focus. Success in nursing school, like many things in life, is enhanced by the effort put into it (Surprise!), and is navigated best through active engagement in the learning process. When we are staring down huge goals, its imperative to break them down into digestible chunks. And while it may feel impossible now that I could one day function productively on a flight-for-life crew or stand at the head of an operating table as a nurse anesthetist, I can be proud that today I learned to hold on to my 10 mL flush during an IV push and got more involved in managing my patient’s care. As they say it’s often the little things in life. *Non-healthcare provider readers: Sorry to get technical back there for a second. To bring you up to speed, when we nurses push a quick dose of medication through your IV, the process involves flushing the line with a saline flush before and after attaching the syringe with medication and administering it. This makes sure the line is patent and functioning properly before administration and makes sure all of the medication makes it in to your body and doesn’t just sit in the line after administration. We could use one larger flush to split between the two, but if the tip of our flush touches anything in the room in between the flushes it is considered contaminated, and I have a bad habit of disconnecting the flush and setting it down, which is a no no. The other option would be to use two smaller flushes and not even have to worry about this issue.
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Alexander McNaChronicles of my journey into the nursing profession. Archives
September 2018
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