Think Twice ..Think Hard ..Get a Sense of Humor : Part I of 3
Written: Oct 18 '01 (Updated Oct 19 '01)
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Pros: Touching and being touched by others. Nursing is a calling, not just a job.
Cons: Very few people will ever know the good you do, or appreciate your efforts.
The Bottom Line: It breaks my heart not to fully recommend the nursing profession, which has been my life for 30 years. Think twice, think hard, but have fun. I have.
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| artbyjude's Full Review: Nursing Profession |
I have been a registered nurse since 1976, and worked in Health Care since 1971, a fact few people on site know. I am going to give you some personal history here, from the depths of my soul, so if you don't want to take the journey with me, take the exit to the left. I'll try very hard not to bore you. (This is going to come in three parts, Early, Middle, and Later Nursing career. So if you aren't interested in the early years, wait for the next installment)
First Question: What Made you Choose Nursing as a Career?
Simple Answer: I didn't. Nursing chose me.
I graduated from a big high school in Cleveland Ohio, part of the Baby Boomer overflow. There were 683 people in my graduating class. I was valedictorian, an accomplishment that required some work, a love of academics and a competitive spirit. When I went to college the next year, I already had more than a year's college credits from Advanced Placement Courses. I was arrogant, and thought I was brilliant. I wanted to do it all. I never in my worst nightmare, ever wanted to be a nurse, although over one hundred of my classmates did. I wanted to be a medical doctor among other things, thinking myself to be the true Renaissance woman of the late sixties.
It took me about a year in the Ford Foundation Independent Study Program to realize that my education was going to be my responsibility. It was part arrogance, part truth that, made me think the classroom had nothing to offer. I dropped out of school after my Sophomore year, 16 credits short of graduation in a combined major. I had married a theoretical Biologist (no I'm not going to go there) and was painting or in the dark room full time. My daughter was born a year later. I thought that would be enough for a life time. I was wrong.
When graduate school landed us in New York, the fellowship just didn't buy the groceries or pay the rent, and I went to work at Sloan Kettering as a receptionist in a clinic. I was very surprised that I enjoyed this job, especially the patient contact. With full permission of my benevolent MD boss (one of the first Women doctors that I would get to know) I was learning every day, asking questions, storing it up for later use. I was fascinated and what's more, I found that compassion could be an asset! In the mutual admiration society of young college bred intelligentsia, "caring" was seen as a weakness (unless it was for family or friends). I liked the detective work that went into healing. I had at least four physicians willing to sponsor my admission into Medical School, and I was ready and willing. One degree at a time though. My husband's school had to come first by mutual agreement.
I started back to school, going to Hunter College after work, this time majoring in Chemistry, pre-med on my mind, still working full time. Hungry for experience, I got part time work as a lab tech drawing blood in my clinic, and they said I was good enough to be on the IV team. (I was starting IV's a year before I started nursing school!) And I started observing and interacting more with members of the medical profession. I didn't like what I saw there, with a few exceptions. I did, however, meet some nurses that impressed me, both with their dedication and their stamina. One or two of them even seemed to have a sense of humor, something that was notoriously missing in the personalities of any doctors I knew. And they could DO things with their hands that doctors couldn't do. Some of them were airheads. But some of the doctors were worse. What I kept thinking was..."Wow. What these people could accomplish, if they could talk TO each other!"
I made a change in my future that surprised even me. (Of course, in my twenties, I never expected my life to go by so fast.) My husband was still two years from his PhD. I started looking for a BSN program, thinking the work would be steady, and I would learn what seemed to be the most important aspect of a doctor's training..that is, how to communicate with patients, nurses and each other. The experience would help me support our family and give me some solid real-life experience in giving health care. I stayed at school at Hunter college, taking Chemistry, Calculus and Spanish.
How did you get into a nursing school?
Simple answer: It must have been by the Grace of God, because I didn't do anything right in my application, interview or statement of personal philosophy
I only applied at one school of nursing, and got my application in one HOUR before the deadline. There were 1000 applicants for the one hundred openings at Cornell University New York Hospital School of Nursing. There were two BSN programs at Cornell, one for undergraduate applicants, the other for people who already had some 4 year degree of some kind. I didn't have high expectations, because unlike most of the serious candidates, the ink was still wet on my signature when I hand-carried the application to the Admissions office. They called me next day to interview!
The interview was a five-person grand inquisition affair, and I doubt that they have ever had anyone answer the essential questions the way that I did, back in the seventies. What you couldn't possibly know about me is that I simply cannot lie in a face to face interview. When they asked me why I wanted to go to Cornell, I told them because it was right across the street from where I live. (E 70th , first Ave) When they asked me why I wanted to be a nurse, I told one of them flat out that I really didn't want to be a nurse, I wanted to go to Medical School. I told another it was because I wanted to see how patients are really cared for, by the people who take 24 hour responsibility . Both answers were true. I never promised that I would stay in the profession for a life time. I never said anything about wanting to help people. I did say I thought I could do the job. Their faces were impassive. They seemed disapproving. I went home, already making an application to another school in my head.
They must have seen my heart truer than I did myself. Or maybe they awarded me extra points for originality. They warned that I would have to stay long enough to repay student loans, and gave me a full tuition scholarship, and a student loan.
Changes in my life
I had a month to restructure my entire life, and see to the details of my existence, as well as the welfare of my family. Classes required full day time dedication so I quit my job at Sloan Kettering, but got work as a Psychiatric Aide on the evening shift at Payne Whitney Psychiatric Institute, an acute care Psychiatric Hospital. For a year, I was taking classes full time at Cornell, finishing my chemistry courses at Hunter, and working full time at Payne Whitney. No wonder my daughter felt neglected.
NURSING SCHOOL: The Curriculum and the Philosophy
In the days when a BSN was not common, the classes were demanding, but fascinating. The science and biology aspects were amazing, and I think we had better professors than the adjoining Medical school. We were invited to attend lectures at the Medical School from time to time, so we did get to know those hooligans and future gynecologists a little. Anatomy, physiology, and developmental theory through the life cycle were standard curriculum items. We innovated the first class in "Head to Toe Physical Assessment" and taught it as a summer course. It would be years before Nursing schools would make that a standard item. We had clinical labs to practice..mostly on each other. (Not to be confused with Clinical rotations)
And then there was theoretical component, including Medical ethics, legal ramifications, nursing theory (ugh) and Statistical Analysis. We were told we were the elite, the leaders. The professors fully expected all registered nurses to be BSN or better by the late 1980's, and an inside-the-profession- rift opened, and has never healed. The diploma nurses were going to be obsolete, we were told, although it never happened. The first spin-off of this lofty goal from the leaders of our profession was that diploma (ADN) nurses immediately resented the arrogance of the book-smart, and the book-smart headed towards advanced degrees, robbing hours from clinical rotations. It didn't mean much to me as a student, but it would later mean a great deal. Two thirds of my graduating class headed directly for advanced degrees, bypassing any clinical practice of their profession.
For the record, I believe that Nursing Theory, (and we have been through at least 8 major discrete theories of how to dress up what nurses do since I started to school in 1973) is a waste of time. If you are looking for a broader educational base, or philosophical statement of purpose, teach it, learn it and move on, or better yet make it an elective. But I refuse to buy anyone else's justification of my profession, because it is an intensely personal choice. We have developed a whole new language of speaking around a problem, just so we won't sound so much like doctors. It's a waste of time, a game that doesn't need to be played if health care is to be delivered by a team of varied professionals. My attitude on this issue is the major obstacle to my advanced degree in Nursing.
What I want aspiring nurses to know is that it isn't enough just to care, although caring is the place you need to start. You have to understand two basic things to be successful in your career. You have to know WHY you are doing something, and you have to know HOW to do it. You need to be able to do the math. So sigh and shrug your shoulders, but if you can't do basic algebra, don't waste your time. If you don't understand how human body parts function, all the love in the world is not going compensate for it.
OK enough chatting. You want to hear the low down on my life as a nurse? Probably not. Well, you are about to hear it anyway.
NURSING SCHOOL: The experience
The class work was a snap. (I like school, love academics) The clinicals were a little harder. The patients were great, but all of a sudden my status had changed dramatically. The people I knew by name, having shared coffee and jokes in another life, no longer tolerated such blatant disrespect. On my first day of clinical, I joked with a young nurse, who I had been teasing every other day for a year, in my previous role as a lab tech. My punishment was to make (and remake) all 52 beds on the ward that day. The next week I made a disparaging remark to a first year Resident who was being rude to a patient. My punishment was to do 13 enemas on 5 different patients until clear.
In my senior year I wrote a play for the yearly senior show, a satirical look at our life as students. My comedy hit a little too close to home and I was expelled from school for 3 days, prior to graduation, although the dean laughed so hard at my mimicry that she wrote me a letter 5 months later, still laughing. When she handed me my diploma she winked and grinned, and told me to "go get'em".
APPLYING NURSING TEXT TO HOME SITUATIONS.
One of the first things I tried to do with my new clinical education is change everyone around me. You! diet! You! Quit smoking! You! Stop drinking! Don't you know what that does to your body? I carried a blood pressure cuff in my purse, along with my stethoscope. I chased my husband around with a reflex hammer. I resuscitated drunks on the street. (Really, I did) I educated everyone, whether they wanted it or not. This was to hit me hard during my Pediatric Clinical rotation, which I elected to practice in a free clinic in the ghetto.
I was doing my senior clinical rotation in public health and Peds in a free clinic in East Harlem. I was having great fun. My daughter always listened solemnly when I was teaching her about her body and medical procedures. (She is a genius by the way). I learned that her kindergarten was going to have some routine screening including a physical and blood work. I described the details as honestly as I could, so it wouldn't scare her. I answered her questions, and showed her some of the procedures.
The other children came out of the procedure with barely a whimper. It took five people to hold Arinn down. My lesson was swift, and negated all the hopeful theory based on child development that was being taught in the classroom.
As a result, my partner in East Harlem based his practice on theory, and it sometimes took him an hour to inoculate one child with routine vaccinations. By swift and painless execution, (and the element of surprise) I could do five entire families in less than twenty minutes.
OTHER LESSONS LEARNED IN NURSING SCHOOL
Med-Surg
My first clinical assignment took me to an "easy" patient in a double room. Her room mate was not given the dubious blessing of a nursing student of her very own. I was in the room when this patient, 340 lbs, first day post-surgery, required a bedpan. Determined to be of help (and make up for my snide remark to the team leader who had me making beds) I got the bedpan myself, and lifted her prodigious rear onto the device (which they kept refrigerated). And when she was done with this massive effort, which turned out to be a delayed reaction to the enema she had been given before surgery, I checked the care plan.
"I and O." Intake and output. Oh boy. I have to measure everything. So I did, with the help of a tongue blade: all 373 cc of solid fecal matter, requiring a little over 20 minutes, and a gut of solid steel. I almost decided this wasn't the life for me, but I did learn one VERY important lesson. There is no such thing as a stupid question. I could have saved myself a lot of embarrassment and subsequent ridicule, if I had just asked " What about this stuff? How do I measure THAT?".
My life as a "tech" in the Psychiatric Institution as a Nursing Student
First of all, you can never hide from an experienced psychiatric nurse. By this time in the seventies, many of the RNS working in psych had sacrificed their clinical skills for the unique requirements of the specialty. If there was any medical stuff requiring a nurse's hands-on practice of basing nursing procedures, I was elected (with their supervision, of course). So I was back to giving enemas until clear, which is a unique and particularly horrible experience for a delusional psychotic. ( I mean the patient, not me!) My favorite job was the fecal impaction problem. It still makes me cringe.
There were some advantages, too. I was able to attend and help in group therapy, learned all the psych-speak jargon, and started smoking, which was seen as a better activity then twirling my key to the locked ward over my head. I learned how to talk a patient down, and how to help when they were out of control. I learned things about personality disorders, manipulation and behavior modification I never wanted to know. I knew what contraband to suspect with the substance abuse people, and what behavior signaled the need for a suicide watch. By the end of my two years, I thought I knew it all!
Nursing Boards and Choosing a Specialty
The Board Exams for licensing were different then, when a thousand people trooped silently into a big room and had to do the whole test, squirming in our seats, with a number 2 pencil and wait several months for our test scores. I was already working in the Psychiatric Research Unit (for BiPolar Illness , Depression and Substance Abuse protocols) as a graduate RN when I took the test, and I worked a night shift the night before the exam. I didn't have time to study. What I learned though was interesting. Focus on theory had left out some basic nursing knowledge and practice. The extra hours volunteered in clinical rotations helped, along with a generous application of common sense. Our curriculum simply didn't cover the spectrum as it should have. I scored highest in an area in which I had no interest whatever, in OB. In Psych, my chosen field, I answered honestly, instead of theoretically, because in truth, practice and theory were not a good match. I don't remember my exact test scores, but they ranged from 96th percentile to 99th percentile. My lowest was in Psych. Of course, the process is much more reasonable and far less competitive today.
Choosing a subspecialty in Nursing is the trend and has been for some time. Maybe by the end of Nursing School you will have some definite preferences, but my advice is to keep an open mind. The great thing about nursing is that you have so many choices. The bad thing is that you don't often get to try them all. In my case, after my clinical rotation, I went straight into the research unit, attracted by the experimental nature of the job and the promising results. But 5 years after my first job I started work as a staff RN in Labor and delivery, and have stayed there for more than twenty years.
SUMMARY and ADVICE (regarding CHOOSING your profession, the first steps: Nursing School)
1. Don't be dragged into a lifetime of drudgery if all you want to do is help people. Nursing isn't the only helping profession. Just getting married and having kids is enough for many people, too much for others.
2. Don't expect nursing school to be easy. You have a lot to learn in a very little time.
3. Do your nursing care plans! It gets you into the detective work that is the fun part of the profession. It seems like drudgery, but it keys you into the "Nursing Process" which is the most valuable tool you will ever acquire in your nursing education.
4. Expect no mercy from other nurses . I don't know why, but this is a common phenomenon. I have spent my whole life trying to reverse the process known as "Nurses eating their young". (More next installment)
5. Try every clinical setting offered with an open mind You may discover something you didn't expect and actually find your calling, instead of a job after you graduate.
6. If you haven't got a sense of humor, get one You will never be able to survive a career in nursing without a sense of the ridiculous and being able to laugh (or cry) if needed. Contrary to what I learned in Nursing school, humor is NOT unprofessional. I have laughed many a patient through their entire birthing experience, without giving any pain medication. You have to be able to laugh at yourself, too.
7. Don't be a nurse if you don't like people. There are already enough nurses in the profession with no compassion, who pre-judge, refuse care and simply don't like their patients. No one is perfect, but I have met many nurses who should have quit years ago. Always treat a patient like you would like to be treated if you were the one requiring care. Make them your partner, not your duty. Your mother taught it to you years ago. It is called THE GOLDEN RULE, not to be mistaken for "Do unto others before they get you". Never forget it!
8. Learn to work twelve hours without lunch or a bathroom break, and don't expect to start work on a 9-5 schedule . This involves extensive bladder stretching exercises. I have noticed that a lot of new graduates have these kind of expectations, and this is simply not realistic. Nursing care in acute care hospitals is administered 24 hours a day, every day.
9. LEARN AS MUCH AS YOU CAN ALL THE TIME . There is always more than one way to do things, and the world is your classroom. In spite of your feelings to the contrary when you graduate, you have just started to learn what you will need to know to practice nursing safely, legally and confidently.
10. Leave your problems at work if you can Your significant other will get real tired of hearing you whine about work. A relationship is hard enough to maintain without that burden. Easier said than done, though.
For the record:
I have never,( until the past year), regretted my life of working long hard hours, for little pay and less respect. I carry in my heart all the people whose lives I have touched, and who have touched mine. The year I left New York, I was accepted for admission to two different Medical Schools (Cornell and NYU). 3 years later, I was accepted at two more(UNM and University of Utah) It took me 10 years to realize that I had never really wanted to be a doctor. Nursing is a lot more fun.
Next installment: First jobs, doctor-nurse relationships, how to annoy people without really trying.
PS: MelissaRN wrote an opinion which inspired my efforts. If you want to read a review from a normal person, I highly recommend hers.
Recommended:
Yes
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Epinions.com ID:
artbyjude
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Member: jude paxton
Location: In a state of confusion
Reviews written: 699
Trusted by: 459 members
About Me:
If I'd known TODAY was to be my TOMORROW I woulda done better YESTERDAY.
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