The first two weeks were an agony. I had five to six patients every day and had a patient who was "going bad" almost every day. Two, we had to send out to E.D. Each shift I ended up staying over two and a half to three hours extra to finish the paperwork I hadn't even had a chance to start until the shift was over, piecing together the day from notes in my pocket, reviewing orders, and tying up loose ends. Exhausted, I wouldn't even attempt the 50 minute drive home, but would crash on my parents' sofa and go home in the morning. Thankfully, I didn't have many shifts in a row - I would spend 12-16 hours sleeping after consecutive work days.
Slowly the situation improved. Staffing ratios dropped to 4 patients more days than not, and even 5 didn't seem so difficult. Soon I started having two good days to every bad day, and sometimes I had half my paperwork done before the shift was over. Still, I couldn't see how other nurses managed to sit at the desk for what seemed like hours and still have all their work done by shift change. I began setting goals with the end of being able to leave the unit at 1930.
Finally, one day, it happened. I had all my paperwork done and was out the door at 1925. That week, I left before 2030 every night. Other than typical frustrations, I was in no distress. I did not hide in the bathroom to cry (as I had done each shift for the previous weeks). But now I had nightmares every night, even when I wasn't working; I would forget a patient. I would contaminate an I.V. I would do something wrong, someone would die, the manager was angry with me, I had overdosed a patient, I had given blood without consent, a patient was choking on his own phlegm and I couldn't seem to get the suction catheter into his tracheostomy. I would wake up sweating, and once, screaming. Dreaming was worse than working.
But this past week, even that changed. I stopped dreaming of botched up nursing tasks. I didn't dream of the unit at all, thank God. I began to feel glad to come into work, and actually miss my work when I had a day off (though, I would rather be with my husband than my coworkers any day). It is good not to feel anxious before an upcoming shift, or fear what the next day may bring.
How did it happen? How did I become more comfortable? How did I learn not to fear making horrible mistakes?
First, by God's mercy and protection. I don't know how I made it through the worst of culture shock and initiation, but somehow I'm finding myself on the other side with each day better than the last.
Second, by practice. With time, I have learned more effective and efficient processes and task sequence for each type of patient. Certain tasks have become second nature, and I am learning to prioritize care more appropriately. I have started to establish a routine of activities for the shift that "works" for me and my patients. As I become more proficient in routine tasks and as I encounter and successfully accomplish more specialized or complicated tasks, I become more confident in my ability to provide care.
Third, by actually making mistakes. No, I have not done any of the horrible things I've dreamed about, nor has anyone suffered physical harm at my hands. But I am human, and I have erred. But each error is a choice and an opportunity. A choice of whether to acknowledge the error and correct the error or keep quiet and deny it's occurrence, and an opportunity to learn to avoid the error in the future and implement better practice. One would think the choice would be easy. Of course you should acknowledge your mistake and correct it. But it is not easy. To admit that one has erred in these regards is essentially to say that one has acted contrary to one's responsibilities as a nurse and that one has no excuse. Thankfully, I am gifted with a rather overactive conscience that will give me not rest unless I appropriately address what I have done wrong. With each mistake and it's proper solution, I become less afraid of that mistake - not because I regard it as less serious, but because I know how to avoid it and that if it does occur despite my best efforts, I can address it and will survive it.
I'm sure there are more factors that have contributed to my increasing comfort with my work. For now, it is sufficient that I have begun to feel that the I am doing good work and fulfilling my job responsibilities. I'm am glad to have reached this point. Each day I learn something new. It is my goal to begin to share these lessons here.
Till Next Time
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