Match Week: A Letter to PGY1 Residents from an RN

First of all, happy residency match day, and congratulations to all the doctors joining us this year in healthcare!! It truly is the adventure of a lifetime, and as a nurse who will work alongside you, I want to offer you the following words.

I am a nurse at a teaching hospital. That means that each and every year, brand new, shiny yet so green, eager and terrified resident doctors like you join us to dive headfirst into caring for real live patients and join the world of writing real life orders. It seems that a lot of nurses dread this time of year, and while I understand their perspectives in some ways, here are few thoughts that hopefully ease your mind a little bit. 

1. You're learning and we get that. I want to be a nurse who creates a culture of giving you the grace to learn, to help you put in the correct orders in the correct format, and to give you a chance to fix the problem before escalating to your attending. Some nurses will get instantly frustrated and go directly to your attending, which may make you feel undermined, and that's okay. Respond with kindness and inquire on how the situation could be improved. We were all new once, and let's give each other the grace to learn in a way that never compromises patient safety. When your nurse calls to let you know that you entered an order incorrectly, or something isn't timed right, or an unsafe dose is ordered - take that call with grace, understanding, and gratitude. Fix the order, and be thankful that the nurse - who is the last safety check before harm happens to the patient - has your back. 

2. You have a lot of knowledge, but we have a lot of experience. You're coming out of medical school with a brain full to the brim with pharmacology and pathophysiology and you're extremely well studied. But we have experience dealing with families, clustering procedures and care, and doing things in a way most conducive and least invasive to the patient's well being. So when we call you to ask if we can add on that lab you just ordered to blood we drew an hour ago, don't give us attitude about it. Understand that we have time management skills, patient advocacy skills, and general efficiency skills that can greatly add to your toolbox if you'll work with us. And, of course, if you really need that lab drawn an hour later, we will oblige.

3. You may feel more comfortable with the patient's condition than we do, but address our concerns. You're insanely busy seeing all your patients and pulling 24 hour shifts, and we get that it's exhausting. But don't forget that we are your eyes and ears and your gauge of how the patient is truly doing. He may have looked fine ten minutes ago when you rounded, but if I'm calling you to tell you that he suddenly looks sicker - don't discount that and add it as the 43rd thing on your to-do list. Come see the patient, who may have already improved by the time you arrive anyways. The nurse will probably know better than you do how the facility works and if this patient meets criteria for higher levels of care than the current unit offers. Support and trust your nurses' assessment, even if you don't necessarily think your exam agrees with theirs. We see that patient for 12 hours straight and notices small changes. If you build rapport with them, they can be, and will be, the biggest asset to your team. 

4. You will have questions that nurses know the answer to. Ask us. Whether it's a policy question, or a question on how something is done in this particular hospital system, your nurses will know. You rotate through several organizations and units, but we stay in one place most of the time and we know the flow and procedures and protocols followed on our floor. Sure, some nurses will be grumpy and not want to help you, but I want to be apart of the culture that helps you learn, grow, and become the best doctor that you can. And honestly, most nurses are more than willing to help if you'll just politely ask. The world needs more great doctors, and I will be a nurse who supports you in becoming that intuitive and well learned doctor. 

Everywhere we go, there are nurses, residents, and attending physicians alike who have a bad attitude about working with the other discipline. In a culture that relies so heavily on communication for patient safety, I truly believe that there is no space for such division. As a nurse who was a new nurse only a short time ago (like literally this year), I know how scary and overwhelming the healthcare industry can be. I vow to be a nurse who supports you, informs you, and learns alongside you as you journey into an extremely rewarding career.

Good luck, and welcome aboard. 

life as a new grad RN

Today I finished my fourth twelve hour shift as a Registered Nurse. It was a pretty great day. Not only was it absolutely insane to stumble across my PUBLISHED article in the Arizona Nurse magazine, it was crazy to sit in the nursing staff meeting and think to myself "I'm not just a student nurse sitting in on this meeting, I'm literally an RN, a staff RN, attending a professional meeting that directly applies to me."

Insane moment. Reality check.

I have been privileged to have really great experiences so far on the floor. While it is overwhelming and there's about 104 things I don't know how to do for every 2 things that I do know how to do, nothing compares to the satisfaction of holding that baby or talking to that kid or educating those parents. Nothing compares to the satisfaction of hearing a mama to a sick baby say "Lauren, you're our favorite nurse we've had here".  Nothing.

Today I took care of two patients who really left a stamp on my soul that I would like to write about, in the most HIPAA compliant way, of course.

Every morning as an RN you get a report sheet that gives you a quick 411 on the patients you'll be taking care of that day. When I first received my report sheet, I noticed that this patient was a few years older than me. That instantly stood out because that rarely happens as I work with a pediatric population. As soon as I walked in and said good morning to this patient, I was instantly struck by his naturally content, calm, and overwhelmingly accepting disposition towards his current condition. Honestly, as someone who is close to my age, I immediately thought about how I would be livid and kicking and screaming and pitching a fit about that state of affairs. But he was so at peace with his situation, that I couldn't help but be thankful for this perspective. I am irritated by everyday situations he would probably love to encounter on a daily basis. I wasn't surprised to find a Bible and a copy of "Greatest Men in History" on his bedside table - clearly he is taking perspective from the Great and the greats - and I respect that. He will probably never know it but he blessed my nurse soul with his sheer contentedness and cooperativeness and all around tolerance of the day which was relatively unpredictable.

After hanging out with aforementioned patient for most of the morning, I ventured to the other side of the hospital to pick up a little friend who would spend the rest of the day with me. This little friend was from a culture very different than mine, and I wasn't sure how to bridge the gap - especially with a very drastic language barrier. After getting the tiny friend all settled in, I went back to my computer desk to chart - with only a few words exchanged between myself and the parents of my kid. A few minutes later, a lady I hadn't met before came out of that room and asked me about the use of a microwave. Who would've thought that such a simple, everyday request would help further my nursing care relationship? I went back into the room eventually to catch up with this lovely woman and her husband, who actually ended up being Missionaries who spent many years overseas. Their main ministry now is teaching English here in Phoenix to those who need the education the most, which is how they knew my tiny patient's family. Somehow throughout our conversation, that lovely question came - "So, how long have you been a nurse?" While I stifled in my chuckling answer of "4 days", I told them how long I'd been licensed, which lead to the next dreaded questions: "So how old are you?!" But little did I know, that question would create a bridge between myself and that kid's mama - a woman who has suddenly found herself in an entirely different culture, with an unfamiliar language, in an unfamiliar place, with a sick little mini. I can't imagine. She ended up asking me again (later, after the missionaries had gone) how old I was, and once she told me how old she was, she used every broken word in her English vocabulary and started to tell me her story. Her story of how a physician kept telling her that the tiny friend was healthy, and discounting her motherly instincts. It was incredible to see her go from being completely silent, to scraping up every word she could use to communicate in a language so far from familiarity to her.

A few minutes later, the missionary couple came back out to the nurses' station and thanked me for the conversation, the common love for Jesus & babies, and for shining the light of the Lord in a very oppressive culture. I was just thankful to think that there was potential for this mom - all alone in a massive hospital, even larger healthcare system, and even exponentially larger country - to let down her walls and trust me enough to tell her story. Did I get behind on my charting? Yes. Was it worth it to spend a few minutes being the hands and feet of Jesus during my everyday duties? Absolutely. I can't help but reflect on days like this and realize that yes, there are harder days and easier days. But all of these days are "worth it" days, because there's truly no more probable way to make a difference in someone's life than taking great care of their most prized possession - their mini me.

#NuggetNurse

On a random side note, I am so thankful for my preceptor. She is gracious, she is patient, she is kind - and she never treats me like I'm stupid, which A) is hard to come-by in the nursing world, and B) sometimes I ask stupid questions and she just shows grace over and over. She is an exemplary nurse and I could only hope to be half as incredible at this job as she is when I'm a few years into the profession. I couldn't be more thankful that God provided for me in this area, because spending 13 hours per day for 3+ days a week with someone could either really wear on your soul, or really pour wealth into your soul, and God has given me the latter. I pray that someday I can orient a baby nurse and be the same way, because it has truly influenced not only my life as a professional RN, but my life as a Christian.

I'm going to be a pediatric nurse.

It has been twelve months of this craziness that is nursing school. It's been stressful, miserable, joyful, exciting, and so trying in so many ways. I'm thankful for where I am today, but getting to this point has been one heck of a journey.

I knew it would be. Everyone warned me. But truthfully, nothing could've prepared me for nursing school. For crying with patients, praying with patients, studying cellular physiology which I formerly HATED, and learning to love studying the nursing process.

One thing that happened this block which has been super cool is falling in love with nursing again. During block 2, I was pretty sure that whatever the heck this nursing thing was was not for me. I hated med-surg, and of course, every staff RN was stoked to tell me that new grads inevitably have to do their time and become med-surg nurses. During block 3, that all changed for me.

I decided to become a pediatric nurse after spending time on the pediatric oncology floor at Phoenix Children's Hospital. That was when I was 12, but I never lost track of that dream. Now here I am, finishing block 3 of nursing school, and 4 months from being an RN. I FELL IN LOVE WITH PEDIATRIC NURSING. I love those babies, those kiddos, and those mamas. I am thankful to be apart of their care, their smiles and tears, their joys and their fears.

This week I went to Camp Rainbow, Phoenix Children's Hospital's pediatric oncology camp. Not only did I get to spend time with AMAZING advanced practice nurses and physicians, I met some of the most amazing oncology nurses in the world - I am sure of it. They know those kiddos so personally and their care reflects the care I know they would provide for their own kiddos. Those nurses have invested not only their vocational skills in those kids, but their entire hearts and souls. It's mind boggling to see.

While I was at camp, I had a conversation with a camper who will be attending Grand Canyon University this year and taking some of the same classes I took my freshman year. She shared with me how her dream career would be to become a neurosurgeon, however, due to secondary health concerns after her cancer treatment, she could never become a neurosurgeon. My heart ached listening to her story. She is beautiful and talented and smart and has dreams just like so many girls I know, but her dream is inaccessible to her. I have taken for granted the fact that I can literally chase any dream I want to pursue. I could become a neurosurgeon, or a lawyer, or stay a nurse. Not everyone has that option. I'll never take for granted the amazing opportunity I have to chase my dreams in an uninhibited way. Also, side note, this lovely lady was not at all complaining or disappointed by her situation. Instead, she joyfully shared with me how she will pursue neuropsychology instead, and focus on a more clinical side as opposed to surgery.

It's been super cool to see everything come full circle, and realize that even though my selected fields of nursing have changed throughout school, I truly still fell in love with the very field I loved when I decided to become a nurse - pediatric oncology. I'm not sure if that's where I'll start as a new grad, but it's amazing to see that even through many changes, the pediatric oncology field has remained my favorite.

Thanks for reading and being involved in my journey. :)

PS. Part 2 to follow on this post tonight - I'm off to study for my comprehensive final exam on Friday.