No photos from the hospital! Imagine a landscape printed page with the list of 30 patients listed – they have their room numbers, what they are in the hospital for, how many days they’ve been there and a bunch more information that I can’t remember right now and then they usually assign nurses to a block of 5 rooms. So my name is listed next to five rooms. My name with my cell extension number that I carry throughout the day. This assignment sheet also tells you who: is on telemetry, has bed sores, is on a bed alarm, has a foley, has a central lines, has a patient control analgesia pump, is on isolation precautions, and needs total care. It also lists the charge nurse and the two technicians who are working the floor. The unit on a sheet of paper.
So I’m on the other side of my first two days on the unit on my own. Though I think I now have a slight cold (probably a rebound immune response – I think one often gets sick after a stressful time is over, your body can hold it together and fight off germs while you are doing the stressful thing, but once you relax into a regular thing, the germs take over. This is not based in science. It’s only based my own experience), I made it through and I’m still standing. I spent the weekend before in a state of controlled anticipatory anxiety which I was trying to suppress and hide (because I’ve come to the conclusion that anxiety over uncontrollable things should not ruin a good time and Sat and Sun were both good times and I was trying to relax and have fun), but both Vince and Jeremy could tell that I was anxious and were extra nice and supportive through the weekend. Vince especially, who I dragged to orienteering on Sunday morning, did not protest the relatively early weekend wake up at 9 am and he played fun music and seat danced in the car on the way there and back making me laugh.
It was the right time to go off orientation – there are things that are not learnable unless you are forced to do it by yourself and figure it out. I had no truly demanding patients my first two shifts – even so, I didn’t stop moving the entire time I was working. I’m happy I get to form my own relationships with my patients which was harder to do when I’m deferring to my mentor. I’m trying to figure out when to take breaks to make it all more manageable. No matter what is happening, everyday around 5 pm I feel an incredible urge to cry. Sometimes it’s because I’m happy that I’ve almost made it another day, sometimes it’s because I’m incredibly overwhelmed. I wonder if it’s some hormonal shift that happens in the early evening. Old people with dementia have sun-downing where they get irritable at about 5 pm. Maybe I have my own version.
On of the reasons that I want to cry at 5 pm is because I’ve been nice since 6:45 am. I mean, I’m almost always nice, but I mean, I’m nice in a particular customer service kind of way. There are many technical aspects to being a nurse which are important, but if you do your job right, no one notices and you can prevent problems before they happen. Watching for a blood pressure that trends lower throughout the shift, watching for changes in mental status – you can figure out what you need to do before it all gets worse. But this isn’t what people care about. A lot of what people remember is how nice you were to them. Did you listen to them? Did you hear their complaints? Did you get them a warm blanket when they asked? So I’m nice to patients and try to listen. They actually don’t care that you were two hours late with the IV antibiotics because pharmacy didn’t stock it in the floor medication machine and you had to call the pharmacist to verify the med and then they wouldn’t send it in the tube system, or if they sent it, they sent it to the wrong floor – so you have to call again and then they said it would take another hour to have it delivered because the tech isn’t scheduled to deliver until 6 pm, but you could come down to pharmacy to pick it up yourself. So I’m also nice in the same way to all the pharmacists, techs, doctors, transporters, housekeepers, and various other staff throughout the day. This level of sustained niceness is a kind of performance (and in a way it is a performance because cameras are everywhere and people are able to take video anytime they want to) that does take a lot of energy from me. I pride myself in deescalation of tense situations, of making people feel calmer and more reassured and to feel like they are valued, but man, it makes me feel like crying at 5pm.