**Note: If you find yourself getting offended by what I write in this entry, please refrain from yelling at me in the comments, and remember this: I am comparing myself to myself, not to anyone else. I am comparing past ideas to present reality. This is all about me, not anyone else. Surprising, since I have an entire site full of me talking about myself, right?**
Okay, here we go.
My first marriage (I can’t believe that’s a phrase I say now) was shitty. I know I’ve said that before, but it bears repeating. It broke down throughout nursing school, and finally disintegrated in an utterly spectacular fashion shortly after I graduated. I actually plan to write a novel about the details one day. We’re talking soap opera material.
My last semester of nursing school, I worked as a nurse aide at a local assisted living/skilled nursing facility. I had tried the entire summer before that semester to get a job at one of the local hospitals, but nothing panned out, so I ended up there. I picked up every shift I could, but the bulk of what I could get with my school schedule was weekend and evening work. Which was fine, but of course, it kept me away from my family at pretty much all hours. Every night I clocked out at 10:30 and every morning I woke up at 4:30, I reminded myself that there was light at the end of the tunnel. That I was only a few weeks away from graduation. That, once I had passed my NCLEX, I would begin applying for jobs at the hospitals again. I could hold out for a hospital job this time. Hospitals love hiring new graduates and training them, molding them, while they’re still green.
I had a plan.
I was going to become a medical-surgical floor nurse first. That’s the “standard hospital nurse” that usually comes to mind (if you’re not medical). They take care of post-operative patients for knee replacements, appendectomies, and the like, as well as patients with everything from COPD exacerbation to pneumonia to cellulitis. Essentially, if it’s not a specialty floor (respiratory, OR, ER, orthopedic, diabetic, cardiac, etc), it’s med-surg. It’s a great place for new grads to gain experience that covers a wide range of skills and pathologies. It’s usually on a med-surg unit that new nurses become familiar with what they’re doing – as well as with their own preferences – enough so that they can move on and specialize, if they so choose.
I was going to spend two years as a med-surg nurse. Twelve-hour shifts, aching feet, cranky patients, hovering, critical family members, strictly scheduled medication administration, bed baths, catheter changes, discharge teachings, balancing and remembering and prioritizing care for five patients at a time, charting (and charting and charting and charting) – I was ready for all of it. It was the technical, under-appreciated, exhausting work that I had been building myself up for – that I was really, truly EXCITED to do – since I was sixteen years old and realized that medicine was the field in which I was meant to spend my life.
My first two years were, in my mind, simply going to be a means to an end. And that end was the ICU.
My classmates and I spent three semesters of clinical days in inpatient rehab facilities, the state mental hospital, the OR, the pediatric floor, the labor and delivery wing, the mother-baby unit, and several different med-surg floors. And then, finally, finally, in my final semester, I got to spend a few glorious, blessed days in the ICU.
That was it; I was home. I had found my calling. I had found my people (ICU nurses have to have a pretty warped sense of humor to get by) and my patients.
It was the first place I used my CPR on a human being, instead of a plastic torso with sensors in it. The first place I watched a doctor declare a patient’s death. It was where I saw a patient with a fever so uncontrollable, he had to be sedated. It was where I pulled my first internal jugular catheter, where I saw firsthand how carefully a chest tube drainage system had to be maintained. It was where I sat and watched the telemetry monitors that confounded me when I was a CNA on a cardiac unit in Denver, but where I could now differentiate atrial fibrillation from atrial flutter, recognize PVCs, and, with the help of some very experienced (and highly credentialed) nurses, determine which patients had previously suffered heart attacks.
Every patient was a puzzle. Every comorbid condition had the potential to throw a hurdle between the patient and recovery. No two cases were the same. Patients couldn’t be treated and discharged using a standardized plan, as they can after many common surgeries. Each one had to be carefully maintained, their medications titrated and dosages calculated with no room for error. In some cases, certain interventions could harm the patient, but allowing the disease process to continue could mean death. It was constant critical thinking. A balancing act. It meant never seeing the same case twice, and constantly learning new things and acquiring new skills.
After every specialty rotation, we were required to summarize what we learned. Conditions we helped treat, new skills we were able to use or observe, new medications we encountered. Any revelations we had or conclusions we drew, we handed them in the following clinical day.
I will never forget what my clinical instructor said to me when she handed back the summary of my first day in the ICU.
“You’ve found your calling, kiddo.”
I was over the moon. I was on cloud nine. I was beside myself. I was every lame, tired, cliche way of saying “utterly elated.”
For several months, I had been feeling disenchanted by what seemed to be the relative routine of med-surg nursing. I was providing the bulk of the care for, as well as charting on, four different patients on my med-surg days. By the end, my instructor had noticed I seemed “bored,” and threw another one at me. I had maxed out on the medications I could give, the care I could provide, and the skills I could perform as a student. I wanted more, but I was limited (which, of course, was in everyone’s best interest), and I was getting restless.
I had gotten to the point where, several times, I told my ex-husband that I didn’t truly want to be a nurse anymore.
But after that day in the ICU, everything changed. I had new drive, new focus, a new plan, new goals. I thrived on the adrenaline, having to problem-solve on a second-by-second basis. I loved the complicated cases and the emotional highs and lows and not ever knowing what was around the next proverbial corner.
I knew, from then on, that I was a critical care nurse. ICU, ER, cardiac critical care. That’s where I planned to spend the first ten or so years of my nursing career. Once I had laid that foundation and truly mastered the skills, I wanted to become a Flight for Life nurse. Of course, that was if I hadn’t fallen in love with one of the other critical care units I was in.
I wanted to experience everything. I wanted to learn constantly. I wanted to be challenged daily. I wanted it all.
My ex-husband and I separated in a very abrupt, kind of unforeseen, slightly drunk moment at about one in the morning at the end of January, 2015. One month after graduation, just over two weeks before I could finally take my licensing test, and my world was suddenly – admittedly, by my own doing – thrust into absolute chaos and uncertainty.
This will probably rub some people the wrong way, but whatever, go ahead and clutch your pearls and judge me for saying this: the dissolution of my first marriage (that has not yet gotten less weird to say) was the best thing that had happened to me, to date. You know, aside from my offspring. I was out of a toxic relationship. For the first time in my adult life, I could be myself. Not even that…he had stifled me as a human being so much that I wasn’t ever allowed to even find out who I was. So I started there. It was like a weight had been lifted off of me. I could move. I could think. I could breathe. It was incredible.
It meant that holding out for a hospital position was no longer an option. With attorney’s fees looming in my near future, along with needing a new residence for myself and my sons, I had to take the first job I could get.
The day after my license became active through the Department of Regulatory Agencies, I began training as an RN at the skilled nursing facility I already worked in as a CNA. But beginning then, every night I clocked out at 10:30, I reminded myself that at least I didn’t live with him anymore. Every morning I woke up at 4:30, I reminded myself that at least now, I was making over twice what I did as a CNA. And every second of every shift that made me miss my children’s fleeting waking hours before I had to deliver them back to their father, I reminded myself that again, this was all a means to an end. This was all for us and our little family and our future on our own. This was all for them.
After a year as an RN at that facility, I applied for a clinical nurse position with a local non-profit that serves primarily those who are under- or uninsured. It was one of the several (sometimes many) areas of nursing I wanted to go into, and for very personal reasons. This is my current job.
I adore my job. I work with the best team of people I could ever have hoped for. I have great relationships with the providers I work for, and they respect my (albeit limited) experience and knowledge enough to trust my medical judgment on a daily basis, with a huge variety of patients, conditions, medications, and treatments. I love what I do. I still have absolutely no doubt that medicine is still where I belong.
I read articles like this one. Or this one. I see posts from my friend who works in a pediatric emergency room about treating kids in respiratory distress. I talk to my friend who works in the emergency room whose job is so in depth, he had to be trained for five months, along with needing at least three advanced life-saving certifications to be on his own with patients. I catch up with my friend who manages home care for a chronically ill child on a ventilator, or the one who now works in nurse education for one of the major hospitals in town. I hear about how hard it is to work night shift full-time, or having a schedule so inconsistent they can’t remember what day of the week it is. I hear about missing out on kids’ school events.
Compared to these people, compared to my dreams of the ICU and the ER and flight nursing…I almost don’t even feel like I can call myself a nurse.
**If you feel yourself getting mad at me for what you assume I mean by that, please return to the top and read my note over again.**
I am not any kind of hero. I don’t feel I’ve earned the right to put myself in any kind of category with those I mentioned above. I just feel unworthy.
Yes, I am proud of what I do. I love my job and my patients and my coworkers and my company. I love the dynamics of my clinic and the small procedures I do get to do or assist with. I love teaching patients about their conditions and how to manage them, I love giving shots, I love the relationships I get to build with our providers’ patients over time. I love seeing chronic conditions improve, and I love seeing our young patients beating obstacles and growing every time I see them. I love learning anything and everything I can, because I have the privilege of working so closely, forty hours a week, with primary care providers. I love – love – providing care for the under- and uninsured.
But sometimes I feel like I’m missing out. My nursing, what I wanted to do, the idea I had in my head of my nursing career was so different.
I have the privilege of having my boys with me half of the time, to include every weekend. Part of the reason I took the job I did was because it was Monday through Friday, 8 am to 5 pm. No weekends. No holidays. In a time of uncertainty and tension, as we shifted from a four-person household, into two three-person households, and finally into one four-person household (their father has a girlfriend who lives with him) and one six-person household (I’m remarried and he has two young boys as well), my boys needed consistency. And that, absolutely, was and is paramount in my priorities. I am off work and pick my boys up from my parents (who watch them after school) by 5:30. They have dinner with me and my husband (and his boys, when we have them) every night. I help them get ready for school every morning. They never have to wonder if I’m going to pick up a shift at the last minute and won’t be there to put them to bed. I have every weekend off of work, and I get to spend that time with them. I’m at home with them every holiday they have on my parenting time.
I love being the mother they can rely on. I love being involved and attending school functions because my schedule allows it. I love never having to worry about whether I’ll be able to take a holiday off to be with them. I love having the same hours as my husband. I love having a full family life, in addition to working full-time in the field that has had me fascinated for over a decade now.
But these two are completely at odds in my head and in my heart sometimes. I miss hands-on patient care and the critical thinking and the balancing act of prioritizing four acutely ill people. But I know that what I do is also absolutely essential, and that it is still essential for me, right now, to be present for as much face time as I possibly have with my sons, as they continue to work through the divorce and a new blended family, as well as being in first grade and preschool.
I don’t know, I don’t really have a way to tie this up in a pretty bow and deliver you a conclusion. It was just a thought that struck me really hard this evening, as I scrolled through Facebook and saw nursing memes.