The transition between student nurse and a registered nurse was a shock. As a student during clinical, you are not able to do anything without the faculty member looking over your shoulder. So many things were entirely off the table for students to do at one hospital we weren’t allowed to check blood sugars. The same shock came after I passed my driver’s license test, for a year I had a passenger. Then it dawned on me I had to drive by myself. This sentiment even fifteen years later upon receiving my RN license and my nursing position. I now have to nurse by myself.
#1 IVs
Every state is a little different in the curriculum and what nurses can do in the field or hospitals. It was my understanding that many Connecticut hospitals were starting to lean towards a team of nurses who only do IVs. As a student, the hospitals did not want students attempting IVs not even with a faculty member. Texas was not like this at all. Every nurse had to be able to insert IV or at least try. There isn’t a team that would come up; it is only the nurses by your side and your charge nurse. It took me many attempts until my first one successfully. To this day I am not a very strong at placing IVs. The technique was a learning experience, and it was on the job.
#2 Machines, Pumps, etc.
There are so many different pumps and machines used in the hospital it becomes difficult to learn each one. Each one is similar and yet so different than the next. IV pumps, probably the most common. My school showed us how to prime tubing and prepare a piggy-back medication. We had to learn math to find the drip rate. Which as a nurse I have never had to do. But the little tricks or troubleshooting when the pumps beeped scared me, at first. Several nurses had offered me some tips and tricks to troubleshooting. As a student and new nurse, I was afraid to touch it. I was worried that if I changed anything with the pump, I could kill a patient. Similar to that aspect was the feeding pump. We learned about TPN and other supplements, but never about changing the tubing and priming the line. The more patients I had with machines, the easier it became.
#3 Talking to Physicians
RN work with physicians. The physician sets up what they want for the patient, their medication, and procedures. When the patient is not doing so well, the RN needs to use their critical thinking and assessment, and page the on-call or physician. Now as a new nurse this is terrifying. Every physician is different. I’ve learned that when I page for a physician, there are some a little bit more understanding than others. Over time my confidence has also increased when making a page. Over time I’ve learned what information I should have the call and a way to do a condensed SBAR. My confidence also grew when I was by myself without my preceptor and knew my patient. I felt the more passionate I was, the more comfortable the call was to make.
#4 Missing Something
Missing something during a shift is a fear of mine, generated somewhere between passing the NCLEX and getting a job. I still have this phobia, although it was more evident at the beginning of my career. One morning or afternoon I was in the middle of three shifts in a row, I woke up panicking that I forgot to document my patient’s PCA. My mind went swirling around the missing documentation. Then it dawned on me. My patient did not have a PCA; the PCA has discontinued the shift before mine. On my brain sheet, I have a list of the expected documentation needed for each patient. The second page of my brain sheet is devoted to the additional notes necessary by the end of the shift.
#5 A code.
A moment when everyone stops and is seen running down the halls in the same direction. A code was called. The code, the possibility of code, scares me. I didn’t know when to call a code. Every aspect of one is a mystery to me. My first code was at the change of shift. The patient went unconscious. I yelled, “call a code.” It was a matter of minutes until nurses and techs filled the room, performing CPR, getting the patient’s blood sugar and vitals. It was minutes before the charge nurse, and ICU nurses came in and took over. The code lasted for the most 15 to 20 minutes. The ordeal felt like it was never going to end. In the end, I made it through the code.
Everything that frightened me when I first became a nurse is now slowly becoming more insignificant. My day to day anxiety is decreasing and only stems out of the unknown of my next assignment. The critical thing to remember is to know where to find answers, don’t be afraid to ask questions. Time will be the only actual variable as you gain your confidence.