Monday, July 04, 2011

I Don't Know Anything About Anything

Hello my lovelies!

I know. I know.
I have been absolutely MIA lately and I am terribly sorry for that.
Will you forgive me if I tell you that I have been suffering from a debilitating case of Writers' Block? Really. It's bad. I'll stare at the computer screen for an hour at a time...watching the curser blink...and blink...and blink...trying to will the words that I so desperately want to say out of me.

This is something I have been thinking about for a while but haven't been able to put into words.
As a new nursing graduate (for some reason, I cannot yet bring myself to say that I am an RN until I am actually hard as I worked for those letters behind my name, go figure), I don't know anything. At all. Seriously.
Sure. I have a book shelf full of binders and binders full of notes and so many textbook that it would make your eyes water and your head spin. I have a shelf full of NCLEX review crap and a CD case full of practice question discs.

But. I. Don't. Know. Anything.

Sure. I may be able to put in an IV on a person who is well hydrated with veins like pipes. I can keep a person calm and listen to them and reassure them that they will be taken care. I can give shots and insert Foley catheters and do a physical assessment and recognize abnormalities. I can quote normal lab values and tell you the general pathophysiology of a disease.

But drop me in the middle of a code? Or have my "healthy patient" suddenly stop breathing?
Well...I hope the patient wasn't someone you liked very much because if I am in charge of their care at the level I am at right now, they probably won't make it. [And yes. I realize that no nursing supervisor worth their salt would put me with a critically ill patient without back up of some kind...but still...the idea remains the same.]

Like I said. I don't know anything about anything.

A professor told me this was normal. Everyone feels like this when they first graduate. That it takes at least two years before a nurse becomes comfortable in his or her abilities. She said that she knew I was ready to graduate because I realized I still had so much to learn.
Say what?

I guess what brought all this up was a conversation that I had with a paramedic friend. I don't even remember how it started but I think I asked something about if all medics were like him (self assured....or cocky, if you will). He said they should be.

Estelle: Why do you think that? What is it about the field that makes y'all like this?

Him: You gotta have big balls to dance with the devil alone in the streets so to speak. There are only 2 of us in an ambulance as opposed to several docs, techs, nurses, etc. We don't have chem 7s, 12s. Can't check cardiac markers, etc. We have to go only on pathophysiology and our gut instincts for diagnosing. And we have to be accurate otherwise it's back to square one when we arrive at the ED. And for me, doing critical care, we have to make acute care decisions that will last several hours.
We have to have ACLS in order to have our license, it's a choice for an RN. I am an ACLS instructor, teach doctors how to run codes. We paramedics save more than doctors do. I can compress chests, do surgical airways, intraossious lines, intubate, reduce fractures, chemical sedation, induce chemical paralysis all while cutting someone from a car or taking them from a house. Nurses really don't know what we do in the field. We do everything but take x-rays.
I teach EKG and 12 lead interpretation to docs. Paramedics are almost as good as a cardiologist. Paramedic school is basically equal to almost 3 years of medical school. We come out of school ready for action. Nursing only prepares you for NCLEX.

First fucking awesome is that?
Secondly, read that last line again.

*Nursing only prepares you for NCLEX.*

I've heard this before. And it pissed me off to no end. My reaction was something like this:

My reaction now?
".....fuck.....i am going to kill someone...because all I knew how to do when I got out of school was pass boards.....fuck...."

Heaven help me....and any of my unfortunate patients.


Absentbabinski said...

So there with you! Half way through my OSCEs today and I totally feel adrift on the waves.

Knowing what to do in a code is very much an experiential thing. I know I nearly went to pieces in my first one! But there will be people around you more experienced and ready to take the lead (eager, sometimes!)

And as for your healthy, breathing patient - If they stop, just pull the crash alarm and ABC until help arrives. Which it will.

You're not alone and everyone you work with will understand you're on the starting blocks of your nursing knowledge. So watch, learn, synthesise and you may discover all that theory pays off.

Amber said...

I hear ya. That's how it was with vet tech school too - it really only prepared us for the CVT (certified veterinary technician) exam, not for actually working in an animal hospital. I could tell you so many stories of freshly certified vet tech school graduates who stepped into an animal hospital on their first day and had no. Fucking. CLUE what they were doing.

I have every confidence that you will get it soon. The practical knowledge, I mean. You have a good head on your shoulders which in my not-so-humble opinion is one of the finest qualities of a good nurse, human or animal. And in that respect you're already WELL ahead of many nurses whom I hear about!

NP Odyssey said...

Paramedics do a wonderful job, but I have to stick up for the nurses here.

I do not know who this paramedic is, but I am sure your knowledge is more rounded than his is. Nursing school has given you a good foundation to build upon. In the hospital, there are so many areas to practice. Think of all the body systems you will be work with and learning you will do, outside of their scope of practice. The paramedic’s scope of practice is very different and limited in the drugs and procedures they can do; it is not better, only different. In other countries, they can do more things than in the US.

He is a part of a team (Is he a team player?) and only on pre-admission to the hospital. I have never had a patient in the hospital say forget the doctors, nurses and other experienced staff; I want a paramedic to take care of me. He sounds jealous that you have completed nursing school and passed your boards. Nurses have degrees and in most cases, paramedics in the US have certificates. What would he do with a patient who has kidney failure, a bowel obstruction, needs a cardiac catheterization procedure or has internal or inter-cranial bleeding? Do you really think they are like a 3rd year medical student, which is almost insulting? They do a great job in the field, but cannot do what you will be doing in a hospital or many other settings. The same as you will not be doing what he does in the field.

You worked hard to get where you are, now is not the time to doubt yourself.

Zazzy Episodes said...

I second what NPO said. Forget that Paramedic and his cockiness!
Now is your time to shine even if you feel like you're not that shiny, it'll come. You'll be polished before you know it.

Estelle Darling said...

Haha. Thanks y'all.
The paramedic is a good guy, a team player, and in school for his RN degree (and he is ridiculously almost intimidating).

What he said just got me thinking though about how much I actually know upon graduating from school. I have the book knowledge but the challenge will be trying to translate that into real world situations.

The Happy Medic said...

Random sent me and I'm glad he did!
This is an age old debate between two distinctly different practices, as has been mentioned before.
Medics are indeed only certified and licensed as opposed to a degree program, although some of us hold AS and I have a BS in EMS so we're getting there.
I think the cockiness of your friend can be traced back to the fact we are alone when on scene, as he mentioned.
Just as you feel lost on certain calls, I would feel lost on the floor monitoring meds, 6 patients, multiple scheduled transfers etc etc.
We like to try comparing nursing and paramedics because we see each other all the time doing similar things but we are apples and oranges.
We're all in the same boat when the ink dries on the card and suddenly we find ourselves in a tough situation.
It goes away. Then it comes back, then kind of goes away, but any one who claims to be perfectly comfortable on challenging calls is either lying to you or themselves.

Thanks for the blog! I love it!

Justin Farrell said...

You know it's funny... I never ran into what you are talking about until after a certain incedent . As a army special forces medic I got my paramedic cert and I am a ACLS & PALS instructor. I have purposely lacerated a dudes stomach in the middle of the desert. I then clamped and ligated his mesenteric artery. I pumped him full of antibiotics and gave him a fentanyl lolly-pop and threw him in the truck and hauled ass back to the out post. The doc, nurse and medics at aid station just looked at me when I was explaining what I did. The nurse asked me who gave me authorization to cut him open in the field and perform such a procedure. lol I was feeling cocky after saving the dudes life so I said " My Whiskey 1 identifier Ma'am" Whiskey 1 is what they put at the end of our job code to show that we attended special forces combat medical school. lol she was taken back that I could and knew how to do all that. It's crazy they don't teach you more, but like me you will learn a lot more on the job and you'll be a bad ass nurse one day. Don't get discouraged just stay confident and sponge all the info you can while you are working with more experienced people. :)