The ceremonial end
It’s like the song that doesn’t end… but seriously, now it’s really, truly, nail-in-the-coffin over! Now time to ponder what’s next… NP? MBA? PhD? Hm…
Nurses’ Week
I know I’ve been remiss at keeping this updated recently. Not feeling inspired, I guess. Life without the peaks and valleys of career crisis and the like is not so very exciting!
Now I will admit that I’ve still been ruminating on the subject of my last post… not the opinions of others on my so-called luck, but my own feelings about where I’ve ended up. On the plus side, if you say to me, “So, do you like what you do?” I will reply, “Yes, I love it!” which is a far cry from how I felt about my L&D gig. But I can’t help feeling extremely odd that I’m not even a year into being an RN and I’m no longer at the bedside. This is not at all how I had mentally mapped out my career trajectory. And while I like what I do, I am missing a big piece of the puzzle that my RN coworkers have. I am struggling with that.
I wonder if some of this has to do with the question asked by those who are not in the healthcare field: “So, what do you do?” If I reply, “Well, I’m a nurse” then I am pretty well assured that the following image pops into the person’s head: me, in scrubs, stethoscope around my neck, mopping a brow, fluffing a pillow, or maybe checking vital signs. Maternity nurse? Well, that obviously means that I cheer “push!” during labor, and then spend a lot of time cuddling babies and admiring their tiny perfection. They most certainly are not picturing me sitting behind a desk, running reports, creating spreadsheets and presentations, wearing business casual… a scene remarkably similar to the one I left in career one, albeit with far less glamorous surroundings (I do miss SOME things about that career!). Most people cannot wrap their heads around the concept that A) nurses are smart people and B) nurses do TONS of stuff that go way beyond brow-mopping and baby-kissing.
You might be wondering what all this yammering has to do with the title of this post. Well, it’s Nurses’ Week (aka, if we stuff enough simple carbs down the nurses’ throats they will be too sedated to complain about anything… though my boss did get me a plant, which was quite a nice break from the ice cream socials/pastry carts/etc… I enjoy simple carbs as much as the next person, but there comes a point where it’s like, okay, nurses bust their asses all year and they’re supposed to jump for joy over stale pastry?). One cool thing about the week, though, is that we usually get a speaker in to talk about issues in nursing. Last year it was a woman who talked about generational differences. This year the speaker was supposedly talking about critical conversations, but really her talk was about nursing image. I found it fascinating.
In the beginning of her talk she mentioned the fact that nursing is one of the most respected professions. Nurses have a public image of being ethical and kind. Both good things! I’d be happy to be considered to be ethical and kind. The challenge is this… when the public was asked to think about how knowledgeable different professions were, nursing wasn’t on the list! Which doesn’t really surprise me, actually. If someone has a shred of intelligence and says, “Gee, I think I want to be a nurse,” the response usually goes, “But you’re smart, don’t you want to be a doctor?” The public image is that we’re angelic… and not particularly bright. Well, that’s just swell. The speaker didn’t mean to imply that we should move away from the ethical, caring aspect, rather that we also need to raise public awareness that nurses are there to save your life! We need to educate people about what it is that we DO. Nurses work extremely hard, but it isn’t a job that can easily be boiled down into a ten-words-or-less description. Often we just stick with “I’m a nurse” and so the dumb-but-kind image remains.
In thinking about this, I’ve come to the conclusion that perhaps I need to get back to more frequent blogging… to explain what it is I do. I am a nurse. Just because I work in an office setting rather than a direct patient-care setting does not diminish the fact that I am practicing nursing (damn it!). So perhaps I need to stop feeling sorry for myself that my job does not fit into the neat public image of “Nurse” and rather start doing my own education about what it is that nurses do. Or, at the very least, what this nurse does. I’m frequently startled at how little even my fellow nurses know about the quality office. Generally we’re viewed as some sort of meanie police that wants to create more paperwork. Believe me, I do not want to create more paperwork… I want to help the nurse at the bedside to have the tools to provide the best possible patient care.
So now I need to think about where to start with all of this. If any of my readers have ideas of things to blog about, I’m open to suggestions!
And to all nurses, nursing students, and aspiring nurses, I do truly wish you a happy Nurses’ Week. We rock. We save lives. The end.
Lucky girl
In the past few weeks since I took on my full-time quality role I’ve gotten the comment, “You’re very lucky, you know,” quite a few times. It rubs me the wrong way every time… perhaps not the comment so much as the tone that goes with it… and what’s surprising is that I’ve gotten the comment from people who I am fairly close to in my work life. The “luck” seems to be in regards to working in an office/administrative role as a new nurse, with the unspoken undercurrent of “gee, how nice that you didn’t have to pay YOUR dues.” Perhaps I’m being too sensitive, but judging from the number of times I’ve heard this, I think I might be on to something here…
Why does this bug me so much? I guess because I don’t know how to respond or I feel as though I should be apologizing for having this job, like I somehow acquired the role in an underhanded, sneaky way… which I didn’t. I feel like asking what these individuals think I should have done… turned down the job when I knew my other option was working per diem with no benefits or guaranteed hours so I could hold out for a nice bedside med-surg job in order to prove that I’m a Real Nurse? Or maybe I should ask what makes me less deserving of the position than someone else.
Here’s how I calculate my luck-to-deserving ratio:
I was lucky to be placed in this office as a student; this hospital wasn’t even on my list of options and it certainly wasn’t the specialty I was planning to go for. But once I was placed there it was MY choice to make it the best experience I could. I could have bitched and moaned that I wasn’t getting the bedside/hands-on experience I was expecting, but I chose to be open-minded and learn all I could.
I was lucky that I was in a department that was supportive of having a student and allowed me to have some independent responsibilities. But it was my own maturity and work ethic that allowed me to carve a niche into the department and prove myself valuable and trustworthy. It was that value and trust that led to my first paid job in quality. I never had expectations that I would be given any sort of job in the department. I was honored to be able to at least continue the work I’d been doing as a student and help out the others where I could.
I was lucky that, when my own work crisis happened, the situation in the quality office was such that they were going to need to hire someone anyway. But it wasn’t handed to me because of some “poor Rori” pity. I bring with me plenty of analytical skills from Career One and that’s what they needed. Not to mention that I just finished a master’s degree the had a major focus on quality improvement in nursing and healthcare. I was already up to speed on many of the measures that I would be reviewing. I don’t need as much help getting going as someone brand new to the department would. I earned this job.
I guess I’m feeling defensive… and I wish I could explain to people how heartbreaking the whole sequence of events of the past month or two have been and how I wish I had never had to make this decision. I went into nursing school in large part because I wanted to be a maternity nurse. I’d dreamed about it for so long and was thrilled to be able to start my career in that specialty. I love birth. I love bearing witness to a family’s growth. I love seeing miracles every day. But I hate that birth is treated as a pathologic process as a rule, rather than the exception. I hate that the only time I ever saw a vaginal birth that didn’t involve Pitocin augmentation was when a woman came in to the hospital three pushes away from having a baby in her arms. I hate that nearly 50% of our births are Cesarean. I do not feel that our care is truly in the best interest of mom or baby. And sadly, I know that the defensive approach to birth is rapidly becoming (if it’s not already) the norm across the country. Many maternity nurses can deal with this… not to say that they like it, but they are willing to provide care under these circumstances and try to make the experience the best it can be given what they have to work with. I couldn’t. And I wanted to. I really really wanted to. Part of me hoped that I could become more complacent with our stats. But I couldn’t. I loved my patients, but I hated the orders I had to carry out. It’s a terrible web to be caught in.
I give thanks every day that I can now wake up looking forward to going to work. I give thanks that I work with a tremendous group of people and that I can impact the care we provide as a hospital. I feel blessed to have a job that I enjoy during this time of economic downturn. But I miss my patients every day and I wish that I hadn’t ended up in my job the way I did. If this is luck, it’s rather painful!
Recipe for a lovely day:
Ingredients:
Self
Good friend
Car
A few bucks
Laughter
Directions:
Take self and good friend and put in car early in day. Drive to local diner you have always wanted to try but never got around to. Eschew healthy breakfast option you planned to eat when you looked the menu up online for the breakfast special called “Cherry Pie Waffle” at the encouragement of friend who is choosing the banana pancakes with walnuts and caramel sauce. Accept offer of whipped cream on said breakfasts. Laugh with sassy waitress. Laugh at the world. Laugh at the fact that your “breakfast” includes ice cream. Enjoy heartily. Return self and friend to car. Go to bank to deposit tax refund. Call local salon and schedule a pedicure for an hour from now. Go to salon. When the person performing pedicures offers a drink and one of the options is wine, choose the wine. Relax. Enjoy. Laugh at the fact that you just slurped your wine too fast. Laugh at the cheap sandals you have been given and the funny way they make you walk. Laugh at the fact that, because it is still cold out and you will soon have to put on shoes and socks, there is no possible way that your nail polish will remain unmarred, and you don’t really care because no one will see your toes for a few months anyway… this was really all about the foot massage. Return to car. Go to discount shoe store. Try out the new pedicure in a variety of shoes, preferably fun, impractical shoes. Buy deeply discounted shoes which are probably uncomfortable, but too cute and cheap to pass up. Laugh about cute shoes. Laugh about the fact that you keep repeating statements that “These shoes would be perfect if only [insert complaint here, which may include: big-ass bow on the toe, ugly color, heel height, pinchy-toes].” Return to car. Go home. Wait for dinner. Look up fun stuff to do on the internet. Look up inspirational videos of large, wild cats on YouTube. Sniffle at cute video. Laugh at other stuff that you can’t remember, but damn, it was funny. Wait for friend’s fiance to show up. When said dude shows up, return to car and drive to a bar/restaurant appropriate for the season (i.e. an Irish bar for St. Patrick’s day). Shrug when the hostess informs you of the ridiculously long wait. Buy a beer. Laugh. Get seated. Eat deep-fried fish because hey, it’s fish, fish is good for you. Enjoy heartily. Laugh some more. Return to car and drive home. Hug friend and her beloved and say goodbye. Go to bed. Wake up next morning and be happy that abs are sore because you laughed so much and decide that more than makes up for the fact that you never got around to exercising during your lovely day.
Quotations
From an editorial in one of my nursing mags: “[this magazine] has always, and still does, emphasize that you need to work in a place right for you, where you fit into the culture, can use your best skills, and work with colleagues who energize you and your passion for what you do. What’s most important is that you stay in nursing.”
From my career and finance horoscope from last week (I swear I do not base my life on these things, I just happened to read it and it fit for that particular week): “Talk to your boss or investigate other ways to let your entrepreneurial spirit soar. Your spirits take a corresponding lift on Thursday when you pay attention to your ambitions. On Friday, a difficult situation can become a pathway for new potential. It’s time to heal old wounds. Too much work leads to burnout, which doesn’t do you any good.”
A week ago Tuesday I did talk to my quality boss about taking a full-time position in the department. I asked for a couple days to think about it. I didn’t want to take the job simply because I was panicked about money. When I returned to the office on Thursday, after talking to a friend and doing a lot of thinking, I decided to go ahead and take the offer. As it says in the first quote, I realized that this department is, in fact, a place where I fit into the culture, where I can use my skills, and my coworkers energize me and my passion. And as my horoscope said, I had to think about where I want to go with my career. I realized that the quality offer made more sense than holding out for another bedside job (which I’d be hard-pressed to find at the moment, anyway!) when I ultimately want to be in the quality business (I’d love to do it as a true clinical nurse leader on a unit level, but the idea hasn’t quite caught on yet).
So my difficult situation has, in fact, become a pathway for potential and I am healing my old wounds. I don’t think I realized exactly how much my clinical job had been sapping my energy. For months now I’ve really felt down in the dumps. Even my free time has been spent feeling as though I couldn’t do much more than nap on the couch. Last weekend (after I made my decision to join quality full-time) I felt so much energy and optimism. I felt as if I could finally get out of my own way. In retrospect, I really was feeling burnt-out… which is sad when you consider that I was only in that job for 8 months.
I wonder how many other new nurses are going through this. I ran into one of the other nurses from my orientation class at a skills fair this week and we were catching up. I could see the exhaustion in her eyes and the fact that she’s not having a good time. We didn’t get into too much detail, but I did get that she’s feeling like she needs more support in her work. We agreed that the best part of the new grad program was the opportunity to spend time with other people at the same experience level and share our challenges and we miss having that opportunity. At the end of the conversation we exchanged numbers. I’m thinking of starting a support group!
The saga continues
Haven’t had any babies in our level II nursery in a couple weeks. This has made observing in there rather boring, though I did get to go to the c-sections and other nursery-attended births. I wish there had been something to see in the actual nursery. In spite of this, I got the sense that I would really like it. I felt like I had come home. I knew I would.
Then comes the blow (not unexpected): there is no room in the budget for me to orient there. I could see this coming from a mile away, but I kept my fingers crossed that the stars might align and things would work out in my favor. No such luck. So I’m back at square one again, the nurse without a home. I can’t be just a postpartum nurse. Well, I can, as long as I agree to be per diem, which really doesn’t work for me. I need the income and benefits. Not to mention that I don’t really want to postpartum regardless of the pay scheme.
So now I’m back to trying to figure out what to do, where to go, etc. If I was willing to do some administrative stuff I could probably get myself more hours in my other job, but I would prefer to find something where I can use the nursing knowledge. And I do want to do something clinical.
I am feeling a lot of frustration at finding myself in this pickle. I was hoping I could at least get through that magical first year without bombing out. Now I have too much experience to try to pass myself off as a new grad, and not enough to say that I’m experienced. I wondered today if I should ask to go back on L&D orientation. I could probably wrap it up fairly quickly and then I could have my 24 hours a week guaranteed. But that screams bad idea for many reasons, key being the fact that I was miserable in L&D and everyone knew I was miserable. I really don’t think it’s worth it. But trying to find a job in this economy blows. Pickings are slim and the jobs that are out there are largely per diem. I get that they want to be able to flex their staffing as needed, but it’s not like I’m doing this for pin money here. Blah…
One of my biggest frustrations is the simple fact that I know what I want to be doing. And I wish I had said so at the beginning. I could have oriented to the level II nursery from the get-go and avoided this whole brouhaha. Argh… Yet even as I type this, part of me knows that this is probably the right thing for me in the end. The scary part is not knowing where this road is leading. Am I supposed to be in another specialty? Another institution? A completely different nursing role? I really don’t know yet, but the universe seems intent on telling me that I need to move on.
So here I am… trying to figure out where my next step will lead. Exploring my options and hoping something good comes along. We can only hope!
As a brief follow-up on my diploma post, I talked to one of my friends from school the other night and was relieved to find out I wasn’t alone in my thoughts. She, too, thought it was a puny document and very unceremoniously presented. Although she at least got her middle initial on hers. Harumph.
The piece of paper
The diploma showed up today… finally, two months after the official graduation date. I was surprisingly underwhelmed. I pulled it out of the envelope, sniffed at it disdainfully, and shoved it back in the envelope. Not quite sure why I felt that way.
Maybe because of its unceremonious arrival. My undergrad degree was handed to me onstage, rolled up and tied with a wide ribbon in the school colors. That is far more meaningful than arriving in a plain brown cardboard envelope. I’m surprised it didn’t say “please recycle” on it.
Perhaps it was its size. Again next to the undergrad diploma, this one is puny in comparison.
Maybe it was the fact that they decided to omit my middle name entirely. No initial or anything. How can it be official if it only has two-thirds of my name on it?
Maybe it was the bland generic-ness of the diploma. Really didn’t scream, “Hey you, what a big accomplishment, yeehaw!” More like, “Thank you for purchasing Cracker Jacks.”
Perhaps I’m just retaining my bitterness about the end of the program. No last class, no class party… We found out we met the requirements by looking up our grades online. The diploma comes in the mail in a plain brown envelope. And the graduation ceremony won’t happen for another three months and many of my classmates have moved away and won’t be making the trek back to campus for that. Would’ve been nice to have a class hoe-down. One of these days I’ll get over it, I’m sure. But for now I remain, faithfully yours, Ms. Disdainful, MS, RN, CNL with a puny, ugly, incomplete diploma in a brown cardboard envelope.
(Seriously, I’m not that bitter, but I am kind of surprised at exactly how underwhelmed I felt by the whole thing.)
Becoming militant
I just finished reading a book I saw recommended on another (or should I now just say “an”) L&D nursing blog entitled Pushed: The Painful Truth Abouth Childbirth and Modern Maternity Care. Wow. It sparked so many thoughts in my head and I am sure I will be thinking about it for some time. Basically it managed to put into words what my gut has been feeling for months now, why I have been so uncomfortable in the labor & delivery arena. I have a lot of things going around in my head right now, too many to put into words. But the one thing I will say is that I went into L&D fearing that I would become complacent and develop the “that’s the way it is” mentality. Instead my original feelings have only been amplified. Maybe I’m quitting too soon, but quite honestly, I can’t practice in a way that goes against my own ethics. I don’t yet know how to join the fight for true reproductive rights in an effective way… but I am not giving up my fight just because I’m leaving L&D.
Meanwhile, back on the farm. After my breakdown on Monday I circled back. I had gone onto my Netflix account to see what was next in my queue and saw a banner saying “You’ve watched ‘The Business of Being Born’ before, watch it again, instantly.” So I thought, what they hey, and watched it again on my laptop. Slowly I began to feel that I had made the right decision. And when I woke up to the alarm on Tuesday morning and realized that I no longer had to do L&D a sense of relief washed over me. That relief was what ultimately signaled to me that I was in the right place.
The hardest part for me was the sheepishness. A phrase from “The Devil Wears Prada” kept going through my head, “A million girls would KILL for that job.” How many new nurses want L&D and have to pay their dues in med-surg? Meanwhile I got to skip all that and go right into a specialty… and then didn’t live up to my hype. I felt guilty. I felt like I screwed it up for some up-and-comer. Like they’ll always say, “Well, I dunno about taking a new grad… remember what happened with Rori.” On top of that, I don’t like looking foolish, and yet there I was feeling foolish for making the wrong choice of first job. I mistakenly thought that I could provide maternity care in an environment that went against my own convictions. After all, most of our nurses will admit that they don’t like the number of interventions that are done, but they strive to make the experience the best possible given what they have to work with. I give them a lot of credit for that. I thought I could do the same. I thought that feeling sick every day before work was normal new-nurse jitters. I didn’t want to throw in the towel without giving it my all. I have often used the phrase “just suck it up” when faced with unpleasant tasks. But one can only suck it up for so long before there’s no more room in the vacuum bag (sorry, dumb analogy, but it’s what I’ve got). I also wanted to leave on my own terms, rather than being told that I should consider other avenues. It was hard not to feel as though I’d been told that I failed, even though my manager assured me that I was a good nurse, that this was simply a bad fit for me.
I had another discussion with her on Tuesday and she asked whether my unhappiness was merely philosophical differences or whether I had issues with the orientation. While I did have issues with the orientation, I knew at that point that it wouldn’t have mattered if I had the best orientation program in the world. It might have postponed the inevitable, but ultimately it would not have changed my feelings. I told her, “I just don’t want to do it anymore.” I felt relieved to finally say that. After months of beating around the bush when people asked if I liked L&D (”well, it’s a lot to take in,” “I still need to work on some things,” “I have some philosophical differences”) it felt liberating to say that no, in fact, I do not like it. At this point I will say, however, that I am glad I had the experience of trying it. Sure, I feel guilty that they spent money orienting me and it’s turned out to be for naught. But I will never regret that I tried. I was able to bear witness to many births in my short stint and I feel honored to have been a part of them. I will never have to wonder if I was missing out.
In talking to my boss I did tell her that I am wary of jumping into another area without doing my homework first. As I’d mentioned in my previous post, she’d offered the potential of going to our level II nursery. I asked if I could shadow a nurse in there for a day and she offered one better… a few weeks there, after which I can tell her whether I want to pursue it. That’s a weight off of me, at least for a while. I have a feeling that I will like special care far more than L&D, after all, I’ve been on a sick baby kick since the one day I got to spend in a NICU during my maternity rotation over a year ago. But I want to make sure that this is the right choice for me. We shall see what the next couple weeks bring.
Until then, this week starts my increased role in quality and I’m looking forward to hashing out my new responsibilities. I am a bit nervous about taking on a more independence there, but I know that I will learn a lot from it, and I can’t think of a more supportive group to learn from.
A mixed bag
Good and bad news this week.
Bad: Awesome co-worker in quality left for a new opportunity. Sad to see such an asset to the hospital go.
Good: Her leaving is allowing for a couple of us to grow our roles in the department. This includes the offer for me to increase my hours in the department from 4 to 16, with a new title and added responsibility. I am very excited about this.
Bad: This change had to get cleared with my other boss on the unit. While she agreed to the change it prompted a discussion between the two of us about my feelings about that job. Which, if you haven’t picked up on the subtlety in prior posts, are generally negative. Okay, I’ll just say it: I don’t like what I do. L&D in a hospital is a bad fit for me. The upshot of the conversation with my boss is that I’m getting pulled off L&D orientation. My boss was very flexible in terms of what I will do now. I’ll just do postpartum for the time being while I figure out what next. She even offered to try to get me into the special care nursery which is a big interest of mine. But I am wary of jumping at that opportunity without doing some serious soul-searching first.
For one thing, I am not sure that my feelings are solely related to my philosophical views on birth. There is the culture to consider, as well. The unit and the hospital as a whole have distinct cultures and I’m not sure where I fit into this culture. This leads me to wonder whether I should look at a specialty unrelated to maternal/child health. Or even beyond that, whether I should look outside this hospital entirely. Not that my brief experience and the current economic situation make that easy. Not a ton of hiring going on around here.
I do count myself lucky for one thing… my awesome mentor (formerly my clinical preceptor). I was able to sit down with her today and bounce my thoughts off her. She understood my feelings of “how much longer do I have to do this?” that come with a job that’s a poor fit and validated many of the thoughts that have been rattling around in my head.
These past few months have been such a roller-coaster. At the moment I feel half-sick and half-relieved. Relieved to have this burden off my shoulders, sick to not have a defined next step and feeling pressured to make a decision. But I was able to think out some next steps with my mentor today, and I guess I just go from here. If only I could stop bursting into tears I’d be all set.
Three sets of initials
That’s right… I now have three sets of initials after my name: MS, RN, CNL. Added the last set this week after taking the clinical nurse leader certification exam. It was one of those tests that you can’t really study for, but at the same time we’ve been spending our entire time in school preparing for it. Passing that test felt like I’d put the bow on the whole package of the last two years. Now to build the skill sets to add some legitimacy to all that alphabet soup!
Unfortunately the last week or so has been a bit of a wash. After not getting sick for over two years I had developed the erroneous notion that I was somehow super-immune and would never be sick again. On New Year’s Day I had started feeling like I got sick, but after a couple glasses of Emergen-C I was back to full force again. This only served to bolster my immunity arrogance. But this past Monday I woke up with a vaguely sore throat and it went downhill throughout the rest of the week. I called out of work on Wednesday, but felt like I had to go in on Thursday… I was signed up to renew my BLS certification and had signed up for a mandatory code of conduct training, so I went in, did a couple hours in quality. I decided I wasn’t really feeling all THAT bad… even went down to Big City for an event with my local undergrad alumni group. Friday I woke up convinced that I felt better. I went to work since I’d only scheduled myself for an 8-hr day thinking it couldn’t possibly be that bad. My coworkers essentially turned me around at the door and sent me back home. It was just as well… I felt worse as the day went on. Saturday was more of the same. I’m finally beginning to feel slightly more normal today. Even dragged myself out of the house to go to the grocery store where I bought all sorts of yummy-sounding things only to find out that nothing I eat has any flavor to it. Dratted stuffy nose.
On the work front… I am hoping there might be some new developments. Nothing has been stated directly to me, but I know a coworker in my, um, preferred department of work, is transferring to another location in our network. My boss there asked me about my normal schedule on my, um, less preferred department of work. I am wondering if they are wanting to give me more hours, which I would gratefully snap up in exchange for fewer hours in the other place. As you can see, I’m still struggling with my transition to the bedside job and wondering whether I’d be better off in an area of nursing where I didn’t hold such strong personal convictions (particularly strong convictions that run so counter to the mainstream way of practicing in the hospital setting). For a while I thought that I’d want to be a midwife and I thought I would be able to do the L&D thing for a couple years to get the experience before I went back to school, but throughout school I found my interest in midwifery waning as my interest in leadership and administration increased. And with that interest in administration I am wondering if I would be better served by working in a more generalized setting (i.e. med-surg). All this swirls in my head. I know that I’m at the point in my career where I’m vulnerable to grass-is-greener syndrome because I’m still in the novice stage. That being said, I knew on day one of career #1 that it wasn’t what I wanted to do, and I ended up sticking it out for 6 years of generally feeling miserable about myself and my work ethic. I don’t want to go down that road again. Trying to find balance between being flighty and pursuing what I want. It’s a fine line to walk.
