As I was cleaning this afternoon, I came across a journal I kept for nursing school. It was only a few short pages, I later realized it was easier to type it up and print out my “journal” to hand in with the infamous care plans we were required to submit after every clinical rotation. Reading those short passages brought back a flood of memories. Some good, some bad, some merely trivial. What struck me was the combination of awe, wonder and extreme trepidation expressed within those pages. Here I was embarking on an entirely new adventure, sailing into uncharted waters and it showed.
My first in-hospital clinical was the ER. As I wrote, “it was overwhelming, crazy and exciting.” Or as my preceptor for the day summed it up, “go big, or go home.” Crawling through the vault of memory I remember giving my first IV push, phennergan and morphine. I was shaking, hardly had my facts together as I approached the patient, clinical educator in tow, did the 5 rights, explained the medication I was giving, how it worked and why, then giving it. I was literally shaking in my scrubs. Compare that to current.
Last shift I gave IV antibiotics, IV push diltiazem, titrated a dilt drip, not to mention the regular cocktail of meds I pass on a near daily basis. All without giving much of a second thought past the required patient identifiers, reason, action and why. All of that was now internal, unless I had to explain to the patient (if they were able to understand me.) I had acquired the confidence to do this, automatically. Like many of things one does on a typical shift, assessments, line draws, manual BPs, dropping NGs and Foleys, starting IVs, the work of the registered nurse. While it is not automatic in a drone-like fashion, it is automatic in the technique. I can’t really explain it without sounding like a robot or a dangerous nurse, but it is almost a Zen-like automaticity. I still have a looooong way to go though.
Confidence is a funny thing though. It comes and goes. Lately, I have had a string of great IV starts. Our facility has a dedicated IV team that will start a line when needed. This is a double edged sword. You have the resources tonot have to worry starting a line, but at the same time, your skills do not improve. It ain’t like riding a bicycle. So I had a run of good starts, even on patients that were not easy. Then a runs of bad ones. I couldn’t get a 20 guage in the healthy (albeit ETOH detoxing) guy who had great big veins, much less the geriatric renal patient. Then out of the blue, I had to get one of my patients ready for open heart. I figured, may as well have a look-see. And there it was, big juicy, right on top the of the forearm. Without a thought, the 18g went in, done. Confidence re-gained.
We’ll see how long it lasts.