How I Became a Nurse Part I-It Could Not Have Begun Worse

It could not have begun worse. I was not prepared for the difficult transition from student nurse to a full-time professional. My first job was working 12-hour night shifts in a high acuity pediatric unit. No one explained that during my two-week orientation I would work days, 7:00 am to 7:30 pm, not nights. The head nurse, Sister Sebastian, failed to see the humor in this misunderstanding, and sent me home when I showed up twelve hours late on my first day. She never liked me, and I was afraid of her.

The unit used a team-leading model, which meant two Registered Nurses managed 30+ sick children with two Licensed Vocational Nurses, if available, and a few Certified Nurses’ Aides. The LVNs could not start IVs or give IV medications. The CNAs took vital signs, and bathed and weighed the patients. The RN’s assessed each patient and new admission, started IVs, drew labs, hung IV medications, and resolved problems. Significant changes in a patient’s condition were phoned to their pediatrician ASAP, unless it could wait until morning. It was expected the RN knew the difference. If she was wrong there was a morning confrontation with Sister Sebastian.

After two weeks of orientation, I had patients, LVNs, and CNAs to manage. Six weeks later, I was occasionally charge nurse. The charge nurse took a full assignment. Ignorantly, I assumed these were realistic expectations for an inexperienced nurse. I worked hard to succeed, but failed miserably. When I made mistakes, Sister Sebastian glared at me during change of shift report. It was overwhelming. Often I would cry at home after shifts. Four months into it, I considered quitting nursing. Then I met Roz from the Pediatric Intensive Care Unit.

The PICU was experiencing a long period of low census. So Roz floated to Pediatrics and helped our chronically understaffed night shift. That first night, we teamed together to do patient care.  Roz was compassionate with patients, and highly skilled. She put them and their parents at ease with humor and a calm demeanor. She carried out several nursing tasks while thoroughly assessing a patient at the same time. I felt the rhythm. We worked together many shifts.

Roz changed my perception of nursing. She did everything my nursing instructors called unprofessional: she laughed a lot and loudly. She made irreverent jokes. She told stories on doctors and other nurses. She talked back to Sister Sebastian and advised me to do the same. We became friends.

Time passed. I arrived for work one night and as I approached the nurse’s desk, Sister Sebastian blocked my way, arms crossed in front of her chest. She said, “We don’t have enough patients tonight for you to work here. I was going to call you to stay home. However, the PICU is busy and they need a nurse to float. Roz asked for you. Try not to kill anyone there,” or something to that effect.

This surprised me. I appreciated Roz’s confidence, but I wasn’t sure I wouldn’t accidently kill somebody down there either. Most of the children were on ventilators, which I had only limited experience of in school. The PICU nurses managed complex IV drips. I was nervous, but believed Roz wouldn’t let me get into trouble. So I reported to the PICU.

The hospital housed a small, but high-powered PICU. As part of a Level Three Trauma Center, they treated every kind of pediatric emergency. All their beds were full this shift and most of the patients were unstable. Rather than giving me a patient to struggle with on my own, Roz assigned us together managing two unstable patients. Her strategy had me helping her with assessments, taking vitals signs, and giving the medications I was familiar with, while teaching me how to draw blood from the central and arterial lines for lab tests. She reinforced my suctioning skills with the ventilated patients. We shared charting in the nurse’s notes.

I loved intensive care nursing! Rather than scattering my attention on a floor full of patients, I found my strength was focusing on the intricate details of one or two critically ill patients. Following nursing tasks through to create a care plan I could assess and adjust rapidly suited me.  This kind of nursing made sense. Of course, I relied heavily on Roz, but by the end of the shift, I knew that PICU nursing was for me.

But how would I get to stay there?