Real World Nursing

A patient comes in on full arrest. She needs an IV STAT so the ER team can get meds on boards and save her life, but her arm is at an awfully awkward angle and she is too obese for one person to move. The doctor and respiratory is busy intubating her, the primary nurse is busy getting the low down from the firemen, the EMTs are busy hooking up the patient to the monitor and performing CPR. The IV should have been in 10 minutes ago. Forget improper body mechanics, get the IV in NOW.

As a new grad, I really notice the difference they taught me in nursing school vs. "real world" nursing. I didn't pay much attention when this comparison was mentioned in school, but now I'm actually immersed in its reality. Supplies run out, staff runs short, patients are erratic--and I have to figure out how to make it work even if that could very well mean compromising legal issues, patient's safety, or even my own safety. I have to weigh the risks and benefits, and make a decision. Sometimes, that needs to be a done in a split second.

When I graduated, I think I was most concerned over if I could still retain my assessment and technical skills, know how to care for the patient and the pathophysiology going on with their disease, or be able to apply the nursing process. Little did I realize, these concerns should have been dealt with back in nursing school. By the time you hit the floor, they should be second nature because there are a ton of other things to be concerned about when you start a new job. Where are the supplies, what's the phone number to pharmacy, what's the protocol in this hospital when transferring a patient, which paperwork do I fill out, who is this doctor evaluating my patient, what is the EMT's name so can I ask him for help, why is my password to the medcart not working? And don't even get me started on hospital politics (luckily I haven't encountered any yet, so far my ER team has been awesome). So many things that I thought shouldn't matter in comparison to taking actual care of the patient, but end up becoming the hardest and most time consuming part of the job.

The world is not just black or white. There are tons of colors as well as tons of shady gray areas. There is not just one right or wrong way to do things. Hopefully this new year, I can figure out at least one of those right ways and survive the struggles in my 1st year as a nurse.