As I write this today, we are marching through National Nurse’s Week. This week there have been lots of fun things at work-free food, free gifts, bowling, and other things to do. It’s a chance for we nurses to be recognized and remembered for what we do for others.

Nurse’s week started in the 1950’s but was originally begun as a one-day celebration of recognition. Later, the ANA adopted the week of May 6 - 12 as Nurse’s Week, and it is permanently celebrated on these dates.

Nurse’s week is more than just a time to get free food and gifts, though. I find it to be a good time of retrospection. It feels like an affirmation of sisterhood (or brotherhood!). To me, having time where we are recognizably appreciated by management and media helps shine a light on our profession, and hopefully shows others that as nurses we are hard-working professionals within our profession.

If you are a nurse or soon to be a nurse, take some time to reflect this week on your reasons for going into the field. Use this time as a chance to reconnect with your initial feelings about nursing and to remember why you chose to become a member of this challenging, busy, tiring, fulfilling and awesome profession. Take a few minutes to relax and reflect; you deserve it!

For a great gift for a special nurse or for yourself, click here.

I had graduated. Before I knew it, I was in my very first hospital orientation, and it was two more weeks of classroom learning. Learning hospital policies etc… the studying started again.

The NCLEX-RN began to loom like a shadow….a big scary nightmare-inducing shadow. Dreams of failing it scored my sleep.  My fellow graduate-nurse buddies and I obsessed over and speculated on it…how many med calculations did so and so get? How many questions did it take to pass? How the hell will I go through with this? The Nursing Boards are a HUGE DEAL. Your life depends on it. Everyone knows the story of the graduate nurse who got her new job at the hospital, and bought herself a fancy car as a reward for finishing school. Then she took her NCLEX. And failed. She lost her new job, her paycheck, her car, and her sense of self-esteem. Yes we’d all heard of her and by whispered fears and nightmare study sessions we tried to ensure that we do not become her.

July 24, 2006 at 0830 I entered the test center. At 0910 I re-emerged into the summer heat feeling like I’d been hit by a truck.  My ENTIRE nursing education…all the labs, objectives, skills, vocabulary, notes, math and meds….all had been boiled down to one test WHICH TOOK LESS THAN HALF AN HOUR. The test itself is all computerized, and the number of questions you get is based on the answers you provide. The minimum number of questions are 75, and the maximum is 265. You can pass with any amount of questions. And you can fail that way too. I got the minimum number of questions. The computer shuts off when its decided that you either passed or failed. Turning off at 75 means you did very well, or really bad. The questions in the test seem to get harder and harder. When after my 75th question the machine clicked to grey and I realized it was over, I put my head down on the desk for a minute. That was it???

All the studying and I had four medicine questions about the same med and NO MATH? And almost all the rest of the questions were priority…no disease specific stuff, no peds, no OB, just almost all priority.
I came out feeling, and dreading that I had failed. I was completely convinced of my failure. I tried not to cry as I stumbled out. My mouth was dry going in…no gum, no mints, and no water bottles allowed. As I stumbled out of the test center is was watery in panic-induced nausea.
Oh my god I wanted to cry. Or laugh. Or sleep. Instead I went out to breakfast with a friend of mine who is already a nurse, and she commiserated with me and told me of her experience, when the exams were several days of written answers. Somehow that sounded better than what I’d just gone through.

That’s it. No more tests. Pass or fail. Thoughts of the student loans that I would have to pay off while flipping burgers at McDonald’s because I have failed the licensure exam hovered in my thoughts.

I went home and started checking the web for my results. The BON in my state posts pass or fail within 48 hours. Sometimes earlier (unusually) but mostly right at 48 hours, or at 10am, whichever comes last.
The first day of waiting I immersed myself in work. The second day I tried not to be sick I checked the site every 15 minutes from 8am on. By 0930 it wasn’t up and I thought okay, I really did fail. I will never be a nurse (By the way, you can retake the test if you fail, you just have to wait for a period of time.)  At 10am I decided to use the phone-in system. It would cost $10 but maybe it would have a result. My poor husband, who was at work and fielding my 10minute phone calls all morning, suggested checking the internet one more time. I did. My results were there. With a license number next to my name.

I PASSED. I was a nurse.

A real, live Registered Nurse. A PROFESSIONAL.

I could wear white pants and a stethoscope and not feel like an imposter. I had been deemed legally competent to practice nursing.

The feeling of knowing you passed your boards is like a weight falling off your shoulders. Literally. You don’t have anything left to study. You have no need for the $150 of exam review books that you’d been reading for the last several months in preparation. You are a veteran, a survivor of the NCLEX-RN. You went in the door of that test center a graduate and came out a nurse.

 Some people celebrated it with parties and drinking and fun. I went to work and began to sign RN after my name with great joy. Then it hit me.

Oh. My. God. I. Am. A. Nurse.

I am a licensed healthcare professional. I have been trained to assess you, and I am responsible not only for providing you with basic nursing care to meet your needs, I also will be providing you with specialized care. I know how to insert a catheter into your bladder and an IV into your arm. I know how to run the IV fluids and I know the reason for using normal saline vs lactated ringers and I can tell you if you ask me. I know the side effects and uses of all of the 15 medications I am giving you and I will tell you if you ask. I can give you a shot if I have an order for it. I also assess your spiritual, mental, and emotional health. I can talk to the doctors about my concerns and the doctors take me seriously as a peer. (Well, most of them) The new doctors ask ME what they should do for you and I can give them ideas, all the while reminding them “Well, I’m not a doctor and can’t prescribe but I have seen drug XYZ used in this case before” or “Did you want me to do ABC for this patient?” I am responsible if the aide/tech doesn’t complete her work and I am responsible to see that you have a safe stay in the hospital and that no matter how bad a shape you were in when you got here, when you go home you will at least not be in any worse shape.

I hug you when your mother dies. I hold your hand when you are taking your last breaths. I bandage your feet. I teach you how to breastfeed. I let you cry when you need to and I hug you until you stop. I laugh with you. I cry with you. I make you do things you don’t want to do, knowing that later you will thank me, and you do. I sneak you a cookie when it’s late at night and you have the munchies and hospital jello just isn’t doing it for you. I wipe your bottom when you can’t reach it and I hold your hair while you puke. I pack your wound and I measure how deep it tunnels. I change your bandages, your dressings, your diapers and your peri-pads. I sit with you and hold your hand where there are no words to say.
I do what it takes to make you well and failing that, I make you comfortable.

I am your nurse.

A page from Deanna’s Journal

Last night I was waiting for my patient to return from Xray confirming his epiglottitis. (Major stuff. Could lead to death d/t airway closing up). The Dr. had his results already and the pt was going to be admitted to the acute ED and from there to a critical floor. Note, he was awake, talking and not acting as if he was about to stop breathing BUT, with the swelling of the epiglottis…it can (and does) become an acute and critical situation very quickly.

The patient returned from Xray in a wheelchair and was wearing a surgical mask. He was put in the reception room, where there were a couple of our other patients as well. I knew he had come back because the transportation tech told me he’d put him there. The Dr. looked through the reception window at him and said “Good, he’s back. Here are the orders. ” (IV, lots of labs, blood cultures, NPO status, and an antibiotic shot)

In our ED, we have a program where med students are available to “line and lab” patients in order to give them hands-on experience. I got the supplies for the IV start and labs, and some labels to both identify the patient and to label the blood samples and went to get the patient. I saw through the window that another med student was already lining and labbing him. “Ok, that’s weird” I thought, since I had the order sheet in my hand, and as far as I knew, no one else knew what he needed.

The patient had a big surgical mask on, all that you could see were his eyes. I had only seen him briefly before, so I didn’t really know what he looked like. I went and asked the med student if this was Mr. Jones. “No, this is Mr. Smith” she said as she worked on starting the IV, and pointed to the gentleman’s med sheet on the table next to her. Indeed the med sheet said Mr. Smith.

Hmm…. Maybe I was wrong and Mr. Jones wasn’t put in reception. I looked in each exam room, and found no Mr. Jones. I asked the other nurses if they had seen Mr. Jones? No one had seen him. During this time, the med student was still in reception working on “Mr. Smith”. Finally I asked the Dr. if he’d moved the patient somewhere else. The Dr. said “No, he is right there” pointing through the window at “Mr. Smith” and the med student. I went back to reception and looked at the patient’s wristband. Sure enough, it said Mr. Jones. I asked him to verify his birthday and his last name. This patient is truly the elusive Mr. Jones, and not the Mr. Smith that the med student thought she was lining. The med student looked like she was going to faint. I told her it was fine. Mr. Jones needed the line and labs, just finish and not worry.

If only it had ended there. I picked up Mr. Smith’s med sheet and left the correct one, the med sheet for Mr Jones. After I walked out of the room, I saw that a medication on Mr. Smith’s med sheet had been signed off by a nurse as having been given to Mr. Smith. This normally would not have alarmed me, EXCEPT it was given during the time that the med student (and presumably the other nurse) thought that Mr. Jones was Mr. Smith.

I located the nurse who’d administered the medication. She said “What do you mean that is not Mr. Smith?” We rush back to the patient and the med student. The other nurse said “You aren’t Mr. Smith?” Pt says “Why no, I’m Mr. Jones.” Another pt in the rooms says “I’m Mr. Smith.” The nurse now looked like she might faint. I took her out of the room. She did, in fact, give the wrong med to the wrong patient. Luckily the med itself wasn’t a huge issue. It was ibuprofen BUT, the wrong patient got it! More importantly, the patient who is supposed to have nothing by mouth because of the risk of throat swelling and occluded breathing, was given a pill. To swallow. The med student looked like she was going to cry. Both men needed lines, so that was okay. But, if she’d succeeded in obtaining the labs before the mix-up was identified, she would have sent the wrong labs on the wrong patient with the wrong labels and it could have been bad. She didn’t. So count that as a near-miss. Now the nurse in question… she gave the wrong med to the wrong patient. Not a near miss. A real med error. If that nurse had taken the 10 seconds to look at the patient’s wristband and verify he was who she thought he was…it would not have happened. But she didn’t and so it did. All were wrong in this case. The nurse in question got lucky… the patient did not have an adverse reaction, but the potential was there. Know your patient, and verify their identification EVERY TIME. That nurse and patient got lucky. That may not be the case next time.

Remember:
Right med
Right patient
Right dose
Right route

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