“A Dios mio! Pain! Pain!” I heard  the woman’s cries all the way down the hall as she was led by the ED tech to my last empty bed. I sighed and took the chart from the tech. 60 year old woman with a three day history of left flank pain. “OK” I thought, this should be easy.

I went in to see her, and introduced myself.  She was tiny, barely 5 feet tall, her graying hair held back in a bun. She told me her name was Sonya and that her doctor had diagnosed her with kidney stones at one of the other local hospitals. She’d decided to come here because “they don’t give me any help.”  I had her put on a gown, started an IV and drew labs, and instructed her to give me a urine sample. “Thank you thank you,” she said in breathless, broken English. “The pain is very much worse.” I smiled and pointed her to her bathroom. She patted my hand before heading that way.  I am always a sucker for the older patients.

In the meantime I checked on my other patient in the same room. David was a 30 year old “frequent flyer” who came in via EMS writhing in lower abdominal pain; he was going to be worked up for possible appendicitis, even though he’d presented five times this month already with similar symptoms. His tests had come back negative each time, and the doctors were starting to suspect he might be a drug seeker. David was resting comfortably, having received a morphine and phenergan IV cocktail.

I could tell when Sonya was back to the room by the progressive moans and groaning she made as she ambled back from the bathroom. I helped her into her bed and assured her we would make her as comfortable as possible. I told the ED resident that Sonya was in a lot of pain, and that she was ready to be seen.

Next I saw David’s call light go on and when I went in to check, he told me that the pain was back again, and he asked for more morphine. The pain was rated a 10/10 and he curled up on the bed holding his abdomen. I remembered his last visits, which were the exact same presentation but nothing was ever found on CT. I looked at the clock; it had only been 45 minutes since he’d received the morphine. I tried repositioning David to find a more comfortable position but it was useless. He was in pain no matter what position he was in. I asked the resident for another order of morphine and she wrote it with a sigh, mentioning that it seems David had increased his visits lately and maybe it was time for a psych consult.

 The resident saw Sonya while I prepped David’s morphine.

When I took the medication back in for David, Sonya saw me and started moaning again. “Is that medication for me?” she asked. I told her I was sorry, it wasn’t, but that I’d have some as soon as the doctor ordered it. She looked so small and alone in the bed. I brought her an extra blanket. I quickly obtained the order and administered Sonya some morphine. She lay back happily.

Shortly, both patients were transported to CT. I went about my shift caring for my other patients.

A half hour later, after both of the patients had returned, “Look at this” the Dr said, indicating her computer screen. Sonya’s CT was perfectly normal, no evidence of kidney stones.

“And this too,” the resident said, changing computer screens. Sonya’s history came up on the screen; she’d had 15 visits in the last 2 months, all with pain. Futhermore, her history indicated a continuous use of street drugs.

The resident sighed and was about to get up and go see Sonya when her pager went off. She returned the call and turned to me. “David’s got a hot appendix. He’ll be going to the OR within the next half hour.”

As I sat filling out the pre-op paperwork for David and listened to the resident as she attempted to explain to Sonya that there was no evidence of kidney stone and that she would not receive any more morphine, I sighed. In this business, it’s so easy to gain preconceived notions and ideas. This was a good night to remember that nothing is ever necessarily just what it seems.

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.

We are pleased to announce a new contributing member to the Nurses Station Blog.

Deanna, a nurse currently working in emergency care, kept a journal throughout her days as a nursing student. She will graciously share he thoughts, experiences, lessons learned and feelings during nursing school.

My name is Deanna and I am an RN.

I am a nurse in very busy, very large ER. Prior to this, I worked in maternity, oncology/hospice and med/surgical nursing. I’ll soon be starting my Bachelor’s degree and then plan to get my Master’s, with the intention of becoming a Nurse Educator when I am ready to leave bedside nursing.

I first attended nursing school when my son was very young. I’d always had an interest in biology and medicine, but I chose nursing mostly because the talk of the nursing shortage seemed to promise a secure job with good wages. I quickly realized that I was too young and too busy as a new mother to fully appreciate the educational opportunity. I left the program and concentrated on my family instead.

I worked part time while my kids were growing up, and always stayed on the fringes of the medical field. It wasn’t until my husband was diagnosed with leukemia in 2002, that I realized how very much I wanted to continue my nursing education. While we journeyed into the murky waters of being an oncology patient, I began to admire and appreciate what the nurses were doing for us. I was feeling a subtle but urgent scratching that was telling me it was time to revisit my earlier educational pursuits.

After my husband’s health was stabilized, and with the support and encouragement of my family, friends, and co-workers at the clinic, I entered the community college to restart the degree program I had begun almost two decades ago. This time I felt I had a true calling to the profession and that I was prepared for the rigors of nursing school.

I graduated in May 2006, just a month before my son graduated from high school.

Becoming a nurse has fulfilled a space in me that I never knew existed before. I truly feel it is a calling, and one for which I am very thankful.