Nurses are clinical experts and expert listeners; researchers, inventors and compassionate caregivers; protectors of patients and promoters of healthy living. They are teachers, but they’re learners, too.
When Nurse.com launched the program “The Next Shift: Nurturing Tomorrow’s Nurses” in partnership with the Johnson & Johnson Campaign for Nursing’s Future during National Nurses Week 2014, our goal was to provide a positive platform for seasoned RNs to impart the wisdom they had gained through years of experience to nurses who are in the early phases of their careers.
Since then, nurses answered our call by sharing their stories and advice and encouraging their colleagues. They’ve passed along their passion, told us how they’ve overcome obstacles — some having skinned their knees on their first hurdles, and showcased their exceptional pride in their profession.
To celebrate this year’s National Nurses Week, Nurse.com and the Campaign are pleased to present a series of stories from The Next Shift. The stories are as varied as the nurses who wrote them, but each in its own way showcases above all else that nurses heal others and, perhaps, each other.
We’re also delighted to offer many more Next Shift stories in a free digital publication, available on our website and in our tablet app, Nurse.com Unbound. Visit Nurse.com/App to select the best reading option for you.
Susie, my brilliant preceptor
By Tabitha Legambi, MSN, RN, CEN
After I graduated from nursing school, I took my first job as an ED nurse in a level 2 trauma center in Baltimore. I was proud to have the opportunity to work in a trauma ED with some of the most intelligent nurses and physicians, although I was afraid I would never be able to match their level of expertise or I simply wasn’t smart enough to be there. I hoped that whoever had the task of training me was patient and understanding.
I recall early in my career, I took care of a patient who had COPD and arrived in respiratory distress. As I cared for him, his spouse held his hand and prayed. He did not want to have an invasive airway, so a do not resuscitate order was initiated. His priority was comfort care. This was a difficult concept for me to understand because, as an emergency trauma nurse, I had learned to rescue those who needed rescuing.
On this day, I had to learn that sometimes there is no need for rescuing, only comfort and peace.
When he passed away, I excused myself and cried. Later, I remember feeling as though I should have been stronger and not cried. I assumed that it was because of my lack of experience, but my preceptor assured me that caring doesn’t take experience, only the ability to care.
My preceptor was a brilliant nurse named Susie. She was a no-nonsense nurse, but she supported me and protected me, whether she was just making sure I submitted my schedule on time or she was standing up for me when I wasn’t as quick on the orders as some of the physicians would have liked.
Instead of berating me, she would give me advice, and she was always encouraging. I remember asking Susie as I neared the end of my orientation, “How will I be able to do all of this on my own?”
She simply replied, “You’ll never be alone.”
Twelve years later, as a nursing educator, I continue to use Susie’s lessons, and now I get to share them with you.
She taught me that a nurse’s voice is stronger than his or her insecurities, and that if I didn’t know something, it’s important to ask for help. Speaking up when you don’t know the answer can save someone’s life.
Also, each shift, identify another nurse as your go-to teammate — someone you’re comfortable approaching to ask questions. And become familiarized with your hospital’s policies and how to access them. This will guide your safe practice and provide a consistent resource when the answers seem difficult to find.
Some of the best organizational advice from Susie was this: As nurses, we must focus on patient-centered care first, but we must not forget the importance of timely documentation. Make sure your documentation is completed and updated. Time management and staying organized are important in nursing. Having checkpoints throughout your shifts will help keep you organized and in communication with the healthcare team.
Don’t forget about your patient. Lying in that bed is a person who is scared, in pain and perhaps frustrated because they want to return home to their family. Think about how patients are relying on you to be their voice and advocate.
And please be kind. Don’t forget the emotions and fears you experienced when beginning your first nursing job. Support new nurses and your colleagues. •
Tabitha Legambi, MSN, RN, CEN, is an instructor of nursing at Community College of Baltimore County, and an emergency nurse at Saint Agnes Hospital in Baltimore.
Be quiet. Listen.
By Cindy Mauldin, RN, OCN
It is hard for me to believe that I’m considering retiring in the next five years. It seems like only yesterday that I first donned my new graduate nursing cap and started my first job, not really sure where my nursing career would take me, but knowing very strongly I was supposed to be a nurse. Little did I know I would give my professional career — and my heart and soul — to oncology patients. I have had many experiences over the last 42 years, but the greatest have occurred in the last 35 years in oncology.
I have worked in inpatient and outpatient settings caring for people with cancer. For 20 years I worked for a home care agency as an oncology nurse. I have learned that these patients are special and courageous in their everyday battle for their lives. I talk to them about being as healthy as they can today, within the restrictions of their disease and their treatments, and tomorrow we start all over again.
I have the utmost respect for them and their struggles, and I have learned so much from them and their loved ones.
The lessons I share with you are those I learned from them. First, listen to patients and their families. If you take the time to really listen, you’ll hear them open up. I once took care of an elderly woman with ovarian cancer who knew she was dying. Her family wanted her home, but she insisted that she wanted to die in the hospital and no one could convince her otherwise. She made the oncologist promise that when it was her time he would admit her to the hospital. Finally she explained to me why. For all the years she had lived on her block she was very involved with the neighborhood children and she could not stand the thought of them walking by her house knowing she had died there.
Another patient who had a diagnosis of stage 4 lung cancer did not want to stay in her apartment with hospice, but wanted to go to a resident hospice in another state, so she could be closer to her son. When she finally confided in me, she said it was too painful to think about staying in her own home and seeing all the things she could not do anymore.
Don’t rush your patients through their care. Sit. Be quiet. Observe. Laugh with them. Cry with them. Pray with them. Absorb all that you can from them, and I promise, if you do, your life and your nursing career will be all the better for it, and it will never be the same.
I have never regretted entering oncology 35 years ago, and I ended up falling in love with the patients who are part of it. It truly has been a privilege to hold their hands as they have walked the cancer journey. If you choose the specialty, don’t be afraid of the disease or the people who are on that journey.
They have so much to give you if you are willing to open your hearts to them. I will miss them sorely when I retire, but I realize they will be in good hands with the next generation of nurses.
Be quiet. Listen. Really care. •
Cindy Mauldin, RN, OCN, is a palliative care nurse with Main Line Health Home Care and Hospice in Philadelphia.
The Art of Compassion
By Mary Alice Santoro, MA, RN
As a nurse for 45 years, I’ve learned so much more about being compassionate from my patients than I ever learned from classes or conferences. I’ve also come to know that communication skills and compassion are just as important as learning to start an IV or insert a Foley catheter.
It’s important for all of us to feel heard and understood, and those feelings are multiplied 100-fold when someone is sick and in a strange and scary place like a hospital.
It is hard to remember every incident over the past 45 years when compassion and communication worked hand in hand to improve a patient’s healing, but one does stand out from the others.
When I was a young nurse working on a med/surg unit, a woman in her early 40s was admitted after a suicide attempt. When I went into her room to start my assessment, I found my patient crying softly. I put down the paperwork, sat next to her bed and took hold of her hand. I had no words of wisdom, no clinical insights, I just wanted to be there for her.
Then she started to tell me how useless she felt. Her husband was a successful businessman and spent many hours and evenings away from home. Her oldest daughter was a senior at college and her other daughter had just left for college. She felt she had no skills to get a job after being a stay-at-home mom.
Mostly I just listened, but I did point out to her some positive things I noticed in the few minutes I spent with her — how articulate she was and how loving a mother and wife she was, and that I believed there was a reason her suicide attempt failed.
The patient later was discharged to a private psychiatric facility. When I said goodbye, she told me she initially was going to refuse further psychiatric treatment, but because of our conversation she decided to seek therapy to learn why her suicide attempt failed, why God wanted her to live.
I learned a great deal from this patient — the value of just being present in the moment. By being present and ignoring distractions, we show patients compassion, and that can help with their healing.
To nurses just beginning your practices, welcome to the profession and remember to make a genuine effort to learn about your patients and what they need. You will never regret taking the time to do this, and your practice will greatly be enriched. •
Mary Alice Santoro, MA, RN, is a staff nurse at Wood River Village Retirement Community in Bensalem, Pa.
Don’t let patients’ needs get lost in translation
By Diana Wilkiemeyer, MSN, RN, PHN
My nursing wisdom comes from a home care perspective, where patients who we might initially think are just being difficult often are sharing information with us in an oblique manner. Their statements might sound humorous or even angry, but they also can help you discover what fears they may have and what they need. It just takes a discerning ear.
For example, a patient once said to me: “Why didn’t you call me earlier? You know I need to plan my day!” My elderly homebound patient was telling me she has a right to plan her day and to not take her for granted.
When I was removing her wound dressing, she complained: “All that slashing and grabbing! Give me a break!” What she meant was, “Take your time and soak it off.”
“That wound has been draining and hissing all night!” Translation: “It hurts and I didn’t sleep very well.”
My mission: Review her pain medication regimen. And when she brings up topics that seem totally unrelated to the purpose of our visit, it is often because she wants me to stay a little longer. I may be the only visitor for that day.
Another difficult client was bent like a hairpin and tough as they come. She was 88 pounds of molton lava. But one day when she was in a placid mood, I remarked how blue her eyes were. “They are green! Could glaucoma have changed their color? I haven’t been able to look in a mirror for years.” My mission:
Forget my plan to teach her to do her own wound care. Her vision is too poor.
Another clue to her poor vision was an unplugged heating pad covering the birdcage, instead of the blanket she usually used. Our visit led to several additions to her nursing care plan, including reviewing home safety, personal hygiene and medication administration.
My patient, Winnie, mused, “I need something to cheer my appetite.” After a little discussion about her food preferences, I reminded her to reorder her medications, since they were all gone. She sighed: “Honey, I was so proud of myself for taking every last one!” My interpretation: More teaching about her medications, not only refilling but also times and dosing, is necessary.
One of my favorite patients told me about her recent visit to the physician. “He said I need chemotherapy and my hair will fall out, and I responded ‘Not this hair,’” she said. My patient described how her physician became serious and wanted to explain why her hair will fall out. She responded again, “‘Not this hair.’ Eventually I admitted that I wear a wig. I just had to pull his leg. He thinks I’m crackers anyway.”
My conclusion: “This lady can cope!”
When we remain sensitive to our patients, we develop insights into lives that can be very different from our own. And that is part of the joy that comes with working in home care, a specialty that calls for sensitivity, but also creativity and a sense of humor. •
Diana Wilkiemeyer, MSN, RN, PHN, is a retired nurse who lives in Berkeley, Calif.
Focus on the patient in front of you
By Louise Rogers, RN
My father once said, “If you make every patient feel a little more special than the one you just left, you’ll be doing a good job. Look for ways to help.” Before he passed away, my father had a lengthy resume as a cardiac patient. At the time I was thinking about becoming a nurse, and when I asked him what qualities make a good nurse, that’s what he told me. To be honest, maybe my journey in nursing is more about being that nurse — the one that would make my dad smile.
His words shaped my nursing career since 1977. Starting off on a med/surg floor — and at the time having up to 18 patients per shift — I practiced the mantra of “This patient is more special than the one I left.” I trained myself to answer questions such as “What is really bothering the patient?” and “What can I do to help?” It became a practice and after a few months it became routine.
It made me focus on the person I was in front of — and not focused on what I still had to do. The patient’s problem may seem small in comparison to the patient you just left, but that does not matter; you can’t compare your patients because each person has his or her own set of concerns.
If a patient is allowing you into his or her inner circle, then jump in and see how you can help. Look for ways to serve from the heart.
Being a nurse allows me many opportunities to help, but some of the most rewarding things I did were not in my job description.
On one occasion, I was working in the ED at 2 a.m. when an elderly man was admitted. His wife did not drive, and she really wanted to stay by her husband while he slept, so she dozed in the chair next to his bed. We were fairly busy, and after a while, I stopped back by the room to peek in on both of them. He was sleeping soundly and so was she. I grabbed a blanket from the warmer and gently tried to put it over her shoulders. She woke up enough to say, “Thanks, I was so cold,” and snuggled under the blanket. Her eyes showed pure gratitude, and it made me glad I had taken the time to do that. It was just a simple little act that, 10 years later, I’m still happy I did.
Practicing those words of advice from my father also helped me to focus on the person as a whole, not just the illness or condition.
Many times after an ED physician left a patient’s room, I would go in and spend time with him or her while starting an IV or explaining procedures or treatment expectations. I would find out pertinent details and I’d ask the physician, “Did he tell you this?” “Did he mention that?” Many times the answer was no, so over the years I developed a skill of making every moment with a patient count. Genuine caring and willingness to help shaped my practice — nursing from the heart was my goal.
If you truly care, nursing is the right profession for you. Technical skills and scientific knowledge are important in developing your knowledge base as a new nurse, and training with a good mentor is irreplaceable. But you need to stay focused on what’s in front of you and be sure to listen with your heart. •
Louise Rogers, RN, is a utilization review coordinator and transfer center nurse at Community Regional Medical Center in Fresno, Calif.
To comment, email [email protected]