For as long as I can remember, I have always wanted to become a nurse. Even though I was not sure exactly why I want to become a nurse, there was always something fundamentally instinctual in my gravitation towards this professor. But as my previous journal entries have shown, wanting to become a nurse is entirely different from the process of becoming a nurse. When I was young, I thought the process would be easy. Now I understand that this is an arduous journey, one filled with challenges on every side. There are tons of materials to read, cascades of nursing papers to write, and endless hours of lectures to attend. My first day at clinicals, however, adds another layer of complexity to the learning process. No guide in choosing a college major could have prepared me for this experience. I like to think that nothing can surprise me, but yesterday proved me wrong in the best way possible. Although I spent most of my time shadowing a registered nurse, the experience showed me what makes this profession demanding, noble, and ultimately fulfilling.
For my first day of clinical immersion, I was assigned to the male medical ward of Abernathy Jones Medical Center, a 500-bed tertiary hospital downtown. Since it was my first day, my proctor instructed me to shadow a staff nurse on the 8-4 shift. I was introduced to Nurse Marie Baxter. She has been a day shift staff nurse of the male medical ward team for five years. Before that she worked as a staff nurse in other units. The first order of business was the nursing handover, during which I noticed that Nurse Marie listened attentively to the information being communicated to them. She also occasionally asked questions related to the plan of care of the patients. During the course of the shift, I accompanied Nurse Marie as she performed many of the duties and responsibilities of nurses. I watched her as she prepared the medications of the patients, go through the rooms for her rounds, and carry out many of the basic and more advanced tasks like feeding patients, performing assessments, and collaborating with other members of the healthcare team.
The most memorable experience, however, was when she conducted health teaching with a patient cleared for discharged earlier in the shift. Mr. E is a 38-year old male patient admitted for pneumonia. He was rushed to the emergency unit two weeks ago after suffering difficulty breathing. He has a history of heavy smoking (12 pack-years). He is single and works as an architect, which he claims prevents him from engaging in regular physical activity. His long hectic hours also mean that he is often forced to order takeout from nearby restaurants and fast food chains instead of preparing meals at home. He started to suffer persistent coughs a month ago, which eventually escalated to difficulty of breathing. Physical assessment, a chest x-ray, and a complete blood count all pointed to ongoing pneumonia. A treatment regimen of antibiotics was started to address the infection. Mr. E’s condition improved and he was scheduled for discharge.
I accompanied Nurse Marie to Mr. E’s room. She first introduced herself and me before informing Mr. E of her purpose. She restated that Mr. E was clear for discharge from the hospital and stated that she was there to provide him with health teaching. One of the topics the discussion covered was the importance to adhering to his medication. Mr. E was provided with some take home medications, and Nurse Marie helped Mr. E in reviewing them. She also informed the patient of the health effects of smoking, highlighting that it puts Mr. E at risk for various health conditions. She also explained that smoking increases the risk for death from bacterial pneumonia. Mr. E expressed interest in quitting smoking for good, citing that his recent bout with pneumonia was more than enough incentive for him to quit. In response, Nurse Marie gave Mr. E a pamphlet of tips for coping with withdrawal and a few flyers for support groups for patients who have quit smoking. Nurse Marie also stressed the importance of eating a balanced diet and getting regular exercise. Mr. E acknowledged that he could enjoy the benefits of physical fitness by modifying his lifestyle and integrating healthier habits. By the time Nurse Marie finished providing her health education, Mr. E had a clear picture of what he needed to do immediately after discharge and in the future. All throughout, Nurse Marie spoke in a clear, audible, and friendly voice that helped convey her message. She also answered all of Mr. E’s questions and encouraged him to repeat the information he received to ensure that he understood all that was discussed.
Looking back at how my day went yesterday, I cannot help but realize how much I have learned from those few hours that I spent with Nurse Marie. While my activity involved simply following Nurse Marie and observing her, it captured the depth and richness of the nursing profession. Firstly, I realize just how demanding being a nurse truly is. For one, the job is physically demanding. I was just shadowing Nurse Marie and not performing the tasks myself, but by the end of the shift I felt drained of energy. I can only imagine how Nurse Marie must have felt after an entire day of walking up and down hallways, assisting and lifting patients, and standing on her feet for hours on end without even a moment’s rest.
But more than the physically grueling days, the work involves a lot of emotional, psychological, and intellectual labor. Nurses like Nurse Marie need to be completely present if they are to accomplish their tasks safely and efficiently. I was amazed by how Nurse Marie could carry out something so simple as taking vital signs to something that requires delicacy of skill, like knowing exactly the right thing to say to a patient’s family going through a stressful time or breaking down complex ideas into explanations that a child could understand. Nurse Marie transformed when dealing with different patients. She was like a chameleon, changing and adjusting depending on the needs of her patient and the energy of the room she entered. These competencies do not come easily; instead, they are honed through years of study and experience. When I asked her why she knew so much, she simply told me this: “The best advice I received from my mentors is that nursing is a profession that thrives on learning. Skills, knowledge, and experience are the bedrock of our work and these areas are ever-changing and ever-expanding. Always try to improve yourself; make a genuine effort and take everything you learn to heart; the competence shall follow.” Her words reminded me of the vital role continuous education plays in this profession. As the Institute of Medicine [IOM] notes in its seminal report The Future of Nursing, nurses are leaders in advancing health and effecting change in the healthcare system, which naturally means they require constant learning to fulfill their invaluable role (IOM, 2011).
Finally, my first day at clinicals showed me how nursing is truly a fulfilling job. Yes, it is exhausting; yes, it demands so much; yet in the end all the hard work and sacrifice pay off. By the end of the shift, it was already becoming difficult for me to not think about massaging my sore feet. But was Nurse Marie, still smiling as she communicated information to the nurses who came in for the next shift. I think I know what keeps her going. We were in one of the rooms for some last minute checks with one of the patients. As we were about to leave, the patient on the bed called her name. She turned around and the patient thanked her. It was a simple “thank you”, the kind that no longer needs any elaboration to convey sincere gratitude. Moments like those reveal the nobility inherent to this calling. While many people go through some experience that teaches them how to choose a major in college, I have always known what is right for me. What I was not aware, however, is the rigorousness of the path towards becoming a nurse. But my experience yesterday did not deter me; quite the contrary. If anything, seeing how hard yet how fulfilling this line of work is only strengthened my resolve to become someone like Nurse Marie in the future.
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. American Nurses Association. https://www.nursingworld.org/practice-policy/iom-future-of-nursing-report/