I have been a registered nurse for nearly seventeen years. I’ve worked most of that time in the neonatal ICU, and a few of those years in other units and roles: pediatric case management, PICU, and general peds. I have even taught nursing students. I have puffed oxygen into premature lungs. I have handed freshly swaddled, rosy-cheeked newborns to their thrilled parents for first-time snuggles. I was privileged to care for the very first ECMO patient in a newly established program at a large Level III NICU. I have successfully resuscitated babies who weighed under a pound, helped stabilize and whisk babies born with their intestines on the outside to the NICU for surgery, and even assisted with a successful bedside balloon atrial septostomy at 2 am for a baby born with an unknown congenital heart defect. In 2019, I was dispatched to help the overwhelmed floors where adults were critically ill with covid: I helped entertain confused and lonely old ladies who had to be sequestered from their nursing homes. I helped prone, suction, and care for actively dying adults with the covid-19 virus. I performed post-mortem care after families said their last goodbyes. Last year I was able to squeeze a travel nursing contract into my life and spent three glorious winter months in California with my golden retriever. It’s been the most insane, emotionally draining journey, and I am both exhausted and thankful for the experiences that being a nurse has provided me. I will carry every one of these patients with me as I move into the next phase of my career. I have six months left of pediatric nurse practitioner school and will, hopefully, have my doctorate by the end of 2024. As I sit and reflect on all my time as a registered nurse there are a few things I would like new nurses or nursing students to know as they, too, start a new career path. Here are my personal lucky thirteen rules for nursing.
- Don’t be a bully. Don’t roll your eyes at the nursing students. Take them under your wing and remember how you felt, fresh-faced and nervous, as you first stepped onto hospital floors in your perfectly ironed scrubs. You shouldn’t immediately assume that a newly hired nurse from another hospital is a complete dolt just because they don’t know what size and brand of sterile gloves Dr. McTurtleface prefers during central line insertions. Nurses are known for being awful to new employees and to new graduates. Our nursing generation can change that.
- Don’t make assumptions about your patients. The man with the prison tattoos may have turned his life around after he served his time for sneaking into Disneyland after it closed. Conversely, the little old lady who is a sweet lil’ muffin for the day shift may very well have a mean right hook after sundown.
- Don’t let your opinion about someone affect how you treat them as a patient, or how you talk about them during report. The mom you assumed doesn’t want anything to do with her new preemie might be going through severe postpartum depression or had a previous loss that has affected how she is coping today. I have repeatedly heard nurses give reports peppered with negative interjections about a patient’s family status, drug use, housing situation, or disease. We interact with this person for a minuscule portion of their life; we most likely don’t know anything about what brought them to this point. Perhaps your care should be even more gentle toward someone who is probably going through something you couldn’t even imagine. They hear what you say about them through those privacy curtains and can feel it in the way you care for them.
- Always be open to learning new things. There is more than one way to get something done, and just because “this is the way we have always done it” doesn’t mean a different method is wrong. One unit’s way of taping an IV catheter is one of a dozen, and you might just learn a new technique if you watch someone perform a task in a way you are not used to, as long as it’s safe and effective.
- Don’t eat the Arizona hospital sushi. Raw fish in a land-locked, hot-as-Hades hospital cafeteria? Nope. Just trust me on this one.
- Don’t stay anywhere that doesn’t appreciate you. I have worked for some incredible companies and managers, and I’ve worked under a few that made me decide to look elsewhere. After a particularly difficult interaction with one manager during my mom’s breast cancer treatments, I thought that I would never love nursing again. I was lucky enough to land a job at a new hospital that has incredibly kind, supportive management. My negative work situation was just a stepping stone to better things. Since then, I’ve spent three glorious winter months in California with my golden retriever on a travel contract, developed the confidence to start on my nurse practitioner certification and my DNP, and my mom has been cancer-free for three years. In summary: don’t stay where you aren’t treated well.
- Move around. This one may be controversial but it’s based on my experience. The hospital raise system is not set up to help you make more money with time and experience, especially if you work for a large hospital system. The annual raise (usually 0-4%) doesn’t keep pace with increases in pay for new employees: new employees will be getting paid more than you, sometimes significantly more, if you stay in one place too long as a new grad. The way to get more money is to leave and go somewhere else every few years or move up in position within the same company. You don’t want your resume to reflect a new job every six months, but every 3-4 years is just fine. You will also develop a broader view of nursing, learn different methods to complete the same task, and have a better understanding of the entire medical system as you experience varying locations and responsibilities.
- Skip the thick-heeled nursing shoes. A lot of us are clumsy, and tripping over your own feet in your new name-brand clogs in front of the adorable new surgeon is just embarrassing. That’s not to say that I haven’t tripped over my own feet in tennis shoes – like I said, clumsy – but nursing clogs are just especially stiff (and tall) right out of the box. If you absolutely must have the Nurse Ratchet look: break them in before you wear them to work. Or at least in front of the cute surgeon.
- Don’t leave your patient a mess for the next shift. No patient likes to be sitting in a filthy gown (or onesie) or laying in sheets covered in poo and tube feeding. No nurse likes to find them that way. Throwing another blanket over it doesn’t count as cleaning it up. That brings me to number 9….
- Stock for the next shift. Starting cleanup of a code brown just to realize the previous shift left you with no wipes? Not cool, man.
- That metal bar/arm above the patient toilet that comes down to clean out a urinal or bedpan? BEWARE. It has more force than one would think and might spray poo-water in your face. Theoretically. I don’t really want to really talk about it.
- Your nursing instructor is telling you that you can’t work in a specialty right out of school? Ignore them. Go where your not-yet-blackened heart tells you to go. There are countless tales of nurses going on to have successful careers who have never set foot on a med-surg floor except during nursing school. That includes me. I would have never made it in med-surg; those nurses are a special breed with extraordinary skills that I will never possess. I was made to work in another specialty; you might be too.
- Let your professional voice be heard. We are a group of humans that will endure situations that people outside of healthcare can’t understand. We trudge in and out of hospital doors, huge Stanley cups wedged under one arm, and our hair twirled into messy buns as if what we do is no big deal. Wrong. What we do for a living is huge. We are there for the crucial moments in people’s lives, and sometimes we are their only support. We are always being treated like we are disposable and told that we can be replaced, or that we don’t deserve more pay. Also wrong. We are valuable and deserve better wages for our years of schooling, our skills, and our medical expertise. Covid demonstrated to the world that we are a vital part of a healthy community and shouldn’t be taken for granted. Get involved in local government meetings that discuss healthcare laws about our patients and about nurse pay, ratios, and rights. Stand behind that microphone at the county meeting and tell them how you feel. We should recognize the implicit misogyny and discrimination that has always been a part of our line of work, and fight it however we can, because we are all worth it.