On a personal, non-nursing note we all need a little momentum in life.  Coasting downhill makes getting up the next, bigger hill a little easier.  When momentum comes at the right time it makes the challenges we are facing and working through not seem as overwhelming.

I have known that I wanted to be a nurse for as long as I can remember.  In high school I started working as a nursing assistant in a nursing home and over time transitioned to the acute care and then critical care settings. I faced many personal challenges during those years; including not getting into nursing school the first time I applied.  Hard work and inspiring friends kept me going!

Working at the bedside has, of course, been filled with challenges as well.  My first year as a nurse was so emotional. I had great preceptors and worked with an amazing staff. They all played an important part in teaching me and leading me in professional practice.  Many of those nurses ad former coworkers I still think of everyday as mentors.  But after I graduated and transitioned into the role of RN, the stress and responsibility I felt changed significantly and it affected every aspect of my life even outside of work.  I found myself dreaming about work and my patients, I had nightmares, I would leave work crying-certain that I would never make it. I would come in nervous with an upset stomach concerned about the assignment I would get and the possibilities that something could happen to my patient and I wouldn’t know what to do. I would rethink every minute of my night when I left in the morning making sure I didn’t miss anything or had forgotten to chart one detail of the shift that was important.

It took about 8 months working at the bedside before those stress symptoms started to ease and I would go home knowing I did all my work and be able to not think about work while I was off. I would sleep and not dream about work, this was a huge success.  It took over 2 years before I felt I had the voice and knowledge to advocate for the specific needs of my patient and I would go home knowing I did the best job I could.

Even though as a nursing assistant I had taken care of patients post-mortem, deaths of patients that were in my care weighed on me.  I had many patients whom I withdrew life-support on in my 1st year of practice and they died on comfort care; peaceful and surrounded by their families.  I had patients that needed to be intubated emergently for respiratory and airway issues but never really had a patient of mine cardiac arrest within that 1st year.  I remember many patients that have died in the ICU while I was their nurse. Even now, I leave thinking about their families, their lives, their illness and injuries. When I was a new nurse, I would look for their obituary and read about them in the paper-it was part of my own healing and coping.  I still feel that sense of loss anytime someone in my care dies- even if it’s peaceful and planned.

During that first year, learning how to cope with the death of my patients and the aspects of critical care that make it unpredictable and stressful; I started writing as a way to reflect. I’ve never kept track of specific patient names, dates, or information but I have found that the patients I have reflected on I remember even without having written down their names.

Over the years, I have been reminded every time I meet a nursing student or precept a new nurse how stressful starting a new job, especially in health care, can be.  As students will be graduating in the next few months and taking their boards, momentum is one thing that we can give to these new professionals and colleagues.  I think its important to validate the fears and concerns that new nurses have. I think it’s important for them to know that they aren’t alone and that we have all been in their shoes.  It is also important for them to know a certain amount of fear is healthy.  It makes you double and triple check yourself. It makes you ask questions when you aren’t sure. It makes you eager to learn and experience new things.  Most importantly,  it makes you seek out feedback.  I have always enjoyed the energy of new staff members. I enjoy teaching and learning myself, because each new person I work with asks new questions and each person needs to learn in a different way.  It helps me keep learning and stay involved with critical care research.  I am eager to hear from new nurses over the next few months about their experiences graduating, taking boards, and finding jobs. I hope they can keep their own momentum going to get through it all successfully.

Momentum for me, has been turning my personal reflections into this blog- it took a lot of energy and inspiration to get started.  The idea of writing and reflecting on my work and patient care came originally from Dr. Atul Gawande after I read his first book, Complications.  I have since seen him speak around the country in different cities that I’ve lived.  His subsequent books; Better and The Checklist Manifesto are personally inspiring.   His ideas and work with the World Health Organization set attainable standards for professional practice improvement that aim to make health care safer for all of us.  If ever the opportunity presented itself for us to cross paths professionally I would need thank him for his inspiration to write and reflect.  I would sure he knew how much that improved my work as a nurse and my health a person.

Thank you to all of you who read this and thank you to all of you that give me feedback-it has been huge in giving me momentum. When I started this I was sure no one would ever read it.  I hope the discussions, feedback, ideas, and opportunities to learn can continue for a long time.

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