“I’ve never felt more stupid before. I honesty don’t know what the hell I’m even doing. Maybe I’m not cut out for pediatrics after all. I should go back to what I know and I’m good at.” – Emily Simmons  1/15/19 23:50

During a new job’s orientation, there’s always an assumption that at some point you inevitably breakdown. Between the learning curves, endless educational classes, sporadic shifts, navigating around a new hospital’s layout, and the sea of new faces and learning who is who, it’s no wonder why many nurses find themselves crying in a stairwell mid shift. Some nurses break initially on the first day, while others find that  their breakdown comes months later, while they are on their own, no longer protected under the watch of their preceptors. Some nurses have multiple smaller breakdowns, while others have one large, “Category 5” breakdown (envision a hurricane full of emotion, exhaustion, and self-deprecation, matched with a Kim Kardashian-esque “ugly cry” face). And for those who claim to have never had a breakdown, either you have the thickest skin in the world, or you’re completely lying to yourself. I firmly believe that hitting the wall is a right of passage, as horrible and embarrassing as it is. But for those reading this who can relate, you know exactly what I am describing; it is brutal.

Although I have been a nurse for over 3.5 years, I can admit that I’ve had multiple tear infused moments throughout my career. Many of which occurred while I was a “new grad” nurse working in a fast paced intermediate care unit in St. Louis. I quite literally was learning everything I needed to know about caring for neurologically compromised patients while running around as if my pants were on fire 12+ hour shifts . I would leave mentally, physically, and emotionally drained, feeling as though I retained next to nothing and was “the dumbest person on the planet”. Up to four patients at any given time would consume my days, all requiring my care and needing something, often times simultaneously! Whether it be pain medications, trips to bathrooms, demanding to speak with their doctor, or pushing the call light “just because”, I started navigating the nursing minefield at a ripe age of 22. I was a baby; a fresh-faced nurse completely ignorant to the majority of everything,  but still eager to be out there and try my hardest.  I can thankfully say that after a while, I began to become comfortable with my patient population and somewhat knew what I was doing (or at least I believed I did!) Younger nurses came in after me and soon I was the one they were turning to for explanations and help. I began taking on leadership roles, and even became a known face at the hospital with the higher-ups due to my positions on councils and vocalness in my residency classes.  I even helped precept nursing students on my respective floor, which I absolutely loved because I was able to create good experiences that fostered learning, leaving them happy to have chosen this career path and hopeful for their own futures.

It wasn’t until I transferred to the Neuro ICU that my second wave of “breakdowns” occurred.  I had envisioned the transfer from intermediate care to critical care to be a breeze! I mean my patient’s weren’t up walking around as much, we weren’t traveling off the floor to various scans as frequently, I was only in charge of 1-2 patients at most, and it seemed as though the nurses just sat around all day (Plus there were a ton of pot lucks… and who doesn’t love a good pot luck?!).  I had a false sense of security when I began in the ICU, only to have all of my confidence shattered as I began taking on patients who were near death’s door. These patients were critically ill and I felt way over my head at times. I had underestimated the seriousness of the ICU and the level of knowledge I was expected to know, master, and regurgitate. Not only was I now responsible for higher level skills, I was expected to use higher level reasoning and understand the “why’s” and “what’s” of things. Why do we give this med? What are these symptoms indicative of? What can you expect from a patient with this diagnosis? Why are their lab values off? And so on and so forth. Ventilators, vasoactive drips, invasive lines, bedside procedures, lab analysis, rounds with attendings, difficult conversations, and even end of life care dominated my new world. I remember being so overwhelmed one shift that I forgot how to do basic skills such as setting up a feeding pump with enteral feeds; a skill that I had taught so many nursing students not long beforehand (my former preceptor, and dear friend, and I now look back and laugh at that day and say that was my “freebie” shift during orientation). I was forced to use my mind and pull all aspects of my nursing knowledge together to provide good care for my patients and work alongside our diverse team. There were days that I would feel so inept, forgetting what it was like to be new again,  having to start from the ground up. However, with experience, and lots of mistakes, came confidence and growth. Sure, I made some questionable clinical judgments at times, and I was nowhere near the perfect nurse (spoiler alert: regardless of what the Joint Commission thinks, its damn near impossible to be “perfect” 1000% of the time), but I had grown so much in just a short time. After a year and a half of time in the ICU, I left feeling self-assured that my new adventure in Chicago would be an easier transition than the one I had previously. But boy was I wrong yet again…..

My transition into pediatrics has been exponentially more difficult than I would have ever imagined. Not only am I learning everything the “Lurie way”, I am also having to unlearn my old habits and think about things from a pediatrics perspective. In a world of adults, 5mL’s of fluid isn’t a huge deal. However, to a small infant barely weighing 10 pounds, this amount of fluid is a HUGE deal! Everything is on a smaller scale and you are aware of the most minute of details, such as how much mL’s a kid pee’s in their diaper. Our medication dosages are all weight based and at the tiniest of rates;  fractions of what I am used to administering to the adult population. I can honesty say I rarely sit down the majority of my shifts, and there are times I struggle to even remember half of what the doctor’s verbally order for me. My kids are critically ill and for some I wonder how they’ll even survive their diagnosis let alone make it through my shift at times. I am now aware of how prevalent child abuse is and have learned the harsh reality that not every family is loving or kind. I am still learning and have a long way to go; thankfully I have many more weeks to go on my orientation and many preceptors to help guide me, otherwise this post would be way more ominous.

Coming from a previous ICU experience, I assumed that I would fall into my new job in the PICU with ease and that I would be a natural. After all, I’ve worked with critically ill patient’s before, just bigger and with more comorbidities. Children had to be just as easy  if not easier, right?! WRONG! These children are proving to be incredibly complex and difficult. I can admit that, in fact, I do not know it all and even though I’ve had ventilated patient’s before, I have no idea how half of these ventilators even work! Instead of cranky “big people” who would get confused and yell profanities at me, I now attempt to console irritable infants who cannot tell me what they want or need, completely miserable from the upper respiratory virus season. I’ve been nocturnal for over a month now and I don’t even remember what It’s like being awake and functional before 3pm most days.  At times I’ve questioned my career choices, and wondered if I have made a huge mistake by making this move to Chicago and completely starting over. I foolishly underestimated how mentally and emotionally challenging this process would be, and sometimes I don’t give myself enough grace for my shortcomings. It is something I am consciously working on and need to remind myself to do.

Despite this time in my life where I am unsure of almost everything and feeling so low at times, I am thankful for the lessons it has taught me thus far. Recently, I have learned what I am good at; I am good at trauma based patients with neurological components (SHOCKER FROM THE GIRL WHO CAME FROM A NEURO ICU AND IS TRAUMA CERTIFIED! I BET NO ONE SAW THAT ONE COMING!). I am also good with older kids who can express their needs and I have the ability to relate to and reason with. I take great pride at listening to parents, asking about their children and life outside of the hospital, and offering collaboration when appropriate. I know that I am not the expert in the room, nor will I ever be, on the tiny human in the bed I am caring for. My parents are often my greatest ally in helping me comfort and care for their child, allowing a child to trust me and let me do what I need to do. I am slowly finding things that I naturally gravitate towards, as well as the things that I must strive to work at. For example, reasoning with a scared, flailing, and screaming three year old to get a temperature or blood draw is proving to be hard on both my back and patience at times (although these kiddos are so cute and you truly cannot fault them for being so scared!). I am learning to slow down, take a breath, and not be so reactionary when I am feeling overwhelmed, which has been one of the hardest lessons, as I am someone who is used to performing procedures on sedated or comatose adults for the past year and a half.  I am learning that it’s OK to be new again and that a PICU RN isn’t made overnight! In fact, my “breakdown” at work was fueled by a tiny two month old baby, inconsolable from RSV, screaming and struggling for hours on end. Between trying to understand the oxygen titrations, attempting to offer help to his sleep deprived parents to get him semi comfortable, talking with the residents and articulating my questions and concerns, and keeping the monitors from alarming falsely from his incessant movement, I felt exhausted and frustrated. RSV season is terrible and often times these children are exceptionally uncomfortable and fussy from trying to breath. I felt so defeated and the tension in the room was mounting as his two parents tried quieting and holding him to calm him down, despite the loud alarms that would send me running in the room every 5 minutes to reset. Eventually, I broke down myself,  in front of my preceptor, telling her that I didn’t think I could do it anymore. This tiny, two month old baby had conquered me with a KO and I was ready to hang up my stethoscope and call it quits! Luckily, after a pep talk and a few dramatic minutes of crying in the supply room, I returned to my respective rooms and pulled myself together (magically the baby slept for 4 hours and I made sure not to touch him at all costs, in fear of “Waking the Dragon”).

To all of those reading this,  there are going to be days that will test you. It’s inevitable that at some point you’ll be faced with something that takes you out of your comfort zone and shakes you up. In the moment it will probably be overwhelming and the instinctual fight-or-flight mechanism will kick in overdrive, either compelling you to walk away or stick it out. When this happens and you are faced with that choice, I hope you find the strength to choose the latter and to learn from the conflict. This choice isn’t always easy, but it’s the one that fosters growth and wisdom. Just take a deep breath and remember that, “This too shall pass”, even if it means you have to shed a few tears in privacy (or publicly if you are me and have no shame).  A bad day, or shift, doesn’t equate a bad life either; it’s an unforseen opportunity to develop resiliency and build character. Perspective is key and there is always something to learn from challenging times.

Most importantly, for the new nurses and veteran nurses who are “new again”, know that I have been there, and I am still there currently. I am with you and I understand. I’ve always said that our profession is a beautiful burden and a calling that speaks to those who are ready to answer. Despite the long hours and shifts where I struggle to stay afloat and keep it together, I wouldn’t change what I do for anything in the world. In my soul, I know that I have been put on this Earth to heal and love and care for others; it is my life’s purpose. As I progress to my time on day shift and live on functional hours again, I will take with me the lessons of the night; patience, steadfastness, and forgiveness. I am hopeful for the next few weeks of orientation and the growth that will occur along the way. The road will be filled with many mistakes and tears, no doubt, but I intend on taking every lesson in stride and being a more tolerant verison of myself.

Cheers to self love and getting through it all, one step at a time!

Signed,

A very exhausted but hopeful nurse