Guest Column | August 27, 2018

10 Unexpected Realities Nurses Face

By Nancy Congleton, RN, contributing writer

Evidence-Based Nursing Informatics

When I decided to become a nurse, I didn’t have a clue. I wasn’t aware of the educational options available to me, what nursing school was really like, or what to expect if I actually graduated and was thrown into the heart of the jungle! Here are some insights from my years in the trenches, and the realities of nursing that most people don’t realize.

  1. Be Prepared to Think and Act for Yourself. It’s a common misconception that nurses simply carry out the doctors’ orders. Physicians may chart the course for patient care by diagnosing diseases and writing orders, but nurses are front and center—monitoring patients’ responses to prescribed interventions and notifying physicians when unwanted or negative outcomes arise. Nurses are responsible for ALL orders that are carried out, including those that are wrong or contraindicated. Therefore, nurses must make sure that the orders they receive from physicians are appropriate for their patients, and they must use their skills and training to know when to interrupt, or stop, an order.
  2. You Know Everything, Right? Be prepared for your family, friends, and the community, to expect you (the nurse) to know EVERYTHING from all areas of nursing and healthcare. On one hand, it’s a compliment for people to think of nurses as having all the answers, but it’s unrealistic and annoying.
  3. Don’t Take the Things Patients Say Personally. I’ve heard it all from patients doubting my capabilities, “You can’t be my nurse, you’re just a little girl!” or “Do you even have a license?” Remember that patients are often scared, hurting, frustrated, and feel as if they don’t have a voice. So, try not to be too self-absorbed; on many occasions it’s not actually about you.
  4. Get Comfortable with Bodily Fluids, and Other Squishy, Gross Things. In addition to snakes in buckets, I’ve been handed fingers over ice in cups and seen the aftermath of toes colliding with lawnmowers. There’s no set pattern or criteria for the ER, anything is possible. But if the ER isn’t your cup of tea, don’t worry —there are many other specialties of nursing you can go into. Just keep in mind; they will have their own version of gross things, too.
  5. Demanding Families. Nurses are taught that patients are their primary focus. In reality, a nurse’s time with the patient is often cut short because they need to address unattainable expectations from the patient’s family members.
  6. Watch Out for Your Back. As a nurse you are faced with a great deal of heavy lifting - someone could faint or have a seizure, you might have to turn a patient or help them get out of bed or to the bathroom. In nursing, a patient who’s 125 pounds or less is considered a lightweight. Yet, many construction workers (who are usually big, strong men) are restricted to lifting far less than that.
  7. Nursing School Doesn’t Prepare You for Everything. Prospective nurses go to nursing school to learn how to be a nurse. However, it is impossible for nursing instructors to cover every disease, symptom, and treatment that a future nurse will encounter. Take advantage of every chance to give a shot, start an IV, or witness a procedure. Most nurses are so busy they don’t have time to encourage you to participate, so be watchful for these learning opportunities and step forward when they arise.
  8. 12-Hour Shifts, Seriously? Yes, but I actually prefer this to the Monday – Friday, 8 to 5 schedule. I know my day’s going to be long, but that’s ok because I won’t be doing it five days in a row like a mindless drone. Plus, the nursing profession provides many options so you can find a time frame that suits you best. But also be aware that your shift’s not over until they say it is. A nurse’s shift may be over according to the clock but that doesn’t mean that they can leave. If a nurse heads out the door without being officially cleared to do so, they could be charged with patient abandonment.
  9. Being in Charge Ain’t a Picnic. In addition to being responsible for patient care, one day you may also be in charge of other nurses, nurse aids, nurse techs, medical assistants, etc. Being in charge of coworkers requires a delicate balance of leading by example, being firm when needed, and sometimes just letting snarky remarks roll off your back.
  10. Keep Calm and Nurse On. Try not to panic too much regarding weight gain, bouts of crying, or brief moments of insanity. At some point, it happens to all of us. Keep your eyes on the prize and take care of business.

About The Author

Nancy Congleton is a registered nurse and author of Autopsy of the NP: Dissecting the Nursing Profession Piece by Piece, released August 22, 2018. Learn more at: www.nursenancyrn.com.