So tonight on #WeNurses chat someone asked:
What would you write in a letter to your self as a first year student nurse? For the bad days: this too shall pass For the good days: this is why your heart brought you here. The bad days can make you feel like quitting, and it’s then, when your heart aches from feeling like a failure, or like you can’t cope, or that this isn’t for you that you need to remind yourself of better days. The days that were filled with the thanks from patients who feel that without you they wouldn’t have got through their traumas. Days come and go. Time washes over a lot of stuff, time allows us to learn and adapt. If I could talk to myself two years ago I would tell myself exactly this: 1. Breathe. When you feel worry and anxiety washing across you just breathe, and sit it out and know that you won’t feel like this forever. It will pass. 2. Give yourself time. You’re learning and growing and time will enhance this. Don’t pressure yourself to know everything now. Learn and in time it will all be in place and together. 3. Don’t beat yourself up for needing to cry. I pride myself on being made of tough stuff, I pride myself on my barriers I carry around with me. But there have been times when I’ve had to walk into the toilets, or the sluice and have a moment. Have a few tears. Because, every now and again a patient, or a situation can slip through that barrier and touch you. And, it’s ok to cry, it’s absolutely fine to cry, it makes you human. 4. Give your time to others. A beautiful advantage to being a student nurse is your time affordable still. Spend your time on patients. Spend your time listening and engaging with people. To give your time to someone is a gift. Always give a little bit of yourself to those who need you most. 5. You can’t save everyone. And, you need to accept that. Being a nurse isn’t about being a hero. It is about doing the best you can. Not everyone can be saved, but find peace in knowing you always gave everything. 6. Smile. Your expressions can speak a thousand words. Always smile it’ll bring sunshine to someone’s day. A lady told me once, when she was terrified seeing my smile made her feel like everything was going to be ok. 7.Understand the importance of holding a hand. A patient, a relative. Know the importance of holding a hand, of touch. Know how much can be spoken through not speaking at all. Know that for an amount of time you can be someone’s comfort and reassurance just through being there. 8. Don't put so much pressure on yourself. Nobody knows everything. 9.Always wear white underwear with a white uniform... 10. Learn to care for/ about yourself, so you can care for others completely. I'm not sure if this will continue. I'm not sure if a) its appropriate, b) chronicling my recovery from ED will hinder or help me personally and c) if I'll remember to blog each appointment.
But, this is the diary of a student nurse approaching recovery from an ED. It is probably more an extension of my headspace... but here goes. This is recovery, and I feel worse than ever. I had my second part of assessment at a specialised Eating Disorders clinic last week. Blood tests and weighing and lots of talking, talking around in circles, and lots of repeating and going round in the same circles. But, she reckons we can break that, she reckons we can do this. And,there is this ‘we’ that seems to resonate in the conversations, it’s echoed in all her sentences when I tell her how scared I am of this. But this ‘we’, it’s together she says, it’s alongside me and helping me through the hardest days. I’m slowly learning from her that this isn’t going to be me observing my recovery, but it will be me engaging and participating and embracing. I’m by no means ready. The most important thing in my life right now is this, I want to be thin. And, I am sat there terrified by this. She says she can see it, she says she understands. I’m sure she does. I’m 27 and I feel like a 7 year old scared of the dark, scared of the dentist. Every time she mentions treatment and recovery I feel this sinking feeling thud through my body, and I want her to see me and see how big and heavy I am and see I need help to get thin, but then that is why I am sat here. I’m 27 and I’m sat here because I am battling every single moment of the day with food and weight, I’m here because eating isn’t easy and mirrors hurt. I cannot begin to explain the guilt that consumes me if and when I eat. I starve myself for long periods of time, I use laxatives and I over-exercise, I am completely drained and exhausted by fighting with food. She’s easy to talk to. I’m finding it easy to be open with her, which is rare – when faced with these situations I tend to create barriers between me and the other person, but then this is her job and she knows how to work me I imagine. She makes me talk and I’m telling her things I never knew I could say out loud. There is a support from her that allows me to be vulnerable and allows me to loosen my grip on control. We talked a lot about treatment and recovery, and she gave me options and choices and I’m going to wait a little while because a) there is a waiting list b) I need some time and space to feel ready and c) I’m totally stalling things. She’s getting to understand me. I arrange it then I cancel it, because I AM PERTRIFIED. But she’s a call me back and reschedule type, so there is no more running away from myself. We did bloods, and there was a lecture about how ‘thin’ my veins are, he took twenty minutes finding one, and then she weighed me. And, I’ve lost 2kg since she last saw me, and I want to celebrate because it’s a loss but I’m disappointed it’s not enough and I’m big and I’m heavy, but she’s there telling me my BMI is now 16 and I’m critically underweight. And that phrase, ‘critically underweight’ made me cringe and tense because can she not see how much I weigh, how much weight is on me? I'm by no measure critically underweight. So, it's going to be a 40-week CBT-ED program, and until that starts it is regular check-in’s with her, to talk, to take bloods and to weigh me. And so, we talk and talk through these circles that are spiralling around my mind and she talks me in and out of myself and she tells me she knows eating disorders are like funnels and eventually all you have, all you care about and want is this eating problem. I am completely in that place. We discussed inpatient if things don’t get better. But most of all we discussed nursing. We talked about how much I want to be a nurse, how I want to work in an Emergency Department and how I want to be the best at this. And, we fall back on perfectionism and stuff, but I can’t help what drives me, and I do put too much pressure on myself but only because it is important to me. She tells me my BMI needs to be at least 18 minimum, and that I need energy to care for people, I need to eat to be present and to be able to give myself entirely. I understand. And she reiterates that I need to give myself to recovery and I need to want to do it. But, in all honesty, right now this isn’t for me. I am not doing recovery for myself. I’ve been here before, and got better for myself. But this time, I am doing recovery for nursing, because I want to be a nurse more than anything and I understand I need to be OK and I need to be treating this or out of this to be successful. I have my own thoughts on the weight limitations regarding fitness to practice as discussed in my post about being fit to practice. I don't think that a weight should define capability, but I do understand that a desire to be thin is not necessarily always healthy. I want to be a nurse more than I want the A word and the B word to be part of my life - nobody said that this was going to be easy, but this is so hard. -Loola. X Only 6 shifts left until (mouthing it, because saying it out loud is overwhelming) the end of second year.
SIX SHIFTS OF PLACEMENT. That is a daunting prospect. I've just completed my 3rd year options and now I have everything crossed I get my choices. My sign off choice is A&E, from day one I have wanted to work in ED and eventually become an ENP. I feel quite drawn to the fast pace, the challenging environment and the learning. I imagine ED to be a place where you need to know a lot about a lot, and I thrive on developing skills and knowledge. My spoke choices are a minor injuries unit - (I'm hoping I get this despite it's similarity to A&E due to the environment being predominantly nurse-led), and a placement with the research team. I'm also hoping to potentially squeeze in some homeless nursing, which I think would be a vast and invaluable learning experience, working with extremely vulnerable individuals who are in very compromised situations and environments and battling physical symptoms but also mental health issues such as dependency. Thought's on elective and currently it has to be a London ED department. 1) because I want to move back to London. 2) the environment would be a prime learning opportunity. I feel utterly prepared in thinking about third year, and utterly unprepared in doing it. I'm hoping the 3 months until I start third year will encourage a transformation into a confident and able third student nurse... - Loola. x This isn't a particularly pleasant post to write, but I think it is an experience that I can share with other student nurses that will offer them reassurance and support. My first time happened on Tuesday. It was before handover started and one of the night staff put a call out for a cardiac arrest.
I've doubted my ability to cope in a situation like that. I'd assumed it would send me into a frenzy and I would panic and not be able to be involved. But, my reaction was to go to the patient and be involved in the resuscitation attempt. Within moments of the call there was a full team assembled, the crash trolly was collected, oxygen was on the patient and his airway controlled, compressions were commenced and blood gases were being taken. The assistant practitioner was drawing curtains around other patients - it didn't really dawn on me until afterwards just how important that was in protecting the patient who was being treated, and the other patient's in the bay. It highlighted the importance of respecting privacy and dignity at all times. For the first few seconds I stood and observed, before rotating in to do compressions. It was an experience that will be valued in my learning. It was not like performing them on the resus-dolls used it training. It was a real chest, with skin and bones. All sensation and feeling is different and although it feels brutal it is important to make compressions count. It is important to do it right. I rotated in for a full cycle. The site practitioner commented the rhythm was good, and that was supportive and reassuring for a first time. For the timing of that cycle I didn't seem to think, just focus. Watching other people do compressions was surreal. Four cycles of CPR were completed before the medical registrar in-charge of the resus attempt ended resus. The patient was elderly, had several co-morbidities and had no output for the entirety of the cycles. It was a decision that had collective agreement from all the team. As we stopped there was no sudden dispersal of staff, people removed the cannulas, and airways, his eyes were closed and his pyjama top was buttoned up. The emphasis on maintaining his dignity in death as it would be in life was encouraging, and provided the realisation of just how much people can care. Nurses particularly as filled with such kindness, and it is inspiring to watch it unfold. The patient was taken to a side room for his family to have privacy and time on their arrival. It was somewhat overwhelming, and probably the most difficult part of the resuscitation attempt for it to be stopped. But the decision was the right one, made by an educated professional who could utilise her clinical judgement to know there would be no output and the patient had unfortunately died. The hard part was knowing he was someone to someone, or maybe many people. He was part of people's worlds. But, there is comfort in knowing there was such intense efforts to try and save this man. Every single member of the team had their sole focus on him. Observing a crash team in action appears like an assembled chaos, it's a mayhem that's entirely co-ordinated. People move so fast to try and save, and preserve a life and no measure is compromised. It is a team of professionals that know exactly what they are doing and are working together as a collective. Having returned to placement for a last block of hub before finishing second year I'm back training on a male surgical ward. It is a particularly organised, well managed ward and it has a lot of big windows (a must when you have a panic disorder, like me!) and for many reasons the placement suits a lot of my needs, but I still struggle with going back. Monday had proved to be a difficult day for me, running on nervous energy and a constant 'on-edge' feeling left me drained and exhausted by the end of my shift, and I had a horrible panic attack that woke me up. I almost didn't go back on Tuesday, I spent twenty minutes stood outside the ED entrance working myself up to go inside and I convinced myself I needed to quit, I couldn't do this, I couldn't cope with the pressure and the environment, it was all too much. But the events that occurred that morning built my confidence. What I say, I say carefully and with hope that it is not interpreted wrong. It was deeply saddening this happened, and I am aware that a life was lost, and he was someones someone. But, it was an experience that has encouraged, educated and inspired me. It has provided invaluable lessons and learning. It is only through experience we gather ability to prepare, and it is through experience that we learn. It was a daunting and saddening experience at once, and it was educating on all area's of patient care - not just the actual provision of CPR, but the staff who worked to ensure privacy and those who ran to to collect clinical equipment. It was enlightening as to how a team works under the hardest of pressures and it was inspiring to see a collective effort filled with determination and such trying. I didn't expect myself to be able to get involved, and it would have been fine to have not, to have just observed or to have taken time away. Not everyone can cope. I was fully supported by my mentor who offered me some time out afterwards, but I didn't need it. I debriefed with my mentor a couple of days after the event, and it helped to understand and reflect on the event. My advice to other students would be to involved yourself if you can, but if you can't do not beat yourself up. Everything is in your own time. -Loola. |