Moving past competency to comfort

Last night I talked to my triage tech during the 10 or so minutes we didn't have patients in the waiting room. The conversation made me want to fall to my knees in gratitude that I'm not in nursing school anymore, and lately in general I've been noticing I must have morphed through one of Patricia Benner's stages (I guess competent to proficient, although to me it's competence to comfort). I think---and hope---I will always have healthy fear, because if nurses lose that we run the risk of jacking something up and hurting somone, but I no longer have big bugaboos I dread because I'm just not sure what to do. This is a big deal, because knowing there is A Thing I'm Not Good At causes anxiety every time I go to work. I still make mistakes, and everyone does, and I've pretty much gotten over aspiring otherwise. I don't make too many mistakes, and I've made only one serious one. It was during my first 6 months of practice, no patient harm occurred, and I managed to use it as a profound learning experience. More to the point, I've learned perspective about mistakes. Notably, is this mistake a bureaucratic thing (don't care as much) or something that compromises patient care (do care)? Most belong to the former category. I also tend to piss people off by being too direct. That makes the ER a good place for me because we're all like that. Unless we're having a drama-queen night where EVERYTHING IS A PROBLEM.

Progress as a nurse happens so slowly that you don't see it as it happens. One day you look back (by, eg, talking to a nursing student) and think, "Holy crap, I can't believe how far I've come." Last night I juggled a full waiting room in triage and put three pediatric IVs in (for two, I was the go-to person). I got all three on the first stick, if anyone's interested. <g> It wasn't a particularly unusual shift except that I recall being totally freaked out about triaging when we are busy and about caring for sick kids at all, let alone babies, let alone fat dehydrated babies requiring IVs. I have lost a decent amount of sleep over the last 18 months dreading having to put IVs in fat babies. It's so stressful. They hate it, I hate making babies cry, the parents hate it, I hate the stress of sick babies combined with upset parents, there's usually a sense of urgency because we don't put babies through that unless they're really sick...there's just not much to recommend it. I literally used to feel queasy when a doc ordered "line and labs" for a baby. But now, somehow, I'm mechanically good at it, I am able to handle the parents and situation acceptably, and I don't spend any time outside work thinking, "I hope there are no sick babies on my next shift." I also take it as a very good sign that people come to me now from time to time for pediatric IVs, because that shows I'm actually good at it. I write all of this not because I think I'm a pediatric IV ninja or something, but rather to give an example of how you can develop proficiency and comfort with stuff you used to fear and you don't even realize you've done it.

Peds are a real yardstick for me because I don't have kids and was never really around them until nursing school. They freaked me out. I think I just didn't know how to communicate with them, because now I have progressed through not being afraid of them and edged over into liking them. I've even had a few docs ask me lately if I'm going to have kids ("you're so good with children"...with me looking behind myself to see who they're talking to).

Triage...is not my favorite thing. It's your job to decide who is seen right now and who waits. It's your ass if you pick wrong. People have to wait. They get mad. They yell. You don't know who might have a weapon or jump you or cough tuberculosis all over you. You don't know who might drive up and run in saying, "I think my friend is dead in the car!" It used to make me want to cry with frustration. One of my charge nurses really helped me by telling me triage is not the place for therapeutic communication and that I can do one thing at a time only. In other words, sometimes you have to seem a bit rude out there, and I used to cringe at that, but truly, I cannot listen to all the background and extenuating circumstances for everyone. I do try to buffer the rudeness ("I do have to cut you off here, but your primary nurse and ER physician will want to hear your health history, and this way you don't have to tell it three times instead of two..."). At some point I just kind of got over it, and I don't know when it was.

I'm just happy that nursing provides us with these oases of knowing we're making progress. Otherwise it would be just too hard.