This issue is devoted to research on practitioner perspectives. I take the liberty of publishing the perspective of a new nurse, who happens to be my granddaughter. She graduated from the East Carolina University School of Nursing in May 2014. She writes about her first professional position at an inner city hospital in Washington, DC. Jennifer Tilley explains how “nursing in theory” and “nursing in real life” differ:
The transition from “nursing in theory” and “real-life nursing” is one for which I knew I was unprepared. I just didn't quite understand how shockingly different the two would turn out to be.
People in the United States have numerous reasons for pursuing nursing as a career. It offers great job stability, the pay is decent, there's a wide variety of job opportunities, and there's the ability to give back to society. I personally chose nursing for a combination of those reasons, but mainly to create a life where I would do well while making a difference in others’ lives. In nursing school we are taught the positive aspects of nursing careers. We learn we will be present for good and bad, happy and sad times. We leave believing we will make an impact on all our patients’ lives and that no matter what, we will be happy we chose to become nurses. Although that's a beautiful foundation to instill in our country's future nurses, educators omit the reality that we don't always walk away feeling so accomplished and proud.
For my first nursing position, I looked for several things. First, I thought it best to be placed in a large urban hospital, preferably a teaching hospital, so that I would be exposed to the sickest of patients. I also wanted to work on a medical/surgical floor to learn as much as I could to refine my clinical skills before pigeon-holing myself into a specific specialty. I believed if I exposed myself to such an environment, I would subsequently have endless opportunities. I accepted a position on a medical floor in a large urban teaching hospital in Washington, DC. I believe that I was wise in my decision because I have learned things at this hospital that I don't think I could learn in any other environment. With that said, there were countless unforeseen challenges.
First, “med/surg” nursing is difficult. Patient-to-nurse ratios are high. Many days I worked 13+ hours without getting to eat or take a bathroom break. Due to the huge variety of medical illnesses, clinical skills have to be broad and sharp. We have to be able to communicate and coordinate care between physicians (including the brand new, and often clueless, medical residents), the social workers, the nutritionists, physical and occupational therapists, the families, and so many others. Patients range from self-care patients, who are hospitalized for observation only, to those who require complete care. The latter can do nothing for themselves and are medically unstable. Our jobs at bedside are hard and stressful. Nursing school has no way of preparing us for this responsibility.
Secondly, the inner city patient population is not an easy group of people to care for. Some are homeless, drug abusers who have very little if any income, have little education, and are “frequent flyers” to the hospital. One of the greatest moral challenges I faced was staying motivated and focused to help those patients who don't seem motivated to help themselves. In school we weren't taught how to care for the patients who didn't seem to want to get healthy.
Looking back on my first 9 months as a bedside nurse, I can honestly say I've grown and learned more than I ever thought imaginable. I have laughed with my patients and also have held the hand of a daughter as her father took his last breath. Nursing school has no way of preparing you for the hard realities of nursing. Not every patient will want to get better. You’re not going to make a big impact on every patient's life. But holding on to solid fundamentals, clinging to the reasons you wanted to first become a nurse, is what will guide you to be someone who will leave a positive impact on the world.
Eleanor Krassen Covan, PhD, Editor-in-Chief, and Jennifer D. Tilley, RN
October 27, 2015