I've found the unpredictable nature of a career to be similar to that of a river. Sometimes the current flows quietly through reassuring pools and other times through rough, turbulent waters. My nursing journey has involved both.

A rough start.

In 1980 I graduated with a bachelor of science in nursing degree from Rutgers University and embarked on my journey in nursing as the evening charge nurse on a 24-bed male medical ward at a large New York City hospital. I was tremendously excited and nervous. My background was very sheltered (my mother is a Mennonite Brethren and my father is a Baptist minister); therefore, working in New York City was a precipitous step for me. In nursing school, the patient-to-nurse ratio in clinical rotations was never greater than 2 to 1, and I envisioned nursing to include interacting with the patients and their families. I realized this was not the case during the first week of orientation. On the unit, I was the only permanent, full-time evening nurse; everyone else had quit because of mandatory overtime. The contract at the time allowed 26 shifts of mandatory overtime annually at the hospital's request.

Every day felt like an assault to my inexperience; at a time I was ill-equipped to be in charge of anything. During the first month I developed a "nervous rash" that became worse when I came to work. When families asked to speak with the charge nurse, they were surprised by my age when I arrived. I stopped coming to work with my hair in a ponytail around this time, as I looked incredibly young. One evening I found a patient shooting up drugs in the bathroom. He told me that if I told anyone he was there, he would kill me. With a shaking hand I paged the supervisor, but she did not show up for hours. I did not report the incident to hospital security, since they had not been receptive to me in the past, and I did not want the patient to see me speaking to them. Another time, a patient became highly agitated, ripped out his central line, and lobbed the glass IV bottle against the ward wall. Glass cracked and blood showered like a grenade explosion, and he took off down the back stairs. I never saw him again. Sometimes, after patients were admitted, they would just leave. On evening flashlight rounds, schools of cockroaches flowed under my feet, and I crunched them under the heels of my nursing shoes.

The unit had two Drinker respirators (iron lungs used to treat chronic obstructive pulmonary disease) and a staff that consisted of me, one LPN (the medication nurse), an elusive aide, and a nurse supervisor who covered seven buildings. One evening shift, I fainted in the room of a ventilator patient and my 24-year-old nurse manager called a code and performed cardiopulmonary resuscitation on me. The rest of the staff thought that the code was surely for this patient. En route to the room, the defibrillator, which was towed on a low metal cart, caught on my coworker's shoe. The cart careened and flipped over, throwing the defibrillator onto the floor. This prevented the staff from putting me on the monitor to check a rhythm, so they sent me to the ED and drew blood, which they promptly lost. Upon awakening, I informed the supervisor that I quit and said that they had broken my spirit and I no longer wanted to be a nurse.

Pharmaceutical sales.

I felt disillusioned and cheated by nursing. I actively sought out and obtained an exciting position for a major pharmaceutical company as a sales representative. I spent one month at the company's headquarters learning how to "detail" (sell) to physicians. After training, I found myself sitting, awkwardly, in OB-GYN offices selling an antiviral drug used to treat genital herpes, using large, full-color glossy prints detailing genital anatomy. The doctors would question me at length about how to use the drug. Oh, was I naive.

In my effort to visit the 250 physicians, five hospitals, and 30 pharmacies in my territory, I became harried and distracted. I would try to see an average of six doctors and two pharmacies per day. This was challenging because of the large geographic area I covered and the physicians' schedules. On the road one day, while searching for the address of a urologist on a map, I hit a sewage culvert, destroying both tires and rims on the passenger side of my car. This had to be a sign. I had never been in an accident or received a ticket before. After I received several speeding tickets and had a few more minor accidents, the head of the company's automobile fleet announced that no one had ever incurred so much damage to a vehicle in just one year. I rationalized that I had better return to nursing before losing my driver's license entirely.

Agency nursing.

Unsure of my direction, I decided to ease back into the field by working through an agency at an inner-city hospital in Newark, New Jersey. My first day on one of the medical-surgical floors, I discovered that all of my patients had the diagnosis of "GSW." Perplexed, I asked the charge nurse what it meant. She told me matter-of-factly, "gunshot wound." I wanted to understand the nuances of inner-city hospitals. At first, the staff liked to test me. I remember one patient whose name was Francine. I put on gloves and began the physical assessment. Francine had marvelous breasts, which she was pleased to display. She had the sweetest drawl and longest manicured nails. I was perplexed at the sight of a full urinal on her bedside stand. The staff was laughing at the door and later explained that Francine, whose given name was Frank, was transgendered and going through the process of sexual reassignment surgery. Eventually, the staff came around and I began to enjoy the patients more and to feel satisfaction in my work.

Clinging to the riverbank.

I decided to work locally at a community hospital. I started on the pulmonary unit and soon transferred to the coronary care unit. I had a phenomenal, nurturing nurse manager who made sure that I acquired the necessary technical skills by encouraging me to enroll in critical care classes, while providing a cohesive , nonthreatening work environment. I found my niche in critical care cardiac nursing and specialized in cardiac care, in which I passed 20 amazing years. I was satisfied at the bedside and staunchly shunned advancement beyond it. I saw others further their education and go into management roles. I kept my head down. I was neither a leader nor a risk taker. A successful cardiac arrest resuscitation gave me a quiet sort of pride.

Unexpected change.

In 2000 I decided with unprecedented conviction to return to graduate school on the adult nurse practitioner track. Both of my daughters had entered grade school, and I abruptly became aware of an unsettling midlife anxiety-that I had not accomplished enough. I reveled in my studies. I was juggling graduate school, family responsibilities, and weekend shift work. But the difficulties are only as turbulent as the psyche allows. The most challenging task was time management. Guilt over ignoring my two daughters remains with me. Nonetheless, they became unexpected subjects on whom I could practice my physical assessment skills. My eight-year-old daughter lobbied to be examined first and practiced with the reflex hammer on her stuffed animals. I explained to my children that my professors don't give stickers to their students, so when my grades arrive, the girls post them with gold stars on the refrigerator.

I have completed two rotations at the Veteran's Administration. A 52-year-old Vietnam veteran stands out in my memory. He had sustained 22 shrapnel wounds over his body, particularly on his legs and abdomen, as a result of his close proximity to a land mine as it exploded. He had undergone an exploratory laparoscopy in the field (to evaluate internal injuries and remove shrapnel), leaving him with a deep flank scar of twisted, puckered flesh, unlike any I had seen before. The wounds probably saved him. He was removed from the front lines where upward of 50% of his company died in combat. He explained at the beginning of the examination that he always needed to know where the exits were, so he sat facing the door. He knew that this was a symptom of posttraumatic stress disorder, but he accepted it as a part of his life. His two young sons understood; when they went to a department store, they would point out the exits. He reassured me that he was fine as long as I didn't make any loud noises or sudden moves. The day before his visit, he lost his job and was concerned that he might need antidepressants again. His life was reshaped by his Vietnam service, and yet he never expressed anger or regret over his military service, just felt lucky to have been spared.

My tightly focused critical care mind has unwound and has time to appreciate the personal stories. I would have missed so much had I stayed in that safe place of my career. I am scheduled to graduate with a master of science in nursing in May 2005.

Writing.

While completing papers for a nursing research class, I discovered an unexpected passion and aptitude for writing. I began seeking out opportunities to write and by chance discovered a program sponsored by the American Association of Critical-Care Nurses, Wyeth Laboratories, and AJN, where fellows (new authors) were paired with mentors (experienced writers) with the goal of publishing a journal article. My mentor and I were one of nine teams selected in 2003 and our article on cardiac arrest was published in the May 2003 issue of AJN.

I hope that my experiences will spark other nurses to consider their own potential for change. My current passion for nursing was not always present; it rose from the ashes of my past trials. It is never too late to consider the possibilities of life, take a chance, and pursue another path. One class, one opportunity at a time.

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