Though busy on my shift, it was never far from my thoughts-the NCLEX, the boards, the final step that would culminate in the letters RN. However, this was no time to think about that, so I pushed back the thought. Only time would tell. My patient's IV had gone bad. I grabbed the IV tray and turned hesitantly to Mary, a seasoned nurse. My hospital had recently changed to a push-button syringe. It was safer, but my beginning IV skills had faltered. I had missed the last five sticks, and my confidence was plummeting. I asked Mary to observe, hoping she could catch what I was doing wrong.
"Hold still, big poke," she said. I slid the needle in and saw the flashback-a moment of hope. It quickly ebbed when the catheter would not advance. I tried again, with the same result.
"What am I doing wrong?" I asked, as we made our way down the hall.
"I thought you had it both times," Mary encouraged, explaining that she didn't do many IV starts and hadn't used the new equipment yet. I tried pushing the clouds of self-doubt away, knowing that I would need to do this many times to gain the experience that only time can bring. I could only go forward, refusing to let my thoughts undermine the slow process.
The problem before me was more basic; my patient still needed a new IV I approach Susan this time. Her personality was harder to read, not soft and smiling like Mary's, but I had seen others ask her to help start IVs. She must be good. I did the hard, humbling thing. I told her about the problem I was having and asked her to start the IV while I observed. We headed back to my patient's room with Susan leading the way.
Once her supplies were set up, she applied the tourniquet and then, deep in concentration, slowly palpated the patient's veins with a single, bare index finger. She was a good teacher.
"Feel this. Can you feel that pouchy feel the vein has? That is what you look for." Taking the catheter, she turned it clockwise once to loosen it for easy advancement.
Well, there it was!! I had forgotten that. No wonder I couldn't advance the catheter. I went back to my duties, hoping that this one piece of information would make the difference next time.
But Susan's lesson for the night wasn't over. She took me with her to watch while she started an IV on an African American woman, whose veins had been scarred through constant use as she battled renal failure. I could feel how hard her veins were, and understood why they always blew. Susan returned to her charge position, and another nurse approached her to start an IV. Susan had been starting IVs for thirteen years. She was good at what she did, and her peers called upon her skill frequently.
I went home thinking about the boards. Were my results online yet? Had I passed? I was eager for the day when I would be past this point. I wanted to be an RN, so I could learn for the sake of my patients-rather than for the test. When that day came, I would shift my focus to new things. I mentally added IV starts to that list of new things. One year from now, I wanted to be good at starting IVs.
I passed!! I was jubilant!! I was the envy of my nursing buddies who hadn't taken their boards yet. I was done. I am an RN with a license that was two days old!! But, I was back at work. No time to think those exhilarating thoughts.
We were busy. I pushed the euphoria away and listened to report. I was teamed with Tess, another RN, because I was still on orientation. I was focused. I was intent. After all, I was now a real nurse!! I would take two of the team patients. One would give me my first experience in giving blood. The other would be my first patient whose problems turned out to be largely psychiatric. She was threatening to sign out against medical advice. She refused medicine and attempted to tear her IV out. That kept me busy!!
I heard snatches about other patients on the team. Room 415 housed an old woman whose heart was failing. She was a no code. There was little doubt that she would die soon. She knew it, and she was refusing her morphine, tolerating the pain to stay alert. She was miserable. We discussed at break the ethics of this situation. Do you give a medication to keep a patient comfortable when she is alert and oriented and refusing it? The consensus was no, but it was uncomfortable for the RN to watch the woman suffer.
In report we heard that she had said she was afraid to die. They were just details on a busy unit on a busy night. Charting at the desk, I heard someone say, "Go check 415's leads." She had bradycardia with a heart rate in the 40s, then 30s. We watched it go to agonal, and then to asystole.
A nurse mused aloud, "I have always wondered if it is an invasion of privacy to watch the last rhythms of a person's life, or if it is a privilege." Odd that we are safely distanced at the nurse's station.
The unit secretary runs a two-foot strip of asystole for the chart. "How long do you want it?" he chuckles. Macabre humor; it too feels like distancing. It is a moment packed with conflicting, fleeting feelings.
The hectic pace calls everyone back to their work. Later I helped Tess care for the body. I was glad for the gloves. I, too, needed distance. I was not comfortable with death.
In the days that followed, I contemplated those two evenings. Was it the newness of nursing or a lesson unfolding? The old woman's death occupied my mind, and my conscience began to prick me. I am a Christian. This woman passed into eternity that night. I never even saw her until she was gone. I knew she was afraid to face death, and I knew the only hope in death.
Did I try to share the comfort and salvation that the gospel offers to one facing her final hours? No. I argued with myself as to the appropriateness of sharing Christ on another's time. Would I have been neglecting my job and duty? On the other hand, what about my highest calling before God? Would I have appeared to be some sort of kook to my peers?
No easy answers to those questions occurred to me. But I knew that I offered nothing different to that woman from any other nurse on the unit. And the knowledge troubled me. Anyone could meet her physical needs, but her greatest need was spiritual. We can see spiritual distress listed in the indexes of nursing diagnoses, but we rarely address the problem in tangible ways.
Holistic and spiritual can be empty words. What nurse is using the nursing process to address these needs? As a Christian, shouldn't I be one? But how? There is parish nursing and missionary nursing, but how could I incorporate my faith into my daily, secular practice without being pushy or obnoxious? How could I learn to seize the moments when people confess their needs and use them as opportunities to minister?
My thoughts took me back to Susan. She has a skill with IVs that is recognized and sought after on the unit. I wanted to be like that-not with IVs, but with my faith. I wanted to live a life that reflects my faith. I wanted to learn how to minister to my patients. I wanted to have a testimony among my peers that was respected so that I could minister to them as well. I wanted someday to be the RN that people come to when someone has spiritual distress because they know I would try to minister to that need. And now that I was past my boards and able to focus on other things, I knew what needs were to come first. I wanted to be a nurse who practices with her eyes on eternity.