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Ask any experienced nurse if he or she has regrets, and you’ll get a bucket load. Some of us regret not advocating harder for a patient who was in some dire strait or another. Some of us regret not getting out of a really toxic work situation earlier (it creeps up on you, like the frog in the slowly heating pot of water who doesn’t know he’s being boiled alive).

I really, really regret falling prey to Nurse Habits. The breakfast from the cafeteria on the days when wings are all-you-can-eat, the lunches of fries and something unidentifiable on the days when you don’t get a lunch break, the glass(es) of wine when you get home from work.

At first, I did great. I came home, went straight to bed to ruminate over work for a half hour, then slept as though I’d been stunned. I made sure I worked out at least three hours a week. My diet, while not great, was mostly devoid of those fries-and-whatever lunches. Because I was married, and because my husband brought guests home for dinner all the time, there were always tasty leftovers to pack or snack on.

Then my marriage ended, my job stayed the same and for the first time, I was responsible for getting myself (and my cat) fed, for going to bed mostly on time and getting to the doctor as needed. Things fell apart. They fell apart in a good way, mind you—I learned how to relax about laundry getting folded and discovered which frozen dinners tasted okay—but the cumulative effects weren’t good.

If I had it to do over again, I would’ve taken more care of my stomach: what went into it, how it felt when my body was trying to signal that I was stressed. I would take better care of my back, knowing that it’d take five years to undo what three years of lifting wrong and not exercising did. I’d take better care of my spirit by reminding myself that I wasn’t the be-all and end-all when it came to doing things; other people could and would do some things willingly and well (or better than I could).

I’m not saying you have to live like a monk to be a nurse, or put your career ahead of having any fun. I’m just saying that your muscles and brain and guts make up who you are both professionally and personally, and that a lot of people depend on your best in both areas. You have to take care of yourself before you can take care of patients. That’s not a cliché—that’s hard-won wisdom. So eat your veggies.

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Now that I’ve been a nurse for mrmphyears, there are a few things that, looking back, I wish somebody had told me all of these tips right off the bat.

Not that I didn’t get good training, you understand, but there are some things that experienced nurses take for granted and don’t even think to pass on.

Lesson the First: Know where every bathroom in your building is.
This is actually both easier and more necessary than it sounds. Most modern hospitals have plumbing that’s centralized around a few points. Learn where those points are and you’ll never be without a biffy, even if you have to go down to the locked psych ward and beg to use one of theirs. I learned this early when, six weeks into my very first job, all of the bathrooms on my floor were being remodeled. Simultaneously. Nurses have big bladders, yes, but not that big.

Lesson the Second: Good pens are rarely cheap, and cheap pens are rarely good.
Does anybody even use pens anymore, what with all the computer charting? Let me tell you something, children: Back when I was first getting started, we had to walk 16 miles uphill to the office supply store to….oh, wait. Sorry. The lesson here is that the cheapo permanent markers and highlighters and stick pens that the hospital provides are rarely worth messing with. Buy your own. For a small outlay, you, too, can have one of those nifty Sharpies that hangs off of your ID tag along with all the other stuff you carry with you. And, speaking of carrying stuff…

Lesson the Third: You don’t really need all that impedimentia.
Calipers are nice to have if you’re working on a telemetry floor. A reflex hammer is nice, and a penlight is essential, if you’re doing neuro. I’ll bet you dollars to doghair, though, that somebody’s stashed at least one of whatever you need in a drawer somewhere. The only really critical things you need to have on your person at all times are coffee money and a stethoscope. The index cards, measuring tapes, quick-reference guides and so on can stay on your carefully staked-out turf where nobody will mess with it.

Lesson the Fourth: Learn where everybody’s “spots” are and stake out your own.
Each unit has its weirdo—the guy who gets really upset if you sit in “his” chair. Likewise, each unit has its own system of territory-staking. For my current unit, home is wherever your coffee cup is. In my previous unit, because we had only one nurses’ station, we all just sort of figured out where to dump our stuff and left everybody else’s alone. If you’re new on the job, your spot might be in the back, where the med students are, but eventually you’ll move up to the front of the station.

Lesson the Fifth: Not only are respiratory therapists great at getting nurses’ butts out of slings, but they also have the best coffee.
If you’re starting on night shift, this is vital to know.

Lesson the Sixth: Anything that’s good in the cafeteria or in the vending machines will be discontinued.
Once, many years ago, I saw some White Castle sliders in the big vending machine in the basement. I bought all of them and stashed them in a paper sack in the fridge. At the time, White Castles weren’t even available in the freezer section of your local grocery store and thus were like gold. Our vending machines haven’t had anything close to that good ever since, but I used those tiny, delicious burgers as currency with residents and attending physicians for a good month. Likewise, our cafeteria used to offer a tasty, healthy, low-fat grilled veggie buffet on Fridays. They don’t anymore. The takeaway? If you see something good, grab it, and don’t be surprised when they replace it with vaguely plasticky hot dogs and stale Ho Hos.

The Final Lesson: Nothing is as bad as it seems the first month (or six months) on the job.
I always tell the students I precept that it’s waaaay easier to be a nurse than it is to be a student. While this is true, it’s also true that for the first three months or so, being a nurse really sucks. You’re constantly overwhelmed and terrified, worried about what you’ll have to do next, and you never actually have time to do something thoroughly enough. This will change, I promise. Most of what you do as a nurse becomes routine after a while, so you can spend more time on actually nursing. Fear not, Chickadees. As your hip measurement increases with your time on the job, so do your confidence and efficiency.

Even without those oh-so-tasty little sliders.

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What’s your favorite “thing” ever about being a nurse?

I have several. Tops on the list: Working in neurology, you gain a basic knowledge of all the little weird bits of the brain that other specialties never hear of. It’s fun to stump or impress professionals with a good background in, say, urology or cardiology (or even neurosurgery!) with the blasé pronouncement that, yes, you’ve seen those symptoms before, when a patient had a blockage of the third branch of the left-lateral mid-coronal whangdoodle, but only on alternate Thursdays.

Another cool thing, along those lines, is the stories you get to tell. Did I ever tell you the one about the guy who stroked out his entire corpus callosum? How about the woman whose only symptom of stroke was that she couldn’t read out loud? Believe me when I say that Oliver Sacks barely scratched the surface in all of his books.

Then there’s the swag. When you do neurology, you get pockets full of cool things like reflex hammers and penlights. You get toothpicks, cotton swabs, von Frey hairs (that’s a set of bits of monofilament to test fine touch perception), and flip-books full of cartoons to describe and words to repeat. Walking down the hall with your lab coat pockets stuffed with testing widgets, you look like a well-groomed mad scientist.

And finally, there’s my favorite thing about being a nurse in general: the variety of people you meet. Working in an academic setting, I meet folks from all over the world. I’ve met a professional rodeo clown, an auctioneer, a couple of Nobel laureates, a guy who spent 10 years studying sociocultural norms in various groups who live in the Sahara desert, and ordinary people who do ordinary things very well. I work with doctors and nurses from countries I’ve had to look up on maps. You wouldn’t believe our parties. Or, come to that, our potlucks.

Happy Nurses Week! May your next year in nursing be filled with all the cool trivia, neat swag and interesting encounters that make our jobs so much fun.

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We all know an introvert: that person who can fall silent during a conversation without embarrassment and who needs several hours to recharge after a party. Introversion is one of those misunderstood personality slants that can be as tricky for the person with the slant as for those around her.

If you’re introverted and choose nursing as a career, you’ll probably feel like you’re spending most of your working days onstage. This is not necessarily a bad thing. As a fairly introverted person myself (I like nothing more than to come home to the silence of an empty house), I find that acting the part of Jo, RN, helps me differentiate between work and life. At first it felt artificial, but I’ve come to cherish the separateness that I feel once I walk out of the hospital. It keeps me from getting burned out.

It can be tricky to manage a lot of different demands during a shift. I think of it as encounter multitasking: There are loads of people who each want something unique from you.

Sometimes it feels overwhelming. For me, the trick has been to learn to take one person’s demands at a time and concentrate only on those demands. Yeah, it can take me longer to get things done, but I get them done without forgetting essentials or making mistakes.

A key point is to make time for yourself during your work hours. I eat lunch alone. Everybody knows it, everybody respects it: It’s my time to let my eyes unfocus and my brain calm down. If you work in a place where you might get lunch twice a week (or less!), even five minutes in the bathroom can be your sanctuary.

Make time for yourself outside of work, too. Don’t socialize only with the people you work with (this is a good tip for anybody). Have friends who aren’t nurses. Spend an hour or so here or there doing something relaxing or physically demanding, like reading or working out, that has nothing to do with anybody but you.

Lastly, treat your at-work time as your onstage time by getting into a routine. I have a morning routine that never varies. It makes me feel like I’m armoring myself for the day, getting into costume to play my role. Not following that routine on my days off helps me keep my work life in its proper place.

Don’t panic! Even the nerdiest, most introverted person can make it as a nurse. If all else fails, work in neuroscience. We’re all like that.

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One of the most frequent questions I get from new nurses (or those about to be nurses) is “How do I choose a specialty?” Ten years ago, the advice to every graduating nurse was to not specialize too early in your career; instead, work on a general medical-surgical unit for a couple of years, then decide what you want to do.

I’ve never really bought into that advice, and I buy into it even less now. For one thing, med-surg is its own specialty. For another, the majority of hospitals, research centers and clinics want to be able to train (or fine-tune, in the case of experienced nurses) their nurses in their own ways. Nowadays (says Grandma Jo, sucking on her dentures), new nurses are expected to start out in a specialty, switching later if they want.

How do you figure out where you belong? And, more importantly, how do you figure out if your chosen specialty isn’t the best fit?

Let’s take that second question first. If it doesn’t excite you to think about all the cool stuff you’re going to learn every day when you get to work, if you don’t perk up your ears when some doctor starts lecturing his interns on a tricky case, if you dread having to re-up a certification, you’re in the wrong place. Just because you earn money doing something doesn’t mean you can’t get joy out of it. Heck, if you’re spending 36 hours a week doing that thing, it had better make you happier, or at least not make you more unhappy.

In that vein, then, think about what excited you most in school clinicals. That probably won’t be the area in which you felt most comfortable; instead, it’ll be the one that had you tipping your head to the side and engaging new parts of your brain. Think of the most interesting problems you had to solve—that’s a good clue to where you might belong.

Remember which nurses and doctors your personality meshed best with. ICU nurses tend to be OCD, while rehab nurses are some of the most patient people ever. Neonatal nurses and psych nurses are both special breeds—in a good way. OR nurses never waste motion. Like-minded people gravitate to certain areas of medicine and nursing for a reason.

Finally, list your own strengths and weaknesses. If you have a problem with mucus, you probably don’t want to work with a lot of ENT patients (unless you’re willing to overcome your snot-aversion). If anxious adults put you on edge, stay away from the neonatal ICU. If you like seeing the same patients every day for weeks and getting to know them, don’t work in a day surgery center—look for a job in rehab.

And don’t panic. You can always change your mind later. The basic skills you learn won’t vary much from specialty to specialty. Just ask the neuroscience-certified nurse I work with who used to run a podiatry clinic.

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Sure, nursing’s tough, but there are some (considerable) perks you may not have considered. There’s always a silver lining somewhere!

1. The uniforms have gotten considerably better over the last 100 years.
Seriously…would you rather be wearing a cornette headdress? How about one of those lace-trimmed caps with the ribbons? And don’t get me started on the pinafores and wool capes. (Though, to be honest, the capes were kind of cool.)

2. The hours are great.
No, really. If you have a typical floor job or a job in a clinic, you can leave your work behind you when you head home. Your mileage may vary if you’re in administration, but generally, once you close the door to the hospital, that’s it. Aside from getting your however-many hours of continuing education every year, you can think about other stuff when you’re at home. Contrast that with people with jobs in brokerages, who are tied to their BlackBerries.

3. The pay? Not to be sneezed at.
Again, mileage may vary, but we’re talking about a job that, in most places, pays both weekend and evening/overnight differentials, as well as extra on holidays. We may not make as much as plumbers, true, but we make more than electrical engineers.

4. Hospital food is a guaranteed weight-control mechanism.
Try not bringing your lunch for two weeks and see what happens. My bet is that, when faced with the Green Glop du Jour with a side of Orange Cheezy Ooze, you’ll lose 10 pounds. In normal office jobs, they tie you to your seat with those little donuts out of the vending machine. If you do well, they’ll promote you to brownies. Your butt gets huge.

5. We’re not used-car salesmen.
We may be mistaken at times for handmaidens, helpmeets, walking medical encyclopedias or people-not-smart-enough-to-be-doctors, but almost nobody thinks we’re on the take. Nursing is on the list of most trusted professions year in and year out. It’s kind of nice to be trusted, and to be doing something that everybody has had some encounter with over a lifetime. Nurses are rarely implicated in coup d’état or the violent overthrow of corporations, which gives you an automatic alibi if you decide to depose the leader of some small country. “Who, me? But I’m a nurse!”

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Nursing is hard. Nursing is an emotionally draining, physically taxing, mentally challenging job that goes on for hours at a time and for days in a row. Nurses are often asked—or made—to work overtime, or stay late or come in early, or work without enough staff or support personnel. Nursing, in short, can suck as a career choice unless you take steps to keep your sanity intact.

Easier said than done, you say? Not so. Take a few tips from my colleagues, who have done everything in the world for 10 minutes at a time before they became nurses, and from me, whose employment history is checkered, and you’ll have an easier time of keeping sane.

1. Remember that you can do anything for 12 hours. Heck, you can hold your breath that long. Twelve hours (or eight or 16; whatever it is you’re working today) is a relatively short time in the grand scheme of things. If the day is going badly, try reframing it. Instead of thinking, “Oh my gosh, I have to get through the next six hours,” consider thinking, “I have six hours to make a difference to these patients.” It sounds hokey and Pollyanna-ish, but it’s true: Simply recasting your shift in terms of doing rather than having done to you can make a huge difference.

2. Try to have rituals. As nurses, we talk a lot about time management and routines on the job, but we rarely talk about rituals. One of my work pals, who sings with an opera company on the weekends, told me about his getting-ready-for-work ritual: “On days when I work, I’m getting into character just as much as I do when I’m getting ready for a role. Everything I do in the morning, from pouring coffee to shaving, takes me one step closer to the Nurse role.” I hadn’t realized it until he put it into words, but I do the same thing with makeup: I wear a certain amount, applied a certain way, and that ritual acts as armor against some of the horrible things I might see during my shift.

More important are the rituals we have when we get off work. When I come home, I put on sweatpants and a bathrobe, take off my jewelry and makeup, and feed the animals, in that order. It’s the same, invariably, every night. Taking off scrubs and heavy leather shoes means I’m dropping whatever happened to me that day into the laundry basket; I make a conscious effort not to think about the shift I’ve just finished. Washing away the mask I put on in the morning helps return me to normal civilian life. Feeding the critters reminds me that there are things in the world more important than my own niggling concerns and stressors.

(Looking at what I’ve just written, I worry that it reads as unnecessarily negative. I love my job, and I feel the work I do is both valuable and fulfilling—but it’s hard. I need to have a separate personality for work, just so the stresses of the day don’t eat me up. Your mileage, as always, may vary.)

3. Try to cultivate an attitude of thankfulness. This sounds even more hokey than reframing your day, but believe me, it works. Your worst day as a nurse is still a thousand times better than the best day of one of your patients. “There but for the grace of the Flying Spaghetti Monster/God/The Universe go I” is not an unhealthy thing to remember. No matter how bad it gets, you still have at least partial use of your brain, your limbs and your cardiovascular system. Things aren’t truly bad unless you’re on one of those beds in a room with a drain in the floor.

4. Set boundaries. This is something that they teach in nursing school in terms of negotiating with patients, but it has another side: the times when you say, “This far I will go, and no further.” It’s okay to confess to a charge nurse or a trusted coworker that you simply can’t go into a room one more time. Most places, the care for those sorts of patients is divvied up in an unofficial way, as in “I’ll give you a Snickers if you’ll just answer that call bell.” If the choice is between bribing a coworker and walking into a room with an attitude, go with bribery.

5. Finally, lean on your coworkers. This is a recurring theme in my essays, and for good reason: I have the sort of coworkers that people only dream about. When I was sick, they cared for me in more than just physical ways. When I’ve had bad days, they’ve mobilized as a group to get my butt out of whatever sling it’s been in. And when I’ve had good days or just been luckier than normal, I’ve tried to pay that back.

Still, sometimes you have to lean. If you have an ethical problem (“This doctor is trying to convince a patient to rescind a DNR order…is that wise?”), a physical problem (“My back hurts; can you help me roll this patient?”) or a mental problem (“I’m going to kill that oncologist if somebody doesn’t hold me back”), your coworkers can be invaluable. They can help you keep things in perspective, provide valuable physical and mental support, and, if things get too rough, collect money for your bail.

Nursing is hard. It’s a juggling act between giving enough and giving yourself away. It’s sometimes dirty and gross and awful; sometimes it’s just plain wearing. It can be amazing and miraculous and beautiful, too, but you have to be awake enough and alive enough to recognize those times when they happen. Boundaries and rituals and trust can help with that.

Every day is different; every day is new. Every day brings us the opportunity to do something magnificent for the people who depend on us. Our responsibility is to be ready to grab those opportunities. Keep yourself healthy not just for your patients’ sake, but for your own.

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Every month, I get an email from the editors here at Scrubs with suggestions for articles I could write. This month’s list of suggestions included “Tell us about unforgettable patients you’ve had.”

Something tells me they have No Idea What They’re Getting Into.

There was the Nobel Laureate with whom I discussed meatloaf recipes, the woman who smuggled her miniature long-haired dachshund into the room, the person who swore up and down that they were allergic to everything our patient kitchen served and so had to have nothing but McDonald’s for their entire stay. (Remembering that makes a Big Mac sound really good right now…I’m sure that’s the stress talking.)

My three most memorable patients, though, are these…

1. The Woman with the Electronic Widget

2. The Man Who was Allergic to Oxygen

3. The Woman Who Brought Her Own Furniture

First: The Woman with the Electronic Widget

Source: YouTube

No, really. I’m for serious, here. I know censuses are high and staffing is low, that time’s at a premium and you barely get a chance for a bathroom break (how well I know that last one!), but you must watch these videos. Even if you don’t have a minute to pee, you’ll always have under three minutes to make your day that much better.

Teddy Bear the Talking Porcupine
The fretful “porpentine” originated with Hamlet, and this is his 21st-century incarnation. It’s a YouTube classic, always good for warm pricklies.

Teddy is from my hometown! This is my biggest claim to fame yet: being from the same town as a talkative rodent.

Porcupine or Puppy?
Another porcupine, this one far from fretful, believes he’s a puppy dog. He paws and leaps and spins in circles when excited.

Puppy porcupine! Far from fretful (You’ll have to follow the link to check this little guy out).

Now I want to rub a porcupine belly.

Emergency Room Rap
In order to qualify for Scrubs, I have to include something nursing-related. This video is actually pretty darned impressive:

I might (or might not…) want to work with them based solely on this rap.

Jittery Jerboa
Okay, back to moments of cuteness to lighten your shift: This next video is of a pygmy jerboa. Although I weigh more than 3.2 grams, I often feel like this little dude:

I mean, really: Who among us hasn’t looked like that at half-an-hour-till-freedom?

A Whale of a Good Time
Mariachi Connecticut has my vote for Most Marvelous Mariachi Band Ever, for serenading a beluga whale (!!) at an aquarium:

Never, ever pass up the chance to watch something adorable on your shift. You’ll be the better for it: Stress decreases and compassion increases the more cute animals you see. True fact!

iStockphoto

Nurses have been a trope in fiction for centuries. From Dickens’ drunken, sleeping slattern to the modern sexy beasts of E.R. and Grey’s Anatomy, nurses have had nursing styles galore. Take this quick quiz to find out which fictional nurse you most resemble!

1. A doctor enters the nurses’ station and asks for help entering an order into the computer system. You:

a. Drag him into the nearest clean utility room and rip off your shirt, revealing a provocative lace brassiere (double points if you’re a male nurse)
b. Light a hundredweight of gunpowder in such a way that a score of wolves is revealed to be blazing around you
c. Try to help him, but become entangled in some wacky computer problem such that you blush and stammer, charming the physician with your innocence and good nature
d. Show him where to click with the mouse and how to enter the order

2. You’re dealing with a difficult patient. How do you try to establish a rapport with him?

a. You reveal that he’s actually your long-lost brother’s second wife’s stepson. Hilarity ensues.
b. You tell him a sweet story to lull him to sleep, then laugh in a horrid manner, disquieting him extremely.
c. You persevere with good humor and efficient, quiet action, accomplishing tasks with such gentleness and intelligence that he can’t help but become fond of you.
d. You read him the riot act and have no trouble the rest of the shift.

3. Something horrible has happened on your shift. What do you do?

a. Immediately stick your hand into a ceiling fan, your head into a helicopter propeller or your entire body into the icy waters of the nearest ship channel in order to provide a good subplot.
b. Drink some gin and go to sleep by the fire. Whatever’s going on, it’ll be resolved by the time you wake up sometime in the next chapter.
c. Widen your eyes in shock, flail about a bit, then come up with a nifty idea that saves the day.
d. Sigh heavily, roll your eyes and call housekeeping to help you mop up the entrails.

4. You fall in love with somebody at work. Who is it?

a. Your immediate supervisor, who, unbeknownst to you, is also your sister’s younger daughter’s half-cousin.
b. A poor yet noble scion of a great but fallen family.
c. A handsome intern with only your best interests at heart.
d. That cute guy who delivers the specialty mattresses on Thursdays.

5. Why did you go into nursing?

a. It’s a glamorous, well-paid job with great-fitting uniforms and plenty of time to gossip.
b. It’s a living. One that lets me afford gin.
c. Because I want to help people! Especially those boys at the front who are giving their all!
d. I couldn’t make a living with a degree in English.

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