I graduated from an ADN program in May of 1985. Back then, we took boards in June or July (I don’t remember which now), and 1500 of us sat in one room for two days, taking each of four sections of the test when we were told, how we were told, and for how long we were told. Total of 1000 questions. If we got up to use the bathroom, we had an escort. I was the first one done on each section, so got asked a lot of questions on the condition of my bladder. I was just done! I think each section was allowed 3 hours, and had 250 questions. To pass boards, one had to get a minimum of 600 correct. None of this 75 and done business 🙂
As soon as I graduated, I went from being an agency CNA to being the only RN-educated person in the building on nights, and after 5 p.m. when I worked double shifts. Trial by fire. There was always an RN on call, so I had back-up, but when it came to on-site hierarchy, I’d gone from the bottom (agency is always at the bottom) to the one in charge. I had to learn a lot quickly; school is all well and good for the procedural part of nursing, but for hands on, clinicals only offered how things were supposed to work. Time for this 21 year old to figure out what needed doing, and just get after it. On my ‘slow’ shift, I had 30 Medicare/full-care residents in a skilled nursing facility. It was great experience for learning trachs, suctioning, catheters, g-tubes (we used a lot of Foleys back then for feeding tubes- much easier to change out), and had to do my own percussion respiratory treatments with these little padded vibrating thingies.
We didn’t have glucose monitors back then, so had to dip urine with sticks that reacted to the amount of glucose in the urine. That was an issue, since the urine could have been in the bladder for a while, even when using needle aspiration if they had a Foley … I had to base the insulin dose (from the sliding scale) on that stale urine. It’s what we had.
“No Not Resuscitate” orders were more of a judgement call. If they were in a nursing home, generally we didn’t jump on them, or initiate CPR while waiting for the 911 guys. They were old, worn out, and dead. It was fairly simple. Sometimes, I think that’s better. What do we bring them back for if they’re already so compromised? For the ones who were rehabbing to go home, there was more of a chance we’d do all we could to get them to the hospital before they totally crapped out, so IF there was a chance, they were closer to the machines that would/could keep them alive until it was figured out if they had any chance at all. If they were in the hospital, it was a bit more formal, but the input from the family was just starting to be included in what orders ended up being written. I didn’t have to agree- just follow the orders.
My first hospital job was about 8 months after I’d graduated, and moved to a different state. I was assigned to the neurology/neurosurgery floor- a far cry from the NICU job I’d wanted. I learned a lot there- and was mortified at some of the things that the textbooks spent a few paragraphs on (or none at all), and the devastation that can happen in someone’s brain. Near drowning (a 4 year old) is close to the top of the list. She’d never be mobile or aware of much. Progressive supranuclear palsy leaves someone’s mind intact, but paralyzes even their eye muscles, so they’d need special glasses to even watch TV- sort of like periscopes. Until they die. Herpes encephalitis is horrendous. Jacob-Creuzfelt (or Creuzfelt-Jacob, depending on where you are) is a cruel, progressive set of symptoms that eventually shuts down everything. I was getting a full frontal about mortality. Yet, I learned so much. I’ve always enjoyed learning more about neuro after that first hospital job, and went on to work coma-stimulation in a head injury treatment center. That’s all they did- head injuries, and all ages. Long term care and skilled nursing rehab were also extensions of the neuro experience I had.
I didn’t start out where I’d dreamed I’d work when I was going to nursing school. I went to school to work pediatrics. Well, let me tell ya… peds isn’t all it’s cracked up to be. I eventually got a full-time pediatric job, and floated to NICU and PICU now and then. I’d taken care of kids on the floors I’d worked on in regular hospitals, and in head injury rehab. But to get non-stop kids, with many, many horrible abuse stories, or knowing that whatever kid was on the news at 5 p.m. would be one of my patients at 7 p.m. got to be a major grind. That and the reduction in hours based on census was tough; I’d tried to reach the nurse manager of an adult unit to make up hours, but never got a return call (Yankees !!). Where I’d worked in the South, people were glad to have someone show up who wanted hours. At any rate, between pediatrics being totally different (I hadn’t anticipated SO many abuse cases), the hours being chopped, and my health starting to be a major issue, I needed to leave. I thought I’d found my dream job when I got that call that I’d been offered the job. In the end, though I am thankful for the experience, I didn’t like it. I really didn’t like NICU. I learned a lot about where the chronic pediatric patients started, but those miniature babies were not fun to work with, unless I got stuck with the ‘feed-and-grows’. All they had to do was gain weight- otherwise they were pretty stable. They weren’t bad. I saw some babies that were totally unbelievable. No thanks.
For the newbies out there, don’t just focus on what you think you want. Take what you can get and make the best of it. There is an overwhelming possibility that it will make you a better candidate for any job where experience of some sort is required. Serve your time, pay the bills, and work for the goal you think you want. But also don’t be surprised when what you want ends up being very different when you are working with a full patient load on your own. Speculation and assumptions don’t end up being very realistic… ❤