- 10 June 2020
- 17 min read
Nursing Life: Expectations Vs Reality
Nursing realities are: the uniform IS NOT sexy, you WILL deal with a lot of poo, you WILL find out what an enema does, what burn out, chaos and frustration is... and what love and care means.
Topics covered in this article
Hi everyone and welcome back to the blog.
My name is Claire Carmichael and I am a newly qualified general practice nurse.
And today's blog is all about nursing life versus the reality of nursing life, which is two very, very different things as to what you think in your head and you imagine it to be to actually what you do as a nurse.
So, if you have never been in healthcare before, you've never gone into nursing, you haven't got a clue what anyone does, but in your head you're thinking, "Oh my God, nurses are amazing. They save lives, they're incredible, they're always so amazing and helpful, patients are always saved".
And, "Oh my God, it must be amazing to be a nurse because it's just must be a great feeling to help someone that really needs it".
Do you know what?
In reality, nursing is tough.
0.55 Nursing is not easy
It takes a lot physically and mentally, a lot more probably mentally than physically, for probably me.
I don't know if everyone else is like that, but it's such an emotional job and it's really hard to detach your emotions from the reality of what you're dealing with.
And your patients will not always survive.
Sometimes, unfortunately, they do pass away and you have to sort of care for the family members, you have to handle that bad news.
It's not very nice sometimes and it is very, very tough.
And you know what? I'm going to say it.
I wasn't going to mention it, but the nurse's uniform is this whole sexualized symbol, "Ooh, the sexy nurse".
No. No, people.
Why? Why are you attracted to the nurse uniform?
Do you know what we get on our uniforms?
Firstly, my tunic trousers come up to here.
I'm like this, my uniform is like this, and it's the most uncomfortable thing to wear.
Although the uniform I now have is very, very comfortable I must say.
Nine times out of 10 it's like cardboard and you get vomit on it, you get faeces on it.
You get urine on it, you get sputum and things that you don't even know what it is on your uniform, and this is unavoidable.
Sometimes it just happens and it's just there and yeah, that's what I'll tell you.
So I was a student nurse and I was in this bay of patients.
I was there like, "I'm a student nurse, I'm going to save lives and make a difference. This can be amazing, this is going to be a great day. Let's go guys, come on. I'm here for you".
This one patient was very, very constipated.
So she needed to have an enema.
So, if you don't know what an enema is, an enema is a suppository that goes up the rectum, that you put up there, and it flushes it out, basically.
It softens the stool so that you can go to the toilet a lot more easier.
That's the easiest, best way I'm going to explain it.
So I gave her one of these and then a little while later, the patient said really needs to go to the toilet now.
However, as she stood up from the bed to turn and sit onto the commode, yeah, it came out all down my leg, because the way I was standing.
I was sort of trying to guide her onto the commode because she was a little bit unsteady on her feet.
She couldn't mobilize and stuff, but I was just that a little bit of extra support for her.
And the way my leg was, it just sort of went all down my leg.
I was just there like, "Don't say anything, don't say anything, don't make any facial expressions. It's okay, it's okay. It's just a bit of poo, it's fine".
So I was there like, "Come on then. Yes, let's go".
In my head I was panicking. I was like, "I've got poo on my leg, Oh my God, what am I going to do? I've got no other uniform to wear for the rest of the shift".
This was at the start of the shift.
And on the outside it was, "Okay, sit down Lovely".
Got her sat down and I run out of there.
I ran, I had to scrub my trousers.
Oh, reality guys.
4.10 Checking patient details is crucial
So my next story I would like to tell you, is all about my home visit this week.
So, I've been doing home visits to the shielded patients from the GP practice during this COVID pandemic.
I went to this patient's house.
In my head I was like, "Yes, I'm doing home visits, I'm visiting these vulnerable people, I'm protecting the world from COVID. This is amazing".
Got to the patient's house and I said, "Oh, hello, so and so", and she said, "Yes, yes, come on in".
So I went into the house and she said, "I wasn't expecting you til next week".
And I said, "Oh, that's weird. Let me just check your date of birth".
So I checked the date of birth. And she said, "No, that's not me".
I said, "Oh, is your name so and so?".
He said, "No, that's not me, that's somebody else. I'm really sorry, you're in the wrong house".
I was like, "Oh my God, in the wrong house. I'm going to be murdered".
I was so embarrassed.
I was in the wrong house, I almost took blood from the wrong patient.
But even the same GP surgery, she's from a different GP surgery.
She had the exact same address as this other patient.
The only difference was, one was core and one was muse, that different ending on the address.
And so I said to her, "Where's the core version of this address?".
She said, "Oh, it's the literally across the road".
I said, "Oh, easy mistake guys, easy mistake".
But word of warning, check your patient details.
I'm so glad that I always check my patient details anyway, before I do anything.
But that's the reason why we do it.
Because if I'd taken blood from her, that would have been the wrong patient, everything would have been wrong.
And the blood test would have been given to the other patient and it would have caused a whole load of problems.
So yes, that is my other slip-up.
We do make mistakes.
We do get it wrong.
5.53 “Too posh to wash”
So, you might be that person that's going on to a shift and you're going to be like, "This is going to be a great shift. I've never worked here before, it's going to be amazing. I don't even know what nursing is, but I'm here. I'm ready to save lives".
And then you go on and they give you a bay of patients to wash.
And you're going around, you're giving a wash, some people literally have no use of their limbs.
So you have to wash every area of their body, even the genitals.
And you're going to be like, "Oh my God, I did not know that I had to do this. I thought I was going to be saving lives".
But you know what guys?
That area, there's this term, “too posh to wash”.
No, you are not too posh to wash, you will wash your patients and you will do everything you can, because you're going to give the best care possible to your patients as a nurse.
And take this time to do that because reality is that you're building that rapport with your patient.
As you're washing them, you're inspecting their skin.
You might notice a pressure sore coming.
You might notice a rash of some sort and you don't know what it is.
Things that the patient might not feel or see, what could be on the back could be on the bottom, they can't see that.
They haven't got eyes on the back of their head.
So unless you're helping with the washes and doing that, you're not going to be able to document that properly.
So it's really, really important.
And that's your time to make conversations with your patients.
It's an icebreaker, it's really nice to get to know your patients and they will start to tell you things as you go that can really help the health and the treatment that you're giving them as well.
They could tell you all sorts of things that you never thought to ask before.
But just that open conversation that you're having whilst washing and dressing them and taking that time with them, is going to make a massive, massive difference.
So, although the reality of it is no one really wants to wash somebody else's genitals, you really need to put this amazing skill to use because it's going to really help you as a nurse.
And not only that, I doubt the patient wants you to do that either.
I would feel so uncomfortable if someone had to wash my genital areas.
I would be mortified.
So I can only imagine what a patient must feel when you can't physically do that and you're having this stranger come in and doing it.
So, it's about making that patient feel as comfortable as possible around you because that's really important care.
People always say, "Oh, it's the basic care".
There's nothing basic about personal hygiene.
9.03 Managing your expectations
Your nursing expectations are that you are going to be alert and bright and remember everything, and you're going to be so knowledgeable and you're going to do this because you're going to save lives, because you're enthusiastic and positive and that's all it matters, it's amazing.
No, do you know what?
Nursing is exhausting in reality.
You're not going to be alert all the time.
You might have to do a series of night shifts, which completely mess up your body.
But you do get into a rhythm so don't worry guys, don't panic.
It's all right to do night shifts.
But in reality, you're exhausted, you're mentally exhausted because of the amount of stuff you have to deal with.
The knowledge that you have now gained is just filling your brain and you're just like, "Oh".
And you will make mistakes.
You will make really, really simple mistakes.
Like you will write down the wrong word or something like that in somebody's notes, and then someone else will read it and go, "Claire, what are you on about?".
And you're like, "Oh, I have no idea, I'm so tired".
But it's really, really important that if you are struggling and if you recognize that you're actually feeling a lot more burnout or a lot more tired than you think, or if you're feeling really, really burnt out that you recognize that and take some time out for yourself, because you have to be your best self to be able to be with your patients and care for your patients properly.
So make sure you are taking some time out if you are exhausted.
9.49 Not knowing something is OK
And something else that coincides with that is, a patient will absolutely ask you something and you will have no clue what they've just said.
They'll be speaking a foreign language that you don't know, or they might say something... let's just say they ask you a cardiology question, but actually you're not trained in cardiology.
You haven't got a clue about cardiology, and you'll just feel absolutely mortified because you don't know the answer and you'll be really beating yourself up.
"This is what I do, I do it every day".
Someone will ask me something and I'll just be like, "I have no idea, but I can find out".
But it's about being open and honest to your patients and not beating yourself up too much about it like I do.
And if you just say to your patient, "I'm really sorry, I'm not an expert in this. However, I will get my colleague who is an expert".
And that's the best way you can handle that situation.
As long as you're giving them a solution, rather than just saying, "Sorry, don't know, see you later" and ignoring it.
No, you can't do that as a nurse, come on.
Get the help for the patient and find out the answers if you can.
But in reality, you don't know it all.
Nobody knows it all, top consultants don't know it all.
I've said this before in a previous blog, it's impossible for you to know it all.
Your brain isn't that amazing and big that it can store everything from all around the world.
There's going to be things that you come across that you don't know, and it will make you feel rubbish, but you'll get over it and it will be okay.
And the patient will leave happy if you do the right things.
Your nurse expectation is you're going to be Florence Nightingale, you're going to be whizzing around making change, being this great nurse, this fantastic nurse.
And then you get on a ward and you've got one patient buzzing over there, you've got one patient that has just urinated all over the place.
You've got another patient where the catheter is leaking, you've got another patient that is bleeding out.
You've got another patient that is also pressing their emergency buzzer, you don't know why.
11.41 You're there to save patients and give the patient the best care possible
It's going to be chaos and you're going to be like, "How can I make change in a situation like this? I'm no Florence Nightingale, I can't even cope with this".
But do you know what?
You can, and it's all about just being mindful as well.
It's about just taking a breath, relax the shoulders and just go, "Okay, who do I need to see first? Where do I need to prioritize my time?".
And it's something that we're taught as nurses as well on the course, is prioritization.
Because there's going to be a lot you have to deal with all at once thrown at you.
And it is about prioritizing your time and also making use of your team.
This isn't Florence's job, this is yours and your team's job to do this collectively, collaboratively.
You're going to provide the best care possible for your patient.
This isn't a solo job, you're not there to save anybody and get all the recognition and all of that jazz.
You're there to save patients and give the patient the best care possible and hope that they never deteriorate under your care.
And yeah, that's what it's all about.
So, no, you're not going to be this knight in shining armour for somebody, or Florence Nightingale, or Mary C. Kohl's of the world.
You are an amazing nurse with an amazing team, because that's the main thing, you have to use and abuse your team to help you out and prioritize your patients for patient safety.
Nurses expectations versus reality.
So, you are so, "I'm so caring and compassionate and all of my patients are going to love me because I'm so down to earth and I'm a really talkative person".
No. Patients especially, if you're working on a ward, patients are in hospital, they've lost their dignity, they've lost their rights to their own medication.
They've been put in a gown.
They aren't well, they're scared, they're nervous.
They don't want to be in hospital and they are hating everything including you.
It doesn't matter if you're the most positive, happy person in the world, this person has a lot going on right now.
And yeah, quite rightly, they're scared and they're anxious.
And it doesn't matter how much care and compassion you give someone, some people, not everybody, but some people will not be happy with any amount of care that you give them, or any amount of compassion you give them, or positivity, or jokes, or laughs, or whatever.
You will always have that one patient throughout your lifetime, I'm not going to say a day, because realistically it's not a day.
But you will have that one patient who is horrible to you.
But you have to understand why, you have to think, "You know what? Why they being like this to me?".
You have to think that they have been taken away from all of their loved ones, they're alone, they're in hospital.
They're not well, they don't know what the outcome's going to be, and they've lost all of their dignity and the rights to their medication in all of this, obviously for the better, for their own good, because you want them to get well and you're trying to help them.
14.30 Understanding the patient is key
But you have to understand that they have a right to sort of feel like that.
But also they're not right if they're going to start having a go at you, swearing at you, abuse.
We do not accept abuse as nurses. Come on.
But you have to understand that someone might be a little bit abrupt or they might not want to talk to you.
They might just want to sit on and be alone.
They might cry a lot.
And it's nothing to do with you and how you are as a person, it is literally just they're not well and they just need some time to process what's going on.
But just to say that not everyone's going to love you.
You will have one or two people that really don't love you, they don't care about your care and compassion, they just want to get better and get out of there.
So, I've probably put everyone off nursing now.
I promise you, nursing's amazing.
Nursing is such an amazing, rewarding, fantastic career.
It is absolutely fabulous, but I just wanted to do a fun little video to show that actually it's not what you think sometimes.
And you are going to have a lot to deal with, but that's where your knowledge and your experience comes in.
This is why nursing is a degree only course now, so that you can build that knowledge, the anatomy and physiology, all of these things to make sure that you're doing it right for patient safety and to make sure that you are the best nurse possible.
So yes, it is an amazing career, I promise you.
Please don't be put off by this.
This was just a little bit of light hearted fun and just sharing some stories that things do go wrong, it's not all roses and it's tough, but I wouldn't be anywhere else.
And if you have any funny stories to share, that's happened to you on the wards or out in the community, with your patients, please let me know.
I would love to read your stories. Obviously keep patient confidentiality, don't mention names, don't mention where you work, anything like that.
But just let us share some comical little moments that we've all had in nursing.
See you next time.