This is the fifth and final installment of our series chronicling the experiences of two nurses in University of Colorado Hospital’s Graduate Nurse Residency Program.
Maggie O’Connor, RN, with the Transplant Unit, and Sarah Doble, RN, with the Surgical/Trauma ICU (STICU), began their residency in February 2015 as part of a cohort of 50 nurses. They were among the 46 who finished the program and were honored March 10 at a completion ceremony in the Bruce Schroffel Conference Center in AIP 2.
Teams from each unit put their evidence-based projects – a requirement of the program – on display as part of the ceremony. Nursing leaders, including Chief Nursing Officer Carolyn Sanders, RN, PhD, and Associate Chief Nursing Officer Cathy Ehrenfeucht, RN, MS, reviewed each of the 19 poster presentations, chatting with and asking questions of the new grads, including O’Connor and Doble.
O’Connor and Transplant Unit colleague Kelsey Christopoulos, RN, reviewed the effectiveness of a tool used to assess the acuity of patients admitted to the unit. Doble and her team – STICU new grads Jonah Cantor, Sara McPherson and Erica Schick – researched the importance of assessing patients for delirium. They received the “Outstanding Scientific Merit Award” for their work.
Sanders and Mandy Moorer, RN, coordinator for the Graduate Nurse Residence Program, addressed the grads and congratulated them for their accomplishment.
After the ceremony O’Connor and Doble sat down to reflect on a year they both described as challenging but also personally and professionally fulfilling.
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A year ago, new grad nurses Maggie O’Connor and Sara Doble spoke with nervous anticipation about a residency program they’d barely begun. Doble, assigned to the Surgical/Trauma ICU, figured she’d “just keep swimming” as the information and new responsibilities poured in. Asked the biggest challenge she’d faced so far, O’Connor gave two words: “Learning curve!”
A whirlwind 12 months later, the two nurses have finished their residencies. They both feel they’ve only begun to develop as nurses. But they also have a much stronger sense of confidence forged by long hours of classwork and many 12-hour shifts learning the ropes on their units and earning the respect of their colleagues.
“Mandy [Moorer] reminded us we’re not babies anymore,” O’Connor said. “I feel much more confident. I’m still not at 100 percent and still have questions, but there is less panic and less fear. I feel much more in control. I might not be calm, but I feel like I can fake being calm better,” she laughed. “And if someone asks me a question, I can actually answer it.”
“I feel a lot more confident in what I’m seeing with my patient assessments,” Doble added. “When I was brand new, I’d say, ‘Okay, this is what I think I’m seeing.’ Now I know if I’m seeing something, it’s probably what I think it is. The instances where I’m not sure are much rarer.”
They both admit to being somewhat intimidated at first by the bustle and mix of more experienced providers on their units. With time, they’ve found their place and established their positions as team members who collaborate with colleagues.
“I feel like I’ve got a validated place now and know what my function is,” Doble said. “I know my part and where it goes from being something I need to do to something I know somebody else needs to do.”
Still a long road
O’Connor said that while she knows she’s come a long way in building her skills, “There is always something you’ve never seen before.” She related the example of recently having a patient on peritoneal dialysis.
“That’s not a big deal but I hadn’t had a patient on it before.” O’Connor needed a little help from a colleague when the patient asked to use the bathroom. She said there are still instances like this when she feels she shouldn’t have a question, but does.
“But the fact is, we’re still learning,” Doble said. “No patient is the same. No situation is the same. You can have someone who has a similar injury [to someone else], but you’ve got two different prior medical histories, and that’s going to change how you treat them. I have a charge nurse who always pushes me with questions, and I love it, because I can flat-out say, ‘I don’t know.’ It’s nice to have people who want to keep you on your toes and encourage you.”
Tip of the hat to teachers
Both nurses give great credit to their preceptors for answering questions and showing them the right way to do their jobs. A central message: Always treat patients and their families with respect. For O’Connor, the primary purveyor of that lesson was Martha Karnell, RN.
“She always taught me not to ignore the family,” O’Connor said. “Address them when they are in the room. I remember a lot of what Martha taught me, and I still think about it, more so now than when I first started. I feel like she’s still following me around. That’s a good thing.”
Doble said she too learned from her preceptors to be an advocate for the patient and the family. “You’re invested in their care,” she said. A big part of that care, she added, is learning to “constantly think critically” and ask questions about what more could be done to manage each patient. That includes ensuring safety. Doble recalled a preceptor – “OCD to the max,” she said – who constantly drove home the importance of keeping patients’ lines untangled and clearly labeled.
“She always made sure there is a very clear path of what is going into the patient,” Doble said.
It’s the job
The two were satisfied from the start with their units and are very comfortable staying with them. Still, they work in a busy academic medical center that treats complex patients and deals more than occasionally with capacity issues and spot staffing shortages. Any given shift can bring less-than-pleasant moments that are part and parcel of providing health care, like the patient who peed on O’Connor’s pants recently. She took it in stride as part of the job.
“I thought, ‘This is my life now,’” she said.
Doble said she still struggles to come to terms with caring for patients who have poor outcomes. “I always feel that there should have been something more that I can do,” she said.
They have learned to deal with the stresses of nursing in their own ways. O’Connor makes a point to take a few minutes to go outside and get some fresh air or eat lunch. “Even if I think it’s the worst shift of my whole life, I say to myself it’s 12 hours, and I’ll get through.” When she has off time she likes to get outside for biking, hiking and decompressing.
For Doble – an admitted adrenaline junkie – stress relief is rock climbing. “It’s meditative,” she said. “When I’m doing it, I’m thinking, ‘What’s my next move?’ I can’t think about the upcoming four shifts that I have.”
The strategy carries over to nursing, Doble added. She tries to organize her tasks and move through them methodically. “I have to think about what’s my next high priority on the unit,” she said. “It’s my go-to thought process.”
On to the next
Learning was a constant throughout the year, and the experience opened other avenues they’d have liked a little more time to pursue. O’Connor wishes there had been time for elective courses in areas like wound care and glucose management. Doble, who is firmly committed to critical care, would like to have floated to the hospital’s other intensive care units. “ICUs have so much to teach,” she said.
As they prepare for year two, the nurses can mull many possibilities. Doble has been asked to take a preceptor class. “If I feel like I’m ready, I’ll go for it,” she said. “I feel like the coming year will be about feeling out what I’m passionate about.”
O’Connor thinks about joining professional organizations and says she’d like to precept “eventually.” She also looks forward to continuing to glean knowledge from her colleagues and learn techniques for things as typical as hanging fluid bags.
“It would be cool at one year to shadow a 10-year nurse to see how they do things,” she said. “It would be interesting to see how they set up their day.”
For those coming after them, they have straightforward advice.
“I would tell new grads there will be ups and downs, and those are to be expected,” O’Connor said. “I know they will be surprised by how fast it goes. I am excited for them.”
Commitment and patience are key, Doble added. “There will be rough days and days you say, ‘I don’t know if I can do this,’” she said, “but those moments will pass. It doesn’t get easier, but you do get better. You are learning in order to be better.”