3 Things I Wish I Knew Then As a Nurse That I Know Now

 

As life unfolds and the years pass, I learned many lessons as a nurse that I wish I had known when I first entered the critical care unit. I was timid, afraid, and filled with insecurity and doubt. Yet, I held a license to carry out physician orders and assist in caring for patients admitted to the hospital with cardiovascular disease, specifically in a unit caring for patients waiting for heart transplants and caring for patients who were recipients of a heart transplant but were in rejection. 

Medicine has come a long way in managing situations after an organ has been transplanted to minimize the incidence of the body responding adversely to the newly transplanted organ by administering particular medications to patients to prevent what Mehra (2018) defined as cellular non-acceptance. However, in worst cases, when a patient presents with a swift onset of organ rejection, patients can deteriorate rapidly, and what we call in critical care circles patients sometimes "crash and burn." 

The learning curve in the unit was steep, but reflecting on it now, I realize I could have been potentially dangerous enough to make someone worse, but I persevered in becoming a competent nurse through blood, sweat, and tears. Nearly two decades have passed since those early experiences, and now I can reflect on them and share at least three insights I wish I had known as a new graduate. Although these thoughts have no specific order, they have all become prominent over time.

Chronic Illness

Number one is understanding the severity and impact on adults with chronic illness in the United States. For Americans, these are cardiovascular disease, kidney failure, strokes, uncontrolled diabetes, obesity and disorders of metabolism, and cancer (CDC, n.d.). They are prevalent and affect adults with an unprejudiced advance on human health. When left untreated or poorly managed, they can be debilitating at the least and increase all-cause mortality. 

As a cardiovascular care provider, heart failure management is the disorder that I am most familiar with, and in caring for patients with heart disease, patients become weakened, especially when untreated. When the heart is sick or failing, it affects all other body systems, notably breathing and respiration. Imagine the difficulty one has when not able to get a whole gasp of air into the lungs or the inability to walk up stairs because of being short of breath.

Not All Doctors Are The Same

Doctors rely on you to be knowledgeable about your patient. Early in my career as a nurse, I believed that medical doctors were the pinnacle of healthcare management, clinical diagnoses, and treatment expertise—and they are. However, as a new graduate in an academic institution, I did not fully comprehend the heterogeneity of medical training: internship, residency, fellowship, and attending levels of our physician providers. Their skill set and privileges perplexed me. 

On average, a patient could have numerous physicians on the healthcare team involved in the treatment plan. As the patient's nurse, you are tasked with interpreting all of their notes, prescriptions, and diagnostic tests that they have ordered. Additionally, I was slow to learn the necessity of all the diagnostic tests and procedures they would order, but they are clear to me now.

I gradually realized that while medical students are bright, enthusiastic, and eager to apply their knowledge, they are still academically differentiated from their peers who are interns. Mark & Wong (2018) explain that there is a distinction between general and specialty knowledge in physician training. While interns are on their path to becoming proficient residents, their hierarchy continues to evolve even as a first-year resident has fewer experiences than a second-year resident. Often, they will graduate and become general practitioners, and some will continue their training through specialty fellowship programs. Fellows need to gain specialized knowledge, training, and experience, particularly when they become attending physicians and join a physician group practice, for they will be the ones calling the shots.

Importance of Self-Care

Finally, I needed to learn how critical self-care is. In the hospital, nurses are presented with first-hand experiential, in-vivo observation of the practice of medicine. In simple terms, you can see how medicine works on patients at the moment they are administered. For instance, when titrating doses of medications that affect heart rate and blood pressure, you can observe the intended effect of certain medications or the pharmacological mechanism of action. In addition, and to conclude my point about self-care, seeing what poor self-care can deteriorate into and, by extension, the effects on patients from nonadherence and non-compliance will wrap up the article.

The American Heart Association has established guidelines for a heart-healthy lifestyle. Following these recommendations as Lloyd-Jones & McKibbin (2018) describe efforts to manage food choices and portion sizes, incorporate daily exercise, maintain a healthy weight, quit smoking, monitor blood pressure, and keep cholesterol and blood sugar levels in check—can contribute to increased longevity and improved quality of life. Navigating health challenges can be incredibly tough, and I remember being a young healthcare provider, feeling somewhat naive about the struggles individuals face in managing their well-being. 

My time in the hospital has deeply influenced my understanding, echoing what Atul Gawande (2014) articulately expresses: our approach to self-care is often shaped by our awareness of the time we have left to live. I recall my experience in my twenties, serving in the Marine Corps, where I felt invincible, almost bulletproof. Yet, now, at fifty, I've realized how profoundly my perceptions of the years ahead affect how I care for my body. It's a journey that many of us experience, where our views on life can inspire us to treat ourselves by making healthy choices or continue to plague ourselves from some of our poor decisions in terms of those modifiable risk factors such as not smoking, for example. 

References:

Centers for Disease Control and Prevention. (n.d.). Fast facts: Health and economic costs of chronic conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html

Gawande, A. (2014). Being mortal: medicine and what matters in the end. Picador.

Lloyd-Jones, D. M. & McKibbin, K. M. (2018). Promoting Good Health. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 1), Harrison's Principles of Internal Medicine (pp. 8-13). McGraw-Hill Education. 

Mark, Daniel B., & Wong, John B. (2018). Decision-Making in Clinical Practice. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 1), Harrison's Principles of Internal Medicine (pp. 13-22). McGraw-Hill Education. 

Mehra, Mandeep R. (2018). Cardiac Transplantation and Prolonged Assisted Circulation. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 2), Harrison's Principles of Internal Medicine (pp. 1797-1801). McGraw-Hill Education.