Rites of Passage

I haven't read my Durkheim or Geertz in years (try fall 2003) but the whole idea of rites of passage in nursing kind of interests me. What are they for us? Do we have them? Doctors have it formalized, right down to the hazing, with the whole internship/apprentice medical model.

But what makes a nurse go from grad nurse to RN to experienced nurse? Nursing school loves to get hot and bothered about "From Novice to Expert: Excellence in Clinical Nursing Practice" by Patricia Brenner. I should read it, because I'm probably not saying anything she hasn't said already (dammit isn't there something interesting out there that hasn't been "done" to death that I can get published in popular press and live off the royalities? HUH?!)..

Any way, my random survey of my own brain came up with a couple obvious ones, like pulling your first "double" (two eight hour shifts back to back, or sixteen hours straight. I've done two in my career--one as a nurse from 3pm til 7a.m. the next day. It was to help out, because they were going to do another famous [community hospital] 3 way swap and leave us with a tele float and a non tele float nurse, plus one original staff member, which is a very unsafe situation as each night shift nurse takes six patients.

The idea is basically, as tele nurses, we can float to any other medical unit in the hospital except acute ICU (we can do sub-side, or sub-acute ICU because we are critical care level I and telemetry certified). ICU nurses can float any where within their speciliaty (medical or surgical). Some units only float to a sister unit. However, medical, non-tele nurses can't float to sub-acute ICUs, but can float to telemetry units. Think about it. It doesn't make any sense, does it?

If we were to play this line of thinking out to its logical conclusion, then tele-nurses should be able to float to acute ICU, too (thank God they don't make us do this, by the way). If a med-surg nurse, who doesn't know, much less is certified, in telemetry, can come to our floor, then we should be able to float to acute ICU, because we aren't Critical Care level II certified, right?!

Any way, they send us non-tele nurses, and then we have to "cover telemetry" for them. Which means, depending on how bitter and lazy the float is (most are good; some are downright scary), you could be just about taking over the patient's care yourself, as I did one night, paging the HO half a dozen times on a patient whose "telemetry I was covering" while the other nurse read a magazine for half of her shift.

You think that's scary, wait until you hear this story. So, I'm working an evening, and we get a float. One of the other nurses tells me the non-tele float came up to her and asked, in one of those "Is that a question or a statement?" ways, "So the monitor says asysotle?" And so the tele nurse says, "Uh, I'm assuming your patient has a pulse and is breathing... did you check the leads?" And then she asks the tele nurse what an "ablation" is, because that's what her patient had, and she has no idea what it is.

Ten minutes later, the nurse we later dub Scary Asostyle Nurse comes up to me and asks me the same thing about the bedside monitor, about how it says "Asystole" and then she went on to ask about what an ablation was. I was like, "Is he off bedrest, how's his groin site look?"

Okay, so this isn't really to diss that nurse. I think she was a rehab nurse, and to be fair to her, it's a completely different skill set. Pop me up to an ortho floor and I wouldn't know how to set up Buck's traction if the equipment came with instructions. (I would, however, figure if the patient was set up to equipment and clearly had a pulse and was breathing, that "asystole" on the monitor means the monitor and leads aren't set up properly. But who knows. It can be very disconcerting to float, especially out of your speciality in an area like cardiac.)

The point is: you shouldn't float non-certified nurses to units that aren't within their speciality and skill set. Like I said, this could happen to any one of us. It would be as silly as sending me to MICU acute side and knowing how to deal with vent settings and multiple cardiac drips.

Okay, so all that prelude is neither here nor there.

I was talking about Rites of Passage. And I'm trying to think of positive ones and I really can't, sadly. Most of what makes you a good nurse are some pretty crappy situations, actually.

Like working doubles, first codes... I had some other points before I got off-topic.

Whatever. I'm going to get a DVT by sitting on my ass for about five days straight.