g'night.

With much trepidation, I start night shift tonight.

With even more trepidation, I'm off orientation next week.

The latter is enough to give me pause, because despite having been at this ICU gig since February, I really don't feel like I'm ready to be doing this on my own. I mean sure, on a good unit, you have your peeps, your back up, your whatever... but I just don't know if I'm ready. It doesn't feel like it's been five months, and sure, I've learned some skilz and stuff, but how can they just let me off on my own like this?!

Wailing and gnashing of teeth does nothing to persuade people I'm Not Ready And Need More Time, however. Again, it's sink-or-swim time. I remember being a new grad, fresh off of orientation, and going to work actually was scary. While My First Nursing Job (tm) was legitimately frightening, there's also that spankin' new green feeling I have to deal with again, and it feels almost precisely like being a new grad. Except there's even more pressure, because I've been a nurse, and I'm supposed to magically know this stuff.

I do admit it is somewhat less difficult now to be The New One than it was really being The New One back in February. (Especially since no one's really thought of me as the new one for months, and people kept asking, "When are you off orientation? Why aren't you off orientation yet?!" and I kept having to explain how I was new to ICU nursing, and then they'd look at me puzzled and say, "Oh, but you know this stuff. Why aren't you off orientation?")

I wasn't sure how to feel about that. Like, did people think, "What the hell is her problem? Is she like, the Special Needs Orientee From a TRY-CU, who clearly isn't up to our world-class standards of bad-ass ICU nursing and needs the Remedial Orientation Version 2.1?" Or were people trying to give me a compliment, as in, "Wow, you're an awesome nurse. What's the bureaucratic glitch holding you up from being One Of Us?"

I certainly don't feel like an awesome nurse. I feel like a brand new grad, right off of orientation, who thinks these people are crazy for letting me practice nursing without a preceptor. I feel like I should be on at least two more months of orientation, or should be allowed to go back to stepdown, where I clearly worried way too much over patients who were stable.

I'd be great at stepdown now. I mean, seriously, what's the worst that can happen? You get an unstable patient you have to manage until they go to the ICU? Big deal.

It's much different now. While every once in a while we do a lateral transfer in an ICU, it's usually to get a much sicker patient instead of the stable ones.

Any way, back to this "Am I ready or not to be off orientation?" internal debate. After about three months or so, my main preceptor kept saying, "Why aren't you off orientation yet?!"

Well, first of all, no seasoned nurse worth her salt is gonna pass up the opportunity to have another nurse ready to back her up if she needs help--I don't care if I was working the floor, I'd still grab the chance to have a "preceptor" for weeks and weeks if I could.

I mean, yeah, the last couple of months have pretty much been me, taking assignments more or less by myself and having my preceptor act as back up/resource when I needed her. And it was a great set up. I loved it. Some days were better than others, of course, but on the whole, I knew one of the reasons I stopped getting so stressed out about work all the time was because I knew I could never get into a situation where I'd be pushed to the brink of fatigue, anxiety, or cluelessness and not have someone help me.

That's where a large part of the burn-out comes from in nursing, any way--feeling (and in some cases having) to do everything all by yourself. I've worked a few of those kind of nursing jobs--and they are brutal pyschological torture at best.

In fact, I think this is how the floors should run: more seasoned nurses acting as back up to the younger ones who need to learn this stuff.

People keep telling me I'm ready to be off orientation, but I think I should feel more ready to be off orientation.

However, like going to nights, I don't have much of a choice. I have to learn how to cope. That, and maybe figure out who I can sleep with to get to the head-of-the-list to go to day shift.

Just kidding.