This week marks 29 years after our class graduation from nursing school. I couldn’t help but reminisce how much we have evolved in our nursing practice all throughout these years. This post most probably will not encapsulate the true image of nursing practice for the past three decades. Nevertheless, let me share with you what my experiences have been.

The Paulinian Brand of Nursing Practice

As I have shared in one of my previous posts, I was educated the Paulinian way. In essence, the Christ-centered education we acquired emphasizes that we treat every person we come across (e.g. patients, colleagues, etc.) as the image and likeness of Christ. This is very fitting since our school motto is Caritas Christi Urget Nos, meaning the love of Christ urges us. In a nutshell, our brand of nursing practice is serving those who needed our care while upholding that human dignity and respect.

It is part of the Paulinian tradition to name each class, and ours is Fidelis Christi Mariae 1993. It is Latin for Faithfuls of Christ and Mary. As nurses, we daily strive to live up to being faithful to the Gospel and to the examples of Jesus Christ.

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Nursing Practice: 1993 to 2000

In The Beginning

I started my career as a volunteer emergency room (ER) nurse in our small local hospital. We basically had our ER, two nursing stations, and an outpatient department. We had a laboratory for simple tests and a radiology department for x-rays.

Our patients were mostly indigents and we depended on government support. With that being said, I was (and still am) impressed with how bright the nurses and the doctors there are. They can diagnose and manage patients even without computed tomography (CT) scan for example. For that reason, I was fortunate enough to really practice my critical thinking skills, prioritization, and triaging because every day was a sink or swim kind of day. What we lacked for technology was more than compensated by the highly skilled and very resourceful clinicians I had the pleasure of working with.

My few months in the local ER aptly prepared me to finally become a full-fledge earning nurse in my alma mater. St. Paul’s Hospital at that time just had an expansion and we were fortunate enough to be hired as newbie nurses. We had more access to technology compared to my old setting. However, we competed with interns and residents to gain hands-on experiences (e.g. wound dressing, intravenous [IV] line insertion, etc.). Pretty soon, I mentored a group of nursing students during their clinicals in the very same setting. I could vividly remember what I used to tell my students before:

You will learn more about these things (e.g. procedure, workflow, new diagnosis, etc.) as you grow in your nursing practice and career.

Little did I know that that line would be applicable to me and to all the other nurses as lifelong learners.

The genesis of my nursing career

Migrating to the States

I was so naive when I first came to the United States. My only expectation at that time was to make enough money to help send my brothers to school. I didn’t even bother to research what I was getting myself into. I was not going to let that opportunity pass me by, was my mantra at that time.

It was difficult working in a long-term care facility. Aside from an unknown workflow, it was not easy adjusting to working with people from different backgrounds. Most of the people I initially worked with were nice, but a few, not so much!

The hardest thing for me was not understanding how to appropriately deal with Alzheimer’s patients. As a typical Filipino, I was very emotionally sensitive. I allowed all those curse words to get to me. I was a tough under board nurse barely making enough to make both ends meet, but I remembered crying myself to sleep at night. My calendar then had X marks, counting the days until my year of contract was over.

Aside from that difficult adjustment at work, I had an unfortunate experience with my kababayans (countrymen). That was when I proved that crab mentality really existed. Nevertheless, I learned my lesson well. Maybe, I needed to go through that dark chapter in order to be more resilient and understand the plight of others, especially fellow Filipino nurses who are just starting out.

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My Biggest Takeaway: Time Management

I continued working in long-term care until the dawn of the new millennium. I first worked as a nurse in the Medicare wing and ended that stint as a nursing supervisor. With so many patients to take care of, it was imperative to develop my own kind of routine. On good days, I had 25-26 patients each shift. However, there was a time when I was the only nurse in the house. I had 204 patients to whom I passed medications. My nursing assistants, bless their hearts, kept everyone alive, clean, and fed. When pressed for time to do everything else, I had to prioritize what needed to be done. I also delegated tasks to other members of the team.

Y2K and the First Few Years of the 2nd Millennium

Medical-Surgical and Oncology Nursing was an upgrade from my skilled nursing facility job. I’ve always wanted to work in a hospital and that was my ticket to the door. That was where I first learned about computer charting, although the functionalities were very basic. We entered our vital signs and documented our care plans in the computer. For the rest, we still maintained individual paper charts. Doctors still wrote their order, and yes, we still had to decipher their shorthand-like penmanship.

What I liked about that experience was how topnotch our tools were when it comes to taking care of our patients. We had IV pumps and all the required personal protective equipment (PPE) necessary to administer chemotherapy. We also had all the isolation protocols in place whenever we had full-blown Acquired Immune Deficiency Syndrome (AIDS) patients in the unit.

That setting allowed me to hob-nob with fellow nurses in the facility to tighten our falls and restraints policies based on lessons learned. Priority setting was still utmost because a stable patient could turn for the worse in a blink of an eye. An example was when we coded a patient who a minute ago was happily eating her breakfast while we were giving our morning report.

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Taking Care of the Pediatric Patients

Working in Pediatrics and the Pediatrics Intensive Care Unit (PICU) afforded me more opportunities for growth. There, I learned to closely monitor a newly diagnosed Type 1 diabetic patient, for example. That also ingrained within me the need to always double-check the weight-based doses of medications. Family involvement was the cornerstone of the care provided to each of our patients. More than the necessary drips, I had to factor in where moms’ or dads’ perspectives have to be considered.

When I was the chair of the Pediatric Unit Council, I advocated for health information technology (HIT) tools to be children-specific. The same went for the training of the staff. We reasoned out that children are not little versions of adult patients. Clinicians who take care of them should have the proper training.

That was the precursor of my age-specific and specialty-specific advocacy for HIT tools. My certification in Pediatric nursing gave me that much-needed boost to get our team’s point across. If we don’t own and advocate for our practice, who will?

2010 and Beyond

Aside from being one of the permanent Charge nurses, I found myself to be much more involved in streamlining workflow and in finding appropriate HIT tools for our population. I welcomed the opportunities of being a superuser for initiatives such as IV interoperability and the use of the human milk management system in Pediatric settings. My frontline activities have evolved into becoming an unofficial leader and educator.

In as much as I am the least techie person I know, I found learning new technology to be both challenging and enjoyable. My Why questions were quickly replaced by How? Instead of saying: why fix what ain’t broke? I started asking:

How can this HIT tool be leveraged for better use at the bedside? Can these tools improve the nurses’ workflow? How can we make it more user friendly to increase compliance?

When subject matter experts were identified to be involved in the implementation of the new electronic health record (EHR) system, I jumped at the chance. At that time, I was juggling a full-time Pediatric nursing job, a per diem Special Care Nursery job (at another facility), a full-time graduate student load, and training for the EHR initiative. I didn’t know how, but I survived those trying days. My firm foundation on time management came to my rescue, yet again.

Exploring the Unknown World of Nursing Informatics

My involvement with the EHR implementation increased my curiosity. I started asking why do some clinicians opt to do workarounds where HIT is involved? Are the available tools we have hard to use? Do we know how many errors didn’t reach the patients because of the use of HIT tools?

To find answers, I started running the reports. Then, I coordinated with the Risk Department. We compared notes on the number of reported safety events. The potential for improvement is still great. We can start working on bridging the knowledge gap.

Those are the qualities that I brought to the table when I applied for my current job. The fact that I understand the workflow like the back of my hand helped me tremendously. Of course, knowing people who know people expanded my network. That wealth of resources provides support to me daily.

Nursing Practice Is Like Putting the Puzzle Pieces Together

Looking back, my almost three decades of nursing career honed my skills, knowledge, and attitude in ways I could never fathom. Having that solid foundation, I just continued to build on that. Every experience, good, bad, or ugly, became parts and parcel of where I am currently at. Each of those days or fields has contributed into the kind of nurse that I am today.

That Paulinian motto still continues to inspire me. I am hopeful, that my experiences will serve as lessons to those who are just starting on their own nursing careers. Eventually, I aim to be a mentor to those who may want to expand their nursing horizons. I am lucky to have met mentors who were genuinely invested in helping me reach my fullest potential.

I want to pay it forward if given the opportunity in the near future!

What about you? How has your nursing practice shaped you into becoming that nurse or the person that you are today?