Do no harm. Take no sh*t. Whether you’re a new nurse or a veteran member of the clan, the nursing learning curve is a vast one. Part how-to-guide with a touch of memoir thrown in, take the time to laugh and cry with an author that says what everyone else in the field is thinking. Sonja M. Schwartzbach, BSN, RN, CCRN is a critical care nurse and blogger for the Huffington Post. She possesses a BS in Nursing as well as a BA in English Literature, both from Rutgers University. Sonja has written content for numerous professional nursing outlets (the AACN; Nurse.com; Scrubs Magazine), and is a contributing author for Thrive Global, the Youshare Project, and her own blog/website. No medical residents were harmed in the creation of this book.

Excerpt from “Oh Sh*t, I Almost Killed You! A Little Book of Big Things Nursing School Forgot to Teach You”

I’ll always remember my first. It hurt. A lot. He was in his eighties, and his name was Joseph. It was uncomfortable nearly to the point of unbearable, but I made it through the cold and gray afternoon. I survived the experience, and I was a changed woman because of it. Every nurse remembers his or her first patient death. I’ve seen dozens and dozens of patients die since that chilly November afternoon, but I will always remember Joe as the one who shaped how I would respond to these moments in the future.

Most people don’t go to work and see dead people. Most people have careers that might be challenging and interesting, exciting and on the cutting edge, but generally speaking, nobody dies from an unanswered email. That is the thing about being a critical care nurse that has both helped me find perspective in some situations, and frustrated the hell out of me during others. There will come a time as a nurse – whether you are brand new or have some solid experience under your belt – that you will lose someone. It might be a dramatic code blue made for television drama, or it could be a planned transition with a morphine drip and a grieving family at the bedside. No matter the circumstance, there is nothing that will prepare for that day when it comes. You’re going to take it all in – every amp of epi you might have pushed; every fragment of rib you compressed; every drop of fluid you administered – that’s going to circulate within you for a while…and this is totally normal. New nurses walk into their roles with the understanding that well people don’t frequent the hospital: sick ones do. But there’s something so raw and real about seeing a human being take their last breath – no amount of studying will ever teach you how to feel or think in that very moment. When I lost my first patient, it was something of a planned event. He was elderly; had multiple chronic issues; and decided that he had fought as much as he was willing to fight. Joe drifted off peacefully into the afterlife while his children surrounded him.

When I compare that experience to my first loss in the ICU, the clinical picture couldn’t be more of a polar opposite. The bleeding and coding and compressing and screaming have left a permanent imprint in my brain. It’s been locked away in my nursing arsenal along with a laundry list of things I felt that were in my control, and others that I only could have dreamed to understand. My first post-surgical bloody ugly code made me feel like a useless member of the surgical team. I blamed myself for the fact that my patient came out with a surgical complication; one that could only have been fixed was through sternal re-exploration. Although I held my own and tried to titrate medications and hang blood products as quickly and safely as possible, my baby nurse reserve was very quickly depleted. After coding the patient back into the operating room and hearing a few hours later that he died on the table, I could feel my face become flushed and the tears well up in my eyes. Maybe I wasn’t tough enough for this place. Perhaps I should have never left my comfort zone and entered a world where life and death are literal components of every single shift. Before I could say a word, my charge nurse approached me and told me to stop. She could see what I wasn’t saying out loud written all over my face, and she halted me dead in my tracks.

“This is not your fault. Sometimes these things happen. We did everything possible, but sometimes that isn’t enough. We can’t save every patient, every time.”
She insisted that I take a walk – grab a cup of coffee, take a breather, maybe even go cry in a bathroom – but refused to allow me to take credit for such a devastating loss.

Every nurse was once a new nurse, and every nurse has a story similar to my own: one that forced him or her to question why she even decided to enter the profession in the first place. I don’t care if you work in the most cheerful newborn nursery or the most sick-as-hell ICU in the place: really, really bad things are going to happen, and sometimes you’ll be the one that carries the weight of it all. Never once during nursing school did anyone explain to me what emotions run through your head after bagging your first body. Nor did any instructor prepare me for blood-curdling screams and tear-streaked faces of loved ones who are devastated by an unexpected end. Hitting the “start” button on a morphine drip – one that ultimately would stop my patient’s respirations and eventually their heart? There’s no chapter or quiz to cover that one, either.

Learning all of the nursing basics is hard enough: the tenets of patient safety, medication administration, knowing when to contact a physician (and how) are just the tip of the newbie iceberg. Now add traumas and codes and emergency surgeries into the mix – well, no wonder we question what the hell we are doing so much of the time! The most critical lesson I’ve learned that I hope to pass on is this: it never gets easier. You simply learn how to deal with the really bad days in a variety of ways. Hopefully these methods – part defense mechanism, part cheap therapy – are enough to send you to bed after a really awful day, and allow you to wake up hopeful to return to work the next.