Competence in Chaos

This was really hard, but if I can make it through, so can you!! I had a mix of seasoned and new nurses who were mean or kind, knowledge sharers and non sharers. Initially this mattered a lot, but ultimately, as I changed and grew, it mattered less and less, because my knowledge base and confidence grew, and I could advocate for myself as well as my patients.

I was so focused on what people thought, and learning how to take good care of my patients, and time management, that I didnt stop to think about why I was full of anxiety and in tears at some point every day. I started having nausea and panic at the thought of coming in to work because of mean nurses who made fun of me, or made disparaging comments instead of helping me to become better. I just believed all the negatives. Dont do that! You can become a great nurse! All of us have different skillsets, and you will find yours, if you are persistent and patient with yourself and others. We all have gifts that the patients and other members of the healthcare team can benefit from.

I didnt realize that the fuzzy anxious feelings, nausea and tears were not all emotional. It was also sensory overload, and feeling overwhelmed. There are buzzers, bells, clicks, tons of people, and a whole bunch of stuff going on all the time. It doesn’t ever fully stop…but there is a rhythm to it. It ebbs and flows. Even in the bathroom, or in the breakroom, call lights go off, lab calls with critical, family members ask for updates at bedside, providers ask you to take orders. You will find the lulls in the rhythm eventually, and use those to catch up on charting, pee, eat something, and step back so you can regroup. Initially, a new nurse doesn’t see the rhythm, and it will feel chaotic.

Some things that help every new nurse: get to work early so you can look up your patients before getting report. Look up med times for each patient, so you can give them each on time. Organize your patients by med times and prioritize by needs. Create a simple sheet that lists basics for each patient- assessment, med pass, charting, chart or order checks, whiteboard, tasks, careplanning, fall precautions, in whatever order works best to keep you on track. Focus only on the patient you are taking care of when in the room with that patient. In simple terms, create some order in your seeming chaos.

Until you are comfortable dealing with patients, script your dialog. An example would be: Hi! My name is Alli, and I will be your nurse today/tonight. Are you having any pain or nausea? Can you point to where? On a scale of 1 to 10 what is your level…. While I am in here do you need to go to the bathroom or be changed ? No? Ok. I am getting report from the prior shift on all my patients, but after that I will start checking on all of you. If you need me just press your call light…yes that button.

Scripting is a great tool to improve patient satisfaction survey scores too. If you announce before you walk in to a patients room let me sanitize my hands for your safety, and they see you rubbing hand sanitizer on your hands, they will say yes you were.doing that on the survey.

The hardest hurdle as a newbie for me was sensory overload. I got better at recognizing when it was happening, and found that all I needed if I caught it in time was a few minutes in the med room or supply closet of quiet, and I could get rid of the impending tears, fuzziness, and anxiety. If I didnt do it, I would fall apart. I also needed to not talk for a few minutes when I was at that point. Talking would also bring on tears. Another trick is to stop thinking 10 steps ahead with all the what ifs…Instead, make yourself focus on only the current task. You have to.

I play soft classical at my computer very low while charting. It gives me a focal point other than the constant noise of the hospital. I can still hear my patients, but it helps me. I have a fidget toy in one pocket, and snacks. It also helps me to know that other members of my team have anxiety, depression, health problems, and various issues of their own, and we support each other. If someone needs a moment we pick up their work for a few minutes to give them that time. It’s part of being a team, and a work family.

As an aspie, it may take longer to build those bonds with your coworkers. You will, though. They need to know you to trust you, and that takes time. Do your best, stay positive,ask for help and advice, and offer to help when you can, and it will happen. My first year was rough, the second was better, and now in my third, I am ok floating to other units, and stepping up to new challenges. I am not going say its it’s easy- I still panicked the first time I floated to the emergency room, as I didnt have a log in, know their charting system, or game plan/rhythm. Our charge rn talked to that unit’s charge, as did I, and I got a quick overview of the charting, a log in and a plan. I did fine, and know I can do it! I still face some challenges being an aspie, but I have the tools to deal effectively with what comes my way. I know I can make a difference and do. Be kind to yourself. That is the first step. You cant be effective if you are being a bully to yourself. Face outward, not inward.

No Express Elevators, Just Lots of Steps….

So now we come to the part that requires courage for any new nurse, the process of learning that will take you from newbie to competent. There are no express elevators, no shortcuts.   For me, in particular, this was especially difficult.  A young confident person sees what they do right more than what they do wrong.  They aim themselves in a direction and go.  I was older, more cautious, and I wanted and needed all the answers so I could see all the options and consequences of interventions.  I was acutely aware of any information missing.  I spent every day looking at my actions and determining what worked, what didnt, and feeling terrible because I wasn’t perfect.  No patient was harmed, they all got good care, but I could not see that then.  All the light, noise, people and stress bombarding me was magnifying my issues, and I had at least one meltdown a day, and could not let anyone see what was going on, because normal people dont do that!!  Despite this,  I loved taking care of people, and all things medical. It was my special interest.

So over time, by working on nights, with persistence, practice, a firecracker of a preceptor, and a few compassionate coworkers,and teachers turned friends, I first got to the point I could tamp the anxiety down, and didn’t hit that meltdown stage til the end of the shift, then until after the shift, and then I had a day where I didn’t cry.  I was over the moon happy to have taken care of my patients well, and was ok on the inside as well as the outside at the end of the shift.  It took me a year.  It would be another 6 months before I started to build confidence and realize I did provide good care, I was becoming the kind of nurse I always wanted to be, and it would be at the two year mark when I stood up and advocated for my patients, and another 6 months before I started advocating for myself, and really caring for myself as well as I did others.  Next up, how to avoid the melt downs in the first place, how find calm in chaos, how to pick your battles, and ask for help from the coworkers who will become family.

Confirmation and Becoming

I finished my nursing prerequisites in 2010, with the help of testing accommodations, and the new knowledge that I was smart, and just needed new coping skills/work arounds to deal with the visual processing deficit, and processing speed deficit,   It was a relief to have some answers, and tutoring on how to shore up my weaker areas with other senses.  I used a program that read the textbooks to me out loud as I read them visually. This brought two senses into play, and increased my focus and retention of what I studied.  I determined that my processing speed deficit only affected my speed learning something new. Once I knew something I could access it just as fast as anyone else.  My grades had jumped half to a full letter grade after learning these things. I felt confident and ready to take the TEAS test, and begin the nursing program.  (The TEAS test is the CA entrance exam for nursing majors at most 4 year colleges.)  I scored very high, and had good grades.  I should have gotten in easily, but was getting turned down at every school despite meeting the requirements.  I had been honest, declaring my learning disabilities, and was told I was admitted to the college, but nursing was an impacted program. I could go on a wait list, anywhere from 1000 to 3000 people long, and it was a lottery program where they accepted 12 candidates per year.

I did the unthinkable and applied to out of state colleges, and panic set in when one of them said I was accepted pending passing their entrance exam. It had been 3 years since my last prerequisite, and I studied for two weeks between jobs, flew into Arizona, and took the entrance exam, and was back at work the next day in California, at both jobs.  I cried when I got my acceptance letter, because it meant doing the scariest thing in the world to me.  I had to quit the two jobs I had from 2001-2013, leave friends that it took me 20+ years to make, move to another state, and figure out how I was going to live and pay for nursing school.  My friend Amber saw how scared I was and helped me move, but then she went back to California. She could see what was going on,  but could not understand why something wonderful and exciting could affect me this way.

Eventually, I did calm down, and I was doing well in the program.  I still had severe anxiety with each new thing, especially skills returns, and group simulations.  I was socially awkward, except when I was actively taking care of patients, because I felt comfortable with them as long as I was doing something for them, or teaching.  Besides, it was the only social outlet I had, other than talking to a few classmates who had accepted me in class but never asked me to coffee or anything.

It was the end of the first year, and all of us who had made it were getting ready for our pinning ceremony, everyone had broken off into excited little clusters of friends, except me.  I felt so very alone in thst moment.   I knew something was different about me, and I didn’t know how to fix it.  I started wondering if maybe the first diagnosis of being autistic that they tried to tell my parents I was in grade school had any truth.  My parents discounted all the diagnoses that I had been labeled with, so I really didn’t know.

I put together the money and had myself evaluated for autism, and all of the other labels that were thrown at me while growing up.  It was determined that I had Asperger’s syndrome., now called Autism Spectrum Disorder.  It explained why I felt anxious with change, awkward in social situations, and did best socializing with a purpose.  It explained why I had to force myself to make eye contact, and sit on my hands to keep from fidgeting, and why after prolonged social situations and 8 hour classes I needed absolute silence and to be alone. I cried when I found out, and it took some time to absorb.

This would be the turning point for me. I quit focusing on being accepted, quit trying to figure out what normal was and emulate it.   I embraced my weirdness, and learned what I thought was anxiety was not.  It was over-stimulation and meltdown.  I learned to take breaks and prepare myself for possible changes, and take my classmates at face value since I couldn’t read between the lines, and was just driving myself crazy trying..  I stopped attempting small talk. I focused on the big picture- practicing skills, scripting my dialogue, reading books on body language and coping skills for Aspies.  These would enable me to function better as a nurse, which is all people, and all change, all the time.  I started talking about what scared me, or concerned me during clinicals. I got help, I got answers, and moved on to the next tasks.  I started running toward what scared me, instead of away from it, as the only way to become a nurse was getting past the roadblocks.

I had 3 teachers who were really there for me, and by the end of the second year, and graduation, I had friends.  Not many, but a few. To know that there were people in my corner was everything.  I was getting ready for graduation, and I felt that feeling of being overwhelmed and panicky.  I knew it was going to be too much.   Too much noise, too many people, and I would have to walk onto a stage and be seen by all of those people.  Amber had come out to be there with me for graduation, and Amy was there hitching a ride with us.  She handed me a Bloody Mary at my request, and it tamped down the feeling for all of 15 minutes.  This should have flattened me, as I don’t drink, but in that situation, it barely did anything.  I got through it, because they were there, and it was important for Dad to see me graduate.  I had promised Mom and Dad that even if she died before graduation I would finish…and she did a month before, after an 8 yr fight with cancer.

So I made it through nursing school, made a few friends, passed the NCLEX-RN, and landed my dream job, at the organization of my choice.  I sat calmly at the interview, hands clasping each other in my lap,  looked the interviewer in the eye, and when asked what I knew, I stated, I know skills can be taught, experience takes time, but what I have right now are the parts that can’t be taught.  How to make someone feel heard, cared for, and how to help someone feel less scared, because I know what it feels like to be where they are.  I got the job, and that steep, scary learning curve was about to begin, but I walked out on top of the world.

 

The first clues and solutions

I know I am skipping over much of my growing up years, but that is because they are not relevant to the subject at hand.  Some of the stumbling blocks I ran into as an adult student were overcome by sheer determination.  Math was my worst subject, but to get into a BSN program, statistics was required.  I ended up taking math courses  7th grade level pre algebra all the way through statistics, so several years of math.All was well, and I was an A student until statistics and chemistry.  I could not keep up with everyone else on time tests and was flunking from not being able to finish.   I was scared something was wrong with me, so I went through getting tested for learning disabilities.  While my IQ was deemed very high, I did have a visual processing deficit, and a processing speed deficit.  I got accommodations to take my tests in a quiet room with more time, and improved immensely.  I learned coping skills, and work around to get past these issues, and gained confidence in my ability to do anything I set my mind to.

A Little History

Some of the odd things I did as a kid that should have been clues….I didn’t play with other kids easily, so I would climb the hills by myself at age 6, to pet the horses at the top, (not mine) and come down when it got dark, or climb a tree and read a book in silence. I liked spinning in circles until I was dizzy, then I would do it again and again until someone stopped me. I was fascinated by patterns in the plants, dirt, my own skin….I liked strong bodily feelings like swinging on a swing, and disliked being touched.  School was overwhelming, so in 4th or 5th grade I took the wooden classroom dividers and built a fully enclosed cube around my desk.  This was frowned on, and lasted 15 minutes.  I stuttered and had a lisp, but was reading and comprehending at a college level in the fourth grade.  I had either no attention or complete hyperfocus, depending on the subject.    I was constantly told I wasn’t trying, when in most cases I was just befuddled by what they wanted me to do. Why did they want me to read Dick and Jane out loud when I had just finished much more interesting books? It was confusing, and the noise and input coming in was too much for a kid with no coping mechanisms.  Thankfully I developed those as an adult.     School was not a happy place for me until I studied science, creative writing, and nursing.  I discovered when I went back to school that I excelled in biological sciences, and that made me reach higher than I ever knew I could.  

Why I am Creating This Blog

I am creating this blog because when I chose to go into nursing, there were no online resources or support systems for someone with Aspergers becoming a nurse. There certainly were no online resources for someone middle aged with learning disabilities, Aspergers, a high IQ score, a genuine love of caring for other, and low self esteem from not fitting in and only being diagnosed a few years back. Try typing in Aspie RN and see what comes up. Nothing, Zip, Nada. You can get Aspie stuff, or Nurse stuff, but not Aspie Nurse stuff. I want to change that.
If you tell someone you are an Aspie and want to go into nursing, you will be discouraged, and it will be suggested that you work with things not people, such as a code writer, a librarian working in the background stocking books, or the like. It is because of the MYTH of Aspies not having emotional intelligence,and being incapable of empathy. Nothing could be further from the truth, at least for me. I have emotional intelligence, and am fully capable of empathy, and can socialize with purpose. This is an important distinction to make, as I am socially awkward. There is no getting around that. I have learned to use words to find out what I cannot discern otherwise. I have learned to recognize most peoples signs of illness, pain, sadness, anger, through decades of being a CNA, and have learned to use humor in small scripted ways to make day to day nursing smoother… Such as “oops! Let me clean my hands before helping you with that…don;t want to give you a gift that keeps on giving!” just small comments here and there that usually will elicit a smile from my patients.
I want to change your perceptions, and give you what I wish I had had as a student, and as a new nurse. If you genuinely love taking care of people, Nursing is a good fit. It will be overwhelming at times, and the first few years are rough, but they are for neurotypicals as well. I will tell you this much…Aspie or Neurotypical, Nursing school gives you a ton of information, and yet when you graduate and pass your NCLEX, and land that interview and sign on with your first job as a new nurse, you are now just ready to start climbing the mountain that will become your nursing practice. You are now ready to learn that you know almost nothing, and you must rely on your preceptor and more experienced nurses to help you do right by your patients. At the one year mark and two year mark, you will see the differences in where you were and where you are, but there will still be so much more to learn. You will become a new and stronger version of yourself, doing what you never knew you were capable of. You will need that aspie stubborn streak, to get you through though. There will be times where you will cry, and times when you will meltdown. Know this, and also know you work with people who went into this field because they love caring for others too, and they will support you just as you will support them. You will get past being overwhelmed, you will still cry and laugh about your patients, but it will be be ok. You will be ok.