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Perhaps you know me, perhaps you don't. It's difficult to say these days who here has any idea of my personal character or how I present myself to the world on a day to day basis. I think sometimes that I am nothing like I used to be, back when I first started writing here some ten years ago. The truth is that I am still me and I am still exactly the same - I've just grown a little and become a whole person on my own. I don't feel the need to attach myself to any one person for security and reassurance. And yet, I'll see something or read something and I will be reminded that there are things in life that I cannot discount despite this new sense of self. I am always profoundly grateful these times.

So, in the interests of me expelling some swirling thought matter from the innermost brain cavities, I have decided to write out a few bits of text about my nursing education to date. I know, I know.. it's not terribly interesting to anyone or even exceptionally significant but in a way it is who I am becoming.

I have been completing some clinical hours at a small hospital. My favourite scrubs are baby blue and I always wear a long sleeve white shirt underneath, with shiny white shoes. It screams student nurse, but I'm not fooling anyone, anyway. I arrive in time to crowd into the nursing station with five or six nurses, a ward clerk, the charge nurse, and at least one doctor. They carry on conversations about the night shift and the current in-patient situation. The doctor has conversations out loud with himself about his next steps while the nurses figure out who they will be caring for and what medications they are on and why. Who slept through the night, who didn't. They talk about hospital politics and sometimes they talk about their children or the weather. No one told me about nursing stations and the interesting dynamic therein. They seem a good group, mostly, in that they seem to care about the people they need to care about. I sort of assumed that everywhere was much the same in that respect - empty the beds, bring in the new shipment. While they seem aware of in-patient count and those who might need to be pushed a little harder in the homeward direction, they do not seem intent on dangerously discharging patients who are simply not well enough to go. I hate to watch these people return days later in a crisis situation. I much prefer this to the larger hospital which seems keen on this rotation through the community and back to the hospital just as easily as one might cycle an outfit through the laundry. Perhaps I exaggerate. Perhaps not.

Nursing is difficult. I know, you'll say, what did you think you were getting yourself into when you started? The truth is I always knew it would be difficult. I didn't know exactly why, I just knew. There are pieces that are simple and pieces that are terribly overwhelming. I feel like nothing more than a set of fumbling hands, most times. "Draw up this insulin, you say? And you are suggesting I shouldn't bend the needle as I remove the cap? Interesting.. yes.. I think I'll give that a try next time, definitely." Oh, they'll say, those insulin needles are so easy to bend. I know, I know. Still - I am not used to being a novice at nearly everything I do. Perhaps this is why you had me spend so much time studying nursing theory, reading Patricia Benner, and talking about Jean Watson. I had dismissed that class as useless but now I think I comprehend. You wanted me to spend a great deal of time understanding that I would probably be largely terrible at this to begin with.

So, here it is, my growing list of thank you cards I can't write because it's not really appropriate to tell the patient or other nurses that you are a complete moron:

Thank you, sir, for not laughing when I bent your insulin needle and had to redraw the Lantus. It had to be the 40 units, too, not the 10 of Humalog. For some reason the extra 30 units made it seem more profoundly failure-esque. Thank you also for kindly offering a tip on opening the alcohol swab which, yes, I probably learned in class too and promptly forgot after bending the needle.

Thank you to the elderly gentleman with the hearing aid for teaching me how to change your hearing aid battery. No - really. Next time I have to change a battery in a hearing aid for someone who isn't so pleasant I will not feel totally incompetent and idiotic. I did say thank you but, I don't think you heard me.

(Sometimes, it makes me sad when someone can't use their hands anymore. Hands that have probably done a million things I couldn't dream of doing. Sometimes, though, it makes me smile when they have to tell me how to do the things that they can't do anymore. I secretly hope it makes them smile a little too.)

Thank you to the charge nurse who knew my name when I walked in on my second day even though we've never met. You smiled and offered me a chair. I said thank you, but I don't think you knew why I was so thankful. Then again, you were a new nurse once, so maybe you do.

Thank you, nurse preceptor, for guiding me through simple procedures I would totally remember how to do if I weren't completely terrified about doing it incorrectly. Yes, I did learn basic wound care in class, but understand the mannequin didn't have advanced metastatic cancer and a coccyx ulcer the size of my drug handbook. Gulp. Scratch this one - I actually did thank her for not once chiding me about anything all day long despite my many small slip ups.

Mostly, I feel nervous and hyper alert while I am there. I really do thank all of my patients at least several times a day for being helpful or for offering me advice or tips. It is different perhaps because this is a smaller hospital. The atmosphere is a little more relaxed. I feel good when I can put lotion on dry skin or when I can help someone understand that drinking more fluids will help with the dry skin, too. At least I know something, I tell myself. At least I can be friendly and nice and bring them extra water and pillows and warm blankets from the warming cupboard when they are cold.

It's difficult to talk about my embarrassing and stupid mistakes but I sometimes feel the need to note them for future reference. Maybe ten years from now I will laugh or maybe ten years from now I will bend another insulin needle and still feel like an idiot. Apparently, I'm told, nurses are always learning. I think that's why I decided to be a nurse in the first place.

I think I have at least one nervous breakdown a month about this career path and where it will take me, what I am doing and what this all means. I still have so much to learn. My next clinical hours will be on the psych floor at a larger hospital - I am looking forward to this, despite the fact that I occasionally fear they will mistake me for a patient. And when I am done this program, on to University to get my degree and specialize in something.

They say you flip back to "novice" when you switch areas of nursing. I am starting to understand why so many nurses seem to have a hard shell with a soft squishy inside. I hope that I am always at least a little squishy.