I am the newest staff nurse in the Department of Neurosciences, Philippine General Hospital. I thought I came well-prepared owing to the fact that I’ve had my clinical rotations in the same hospital and even in the same department. But a beginning nurse like me would know that there’s so much to learn – knowledge, skills, and yes even attitude. Nursing wasn’t in my top course / career choices but somehow the universe conspired and led me to become one. As a beginning professional nurse, I find it amusing that each working day feels like a teaching session. I still have so many things to learn and I am eager to develop all the skills and acquire the knowledge required of a nurse working in the neurosciences.

The following are the fifty (50) lessons I learned during my first fifty days as a full-fledged staff nurse:

1. It’s better to ask than to pretend you know everything. Being a know-it-all doesn’t do any good especially when a person’s life is at stake.
2. We write / document  a lot. But it depends on us if we let documentation eat our time meant for bedside care.
3. It pays to be patient. Working in a state-run hospital full of bureaucratic processes could be frustrating. I hope we could streamline these processes.
4. Respect isn’t always earned. Sometimes, you give other people (some) respect as a reflection of your character.
5. Aside from honesty, empathy is key to establishing a good nurse-patient / caregiver relationship.
6. Professionalism is warranted. Problems at home should stay within the walls of the house. Caring for patients while carrying a baggage from home could compromise nursing care and affect patient outcomes.
7. Being with the patient is different from merely staying with the patient.
8. Pharmacists play a crucial role in medication administration specifically procurement, distribution, and patient counselling. (Swiss cheese)
9. Assert your rights. Remind doctors that you are a professional and that they cannot just call you “hoy”. You have a name and a profession.
10. Practice basic telephone etiquette. Never forget to mention your name.
11. Go back to the basics / fundamentals. The foundations of nursing will help you survive your daily life as a nurse.
12. Never forget to do skin test! I’ve seen many patients suffer allergic reactions because the nurse forgot or did not do a skin test. Maawa kayo.
13. Don’t be afraid to teach or guide students (most especially medical students / clerks) in simple procedures (e.g. aseptic technique, collection of specimen, etc). It is empowering both for you and the student.
14. Make sure that your patient is clean, IV lines are patent, and the patient’s papers are complete before endorsing a patient to another nurse. Huwag naman mag-endorse ng pasyente na out ang IV lines!
15. Listen to the change-of-shift endorsements and check if these are correct during nursing rounds. Kapag ang naendorse na IVF ay nasa full level dapat aabutan mo rin siyang full at hindi empty. Please lang.
16. Change IV tubings especially for Mannitol! Huwag hintaying balot ng crystallized Mannitol ang IV tubings at needle.
17. When the hospital pharmacy supplies your patients with IV tubings with needleless ports, enjoy. Haha. Bihira e.
18. Don’t wait for the doctor to order a change in the IV dressing or switch IV sites. Have the decency and initiative to do so.
19. Neuro patients are sometimes unpredictable. A stable patient could easily become a toxic one. Clinical eye should be developed. Takes time though.
20. Never forget to greet the patient. Tell your name, the date and what procedure you’re about to do. Yes, include GCS 3 / comatose patients.
21. Take care of your self. Ika nga, bawal magkasakit. Maawa sa nurse na magcocover sa shift mo kapag bigla kang nag-absent.
22. UPCN taught me to do everything and address even the simplest needs of the patient within an 8-hour shift. This sometimes leads me to only have a total sitting time of 1 hour. Pero masakit sa paa. Sit down whenever you can.
23. And also because of #22, I tend to skip meals. But that is not good. Eat (healthy food).
24. Ask / tell something nicely. You’re not the only one who’s going through a difficult life. Everyone is.
25. Misunderstandings should be dealt with in a professional way. Go inside a room and talk it out. Never quarrel in front of the patients!
26. Large condom catheters don’t look like large condoms. Hirap po ilagay. Struggle is real.
27. In PGH, we now have a document (printed in blue bond papers) called “Pharmacist’s Notes” where status of a patient’s funds or unavailable medications are indicated. A bit helpful for us, nurses.
28. Never restrain a patient unless really necessary. If possible, use old linen. Release at least every two hours. Nakakaawa sila.
29. Hourly neuro vital signs monitoring  is quite impossible even if we only have 15 patients in the entire ward. However, it is necessary for patients who are not stable (especially those who are intubated).
30. Aside from ward movement (trans in/out, admission, procedures such as CT scan and CXR), most of doctors’ orders are given and carried out in the afternoon. Most tiring shift (for me).
31. Learn to prioritize. During my first few days, I used a time and activity plan which was a requirement in college (4th year). It was helpful. Now, I think I am able to prioritize nursing interventions and manage my time well.
32. Answer a patient’s or primary caregiver’s questions adequately. Sometimes when you don’t know what to say, tell them that you’ll return with an adequate answer. Be sure to go back with an answer. Trust vs mistrust.
33. Sometimes, even doctors do not know what cured the patient. And you don’t have anything to say but “Thank you, Lord, for these healing hands”
34. Appreciate patients’ efforts. It means a lot to them that you see their progress and appreciate their effort to help themselves.
35. Call the patient by his/her name. Never call them by numbers. I consider it inhumane. They have names.
36. Allow the patient / primary caregiver to express his / her feelings.
37. Maintain composure when a situation becomes chaotic or full of mixed emotions. Handle pressure  with grace.
38. Confidence is key! Be confident and demonstrate professional knowledge and skill.
39. Return to the patient voluntarily. Ask if he / she needs anything. This helps develop a trusting relationship.
40. Appreciate the patient as a human being.
41. Care not only for the patient but also for his / her relatives or significant others.
42. Be hopeful with the patient and his / her significant other. Even though science dictates an end, hope. Hope because miracles do happen.
43. Keep bed side rails up if the patient is uncooperative or unconscious. Let us hope that all the beds have side rails (Hi PGH). Haha.
44. Talk to the patient with a calm, gentle, soft voice.
45. Offer help whenever you can. Offer help when changing diapers, turning the patient to the side, etc.
46. Never forget to include the patient in planning his / her care.
47. Respect and appreciate the work of allied health professionals (as well as utility workers, admin aides, and janitors) included in the team.
48. Ensure patient privacy! Use drapes when available.
49. Working as a hospital nurse is far different from the experiences we had as student nurses. Stick with the ideal but also be flexible enough to learn new techniques (that are evidenced-based). Learning, after all, is a lifelong journey.
50. Enjoy your work and love your profession. Nothing, I suppose, is more fulfilling than being able to care for other people, especially those you do not know.

These are but few of the learnings I had during my first fifty days in PGH. I am thankful that I am given this opportunity to serve the Filipino people, to care even for those who care.

A WORK OF HEART. Nurses of the Department of Neurosciences together with DCNO, DNRD, DNET employees during the 2016 PGH Nurses’ Week