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An open letter to new nurses:

The most important skill you possess is your presence.

Suddenly, I found myself leaning over the hospital bathroom sink, unable to control my tears and struggling to catch my breath, feeling profoundly insecure and wondering if what I had to offer my patients was enough.

It was January 1999. I was fresh out of nursing school, passed my boards, and married with a 3-month-old at home. I was 23 years old and looked 12 when I accepted my first job as a swing shift nurse on the oncology floor of my local hospital.

Not too long after I finished my three months probationary, I had one of those NIGHTS. You know, those nights when you walk on the floor, and the weight of the moment is physically palpable.

Despite my internal warning signs signaling "run" that night, I walked into pain and chaos. As I went into the locker room to prepare for my shift, through whispers, I was made aware of the source of our collective distress. During the day shift, my fellow nurse and beloved preceptor assisted one of our oncologists with intrathecal chemotherapy treatment. Only after completing the procedure did they realize it was the wrong medication dosage — a mistake that cost a man his life.

I felt the weight of this reality over me. My body stiffened as I understood my humanity. Insecurity overwhelmed me as I thought, "If this could happen to her, then surely I, too, could make a life-ending mistake."

During this debilitating moment, I looked at the whiteboard and noted that I was assigned to care for three patients. My first patient encounter with rejection came swiftly. A middle-aged gentleman declined my care, citing my youthful appearance as a reason. Insecurity surged within me, a painful reminder of my perceived inadequacy.

So, instead of caring for this patient, I was told I would get the next admit…

The night unfolded with a second patient, a man in excruciating pain, aching for relief. Despite tireless efforts, my ability to alleviate his suffering felt insufficient.

My final patient was a woman in her 60s with a cheery, friendly demeanor. Her husband was at her bedside. She had just undergone surgery, and we all knew today was the day—the day when the test results would come in.

About two hours into my shift, her oncologist arrived and asked me to go with him into the room and offer them comfort as he delivered the news. She had metastatic cervical cancer. I watched and tried to comfort them as waves of fear, loss, and hope struck them.

It was after this encounter that I found myself sobbing in the bathroom.

After catching my breath and willing my face and eyes to return to their pre-sob state, I grabbed my clipboard (you know, those things we used before we charted on computers in the room) and headed back to the floor to care for my patients.

I entered the room of my cervical cancer patient with my best "I am completely calm, confident, and ready to take care of you" look on my face. As I opened the door, I was caught off guard by what I saw. The woman and her husband's face still showed the weight of the upcoming journey, yet they radiated with hope. They had stabilized after plummeting into the first crushing wave that comes with such a diagnosis.

They thanked me for my kindness and tender care. They reminded me that my gifting as a nurse had less to do with my technical skills than my innate ability to remain present in their suffering.

Suddenly, I was caught off guard by a sacred moment – a reminder that my most important nurse skill was my presence.

Fast forward nearly 20+ years, and it's me sitting at my daughter's bedside in an urban Covid-designated ICU. We were in the middle of an Omicron surge, so my husband and I were grateful to be allowed to take turns sitting with her as IVs beeped, and the ventilator forced air into her lungs while we awaited the latest EEG results.

As we held the reality that our beloved 24-year-old daughter was showing no brain activity, we were lost in a fog of grief, confusion, and unknowing. We felt the heaviness of questions like:

What could we have done differently?

How did we get here?

What did we miss?

God, WHY?

We felt helpless, isolated, and alone except for the nurses and chaplains.

My daughter was one of the few on the floor not suffering from the deadly virus. Outside the glass windows of our room, we could see our nurses weighted down by PPE and their inability to meet the psychological, spiritual, and sometimes physical needs of their patients.

On day two of our hospital stay, I watched our nurse spend an hour with the COVID patient next door, then after removing his PPE, offer us his full presence while changing IV medications, documenting her condition, and mentoring a student nurse. He had unmatched clinical skills, but his real gift was his ability to be present with us. His care for us was palpable. Even though his technical skills would not save our daughter's life, his presence offered us a balm to our suffering.

I wonder if, on that day, he had to sneak away to the hospital bathroom to express his grief and ask if what he had to offer us was enough.

He came to say goodbye at the shift change, and I had to ask him. "How do you do it?" "How do you stay present with your patients and their families when machines are buzzing, PPE is suffocating, you don't know how to operate a new device, and God forbid you have to go to the bathroom?"

To the new nurses, I pose the same question: How do you stay present and navigate the storms of suffering, pain, and chaos while honing your clinical skills? Seek mentors, find guidance, and cultivate your most crucial skill – presence.

As you embark on this journey, remember that sometimes, in the quiet moments of connection, your mere presence can be the balm that soothes the wounds of others.

*** Side note: Do you need a mentor, coach, or spiritual support? We at CODE YOU are here. It may be the best gift you give yourself and your patients.

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