Daily Lesson Archives

The first days as a nurse

The first thing that comes to mind when I think back to walking into the hospital as a nurse — not a student, but a nurse — was this: I am being watched, I am being guided, but I am now practicing new skills in real life.

That meant walking up to complete strangers and asking them to trust me. And the secret? I knew nothing.

So how do you work through it? Start basic:

• Your pen is for charting.

• The stethoscope goes in your ears.

• And there’s no such thing as a stat semen count.

Once you’ve got that down, it’s time to move on.

Getting to know a stranger without killing said stranger is part of the job. As a student, we learned this quickly. One of our first lessons was to stand, hands at our sides, face to face with a classmate, just six inches apart, for two minutes. Don’t try this in public. But what it taught us is that, yes, we will often be uncomfortably close to strangers. The ice was broken.

Here’s the best advice I was ever given by my RN preceptor:
“Walk in like you know what you’re doing, but always know what you are supposed to be doing. If you don’t — stop.” 

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Week 1 Sept.

Losing Charlie Kirk has weighed heavy on me this week. Loss always makes us wrestle with questions of meaning, redemption, and what really matters.

In the ER, we live at the edge of those questions every day. We carry the weight of decisions, the speed of response, the requirement to stay steady when others can’t. It isn’t just a job — it’s a calling that demands more than skill. It demands heart.

And yet, even in grief, I see redemption — not as something flashy, but as the quiet return to what God calls us to do: keep showing up, keep caring, keep carrying others when they can’t carry themselves.

Maybe that’s the true mark of an ER nurse. And maybe that’s the way redemption finds us — not by avoiding the weight, but by walking through it. 9/15/25

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Where have you seen redemption show up in heavy? When did all of the sand last run out of the hour glass?

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Not only so, but we also glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not put us to shame, because God’s love has been poured out into our hearts through the Holy Spirit, who has been given to us.

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Can we talk about the pain scale? Similar to “one man’s trash is another man’s treasure,” one person’s 2/10 might be another’s 9/10. Somewhere along the way, this became part of our vital signs. Used correctly, I’d say keep it. But as it’s been passed on to patients, some use it to their advantage.

Here’s the problem: if a blood pressure is high, we treat and reassess until it normalizes. But in nursing, a patient reporting 7/10 pain—without any other objective findings—automatically raises their acuity.

A burned-out colleague once tried something new while triaging. The patient, calm and comfortable, reported “10/10 pain.” He entered it, paused, then turned back with his pen in hand. “Right now, I’m 0/10. Let’s say I take this pen and jam it into my eye. Now I’m at 10/10. Would you say your pain is similar to that?” The patient, a little startled but thoughtful, replied, “No… maybe 4/10.” And just like that, perspective shifted.

In NP school, I even wrote the National Pain Institute suggesting a modified pain scale — one that blends subjective report with objective observation. For example, a patient calmly eating chips and laughing while claiming 10/10 pain might land at 14/20: above average, but not emergent. They never wrote me back.

The truth is, some patients use the scale correctly. Others abuse it. I’ve even been told, “You have to treat my pain.” But here’s the reality: the pain scale is broken — or at least in need of serious repair.

​ER Drama

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Daily Lesson: If you’ve watched ER dramas, you’ve probably wondered: Does that really happen? Yes—and more. Emergencies don’t wait for a perfect setting; they show up in clinics, hallways, and sometimes at your back door. That’s what drew me to emergency nursing: a constantly changing environment and the surprise that arrives at 2 a.m. when everyone’s resetting for the next wave. An attending once told me the ER is simply responding to an event and improvising a resolution. In anaphylaxis, the plan is usually clear and fast; other times you feel like MacGyver—pulling together the team, tools, and a plan in seconds. What makes a nurse isn’t TV heroics—it’s time at the bedside, seeing countless scenarios, and building the judgment to act quickly and safely. That day a small child hit our doors, a team named it, moved, and delivered life-saving care. Nursing school didn’t teach that shift. The work did.

Today’s Thought:
Instead of just planting a thought, I want to encourage some thinking. At first, I planned to throw out open-ended questions without answers. But the longer I sat, I realized the better way is to walk through how the questions themselves evolve.

When we started nursing school, the questions looked intimidating at first, but they became easy: “You need to give Tylenol 650mg, and only have 325mg tablets. How many do you give?” The answer: 2. Simple math.

As time went on, critical thinking had to bloom: “What’s the best way to prevent falls in the elderly? Non-skid rugs, better lighting, or shower handles?” (In reality, we’d want all three — but you only get one answer.)

Then came clinical rotations: monitoring vital signs, doing physical assessments, and — OMG — giving medications. Questions became: “How do you chart a high-pitched whistle on expiration?” or “How do you time skin turgor? Count an apical pulse before giving Digoxin? Is 61 bpm safe, or dangerous?”

Graduation doesn’t end the questions — it just raises the stakes. Now in the ER, wrong question, wrong response, or hesitation can alter outcomes.

Picture this:
A 50-something woman signs in with “tingling fingers.” No other symptoms. Vitals fine. Waiting room packed. No rooms open. She looks concerned but says it started two hours ago and hasn’t stopped. Do you hold her? Do you move her? Do you trust the monitor, or your gut?

That’s the evolution of a nurse: the starting point may be the same, but where we rise depends on how we learn to answer questions not on paper — but in front of us, in real time. I’m grateful for the start I had, for the doctors and nurses who taught me, and for the chance to keep learning every shift. 9/25/25

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