1. Conlon, Lynn M. BSN, RN

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HAVING BEEN A NURSE for over 25 years, I sometimes think I've seen it all and heard it all. Yet I still remember the process of learning how to be a nurse. There were always so many questions to be answered. Is the patient in pain? Does the patient have bowel sounds? Clear breath sounds? Is it time for the patient's medications? Has my patient ambulated? We learned exactly what to do.

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In the perfect world of school, we learned that the answers to our questions are black or white, yes or no. But the real world shows us that along with black-and-white answers are some that can't be easily pigeonholed. These answers fall between the black and the white. They are, in fact, different shades of gray.


These shades of gray have more to do with the emotional side of nursing. As nurses, we're educated to assess whether our patients are in pain. Over time, we learn to determine whether it's strictly physical pain or whether it includes elements of emotional and psychological pain. We broaden our ability to assess our patients' total needs, ultimately helping to develop our nursing intuition. It's a quality not taught in nursing school-it's learned in the real world, in the hands-on practice of nursing.


Looking back

My first job as a new grad was in the neonatal ICU at a large hospital. My first shift saw six admissions with very little time for orientation. The experienced nurse I worked with kept telling me, "Watch me and do what I do." My problem was that before that day, I'd rarely even held a baby, much less weighed, bathed, assessed, and fed one! I remember my hands shaking so badly I couldn't open a bottle of formula.


Eventually, my skills sharpened and my intuition and knowledge broadened. I became comfortable working with newborns and developed the ability to assess and meet their needs. I also realized that not only were the infants my patients, but their parents and families were too. I sensed which of these critically ill little ones in the ICU had given up the long and difficult fight, and I'd speak words of encouragement to them and their parents. I understood which parents wanted or needed to talk just by the look in their eyes. I learned when to speak up and when to just listen.


Becoming the expert

As time goes on, we learn there's no one right or simple answer to some of the questions we ask about our patients. As we learn more about them, we start to understand the intricacies of their needs. Not just their physical needs, but those emotional, psychological, and spiritual needs that must be met before they can completely heal.


Our skills are sharpened, our intuition and knowledge broadened, and our understanding deepened. We acknowledge the education and training we received from coworkers and mentors. We seek out resources to help us resolve challenges or conflicts we can't solve on our own. We look back at our beginnings and realize our passion for nursing has grown and developed and changed. Along the way, we've become the experts, the ones who can see those many shades of gray.