
I now work at SFGH on the fourth floor.  My unit specializes in Traumatic Brain Injury, ICU step-down and acute alcohol withdrawal.  All I can say is that if the Nursing  School learning curve was a Sunday drive in the park, the curve I am on now is a demolition derby. 
     Several factors make this nursing very daunting: The sheer volume of documentation, the constant manual keeping up with ever changing Doctor’s orders; the clarification of said orders; the delivery of medications and procedures in a timely and accurate manner; the pressure to know what each of these meds do and whether or not the Doctor is wrong.  All the while, since this is ICU step-down, knowing that my patient may head south and I may need to call a MERT (Medical Evaluation Response Team) or a CODE.  In addition, because General hired me as a Per-Diem Nurse, I only get 14-days training and I am on day eleven. I have already challenged the logic of this with my manager and nurse educator however. 
    Presently I am handling three patients with my preceptor (the maximum for my unit) and I am learning team nursing, where I work with an LVN who has three patients also.  This means though that I am ultimately responsible for all six patients and for the delivery of IV medication to my LVN’s patients.  I also need to sign off on all my LVN’s massive documentation. 
        My brain is literally being rewired.  I have the ‘overwhelm’ dreams typical of any new intense job; during  my days off, my mind is constantly gravitating back to work.
Don’t get me wrong, I am okay with this.  At this point in my life, perhaps because I realize there are fewer days ahead than there are behind, I don’t care about the stress.  I have absolutely no interest any longer in finding what will ultimately make me ‘fulfilled’.  I don’t care if I have mean coworkers or bosses.  I obsessed about this ad nauseum in the past and no longer have any patience for it.  Miraculously, I have learned to completely ignore insults, slights, and even outright aggression.  There is even time to crack an inappropriate joke now and then.
    I have found a good career; it will likely be my last, albeit with variation along the way.  I will get through this learning curve.  Four of the charge nurses on my unit are City  College graduates who came to 4B between two and four years ago; they make it look easy.  Eventually, so will I.