by jitze couperus via Flickr

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

I’m going to swim from Alcatraz.

It’s daunting, yet irresistible, and a challenge I’m not taking lightly. As part of my preparation, I’ve purchased the book Open Water Swimming: Lessons from Alcatraz. In it, Joe Oakes and Gary Emich deliver a wealth of information and practical advice in a very direct way. They’ve provided much to mull over during my long training swims—and I’ve been struck by how well the principles they stress can be applied to nursing:

“Never swim alone and always swim with a competent pilot.”

It would obviously be unwise to attempt a treacherous swim alone. Similarly, it’s vital to work with a team who can be trusted to back one another up. It’s also vital to know who the resource people are and to have a mentor, whether formally or informally.

“There are plenty of sharks in San Francisco Bay.”

Unfortunately, there are occasionally sharks amongst hospital staff, as well. Shark-like behavior should be identified for what it is, and handled accordingly. It should never be taken personally.

“Wet suits are the most obvious way to keep yourself insulated.”

The authors go on to discuss the relative merits of different types of wet suits, swim caps, booties, gloves, earplugs, and swim goggles. In the ICU, a decent stethoscope and good penlight are absolutely essential. Scrubs with good pocket placement are also important, as are comfortable shoes. Some of the other, almost limitless nursing gear available, like pen lanyards, badge holders, and stethoscope holders, are more arbitrary.

Regarding waves and choppy water, the authors advise,

“You must learn to compensate for rough water and overcome these disruptive conditions” and “Do not panic, retain your composure.” Also this: “When you are swimming in choppy water with the wind making waves on one side of you, you had better be able to defend yourself by breathing on the other side.”

Sometimes, overcoming disruptive and difficult work situations requires re-prioritizing the entire day. Amid chaos, it always helps to take a deep breath and collect oneself. In all cases, adaptability is indispensable to nursing.

“Log enough quality training hours or log out.” And: “Do not attempt to swim from Alcatraz on inadequate training.”

I never regret the time I spend attending in-service trainings or reading current journal articles.  The continuing education requirements of the AACN (American Association of Critical-Care Nurses) for CCRN status help me stay up to date on current evidence-based practice, as does volunteering to take part in research and process-improvement committees at work. The payoff for continued training is immeasurable—and priceless.

And finally, a line that sums up one of the things I love most about nursing:

“The unexpected always happens, and not always to other people.”

I feel exhilarated every time I imagine standing at the edge of a boat and throwing myself into San Francisco Bay. My chest flutters and my stomach clenches with adrenaline. I also get a sharp, electric taste in my mouth that’s surely owed to fear. It’s not entirely unlike the feeling I used to get when I was a graduate nurse, heading to work and terrified I’d somehow fail my patients.

It’s also not much different than the feeling I get now, when I’ve taken report from another nurse and am waiting on a crashing patient to arrive in the ICU. The suspense is like standing at the edge of a great height, considering the waves and preparing to jump, trusting that all I’ve invested will come together and shore me up.

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