Integrity: Who am I when it's just me?

I was just 25 years old when I entered the hallways of the Level 1 trauma center that would change everything about how I perceived being a nurse. I had a few years of experience, just enough to have seen all the common things and to know what to anticipate. I knew my protocols and my skills. I knew what to do. But this hospital was going to change how I thought. 

This was the largest hospital I had ever worked at. The hospital stretched over city blocks, connected with enclosed bridges. The ER had multiple sections that essentially ran independently of each other. I stepped into my training shift rather overwhelmed. The confidence I had felt in my skills suddenly felt like the bravados of a teenage boy. I looked up at the nurse I was assigned to for the day. Let's call her Katrina. She had been a nurse for over 20 years and she was unflappable. She moved up and down the hallways at one constant speed. She didn't run, but she wasn't slow. And she moved in near silence. She magically appeared in rooms where patients were shouting and quelled conflict instantly with short, whispered phrases like, "Come on, let's just go get an x-ray" or "Do you want to try…? I think it would help." When nurses would approach her with an I.V. they could not start or a patient they couldn't reposition, she quickly responded with "Show me" or "Let's go take a look." She was helpful, but firm, ever willing to work with you, but certainly not doing your work for you. With her few words and stoic face, she was silently holding the bar high and challenging each of us to match her. She reminded me of a general, leading the troops through unknowns yet everything seemed somehow known to her. 

It was during our first few shifts together that she laid out all the rules of this new world I had stepped into. Medications would always be pulled under the correct patient. If I needed a witness, I would get a witness at the medication dispenser. I would waste unused medicines in the medicine room and the medications like morphine would be wasted on camera. Blood samples drawn from a patient would be immediately labeled at bedside and scanned for computer verification. If I wanted an extra tube, I would order the extra tube prior to blood draw. I would print a label. And I would scan that label immediately as well. There would be no unlabeled blood tubes left in the room for “just in case”. If I needed a “just in case”, I could clarify that before I started. There was no room for discussion. This was how to do it correctly. She then informed me that I would see other nurses not do it this way, that as a shift got busy, I may be tempted to also cut corners, and that I wouldn't. I nodded my head in agreement not sure if I fully agreed or was just too terrified to disappoint my steal-gazed captain. But after just a few short shifts, I was on my own in this ever busy, bustling world. 

And Katrina was right. Things did get very busy. Each nurse was assigned 4-5 rooms and when the rooms filled, sometimes we had extra stretchers in the hallways. I remember one particularly busy night; it felt like we had filled every corner. To create more space, we removed the equipment cart from the room and slid in a second stretcher. This left only a small aisle between the two patients for me to squeeze in and out of. The momentum of the ER seemed to spin faster and faster. I moved as quickly as I could and still felt like I could not do enough. To combat the building pressure, I started to think of creative ways to multiply myself- pull meds for two patients at once to avoid multiple trips to med room or skip repeat assessments that seemed redundant. But Katrina's calm, cool voice quickly returned to my mind. "You're going to do this; and you're going to do it right." And her second commandment - "You’re going to do it right, even if others don't." So I checked myself. I would have to work hard; I would have to be fast. But I wouldn't cut the corners. I strongly desired to live up to the quality of care my fearless leader had demonstrated in my 3 orientation shifts. But the question I was ultimately answering was - did I believe in integrity? Who was I as a nurse when no one had the time to look over my shoulder? When it would be easier to skip steps, and no one would notice, how would I choose to treat my patients, especially when they wouldn’t know the difference?

It was after 5 am, when I went to reassess my patient laying asleep in a hallway stretcher and realized his snoring was not the resounding vibration of deep sleep. This patient had arrived significantly intoxicated and had slept unbothered by the noisy ER. But now he was suddenly not arousing at all, and his snoring was not regular snoring. I grabbed a doctor and he came to the bedside. He asked me when the last time I had been able to arouse the patient was. I felt my pounding heart racing. I couldn't remember. This shift had been too busy. I had seen too many people. I was going to fail this poor man. But wait - I had taken his vitals. And thanks to Katrina's rigid rules, they had been taken on a 2-hour schedule. They had been documented in the computer, with a time stamp. While I hadn't had time to document assessments, a quick peak at the chart gave me a timeline for his night. The patient was rushed off to the CT scanner, and then to the operating room to relieve the pressure building from the bleeding in his brain. 

Walking away from that shift, I felt a moment of awe. The ER had survived that night. The nurses had pulled together as a team. We somehow had managed to see more patients than I knew we had stretchers for. And the patients seemed to have mysteriously all received what they needed. But the biggest relief I had, was the confidence I felt walking away from that night not second-guessing which med I gave, or if I confused two patient's vitals in the same room, or worse sent labs on the wrong patient, resulting in someone getting the wrong treatment. I still had a lot to learn, and I required help from the nurses to get through that night. But what I had done, I could stand on. 

Suddenly, Katrina's singular speed made perfect sense. In her magical, unrushed way, she moved with intention. And what I had mistaken initially as knowing everything, was just her moving in integrity with the knowledge she did have for the moment she was in. She couldn't predict what every patient would need 2 hours from now or sometimes even 30 minutes from now, but she didn't need to look that far ahead. Her integrity made her decisions simple. There was nothing to overthink. She would do what was right when no one was looking, and she never had to doubt her actions. So, neither would I. When the world was overwhelming, one must simply do the next right thing, and commit to doing it to the best of their ability. The extraordinary opportunity to save a life, to change a world, or to accomplish a dream is created by doing the ordinary exceptionally well. If you ever listen to an interview after a heroic save, a selfless act, or a generous gift, you will often hear the person respond with "just doing my job" or "just doing what needed to be done" or "doing what anyone else would do." These are not self-debasing responses. They are not even feigned humility or performative accolades. It is that extraordinary acts are rarely a heroic first; rarely does an undisciplined or selfish or timid or lazy person suddenly act so intensely out of character. These personal acts of excellence have existed for as long as that person has been determined to act with integrity. The limelight has just now fallen on this one blip of their life. But if you took a flashlight and scanned through the rest of their lives, you would find all their other acts of kindness, generosity, and grace have merely gone undocumented.

So, friend, if you're finding the world spinning with too many things calling for your attention, too many tasks requiring your hands, too many obligations stealing all your minutes before you know they have ticked by, and you're tempted to cut corners, to let things slide….breathe. Then commit your mind to holding high standards regardless of how you feel and to push aside distractions that compromise integrity. For if it is worth doing, it is worth doing right. It's ok to pause for a moment, recall the basics, simplify if needed. But whatever you do, do it well, even if no one is watching. In a world of uncertainty, you must only be certain to do the next right thing. You will never have all the answers. You will never be perfect. Sometimes we must walk without seeing the destination. But you will never regret doing what is right. And each right step will elevate you until the fog clears and clarity comes. Excellence is not obtained; it is mastered. So, if you are unsure of your next steps, unhappy with where your job has landed you, had hopes for a different outcome, your pathway to your next success starts with who you are today. Do whatever you're doing right now with excellence. You don't need to have five years or even five steps figured out. Just commit to making the next right step. And each right step will lead you to the next right step. Because when the day ends, and the only person watching you is you, will you be satisfied with the choices you have made?