Critical care, crayons, and the Loop of Henle: professional identity formation in nursing.

I am cuddled on our dusky gray sofa that gives World War II dress uniform vibes with comparable rigidity and unforgiveness. It’s two days before my next preceptorship shift in a cardiac ICU and one day after I realized my Ethics quiz is due Saturday. The little one is at daycare. Hubby is at work. I’ve got my laptop, my nursing school notebook, and coffee in hand. This is the life of a nontraditional nursing student. Let’s do this. I open my notebook and much to my surprise are my daughter’s colorful sketches and squiggles that felt so profoundly moving when I watched her draw them—not realizing they were in my nursing school notebook. But the joy-by-proxy I received in seeing them negates the fact that they are in my nursing school notebook. Along side red crayon curves are my critical care nursing student notes. Lovely.

Real Estate in the Margins

Regardless, life goes on and so does nursing school. So the spaces between her stippling and the areas around her ascending loops (note—the calligraphy stroke—not the Loop of Henle in the nephron, but put a pin in that) became the available real estate for my notes on the nurse’s role in health policy. This is what balancing nursing school and motherhood look like, at 0953 on a Wednesday.

She Thick…the Thick Ascending Limb

The thick limb of the ascending Loop of Henle is a powerhouse precursor for functional activities in the nephron, the functional unit within the kidney. It is key to acid-base balance and sodium (Na+) reabsorption, and yet it is often misunderstood by most clinicians (Zacchia et al., 2018). In many ways, I find this soooo relatable: I’m definitely thick and have the BMI to prove it; I’ve been told I’m salty, but I like to think that the work I do on my way to the top helps prime those who follow behind me for success. In this way, I keep it balanced. I’m sure I learned this five times over—the whole thing about the ascending Loop of Henle; most recently, at ICU preceptorship experience (think: CRRT and hemodynamics). As a critical care nursing student, I’m finding I can never escape a good Anatomy & Physiology lesson, and I love it. I’m here for it.

A Nontraditional Nursing Student in Critical Care

As a nontraditional student, my lived experience is a lot different than most of my peers. I am a mother, wife, and already have a bachelor’s degree. I’ve owned a business, managed a company, and had my fair share of life lessons to learn—all before many of my classmates were old enough to drive. What’s been great about nursing school, is that there’s space for nontrads like me and opportunities to use my experiences to help others balance life’s salty with the sweet in the systems wherein they thrive. Sometimes that looks like spoon-feeding a newborn and gleaning life lessons from their babbles. Other times that looks like spoon-feeding a fluid overloaded patient too weak to pick up his spoon, gleaning life lessons from his stories about growing up in the Pacific Northwest.

Designing a Professional Identity

Either way, nursing school doesn’t happen in isolation, and my professional identity is a built environment that I’m designing around my lived experience. A critical care nursing student requires adaptability to adjust to a dynamic environment—one moment you’re spoon-feeding a patient and the next he’s coding, the room is a madhouse, and you’re on compressions. Being a cardiac ICU nurse, I am learning through preceptorship, is not much different. Motherhood also requires adaptability and resolve. As I build myself and my professional brand first as a nontraditional nursing student and soon as a cardiac ICU nurse, I am the architect of what professional Leslie will look like, and how she can be a powerful force for systems thinking in nursing.

References

Zacchia, M., Capolongo, G., Rinaldi, L., & Capasso, G. (2018). The importance of the thick ascending limb of Henle's loop in renal physiology and pathophysiology. International journal of nephrology and renovascular disease, 11, 81–92. https://doi.org/10.2147/IJNRD.S154000