Oh Sh*t, I Almost Killed You! A Little Book of Big Things Nursing School Forgot to Teach You

"July" is genuinely dangerous in teaching hospitals. Each July 1st, medical students in short white coats become residents in long ones, flooding hospitals with brilliant but clinically green physicians. Schwartzbach, who insists she is no physician-basher, argues that a core nursing job is protecting the patient from hastiness, inexperience, and sloppiness.

Her signature story: a post-surgical patient's blood pressure crashed to half of normal. The terrified surgical resident froze. Her veteran preceptor took one look at the x-ray, declared the chest had to be opened at the bedside, and calmly walked the resident through cracking a sternum to stop internal bleeding. The lesson she absorbed sounds absurdly simple but is hard to execute under pressure: a bleeding patient needs blood and the bleeding stopped. Nurses supply the experience that book-learning cannot.

The record is the only version of events that survives. Schwartzbach invokes the old adage that if you didn't document it, you didn't do it. Years later, on a witness stand, you won't remember a patient, but whatever you charted becomes the only admissible evidence. Every electronic signature carries the full legal weight of a handwritten one.

Her rule for documentation borrows from a mini-skirt: short enough to get to the point, long enough to cover what matters. Document what you see, do, and who you call. Under-documenting leaves no proof; over-documenting digs a hole. She also urges every new nurse to spend roughly a hundred dollars on personal malpractice insurance rather than relying solely on the employer's coverage, because the universe does not always behave logically and, as she puts it, shit happens.

Nursing's cruelest tradition attacks its own tribe. Schwartzbach describes being called ditzy, dumb, and blonde, too pretty, too happy. The phrase "nurses eat their young" captures a sorority-style hazing culture where veterans belittle beginners under the logic of "I survived it, so you must too." She rejects the idea that this builds a thick skin, calling it a scare tactic that harms staff and patients alike.

Her practical counsel: bullies don't know what to do when you stand up to them. First they're confused, then annoyed, then they retreat. Assert yourself respectfully, back your practice with competence, and escalate to management if it continues. She frames it as a Mean Girls dynamic, urging new nurses to be Cady Heron in a hospital full of Regina Georges, and to remember that one hazing moment is never forgotten.

Everyone in the trenches keeps your patient alive. Schwartzbach offers a two-part chant. First, you are not above the nursing assistant, housekeeper, food-service worker, pharmacist, or respiratory, physical, and occupational therapists. Second, you are not beneath the attending physician, surgeon, executive, or nurse manager. The aim is to deliver competent, compassionate care as one team.

Drawing on her own grueling stint as a patient care technician, she notes the ancillary staff make nurses look good, and they remember how they were treated. Advanced practice nurses and physician assistants, though technically above staff nurses, depend entirely on the bedside nurse as the eyes and ears of the patient. Scratch backs through thoughtful interaction, she advises, and colleagues will treat you as their reference point. When you're hangry and frazzled, reorganize your priorities rather than taking it out on others.

Never trust another nurse's assessment over your own eyes. Schwartzbach runs the same head-to-toe sequence on every patient, every shift: neuro, pupils, motor, pain, respiratory, cardiac, gastrointestinal, genitourinary, pulses, skin, access, endocrine, and infectious disease. The ritual consistency means nothing gets skipped, whether she's admitting a patient, rounding, or handing off.

Even if the Chief Nursing Officer swears a patient has a perfect functioning IV, she says go into the room, look, touch, and flush the line yourself. She extends assessment to the environment: family chairs blocking the resuscitation bag, a tray table blocking a fire exit, no room for a code cart if the patient arrests. She learned this environmental vigilance only in the ICU, and it becomes life-or-death the first time a patient falls or codes. Look, listen, feel, and get a second set of eyes when something feels off.

No lecture prepares you to watch someone die. Schwartzbach's first loss was Joseph, an elderly man in his eighties who chose to stop fighting and drifted away peacefully surrounded by his children. Her first ICU death was the opposite: a bloody, screaming code, a patient who died on the operating table after she'd titrated medications and hung blood as fast as she could. She blamed herself until her charge nurse stopped her cold and refused to let her take credit for a loss no one could have prevented.

The hardest lesson she offers: it never gets easier. You simply build coping methods, part defense mechanism and part cheap therapy, that let you sleep and return the next day. Nursing school covers medication administration and when to call a physician, but never how it feels to bag your first body.

Laughter is the crutch that lets beaten-down nurses limp through. Schwartzbach ranks coping mechanisms only half-jokingly: laughter holds a solid number-two spot. When a unit is short-staffed and every admission goes wrong, the ability to crack a well-timed joke amid death and destruction is genuine survival equipment, not evidence of callousness. She was judged for seeming too cheerful in the ICU until colleagues realized her upbeat demeanor was how she contained the strain.

Crying earns equal respect. Her thirty-year veteran preceptor taught her that some days you need to cry because it feels like the only honest thing you did all day. She warns against the darker outlet: nursing carries what she calls a silent epidemic of substance abuse, and self-medication is a slippery slope. Find a healthy release, whether a run, a journal, or a garden.

Caring for others while neglecting yourself is not heroic. Schwartzbach insists nurses need an outlet to decompress: a drink with the crew at 8am after a night shift, a journal, a run, a garden, or ice cream and Netflix in pajamas. Once a nurse, always a nurse, but keeping the passion alive requires cutting the cord during time off.

Her most personal chapter recounts her mother's lung mass, discovered when presumed pneumonia turned out to be a tumor requiring removal of the right lower lung. When the phone call came, she tried her old trick of smashing bad news into a corner of her brain, wore extra-dark eyeliner so she wouldn't cry at work, then ruptured on her bedroom floor that night. The lesson: you cannot be a nurse first and a daughter second when it's your own mother. Take care of yourself first, or you'll have nothing left to give.

Disinterest at the bedside is dangerous, not just sad. Schwartzbach argues that when you clock in for the paycheck and not the work, you set yourself up for the kind of distraction that borders on unsafe patient care. She doesn't demand relentless cheer, which she finds annoying and unrealistic, but she insists you feel invested most of the time and constantly reassess where you stand.

She models this with her own indecision: she applied to, was accepted by, and turned down top nurse-anesthesia programs, a doctorate in nursing practice, and acute-care nurse-practitioner programs, before choosing, for now, to stay at the bedside and write. Her point is that more letters after your name don't guarantee more money or fulfillment, and an entry-level advanced-practice salary can dip below what you earned as a staff nurse. If nursing itself stops fitting, the degree still travels to case management, legal consulting, informatics, teaching, sales, and telemedicine.

The profession's dirty secret is competence, not sainthood. Schwartzbach dismantles every cultural cliche: nurses are neither the starched-cap saints of history books nor the fishnet-stockinged fantasy, nor failed medical students. Male nurses, under 10% of the profession, battle constant assumptions that they're doctors or should have gone to medical school. Nurses swear, joke darkly, make mistakes, and are fully human.

Her closing argument is that when a family shouts "miracle" and a physician credits "modern medicine," the truth is often a critically thinking, intuitive, fiercely devoted nurse who caught the subtle change, questioned the order, and quietly kept the patient alive. There is no such thing as "just a nurse." She learned this watching her preceptor direct a bedside chest-opening, realizing nurses are the silent benefactors who keep patients comfortable, keep doctors on track, and most of all keep people alive, rarely taking credit.