From trainees in the hands of their teachers, they slowly become independent, self-confident young nurses. After facing doubt, uncertainty, inner struggle, and trial after trial, they finally experience the joy of becoming new persons.

CHALLENGE AND GROWTH

Trainees and registered nurses all inevitably run into frustration. When I had just graduated, I worked in the internal medicine department ICU ward. Whenever I was faced with any emergency case that I didn't know how to handle, I would feel a lot of pressure and anxiety. The patients gave me a lot of help in getting over these obstacles. Whenever I faced my patients, I also directly faced my own problems.

-Lin Li-ping, Tzu Chi Hospital registered nurse

Li-ping has five years of experience in bedside care. At first, she simply wanted to avoid the pressure of university entrance exams, so she blindly went into the field of nursing. But from the nursing school to the hospital, she often wondered whether she really wanted to do this for the rest of her life.

When Li-ping entered the Tzu Chi Junior College of Nursing, the school was just two years old. Hence, the curriculum designs and the school management style were still being tested. Her fantasies about college life vanished through her tightly organized daily activities. However, she obtained a much clearer idea about nursing than she had at the age of sixteen or seventeen in the nursing school.

Li-ping lives in Hualien, so during the summer vacation after her first year of college, she volunteered part-time at the Mennonite Christian Hospital in Hualien, where she was assigned to the internal medicine ICU ward. Although she was only a part-time employee, she still received a lot of assistance from the senior nurses. With their encouragement and guidance, she was able to overcome many problems. She learned how to communicate with patients' families, as well as how to care for the patients.

"One pregnant woman with acute pulmonary edema couldn't keep her embryo. Her husband was in a panic and didn't know what to do. A senior nurse was next to him and gave him her support and comfort. When I saw that, I realized that nursing was not just based on techniques. Mennonite gave me some deeper understandings about nursing."

Because of the experience at Mennonite, she naturally chose the internal medicine ICU ward at Tzu Chi Hospital as her first formal work assignment, but she felt frustrated by her lack of experience and self-confidence. Along with the guidance from her teachers and senior nurses and the mutual support of six other classmates who also came to the hospital at the same time, the patients also gave her a lot of help. "Whenever a patient got better, it gave me a lot of confidence."

During the two years of training to become a registered nurse, Li-ping learned all the basics of nursing, and she also continually pondered her future.

"It's very important to plan one's life," she said. "Whenever I can't get past any bottlenecks, I always transfer to another department to readjust myself, but I always keep in mind where I want to go, and I keep at it through all the changes. Nursing is an ever-changing kind of work, so you must think fast to keep up with the ever-changing environment."

After working for five years, she feels that nurses are in constant contact with patients and have a greater chance to discover their problems. Thus, nurses should actively discuss patients' problems with doctors.

Now, Li-ping is a specialized registered nurse. Her duties are similar to those of a resident doctor, but she still needs to get a doctor's approval. "Sometimes, there are too many patients and there isn't enough time for each one of them, so I can't keep up with all the doctors' or nurses' suggestions."

"Nursing is probably my life's career. I feel that looking after patients really makes me happy. It is a real challenge to combine nursing theory with actual bedside care." Now, patients wave at her whenever they see her. This reward makes her more devoted to her work.

"I often think that I'm the kind of person who enjoys serving other people, and this makes me naturally suited to this kind of work. If a nurse lacks this devotion to service, she will become less enthusiastic."

CHOICE

Working in three shifts is very difficult for nurses, but you choose your own attitude towards life. Planning out your life, learning something new, or setting up short-term goals can keep life from becoming boring and empty. Tzu Chi is a place for positive growth, and I have learned wisdom, blessing, tolerance, gentleness and sincerity. Besides death, what else in this world cannot be solved?

-Huang Hsin-chiao, West Ward 3 head nurse

At every moment, Hsin-chiao's loud laughter and shining eyes show her warm, sweet charm. She enjoys her work very much and says that she likes dealing with patients. However, she also feels that it is quite cruel to force an immature sixteen- or seventeen-year old student to face birth, death, aging and illness.

When Hsin-chiao was a student in nursing school, she went to a local hospital for her clinical practice. She had to look after fifty patients and measure their blood pressure and temperature every day. In the end, she almost became deaf. This made her feel like cheap labor used at the whim of the hospital nurses. "About ten years ago, students were told to obey blindly and no one dared to complain. When they also had to face all kinds of illness, they simply felt that life was meaningless."

After graduation, Hsin-chiao felt that she needed to study further to have a better future, so she studied hard to enter a two-year college. At that time, nurses worked in three shifts, and they had to do two or three times as much work as they do now. In order to prepare for college entrance exams, Hsin-chiao also studied hard every day after work. Sometimes she was so tired at work that she even fell asleep in the restroom.

Her hard study paid off: she was admitted to the Tzu Chi nursing college in its first year. There were only 107 students in the school.

Although she was the leader of her class, she became dissatisfied with the college administration. Her mental image of a perfect Tzu Chi crumbled and she almost dropped out of school. Although she did continue to study, she chose to live her life rather indifferently.

"I would even ignore my Yi Te 'mother,' but she would still ask my friends to bring me stuff for them. Sometimes when I returned to the dorm and saw an apple on my table, I would still feel moved. With her silent actions, my Yi Te mother made a deep impression on me, which I didn't realize until after I graduated."

Hsin-chiao feels grateful for that depressing period and she's happy to have overcome it. "At that time, I shouldn't have expected a one-year-old baby to act like a five- or six-year-old. I forgot that Tzu Chi was formed by normal people with all their shortcomings. I should have been more tolerant and grown up with Tzu Chi."

After graduation, she stayed to work at the Tzu Chi Hospital. Three years later, she became a head nurse. However, she felt that nursing skills were constantly changing and that she was quite drained. She applied for funding to study in Australia, and after fifteen months she received her university degree.

"That was a good experience," she said. "I broke the language barrier, and the free style of the teachers and their respect for students allowed me to learn many things. Now I bring this free style of discussion to the on-the-job training here in the hospital. I've discovered that the students have a lot of potential. The class also trains them to think."

She feels that nurses need to think independently. She occasionally gives them oral tests to make them think about the reasons behind any simple action, so that they won't feel that they are just doing routine work every day.

As a head nurse, Hsin-chiao is responsible for administration, education and clinical work. She also realizes that it is not easy to supervise other people. "There were many good people around me who gave me a lot of room to grow when I just came in. They probably felt that I had a lot of potential. I'm still learning this ability torecognize the potential in people."

As for her future, she immediately thought of the changes that marriage would bring. "In the past, I would have insisted that nursing was my life-time career, but I don't think so any more. If my work and life become incompatible after marriage, I will focus on my children and family. I think my father has influenced me in this regard. He was a civil servant, and he turned down promotions and chances for better stations elsewhere because of his family and children."

Although her family will be the focus of her future life, Hsin-chiao insists that she still likes nursing. "I like this work, especially clinical nursing. After I wash a patient and his face breaks into a big smile, that's the best reward for me. Actually, I'm very easy to please."

REACHING A BALANCE

After two years of working, I'm still struggling with many things. The only thing that makes me feel good is a patient's smile. Whenever I feel frustrated, I sing my school song, "Compassion is power..." I believe I'm a useful person, and I constantly remind myself of the enthusiasm for serving people that I had when I chose this work.

-Hsu Ling-li, Tzu Chi Hospital registered nurse

Ling-li is very tall but speaks softly. When patients hear her voice, they feel much better. When she first went to nursing school, she didn't like nursing and didn't study very hard. During her clinical practice in her second year, she realized that nursing was a way of serving people, and so she became more interested in her studies.

Her first experience with death came while she was caring for a terminally ill patient in that second year. At that time, she didn't know what to do for him. She could only rely on her religious strength to soothe his emotions and alleviate his pain. The patient soon passed away, making her feel that the course of a person's illness changed too quickly. This experience has always made her feel that it is a huge pressure for a fifteen- or sixteen-year-old girl, who still has no idea about life, to face such a heavy load.

After she became a nurse, she faced more pressure. Her ideals and ambitions were totally wiped out after two years of reality. She had to work three different shifts each week. After adjusting herself to the time changes, her life seemed to be nothing but working and sleeping. She smiled and said earnestly, "If you look closely, a twenty-year-old nurse looks like a thirty-year-old."

"When I had just graduated, whenever I felt frustrated, I would invite some friends to ride our bicycles towards Tzu Chi College. We would ride and ride, and my tears would roll down. Yang Szu-piao, the former college principal, once sighed about a student who had graduated and done two years training in the hospital. Just as she was about to become a first-class nurse, she quit and left nursing. When I heard that, I was very angry. I wondered how anyone could do something like that and let our teachers down. Now I know why."

There once was a patient with oral cancer. His mouth, tongue and neck were rotten. He did not want other people to take care of him. Because of the stench, the medical staff would feel like throwing up whenever they entered his room, and they would try to leave as soon as possible. However, Ling-li tried to talk with him. Because he could not talk, she had to guess what he needed. She even explained to him what would happen if he did not accept any treatments. The patient rejected her at first, but he slowly began to respond, and he allowed her to trim his nails and to shave his beard.

"Although this patient rewarded me a lot, I still had some questions. If I only went there to give him medicine, it would take only a few minutes, but if I wanted to know his needs, then it was not just a matter of a few minutes. I didn't mind doing it, but my colleagues asked me why I bothered."

When her colleagues go home from work, she still has to stay behind to finish her job, because she spends all her time on patients. She also wonders whether this is right, whether she needs to spend so much time on a terminally ill patient, and how she can reach a balance between work efficiency and the value of life.

"Sometimes when I'm looking after a patient, I need to go away to give health education to others who are being discharged or hospitalized. So, the patient wonders what I'm doing and why I'm missing." She observes that nurses have many odd jobs to do too. Furthermore, students graduating from the Tzu Chi nursing college have to bear other people's high expectations towards Tzu Chi.

She will have worked for two years in August. She once wondered whether she wanted to continue. When she was doing clinical practice, she already had varicose veins. Now it is even more serious. Besides the heavy workload, she sometimes has to jog, carry things... "I don't know whether my body can take it anymore," she said uncertainly. "Maybe I'll choose to go for further studies."

SPRING IN THE EMERGENCY ROOM

I feel students from Tzu Chi College are better than those from other schools with regard to their attitude or tolerance. Actually, we have to feel sorry for the patients and forgive their behavior. Why should we be angry with patients? When we try to empathize with them, we will not get upset. Nurses must respect others and also themselves, and it's very important that we do a good job.

-Huang Pei-ju, Cathay General Hospital registered nurse

When Pei-ju graduated from the Tzu Chi nursing school, she only knew her job was to look after patients. When she was doing her clinical practice, she realized that nurses had to touch things that other people would not, such as catheters. She was shocked and thought, "Oh, my god! I have to do this!" She was lucky that she could change her attitude quickly. After some time, she got used to it.

She didn't come in contact with any dying patients, but she did have to deal with dead bodies. When she saw family members sobbing around them, she was quite depressed. She wondered why she had to see something like this when she was still young. She felt that she was growing too fast.

"You naturally experience much more in this kind of work, and I became mature in handling things like this. Sometimes I feel that I missed the naivet* of that age, but that was what I chose. You gain something when you lose something, as long as the gain is worth it."

After five years of study and two years of practice, she feels sorry for old people. She tells herself all the time not to live to be too old. After seeing so many lonely, helpless, old people, she feels that life is really fragile.

After Pei-ju graduated, she volunteered to work in the emergency room at Cathay General Hospital in Taipei. She sometimes laughs that she works like a dog, but she doesn't regret her choice. "The excitement in the emergency room stimulates me. Although the emergency room here doesn't have the sense of sunshine that Tzu Chi Hospital does, the patients here are not classified into any department. And they have all sorts of illnesses. So, whenever a patient comes in, we must treat him immediately. The right decision is an instant reward. After a year here, I feel my reactions are better than before."

"My instructor used to say that theory and practice had to be combined." She recalled the chaos she created at the beginning and smiled. "At first, I was too busy to finish anything. After a while, I got used to it and realized that I should educate myself more. So now I combine my learning and practice better."

Pei-ju feels that it is up to each individual to break through the routine duties and complications of one's work. It is just that everyone does it differently.

"When I get home, I just want to sleep. I can't study. If I see a book, I fall asleep. Actually, my spare time at work is the best time to study, or else I simply ask the doctors. Doctors are great sources of knowledge. Some doctors use real examples of patients to teach me things. I can absorb things faster this way than by reading textbooks."

Each patient in the emergency room claims that he is the most important, because each only thinks of himself. The medical staff treat the most critical case first, but patients may not understand that. Because of the open space in the emergency room, a patient is usually accompanied by family members. While Pei-ju deals with one patient, she has to listen to calls from several others. "It's like a war. If you've seen the TV show, 'ER,' you can imagine how busy we are."

She often sees patients who die just as they arrive. A few months ago, a four-month-old baby was beaten badly by its father. When the baby arrived at the hospital, it had no pulse. Pei-ju tried to bring the baby back with CPR, but the baby had no response at all. She was deeply depressed the rest of the day.

"You can't avoid this kind of depression, so you have to learn to deal with it. Otherwise, you will hurt a lot. When I saw that baby, I suddenly felt that each person's life is so different. We really have to be grateful that we could grow up peacefully and thank our parents for that."

Breathe Some Air Into Him

I didn't discover that nursing was a road of no return until ten years after I started. Nursing allows me to grow spiritually and also in the areas of human relationships and raising children. I often say that people in this field are very lucky.

-Hu Ching-mei, Mennonite Christian Hospital emergency room deputy head nurse

"I've been working for twenty years! You can say that I walked past the past and caught up with the present." Hu Ching-mei's clear features express the sincerity and warmth of her aboriginal Bunun tribe. "Do you know that the Mennonite Christian Hospital used to have a nursing school? At that time, the school was free, so my parents let me go. All the students were aboriginal girls."

When she graduated in 1974, she could not receive a nursing certificate. The Mennonite church prohibited its members, including students, from taking up arms, and this contradicted government requirements for military training in schools. Hence, the Mennonite school was not officially recognized. "Four years of studies were wasted," she sighed.

Although Ching-mei did not receive a diploma from the Ministry of Education, she had a concrete foundation in nursing skills. "At that time, we had classes in the morning and went to do clinical practice in the afternoon. Thus, study and practice were combined very well. The missionaries would show us how to do these things. (Sigh!) Those missionaries..." Ching-mei could not find words to express her gratitude for the selfless sacrifices of the missionaries.

Influenced by her religion, she always feels that nurses must look after patients, their families and even physicians. She discovered that one's growth was closely related to one's social background and living habits. This discovery helped her to grow and also benefited her when she later married.

She had just worked as a nurse for a short while when she quit and went to study for three years in a business school. Because she disliked numbers and felt that nursing was much more fun, she went back to nursing again.

Ten years later, she discovered that nursing was a road of no return. She had just gotten married then, and her only thought was to take good care of her children. When they were older, she would go for further studies.

Four years ago, Ching-mei fulfilled her dream by entering the Tzu Chi College of Nursing. Even though she had never received a nursing certificate, twenty years of experience had made a deep impression. "The diploma from the Tzu Chi nursing college qualified me to take the nursing license exams. Actually, twenty years of working experience made me feel that the teachers at the college were too young, because I had more experience than they did, but I still learned a lot of theory. To tell the truth, our educational system puts too much emphasis on having degrees. Bedside working experience is much more important in nursing."

After she graduated last year, Ching-mei immediately became the deputy head nurse in the emergency room. Although there is more work and more pressure, she feels that her everyday sense of accomplishment comes from everyone she looks after. Even when a patient dies, the family still thanks her. This is her happiest moment.

She used to cry a lot. Whenever a patient died, she would cry together with the family members. Now she knows how to control herself and comfort family members. "Whenever I touch a dead person, I always want to breathe some air into him or her. I feel that being able to breathe is the only difference between us."

Having been married for thirteen years, she feels that working in three shifts can be hard on a marriage. Her husband has no problems with it, but it has affected her two young children. Now both often ask her when she will have a break from work and when she must work at night.