In nursing school they told us doctors will mess up and we have to catch it. They said, “You gotta catch it or your patients will die." I feel like that’s all they ever said in nursing school. So sometimes that’s what I’m thinking about when I’m on the floor.

Personal Information

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NAME

Michael Cianciulli

JOB TITLE

Registered nurse

LOCATION

Boston, MA

SALARY

Undisclosed

NUMBER OF YEARS IN THE FIELD

Less than one year

COMPANY

Massachusetts General Hospital

Education

Brooklyn College
B.A., Environmental Studies

MGH Institute of Health Professions
B.A., Nursing

Career Bio

The profession

I’m a registered nurse on a cardiac access unit. In my job I literally run around trying to keep everyone alive.

There’s a lot of pressure on us. In nursing school they told us doctors will mess up and we have to catch it. They said, “You gotta catch it or your patients will die." I feel like that’s all they ever said in nursing school. So sometimes that’s what I’m thinking about when I’m on the floor.

How I got here

I was an English major my first year of college. But Pace University is expensive and I couldn’t pay it. The second semester bill came in for $15,000 and I was like, “I can’t do this!” I couldn’t take any more classes or apply to any new schools because they were holding my transcript until I paid it. I was stuck. I left school, worked in retail, travelled and finally paid it off and went to school at Brooklyn College in 2009 for Environmental Studies.

By the time I went back I no longer wanted to major in English because I didn’t think I could make money. The first semester I just took the basic stuff and I realized I really like science and I care about the environment so I decided to study environmental science instead. It was a very new program so basically got to pick whatever classes I wanted to take.

During my last semester I met a girl in my microbiology class. I needed microbiology for my environmental science degree and she was taking it for nursing. One day we were studying together--I was teaching her something, explaining a concept to her–and she stopped me. I remember this vividly; I actually wrote about it in my letter to get into nursing school. We were in the library, the light streaming in, books everywhere, and she was like, “You should be a nurse!” It was an ah-ha moment for me. I was like, “What? Really?” and she was like, “Yeah, you already did most of the pre-requisites. You should just do it.” I decided to go for it and scrambled to make sure the credits I took for the environmental science degree would also be prerequisites for nursing.

I still needed a few of the prerequisites for nursing. The following summer I took Anatomy Physiology I and II, two of the hardest required courses. I took the first class the first six weeks of the summer and the second class, the second six weeks of the summer. It was intense. It was Monday-Friday, 8 a.m. until 8 p.m. But that summer I completed all of my prerequisites and immediately started looking at nursing schools, which took about a year. The prerequisites narrowed down the schools I could apply to, because the schools varied a lot with their requirements. Some required two semesters of chemistry -- not my thing at all. Some required standardized tests--I didn’t want to take these either. I ended up going to nursing school at Massachusetts General Hospital (MGH) Institute of Health Professions in Charlestown, MA. Out of the many nursing schools in Boston, this school has first dibs on clinicals at MGH , so this was a big draw for me. Clinicals are shifts at a hospital under observation, during nursing school. Most of our clinicals were at MGH. Also I had a scholarship for half of my tuition.

I would say it matters who teaches your classes. As a gay man I felt like I spent all year fighting for my rights as an LGBTQ (lesbian, gay, bisexual, trans and queer) person. I always had to be the token gay person to be like, “this is a perspective we should be talking about.” Mostly all my classmates were receptive but sometimes I felt like my professors would tell me my opinion matters and then would go right back to talking the way they had been talking before. I felt like I was constantly saying, “this is the gay perspective!” or “what about gay people!” There were only five or six men in my nursing class of 60 students. And the teachers were mostly women, which I loved.

Before getting into nursing school I was pushing 30 years old and was like, I need to do something with my life, quickly. The nursing program was fast and I started practicing soon after I got out of school.

A typical day

They recommend your first job as a nurse is on a medical/surgical floor so you can see a little of everything. I’m on a cardiac floor. It's VIP! Some people don’t recommend it because you don’t learn some basic skills like changing a bedpan or talking to a family member when their family member is dying. Lots of people also recommend being a nursing assistant first but I didn’t have any of that--I was thrown to the wolves! Two years ago I had no idea what anything was, and now I’m trying to keep people alive.

I work 40 hours a week, either eight or twelve-hour shifts. I rotate between day and evening shifts. Nurse practitioners work until 10 p.m. or 11 p.m. Overnight there’s a fellow in charge. A big part of my job is explaining things to patients. The doctors come by like once a day, but I spend a lot more time with the patients than they do. We also have the same patients several days in a row. You see if the patient is getting better or worse and you form a rapport with them. For example, the other day a doctor told to a patient he was getting a new heart and then left, so the patient really looked to me to talk about it.

As a nurse you’re always teaching patients. You’re repeating ways to stay healthy and explaining why we give certain medications. Or we explain why they're having trouble breathing and explain what their body is doing. So we’re teaching, and teaching, and teaching.

The hardest parts

Everyone is so overworked. Sometimes I am the only person who sees a patient all day. I have to notice if something is wrong but sometimes I don’t feel like anyone listens to what we’re saying as nurses. For example, last night I was chatting about one of our patients with one of the other nurses. This patient had been here for three weeks--I saw him on the day shift and this other nurse saw him on the night shift--and he kept getting worse and worse. He had really bad valvular heart disease, a body full of fluid, and trouble swallowing. On top of that he was getting delirious. When you’re in a hospital and you don’t sleep, you can get very confused and combative at night. The patient had to have a sitter at one point, someone to sit with him to make sure he didn’t pull out his lines. It’s emotionally draining for us because we see this patient for weeks and weeks and feel like nothing is being done. He ended up dying on the way to a procedure, when, as far as us nurses were concerned, he should have been put in hospice care weeks earlier and had a more peaceful death.

Another example, the other day a patient came in with really bad valve problems and edema. Your heart’s a muscle with four chambers and valves between them. If the valves aren’t opening and closing properly, blood backs up and it can lead to fluid in spaces where it shouldn’t be, like your lungs, which makes it hard to breathe. This causes edema, the medical term for swelling, in other parts of the body.

Usually edema occurs in the legs, but this patient had edema everywhere. The patient came in late at night—this is always hard because there is only one fellow overnight--and no one came to see this patient all day long. I don’t know why. Maybe the doctor was busy? I came in at 3 p.m. and the nurse told me no one had seen the patient yet. So I checked on the patient and talked to the nurse. I don’t know if it’s because I’m new or they’re busy, or maybe both, but I felt like I kept telling everyone something was wrong with this patient, and no seemed very concerned.. The patient’s breathing got worse over time. When you start your shift you have to assess the patients and pay attention to when things change because they can change quickly and they’re reliant on you for that information. I ended my shift at 11:30 p.m and felt like I had accomplished nothing all day. It’s really frustrating to see your patient get worse and worse and not be able to do anything for them.

The best parts

I spent my preceptorship my last semester of nursing school at Children’s Hospital in the medical Intensive Care Unit. I wanted to continue to work there but it didn’t work out, for now. In the future it might be something I will pursue. That’s the thing about nursing—you can change your mind and you can do all kinds of things. I could do cardiac for two years and if I don’t like it, I can switch to pediatrics, or go work on a neurology floor, or do travel nursing. I could go all around the world or the country, I can teach, I could be a nurse manager if I wanted to do administrative things, or I could do research.

Working in a profession created by, and full of women is a really great part.

The myths of the profession

I think there’s a myth that nurses stand there and hand doctors instruments because nursing was maybe like that at one point. Some of the older nurses who’ve been working for 30, 40, or 50 years still have that kind of mentality. But the new mentality is that nurses have a voice in the conversation. We are expected to be at meetings and in the room when the doctor is with the patient. My opinion matters in the conversation about the patient.

A nurse should question everything – that is the new nursing way. Why am I giving this medicine? I’m not just giving the medication because I’m told to do it. I have to decide if it’s a good time to give it or if I should wait to give it.

I love the television show Grey's Anatomy because those surgeons do so much more than they actually do in real life and it always makes me laugh. Basically if the surgeon is doing anything other than being in the Operating Room (OR), they're probably doing a nurse's job. We are very underrepresented in pop culture.

The workplace

Our floor is different from other floors because it's managed by Nurse Practioners (NPs). The NPs work with the doctors (who are not physically on the floor much of the time). NPs are registered nurses with advanced and specialized training and education. Them NPs are amazing because they understand and respect the nursing aspect, and are great teachers to us nurses.


Everyone is really helpful on my floor. It’s been a saving grace. If I have to do something I’ve never done before, I always ask someone to tell me how to do it, or help me do it.

I don’t have much of a work life balance. Because I’m new I still get exhausted, so I don’t have much of a social life. I’ve only been on this job for six months.

There is also a new computer system called EPIC. They got it last May so it’s new for everyone. It’s a system that all hospitals are moving towards so there is continuity between hospitals and you don’t have to transfer paperwork. But it means a lot of change. There are things that happen automatically too with the new computer system. When a patient transfers to a new floor there are things that have to be checked off and sometimes a nurse practitioner might not check it all off so once it comes to me as a nurse I have to through it all to make sure it’s correct.

Advice for someone thinking about going into the field

It is really hard at first. The reason I became a nurse is because I wanted to save the world and help people. It seemed like an honorable job and it is! So my advice is if you care about how the body works and want to help people, think about nursing.

Advice to my younger self

I would tell my younger self to not be so hard on myself.