Thursday, November 29, 2007

It's My Turn To Shut Up

Thanksgiving break was a breath of fresh air - in more ways than one! A huge cold front moved in and dropped the temperature 40 degrees. Sweet! My down time was very much appreciated. There is a lot of talk about how we are so burned out with school, and now that graduation is a mere six months away, it is even harder to concentrate.

Now that I'm back in school, being around my classmates gives me stuff to talk about. For example, today's topic was How Nurses Don't Know What They're Doing And I'm Going To Be The Perfect Nurse Someday.

Nursing school teaches many things, but often what we’re taught doesn’t apply in practice. My favorite thing to do in nursing is procedures. I love doing dressing changes, fiddling around with catheters, and oh, the joy of putting a needle in someone’s arm. No, no, no. I don’t enjoy inflicting pain. What I enjoy is doing something with my hands and using my senses to do a job. As a cube-farm refugee, it is a breath of fresh air to do something with my hands besides type.

The problem with procedures is they can’t always be done the way it is taught to us in nursing school. When one is standing over a patient doing a procedure the reality is your pocket phone is ringing, a call bell is going off next door, you’re behind on checking on a patient who might be having a problem that is potentially life threatening, you’re trying to remember if the person you just talked to wants extra cream for their coffee or extra Ranch dressing for their salad, the person before that has shat himself and now he’s cleaned up, but there are no clean linens and you told the tech to see if they can get some from another floor but you haven’t seen or heard from her in about 45 minutes, and meanwhile he is sitting in a chair waiting for the clean linens so he can get back in bed.

What to do, what to do?

In that moment we prioritize. We decide what is the most critical thing we must do, and we go with that until the next critical thing happens and we have to rearrange the priorities and still keep track of the Ranch dressing issue.

In the next moment you begin to think about taking shortcuts. You know what the proper procedure is, but you realize that if you do this, you will be hours behind and the end of the shift is approaching. The nurse coming on to take your place will be highly irritated that you haven’t gone things done, so this creates tension between you and she most certainly won’t hesitate to vent this irritation to the other nurses on the unit. Next thing you know nobody will talk to you, and even worse, the story of your slackitude grows with every telling until everyone thinks you’re a pain in the ass to work with. Besides that, you haven’t done any charting and if you stay after your shift to work on it, before too long you will be invited to a meeting with your supervisor to discuss how you’re working too much overtime, and maybe a snarky comment or two about your time management skills.

So you begin to think of the steps you can eliminate from the procedure. You try it and it works great. You have cut 45 minutes off the time you would have spent taking care of the issue.

On good days you do all the steps you are supposed to, but the bad days are crowding closer together. More and more you use the shortcut until eventually you use it all the time. Nothing bad has ever come of it. The patients are happy. Your coworkers are happy. Your supervisor is happy.

Then one magical day, a nursing student appears on the unit. It’s an inconvenience, but it’s part of your job description and, hey, you remember what it was like to be a student and you made a promise to yourself to not be one of those nurses who is mean to students.

Off you go, the nursing student in tow, to do a procedure that you’ve done a million times. You are doing your thing when the student blurts out “aren’t you supposed to be doing it this way?” and she explains how she learned in lab that week.

I would like to treat that student to a mighty bitch-slap.

Nursing school is the soft, safe cocoon where everything happens the way it is supposed, hospitals aren’t hotels, we can focus all our attention on one thing at a time, and we have all the time in the world to listen to the patient talk about their concerns. Unfortunately reality is far different.

Because I have had experience with patient care, and now working as a nurse, I have noticed how people are dynamic and ever changing. They have moods. They have opinions. Sometimes they have body odor. What works one day won’t work the next. We always try to do the best we can, but we have a lot of things working against us. I have taken this understanding with me into my nursing school clinicals.

I stand back and watch. I get in there and help whenever I can within the scope of training I have to that point. I didn’t do a sterile dressing change until I was checked off in class. Then once I was checked off, if I see my patient needs a dressing change, I don’t wait to be asked. I tell the nurse I’ll do it since that’s what I’m there for.

Meanwhile I keep my mouth shut. If I have questions, I wait to ask it when things have calmed down. If I see the nurse doing something differently than what I was taught in school, I observe and learn from it. I might use that technique later when I’m a nurse. I just make sure I never say a word about it to the nurse. I may ask her about it later if I can sense she’s open to those kinds of questions. But I use tact and care with my question, and I never, EVER ask the question in front of the patient.

My goal is to make the world safer for student nurses who will come after me. I want the nurses to have a good experience with me so maybe they’ll be more willing to work with a student in the future. Nursing students who make themselves a pain make nurses not want to work with them. This is the only way we can learn is by watching and doing. If I see something I feel is unsafe or illegal, I take it to my instructor and let him handle it. I don’t feel it’s my place to address it. Chances are I’m wrong. If I open my mouth that nurse and I are going to have a bad day. Neither of us is thrilled to have to be together in the first place. I don’t want make the situation even more unbearable.

So I let my classmates talk about those terrible nurses and how they’ll NEVER do what they saw the nurse doing. I smile, keep my mouth shut and think “well, honey, wait until you’re a nurse.”


FetchingGal said...

Wish we had more students with your work ethic and attitude. Wish you were my student. However, we don't, and you aren't, respectively. So that is why I tell my students up front "I am doing this procedure this way because I have my license, because it is still safe for the patient although it may differ from what you learned in school this week." I also tell them when they have to do the procedure for their teacher they will need certain supplies and I tell them why. I know, I am a rare breed. :p

When are you writing the NCLEX?

License Pending said...

Why thank you.

One of the benefits of middle age is time to develop the ability to put yourself in someone else's place. I imagine myself as a nurse and how I'd like to kick someone's butt for being a jerk like that.

I take NCLEX in June or July - if I can pass HESI.