I am no expert when it comes to nursing theory, but I do know a thing or two about it. For instance, I know that it is very complex, and that not a lot of nurses know or understand a great deal of it. I find that a bit disheartening because our practice should be "guided by theory", right? Perhaps the problem is that there are extremely diverse fields of nursing theories, found at many levels of complexity and practicality. Modern nursing theory is said by many to have evolved from the works of Florence Nightengale in the late 19th century. Since that time, there have been a multitude of nursing theorists who have thrown their proverbial hat in the ring. There are so many types of nursing theories out there, that they have been categorized into "grand theories", "middle range theories", and even "practice theories". It's no wonder nursing students have a hard time understanding nursing theory, and why professional nurses, for the most part, couldn't name many theorists...let alone a theory that "guides their pactice."
So what are we to do about that? How can we be professionals, "grounded in theory" and "based in science" if our practicing membership...our frontline representatives...do not understand the very essence that is their "profession?" I suppose that is a complex question in and of itself. So what about this: why can't practice guide theory? Perhaps it can be argued that it does, in many ways. Evidence-based practice (EBP),I think, is fairly close to this...even though the practice is still "guided" by something. Taking all of the evidence we have on a particular practice issue, such as family presence during resuscitation or palliative care efforts, helps to formulate how and why we should practice in a particular way. But could it also guide theory development too? What about Elizabeth Kubler-Ross' work with the stages of grief? Now, she wasn't a nursing theorist, but her work is most definitely found in nursing practice. It can be, perhaps, known by what is referred to as a "borrowed theory": non-nursing theory that has been adapted for use within the profession.
We incorporate so many "bits and pieces" of so many different theories into our practice, that perhaps we do it without even realizing it. I think that unless you work in a particular area of nursing, where one particular theory almost entirely supports your practice, it is difficult to pick just one and stick with it. As nurses we must adapt to our ever-changing environment. We must be able to learn-unlearn-relearn many times over, as our practice is constantly changing...yet our theories rarely do. Now some of you will recall that there is a nursing theorist who spoke about "adaptation": Sister Callista Roy. I'm not going to discuss any particular theorists here, just making observation.
So maybe you are mot familiar with any one particular theory, or maybe you combine many theories into your practice...either way your practice is guided by something. Maybe your practice will guide you to develop a new theory in nursing, or perhaps improve upon an existing one. I think where many nurses lose interest in nursing theory is when they begin discussing some of the grand theorists, such as Martha Rogers (not picking on anyone in particular). Rogers' theory is very abstract and difficult to follow, yet she touches on some very key adpects related to complexity, which is a big topic of today. She was truly ahead of her time, when compared with theorists contemporary to her day. But at what point do these theorists say, "I think I'm going to make up a nursing theory today, I have nothing better to do today..." my guess is probably never. I would imagine that their theories were formed out of experience and practice. So, who guides who?
I think that in the end, it will be up to us as individual nurses to identify with a particular theory or theorist. Maybe it's time we start looking at a theory that helps circumscribe our own professionalism and interpersonal relations (beyond the work of Peplau). What about achieving professional growth? Or one about nursing as a unique culture, and the many ways we tend to interact with one another (good and bad), and what we can do to improve. Do any one of us have the answer? I doubt it. Many times, the best things to happen are not from the "inventors", but the "innovators"- the ones that improve what was discovered by others. And, again, that's the beauty of complexity science: we can never predict the effect one thing has on another.
So, who guides who: nursing practice or nursing theory??? Are patients in a continuum of wellness or illness? I think we could argue either point.... But I will leave you with this: do your homework- find out about nursing theory, EBP, and complexity science. Find out what your profession has to say about your practice style, and more importantly, what it needs to say about it.
We need to be more aware of the "forces" that fuel our practices, and the practices that can lead to better, more effective theory.
Thank you.
Steve
Saturday, May 28, 2011
Wednesday, May 18, 2011
Taking that next step
Every journey begins with one step....and then another....and another....
We cannot simply leap to our destination instantly- although I would find that helpful at times. Instead we have to take that initiative to begin the journey that will take us toward our destination. Now think about that: toward our destination. Notice I did not say to our goal. I believe there is a significant difference between these two statements.
First, toward, indicates "moving in a general direction which results in closer proximity to something", in my own words. I think we are always moving toward something, sometimes we know, and most of the time we do not. It is that unknown that often surprises us...or frightens us. Yet, there we are, every day, progressing toward something. What "thing"? Well, that depends greatly on the individual, and the situation, for that matter. Sometimes simply moving toward the end of a shift is all we want! However, I think you all know that I am referring to something much broader than that. I think that we are all moving toward becoming better nurses. I think we are moving toward more education, training, and career options. Sometimes we know we are on this journey, and sometimes we may not. We all have something to learn from one another, no matter where you are in your career. Some have great time management abilities, some great interpersonal communication skills, while others are very gifted with complex procedures. I think we all have something to learn. Each time we learn something new, or take a step toward improving our nursing practice, we are moving toward our destination. So what is our destination?
To me, a destination is waypoint along a continuous journey. A destination is not necessarily a "final" location, but merely a point at which we must reassess our bearings, reevaluate our options, do a bit of retrospective analysis of our path thus far....and then plot a course toward a new destination. So, where is this destination? Well, again, that depends on the individual. Some may choose career destinations, such as leadership positions within a company. Others may choose educational destinations, such as earning undergraduate, graduate, or post-graduate degrees. I think that as long as you are moving toward your destination you are where you should be. But the problem with all of this is that we cannot simply think of our journeys in preconceived, somewhat forced "linear" terms. We cannot always put our plan into a nice box and tie it up with a bow. There are far too many variables in life that can forever alter a journey in ways we cannot predict. For that reason, we must accept that we are not always in control (or in conscious awareness) of our destination, although we may be moving toward it.
For instance, I knew that I wanted to go back to school to get an advanced nursing degree. I have known this for quite some time. The only problem was, I had no idea which program I wanted. Do I want to be an advanced practice nurse??? Do I want to be in charge of something??? So I want to teach something??? Where do I apply??? Should I choose online or classroom format??? So I researched for a long time, "knowing" what I wanted to do was teach nursing students someday. I figured out I had no real desire to be an advanced practice nurse, so I eliminated that option. Then, after much agony, I had a moment of "clarity"...or what I might call, "intuition". I discovered a new nursing role called the Clinical Nurse Leader. This was to be an "advanced generalist" role, with advanced patho, pharm, and assessment....but with added courses in finance, leadership, and CNL role development. I thought "that's it!!" So I began my graduate education in a CNL program. Destination reached.
Then, during the course of the program, I was introduced to "complexity science" and "complex adaptive systems" in a leadership course. Learning about complexity science seemed to validate, somehow, my inner thoughts and feelings about how I perceived the world. And to know it had a name...and a whole field was dedicated to it! I became immediately interested in learning more. After the course was completed, I continued my research into the field, pulling as much information as I could from a variety of sources. The thought of healthcare (and healthcare organizations) being "complex adaptive systems" seemed to be a perfect fit for my thinking process. This proved to be a "turning point" in my career...and thus I was moving toward a destination. I began to get that "intuitive" feeling again, and have decided to change direction from the clinical aspect of nursing (the CNL role) and move to the "non-clinical" aspect of nursing informatics. I have therefore begun plotting a course from this destination (or waypoint) toward obtaining my graduate nursing degree in nursing informatics. I will start this Fall.
This is but one example...there are countless others. I "knew" what I wanted...but I am not where I thought I would be. I am more excited about nursing and my career now, than I was when I "knew" what I wanted. The point is, we can't "know" anything about the future. We can aspire, dream, "plan", and move toward it...but we can't "know" it or "predict" it. That is why linear thinking methodologies cannot apply to our future as nurses...or our future in healthcare. Healthcare is far too complex and interdependent on infinite variables to ever be reduced to linear terms. So, you see, we can only move toward a destination because there is never a straight line between points A and B...more like a general path, consisting of a variety of points and directional paths leading from these points. We always have a choice...but sometimes we need to think with our whole body...not just one side of our brain.
So keep moving...or get moving...and you will reach the next destination in your career's long journey. Maybe it's just getting through the next shift...maybe it's getting though a class or two...perhaps it's obtaining certification...it doesn't matter. Keep moving, keep learning, keep growing, and most importantly of all...KEEP HAVING FUN!!! We are all in this together, and we need to do a better job of supporting one another, instead of looking for ways to tear each other down.
Accept the present for what it is...learn from the past for what it was (and what it could have been)...and embrace the future for what it CAN BE (and SHOULD BE)! If we knew the end to every story, what fun would that be!?! Enjoy the mystery!
Thank you.
Steve
We cannot simply leap to our destination instantly- although I would find that helpful at times. Instead we have to take that initiative to begin the journey that will take us toward our destination. Now think about that: toward our destination. Notice I did not say to our goal. I believe there is a significant difference between these two statements.
First, toward, indicates "moving in a general direction which results in closer proximity to something", in my own words. I think we are always moving toward something, sometimes we know, and most of the time we do not. It is that unknown that often surprises us...or frightens us. Yet, there we are, every day, progressing toward something. What "thing"? Well, that depends greatly on the individual, and the situation, for that matter. Sometimes simply moving toward the end of a shift is all we want! However, I think you all know that I am referring to something much broader than that. I think that we are all moving toward becoming better nurses. I think we are moving toward more education, training, and career options. Sometimes we know we are on this journey, and sometimes we may not. We all have something to learn from one another, no matter where you are in your career. Some have great time management abilities, some great interpersonal communication skills, while others are very gifted with complex procedures. I think we all have something to learn. Each time we learn something new, or take a step toward improving our nursing practice, we are moving toward our destination. So what is our destination?
To me, a destination is waypoint along a continuous journey. A destination is not necessarily a "final" location, but merely a point at which we must reassess our bearings, reevaluate our options, do a bit of retrospective analysis of our path thus far....and then plot a course toward a new destination. So, where is this destination? Well, again, that depends on the individual. Some may choose career destinations, such as leadership positions within a company. Others may choose educational destinations, such as earning undergraduate, graduate, or post-graduate degrees. I think that as long as you are moving toward your destination you are where you should be. But the problem with all of this is that we cannot simply think of our journeys in preconceived, somewhat forced "linear" terms. We cannot always put our plan into a nice box and tie it up with a bow. There are far too many variables in life that can forever alter a journey in ways we cannot predict. For that reason, we must accept that we are not always in control (or in conscious awareness) of our destination, although we may be moving toward it.
For instance, I knew that I wanted to go back to school to get an advanced nursing degree. I have known this for quite some time. The only problem was, I had no idea which program I wanted. Do I want to be an advanced practice nurse??? Do I want to be in charge of something??? So I want to teach something??? Where do I apply??? Should I choose online or classroom format??? So I researched for a long time, "knowing" what I wanted to do was teach nursing students someday. I figured out I had no real desire to be an advanced practice nurse, so I eliminated that option. Then, after much agony, I had a moment of "clarity"...or what I might call, "intuition". I discovered a new nursing role called the Clinical Nurse Leader. This was to be an "advanced generalist" role, with advanced patho, pharm, and assessment....but with added courses in finance, leadership, and CNL role development. I thought "that's it!!" So I began my graduate education in a CNL program. Destination reached.
Then, during the course of the program, I was introduced to "complexity science" and "complex adaptive systems" in a leadership course. Learning about complexity science seemed to validate, somehow, my inner thoughts and feelings about how I perceived the world. And to know it had a name...and a whole field was dedicated to it! I became immediately interested in learning more. After the course was completed, I continued my research into the field, pulling as much information as I could from a variety of sources. The thought of healthcare (and healthcare organizations) being "complex adaptive systems" seemed to be a perfect fit for my thinking process. This proved to be a "turning point" in my career...and thus I was moving toward a destination. I began to get that "intuitive" feeling again, and have decided to change direction from the clinical aspect of nursing (the CNL role) and move to the "non-clinical" aspect of nursing informatics. I have therefore begun plotting a course from this destination (or waypoint) toward obtaining my graduate nursing degree in nursing informatics. I will start this Fall.
This is but one example...there are countless others. I "knew" what I wanted...but I am not where I thought I would be. I am more excited about nursing and my career now, than I was when I "knew" what I wanted. The point is, we can't "know" anything about the future. We can aspire, dream, "plan", and move toward it...but we can't "know" it or "predict" it. That is why linear thinking methodologies cannot apply to our future as nurses...or our future in healthcare. Healthcare is far too complex and interdependent on infinite variables to ever be reduced to linear terms. So, you see, we can only move toward a destination because there is never a straight line between points A and B...more like a general path, consisting of a variety of points and directional paths leading from these points. We always have a choice...but sometimes we need to think with our whole body...not just one side of our brain.
So keep moving...or get moving...and you will reach the next destination in your career's long journey. Maybe it's just getting through the next shift...maybe it's getting though a class or two...perhaps it's obtaining certification...it doesn't matter. Keep moving, keep learning, keep growing, and most importantly of all...KEEP HAVING FUN!!! We are all in this together, and we need to do a better job of supporting one another, instead of looking for ways to tear each other down.
Accept the present for what it is...learn from the past for what it was (and what it could have been)...and embrace the future for what it CAN BE (and SHOULD BE)! If we knew the end to every story, what fun would that be!?! Enjoy the mystery!
Thank you.
Steve
Sunday, May 15, 2011
When the end is near
Most of us have dealt with end-of-life issues from our patients and families. Some of us have faced them within our own families. But how many of us have faced them individually? By this I mean actually coming to grips with our own impending mortality. I know that I have not, and I bet most all of you have not either.
Sure, I have thought about what it might feel like to be faced with those thoughts and decisions. But how accurate are my assumptions? What am I really going to be thinking about at that time in my life? I will never know until that time arrives. I may speculate and opine about what may be important to me, but that is all it really is right now...speculation.
My my grandfather is not doing well, and has been declining in health for some time now. I am certain he is not going to be here much longer, and I suspect he knows this as well. I can see him being more and more desperate to maintain as much control as he possibly can over his life. He is an extremely independent and stubborn man. Nobody can tell him what he needs to do, or what he shouldn't do...he knows far more than any of us. Or at least that what he wants us to believe. And I can't help but wonder who, exactly, is he trying to convince...us or himself?
When we are caring for someone who is facing their own mortality, we know there are a spectrum of emotions he or she is faced with. Elizabeth Kubler-Ross taught us that we typically transition through 5 stages of grieving: denial, anger, bargaining, depression, and acceptance. I can clearly see my grandfather in the first and second stages. And I think that, as a nurse, I want him to continue to express his emotions, and to work through the stages. Additionally, I recognize these stages exist, and anticipate that he may react this way. As his grandson, I want to tell him what a stubborn, irrational man he is being, and tell him to listen go his doctors and nurses. I know that wouldn't work, and would be extremely counterproductive. I know that he must make these transitions on his own, knowing that he has family at his side all the way. Some people will never say "sorry", "thank you", or "I love you." I believe my grandpa is one of them. But I know he doesn't have to say it to know that it exists.
I think that things happen in our lives very purposefully. Things seem to happen at either the "right" time or the very "wrong" one. It is really all a matter of perspective, and we all have heard that "hindsight is 20/20", illuding to the concept that the best perspective is perhaps the retrospective one. Maybe that is true. I believe that there are some, although not as many, that are known to us immediately as being very significant. It is how we react, it is the paths we choose at that crossroad, that can determine future events...and perhaps only hindsight will allow us to see them in more clarity. It's just that sometime we do not have the luxuries of time and retrospection at our disposal. It is at these times that what is "not" said may be more important than what "might have been."
I think that we, as nurses, are oftentimes faced with these situations. Sometimes we know that the most therapeutic thing you can do is listen. It may seem like we are doing nothing...and that would be absolutely correct. By doing "nothing", we allow our patients and their families to express their thoughts and feelings...sometimes for the first time. An open ear and a warm hand can provide more healing than we can ever know. We all know this to be true. It is what sets us apart as nurses. We should be proud to be in such an influential position in health care...even if we cannot see it at the moment.
Recognize every moment as being significant, for many times it is...just maybe not for you. Many times YOU are the turning point in someone else's life. I have said it before, and I am certain I will say it many more: you have an impact on many people, and you probably have no idea how important you are to this profession.
When my grandfather is in the hospital, alone at night, and he is being stubborn with the nursing staff, I can rest comfortably knowing they recognize his actions for what they are, even if he doesn't. I know that no matter what, he will be listened to, and be cared for indiscriminantly.
So, I say to each of you: the next time someone is angry with you, will not listen to your attempts to educate them on their disease, or just doesn't seem to want to accept the fact that "the end is near", please know that this person, this human being, is someone's mother, father, brother, or grandfather...and that they are resting comfortably at home knowing you are taking great care of their loved one, and that they are truly not alone.
Thank you for being there when no one else is. Thank you for the long, thankless hours you devote to others. Thank you for being a nurse. As this "Nurses Week" draws to a close, I want you to know that if no one else says it, I will: Thank You!!!!
Steve
Sure, I have thought about what it might feel like to be faced with those thoughts and decisions. But how accurate are my assumptions? What am I really going to be thinking about at that time in my life? I will never know until that time arrives. I may speculate and opine about what may be important to me, but that is all it really is right now...speculation.
My my grandfather is not doing well, and has been declining in health for some time now. I am certain he is not going to be here much longer, and I suspect he knows this as well. I can see him being more and more desperate to maintain as much control as he possibly can over his life. He is an extremely independent and stubborn man. Nobody can tell him what he needs to do, or what he shouldn't do...he knows far more than any of us. Or at least that what he wants us to believe. And I can't help but wonder who, exactly, is he trying to convince...us or himself?
When we are caring for someone who is facing their own mortality, we know there are a spectrum of emotions he or she is faced with. Elizabeth Kubler-Ross taught us that we typically transition through 5 stages of grieving: denial, anger, bargaining, depression, and acceptance. I can clearly see my grandfather in the first and second stages. And I think that, as a nurse, I want him to continue to express his emotions, and to work through the stages. Additionally, I recognize these stages exist, and anticipate that he may react this way. As his grandson, I want to tell him what a stubborn, irrational man he is being, and tell him to listen go his doctors and nurses. I know that wouldn't work, and would be extremely counterproductive. I know that he must make these transitions on his own, knowing that he has family at his side all the way. Some people will never say "sorry", "thank you", or "I love you." I believe my grandpa is one of them. But I know he doesn't have to say it to know that it exists.
I think that things happen in our lives very purposefully. Things seem to happen at either the "right" time or the very "wrong" one. It is really all a matter of perspective, and we all have heard that "hindsight is 20/20", illuding to the concept that the best perspective is perhaps the retrospective one. Maybe that is true. I believe that there are some, although not as many, that are known to us immediately as being very significant. It is how we react, it is the paths we choose at that crossroad, that can determine future events...and perhaps only hindsight will allow us to see them in more clarity. It's just that sometime we do not have the luxuries of time and retrospection at our disposal. It is at these times that what is "not" said may be more important than what "might have been."
I think that we, as nurses, are oftentimes faced with these situations. Sometimes we know that the most therapeutic thing you can do is listen. It may seem like we are doing nothing...and that would be absolutely correct. By doing "nothing", we allow our patients and their families to express their thoughts and feelings...sometimes for the first time. An open ear and a warm hand can provide more healing than we can ever know. We all know this to be true. It is what sets us apart as nurses. We should be proud to be in such an influential position in health care...even if we cannot see it at the moment.
Recognize every moment as being significant, for many times it is...just maybe not for you. Many times YOU are the turning point in someone else's life. I have said it before, and I am certain I will say it many more: you have an impact on many people, and you probably have no idea how important you are to this profession.
When my grandfather is in the hospital, alone at night, and he is being stubborn with the nursing staff, I can rest comfortably knowing they recognize his actions for what they are, even if he doesn't. I know that no matter what, he will be listened to, and be cared for indiscriminantly.
So, I say to each of you: the next time someone is angry with you, will not listen to your attempts to educate them on their disease, or just doesn't seem to want to accept the fact that "the end is near", please know that this person, this human being, is someone's mother, father, brother, or grandfather...and that they are resting comfortably at home knowing you are taking great care of their loved one, and that they are truly not alone.
Thank you for being there when no one else is. Thank you for the long, thankless hours you devote to others. Thank you for being a nurse. As this "Nurses Week" draws to a close, I want you to know that if no one else says it, I will: Thank You!!!!
Steve
Friday, May 13, 2011
Find the hat that fits!
Wow...it's been a while!
For those of you that have been following my blog, I want to say that I very much appreciate it, and hope you find sone good out of it. Also, I want to apologize for not posting in over a week...life gets busy, and you know the rest.
And, for a bit of an "FYI", I do blog from my iPod sometimes, which limits my editing and spellcheck abilities somewhat. So, if some of my posts appear a little rough, you know why. I will polish them up eventually, but please know my intent is well-meaning!!
Anyway....
So I have a lot of colleagues, friends, that are going through a bit of a rough patch in their careers. That is, they just aren't happy. I understand their feelings, I really do. I hate to see anyone frustrated with their jobs; especially in healthcare. As nurses, we are positioned in a very challenging, and very crucial, role. Or more appropriately, "roles." Hildegard Peplau felt nurses serve many roles, including technician, counselor, surrogate, and several more. Nursing is not a single act. It combines many roles together, each one unique, yet essential. As nurses, we often find ourselves performing many of these roles simultaneously...and not even know it...or perhaps not even understand its importance.
For example, as a NICU nurse, I often found myself wearing about every hat you could possibly wear...many times simultaneously. I could be speaking with parents of a premature baby, telling them about how their child adapts to his or her environment, how the ventilator is helping them to "breathe", assisting the parents with holding/changing a diaper, manipulating ventilator settings based on the baby's response to the stimuli, and listening to the parents' fears, concerns, and hopes. This all occurs in a matter of minutes, or even seconds, and yet I have "worn" many different hats. So what does that have to do with you??? Well I hope a lot!
If you enjoy your job, then that is awesome, and I hope you continue to do so for a long time to come. If you are at a point in your career/life where you are not so happy, then that is where my point comes in to play. Your environment does not define you or limit your options. Do not become quickly disillusioned that you are "stuck", or that you don't want to do it any longer. We all have those moments when we look at our jobs, at our daily routines, and feel "less-than-enthusiastic" about it. I believe it is in these difficult times we do our most important thinking and reflecting. What would make me happy? What would I be happy doing? Am I challenged enough...or maybe too much right now? The only person that can answer these questions is the one asking them.
We are very fortunate to be nurses. We are the most trusted profession in the nation...in the world! We are there for people at their worst, during critical times in their lives, using our skills, or training, or knowledge...but most importantly, we offer ourselves. There is no substitute for a warm touch or an open ear. Technology can never replace the tremendous impact one human being can have on another. It is because of the many hats we wear that we are so valuable, so important, so unique. We are adaptable creatures. We can take our skills just about anywhere and be fine. But what about our passion? What about the thing that motivates us to do our very best, to give our all everyday? Maybe some are better "technicians" than "counselors"...or vice versa. It is when we reflect back on our roughest days and say, "I still love my job" that we know we are where we are "suppose to be."
Maybe you have had some bad days at work. Maybe you are feeling like you are having more bad than good. Your body is telling you something; listen closely to what it is saying. We are capable of wearing many different hats...maybe you are not wearing the right ones. If your heart is not in it, it will show. How can we effectively connect with others if we first cannot connect with ourselves? And, very importantly, we must stop thinking in "linear" terms.
As nurses, we work in a very complex system, locally and globally. Connections and relationships do not behave in a predictable manner, as they often do in linear mindsets. The whole point of complex adaptive systems is that we cannot know the end result... we cannot k ow how one thing will affect the next. In more relative terms, we cannot see our career play out before our eyes. We never know what kind of opportunity the next challenge brings. We will experience those "turning points" in our careers that will have unforeseen impacts in your life. You never know where a day can take you.
So, if you find yourself unhappy, just switch hats, until you find the one that fits the best! And no matter what, please know that you do have an impact on a much larger scale than you may be aware. Hang in there, stay focused on the patient, and stay connected!
Thank you.
Steve
For those of you that have been following my blog, I want to say that I very much appreciate it, and hope you find sone good out of it. Also, I want to apologize for not posting in over a week...life gets busy, and you know the rest.
And, for a bit of an "FYI", I do blog from my iPod sometimes, which limits my editing and spellcheck abilities somewhat. So, if some of my posts appear a little rough, you know why. I will polish them up eventually, but please know my intent is well-meaning!!
Anyway....
So I have a lot of colleagues, friends, that are going through a bit of a rough patch in their careers. That is, they just aren't happy. I understand their feelings, I really do. I hate to see anyone frustrated with their jobs; especially in healthcare. As nurses, we are positioned in a very challenging, and very crucial, role. Or more appropriately, "roles." Hildegard Peplau felt nurses serve many roles, including technician, counselor, surrogate, and several more. Nursing is not a single act. It combines many roles together, each one unique, yet essential. As nurses, we often find ourselves performing many of these roles simultaneously...and not even know it...or perhaps not even understand its importance.
For example, as a NICU nurse, I often found myself wearing about every hat you could possibly wear...many times simultaneously. I could be speaking with parents of a premature baby, telling them about how their child adapts to his or her environment, how the ventilator is helping them to "breathe", assisting the parents with holding/changing a diaper, manipulating ventilator settings based on the baby's response to the stimuli, and listening to the parents' fears, concerns, and hopes. This all occurs in a matter of minutes, or even seconds, and yet I have "worn" many different hats. So what does that have to do with you??? Well I hope a lot!
If you enjoy your job, then that is awesome, and I hope you continue to do so for a long time to come. If you are at a point in your career/life where you are not so happy, then that is where my point comes in to play. Your environment does not define you or limit your options. Do not become quickly disillusioned that you are "stuck", or that you don't want to do it any longer. We all have those moments when we look at our jobs, at our daily routines, and feel "less-than-enthusiastic" about it. I believe it is in these difficult times we do our most important thinking and reflecting. What would make me happy? What would I be happy doing? Am I challenged enough...or maybe too much right now? The only person that can answer these questions is the one asking them.
We are very fortunate to be nurses. We are the most trusted profession in the nation...in the world! We are there for people at their worst, during critical times in their lives, using our skills, or training, or knowledge...but most importantly, we offer ourselves. There is no substitute for a warm touch or an open ear. Technology can never replace the tremendous impact one human being can have on another. It is because of the many hats we wear that we are so valuable, so important, so unique. We are adaptable creatures. We can take our skills just about anywhere and be fine. But what about our passion? What about the thing that motivates us to do our very best, to give our all everyday? Maybe some are better "technicians" than "counselors"...or vice versa. It is when we reflect back on our roughest days and say, "I still love my job" that we know we are where we are "suppose to be."
Maybe you have had some bad days at work. Maybe you are feeling like you are having more bad than good. Your body is telling you something; listen closely to what it is saying. We are capable of wearing many different hats...maybe you are not wearing the right ones. If your heart is not in it, it will show. How can we effectively connect with others if we first cannot connect with ourselves? And, very importantly, we must stop thinking in "linear" terms.
As nurses, we work in a very complex system, locally and globally. Connections and relationships do not behave in a predictable manner, as they often do in linear mindsets. The whole point of complex adaptive systems is that we cannot know the end result... we cannot k ow how one thing will affect the next. In more relative terms, we cannot see our career play out before our eyes. We never know what kind of opportunity the next challenge brings. We will experience those "turning points" in our careers that will have unforeseen impacts in your life. You never know where a day can take you.
So, if you find yourself unhappy, just switch hats, until you find the one that fits the best! And no matter what, please know that you do have an impact on a much larger scale than you may be aware. Hang in there, stay focused on the patient, and stay connected!
Thank you.
Steve
Sunday, May 1, 2011
Nursing school is a floor, not a ceiling
"Everything I need to know I learned in Kindergarten"...or perhaps "nursing school", right?
Not quite.
One fundamental problems with some new graduate nurses is the fact that "they don't know what the don't know", and yet practice as if they have nothing else to learn. Being eager to step in there and get your hands dirty is an admirable quality. Experience is the best teacher, after all. But we must make sure we are careful not to overstep our professional boundaries when we pursue these great learning experiences.
For instance, a new nurse...on orientation perhaps...should probably not make independent adjustments to ventilators or other complex equipment. We gain some exposure to this sort of thing in nursing school, but it is not a "see one, do one, teach one" concept. Making adjustments to the ventilator does much more than change a few numbers here or there. It controls the patient's physiology...and anatomy. We must make sure that we know that some equipment surrounding a patient is actually an extension of that patient...and to manipulate the equipment is to manipulate the patient...and we must be ready to anticipate the effects of the changes we make. We have a duty to the patient, which extends far beyond the legalities of a patient assignment. We have an obligation to know what we are doing, why we are doing it, what the effects (good and bad) may be, know what we are monitoring (and why), and most important of all, know what we don't know.
Nursing school prepares you with basic education and training necessary to sit for the respective licensing exam. I prepares you with knowledge and experiences in a variety of settings, and with a variety of patient populations, so that you may begin practicing as a competent generalist nurse. Although some new graduates do enter specialty areas such as critical care or the emergency room, many start in a "med/surg" unit, where they will gain valuable experience in delegation, time management, communication, and organization....among others. Wearing a badge that identifies you as a "critical care nurses" or an "emergency room nurse" doesn't do anything more than just that. You do not gain immediate competence in the necessary areas of knowledge necessary to practice independently. It does not grant permission to "cut corners" and skip steps along the way. I am not picking on the CCU or ED by any means. I am using these highly specialized areas of nursing merely as examples of where new nurses may find themselves in situations they are not trained or experienced to handle alone... and must be readily aware of knowledge and training they do not possess just as much as that which they do. Of course, this applies to us all.
I say, seek out every educational opportunity you can. Learn as much as possible. Every tool you have in your belt will be necessary...only time will tell. You should never say, "I don't need that...I'll never use that..." How do you know? You don't. You never know when something you learned a while back...that seemed totally unrelated to your current job...could actually be of great benefit to you, but more especially to your patient. As nurses, we must accept the fact that our care is not as "siloed" as we might think. Patients carry everything with them at all times...their diabetes, respiratory disease, mental illness, social drama, etc... we don't get to pick and choose how we care for the patient...it's all or nothing. We could all gain from any education we can get. Do not limit yourself...and certainly do not wait for your employer to provide everything you need to know. They offer what they must so they can have documentation of training. That's it. Sure, they want to have safe patient care as well...but they are in a business, and they have limited funds. We must seek out the opportunities if they are not readily available to us where we are. Attend conferences, workshops, webinars, at-home study, etc. Read a journal! There's a wealth of information in there, you just have to start reading.
So, I say to everyone, young, old, novice, expert...keep on learning. If we truly want to provide patients with the safest care possible, we must take control of our own practices and be ever aware of what we don't know! Keep chipping away at it...you will be amazed at what you have to gain!
Thank you.
Steve
Not quite.
One fundamental problems with some new graduate nurses is the fact that "they don't know what the don't know", and yet practice as if they have nothing else to learn. Being eager to step in there and get your hands dirty is an admirable quality. Experience is the best teacher, after all. But we must make sure we are careful not to overstep our professional boundaries when we pursue these great learning experiences.
For instance, a new nurse...on orientation perhaps...should probably not make independent adjustments to ventilators or other complex equipment. We gain some exposure to this sort of thing in nursing school, but it is not a "see one, do one, teach one" concept. Making adjustments to the ventilator does much more than change a few numbers here or there. It controls the patient's physiology...and anatomy. We must make sure that we know that some equipment surrounding a patient is actually an extension of that patient...and to manipulate the equipment is to manipulate the patient...and we must be ready to anticipate the effects of the changes we make. We have a duty to the patient, which extends far beyond the legalities of a patient assignment. We have an obligation to know what we are doing, why we are doing it, what the effects (good and bad) may be, know what we are monitoring (and why), and most important of all, know what we don't know.
Nursing school prepares you with basic education and training necessary to sit for the respective licensing exam. I prepares you with knowledge and experiences in a variety of settings, and with a variety of patient populations, so that you may begin practicing as a competent generalist nurse. Although some new graduates do enter specialty areas such as critical care or the emergency room, many start in a "med/surg" unit, where they will gain valuable experience in delegation, time management, communication, and organization....among others. Wearing a badge that identifies you as a "critical care nurses" or an "emergency room nurse" doesn't do anything more than just that. You do not gain immediate competence in the necessary areas of knowledge necessary to practice independently. It does not grant permission to "cut corners" and skip steps along the way. I am not picking on the CCU or ED by any means. I am using these highly specialized areas of nursing merely as examples of where new nurses may find themselves in situations they are not trained or experienced to handle alone... and must be readily aware of knowledge and training they do not possess just as much as that which they do. Of course, this applies to us all.
I say, seek out every educational opportunity you can. Learn as much as possible. Every tool you have in your belt will be necessary...only time will tell. You should never say, "I don't need that...I'll never use that..." How do you know? You don't. You never know when something you learned a while back...that seemed totally unrelated to your current job...could actually be of great benefit to you, but more especially to your patient. As nurses, we must accept the fact that our care is not as "siloed" as we might think. Patients carry everything with them at all times...their diabetes, respiratory disease, mental illness, social drama, etc... we don't get to pick and choose how we care for the patient...it's all or nothing. We could all gain from any education we can get. Do not limit yourself...and certainly do not wait for your employer to provide everything you need to know. They offer what they must so they can have documentation of training. That's it. Sure, they want to have safe patient care as well...but they are in a business, and they have limited funds. We must seek out the opportunities if they are not readily available to us where we are. Attend conferences, workshops, webinars, at-home study, etc. Read a journal! There's a wealth of information in there, you just have to start reading.
So, I say to everyone, young, old, novice, expert...keep on learning. If we truly want to provide patients with the safest care possible, we must take control of our own practices and be ever aware of what we don't know! Keep chipping away at it...you will be amazed at what you have to gain!
Thank you.
Steve
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