Monday, March 02, 2009

go ahead, dooce me

Coincidence, placebo or super naturopathy, I feel better. It seems a little quick to me, but since I've been detoxing and swigging zinc, parex and another natural remedy or two, those nasty symptoms have declined. It made for a great day at work. I faced the onslaught with renewed energy, enthusiasm, cheerfulness and calm and loved it. What I didn't love was the way the day ended.

I had been looking after a patient for several hours. They were mostly OK, but failed to meet one of our nonnegotiable discharge criteria and consequently I could not send them to the ward. I was trying to deal with the issue, but we were all busy and in the deluge of post-operative patients I found myself looking after other people in addition to my original case load. We were all doing our best with the resources at our disposal, but inevitably some things slipped through the cracks. In the end I could not resolve my patient's issue before my shift finished. I handed over to another RN, explaining the situation, my actions and the outcome of these interventions.

I hate this moment in nursing. Actions undertaken with the best of intentions are laid bare before the incoming nurse, but the context of care is lacking. As I relay my story of assessment, planning, intervention and evaluation, I cannot hope to recreate the noise, busyness, tension and concomitant demands on my time. The record of my nursing care is instead detailed in cold, clinical terms and laid open for the assessment of the next RN.

The nurse I was handing over to today immediately started sniffing through my actions and charts. Her whole attitude was one of superiority, looking for the problems in my care. I am the first to admit I do not always make the best clinical decisions - any nurse who thinks they never make mistakes is most likely deluding themselves - but I have been nursing a long time. I know where there is room to move and where immediate action must be taken. I prioritise my patient's needs and make quick decisions about where I should focus my attention. I resent the feeling of being evaluated, especially when the nurse has significantly less experience than myself, and particularly when I cannot convey the full reality of the situation. My patient today was not recovering without complication, but they were basically OK and I did my best under the circumstances. I still left feeling judged, and no amount of rationalising would shake it.

I walked home reflecting on the situation, muttering and mumbling to myself about that RN. They've done it to me at least twice now - come on and questioned my decisions and actions. There are a number of factors at work here, not the least being individual personalities and nursing culture.

And that's when I saw them - the three fingers pointing back at me. I started thinking about my attitude when I take over a patient's care. Usually I am curious about what has happened (I love a good story) and want to know what is required of me to meet the patient's needs. I might ask clarifying questions but generally I am open and relaxed... until the previous nurse walks away. Then I start going through things with a fine tooth comb. 'They didn't do that? I wonder if they picked this up. I don't think they wrote that figure down anywhere!' and so it goes on. My demeanour with the nurse might be pleasant enough, but beneath the surface I too have the claws out ready to rip their practice to shreds.

Again, nursing culture and ingrained ways of thinking play into this. Wouldn't it be great if we saw the handover as a time of collaboration? When we ask questions, bring them humbly, hoping to offer insight from an alternative perspective, aiming to aid the situation rather than critique. And why not acknowledge the good work the nurse has done - we're all under pressure, let's honour each other and encourage each other in the face of difficulty. Let's give each other the benefit of the doubt - we mostly do our best in sometimes trying circumstances. I dream of handover being a time of affirmation, support and good will, with the patient's needs in the centre rather than our overinflated egos.

I'm kind of hoping good can come from this situation. I want to remember what the RN did to me and make a conscious effort to be different. I'd like to offer positive feedback to my colleagues. I can't change the personality of that nurse, but I can chip away at the dominant nursing culture. And who knows - one day we might stop kicking each other down with horizontal violence! Bring on that day.

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At 8:27 am, March 03, 2009, Anonymous deanna said...

You're a good one, Cecily. I'd want you for my nurse anytime. :o)

At 1:24 pm, March 03, 2009, Blogger Cherie said...

Love this - so insightful. And a great lesson for us all.

Good job!


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