Print Version

Email Entry

by jodi_cmsrn

Reader Rating:

Posted: Nov 17, 2007 07:33 PM

Views: 2062

Received 12 "Thank You" From 4 Posts

As a new nurse starting out, I remember learning multiple new things every day. Our facility has a couple physician's that are legendary for their temperments. I have always been the type of person that wants to understand why I am doing something, and would always ask why?
Why are we doing this? Why are we doing this like this? Why is this going to work?

One day I was preparing a patient for an angioplasty and the patient had a critical high potassium level. Upon notifying the physician (and expecting a kaexylate order), I received an order for an amp of D50 and insulin. After asking every nurse on my unit, and looking in all the drug books I could find, I still didn't find the answer. I gave the medications, rechecked the patient's potassium level as instructed and sure enough it had improved.

When the physician arrived on the unit later (of course one of the famous temperments), much to the surprise of my co-workers I simply asked him, "Why did we do this, and why did it work?" He happily explained it to me, and actually thanked me for asking. He also told me it was refreshing to have a nurse want to learn and has continued to go out of his way to show me new things, and actually praises me to patients, co-workers and physicians.

Don't be afraid to ask "Why?" You just don't know what you can learn.

Nov 17, 2007 09:39 PM - Jodi hugs love, you are a good nurse...!!!!!

Nov 17, 2007 10:40 PM - I've found the same thing with our famously tempermental doctors. Most of the more demanding docs I've worked with just want good patient care. They are usually smarter than most and are frustrated by people that don't know as much as they do. People that just do what they are told without understanding the reason why are dangerous. The more you know the better your judgement is going to be. There guys usually understand this and are more than happy to teach.

Nov 18, 2007 02:36 PM - Awesome! I love it when docs take the time to teach. I once asked a surgeon about gastric bypass. Not only did he share the risks and reasons why he always excused himself from these cases, he actually explained the procedure and drew me a pic. Talked me out of it for sure.

Nov 19, 2007 03:27 PM - Thanks so much, I am always afraid & hesitant to ask, but I do want to understand & learn more. I think I will start giving that a try. It's good to know that doctor's like to see that instead of being irritated by it as I suspected they would be.

Nov 20, 2007 12:42 PM - Thank you for the post, it seems so basic . . .I don't know why I don't do it more. I will remember your experience the next time I hesitate to ask why.

Nov 24, 2007 01:52 PM - Thanks for posting, Jody, and I'm glad that you spoke up and found your answer.

I do have one suggestion for you, though: next time, it may be best to ask why before giving the med or treatment.

If an order doesn't make sense to you, it might be because there's something you need to learn.... but it also might be because an error has been made. Even as new nurses, we have the right and responsibility to use our knowledge and judgement and to question or challenge an order.

I'm a new grad orienting in the NICU - a few weeks ago, my preceptor and I gave a fluid bolus to the wrong baby because the doctor had written the order on the wrong chart. The original error may have been the doctor's, but there was also a nursing error made when we gave the bolus without seeing for ourselves why this baby would need one.

No harm done, fortunately, but this incident helped me to understand the importance of checking things for myself. In the months that I've been working, I've come to realize that the hospital world is full of mistakes - prefilled syringes where the volume doesn't match the label, expired feeds sent up from pharmacy, equipment that doesn't work properly, equipment manuals that get "distal" and "proximal" mixed up. Checking for ourselves and thinking for ourselves isn't just an extra layer of caution - it's absolutely essential to safe practice.

Take care, Marion

Nov 24, 2007 03:19 PM -

Originally Posted by jodi_cmsrn

As a new nurse starting out, I remember learning multiple new things every day. Our facility has a couple physician's that are legendary for their temperments. I have always been the type of person that wants to understand why I am doing something, and would always ask why?
Why are we doing this? Why are we doing this like this? Why is this going to work?

One day I was preparing a patient for an angioplasty and the patient had a critical high potassium level. Upon notifying the physician (and expecting a kaexylate order), I received an order for an amp of D50 and insulin. After asking every nurse on my unit, and looking in all the drug books I could find, I still didn't find the answer. I gave the medications, rechecked the patient's potassium level as instructed and sure enough it had improved.

When the physician arrived on the unit later (of course one of the famous temperments), much to the surprise of my co-workers I simply asked him, "Why did we do this, and why did it work?" He happily explained it to me, and actually thanked me for asking. He also told me it was refreshing to have a nurse want to learn and has continued to go out of his way to show me new things, and actually praises me to patients, co-workers and physicians.

Don't be afraid to ask "Why?" You just don't know what you can learn.

I agree to that. People love to explain their knowledges. If someone asked me how things work this way, I love explaining things because it shows how knowledgeable you are.

Also, it's our role to be the patient's advocate. We are the security guard. We are the voices for the patient. We speak for the patient. We need to know why this thing are being done. If we know that it is safe, then we follow Doctor's order. We don't just follow Doctor's order, we are not just Nurses anymore, we can question for every drug, intervention, that we give to the patient if we don't know why it works.

I have this patient who has an PRN order for Tylenol for Anal route for moderate pain, and Morphine for Oral route for severe pain. I questioned the physician if we could have Tylenol for Oral route, since Morphine is ordered for Oral route. I told the physician that the patient doesn't like to be inserted through rectally. Then, the physician approved my request. Cool huh?

I'm a new Nurse just like you. The Board Exam doesn't prove us we know everything. Nursing is all about learning new things.

Nov 27, 2007 04:24 PM - So why did it work?

Nov 28, 2007 04:55 PM - I too am a new nurse and I am constantly amazed when I see seasoned nurses tip-toe around doctors. My opinion is "aren't we in this together" and doesn't our work include safe practice? With that in mind I do approach doc's and ask questions when my co-workers haven't the answers. So far everyone has been very helpful except for one doc and I attribute his hostility to his own insecurities. He is not the person I would seek advice from. Cheers and happy nursing!