The culture of nursing - Professional behaviour & conduct

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    I'm currently a second year student and getting ready to go on my first clinical placement as a second year in two weeks time. I'm really, really looking forward to placement, especially now that we have a larger repertoire of skills to perform. I'll be going to a medical oncology ward and I'm looking forward to learning about different aspects of cancer and participating in cancer care. However - I have had problems with my clinicals in the past. Prior to my last placement (August, 2009) I posted here seeking opinions and advice from seasoned nurses as to how to improve myself and I received some absolutely astounding feedback. I am sure that the feedback I received and the reflection that it prompted within myself played a significant role in my passing that placement, though it was still a very close call. You can read that post HERE if you're interested.

    Anyway, the reason I am posting today is that while I'm incredibly excited about going on this next placement, I'm also acutely aware that even though my practical and procedural skills are up to par I still have a lot of deficits regarding my ability to practice professionally and appropriately within the scope of a student nurse. I was hoping for some advice and prompting from those more experienced that I am to help my prepare myself to do well on this placement and improve on the areas that I am still lagging behind in, even after three clinical placements.

    Slowly, and after much exposure, I have begun to understand the "culture" of nursing and the place of the student nurse within that culture. Right or wrong, I have developed the impression that nursing can be, all to often, a very cut throat profession with a good dose of passive-aggressiveness and that students are almost always at the very bottom of the food chain. (I'm not suggesting that all nurses are like this. I am insinuating that this has been my experience so far.) While this makes me very sad, I have come to accept that the culture of the nursing workplace may be the ultimate downside to the career of my dreams. However, I'm willing to work through that, which, I guess, is why I'm here and asking for your help.

    I am, by nature, an outspoken person. Further, I'm incredibly passionate about nursing and really want to be as involved as I can in the activities of the ward, though often this means simply observing. Unfortunately, as a bottom feeder in the nursing world, my outspoken, enthusiastic and sometimes loud personality does not sit well with the nurses who have had the unfortunate luck of landing a student on their shift. Being proactive and enthusiastic is often interpreted as just plain getting in the way and I find it difficult to balance meeting my learning needs with not getting in the way and stepping on anybody's toes. However on the other hand, keeping quiet and out of the way is detrimental to my learning and just plain looks bad for a student! Confidence is often interpreted as overconfidence (which I've learnt is a really, really bad image to present and sends nurses running the other way) and I'm not sure how to project a balance of confidence in the skills I do have with uncertainty about skills I'm still unsure of and appropriately ask for assistance without getting in anyone's way.

    I often feel like the simplest way to just pass each clinical to keep quiet, shut up, don't ask questions and just watch unless someone asks you to do otherwise. Obviously it's not ideally appropriate but so often I come up short about the best way to meet my learning needs, not get in the way and just plain pass.

    I know this hasn't been a very clear post. I am so very unsure of what the exact nature of my problem is, which makes it difficult to ask for help. I really hope that there is something - anything - in this that AllNurses members can offer me feedback on. I'd really appreciate your thoughts and opinions prior to my upcoming clinical. More than just passing, I was to be a good nurse and make a good impression. & I don't think I have the knowledge or the skills to do that within the culture of nursing. I'm hoping that your feedback will help me find my feet a little bit more and help me take the next steps toward preparing for my clinical.
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  5. 3
    So your problem is you're smart, loud, sassy, mouthy, and think you know it all? Eh, I feel you're pain.

    Basically, from what I read in your post, you worry about coming across with those qualities, and so you back off, don't ask questions; and then you feel that you aren't getting as much as you should out of your clinical experience.

    Because I, too, am a smart, sassy, loud, mouthy, insufferable know-it-all, here's my advice to you.

    Accept that you are not going to have all your questions answered to your satisfaction. This is so difficult for me. A question pops into my head that I can't answer myself, I can't find the answer, dammit, I want it answered. Your precepting nurse and/or your instructor might not know the answer, might not be able to explain the answer thoroughly, or might not understand your question. There are some questions that just do not need to be answered in order for you to be a good nurse.

    Think about your word choice and your tone of voice when asking a question. Do not use accusatory tones or words, placing your preceptor or instructor on the offensive.

    Accept that there is more than one correct way to do nursing tasks. When a nurse does things differently than you learned in school, take care in questioning it. If it is something major, you can go ahead and ask, in a nonthreatening way. If it is something that *really* doesn't make much difference, if it bothers you, you can discuss it with your clinical instructor later. Another good resource is the protocols and procedures manual for the unit (probably online). You can look up a procedure and see how your facility wishes this to be performed; usually the rationales and references are included in each procedure or protocol description.

    Keeping your head down is not defeat or a time waster. Observation *IS* important. So is working things about on your own, instead of asking about them. Respect for the patient and nursing staff is also an important aspect of your education, and although you wish the world to revolve around you, it actually doesn't (I still struggle with this concept...).

    I found that if I only spoke up once every three times that I had a question, I came across as less aggressive, less prickly and less annoying than if I asked every question that popped into my head. Basically, FILTER, FILTER, FILTER was my mantra, and it served me well.

    Good luck. You'll be a fine nurse. Even a less than perfect clinical experience teaches you a lot. Don't forget that.
    CBsMommy, BEDPAN76, and streptococcus like this.
  6. 0
    Quote from BluegrassRN
    So your problem is you're smart, loud, sassy, mouthy, and think you know it all?
    Yes! This is exactly my problem. Sometimes I wonder whether I would be better off as one of the many students in my course who do not speak a good scope of English and act more like flies on the wall than students ready to learn.

    Quote from BluegrassRN
    I found that if I only spoke up once every three times that I had a question, I came across as less aggressive, less prickly and less annoying than if I asked every question that popped into my head. Basically, FILTER, FILTER, FILTER was my mantra, and it served me well.
    This is great advice and something I think will be really helpful for me, thank you! I'm going to write it down and keep it in my pocket whilst on clinical to consistently remind me!

    Quote from BluegrassRN
    Even a less than perfect clinical experience teaches you a lot. Don't forget that.
    I'm certainly not looking for the perfect clinical experience, if there is such a thing. I'm just trying to find a way to be a good student, learn and not step on any toes in the process. For me, this is so much harder than it sounds. Sometimes I wonder what is wrong with me... I mean, all the other students pass their placements no problems, so it can't be that hard, can it?

    Quote from BluegrassRN
    Keeping your head down is not defeat or a time waster. Observation *IS* important. So is working things about on your own, instead of asking about them. Respect for the patient and nursing staff is also an important aspect of your education, and although you wish the world to revolve around you, it actually doesn't (I still struggle with this concept...).
    I certainly don't think that observation is a waste of time. This is how you learn, especially in the beginning, right? I also think that respect for the staff and patients is crucial in forming a good working relationship with everyone on board. I guess it's the world revolving around you part I struggle with... I don't expect to be the centre of everyone's attention or the concern of all the nurses on the ward. I get that students are often just an extra burden on the ward and get in the way and I would really hate to get in the way. I try not to, I really do. I guess it's an intricate balance between observing, practicing skills/being involved and not treading on any toes in the process. This is what I find so difficult.

    Thank you so much for your feedback.
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    Just like in other areas of life you get good people and bad people. I am just in Block 2 so I don't have a huge amt. of clinical experience yet. We did 6 weeks last semester in different types of care settings.

    I too am a very outgoing, friendly, curious type of person. It's hard for me to just sit there and act dumb. Instead of choosing a pt, I choose the nurse in charge of my pt. I start by asking her about something I notice she's really good at, how can I learn to be good at that, too. Usually that makes her more open to having me around. I give my assigned nurse breaks from me to catch up on charting and stuff, and try to take my lunch when she's not on lunch break to again give her some time "alone."

    What also works is to show I'm willing to do the grunge work. If someone needs cleaning up, I'm the first one to step in. I don't mind doing nursing assistant work because it helps me to learn to assess people. I would maybe never get a chance to look at someone's skin quality until I am able to see all of them undressed during a bed bath. Then I can sneak in a quick assessment. When the nurses realize I'm willing to get my hands dirty they seem to welcome me more into their unit.

    When I'm on a floor of hands-off, not so friendly nurses I escape into the patient's rooms and talk with them. Usually the pt is only too happy to tell you about their health issues, family, social life, etc. and what they wish would be different about their nursing care. They are flattered that a person would be so interested in them. ;-)

    There was a time when some tenseness was happening on my pod due to a pt. family issue, and it affected the moods of all the nurses. A social worker was brought in. I sensed that I needed to stay out of everyone's way for a couple of hours, so I literally went room to room asking pts if they needed anything, and keeping busy that way. And then talking to the pts in the process. Or, I find a pt who needs to go elsewhere for a test/procedure and I ask if I can go with them to learn more about the procedure.
    hikernurse likes this.
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    It sounds like you have the tendency to over-think things. I get that, as well. It's just an effort to understand as much as possible; it's okay.

    You'll do just fine in your clinical experience. You'll misstep at times; everyone does. It's okay. Every misstep, every mistake, every poorly phrased communication is a learning opportunity. I tend to over-analyze my day as I'm on my way home form work. I always make myself think of what I've done well, in addition to what I've done poorly, what I could have done better. This is what I do to help me become a better nurse and coworker. Just a suggestion, it may be helpful for you, it may not be something you need.

    Good luck with your clinicals!
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    OP, here is something to ponder....

    Nursing school is really not set up for you to learn. That is, from other nurses.

    The learning comes on your own time and I mean without assistance. More often than not, you need to just do what needs doing to get thru school, no more, no less. I think there are probably few places left where a student can actually learn the way nurses used to learn in the past -- which was more like an apprenticeship. This is very unfortunate, but it is reality. You will find that most everybody in nursing these days, just doesn't want to be bothered with an intelligent student. The majority pretty much just wish the gaggle of students on the floor would just go away. If you get lucky and get a "live" RN who does want to show you stuff, don't get in her way, and allow the teaching to happen. Don't ask her silly questions that throw her off her schedule, just let her teach, and take it in. Then consider yourself to have had a wonderful day.
    wooh likes this.
  10. 0
    Quote from rachelgeorgina
    I'm currently a second year student and getting ready to go on my first clinical placement
    I often feel like the simplest way to just pass each clinical to keep quiet, shut up, don't ask questions and just watch unless someone asks you to do otherwise.
    and just plain pass.
    Yes. You are correct. Be quiet, don't stand out and pass.

    Give someone even the slightest opening and they'll exploit it.
  11. 1
    Look, think of a ward as a well (or not so well) oiled machinery. And you, the eager student, willing the clog to roll when it's actually meant to stop, poking your fingers through little holes when you shouldn't, staring dizzy at the whole thing and not knowing where it's meant to start and where to end. Got that picture in your mind?
    Good.
    Now. What's the machinery for? What does it do? An oncology floor.
    Ok.
    Go to the clinic for a day or two. See the patients with the first complaints, see how the doctor responds, what tests they order, how they speak, etc. Read on the subject.
    Then go to the ward and see then getting ready for surgery/chemo etc. What do the nurses to? What's the schedule?(dr rounds, meds, meals, etc)
    Focus a day or two on wound care, then on meds, then on surgery (go see it if you can).
    Then post op care (choose a bit or two, don't go after the whole package, remember all those clogs with nasty sharp teeth? drains is always a good one, CV lines-even if you don't get to pull them out, learn about them, there are tens of hundreds of them, why choose a robinson over a redivac, how long do they stay on, when to change them, can you think of a method to disguise them, such as a nice bag etc, etc, etc, you get the picture)

    Basically, after you made a cup of tea for your mentor, tell her what the focus of the day is for you. There's plenty to learn about stuff even after you've been doing it for years. You're there for a 'taster', to get an idea, not to become proficient at any of that, it takes much longer than a placement.
    You've got the luxury of learning without the fright of losing your pin. Take bite sizes and focus on basics.

    Also, find out what's the best way for you to memorise stuff. It's all a jumble, and it's coming on your head like a ton of bricks. I will never forget what omeprazole is and what it does, side effects, everything about it, because this guy once draw me a picture of the stomach, complete with esophagus, explained to me how the reflux works, what happens when omeprazole gets in there, etc. I found that drawing really helps me, so I've been drawing ever since(badly, I hasten to add, but it makes sense to me). Keep a little notebook in your pocket and scribble quickly something new, if you get the chance later, ask more, your look it up yourself.

    When it all gets too much to you, choose a day of 'taking a step back' and performing 'menial' tasks. Dish out food, or clean the trolleys or something that doesn't require more learning. Pace yourself.
    Good luck.
    TrishJK likes this.
  12. 0
    My psych rotation was with hospice and I was like huh? Until the first shift and I figured it out. I didn't learn or even use ONE nursey taskey thing but learned the most that rotation just by listening. I'm not saying that will be the case for you as a med onc floor can be extremely busy but sometimes you CAN learn excellent therapeutic comm skills from these nurses on this type of unit. And those skills are priceless no matter where you end up working! Good luck I hope you enjoy your next rotation, I love this population of patients it really helped me learn empathy and put some things in my life in a better perspective.
  13. 1
    In nursing school, I drew on my work experience in customer service at a restaurant. I would give this pep talk to myself to set my head straight:

    1. Get your stuff done quickly and quietly. You are there to pass nursing school, period. Put your school work first.
    2. THEN ask questions, and make sure you prepare first. Look it up.
    3. Do helpful nurse aid type stuff if there's down time.
    4. I practiced these phrases: "What else can I get/do for you?" "I'm a student nurse, here to help your nurse take care of you today." "I haven't yet seen [a certain procedure], could you notify me if there are any opportunities to observe today?"
    5. Clarify with the staff: what you can / can't do, how long are you there, what you'll do for the nurse who has your patients.
    6. Keep your enthusiasm and energy for learning, even if your fellow students call you an "overachiever" (like my classmates did... but hey, who graduated magna cum laude?? me!)

    Hope my pep talk works for you too! Good luck.
    wooh likes this.


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