How To Become A Highly Effective Nurse

[gypsyd8]

I saw this while on break last night and did not have the time to articulate a fair response. I do not want to come off as disrespectful, but something about this really rubbed me the wrong way. The first issue I had was this:

"Any seasoned pro will be able to tell you about the numerous times in which they were on their feet all day and not once stopped to consider a break."

This statement is not only untrue, it is actually wrong due to the implication (by the previous sentence) that this is somehow desirable. A "seasoned pro" will not be on their feet all day, and seasoned nurses take their legally mandated and justified breaks. There is nothing wrong with this. This is actually the desired state of affairs. Perhaps the author did not intend it to be interpreted this way, but as a read further it appears that the author has internalized some form of corporate sycophany.

My second quibble was with the repeated use of the word "task" to describe the activities we perform in the course of our professional duties. I suppose technically the things we do could be called "tasks" but honestly I never heard them described this way. In nursing school we learned the nursing process, and were repeatedly admonished to avoid becoming "task oriented." The theme of a problem solving process that uses critical thinking has permeated my work as a nurse for more than ten years. It was reinforced when I went back to school for by baccalaureate, and again when I returned for my masters, where nurses were repeatedly described as "knowledge workers." I have never hear the work I do be relegated to a "task list" until I learned Cerner, so maybe that is why I notice it now.

Finally, some of these seem like simplified versions of reality. "Avoid taking shortcuts."

Why? If something can be done more efficiently without sacrificing safety why not take a shortcut? Is it because it would allow the nurse to take their legally mandated and justified breaks? Please understand I am not talking about (for example) scanning a patient label and all the meds outside the room in the hall somewhere and then administering the medication. This is something that is routine practice at a facility I used to work at and students were actually being taught this practice by the staff nurses they were following. This defeats the whole purpose of barcoding and scanning patient wristbands and medications, it is the modern equivalent of signing off the MAR before med administration and is a dangerous practice. I bring up this example because there is actually a fairly nuanced conversation that could be had about positive deviance in nursing (Clancy) and the old adage to "work smarter, not harder." I have also had experiences where any deviation from protocol is harshly punished, even if there is a positive outcome. I think there is a place in between following policies, procedures, and protocols for the sake of following them and flagrant violation of standards designed to ensure safe practice. It is our job as nurses to find that happy medium.

"Don't rush tasks." Well this I can agree with, to an extent. I have felt for some time that it is better to be late (administering medications, for example) and correct than on time and in error. Time and time again I have been leisurely preparing my patient's meds when I find one that should not be administered for one reason or another. When I have been rushed and given everything early the physician invariably discontinues a medication after I have administered it. I still hate being late, though, and sometimes rushing is necessary. Again, nuance. there is no right or wrong answer here. It depends on the situation.

Right after "don't rush" is "manage your time effectively" with the suggestion to "break each day into different periods of time, in order of importance." That is not how nursing works. We do not prioritize our days by periods of time. We prioritize our patients, from most acute to least acute and go from there. Then, they change. The quiet one who never calls is septic and the one on the call light every five minutes is a drug seeker. Or, the one you think is a drug seeker actually has a dissecting aortic aneurysm and the quiet one needs to be transferred to a lower level of care. It is an ongoing process of assessment, diagnosis, outcome identification and planning, implementation, and evaluation. It is literally impossible to break each day into different periods of time in order of importance. Each day is different.

"Don't be afraid to ask for help." Okay. Don't be afraid to offer it, either.

"Set your own targets." I seriously need help on this one. I wake up, shower, get into scrubs, go to work, clock in, and do my job for twelve hours. Those are the only targets I need. The admonition not to "wait for someone in management to allocate you certain goals" makes no sense to me. Management does not do my job, and I am happy when I do not see them.

I suggest my patients for transfer when they no longer belong in the unit. This is not because I want an admit, but because throughput is important so people do not die waiting for a bed. I transfer my patients when a bed is available for the same reason. I call the ER or OR or cath lab for report when I am ready for the same reason. It is not because I am itching for that trainwreck of an admit. If I am having an easy shift I will allow myself that. I will take care of my patients and leave on time contentedly knowing my patients were cared for, they got the appropriate medications, physicians were made aware of important issues, my charting is done and I didn't forget anything. Anything extra I do only when I am told, it is required and/or there is additional pay involved.

There is nothing wrong with that.

[NurseNJoy]

Tasks!

..sounds like a word from ancient Hebrew.

[nutella, MSN, RN]

The longer I work in nursing, the more I have come to the insight that the system itself is wrong.

Just because a lot of nurses are not able or feel they are not able to take breaks does not mean it is good, right, or desired. There are more and more "tasks" for RN and therefore less time per patient.

There is a reason why nurses leave the profession or go back to school after a short period of time to become a NP. The amount of new graduates who feel that they are not able "to do the job" is huge.

As long as the system produces more and more nurses and just replaces the ones that give up with another new nurse nothing will change.

Perhaps primary care in hospitals the way it was envisioned is not working out that well and "group" care would be better. Nurses who get stuck in a situation where the CNA are not doing their job or are also too overloaded often do two jobs because they are being held responsible.

While it is great to say "hey, just use some strategies to get your nursing job done" I think we also need to look at how the current system forms and shapes nursing.