The grayness of nursing...

[Happynurse12]

Does the gray area that exists in nursing bug any of you all? I tend to be a black and white person, so nursing can be difficult for me sometimes. People will say "use your nursing judgment" but I am more of a policies and procedures type of person. I am not sure if its my personality or from time spent in the military. I am currently working urgent care and wonder sometimes if something a little more black and white would suit me better? I was told today I would do well in an OR/PACU area or case management. Are there any more nurses out there that are like me? where do you work? Thanks!

[paganoid]

Sorry it took so long to get back to you on this. I identify with your use of "ambiguity" because that is a more precise description of the "grey areas." BTW, I am HM2-to-BSN the long way 'round.

My instructors in nursing school hammered the philosophy "become comfortable with uncertainty." There is no way to be 100% sure, so therefore there must be a point where you are just satisfied. That point is different for each of us. Coming from a computer science background I found it difficult to surrender to ambiguity/uncertainty. I tended to over-research my care plans in the mistaken belief that I could prepare for any possible outcome. Patients proved me wrong. Sometimes "the best you can do" is the best you can do. A good nurse will exercise due diligence in preparation and execution of her/his duty but sometimes patients fall when you're in the next room or down the hall.

There are jobs that are the same every day. I think they don't pay as well as working at the bedside. In the quality improvement department, for example, you can abstract data from the medical record for projects to improve care. Some people find this kind of work too dull, others prefer it. Again, a continuum. If you think this might be for you, Google the RN CCDS credential. Doing so, I found an interesting article and have appended to this message. Good luck!

document.pdf

[Happynurse12]

Thanks so much Paganoid!! I've actually been interested in QA/QI for sometime now so I'll def take a peek at the article. I think in just trying to find a comfort level with the ambiguity as you mentioned. Some days are great others not so much. What area of nursing do you work in?

[firstinfamily, RN]

I think it takes a while to find the "magic" in nursing. There are times when I have stepped outside the protocol box and my patients did better because of it, but having the knowledge to do this was what kept me comfortable. However, if you are stepping outside of the protocol box you are also leaving yourself open for legal action, so beware!! Your responses to patient situations are not always clear and cut, everyone(patients) are different. You have to access your knowledge, your facilities protocols and what is the expected outcome and put it all together. If the expected outcome is not a positive thing then you as the nurse have to make a move, sometimes you may be out on that tightrope by yourself, but you are doing it to improve your patient's outcome. Sometimes protocols are made to justify how a facility does things and then the protocol does not get changed when the procedure needs updated etc. and legally you are bound by an outdated protocol. Your facility should have a continuous plan of action to maintain updated protocols, you can get that good old Nursing Policy and Procedures binder down and look at the protocols and see when they were last reviewed or updated. Your nursing judgement is the best resource you have, and if you are unsure ask your attending MD or a MD that you respect or your nurse educator, nurses are not alone, although we feel we are most of the time. It is a team that helps our patients to recover to their optimal health or demise. But if you are the only one on the team who sees a problem then take up the challenge and bring the problem forward so that it can become something the entire team is looking at!! Sorry, it is not always black and white, there are a lot of gray areas in generalized nursing.