A look at the lessons I've learned or re-learned this year. Hopefully, I learn new things every year -- every day even. But some are more memorable than others. Here, then, is a list of the more memorable things I've learned this year.
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There are three kinds of people: there are those who get it, and there are those who don't. The third kind are those who don't get it but think they do. The latter kind are the worst ones to deal with. Just like you cannot teach anyone who already thinks they know everything, you cannot hope that those who don't get it but think that they do will ever get it. They won't. Instead, they'll keep trying to argue that you are wrong, and that they get it and you don't. That can be frustrating and infuriating. Typical example: vent threads. There are those who get that you're venting and either express sympathy or happily pile on with their own (usually humorous) vents. And then there are those who "step on" the vent thread by telling everyone who vented that they are lacking in courtesy or compassion, that they must be horrible nurses/preceptors/people and they should consider a career change. You cannot convince those folks that they are wrong or missing the point. If I were a better person, perhaps I wouldn't bother.
A sense of humor makes everything better. It's not that I didn't know that before; I did. I've always used my well-developed sense of the absurd as a coping mechanism. It's just been driven home to me yet again that it is better to laugh than to cry. Explosive diarrhea forming a river off the bed and across the room? You're going to have to clean it up anyway, so you might as well laugh about it while you're doing it. The patient's wife who nit-picks everything you do, don't do or have considered doing. You could get angry and frustrated and tell her off -- I'm not saying I haven't done that now and again. Or you could just laugh about it and let it go. That's a far more successful coping mechanism in the long run. The patient that calls the police to report an assault by the np who drew blood cultures on her? That's pretty funny, too, when you think about it.
With respect to Samuel Shem and "the house of god", there is no body cavity that cannot be violated with a good, strong arm and a 14 gauge needle. The left ventricle, the pleural space, the last remaining unviolated vein on the chronic patient's arm . . .
And there are some body cavities that ought not to be violated with a good, strong arm and a 14 gauge needle. The left ventricle perhaps.
The size of the health care practitioner's knowledge base in inversely proportional to how much they think they know. The new grad who thinks she knows everything doesn't, and the one who thinks she doesn't know anything knows a lot more than she thinks she does. The second new grad is a pleasure to precept and a valued colleague down the road. The first will probably get into anesthesia school after a year or two and we won't have to deal with them any more.
And while I'm on the subject, the ability to get into anesthesia school seems to be completely unrelated to knowledge base, common sense, critical thinking skills or general intelligence. I'm hoping that the ability to actually graduate from anesthesia school involves all of those attributes.
Becoming a nurse practitioner does not automatically endow one with common sense, a good work ethic or the ability to behave in an appropriate and professional manner. Hair flipping, gum chewing, non-listening NPs who shop on the internet during multidisciplinary rounds lack all three. (and see above for a comment on how much that particular NP actually knows.)
There are "tube drainers" and there are "non-tube drainers." some of us absolutely lack the ability to pass by a chest tube, foley catheter or rectal tube without draining the tubing. Others will chart "0" for chest tube output and urine output for hours on end.
When you work in a teaching hospital, part of your job is to educate doctors. The relationships they form with you and your colleagues will influence the relationships they have with nurses for the rest of their careers. You can either teach them that nurses are valued members of the health care team who can save their butts, back them up and teach them how to pull a balloon pump (even though we're not allowed to actually pull a balloon pump) or you can teach them that nurses are a pain in the posterior they have to put up with every time they enter a nursing unit. And thirty years later, when they become medical director in the ICU where you're currently employed, you'll be very grateful if you actually taught them to value nursing input. (and your current colleagues will be, too, even if they don't know who to thank!)
