Mastering the art of working in the clinical environment should be seen as a work in progress for each of us. Looking to enhance your clinical skills and game? Whether seeking a job or actively working in one, each patient exposure is an experience placed into a clinical toolbelt from which you can learn, grow, and discover. Blossoming within the clinical environment comes easy for some, but may take years for others.
1) Run Toward as Many Clinical Experiences as You Can
From day one of orientation on your new unit, I repeat, run toward as many clinical experiences as you can. Okay, maybe not run, but join your colleagues when you're able so you can obtain exposure to a multitude of patient presentations, procedures etc. During your orientation let your preceptor and charge nurse know your wishes. Sure, your orientation may have a specific plan and timelines attached, but expressing your wishes can never hurt.
Here is the real deal...there will come a day you're on your own, help may be limited, or the entire staff (but you) have less than a year of nursing experience. You may find yourself as the senior nurse and with no idea how to perform an infrequent procedure, troubleshoot or operate a device, and/or even know who to call. Clinical exposure to a multitude of experiences is key!
2) Listen to Every Detail that is Mentioned by the Patient and in Nurse to Nurse Report
A single patient, so many details. You weed through the report and volumes of medical records trying to make sense of it all. What information really matters and what doesn't? You get the overview of the patient presentation in an SBAR report (situation, background, assessment, recommendation). In casual conversation, the off-going nurse mentions the bizarre behavior of one family member and in essence how he is a 'nuisance" to her delivering patient care. At the time the conversation seems more like a vent session by a fatigued night shift nurse. Trivial information at best.
Yet later into the shift you begin sensing something odd, and you remember the earlier conversation, the patterns the night shift nurse described, and you begin to have suspicions of intimate partner violence. You observe that the gentleman always speaks for the patient, he never leaves her side, and he seems nervous as you do your assessment. In the end, your instincts were right. Remember: Don't ever discount information shared. Sometimes the littlest of details end up being big clues.
3) Access your Resources When Needed
We are human. We don't know everything and most of us never will. If you work in an acute care setting, a plethora of resources are often (okay, rarely in some facilities) just a phone call away. Always go through your own process of critical thinking and collaboration with your peers, but think about other resources you can reach out to in order to ensure the delivery of safe patient care.
Have an infrequently requested blood draw and you need to obtain the sample? Don't know what color tube to draw or type of container to place the specimen in? Consult with lab. Cross-checking with the lab before obtaining the sample will prevent the need for another needle stick saving the patient frustration and you time.
Does something seem off with a medication order and the physician insists all is correct? Call the pharmacist. In my experience, the pharmacist is typically happy to ensure a patient is not under-dosed, over-dosed, or given the wrong med.. Don't be afraid to call the pharmacy to cross check pediatric drug calculations. Finally, never assume what is in your patient medication dispenser is the right medication. The pharmacist and technicians do make mistakes as they are human too. Remember the 5 Rights (right medication, right patient, right dose, right time, right route).
Other experts to consider calling may be the Intensive Care Unit nurses or Rapid Response Team when you run into challenges or questions with titrating drips or initiating a rare Swan Ganz catheter in the emergency department. Maybe the facility stroke nurse can help you overcome your concerns about some subtle symptoms. No matter what the situation, if your instincts say something is off, you're probably right. Don't ever hesitate to collaborate with others on the healthcare team.
4) Take Care of Your Patient Before the Electronic Health Record
Let's face it. Taking care of patients and working with the electronic medical record is a true art. Staring at the computer screen can become an easy pattern if you aren't careful. Make a habit of always walking into a room, addressing the patient, assessing their clinical condition and their needs, before settling into looking at the computer screen. Sure, you may be learning the ins and outs of where to document what, but if you have shown compassion and caring about their needs first, spending time on the computer will likely be less bothersome to the patient and hopefully will create fewer interruptions when you sit down (or stand) to document. Some nurses prefer to do a procedure and then document. Give a medication, then document. You'll find your groove, but always remember to put the patient first.
5) Ask for Feedback from Everyone
Ask for feedback from other staff especially after challenging cases. A simple inquiry about if you could have (or should have) done something differently may open your eyes to different ways of doing things. Even asking a physician if you could I have assisted them in a different way? Did you set up their supplies how they like them?
Inquire with patients upon discharge for some genuine feedback...tell them how you really want to be the best nurse you can be... "Is there anything I could have done better for you while you were here?" Sure, there is always the challenging patient that might make you feel you don't really want to know the answer. That's okay, but for those patients who may help you grow as a nurse, go for it. This habit is a good one to build whether you're in your first year or twentieth year as a nurse. At times, we know what we could have done better if we weren't spread so thin, but definitely do a self-reflection, and when appropriate, ask your patient and their loved ones for their feedback. If you're open-minded, you can learn as much from your patient as they can learn from you...and they just may enlighten you!
Take Action!
Hopefully I have given you a few thoughts to ponder as you work to either transition into the clinical environment or aim to up your delivery of care. More tips to follow in part 4 of this blog series. Until then, I challenge you to try one of these tips and let us know what you learn. In the meantime, new graduate nurses, please share what worries you have. More experienced nurses, what beneficial and uplifting tips can you share with the future of nursing?
Until next time...Embrace the Journey
