Fundamentals

GrumpyOldBastard, MSN, RN · Aug 30, 2018

It is very easy to get swallowed up by the minutiae of a myriad of skills.

One of the best things that you can do is identify and master the PRINCIPLES that underly why procedures are done in specific ways. This is critical to success at the bedside. At the bedside the situation may not allow perfect adherence to the procedure as described in the book. However, if you understand and apply the principles.... you can execute the skill effectively and safely.

I see this all the time when working with students at the bedside. Those who simply memorized long lists of steps usually forget the list and are useless. Those who understand the principles, are able to solve the puzzle without the list.

donsterRN, ASN, BSN · Aug 30, 2018

This course will be crucial to excel in because everything hereafter will build on it. Truly. If I may offer a tiny piece of advice... know this stuff. Read everything. And then read it again.

Continued success to you!

Zahraa · May 25, 2021

I see you’re in Evergreen nursing program. I’m planning on applying. How did you like it?

Hannahbanana, BSN, MSN · Jun 30, 2021

On 8/29/2018 at 8:12 PM, GrumpyOldBastard said:

One of the best things that you can do is identify and master the PRINCIPLES that underly why procedures are done in specific ways. This is critical to success at the bedside. At the bedside the situation may not allow perfect adherence to the procedure as described in the book. However, if you understand and apply the principles.... you can execute the skill effectively and safely.

I see this all the time when working with students at the bedside. Those who simply memorized long lists of steps usually forget the list and are useless. Those who understand the principles, are able to solve the puzzle without the list.

I’ve told this story before here many times, but GOB is exactly right. This is why.

~~~
You just never know when the stars will align and you'll hear, see, or do something that will determine the rest of your career. I had a moment like that on my very first first clinical day, the day a gifted teacher taught me to think like a nurse.
Who forgets the first day of clinical? Even if you've been a CNA or a candy-striper, getting up and putting on that spandy-new student nurse uniform and shoes, walking into the hospital, and meeting your new classmates on your first floor is ... .
Oh, who are we kidding. Many of us don't remember a lot about our first days, really. Some had genuinely horrible experiences they laughed about later -- much later-- and most of us, meh, maybe not so much. But I did actually have a career-changing experience on my very first day of clinical, and if I haven't told you about it before, sit down a minute and indulge an old bat. It might surprise you. Heck, it surprises me even now.
We were sophomores in college. We picked up our uniforms at the downtown store the week before, individually, sight unseen; we dressed in the dark, and self-consciously made our way by subway or bus to the big hospital, finding the right building, riding the dark and creaky elevator to the sixth floor. We were excited but scared, with the usual wondering whether this was really the good idea it seemed a year --or gosh, a week-- ago. We assembled in the hall in front of the nursing station and met our instructor for the first time. We exhaled a sigh of relief when she smiled kindly at us, noticing that we had sort of been holding our collective breaths.
"Good morning. I am Mrs. Vartanian and I will be your clinical instructor on Colly Six." She read off our names alphabetically and peered at us over her glasses when we said, "Here" in small voices. She showed us the lay of the land and set us to passing out the breakfast trays, following up and down the halls looking for all the world like a big Rhode Island Red hen keeping an eye on eight chicks in the barnyard. After the trays went out she herded us all into the clean utility room. It was a cozy fit.
She showed us where things were, pointing out the various shelves: cath kits, gloves, wound packing supplies, liters of solutions. Then she picked up a huge brown glass bottle labeled "STERILE APPLICATORS" and unscrewed its lid. Applicators, we saw, were sorta like Q-Tips, but 6" long ones with wooden stems, cotton end down. About about a hundred and fifty of them, about an inch down below the lip of the glass. "How would you get one of these out without contaminating the rest of them?" she said.
Eyes looked rapidly right and left. Feet shuffled a little, quietly, those soft-soled so-white Nursemates. We had done a lab on sterile technique but this wasn't one of the things we practiced until our gloves were wringing wet inside. What to say? What if we get it wrong? What would happen to us?
Finally one of us said, hesitantly, "Pick one out with sterile forceps?" Mrs. Vartanian smiled and said firmly, "Good. Who can think of another way?"
Another way? What another way? We thought there was only one way to do any nursing task. Hadn't we just spent a week in lab getting each item on the check-off list perfect? But...she wanted us to think of another way. Slowly, we started thinking. "Sterile gloves?" "The sterile scissors in a suture kit?" "Try to tip one out onto a sterile field? Even if there was more than one?" And as each new answer came, she smiled and nodded.
Standing in the middle of the group I felt a terrific idea forming. It give me goosebumps. We were free to think of different ways to do things, so long as we had a good rationale. No, that's not it: We had to think of different ways. Knowing the why of things, you know how to apply them. There can be another way.

And so ever since that day I've looked for different ways to do things. When I was an ICU nurse I thought about the many physiological processes going on so I could choose a useful intervention. When I taught students I tried to explain things in several different ways, figuring each student would catch on to at least one of them. When I did case management I thought about the why and how of the challenges of explaining to employers and insurance adjusters.
Now I'm in independent practice and I have different challenges. But you know, to this day it surprises me to feel goosebumps when I figure something out. I hear Mrs. Vartanian's voice just as it was that day, making me bold, defining my whole career in then-unknowable ways. "Who can think of another way?”