The grayness of nursing...

Nurses General Nursing

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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!

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My first thought was "oh, here we go, all the grey-haired nurses are keeping us young 'uns out"

I see your problem often and yes part of it time spent in the military or police. My hospital has military nurses work shifts to keep current and there are issues with using your own judgement and they also have a lower tolerance of drug seekers.

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LOL thanks! I didn't think about that when I wrote the title.

I don't mind critically thinking but I feel like people use their "nursing judgement" too often. I am just trying to find something that will fit my personality at the moment.

Thanks for your reply!

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I understand what you mean, it can definitely be frustrating to not always have a clear idea of what the absolute best thing to do is. However, keep in mind that your ability to make those decisions is the reason why a nurse is hired to do a certain job. Because we have gone to school to learn how to make decisions about patient care!

I don't know how long you've been a nurse, and don't mean to insinuate that you're inexperienced if you've been working for a while. But I would like to add that, if these frustrations are part of being new, that the longer you're doing your job, the more obvious some of these judgement calls will seem. By that, I mean things do start to appear more black and white (they have for me at least).

At my job, there are only policies/procedures for more task oriented type things. For example, there is a step by step process for extubating a patient after surgery. But it's up to me, as the patient's nurse, to decide if the patient is ready to be extubated, if they need to stay vented for a while longer, or if I need to go ahead and call the doc for some predators to get their pressures stable enough to sit them up and get them breathing on their own.

I've never worked in the OR, but it does seem to me like that's a place where expectations are more clear cut. If that's something that interests you, I would definitely see if I could shadow an OR nurse!

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Specializes in Med/Surg, Ortho, ASC.

As a black-and-white thinker who craves autonomy and the ability to use my nursing judgment, I found my niche in an ambulatory surgery center. Working in the PACU with at-my-discretion protocols suits me just fine.

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Nursing is an art and a science. There is often no right or wrong answer to treat your patient.

You will bring the skill of compassion and combine it with past insights in order to provide your patient the best outcome.

Each and every patient comes to you with an individual need. Tailor your practice to fulfill that.

I have gone from 30 years at the bedside to case management, every patient requires and deserves much more than just the scientific approach.

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Oh also, from what I know about case management, that is a nursing specialty that has a ton of gray area. Kudos to them, I don't know if I could ever do that job!

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Been there, done that..its not the treating the patient part I am talking about, that is actually the area I enjoy the most. It is more of the way things are done task wise I guess. For example you should always collar someone with two people, but I have seen paramedics do it by themselves. Or if a fall from more than 3x your height is a trauma, it should always be treated this way. I guess in the area I am working a lot of the ways things are done is provider driven and not protocol driven. I just feel "damned if I do and damned if I don't"!

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Been there, done that..its not the treating the patient part I am talking about, that is actually the area I enjoy the most. It is more of the way things are done task wise I guess. For example you should always collar someone with two people, but I have seen paramedics do it by themselves. Or if a fall from more than 3x your height is a trauma, it should always be treated this way. I guess in the area I am working a lot of the ways things are done is provider driven and not protocol driven. I just feel "damned if I do and damned if I don't"!

Each and every task management is your patient management. There is no textbook answer to the current situation.

I have taken down a psycho alone, or decided to call armed security.

You called it.... damned if we did, damned if we didn't. That's why they pay us **cough** the big bucks.

For our judgement.

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Haha guess I need to move, because there is no big bucks to be had here! LOL... I see where you are coming from and I appreciate your perspective. I am just struggling to find my niche I guess.

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It is true. Our judgement is why we are paid more than the MAs and CNAs. Anyone can give a med. The nurse has to have the judgement to know when to give, when to hold, when to call the doctor or pharmacy.

Your patient says he has 10/10 pain. His BP is on the low side. Do you give the med? Wait? Get OK from the doctors?

Tasks are the easy part. The black and white protocol jobs are given to techs.

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Specializes in Pediatrics, Emergency, Trauma.

I enjoy the grayness of nursing; I have learned to hone my nursing judgement because of it; being able to assess and think about what can be done better and collaborate my assessment and judgement has netted me positive results for my patients.

I understand you are trying to find you niche; however, while floating on that life raft that is your career; you can do a world of good by developing your nursing practice that transcends any area of nursing; having the mindset to remain objective; ask questions, gain confidence in your practice and have an humble perspective on the misses that may come your way; it will certainly make you a better nurse. ;)

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