Nursing School Won't Teach You These Things

TheCommuter, BSN, RN

Student nurses have the awesome opportunity to learn about the art and science of nursing during the time they spend enrolled in school. Nursing students are bombarded with different theories, introduced to procedural skills, drilled on critical thinking strategies, exposed to new information, and tested constantly to determine their ability to apply and analyze the mountain of material rather than recall facts through rote memory. In other words, pupils must adapt to a new way of learning once they start attending nursing school.

Conversely, two worlds of nursing exist side by side. A textbook world of nursing exists where everything is done strictly by the book, colleagues conduct themselves with professionalism, patients have optimal outcomes, and family members are reasonable. And a real world of nursing exists that seems to contradict a great deal of what we've been taught in school. Sometimes these two distinct worlds do not mesh harmoniously. To be perfectly honest, these two worlds clash rather often.

The Real World of Nursing

Your personal experience may vary once you secure your first job as a licensed nurse.

Unspoken politics exist.

In today's ultra political workplace, it's not about what you know. It's all about who you know. The floor nurse who has friends in high places typically receives preferential treatment and sometimes gets away with antics that would have resulted in firing if you had done the same things.

Interpersonal skills will make or break you.

I've watched as many highly skilled and proficient nurses were either fired or forced to resign. Although these people were competent, they rubbed coworkers and management the wrong way due to poor interpersonal skills. Interpersonal skills are the soft 'people skills' we use to conduct ourselves acceptably and interact with others.

People with good interpersonal skills enjoy great workplace relationships. Those with poor interpersonal skills will not remain employed at any one place for very long. I've seen nurses with good interpersonal skills remain with an organization for many years, even if they lacked competence in hands-on procedural skills.

People with 'quiet' personalities are sometimes viewed suspiciously.

Some new nurses wonder why their employment was terminated at the end of a 90-day or 180-day training program. Even though they were learning at an appropriate pace and able to manage their own patient loads, the quiet personality was the unspoken trait that broke the camel's back.

Some established employees grow increasingly alarmed when you never have anything to say and fail to ask any questions. A few of your needy coworkers will be offended that you never eat lunch with them or take breaks together. These are the same people who will report on your progress to the unit manager, so you might want to be likable.

Sometimes the best nurses are the first to be punished.

For some reason, the nurses who are idealistic and honest to a fault are often the first to be punished by management. I don't know why this is. Perhaps the idealism causes insecure coworkers and managers to cringe.

Sometimes the worst nurses fly under the radar undetected.

This phenomenon is slightly related to number one (politics). In some practice settings a nurse can do sloppy, absent-minded work and get away with it if he/she has friends in high places in the organization.

Workplace Settings May Vary

It is not your job to criticize your coworkers.

Some new nurses feel judgmental toward coworkers who aren't doing the work the same way they would get the job done, or with the same enthusiasm they would show. At times you will work with colleagues who give only 80 percent of their energy and effort. If you have a perfection-oriented personality, other peoples' laziness may drive you nuts. And even though you think these coworkers should give their all (100 percent), you must internally realize that 80 percent is still passing. Don't criticize. You are not going to change anyone's work ethic!

For instance, the public has no interest in hearing about your coworker who forced a post-surgical patient to wait twenty minutes to use the bathroom because she continued to chat about her young daughter's birthday party at the nurses station. This nurse is not giving 100 percent of her effort, but she's still 'passing.' However, the public definitely wants to hear about the nurse who neglected her patient for an entire 12 hour shift, and now the same patient developed a pressure ulcer on his bottom in the shape of the bedpan on which he laid for 11 of those hours.

Revealing a person's flaws hardly ever works to improve performance.

People don't react well when you point out serious flaws in their job performance. Instead, they'll see you as a righteous complainer. A much better tactic is to discover what inspires individuals and address the situation from there. The overall objective is improvement, not decline. And as a rule of thumb, coworkers who think they are being unfairly criticized react with passive aggression by doing worse than previously noted. They'll move more slowly and work more inefficiently just to spite you. It's better to provide inspiration so people will have aspirations.

Many nurses will value their emotional needs more than others.

Some people use their jobs to achieve validation of their very existence. Others use the workplace to fulfill emotional needs that aren't being satisfied at home. In fact, a significant number of people in this profession desperately need the twenty minute chat at the nurses station about their child's birthday party to get through the shift and perform at their very best. Although it might be wrong that her patient is forced to wait to use the bathroom, be cognizant that this slow nurse might care for her patients more optimally now that she has focused on her own emotional needs first.

Some colleagues do not want to know what they did incorrectly.

Some people claim to want the truth. However, many people cannot handle the truth, regardless of how nicely you present it. Instead, you might want to nurture coworkers' emotions rather than tell them where they went wrong. So when the oncoming nurse who is supposed to relieve you arrives at work 45 minutes late due to heavy rain, he doesn't want to hear that he needed to leave his house a little earlier than usual. He wants to hear how relieved you are that he got to work safely. The moral of the story is to tell people exactly what they want to hear, because this will ensure your workplace interpersonal relationships stay pleasant and civil.

Being a good employee is not the same thing as being a good nurse.

I credit the longtime member @ZASHAGALKA with the aforementioned quote. Anyhow, the unfortunate events that have recently transpired at Texas Health Presbyterian Hospital in Dallas somewhat illustrate this tenet. As many of you know, Dallas-area nurse Briana Aguirre is the Texas Presbyterian employee who blew the whistle on the facility's lack of preparedness and faulty infection control protocol, which might have resulted in two other nurses contracting Ebola virus disease.

Briana Aguirre is a good nurse for blowing the whistle and voicing her concerns. However, I can almost unequivocally guarantee that Texas Health Resources (the corporation that owns and operates Texas Health Presbyterian Hospital) does not consider her a good employee. In general, the managerial and administrative figureheads who run healthcare facilities prefer employees who do not bring negative attention to the hospital.

Retaliation is not always blatant.

In previous interviews, Briana Aguirre has stated that she fears losing her job and even mentioned on national television that she is paychecks away from not being able to pay her mortgage. However, retaliation is not always as blatant as having one's employment terminated immediately after engaging in whistle-blowing activities.

Managerial members of staff will instead take subtle, but legal, steps to ensure that conditions are so miserable for the outspoken employee that he/she will want to voluntarily separate from the company in short order. They'll often subject the nurse to questionable last-minute scheduling changes, force him/her to float to undesirable departments, and issue written warnings for trivial issues to establish a paper trail.

No good deed goes unpunished.

This idiom is closely related to the previous two points. Essentially, this means life contains its fair share of injustices, and the people who do the right things are often punished. We sometimes see this occur in the nursing profession. Unfortunately, the nurses who are extremely honest and ethical to a fault may end up with a bulls-eye on their backs if someone feels threatened by them.

Human life is temporal and finite.

Patients can be here today and gone tonight. Your favorite colleague, with whom you enjoyed coffee in the break room, might not report to work ever again. One of my longtime coworkers lost her battle to cancer a few days ago when, just last month, she was answering call lights with cheer. And, at the beginning of this past Summer, one of my former colleagues died secondary to a vehicular collision that occurred as he was driving to work. He left behind a wife and two infant twin sons.

This is a reminder that human life comes and goes with fluidity. Therefore, be nice to your classmates, instructors, coworkers, patients and others. You do not want their last living memories of you to be filled with negativity. Always ensure that your interactions are filled with professionalism and guided by the Golden Rule to treat others as you'd want to be treated.