How to be a Perfect Nurse

[mtnNurse.]

Let's define "perfect nurse" so we can know how to be one. A perfect nurse is one who never makes a mistake. One who never makes a medication administration error and therefore adheres to all patient rights of medication administration every single time without fail. One who adheres to all professional standards of practice throughout every second of every work day. One who distinguishes between being a "good worker" and a "good nurse" and so knows when to stand up to her boss and refuse work assignments. One who knows her limitations, so can anticipate coming across something she might not have learned yet and will avoid being put into situations that might cause her to exceed her limitations. One who will always without fail ask for help when needed and ask or look something up before doing something new.

The nature of nurses' work and their role as "last line of defense" in patient safety demands that a nurse be able to think critically. So the nurse's brain is the utmost important tool in her work belt and must remain sharp. Brains are complex and often fail unexpectedly in people of all intelligence levels...e.g. looking for glasses when they're on your head. Brains can have moments of lapses when people are: fatigued; sick; distracted; overloaded with information; under intense stress; etc. Yet a perfect nurse does not have brain failure...EVER. A perfect nurse can work 12 hour shifts and still not have one single second of brain failure...EVER.

Questions for Consideration:

1. Is it possible to be a perfect nurse in an understaffed hospital? Is it possible to be a perfect nurse in any imperfect work environment? (Yes? -Tips to do so?)

2. Tragically, being a "good worker" is too often in conflict with being a "good nurse". If a working nurse is striving hard to please the boss due to her high work ethic, she quite possibly is failing to ensure patients' safety by taking on more than she can handle. So how do we reconcile nursing school knowledge and professional standards of practice with current unsafe conditions of many nursing jobs? Do employers have any obligation to make being a "good worker" the same thing as being a "good nurse" -- or does it all fall on the nurse to be perfect when faced with imperfect demands in an imperfect environment?

3. How can work environments, administration of health facilities, nursing schools, health care laws, or other entities which affect nursing jobs make it possible for the perfect nurse to remain perfect at all times in her job?

4. If any of you nurses have never experienced a second of brain failure (especially not a full 30 min. or more of brain failure), and if any of you are incapable of skipping one or more med. admin. safety steps despite any environmental circumstances, and if any of you declare yourself to be a perfect nurse as defined here...do you have tips to help the rest of us become more like you? This is a serious question and I for one am grateful you are a nurse, grateful for your service, and would be grateful to learn from you. Because truly, what nurse wouldn't want to be perfect? Sign me up!

---

Disclaimer: I don't believe there exists a perfect nurse who is incapable, regardless of any imaginable circumstances and environments, of skipping multiple safety checks in medication administration. Yet some claim to not ever be capable of such grave errors. To ignore the potential of our brains to fail and to so willingly condemn the charged nurse as a criminal without even knowing what was going through her mind and what circumstances and environment led up to her giving the wrong medicine is scary to me and lacks something the perfect nurse would surely have: compassion; the desire to understand; the desire to remedy rather than penalize; the desire to heal.

Some will say she should no longer be a nurse because she failed too badly in the professional standards of practice. I believe she was being mindless so never made the choice to skip any safety measures; I believe she had every intention of helping patients and that she took it for granted that she had no chance of harming them because she believed in those moments that there was no chance. I believe it was an accident that would not have happened in ideal work conditions, and I can imagine many things leading to a nurse becoming mindless through no fault of the nurse. Maybe she should never be a nurse again or maybe she would be the best nurse in the world after this experience. I'm not forming an opinion on non-criminal consequences right now. I try in the "Nurse Charged with Homicide" thread to convince you why, from what we know so far, the case does not warrant criminal charges. What should have been in her mind and what was ;in her mind are two different things, and that difference is why she is not a criminal for being in a mindless rush to give a medicine she believed would not harm the patient and then to not monitor the patient because she believed the patient was unharmed by the medicine. That's just my interpretation of the law. Don't forget, law is subjective so you get to have your interpretation too; I just hope judge and jury have more in common with my way of thinking. I hope this nurse doesn't spend a day behind bars when she likely was just trying to be a "good worker" and not experienced enough to focus solely instead on just being a "good nurse"

Anyhow, though writing this was inspired by my strong feelings in the other threads, we could keep our continual conversation about this case in the other threads (if you want) and save this particular thread for positive, creative ideas that might answer some of the questions above.

Also, there is a well-written and worth-reading article in this forum Is It Possible to Never Make an Error? The Perfect Nurse Fallacy by @SafetyNurse1968 (I wrote this and forgot that article was already broaching these topics!), but the discussion following it didn't seem to have a lot of tips from any perfect nurses for how to be perfect in understaffed hospitals or otherwise unsafe work conditions, so I'm trying here too.

[SafetyNurse1968, ADN, BSN, MSN, PhD]

You tagged me! I'm not worthy! (quoting from Wayne's World...hope that's okay here...) I SO appreciate the shout out from the OP (original poster). Made my day. You want to know your best strategies for staying safe in an insane work environment? As a patient safety specialist, I have a few suggestions:

1. if your employer isn't promoting a culture of safety, if you can, work somewhere else. I know this isn't an option for most of us, but if you can, place the highest value possible on the safety reputation and practices of your employer. When looking for a job ask about patient ratios, just culture, and how errors are handled. Employers should have a pro-active, anonymous error reporting tool and the results of error analysis should be regularly shared with staff by a patient safety officer.

2. volunteer to be the patient safety officer for your unit (collect and write up all the errors reported on your unit each month and report them back to your colleagues, look at trends, aggregate data...my dream job). I know, more work for you, but the more you know about what mistakes are happening around you, the less likely you will be to make those same mistakes.

3. Rely as little as possible on memory. Use any and all tools made available to you so that you don't have to rely on it.

4. Pay attention to your instincts. If you have even the smallest feeling that something isn't right, stop what you're doing, find a trusted colleague and talk it out.

5. Use a checklist for everything possible. If there isn't a checklist, make one. Checklists save lives.

6. USE YOUR PHARMACIST. Call them, make friends with them, ask them lots of questions. Your pharmacist is your friend. Don't have one? CVS does, call them.

7. Take advantage of ANY and ALL training opportunities that involve simulation. Hi-quality, hi-fidelity simulation allows you to make mistakes without hurting anyone.

That's just a few for now - I hope they inspire you. Would love to hear what others think. Thanks for keeping the conversation going!

-SafetyNurse

[dnurse1234]

I graduated from nursing school in the 80's and  "the perfect  nurse" was on of the topics in "Nursing Seminar" which was a course directed at graduating nurses and addressed reality shock and  patient nurse relationships and many issues in the real work life of a nurse.

The subject was correlated to being a "perfect" parent.

Perfection as a quality in a nurse is personal subjective criteria that's purpose serves the nurse's ego, not the patients needs; also- if a parent it would be the same for a child.

 The patient mainly needs proper care and the feeling to trust a nurse and caregiver whether or not that is in the face of a mishap like getting a medication late, which might throw a perfect nurse for a loop but not a patient.

In fact, being  perfect might be alienating to a patient, especially if their immediate needs are more or less on the emotional side of a hospitalization. I.e. MVA in a young adult. Or slews of other reasons.

 

Concluding- that perfection should not be a goal, but rather proficiency in the skill set needed, knowledge and the trust/rappore of caring which is authentic and non- condescending.

Ironically, now that the patient/client really is a part of the "health care team" and participant in their own care, there are those clients who seem to expect perfection.

And that attitude on the client side probably serves their ego not their outcome or care.