Professional Behaviour & Conduct - help!

Whispera, MSN, RN · Aug 7, 2009

I don't think you should try to appear meek. If you aren't meek, you aren't meek and you would be going against your personality to pretend. Just be interested and un-pushy. Be pleasant and cooperative and helpful, and ask questions, and ask for experiences. That's assertive and logical.

You can lower your volume. Everyone should be quiet so patients can heal. That means lowered voices as well as not talking to each other where patients can overhear even if you are quiet. As you start to talk, think of how loud you were going to speak and crank down a notch. It's worked for me. You can also practice at home. I know it's difficult to stop being loud when it's a habit.

As for carrying yourself as a professional, the things I've mentioned above fall into that plan. Please remember that you may not be employed where you're a student, for pay, but you are providing a service to the staff and to the patients with the work you do there. You are their equal as a human, even if not educated to everyone's level or employed for pay. Hold your head high and be proud of what you can do. No, you're not their friend, but you are a valuable person, who is there to care and learn how to care more effectively!

Grace Oz · Aug 7, 2009

[*]Appearing meek, proactive and willing to learn without stepping on anyone's toes, getting in the way of the staff or stepping outside my role as a student
[*]Lowering the volume of my voice consistently
[*]Carrying myself as "a professional" - not a friend of the patient or the staff (and not an equal of the staff, either)
]

G'day Rachel! :)

Well hon, we all had to learn, so don't be too hard on yourself.

From the above, it's evident you already have identified the areas needing revision.

That LOUD voice of yours is something only you can control. Try to become aware of the volume as a regular self check. Work at making your speech quieter but still audible. There is nothing worse than LOUD voices in any given situation, worse still in the professional setting. Especially for patients. A LOUD voice can be construed as you lauding it over others. Trying to dominate and control the discussion/situation. While your voice being naturally LOUD, it is possible for you to train yourself to speak in a softer tone/volume.

There's no need for you to appear "meek", not at all. Displaying confidence but in a way which does not project arrogance is what you're aiming for.

While you are somewhat experienced in that you work as a nursing assistant; in the clinical placement situation, you are first and foremost a student. A learner. Importantly, you are training to be a nurse. Not a nursing assistant. The two roles are distinctly different. You need to immerse yourself into the role of the student and put aside any reference to or prior knowlegde as a NA.

If you need to ask questions, first enquire if now is a good time to ask, or ask would the person be willing or available later to give you time in order to answer some questions. This shows consideration and a willingness to be patient.

As for you not being an equal . . . while your role at this point is that of a student, you are no less a person than anyone else.

You have the same entitlement to respect and consideration and dignity as anyone with whom you work, learn from, study with etc etc.

The key is in remembering to operate within the parameters of your role at any given time.

Sometimes you just might know more than others, but there's a sweetness in keeping that knowledge to yourself while allowing them the spotlight. :)

Your turn will come, when the time is right, for you to express and share what you know without it appearing boastful or overly proud.

Be friendly without being familiar.

Keep comments and conversation light and bright, non-personal, never political, nor religious, and never about money! lol

If anyone- a patient for example - ever asks you a personal question, ask them, in a pleasant polite manner; 'why do you ask?' This response more often than not makes them check themself and realise that perhaps they're being inappropriate. More often than not, it'll be you who has to set the standard. Many people can and do overstep the boundaries and they can become blurred between being professional and too familiar. You have to find a balance.

It's like all aspects of life, it's all a learning curve! We all make mistakes! It's through the mistakes that we grow and learn. Just try not to make too many! :)

I hope some of what I've written might be of some small help to you and I wish you every success with your studies and nursing career.

buttercup99 · Aug 7, 2009

I had pretty much a similar experience on my nursing home placement. On the Wednesday of the last week, i had to work with an EN who my facilitator surmised was threatened by me (as an RN student.) I had no complaints throughout my placement until that day. These were the complaints:

a) a patient was moved from the general section to the dementia ward (which the EN was in charge of) and I asked why she was moved. this was interpreted as me saying "I don't think she should have been moved. i know better than you." in fact, I was quoted as saying "that patient doesn't have dementia." What?!

b) i witnessed a patient having what the EN interpreted as a TIA. (but I alone witnessed this.) 30 mins later, the doctor comes in and asks me something about the said patients rash. i said to him "I don't know about her rash. What i do know is that she blanked out while I was feeding her breakfast." OOOH! i got in A LOT of trouble for saying that. I was told i should've referred him to the EN. Okay i agree. But at the time, i thought I was doing the right thing by not saying anything I didn't know and only saying what I had witnessed. How can the EN tell him, she wasn't there.

c) I was told to go to lunch, on the way 2 carers were giving out lunch trays while at the same time arguing with (and yelling at) a patient as the pt did not want to get her hair cut. i offered to take the pt outside for a walk to let them get on with handing out lunch. I had built up a r/ship with this lady too. i took her for a walk in the garden and asked what the problem was. I suggested that she get her hair cut today and then speak to her daughter about it as her daughter pays the hairdresser. This was interpreted as me taking over and me saying the hairdresser is bossy. I had never met this hairdresser, i didn't know her even by sight!!

d) i then went to write in the patients communication book to inform her daughter of the conversation I had with the patient. The EN walked past and saw me writing and yelled at me to go to lunch. A few minutes later she walked past again and i was still writing. Then she went off her head! I burst into tears and I'm not a meek person.

e) later I went into the nurse station and saw the communication book there. I said to the RN " what is that doing here?" as it belonged to the pt and it belonged in her room. It was there because I was in trouble for writing in the book. The next day, the daughter (who is also an RN) came in and started a new book and wrote a note in the beginning stating the purpose of the book. I apologised to her and she said "dont be silly thats what the book is meant for."

It didn't affect my mark but I got a **** write up from the RN on my final evaluation. My facilitator gave me a decent one though.

My issue with what happened to you is that you seem to have not got feedback until it was too late. You are supposed to receive feedback as the placement progresses. The burden lies on both of you to seek and give feedback but more on them if they had a problem with your professionalism.

It sucks what happened to you. Be aware that it is not that uncommon in nursing homes. The carers seem to resent the nursing students and the RNs look at you as student carers as usually it's a first year placement.

My advice to you is to a) focus on keeping your voice down! Lol.

b) be aware of the workplace politics. Don't get too comfortable and don't act as if you work there. You are a guest in their ward. At least until you have got to know the staff better.

c) be assertive, ask questions, but ask away from the patient unless it is necessary and emergent. Never speak about other pts in front of another pt, even if it is an emergency.

d) Be confident but not overly confident. Just try and be aware of how the staff view the situation. We are guests in their ward, they get students all the time so while we might think we have built up a great r/ship with the pts and staff, to them we are just another student who will be gone in a month or two.

e) be aware of the staff's concerns. There are a lot of logistic concerns that staff, shift co ordinator and CSC or DON are dealing with that we don't know about. So when they yell at you for something, it is usually due to a pressure we are unaware of. Like, once I went to take a BGL and I chatted to the pt for about 2 or 3 minutes. Well, I got in trouble and I thought what the hell, I was only talking to him for a couple of minutes (the guy was opening up to me about "why me?" re his cancer diagnosis so I couldnt just walk away.) but I realised later on that the nurse had other pressures that i didn't know of, she needed the BGL reading to pass on to someone else so she was waiting on me.

Don't appear meek, that will work against you. Just be confident, proactive and assertive but be aware of underlying politics or forces that might be there. In short, be yourself but tone it down a bit!

Good Luck in your future placements. Learning your "place" as a student nurse takes time and experience. Unfortunately, we don't get enough clinical placements at my uni, I don't know about you. I am about to do my final 8 week placement and i still haven't sussed it out. Problem is it changes with each set of staff.

Buttercup

DolceVita, ADN, BSN, RN · Aug 7, 2009

I too have trouble with volume control. I have a little hearing loss and, although I try to be mindful, sometimes it gets the better of me -- like when I am in new or stressful situations. So my clinicals will be interesting.

Og course not everyone who speaks loudly is brash nor do they have hearing issues. What bothers me is people say nothing at the time and then complain.

teensmom · Aug 7, 2009

I am always told to speak more quietly-although oddly enough, not at work. I have quite a bit of hearing loss and have no idea that I'm speaking loudly when people ask me to quiet down. It is embarrassing and kind of insulting when it happens. I have no idea why I am not asked to speak more quietly at work. Maybe no one wants to say anything? Or am I really not loud there? I have the worst time in the operating room though because I must read lips and since everyone is wearing masks I can't and also the masks muffle their voices even more. So long way of saying you might want to get your hearing tested.

I worked 20 years in what has a reputation of being a very cut-throat business before I came into nursing. I have never seen such backstabbing and general ill-will towards co-workers as I've seen as a nurse-I am hoping it's just my unit. Anyway, continue to be yourself, don't be meek-you'll be runover, just keep asking questions-or ask when would it be a good time to ask questions.

Good luck.

mykidzmom · Aug 7, 2009

i would like to give a big thumbs up to all posters, especially the OP who have had the courage to strive for self awareness. most people go through life blissfully unaware of their own faults but are very adept at identifying other peoples'. i myself am an expert at how the rest of the world should handle their problems (if they would only listen to me!) and yet solving my own problems is so elusive....

the fact the you acknowledge that in some instances you may have been treated unfairly, while being open to the fact that you might have actually said or done something to warrant the reprimand is a rare quality indeed.

when a person has a strong personality or presence, other people will always have an opinion of you. you are not one of those people who blend in. it can be tough being a strong personality. i don't know where you are right or wrong in the examples you gave. but i sincerely applaud your quest for honest self improvement. because people might say things you don't like or don't want to hear--and yet you are still putting yourself out there. and god knows we nurses can be a VERY judgemental group.

since you are open to improvement, perhaps there is a person you trust (teacher, friend, spouse)that you could say "i'm trying to work on _____(lowering my voice, not appearing arrogant) would you please help me by pointing out when you seeing me do this?" you should have a code word or a look or something that no one else knows--you don't need anyone embarrassing you.

good job you guys.

emmalou* · Aug 7, 2009

Yikes you had it a bit tough girl. Despite that you sound very enthusiastic, eager to learn and seem to be taking the criticism you received to heart - I admire you for that.

I'm Australian, and remember my clinicals back in the mid 90s. Seems like some things haven't changed unfortunately (the attitudes of the staff whose job it is to teach you for one and the hard nosed facilitators). It actually used to really get me down.

Like others have said, the loud voice is only something you can change. Is it something that poses a problem while you're in your paid employment?

I feel your confidence is probably rubbing people the wrong way. In my experience as a student and grad nurse it seems like you're expected to always keep your head down and never disagree with anyone. I don't think this is a good thing though. While I think you should be respectful to the staff and patients, I think questioning things and being genuinely confident in your ability are very good qualities. You will always come up against people, even experienced staff, who are not confident in their abilities, or who dislike their job or are burnt out who find this hard to deal with. One of my friends from uni was an enrolled nurse who was sometimes loud, opinionated, was very confident and could often be over bearing - she was a pain in the bum a lot of the time TBH but she was an excellent nurse.

My feelings about personality is - you are who you are - to an extent anyway. That said, nursing is a lot about personality really - you have to build a rapport with staff and patients to give good, safe care. Behavioural qualities like effective listening, respect, compassion, empathy and tolerance are important. Your personality characteristics of being confident, maybe a bit loud will be difficult to control - it's who you are. I would hate to see you lose those qualities of what I perceive to be enthusiastic, hard working and taking things on the chin because I think those are very good qualities to be a nurse.

Appearing meek, proactive and willing to learn without stepping on anyone's toes, getting in the way of the staff or stepping outside my role as a student
Lowering the volume of my voice consistently
Carrying myself as "a professional" - not a friend of the patient or the staff (and not an equal of the staff, either)

As far as being meek - you don't seem like a meek person and anyway, that's not something a nurse should be. Remember you need to advocate for your patients and be tough when it comes to appropriate, safe treatment for your patients. Being proactive and willing to learn is definitely something you should continue to be, never lose that, no matter how long you are a nurse. You should also only work and learn in the boundaries of your student role. Stepping on anyone's toes or getting in the way - well you can try mate, and good luck to you, but realistically sometimes you will step on toes and get in the way, especially when you're learning and especially in the health field. That's life.

The other 2 you've suggested are probably reasonable, in that not being equal means you are a student and there to learn. You are certainly equal in deserving just as much respect as anyone else though, never forget that.

Good luck with the rest of uni and your career. :heartbeat

Trishalishus, PhD, CNS · Aug 8, 2009

I agree with most of what Grace, Whispera,mykidzmom and emmalou said and think they have given you wise advice. I think Teensmom's idea of getting a hearing test is a good one. Dolcevita's point about passive aggressive people complaining sotto voce behind backs is valid in this case particularly because people are being asked to judge your performance behind your back.

So why do I post separately, here? I want to be tough on you, Rachel - since you've got the guts to take it and reflect on it constructively. If you leave it for a couple of days, (until the heat goes out of you on this) you'll see that while your post gives the appearance of acceptance of the drubbing and trying to learn to do better, there is also a strong underlying element of "poor me - nobody understands (those Philistines - I have a heart of gold) - it's not fair."

You are on placement as a courtesy - but it's an even balance - you give your labour for free and in return you are entitled to be given tips by your preceptor - not every other RN or EN on the floor or in the lunch-room, or the NUM (who, depending on his/her age and ego-strength may be entirely unaccustomed to being questioned by a brash student and in any case is too bloody busy for you).

Shut up. Speak only when spoken to. Ask questions only of your preceptor (who has agreed to be placed with a student) and only after the rush is over and he/she is receptive to your desire to clarify things - never in the middle of his/her work - unless by prior agreement (eg "Is it OK with you if I ask why you're doing things while you're doing them - or would you prefer me to save questions for later?")

Shut up. Look alert and interested at all times and ready to engage if someone is willing to engage with you. You are on their turf. They are busy. They may be tired or sheety or wotever else you don't know about - and don't need to know. You'll be gone soon; you may never see them again; you are not a member of their team - they have built trust with each other over time you don't have.

Never ever ask a leading question - ("Here comes that smartorifice student") - it implies you know better and are giving them the opportunity to explain their mistake. (eg. "Why are you giving that IM dorsolateral? We were taught that EBP is ventrolateral.") another example where you are directing people to behave in a certain way is

I'd really appreciate the thoughts/opinions/advice of the members here as all the evidence (i.e. your postings and responses) are filled with intelligence, social awareness, warmth and understanding.

Really? BS, Rachel - you are trying to direct your audience to behave in a certain way.

Listen. Learn to listen. Listen harder. Listen to body language as well as to words. Shut up and listen. Stop giving the appearance of honesty and be honest - with yourself mostly (Sorry that sounds hard - you can take it, you sort of first year, sort of second year student, sort of expert in so many different nursing areas, you.)

So, I have a fairly decent basic understanding of how a hospital ward works (simply in comparison to many of my fellow students who've never set foot in a hospital!)

No you don't - not of the RNs' perspective - and since when is the other students' behaviour relevant? (Hint: it's not.)

On the first day, this was fine and all went to plan. However from the second day onwards it became our responsibility to find a nurse to buddy with (most not being very receptive to students, we often ended up with casuals who had no idea about the ward)

Could it be they heard you coming, Rachel, and ran the other way?

Listen to your facilitator - don't give us the "what would she know", number

However, my facilitator (who was barely around and took most of her reports from the staff on the ward, with whom which she normally worked)

In this quote you are doing the same thing you did in my first quote from you - telling us how you want us to think. (Think about this - it is not conducive to learning.)

1. I, naturally, have a loud voice and often failed to control this in the clinical setting

Bad. Very bad. Shut up. What's natural? Dogs bark at strangers - do we allow it in the house?

re: bronchosocopy - I let out a small, shocked "oh!" on the sight on an extra large glob of sputum on the screen. Totally unacceptable, as even though the patient was sedated, they were still concious and I could have scared them awfully! I recognised my fault immediately and shut the hell up and apologised to the nursing staff in the suite following. (Unfortunately, they intreperted my "oh" as an "ew" and passed this on to my facilitator.)

I'm not going to do this for every one of your points, Rachel, but trust me, I could if I wanted so to do. You're a smart woman, you'll get the gist from this one:

1. "I let out" implies that you don't own the mistake - it escaped by accident/you were not in control - why not? Were you not conscious, alert and oriented? If so, you are responsible and should own it if you really want to learn. "extra large gob of sputum" implies that you think anyone sensitive would have responded as you did (ie another justification for your error - and one that also implies other people are not as sensitive (valuable) as you.

2. "Totally unacceptable, as even though the pt was sedated..." You again demonstrate that you believe you don't own the unacceptable action - there is no pronoun here - whereas elsewhere you use the pronoun easily.

3. I can see you resentfully rolling your eyes - after all - the guy was doped up - that should have made it ok, right? (Won't someone please agree that they've been too hard on poor lil me?) - ie another special pleading.

4. "I could have scared them awfully" is just pure sarcasm

5. Your apology was you and your strong personality forcing yourself into their consciousness again, begging them to treat you as one of the team.

6. "Unfortunately they treated ..." bullsheet, Rachel - stop lying to yourself, let alone your audience - some of us are smarter than you and most are as smart as you (surprise, surprise) and none of us likes to be patronised - especially by a young pup with an ego as big as the great outdoors.

All your examples are like this, Rachel. You want to learn? Take the ouch - I mean it well - obviously I too have a strong personality and have made the kind of mistakes you're making - and still do: pobody's nerfect. You don't "appear" "overly confidant" - you are - and you are defensive - saying you're not don't make it so, too)

Specifically, I think you need a hand with:

Being willing to learn - you can't step "outside [your] role as a student" - duh - you are a student. Learn to listen, first. Don't they teach active listening at your uni?
Shut up and listen with respect to your elders and betters and do as you're requested to do.
"Carrying myself as "a professional" - not a friend of the patient or the staff (and not an equal of the staff, either)" correct - and stay away from the NUM
Taking your licks with dignity and honesty
Be kind enough to yourself that you allow yourself to make mistakes - so you can own them when you do make them.

Because you're a smart, energetic, passionate person I'm sure you'll do well. Good luck.

ps I wouldn't have bothered if I didn't think you were worth it

Best wishes

mykidzmom · Aug 8, 2009

trish/jk has just given you a gift my dear. i hope you are or get to a place to know that. as a person who constantly wants to better myself and at least be aware of where my faults are--or what about me ****** off other people, i sometimes find someone i think will be honest with me and ask for brutal feedback. never has anyone just spilled it out there and said "look, when you work back here you slow every thing down when you_____i don't think the patients think your sarcasm is as funny as you think they think.....3 times last week you did this bad thing......your constant self depracating is getting on everyone's nerves...

for me, either no one is honest with me when i ask because they are afraid to hurt my feelings or they would rather complain about me behind my back or maybe i really don't annoy anyone and i am really doing just fine!!!! to be able to see yourself as others see you is truly a gift.

on this site i find many of the posters to seem to get a charge out of criticizing others. all it seems to do is hurt feelings. either the critic communicates in a mean, insulting way. or the OP is just oblivious to anything outside her own narrow perspective of herself and wouldn't be able to hear anything.

i believe that trish JK was pretty darn harsh on you. but it was not mean or negative. i hate the expression "tough love" but at 1am i am at a loss to what would be a better word. i think --i hope anyways --that you posted to hear something like that. i have seen so much bickering today i am happy to end my computer time tonight seeing someone try to really teach someone how to do what must be done. thank you to the trishJK and to wispera.

Scrubby · Aug 8, 2009

rachelgeorgina-you need to moderate the tone of your voice. I too have a naturally loud voice (yes trish some of us do naturally revert to speaking too loudly, just as some people speak so quietly that you can't hear what they are saying).

My two cents worth:

Many RNs, ENs and preceptors really don't like confidence in nursing students. What these types tend to want is a meek little student who follows them around, laps up everything they are taught and NEVER asks difficult questions. I suspect half the time they don't even know the answer to challenging questions anyway and disguise this by acting all annoyed that they are busy etc.

You need to just keep your head down, do as your told. If you have any questions then ask the preceptor. That's what I did and you'd be surprised and what most of them really don't know anyway. It helps too if you flatter the super awesome nursing skills of these types of nurses that I'm talking about (but don't overdo it either because they ain't that stupid). They love feeling superior and while your a student I recommend you play on this to get through.

As for the 'oh' or even 'ew' in the endoscopy well I work in the OR and if a student did this we wouldn't even bat an eyelid, even if the patient was awake. Your being exposed to something you don't see everyday and we're not robots.

I personally love confidence in nursing students. As long as it is backed up by skills and knowledge otherwise quite frankly I find them a nuisance because I have to keep an eye on them to make sure they don't do something silly and I'll get in trouble for it. The reason I love confidence in nursing student is because I can tell once they are a nurse they wont' be afraid to advocate for their patients and won't put up with the antiquated crap that we get from other nurses and doctors.

Trish-I fully disagree with you that nursing students are not part of the team. If they are helping the patient and providing care then they are a part of the team, even if they only transient. I think this is bad advice because from day one students need be able to participate in team work and understand the role of the health care team in terms of looking after patients and other staff members.

So rachel-head down, lower the volume and don't get too friendly with staff or patients.

Trishalishus, PhD, CNS · Aug 9, 2009

Trish-I fully disagree with you that nursing students are not part of the team. If they are helping the patient and providing care then they are a part of the team, even if they only transient. I think this is bad advice because from day one students need be able to participate in team work and understand the role of the health care team in terms of looking after patients and other staff members.

Thanks Scrubby - I agree. To clarify, then - while working with them she is an honorary member of the team - who they can expect (hope) to rely on to do as she is requested, and participate as required. Teamwork in the multidisciplinary team is essential. As such, the student needs to learn how to be a teamplayer and will be measured on this variable.

Best wishes

ps mykidzmom was right, Rachel - I absolutely do not intend to take out angst on you - I purely intend in my blunt way to give constructive input on the basis of my experiences. My response took hours to write. I believe that spleen and vents tend to show signs of rapid "explosive" typing with typos etc