The culture of nursing - Professional behaviour & conduct

Trishalishus, PhD, CNS · Apr 1, 2010

Hi Rachel

Zana2, HouTx and Emmalou have said more useful stuff than I could think to say. I went back and checked out last year's comms. You got some t'riffic advice there, too. So, as requested, here goes again - apologies to the three above - you have probably already said it:

1. Remember the universe wasn't created in one semester. Slow down. If you run the whole time (from experience to experience) you won't really appreciate any but the most shocking/toe-stubbing moments. And, as you discovered last year, your metaphorical charging around upsets the locals.

2. Keep a small notebook in your pocket so that when you feel that almost uncontrollable urge to interrupt with your oh-so-important question you can consider stepping away and jotting it down for reflection/research and/or later clarification with an experienced nurse. This will depend on the situation and all those variables already identified. Learn how to exist in the moment without seeking validation from others that you exist.

3. You are the future of nursing. You are an important person. You are a valuable person. You are being given a huge privilege by very sick people and very hard working nurses - the opportunity to learn from others' experiences and to practice so that you can make mistakes safely. I applaud your desire to be as good as you can be. Regard this semester as an opportunity to hone your judgment skills.

I sense your fear that you will receive more criticism than praise - and that this is your personal valley of the shadows. You have a huge hunger for approval. If you are not careful, it will continue to be your undoing - in nursing, in life, in general... Learn to make a steady, quiet inviolable centre, Rachel. Learn it sooner rather than later - and spare yourself this continuing world of hurt. (Consider signing on with a private psychotherapist who can help you to build it).

People will not remember what we said. People will not remember what we did. People will remember how they felt when they were with us.

Sometimes the best we can be is quiet and present for someone else - learn how to be quiet, Rachel - so that you can really learn what's going on around you. If you can really learn what's going on and then respond appropriately, you will make the kind of difference that people remember because it mattered (and coincidentally, get the kind of recognition that you crave.)

When I was an oncology patient I felt very, very physically sick. Early on after my surgery, if my oncologist had stood at the end of my bed and said "You're cactus, babe." I would have said "Thank God." That's how physically sick I felt. There was a young nurse there who was assigned to look after me. She thought it was all about her. She had no idea that I even existed as more than a praise and gratitude machine for her. She spoke loudly, she moved loudly. Her keys rattled loudly. She smelled loud! She bristled with a sense of dramatic self-importance ("Look at me - I am Flo Nightingale reincarnated. And I am sexy - just like those gorgeous nurses on tv.")

If I had had the energy I would have told her to go away. If I hadn't been scared that the quality of my care would deteriorate even further, I would have told her to go away. I dreaded hearing her coming. She didn't notice that I was in pain and too sick to say so. She didn't notice that the sun was reflecting off a picture hanging on the wall right into my eyes and I was too sick to turn over without help. She didn't notice that my mouth was dry but I was too sick to sit up to take a drink. I told her I was lying in a puddle of urine and she was hugely irritated that I wanted her to change the sheet. I used the very last of my energy to ask her to wash her hands when she tried to change my SPC without doing so first. She stormed off in a huff and I didn't see her again - thank gawd!! I will never forget her - and I love to tell the story of her complete incompetence. She made me feel that I didn't matter; that I was a nuisance. She terrified me. If I ever see her again - I will happily tear her a new a-hole.

Good luck, Rachel. You can do it.

emmalou* · Apr 1, 2010

People will not remember what we said. People will not remember what we did. People will remember how they felt when they were with us.
Sometimes the best we can be is quiet and present for someone else - learn how to be quiet, Rachel - so that you can really learn what's going on around you. If you can really learn what's going on and then respond appropriately, you will make the kind of difference that people remember because it mattered (and coincidentally, get the kind of recognition that you crave.)
When I was an oncology patient I felt very, very physically sick. Early on after my surgery, if my oncologist had stood at the end of my bed and said "You're cactus, babe." I would have said "Thank God." That's how physically sick I felt. There was a young nurse there who was assigned to look after me. She thought it was all about her. She had no idea that I even existed as more than a praise and gratitude machine for her. She spoke loudly, she moved loudly. Her keys rattled loudly. She smelled loud! She bristled with a sense of dramatic self-importance ("Look at me - I am Flo Nightingale reincarnated. And I am sexy - just like those gorgeous nurses on tv.")
If I had had the energy I would have told her to go away. If I hadn't been scared that the quality of my care would deteriorate even further, I would have told her to go away. I dreaded hearing her coming. She didn't notice that I was in pain and too sick to say so. She didn't notice that the sun was reflecting off a picture hanging on the wall right into my eyes and I was too sick to turn over without help. She didn't notice that my mouth was dry but I was too sick to sit up to take a drink. I told her I was lying in a puddle of urine and she was hugely irritated that I wanted her to change the sheet. I used the very last of my energy to ask her to wash her hands when she tried to change my SPC without doing so first. She stormed off in a huff and I didn't see her again - thank gawd!! I will never forget her - and I love to tell the story of her complete incompetence. She made me feel that I didn't matter; that I was a nuisance. She terrified me. If I ever see her again - I will happily tear her a new a-hole.

^ this. If you listen to nothing else on here, listen to this. Most of us have concentrated on the 'doing' tasks, which are important obviously, but qualities which are as important are empathy, kindness and active listening. Nursing students and new nurses tend to concentrate on the physical and you forget that is a person in the bed there, with a mum, dad, husband, wife, kids, friends in their life.

Best advice I've read on here, from the best kind of person, someone who was a patient.

CBsMommy · Apr 1, 2010

Hi Rachel
Zana2, HouTx and Emmalou have said more useful stuff than I could think to say. I went back and checked out last year's comms. You got some t'riffic advice there, too. So, as requested, here goes again - apologies to the three above - you have probably already said it:
1. Remember the universe wasn't created in one semester. Slow down. If you run the whole time (from experience to experience) you won't really appreciate any but the most shocking/toe-stubbing moments. And, as you discovered last year, your metaphorical charging around upsets the locals.
2. Keep a small notebook in your pocket so that when you feel that almost uncontrollable urge to interrupt with your oh-so-important question you can consider stepping away and jotting it down for reflection/research and/or later clarification with an experienced nurse. This will depend on the situation and all those variables already identified. Learn how to exist in the moment without seeking validation from others that you exist.
3. You are the future of nursing. You are an important person. You are a valuable person. You are being given a huge privilege by very sick people and very hard working nurses - the opportunity to learn from others' experiences and to practice so that you can make mistakes safely. I applaud your desire to be as good as you can be. Regard this semester as an opportunity to hone your judgment skills.
I sense your fear that you will receive more criticism than praise - and that this is your personal valley of the shadows. You have a huge hunger for approval. If you are not careful, it will continue to be your undoing - in nursing, in life, in general... Learn to make a steady, quiet inviolable centre, Rachel. Learn it sooner rather than later - and spare yourself this continuing world of hurt. (Consider signing on with a private psychotherapist who can help you to build it).
People will not remember what we said. People will not remember what we did. People will remember how they felt when they were with us.
Sometimes the best we can be is quiet and present for someone else - learn how to be quiet, Rachel - so that you can really learn what's going on around you. If you can really learn what's going on and then respond appropriately, you will make the kind of difference that people remember because it mattered (and coincidentally, get the kind of recognition that you crave.)
When I was an oncology patient I felt very, very physically sick. Early on after my surgery, if my oncologist had stood at the end of my bed and said "You're cactus, babe." I would have said "Thank God." That's how physically sick I felt. There was a young nurse there who was assigned to look after me. She thought it was all about her. She had no idea that I even existed as more than a praise and gratitude machine for her. She spoke loudly, she moved loudly. Her keys rattled loudly. She smelled loud! She bristled with a sense of dramatic self-importance ("Look at me - I am Flo Nightingale reincarnated. And I am sexy - just like those gorgeous nurses on tv.")
If I had had the energy I would have told her to go away. If I hadn't been scared that the quality of my care would deteriorate even further, I would have told her to go away. I dreaded hearing her coming. She didn't notice that I was in pain and too sick to say so. She didn't notice that the sun was reflecting off a picture hanging on the wall right into my eyes and I was too sick to turn over without help. She didn't notice that my mouth was dry but I was too sick to sit up to take a drink. I told her I was lying in a puddle of urine and she was hugely irritated that I wanted her to change the sheet. I used the very last of my energy to ask her to wash her hands when she tried to change my SPC without doing so first. She stormed off in a huff and I didn't see her again - thank gawd!! I will never forget her - and I love to tell the story of her complete incompetence. She made me feel that I didn't matter; that I was a nuisance. She terrified me. If I ever see her again - I will happily tear her a new a-hole.
Good luck, Rachel. You can do it.

Wow. From another student nurse just going into first clinical rotation, I say thanks. I will keep this in mind for the rest of my schooling and hopefully my life as a nurse! This touched me when I was having a very bad day and I thank you again from the bottom of my heart!

llg, PhD, RN · Apr 1, 2010

I think you have gotten some great advice in this thread, Rachel. I'll just add a couple more thoughts.

You seem to be over-thinking things, focused intently on super-analyzing everything -- and especially focused on yourself and how others perceive you. Being so self-conscious will only get in the way of good performance. To perform at your best, you need to focus outside yourself -- focused on the needs of others and how you can best meet those needs.

Instead of focusing on what the nurse thinks of you ... focus instead on how you can best help the nurse. What does the nurse need? What does the patient need? What do they need from you? How can you best meet those need? Instead of obsessing about your personal goals -- focus on the situation and on doing your best job to be useful to those around you. (Only focus on yourself a little bit now and then to make sure you are heading in the right direction.)

Expert performance is not self-conscious.

Grace Oz · Apr 1, 2010

G'day Rachel ..... many thanks for your kind words in your PM, I'm only too glad to have been able to offer some advice and support.

Other than to second some of what the OP have written, I really have no further advice or suggestions to share with you this time.

Ultimately it's up to the individual to learn, grow and be the best they can be in any given situation.

Nursing, as is life generally, is one continuous learning curve.

The main thing is to not be your own harshest judge .. others will openly, gladly and at times, cruelly, be that for you!

Learn to listen to your instincts, learn to trust yourself and your own judgements. The [earthly] person who we owe the most to is the one looking back at us in the mirror.

Apart from the above, I really have nothing more to add but do wish you continued success and encourage you to hang in there and keep on keeping on.

metal_m0nk, BSN, RN · Apr 1, 2010

I'm no seasoned nurse, so I can't offer you any constructive advice about how to behave in a clinical setting specifically, but I can offer you my perspective as a person who is accustomed to challenging people's ardently held beliefs and managing the fallout.

I was just reading over the thread you posted a year ago. What stuck out for me was the mention that intelligent, passionate, reflective people are a rare breed. I agree with that sentiment. The rub though (I believe), is that they are SUCH a rare breed that the majority of people they come into contact with don't know how to recognize or interpret them and will use whatever recollective tools they have at their disposal based on their (possibly limited) experience, i.e., every loud, intelligent student they've ever worked with has been equally disrespectful and unwilling to learn.

While it will be helpful to your success to do what you can to transform stereotypes, there is only so much you can do. Your control over how your actions are interpreted is lost directly after you've acted. The rest of the work is up to the interpreter and if that interpreter has no capacity or no desire to consider your motives irrespective of the prejudices they hold then the only real advantages you have are time (time to challenge their stereotypes again and again and again until they consider the possibility that what they can expect from you is different from what they've come to expect from others who exhibit similar qualities) and luck (the hope that whatever waves you make by just being you aren't large enough to drown your objective).

In reading some of the specific criticisms in the clinical evaluation from your previous thread, I thought that some of them were pretty dim when taken at face value (giving you the benefit of the doubt here) and I was left with the impression that a few of them were attempting to serve as evidence to reinforce what they believe amounts to a personality deficit (back to the stereotypes) that you may not actually have. If that is the case, my best advice is to 1) keep a journal and 2) find appropriate opportunities to explain your motives in writing to those who have questioned them (though this might not always be possible and can sometimes hurt a situation more than help it).

If you do find an opportunity to explain yourself that won't compromise your objective, make any written communication brief, benign, respectful, and professional. Don't use loaded words, don't rant. A written presentation gives the recipient the benefit of engaging on their own time and serves to address the situation in a forum that can not later be construed as disruptive to some more important goal or inappropriate to the setting in which it was presented. Additionally, I have sometimes found that the act of presenting a written record of my interpretation of events can have the effect of encouraging the recipient to manage future situations in a professional manner. But either way, keep a written, chronological record of your experiences from your point of view. Be as detailed as you can (in the journal). If for whatever reason it proves impossible to change a course of events that stems from misinformation, maliciousness, or being given no reasonable opportunity to improve your behavior (or if your efforts to improve are ignored in favor of maintaining the stereotype) it may prove useful in combating premature and/or unfair disciplinary action.

Beyond that, be mindful of your behavior without being self-conscious and if the volume of your voice raises above an appropriate level, apologize for the disturbance and mentally remind yourself to keep it down. Meet your limits in terms of what you can do to improve people's impressions of you, but also realize that limits exist.

Good luck!

Edit: One last thing. I'm willing to bet that a large part of the reason you face some of the resistance that you do is because you are 20 years old. Trust me, it gets easier as you get older and people start to mentally accept that your forethought, confidence, and maturity are a direct result of the number of years you've spent on this Earth (even though they aren't). But the above are some tricks that might help you get through these younger years with a little less personal (and professional) turmoil.

Zana2 · Apr 1, 2010

People will not remember what we said. People will not remember what we did. People will remember how they felt when they were with us.

That's a beautiful thing to say Trish, I'll always remember this. That really sums it up, that's what it's all about.

NurseAdida · Apr 1, 2010

I really don't mind having students when am having a good night but I dislike it when I have so much to do is so little time, this is the ONLY time when I feel they are dragging me down. Like they have to get their instructor who is God knows where to watch them give meds on my patients so I have to wait for her to show up so the student can give the meds...when I could have done so in a second and moved to the next patient. I also don't like students sitting on my computer at my desk charting...find another one we have numerous.

But for most part students love me and I love them, I love to teach, I encourage questions, I do particularly love students who introduce themselves to me not the ones that I find in my patient's room doing "stuff" to my patient yet I don't know who they are.

I honestly don't like loud students:o...most tend to know-it-all. I like humble students who want to learn. I love smart students who demontrate to me that they know yet they want to learn more.

metal_m0nk, BSN, RN · Apr 1, 2010

One last last thing. It's probably wise to go into it with the understanding that what you perceive as a cut-throat environment now may very well be that. Save yourself the heartache of expecting utopia and meeting with reality. But be open to the probability that the real world of nursing likely mirrors the real world of most things - a limited number of environs fall to either extreme and the majority lie on a gradient somewhere in the middle. If it turns out to be more friendly than you've envisioned, you'll be pleasantly surprised, but be prepared.