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Discussion

What is task-oriented nursing, and why is it bad?

I am a 4th semester nursing student at a technical college. I currently work as a nurse intern on a med/surg floor and float to ICU occasionally. I was informed that on graduation there will be no jobs except in ICU. There are two part-time jobs there. Amidst much discussion about taking on a new grad I as placed as an intern in the ICU for the remaining four months until graduation to "try things out." I was given the opportunity to apply for one of the positions, and my interview seemed to go well. I have had nothing but positive reports from my R.N.s, and my manager informed me that my evals look good and have been improving nicely. However, after several "confidential" meetings with my various nurses they have "said that you don't look for enough new experiences. You're too task-oriented." It is now too late to change anything to be able to get a job there. I will continue to work in the ICU until graduation, at which time I will begin 3 months of orientation back on the med/surg floor and then will be offered a float-pool position as that is all that is available there now. "We don't want to lose you, but we think you need to learn to dig deeper before working in ICU." Help! I don't understand what I'm doing wrong. All of my work is done on time every time, the doctors have complimented me several times on good nursing skills, such as noticing new abnormal heart rhythms which necessitated a move to the ICU, and my patients love me. The med/surg nurses that I work with the most have no complaints. I need to know what to change so that I can fix it. I don't want this to be a black cloud hanging over every resume I ever send out! Also, I'm not sure that I want to be there... I have an opportunity to work in a clinic. I know it's not as glamorous, but the hours would be perfect for me as I'm a young-married and hope to have kids. Am I giving up if I take a clinic job and work float-pool?

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  • Guides

Sounds like the clinic job would be your best choice........the money isn't as good as it would be in the ICU, but peace of mind and good hours are worth a lot more than high wages. (Believe me, I know.)

That said, I'm wondering just what your preceptors' expectations for a student nurse are.......seems to me they're a little high. New nurses are, by nature, task-oriented; they don't have the knowledge or the critical-thinking skills necessary to 'dig deeper'---those come only with time and experience!

It takes at least a year, and usually more, even to become comfortable with the job; by then you've seen a lot of things over and over and learned how to respond. Being proactive comes even later.......I've been a med/surg nurse now for about 5 years total, and it's been only in the last year or so that I feel I've really come into my own, that I'm competent and know my 'stuff'. So, even without really knowing the specifics of the situation, I feel the criticism given you was a little unfair, and I think they're expecting too much for someone who's still very much a beginner.

Good luck to you. :)

  • Author

Thank you, that makes me feel a little better. I have interned for two years, and apparently the criticism comes from the fact that I have been compared with two other interns (one of whom is competing for the same job and has been working as a CNA/EMT for 15 years) and a couple of students who have also worked in ICU at one time or another. My husband agrees that if I think I would like clinic nursing I should try it. Thanks again!

New nurses are, by nature, task-oriented; they don't have the knowledge or the critical-thinking skills necessary to 'dig deeper'---those come only with time and experience!

That's true. I really don't have a lot to add what Marla wrote; she pretty much covered the bases. As a new nurse, you are trying to learn a lot of new skills as well as where all the pieces of the puzzle fit. I wouldn't feel too bad about performing "task-oriented" nursing at this point in your career. Now when I work with nurses of 5, 10, and 15 years of experience who do nothing but what is in the physician order set and nothing else, then I get frustrated.

  • Author

Okay, all of this is comforting. However, it still doesn't explain what "task-oriented" means, and how I can change it. This is my problem. Nobody will tell me what to do differently. They say nurses eat their young. Unfortunately I'm starting to agree. The nurses I work with are great, at least on the evening shift. However our day-shift nurses have been there so long that they expect everyone to meet their level of nursing. Soooo, they don't answer questions. They just expect me to figure it out on my own, like if I don't I'm not good enough to be a nurse with them. Someone please help. I want to change, so that I can be a better nurse.

Okay, all of this is comforting. However, it still doesn't explain what "task-oriented" means, and how I can change it. This is my problem. Nobody will tell me what to do differently. They say nurses eat their young. Unfortunately I'm starting to agree. The nurses I work with are great, at least on the evening shift. However our day-shift nurses have been there so long that they expect everyone to meet their level of nursing. Soooo, they don't answer questions. They just expect me to figure it out on my own, like if I don't I'm not good enough to be a nurse with them. Someone please help. I want to change, so that I can be a better nurse.

I think what they mean by task oriented nursing, is focusing on completing task X (such as inserting a foley) rather than WHY we are performing task X and even if we should be performing it. (does pt have hx of fx UTI etc. etc.). It's tough to think that way all the time when just performing the task is such a new experience. I don't know how long their preceptor program is, or what they have to offer, but I guess they feel they don't have the ability to take a new grad from task oriented nursing (which is what we all do as new grads, so don't fret) to the level of critical thinking it takes in ICU. it reflects on them, not on you. You are exactly where you should be.

good luck in whatever you choose :)

  • Author

Well, thank you all very much for your help. Now, it gets better. I was turned down for this job because I was too task-oriented, and becuase I "need to have a medical-surgical foundation first." Sooo, my manager has gone on to hire a girl who graduates with me who has never worked on a med/surg floor except 5 years or so ago when she was a CNA there. I'm a little offended, I have to say. I have worked on the Med/Surg floor as an intern for two years, and have floated to the ICU at least two or three times a month almost every month. How is it that I need a better foundation, but she's okay when she has NO foundation? I'm a little confused. I wish her the best, but I'm having a hard time understanding my manager's thinking process. Especially since the general thought in the unit was that she didn't do well on her interview, couldn't time manage and fluffed her way through the answers. I guess on the one hand it makes me realize again that it truly is not what you know but who you know.

float nurses usually should be a more experienced nurse because they are confronted to many different parts of the hospital but if you feel like you can handle this assignment you will certainly learn more than you could possibly do in a clinic setting

  • Author

I actually will not be working in that type of float position. It's more of an occasional position. Also, I have since been offered a regular part-time position. It's kind of crappy hours, and nobody wants me there because we don't really need another nurse on our floor right now. Yeah, there MIGHT be another nurse quitting soon and then I'll get more hours. However, when I told my manager that I had some other places I had applied, she got all huffy and said she wasn't sure if she could guarantee me that job either! I really need the med/surg experience, because without it I don't have a chance of getting a job in my dream spot-E.R. I'm doing my preceptorship in our E.R. right now. I love it. We had a 2-car MVC with 2 injured patients that came to our E.R. One of them ended up in my area and my nurse and I were on the trauma team. It was an amazing adrenaline rush. Also, we probably saved the girls life. Very cool. The team-work was amazing, and I recieved some nice compliments for how well I handled the situation. I think that is what nursing is all about.

That Manager sounds like she has something against you. You don't need that kind of treatment, especially if you have worked there for 2 years. If I were you I would apply elsewhere and gain that medsurge experience. OR what about applying in the ER? they take new grads sometimes.

I actually will not be working in that type of float position. It's more of an occasional position. Also, I have since been offered a regular part-time position. It's kind of crappy hours, and nobody wants me there because we don't really need another nurse on our floor right now. Yeah, there MIGHT be another nurse quitting soon and then I'll get more hours. However, when I told my manager that I had some other places I had applied, she got all huffy and said she wasn't sure if she could guarantee me that job either! I really need the med/surg experience, because without it I don't have a chance of getting a job in my dream spot-E.R. I'm doing my preceptorship in our E.R. right now. I love it. We had a 2-car MVC with 2 injured patients that came to our E.R. One of them ended up in my area and my nurse and I were on the trauma team. It was an amazing adrenaline rush. Also, we probably saved the girls life. Very cool. The team-work was amazing, and I recieved some nice compliments for how well I handled the situation. I think that is what nursing is all about.
  • Guides

Task oriented means you are focused more on getting specific things done, rather than paying attention to the whole global picture surrounding the patient and the situation around you. Which is totally okay, at this stage of your career, just like everyone has said.

If you are curious about where this idea came from, it is described very well in Patricia Benner's nursing theory, From Novice to Expert. She described 5 stages: novice, advanced beginner, competent, proficient and expert. (Gee, can you tell I just wrote a paper for my nursing theory class :rotfl: ). You are somewhere in the advanced beginner area, moving along (its a continuum, not set stages) quite well especially if you can notice rhythm changes, and keep it together in a trauma scene in ED.

Keep asking questions whether some others like it or not, its the way to learn. Sometimes the key is in the way you ask, as in "check me on this, we are doing this because ....., is there anything else about it I'm missing?" That lets people know you aren't totally unaware of stuff, just wanting to know more. Find one person you really respect and ask if she will be your unofficial mentor for a while, someone you can come to without being made to feel stupid.

Most nurses in the proficient and expert stages also get all the tasks done efficiently, but can see many more things around the patient, implications of things, etc., so can do more than just tasks but also meet multiple needs of patients (not just the stuff that physical tasks take care of). Google some articles by Benner, she's really good.

  • Guides
Okay, all of this is comforting. However, it still doesn't explain what "task-oriented" means, and how I can change it. This is my problem. Nobody will tell me what to do differently. They say nurses eat their young. Unfortunately I'm starting to agree. The nurses I work with are great, at least on the evening shift. However our day-shift nurses have been there so long that they expect everyone to meet their level of nursing. Soooo, they don't answer questions. They just expect me to figure it out on my own, like if I don't I'm not good enough to be a nurse with them. Someone please help. I want to change, so that I can be a better nurse.

Again, you don't have to "change", just grow. And that takes time and experience, and you sound like someone I would love to work with. Wanna move to New Mexico?

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