Don’t Sweat the Clinical Stuff

file000128753155Many new nurses are in a panic because they have had very little if any opportunity to perform various procedures such as bladder catheterization, NG tube insertion, tracheostomy care, etc. They also fear that experienced nurses will turn their nose’s up at them for not having that proficiency or even exposure. But the truth is that those “tasks” can be learned by anyone with some due diligence. Wendie, an experienced nurse educator, puts it all in perspective.

“When I taught nursing students, we would have this talk about what I called “stuff” – the check-off list, like a birder’s life list or a stamp collector’s inventory. That’s all it is. We teach lay people “stuff” all the time. Think of the parent with a child on a home ventilator who knows how to change a trach tube and suction. Or the middle-aged woman who does her husband’s home dialysis (hemo or peritoneal). They can do tasks well, in some cases better than licensed persons. But are they NURSES?

“The fact is that NOBODY “gets to do all that stuff” in school. You don’t have to. What you need to learn is the difference between what nurses do and what nurses are. You need to learn principles of sterile technique, assessment, anatomy and physiology, pharmacology, psychology, and above all, how to ask questions and develop the habit of life-long learning. Your schooling doesn’t stop at graduation, or at one year after that, or when you get your first professional certification. It goes on forever.

“You will have plenty of time to do your first NG tube insertion, your first IV start, your first Foley insertion, your first IM injection or suctioning or wound packing or any of a thousand other pieces of “stuff.” One of my students, a young woman with a long work history of being a nursing aide who came to nursing school for the credential, “because she already could do what nurses did and needed to have the license so she could do medications.”

“One morning I find her in the nursing station about 9 a.m. reading a nursing magazine. I said, “What are you doing out here? Why aren’t you with your patient?” She said, “He’s all done up.” That is nursing aide-speak for the bath/linen change/feed – the tasks of the early morning. As an experienced aide, she was much better at this than most of her classmates who were new to patient care, and would still be making beds at 11:30. I told her to get back in there and stay with him, be with him, a 60ish man with a new diagnosis of cancer, which would probably kill him within a year, even if there was no conversation and he didn’t “need anything.” She shot me a look and heaved herself out of the chair.

“The next time I saw her was around noontime, when she came out for noon meds. She was almost in tears. Seems after about 15 minutes of silence he started talking, and talking, and talking… about his family, his fears, his joys, his sense of being overwhelmed, all of it. He had been on this excellent oncology unit for a week but nobody had sat down and just listened. I said, “Now you know the difference between what a nurse does and what a nurse is.” I got cards from her for years.

 

Excerpt from Your 1st Year as a Nurse – Making the Transition From Total Novice to Successful Professional, 2nd edition by Donna Cardillo, RN