Tuesday, August 01, 2006
CompromiseSo I'm sitting here on this rainy day, looking at the Mediblogopathy template (which HK, in a fit of what can only be described as insanity, has let me loose on) and thinking about compromise.
I could design something that would suit me perfectly. It would likely be minimalist, a kanji sort of blog...
My colleague's ideal blog could be more colourful, vibrant, in your face...
It's a very personal thing, to open up your writing space to some stranger on the other side of the world. Never mind that Mediblogopathy is a bit overdue for a tidy-up, and we were working on just that a few months back, but it's still an invasion of sorts to have someone come in and suggest changes, or even pass comment on what had gone before.
Having a nursing student is a bit like that. An interloper, come to scrutinise your territory and make observations about whether your clinical practice is in keeping with the standards of the day. There's nothing quite like some young thing comparing you to a textbook definition to make you take a second look at your work.
It's not possible to assign students their own patients on our unit, due to the unstable and challenging nature of the patient population. Instead, they're assigned to an RN who works with them for 12 hours at a stretch. That's 12 hours of one-on-one instruction. Even school teachers get to go home after 8 hours.
The energy required is not to be underestimated. I sometimes wonder if some people at my work think I'm lazy, having the student do everything for me and just sitting on my hands. The truth is, I go home exhausted at the end of those days when I'm assigned a student or new grad. Completely drained. It's hard. The easy route is to do everything yourself.
There is compromise, or a balance to be found, in having students in critical care at all. Allowing them to do more than just sit, staring at the monitor, but keeping them and the patient safe. There are certainly those in the profession who would like nothing better than to have students sit in the corner and never go near the patient, or better still not be on the unit in the first place! These nurses have perhaps never admitted to themselves this fundamental truth of paediatric intensive care:
Killing a patient is difficult.
Don't believe me? It's true, I swear! These kids are actually fairly hard to kill. We're so careful, but in fact much of what we do is of necessity over-cautious. Students, by and large, don't kill patients nearly so often as graduate registered nurses. It's not the students we have to be worried about.
I had a student once who, while I had a few days off, was assigned to another nurse and left a bedside down while she went to get something from out of the room. You simply would not believe the wailing and gnashing of teeth that arose from this simple incident. Never mind that doctors reviewing a patient do it all the time, or that the patient in the bed was no more capable of rolling out of it than of conquering Everest; safety had been compromised. Shock. Horror.
That's not to say I wouldn't have kicked her ass if I'd been there. Soundly and swiftly would that ass have been kicked. Tell you what wouldn't have happened though... she wouldn't have been left to feel as if she'd failed her training because of one ridiculous little incident. It's about finding a balance.
Maybe preceptors do assume a little more risk on behalf of their charges. I know this same student had other difficulties, where she was felt by those working with her to be overconfident, unsafe, even to the point that her clinical lecturer asked me whether or not she should pass or fail the placement, and what grade should be assigned. I told her I thought the mistakes stemmed from a tendency toward over-enthusiasm for her work, and that I felt sure she would settle down within her first few months of new graduate practice. I could have said, "No, kick her out for screwing up a few times," but then I would be compelled to recommend the expulsion of 95% of working RNs for the same offence.
Compromise. I will accept your questions, and sometimes your implicit criticism, because I know that you have yet to find your understanding of your intended profession, and I will keep you safe while you search for it. I will not expect perfection, and you will learn not to; we'll find the middle ground in our own time.
Posted by PaedsRN at 10:52 AM