On Nursing

[gateslacker]

I have been waffling again over my chosen grad school track. I think Patho is so fascinating that I have been thinking more  and more about changing to the NP program of study rather than the education path. Of course, at the rate I am going, I have a fair amount of time to make my final decision and I really should spend some time with an NP to see how I would acclimate to a clinic setting. My preconceived notion before now is that because I am such a hands on person and have become accustomed to the drama and excitement that often accompanies working in the hospital/ER setting, that I wouldn't be satisfied. My preconceived notions are likely wrong, in any case.

I love Nursing but it can be such a bizarre work culture. No other health care professional, i.e. lab techs, X-ray techs, respiratory therapists, etc, run such a large gamut of professional responsibilities. I can be giving a bath one minute and administering potent drugs the next. My duties can overlap other departmental duties such as lab and respiratory (drawing blood and giving respiratory treatments) but, rarely, do their job duties overlap with mine.Nurses don't diagnose or order medications or tests, but I have to have the knowledge to be able to say, "are you sure you want that medication" or "that medication can't be given IV" or "what do you think about adding a troponin to the labwork". Of course, I have to do all of this in a way that makes it look like it was a mere oversight without undermining the physician's authority. It can be a thankless job. It is nursing staff who are typically attuned to subtle signs that a person will likely be "circling the drain" in short order and work very hard to prevent it. When good patients go bad, we are the ones jumping through hoops in order to stablize them. Yet, in the end, it was the doc that saved their lives. If you don't believe me, just go watch any of the myriad medical dramas currently on the tube. Except for some obvious exceptions, these doctors are often portrayed performing activities that nursing typically does. Though nurses historically score the highest on those surveys about patient trust, there is an obvious misconception that nursing is simply following "doctor's orders" and is often not seen as a discipline in and of itself.

Though the tendency is diminishing as time progresses, there still exists the "handmaiden" ideal, especially when dealing with older physicians. It is the ultimate contradiction that I am expected to function as a patient advocate while simutaneously remaining submissive and subordinate. Often, the two are mutually exclusive! Ultimately, this handmaiden ideal negatively impacts nursing interactions with one another and I believe that it is partially responsible for the concept of nurses "eating their young" via the trickle down effect. For some, it is expressed as the idea that if I make them look bad, I will look good and achieve some measure of recognition and/or respect. It is absurd. Fortunately for me, I truthfully haven't fallen into that trap though I am ever vigilant about not becoming a victim. I realized long ago that I have no need to be supernurse and that I don't really need to be told that I am doing a great job or that I am a good nurse all the time. Naturally, it is nice when that happens but it isn't really necessary for my nursey confidence. I hold myself to my own standards and usually know when I am getting it right. Mostly, a nurse can tell with patient/nurse interactions and I am aware that I am very good with patients. In the end, most of those "attaboy" moments from colleagues are rather subtle. It can be a coworker saying that she is "glad I'm in charge". It can be someone seeking you out for your advice, opinion,  and/or to answer questions. With physicians, it can be even more subtle in that they are quick to provide "constructive" critism bit very rarely engage in blatantly postitive feedback. They will demonstrate that they trust your assessment of a patient's status by responding more quickly or engage in a discussion about a patient where you are an active participant rather than a passive bystander.

A coworker of mine told me about an article where a nurse has the potential to be charged with murder. It seems that this OB nurse, who had been on duty for over 20 hours, inadvertedly hang the epidural infusion as a piggyback infusion. Therefore, epidural anesthesia was accidentally administered intravenously (and probably at a much higher rate) and the patient suffered cardiac arrest. A horrible, tragic mistake to be sure, and one that any nurse lives in terror of making, but is the culpability that nurse's alone. According to the article, the epidural admixture bag looked very similar to a piggyback admixture bag and was just lying there. Where was the anesthesiologist during all of this? I am certain that the 20 hour shift and the fatigue that goes with that played a large part in the error. Some might say that the nurse should have went home, knowing that she was too tired. My question is why was she working a 20 hour shift? Did someone call in? Perhaps leaving would have constituted patient abandonment, which carries its own set of legal issues. If I am working and no one shows up and/or there is no relief available, I would be unable to leave, even if it meant working a 24 hour shift. Certainly, the nurse made a horrible error and action should be taken. However, should she go to prison for it? Humans make mistakes and there are all sorts of safety procedures we go through when administering medication that this nurse likely didn't adhere to, for whatever reason. But prison time! That would certainly set an alarming precedent and likely dissuade folks from becoming nurses at all, exacerbating the nursing shortage even further.

So, how did I get on this lengthy discourse. Strangely, it was an episode of the "big head" that started all of this. For an assignment in my patho class, I have to do a clinical pathway paper for hypothyroidism. After looking for a suitable patient example, I decided to just use myself as the example. However, when I was diagnosed, I wasn't a nurse and I certainly don't remember all of the relevant test and lab results from way back when. So, I decided to take a backtrack approach starting from some current day lab results. I asked my doc for some copies and we started talking about school and what I was planning on doing. I told him about my waffling and about considering the NP track after all. He said that I should "definitely" consider becoming an NP stating that I would be an "excellent diagnostician". As I was picking my jaw up off the floor, he further increased my head size by saying that he has "seen the way I think" and that, because of my personality, he stated, "patients would love you". Of course, it made my day and I told him so. It was also some confirmation that there exists some measure of respect and that I am not merely imagining it all which naturally led to my thinking about the topic of nursing and respect.

Whoever managed to get to the end of all this is certainly to be commended for having the utmost patience. As for me, it seems that I can find the most ingenous ways to avoid studying.

Comments

[soniag.livejournal.com]

I wish you the best in your decision process. I was so excited to read what the doctor said to you! You are super fabulous! I'm sure you'd be a great NP. Was the other option to teach? Well, of course, I think you would be great at that, too.

This seems like an exciting time for you -- deciding what you truly want to do!

For me this changes all the time. I'm not sure I'll ever grow up and find my passion. I think writing is my passion, but a) it's hard and I don't do it as consistently as I should, and b) I haven't gotten anywhere with it so I can't really quit my day job just yet.

[gateslacker.livejournal.com]

Thank you, Sonia! I was definitely bowled over!!The other option, and the one that would take less time, was teaching. Another factor is the fact that an MSN prepared NP can teach, they just don't have that education preparation that would be beneficial or even necessary for teaching.

But, you would know more about that than me. Does the study of education and education theory make you a better educator? My advisor said "a good clinician does not an educator make."

It's not like I have to decide this very minute but, naturally, I need to be thinking about it.

I do love nursing although I am not quite sure I could say I love it with a passion. Certainly, taking these classes has renewed my vigor for it. One of my reasons for pursuing "Plan B" as I call it is the fact that I'm not getting any younger. Will I really be capable of working at my current pace when I am in my 60's? It can be a physically and mentally demanding job!

I think it's great that you are actively pursuing a writing career! I can only imagine how hard it would be to write a novel. The amount of research needed must be phenomenal.

[soniag.livejournal.com]

Does the study of education and education theory make you a better educator?

In my opinion . . . NOOOOOOOOOO! I hate all that crap. Getting in the trenches with students and working with other teachers makes you a better educator. If your program offers opportunities for observations and practicums, then it might be worthwhile.

I couldn't even handle your pace now, so I can understand how hard it would be in your 60s! It's good that you have options. But it's hard to decide, I'm sure.

[de23.livejournal.com]

Inserting a random thread about myself here:

NOOOOOOOOOO! I hate all that crap.
As I read this I was agreeing with you, and it occured to me that I also held this conflicting viewpoint that I would want some educ classes before I became a school librarian. I decided it was because I am really more worried about working with the other teachers than with the kids, so I want to make sure I know the lingo and all. If I decide to do it, that is. As of now I'm leaning that way.

[gateslacker.livejournal.com]

I certainly appreciate your opinion because I don't really know and it helps to see what someone who is in the know really thinks about it all. Doing something is usually far more enlightening than studying something.