NurseTwain

As an actor discovers and creates a character, they must first answer a series of questions, of which set the stage for the entire performance:

• Who am I?
• Who am I talking to?
• What is my objective?
• What is my opposing character’s objective?

An actor’s objective is what/how they want to affect their opposing character (the person they are speaking to). An objective is always about the other person and how words are meant to affect them. For example, I recently played an evil History teacher who never reached her goals at her pre-determined milestones. Because of this, I cannot let any of my students achieve their goals, and I make it my life purpose to teach them that the world is against them, so why even try? My objective in this scene is to bring my student to the reality that she will never reach her goals.

Tactics are different methods that are used in conversation, body language, etc. that allow the opposing character to feel a certain way. Tactics are used to achieve the objective. In the above example, I may use guilt to cause my opponent to feel like she doesn’t deserve success. If that doesn’t work, I can evoke fear in her because I know that this is her weakness; I can convince her that her fear will get the best of her, so she should save her effort. Tactics will always tie back to the objective to achieve the desired outcome.

So, how in the world does acting compare to the Clinical Judgement Measurement Model in Nursing??

Well, do the terms objectives and outcomes sound familiar in the Nursing world?

The first step in writing a Next Generation NCLEX (NGN) test item is looking at which content objective needs to be measured. For example, if students are expected to read an EKG, one sample content objective would be to Identify and Measure the following on an EKG tracing: P wave, PR interval, PR segment, QRS complex, QT interval, ST segment, T wave, U wave (if applicable).

The second step involves “Building the Case”. This step includes the creation of learning activities and different teaching methods (tactics) to allow students to achieve the content objective. Students may review a client’s EHR and note an abnormal EKG as they identify and measure the duration of the EKG elements. Students may read in their textbook and/or listen to a lecture on the appropriate values for each element. These class activities are tactics to allow the students to reach the objective.

The final step in creating a NGN test item is to write the question using one of the many new item types. This step is where student outcomes will be evaluated and the instructor will observe if the content objectives were met or were not met and the student requires remediation.

The actor’s process may not be so different than the nursing process. When in doubt as a new educator, remember that you have the knowledge and these students do not have the experience that you do. Be confident in your knowledge and be flexible with the attitudes of students to keep them engaged!

Until next shift,

Shania

In April 2019, a Washington State senator denounced a bill to allow uninterrupted lunch breaks for nurses and stated that nurses “probably play cards for a considerable amount of the day.” Not surprisingly, the senator was faced with much opposition from nurses across the nation, refuting her ignorance and false claims.

After the initial anger from the comments died down, nurses “playing cards” became a joke as memes and apparel were created in reference to the comment.

Nurses are lucky to get a 30 minute lunch break in a 13-hour shift, let alone sitting at the station and playing card games. However, I was laughing at myself during my previous night shift because I did end up playing cards.. Rummy and UNO (in case you’re curious).

I had a patient who was on enhanced safety precautions due to suicidal ideation. She was medically cleared and just waiting for psychiatric placement. She repeatedly said she was just so lonely and asked any staff members to play cards with her.

Typically, requests like this are hard to fill due to short staffing and other duties being priority. I was lucky to actually have some time and it was a “quiet” night shift. We played multiple rounds of cards together throughout the night.

This is patient-centered care. No staff member had to play with her even if they had time. Extra activities and requests such as this are often unable to be completed due to the nature of healthcare. It is moments like playing cards with a patient, braiding their hair, taking a patient down to the lobby to play the piano, etc. that remind us of our why’s of nursing.

No, I did not get into nursing to play cards all day, but the shifts that I can fulfill a patient request, are the shifts that keep me at the bedside.

Until next shift,

Shania

Conversational. SBAR. Therapeutic. Assertive. Passive. Slurred. Clear. Articulate. Aphasic. These are all words to describe methods and/or characteristics of communication.

Effective communication in Healthcare is crucial, however, what may seem like an elementary skill, communication does not come naturally for many people. Disclaimer…I may be bias as I do speak to myself in a closet for a living (voiceovers), but it is an issue that I have experienced a lot lately.

I have learned that I need to ensure that my students communicate abnormal vital signs. I have observed students completely disregard the patient in the room during a med pass or not address a family member. And then, of course, there is the dread and anxiety of calling a physician for the first time.

Aside from nursing, I have dealt with several different contractors for our one year house inspection and NONE of them have communicated well. Some would show up at our home at 8:00am with no notice. Some would reschedule our date and notify us days later. Some wouldn’t respond for days… I joked to my husband that I would give them all 5 stars if they just communicated appropriately! We need to plan and want to know what is going on!

The parallels in nursing are large. I think of these everyday scenarios and then remember how patients feel when they do not have answers or when family members call during shift change asking for any updates. Early on in nursing, I learned that simply communicating that we are still waiting on MD orders, at least, allows the patient and family to know that they have not been forgotten. Reminding a new nurse that it is necessary to call a physician and that they should never feel belittled or afraid to do so is critical to reduce risk for burnout. Developing assertive communication does take time, but it gets things done!

Until next shift,

Shania

The infamous question from new grads to preceptors is, “How long does it take to know what I am doing?” For many, the answer is one year. Nursing school starts with fundamentals, where students learn how to give a bed bath and safely transfer a patient to the bathroom, to Medical-Surgical Nursing III, where students learn complex disease processes such as Acute Respiratory Distress Syndrome and Shock.

Clinicals aim to transfer the knowledge learned in lecture to practice with real patients. Due to the lack of preceptors, clinical facilities, and strict student guidelines, it is often hard to create a realistic nursing experience as a student. Students often only learn how to care for one patient at a time, and then receive up to 6 patients on a Medical-Surgical floor and are expected to manage their time and priorities.

It takes a year after nursing graduation to really feel confident in our abilities. That year mark is where instead of simply recognizing abnormal assessment findings, we learn to provide recommendations to physicians about a potential intervention.

When I first began teaching one year ago, I was also told to “give it one year.” However, the first year of teaching was way different than a first year of nursing. I know how to be a bedside nurse, but teaching brought on many unique challenges. I feel like I forgot the minute details that we teach and is tested for our complex medical topics. I still study with my students and have started to adapt creative ways to teach content. My stressors as a new grad far outweigh my stressors as a novice instructor. In my first year of teaching, I have improved on exam writing, active teaching strategies, and connecting lecture to clinical practice. But, I still have much to learn just as my students have much to learn on their nursing journeys.

Until next shift,

Shania