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From Proficient to Novice

March 30, 2023 by NurseTwain

Dr. Patricia Benner created the nursing theory of knowledge progression ranging from novice to expert. She describes what it means to be an expert nurse and the step by step trajectory a typical nursing career follows.

Student nurses are novice nurses. New grads progress to advanced beginners after their preceptorships, orientation, and passing the NCLEX. The beginning stages of this theory revolve around building those initial nursing experiences for each different disease process. At the early stages, nurses are able to recognize abnormal findings, but may not be able to decide the appropriate interventions or recommendations to treat those issues. As they gain more experiences, review order sets, and recognize patterns, the nurse becomes competent. Several more years later, the nurse becomes proficient and can expect order sets for each finding. An expert nurse has many years of wisdom and experience to draw back on. They develop intuition, offer more creativity and alternative solutions, and seamlessly care for the whole person.

When I left the bedside, I classify myself as proficient. 5 years at the bedside allowed me to recognize orders, recommend interventions, and expect outcomes based on selected treatments. However, I am only proficient at the bedside. Once I moved into education full time, I am now a novice educator. I relate so much to my novice students in fears of the unknown and learning to be okay with discomfort.

There is so much to learn in each Individual field of nursing. Lecturing disease processes is so different than practicing it at the bedside.

I am a novice nurse again and that is okay.

Until next shift,

Shania

Filed Under: patient stories Tagged With: bedside, benner, education, hospital, medicine, nursing, patienttalk

“Your discharge is not priority”..

January 7, 2023 by NurseTwain

“Due to short staffing, we are closing early. Sorry for any inconvenience.”

“Please expect longer than usual wait times due to short staffing..”

“Now hiring. $15/hr starting pay.”

These signs and statements look all too familiar within today’s society. The nursing shortage has been ongoing for years and only getting worse. Short staffing at grocery stores or restaurants cause frustration and inconvenience. However, short staffing in healthcare is deadly and only increases the shortage as healthcare workers are overworked and burnt out.

It is really hard to be the nurse that we signed up to be…

  • When we can’t talk to our patients like we would like to and truly listen to them without having 1000 other urgent tasks to complete
  • When we don’t have time to brush our patient’s hair or give them a shower
  • When we don’t catch a dangerous trend in labs or vital signs because we are too busy to think
  • When we make a simple medication error because our phone keeps ringing or call lights are nonstop
  • When we don’t have the compassion we did as a new nurse..

As a nurse, we pledge an oath to do no harm, but it is very difficult when we do not have the resources we need to be successful and advocate for our patients as we should.

What doesn’t make sense either, is that administration views short staffing as doable, giving more and more patients to staff because they have to. But, are these overworked staff receiving additional pay? Most of us are not. The healthcare system does not operate on the usual economical supply and demand system. As demand rises, our pay does not increase.

From a patient standpoint, outcomes and satisfaction suffers. Healthcare worker violence rises and staffing is a major factor. Nurses must prioritize care, especially when having high-acuity loads and no help.

  • We must treat a low blood pressure before performing wound care.
  • We have to prevent a patient from falling before administering your home medication on your own schedule.
  • We will attend to a code before patient teaching.
  • We have to administer scheduled medications and/or pain medications, before printing discharge instructions.

Your discharge is not priority. We are literally saving lives and patients need to realize that a hospital is not a hotel.

I guarantee you, nurses are not just sitting at the station playing cards, drinking tea, or any other outrageous assumption made by the media. We are trying…

Until next shift,

Shania

Filed Under: patient stories, Uncategorized Tagged With: hospital, medicalsurgical, medicine, nursing, nursingshortage, patient, patienttalk, staffing

It’s okay to take up space

August 13, 2022 by NurseTwain

Do you ever say sorry out of habit? “I’m sorry for..”

Making it into the grocery line first

Being in the med room as another nurse walks in

Filing a valid complaint

Asking for a favor

Waking up a doctor for a patient need/concern

I have a habit of apologizing for things that 1.) are not my fault 2.) unintentionally inconveniencing others, 3.) allowing others needs to be greater than my own. In other words, I say “I’m sorry” for things that those words are not even intended for. The word “sorry” stems from a word meaning sorrow or sorrowful. Do I feel sorrow for any of the above scenarios? Of course, not.

While out wedding dress shopping for my sister, my sister was constantly apologizing for bringing more dresses into the dressing room or needing a different size, etc. Finally, the sales associate said, “you need to stop saying, ‘I’m sorry’. I told myself that I need to stop saying that because I am allowed to take up space.”

I am allowed to take up space. We should never let ourselves feel less than others. Apologizing for being a customer doesn’t even make sense! Also, we have learned over the years that empathy is way more affective than sympathy which the words ‘I’m sorry” go with. So, allow yourself to take up space in this world like the billions of other humans that walk the earth.

Until next shift,

Shania

Filed Under: Nursing tips, patient stories Tagged With: hospital, inspiration, medicalsurgical, medicine, nurse, nursing, patient, patienttalk, RN

Retention, Recruitment, Resilience.. Oh, My!

July 2, 2022 by NurseTwain

These three words are dominating the media when it comes to nursing. Facilities attempt to retain their current staff while also trying to combat the ever-increasing staffing shortage by recruiting new hires. Staff are also reminded and educated on ways to be resilient and how to prevent burnout.

Unfortunately in America, even nonprofit hospitals have to be run like a business. Our bedside nurses are the number one asset to a successful hospital as they care for the income drivers.. the patients. Bedside nursing is a physically and emotionally demanding job that wears on even the best of nurses. I left the bedside for these reasons and also to follow my career path of leadership and education. By accepting my position into Nursing Professional Development, I see the leadership perspective of how to run a hospital.

Yes, staffing is a problem. Yes, nurses are not getting paid enough. Yes, there are more and more demands placed on nursing without incentives or relief. But, one of the main issues regarding increasing nursing staff is actually getting additional nurses into the door. The time to hire is a challenge for many organizations. This can be related to slow HR processes (they are short-staffed, too) and/or the amount of time it takes to train a nurse for the assigned unit. Even an experienced nurse can take several weeks to get acclimated to a facilities’ policies and procedures. Certain positions, such as the OR and Critical Care, are noted to be some of most challenging positions to fill due to the scope and specialty.

According to the 2022 NSI report, “on average, it takes 87 days (3 months) to recruit an experienced RN.” During this period, more staff may be leaving, additional positions, and the cycle continues. As the need increases, the vacancy rates continue to increase, and bedside nurses leave due to thin staffing, hospitals cannot keep up with the demand.

I write this mainly to draw attention to our strained and flawed healthcare system. Pay incentives and large recruitment bonuses are only temporary solutions. Long-term solutions can only be successful if we can recruit, retain, and promote resilience within our organizations. Be sure to listen to the staff, be transparent, suit their needs, and acknowledge the work that each individual contributes.

Until next shift,

Shania

Click to access NSI_National_Health_Care_Retention_Report.pdf

Filed Under: Uncategorized Tagged With: healthcare, hospital, nurseretention, nursing, patienttalk, recruitment, resilience, staffing

Defensive Medicine: Protect Thyself

May 17, 2022 by NurseTwain

The NIH defines defensive medicine as “departing from normal medicine practice as a safeguard from litigation.” In essence, it is over-prescribing to prevent from getting sued due to missing any clinical components. But this isn’t the type of defensive medicine I am referring to. The type of defensive medicine I am talking about involves appropriately and effectively documenting in order to cover your a**. We often use the improper term of CYA documentation.

“If it’s not charted, it wasn’t done.” This is a phrase I heard all of the time in nursing school. I understood this intellectually when it came to nursing skills, procedures, and medications, however, I didn’t realize that I would need to document a physician response, tagging and changing IV tubing, patient education, patient mobility, etc. Even the most mundane nursing activities must be documented.

In order to protect yourself from lawsuits or chart reviews, we have to chart everything that we do to our patient during our shift. It always made me laugh when I had to document inappropriate patient comments or physician responses that were either rude or incomplete. Documentation is what saves your butt. Even though it’s tedious, it is necessary.

Remember to CYA.

Until next shift, Shania

Filed Under: Nursing tips Tagged With: defensive medicine, hospital, medicalsurgical, medicine, nurse, nursetwain, nursing, patient, patienttalk, trial

Communicating for Change

April 26, 2022 by NurseTwain

“All communication must lead to change”- Aristotle

In acting, we learn that words are useless. Words only become effective once humans add purpose to them. The greatest actors understand the power of each word and use that power effectively to change the person they are speaking to. The change can be a perspective of a topic or a perspective about themself. We sometimes use the same words with different meanings or inflections to mean different things. This is the beauty of language and communication.

We conducted a communication survey within our facility to evaluate our current communication methods, strategies, and opportunities. A majority of the respondents voiced that they were “not confident” or “fairly confident” about our internal communication, communication with hostile patients/ family members, and communication to different departments.

With Covid, we realized that nurses are out of practice with communicating with visitors and the routine communication with interdisciplinary staff, most of which was eliminated during Covid.

There are two main types of communication that can be evaluated here: assertive communication and aggressive communication. Assertive communication is standing up for your beliefs, voicing your concerns, and not being afraid to communicate different viewpoints. Assertive communication is essential for leaders as it does not just go with the flow, but uses words effectively to evoke a positive change. Aggressive communication is not normally effective because it downplays other views, does not accept criticism, and has the “I am always right” mentality. Rather than offering suggestion like assertive communication, aggressive communication demands a certain way.

Communication is essential for a healthy work environment and relationship with coworkers. Ensuring that all voices are heard, points are spoken clearly, and evaluating different approaches are all ways to improve current communication modalities. If people have the sense that they have a say, their motivation for change can be greatly improved.

Filed Under: Nursing tips Tagged With: communication, hospital, leadership, medicine, nurse, nursing, patient, patienttalk, talk

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