Shut your boca...and when to speak up

Something struck a chord with me today probably because I am an older person. I guess nothing you do in school can prepare for the circumstantial things that will stay with you in clinical. For instance we were in lab doing assessments (this is the practical applications of nursing without real patients~but scenarios and role playing ...I think that's probably why I was such an intuitive claims person and fraud investigator, I loved putting the puzzles together and I played with a lot of barbies when I was young, so there was hours of role playing. Today, we did vitals again and also pain and skin assessments. Hospital Barbie (I thank you) and all those little old people at PVCH who put up with me when I was a CNA kid.

When you are in pretend situations, story telling comes out of real life experience and so we get to hear a lot of war stories from more experienced student nurses and instructors. I like the war stories because they bring the theory down to tangible learning...I call that my 'note to self' moments...for instance, so-so told me she did this...don't do that! Or so-so told me about a great thing she or he did, I am going to file that away for future reference - remember to do that! That's the primary reason mentors and preceptors are so important when it comes to the healthcare professions.

The war story I heard today reminded me of the days I spent in the hospital with my Dad and daughter. I learned more from seeing how good nursing affects outcomes and how bad nursing makes the situation worse. One of the stories we heard today was a nursing student who was doing a dressing change on a patient that was a terminal patient who had all kinds of multi-system complications, including lesions, organ failure and intractable, excruciating pain. The student didn't want to change dressings without providing pain relief prior to starting procedure (essentially wanting the patient medicated 30 mins before) and the supervising RN working with the patient said no. No reason, no explanation..just no with a cursory intonation "don't ask me why, it's none of your business...get to work"

How to handle the difficult people...the politics of students/nurses/faculty and then the ethical issues that come along with what one perceives to be their primary responsibility (the patient)..why these should be in conflict is a mystery to me when you consider that the new wave of healthcare is supposed to be collaboration and team building. Are we that much of a threat to someone's ego, that patient care gets compromised? Is it politically incorrect for me to even think that this is some sort of travesty. Am I an idealist student nurse who will soon be a burn-out? Doesn't it seem reasonable to think that with a little prioritizing and planning that we will have time to provide pain relief prior to dressing changes or will we stop caring about these minor little details. It seems to me that the nurse who had this patient, had little time to either pay attention to the student nurse, the patient or what is the best practice. Does this happen to everyone at some point? These are all hypothetical questions that our whole group talked about today.

We talked about whether it would be a good idea to speak up, because after all, we are supposed to be advocates. Who knows when to shut your boca and when to speak up. I've always spoken my mind (not in a harsh manner, but asking questions in a probing way that seeks to clarify a purpose - we are supposed to do this as students and patient advocates). When to speak up...? I guess I'll find out for myself as time goes on, whether I will have to shut my boca or speak up. In effect, we need to challenge ourselves to ask questions in a manner that is non-threatening or in a way that seeks to clarify a procedure or the best way to do it. Right now, I think diplomacy goes a long way, whether you are a patient's family member, a friend, a colleague or a merely a student nurse. I pray I have the patience to listen when it's my turn, be patient in the process and grateful that someone else has provided input. It could mean so much to a client, having the courage to speak up in a diplomatic way without calling someone's expertise into question.