Tuesday, August 31, 2010
Tuesday, August 24, 2010
Monday, August 23, 2010
Saturday’s shift felt like an assault. The babies coped well - no one got sicker or died - but some of the nurses reached and then exceeded their frustration tolerance. The night went on forever, while we struggled to do what usually came easily:
Umbilical vein catheters took aberrant pathways.
Interruptions battled coherent thought.
Nothing went right.
Sunday night I asked my friend, Cheryl, a thirty-year Neonatal Intensive Care Unit veteran who has been recognized for clinical excellence (and who shared that bad shift), what nurses need to know.
She thought for a few seconds and said, “They need to know how to be at peace with the care they give.”
I asked her to explain.
She said, “You know – all of us – we’re only human. If we’ve done the best we could, we’ve got nothing to apologize for.”
Sometimes I have the mistaken idea that what I do here at work is about me. If a PICC fails to advance, I lament the end of “my streak.” And I do love a good resuscitation, but I sometimes wonder if it’s on account of the happy ending for the baby or because it made me feel so good?
Basing our self-image on success with procedures and pride in our skills is a huge mistake. After all, there are days when we’re the picture of efficiency, but despite our mad skills, the outcome stinks.
You know the saying – “the operation was a success but the patient died.” Does our stock go up when the IV goes in first stick? Or crash when it doesn’t?
And if we take personal credit for a patient doing well, do we also take credit when she doesn’t?
How do we see ourselves on a bad night?
What do we do with our failures – those times when nothing goes right?
- Remember, although we strive for good outcomes, we can’t control all the factors that contribute to our patients’ problems. We don’t (and never will) have ultimate control.
- Failures hold valuable keys to improvement. Avoid the temptation of immediately putting that bad shift out of your mind. Instead, examine your failures and wring all the juice out of them.
- If your hospital practices debriefing after difficult cases or critical incidents, participate. If they don’t, look into ways of starting the practice.
- Informally debrief. In a secure environment, talk with your co-workers about what went well and what didn’t. Without blaming, look for possible solutions.
- Work through your own feelings about the failed procedure. What in particular bothered you – your embarrassment or perfectionism; or the patient’s discomfort or disapproval? Deal with your discoveries in ways that work for you – journaling (no case-specific information here), prayer, counseling, even self-help reading.
- Control the things you can. While you can’t solve every problem, succeed at every procedure or heal every patient; you can decide how you will deliver care.
- Avoid tunnel vision. Don’t focus on the procedure at the expense of the patient. Ask for help when you need it.
- Offer care in every sense of the word. Preventing pain, promoting comfort, and offering reassurance are foundational to nursing. Value these aspects of caring. Your patients do.
- Pay attention. To your patients and your colleagues.
- Listen. To what people say and what they leave unsaid.
- See the patient. Ask for their goals. If they’re unable to tell you, use your imagination. Zero in on their perspective. Rein in your personal motivations.
- Work together in humility. Lift someone’s spirits. Remind them of the good you’ve seen them do.
You, me – all of us have flaws. Despite them, we do an awful lot of good. Like my friend said, we can be at peace with the care we provide.
In the end, all you can do is all you can do. Remember you’re human (and every shift ends).
Nurses, please leave a comment sharing your thoughts on this article!
About the Author: Suzanne Davenport Tietjen, RN, NNP-BC is a Nurse Practitioner, writer and shepherd. She takes care of tiny sick babies in the Neonatal ICU and a flock of natural-colored sheep at her family's century-old farm. Suzanne has written for nursing journals and Christian magazines, and has published two books, 40 Days to your Best Life for Nurses and The Sheep of His Hand.