Finesse
I'm back on days now, and worked 7A-7P last Thursday and Friday. As a special surprise bonus, I got to have my beloved Julie as my preceptor on Thursday because Jessica happened to have somebody else to precept that day. So that was awfully nice. But then of course I did have to have Jessica on Friday.
Friday morning on the bus, for the very first time in this job, I found myself dreading (ever so slightly) getting to work. And, as it turned out, I wasn't really wrong. Nearly as soon as I got there, Jessica was on me, micromanaging even the smallest details of my day, "correcting" my decisions about which task to do first, giving me little lectures about time management. I managed not to say "Fine, fine, FINE!" but let slip a sort of understated, "Okay, okay, okay, I'll go get the 8 am meds now." It did have a slight edge to it, but was nonetheless substantially filtered down from the "would you shut your flapping piehole and leave me the hell alone?" that might have more accurately represented my true emotions at that second.
Things did kind of settle down after just an hour or two, but I was feeling pretty chafed, and it really wasn't helping my concentration or my efficiency any. Fortunately, there turned out to be some more substantive, actual patient-care-relevant issues to talk about come late morning, and we were able to warm up to each other again a bit. It occurred to me that one school of thought would be to initiate a frank dialog with Jessica, explaining my frustrations and asking for a change in behavior. The advice columnist solution. I briefly tried to consider it seriously, but gave up on it pretty quickly. It just seemed too ham-handed in the situation, and seemed like it would make things more, not less, tense. Plus I really didn't feel like it.
By noon, Jessica was finally pretty much leaving me alone, since she had a new admission to contend with herself. Around 4:30, we reconvened, and she said, "okay, there are 2 1/2 hours left, and there's still a lot to get done," (subtext: you haven't been taking my time management advice, have you?) and had me list what remained to do. Then she offered to take over Room 16 so I could concentrate on 32A for the rest of the day. That was nice of her, though in context, it did have a little shading of I-told-you-so. So I went and finished up with 32A--changed the caps on her triple-lumen Hickman catheter, belatedly got her 4 pm Benadryl as well as the Zofran she requested, hung her vanco, emptied her urine & tidied the bathroom, changed her bed (finally), took her vital signs again (I'd taken them at 4, but then had not written them down, and uncharacteristically forgot the numbers completely), and charted her Is and Os.
There was one notable Jessica moment, when she poked her head in and noticed that the patient had... an orange! If it had been Julie, I know that whatever she said would have been compassionate and diplomatic, but Jessica blurted out a rather snippy and condescending, "Has anyone explained to you what neutropenic means?" and told the patient she wasn't allowed any fresh fruit (as part of the "low-bacteria" diet that people with severely compromised immune systems have to follow). The patient, a kind of salty working class middle-aged woman with newly diagnosed leukemia, quite reasonably replied that she had been told that oranges and bananas were okay because they had thick, protective skins that you didn't eat. Jessica bustled off to ask the nurse practitioner, and the patient mischievously hurried to peel the orange so that she could eat at least one section before Jessica came back. "They're really good oranges," she said to me. I probably should have stepped in, with a gentle, "why don't we wait for the answer, just to be sure..." That would have been the nursely, responsible thing to do, right? But I couldn't bring myself to. I just stood there and, well, maybe kind of twinkled as the patient peeled her orange. Jessica then came back with the news that the nurse practitioner said it was okay. Oh, whew.
When I was talking to our friend Max on the phone shortly after my shift, I was trying to describe what Jessica was like, and I think I was being a little incoherent. Finally, he said, "oh, does she have her hair pulled back into a very tight ponytail?" "Um, yes," I said. "Yes, actually, she does." And he laughed, because then he got the picture exactly.
What's funny, though, is that for all her uptightness, Jessica also cuts corners that I don't feel comfortable with--and that Julie (my role model and exemplar in all nursing standards) doesn't cut. I guess maybe it's that Jessica's tightly-wound-ness is more about rules and efficiency and less about the big picture of providing good patient care. It's really nothing egregious, and I think she probably provides perfectly safe patient care, but she often doesn't go the extra step--doesn't look stuff up when there's a little question; she just fills in paperwork to get it filled in and doesn't take time to think carefully about it. Things like that. Julie always seems to do both, to get things done efficiently and to make sure to serve the larger good of patient care.
At the end of the shift, as we were sitting and charting, Jessica and I were talking (pretty amicably by now, thank goodness), about the weekend and when we were next on together. She had been looking out for me and made sure that since the Clinical Nurse Specialist was on vacation, we got the Nurse Manager to make up a schedule for me for the next few weeks. I was really very grateful, because I was feeling shy about making it happen, but at the same time really wanted to know what my life is going to look like. And we saw on the schedule that our next workday was Tuesday. "So at the beginning of the shift, we'll sit down and plan out the day together," Jessica said. Oh dear, here we go again.
"Um," I said. "Um, I was thinking that maybe I should try to plan out my day myself. I really, really appreciate your stepping in with Room 16 so that I could finish up everything for 32A today. It made it so much easier. But I'm thinking it might be a necessary part of the process for me to, you know, make mistakes, and to some degree suffer the consequences, you know? I mean, not to the point of, I don't know, going to cry in the bathroom or anything, but it just seems like I really have to learn the process of time management from the inside out. So I should try to kind of, you know, go through the process from scratch. So I can slowly learn how to be independent. I mean, if I'm really super overwhelmed, I might have to ask you to rescue me a little occasionally, but I think I should try to do it by myself."
I have to admit, I felt like a frigging genius. None of what I said was at all untrue--I had just managed to find a place to stand from which I could say what needed to be said without it being at all threatening or angry or anything. It was all about my shortcomings and my weaknesses and my vulnerability, and not a whisper about her driving me bats. And she relaxed immediately. She seemed truly relieved. I gave myself an internal high-five.
So that's the plan for Tuesday, and I have to say I'm feeling fired up. My twin (and fortunately complementary) goals: provide excellent, safe, and efficient patient care, and keep Jessica off my damned case. I figure I have to be so good, so thorough, so on top of things, that she isn't tempted to put her little fingers in. I'm in the process of making up my own special scut sheets, a format for writing stuff down and figuring out my priorities and keeping the important things in mind, and prompting myself to do the stuff I have a tendency to forget. And then I'll go in a little early, and I'll read the charts and look up the labs and get everything all mapped out for myself. And buy myself the right to go in and check in and say good morning to my patients before I get their damned 8am meds, if I so choose. We'll see how it goes.
Friday morning on the bus, for the very first time in this job, I found myself dreading (ever so slightly) getting to work. And, as it turned out, I wasn't really wrong. Nearly as soon as I got there, Jessica was on me, micromanaging even the smallest details of my day, "correcting" my decisions about which task to do first, giving me little lectures about time management. I managed not to say "Fine, fine, FINE!" but let slip a sort of understated, "Okay, okay, okay, I'll go get the 8 am meds now." It did have a slight edge to it, but was nonetheless substantially filtered down from the "would you shut your flapping piehole and leave me the hell alone?" that might have more accurately represented my true emotions at that second.
Things did kind of settle down after just an hour or two, but I was feeling pretty chafed, and it really wasn't helping my concentration or my efficiency any. Fortunately, there turned out to be some more substantive, actual patient-care-relevant issues to talk about come late morning, and we were able to warm up to each other again a bit. It occurred to me that one school of thought would be to initiate a frank dialog with Jessica, explaining my frustrations and asking for a change in behavior. The advice columnist solution. I briefly tried to consider it seriously, but gave up on it pretty quickly. It just seemed too ham-handed in the situation, and seemed like it would make things more, not less, tense. Plus I really didn't feel like it.
By noon, Jessica was finally pretty much leaving me alone, since she had a new admission to contend with herself. Around 4:30, we reconvened, and she said, "okay, there are 2 1/2 hours left, and there's still a lot to get done," (subtext: you haven't been taking my time management advice, have you?) and had me list what remained to do. Then she offered to take over Room 16 so I could concentrate on 32A for the rest of the day. That was nice of her, though in context, it did have a little shading of I-told-you-so. So I went and finished up with 32A--changed the caps on her triple-lumen Hickman catheter, belatedly got her 4 pm Benadryl as well as the Zofran she requested, hung her vanco, emptied her urine & tidied the bathroom, changed her bed (finally), took her vital signs again (I'd taken them at 4, but then had not written them down, and uncharacteristically forgot the numbers completely), and charted her Is and Os.
There was one notable Jessica moment, when she poked her head in and noticed that the patient had... an orange! If it had been Julie, I know that whatever she said would have been compassionate and diplomatic, but Jessica blurted out a rather snippy and condescending, "Has anyone explained to you what neutropenic means?" and told the patient she wasn't allowed any fresh fruit (as part of the "low-bacteria" diet that people with severely compromised immune systems have to follow). The patient, a kind of salty working class middle-aged woman with newly diagnosed leukemia, quite reasonably replied that she had been told that oranges and bananas were okay because they had thick, protective skins that you didn't eat. Jessica bustled off to ask the nurse practitioner, and the patient mischievously hurried to peel the orange so that she could eat at least one section before Jessica came back. "They're really good oranges," she said to me. I probably should have stepped in, with a gentle, "why don't we wait for the answer, just to be sure..." That would have been the nursely, responsible thing to do, right? But I couldn't bring myself to. I just stood there and, well, maybe kind of twinkled as the patient peeled her orange. Jessica then came back with the news that the nurse practitioner said it was okay. Oh, whew.
When I was talking to our friend Max on the phone shortly after my shift, I was trying to describe what Jessica was like, and I think I was being a little incoherent. Finally, he said, "oh, does she have her hair pulled back into a very tight ponytail?" "Um, yes," I said. "Yes, actually, she does." And he laughed, because then he got the picture exactly.
What's funny, though, is that for all her uptightness, Jessica also cuts corners that I don't feel comfortable with--and that Julie (my role model and exemplar in all nursing standards) doesn't cut. I guess maybe it's that Jessica's tightly-wound-ness is more about rules and efficiency and less about the big picture of providing good patient care. It's really nothing egregious, and I think she probably provides perfectly safe patient care, but she often doesn't go the extra step--doesn't look stuff up when there's a little question; she just fills in paperwork to get it filled in and doesn't take time to think carefully about it. Things like that. Julie always seems to do both, to get things done efficiently and to make sure to serve the larger good of patient care.
At the end of the shift, as we were sitting and charting, Jessica and I were talking (pretty amicably by now, thank goodness), about the weekend and when we were next on together. She had been looking out for me and made sure that since the Clinical Nurse Specialist was on vacation, we got the Nurse Manager to make up a schedule for me for the next few weeks. I was really very grateful, because I was feeling shy about making it happen, but at the same time really wanted to know what my life is going to look like. And we saw on the schedule that our next workday was Tuesday. "So at the beginning of the shift, we'll sit down and plan out the day together," Jessica said. Oh dear, here we go again.
"Um," I said. "Um, I was thinking that maybe I should try to plan out my day myself. I really, really appreciate your stepping in with Room 16 so that I could finish up everything for 32A today. It made it so much easier. But I'm thinking it might be a necessary part of the process for me to, you know, make mistakes, and to some degree suffer the consequences, you know? I mean, not to the point of, I don't know, going to cry in the bathroom or anything, but it just seems like I really have to learn the process of time management from the inside out. So I should try to kind of, you know, go through the process from scratch. So I can slowly learn how to be independent. I mean, if I'm really super overwhelmed, I might have to ask you to rescue me a little occasionally, but I think I should try to do it by myself."
I have to admit, I felt like a frigging genius. None of what I said was at all untrue--I had just managed to find a place to stand from which I could say what needed to be said without it being at all threatening or angry or anything. It was all about my shortcomings and my weaknesses and my vulnerability, and not a whisper about her driving me bats. And she relaxed immediately. She seemed truly relieved. I gave myself an internal high-five.
So that's the plan for Tuesday, and I have to say I'm feeling fired up. My twin (and fortunately complementary) goals: provide excellent, safe, and efficient patient care, and keep Jessica off my damned case. I figure I have to be so good, so thorough, so on top of things, that she isn't tempted to put her little fingers in. I'm in the process of making up my own special scut sheets, a format for writing stuff down and figuring out my priorities and keeping the important things in mind, and prompting myself to do the stuff I have a tendency to forget. And then I'll go in a little early, and I'll read the charts and look up the labs and get everything all mapped out for myself. And buy myself the right to go in and check in and say good morning to my patients before I get their damned 8am meds, if I so choose. We'll see how it goes.
posted by Rosie Bonner at 10:16 AM
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