i was going to blog about the fact that i have noticed something about myself that completely threw me off the wall. then i stumbled upon this post by beth over at pixel RN, and i decided to stop talking about ME, because as we all know, that is not so interesting.

anyway, the supposed intellectualization of nursing.
that sounds like a topic i should not really put my nose into. if you have been dropping by this little blog for awhile, you probably already figured out that i usually just talk about my experiences and how those experiences affect me either in a positive or a negative way.

beth, i completely agree with you that it is a disservice to the future nurses to give them the idea that they will, when they become RNs enter a job that will only involve their autonomy and intellect, just to find out that isn’t the case. after all, when they work at the bedside, they will be expected to look, smell, and eventually clean up vomit and poop just like everybody else.

but if i may disagree, i will point out that i won’t consider what you do in the recovery room as something that does not involve autonomy and intellectual skills. i could be wrong, but i think the reason why you feel that way is because everything has been so routine and common to you. when you think it over, you will realize that a person without your nursing education, training and experience cannot do your work, no matter how simple it is for you, with the same confidence and competence you have, because you practice with that knowledge that backs your actions up.

can you imagine pulling out some random person from the street to watch a patient recovering after a surgery? will that be the same as paying a registered nurse to do it? if you define autonomy as being capable of being left alone to care for recovering patients with the possibility of going bad, and knowing exactly what you were supposed to do even if the doctors are not around, i think you are autonomous. and intelligence? i think you’ll agree with me that it takes more than a set of eyes, a nose, ears, and a pair of hands to assure that the patients are safely recovering.

going back to nursing education of today, i have nothing against pushing students to embrace the idea that a job in nursing requires them to have that certain amount of brain cells, and that they are expected to use them in their future jobs. i think that every profession are gearing that way. it is some kind of a proof that the profession is evolving, and that education is moving forward. it doesn’t bother me that instructors are hyped up about nursing theories and what not, because those theories are important.

what concerns me is the imbalance. if i went to nursing school and was taught that i need to develop ONLY my intellectual skills, i am screwed. there is no such thing, and it will be an ugly scenario for me to dive into bedisde nursing with that expectation.

i have seen new graduates behave like they were on the floor only to question a doctor’s orders and analyze test and lab results like they were expected to change the treatment plan that the attending has in mind. they look the other way when the call light is on and if the patients need bedpans or emesis basin. they don’t say it, but the look on their faces imply that all those gooey “dirty” stuff are not their responsibilities. i could be wrong, but i think nurses with this kind of attitude, whether new or veteran, are misguided.

on the other hand, i have seen nurses, both new and veterans, who act like they are only on the floor to clean up patients’ mess and never question an order or look up test and lab results because it is not their responsibility. they behave like doctors’ blind followers who do not have a mind of their own, and are not confident enough to suggest interventions, afraid that they will not be heard. i could be wrong, but i also think these nurses are dangerous.

where is the balance?

head. hands. heart.
this is the spirit and core of nursing.
this is the definition of nursing.
being an effective nurse is using all three, having all three.
to be effective is to have that balance.
an effective nurse IS a good nurse.

i have mentioned this in a post a long time ago, as i learned it in nursing school, and i will say it again. we cannot work with just our head, overruled by theories and scientific explanations we memorized and understood in universities and act like we do not have hands therefore we are not supposed to clean up poop. it is not enough that we know what a dirty behind can do to a patient. it is not enough that we have the hands to keep them clean. if we are rough and impersonal, not valuing a patient’s privacy because we think keeping them clean is enough, we are wrong.

we have to know what to do, why we are doing it, and how do we do it.
missing one concept is a disadvantage to our patients.
teaching nursing students, who will be nurses of the future, to focus only on one is not right, and it is dangerous.

nursing is head on, hands on, heart on. all together. all at once.
maybe that is enough explanation why there is a nursing shortage.
it is because not a lot of people can be all that, all at once.

smart people who know every pathophysiological explanation for every disease process but can’t be bothered by unimportant nonintellectual things like changing dirty sheets and cleaning gunky teeth or dentures are probably not cut for it. they will be financially compensated but will never be satisfied.

people with a lot of initiative changing gowns, diapers, and keeping the patient’s environment spotless but do not think twice in giving lasix to a patient with a blood pressure of 70/40 are probably not cut for it. they will be very produtive but will never be efficient.

people who are smart and are hands on who make sure the patients are stable and the orders are unquestionable but do not have time to really listen and show compassion are probably not cut for it. they will always be efficient, but will never feel rewarded.

it is hard to be all that all at once.
very hard.

i know that, because to be honest, i cannot say that i am all that, all at once, all the time.
i keep trying, i keep learning. we all keep trying, we all keep learning.

we have to, because beth’s hanging question is universal, straightforward, and clear.
if no one’s going to do it, who will?