As a new nurse, I was constantly overwhelmed. I had spent four years of my life learning how to become a nurse, and then here I was, being “a nurse” and wondering all the time whether I was even any good at it. My heart was in it. But every moment of every shift, I felt anxious about my understanding of the information presented to me. I remember conversations with my mentor, Deb, where she finished talking, and I thought, “Huh?” The depth of her clinical knowledge was beyond what I had begun to appreciate about nursing. While I was on orientation with Deb, I remember one particular moment that I stood in awe of her capability. There was a baby in respiratory distress who had suddenly worsened and required bag-valve-mask ventilation. No one in the room could successfully bag the baby, who was turning more and more blue by the second. I stood in the doorway helplessly, lacking the knowledge to make any new suggestions. Deb pushed her way to the top of the bed and flipped a valve on the bag, then began successfully bagging the baby. With our whole pediatric critical care team at the bedside, it is possible that Deb’s knowledge saved that baby’s life that day. She shrugged off the event like it was nothing, and later explained to me what she did so that I could share her knowledge. “The baby had a mucous plug,” she casually explained to me, “he needed more pressure to push it down.” I can still feel the admiration for her today that I felt all those years ago. In a room full of experts, it was one person who had the knowledge to save a life.
Nursing is a tremendous career. Joining the nursing workforce as a new nurse, especially in high-acuity areas, you have just enough knowledge to putter along at a slow pace keeping people alive. You have just enough knowledge to know when you are in over your head. “Calling uncle” and grabbing an experienced nurse when you have run into a new situation is a life-saving skill. I am sure I would have killed many patients if it weren’t for nurses like Deb, who walked me through complicated situations.
I have witnessed a scary phenomenon over the last few years of my career that seems to be very common in new emergency nurses. It is the phenomenon of a new nurse not asking questions, not acknowledging their immense lack of knowledge, and not showing respect for the skills or knowledge of their more experienced colleagues. It scares me to my core. I think back to myself as a highly-motivated new grad nurse, the hours I put into my own critical care education outside of work so I could take great care of my patients. And remembering that, I also recall how many years it took me to finally feel like I had a clue — like I could hold my own when crap hit the fan. I find myself now working with nurses who have one or two years of experience and never ask questions. They argue with their experienced colleagues and display a level of pride that makes me worried for their patients. Some of them treat the older nurses with disdain, the older nurses who shaped nursing before these new nurses were even out of the 3rd grade. How will they ever learn if they don’t ask? How will they improve if they don’t admit they’ve reached their knowledge limit? How will their patients fair? How many things will be overlooked simply because they didn’t ask someone for help? How many patients will suffer or have poor outcomes?
I cannot say whether this phenomenon is a generational issue, a personal pride issue, a schooling issue, or a nursing culture issue. I know that there are some units that garner a culture of disrespect to new nurses, with gossip centered around their “dumb questions.” This is unacceptable. There are some nurses who go into emergency or critical care nursing to look cool and play the hero, not to provide excellent care or do anything that isn’t glamorous. They will pass up every opportunity to make real connections with their patients unless it brings them some kind of personal benefit. This is unacceptable. There are some members of the newer generation that do not respect the knowledge of those who came before them, who hold no regard for the nurses who paved the professional roads they walk every day. This is unacceptable.
In my opinion, a great nurse is someone who knows and acknowledges their limits. A great nurse respects each person on the team as important and treats them with kindness. A great nurse asks questions and seeks out expertise with a willingness to listen to the knowledge shared. A great nurse shares their knowledge and does not judge those who have less knowledge than they do. A great nurse will do whatever is best for their patient, even when no one is watching or if it will not further their social status on the unit.
We are charged with a great and noble task: to nurse our patients back to health in even the direst of circumstances. And our patient’s lives depend on our ability to work together and learn from each other.
Rachel Basham is a nurse.
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