Because the last time that I have posted to this Blogger account was over 2 years ago, I assume very few people are following this blog. I am going to continue to call this my "Photo Blog" and don't intend on sharing these posts on social media any time soon. I also don't plan on naming my place of work or the names of my coworkers. That being said, I also know that whoever does read this will probably know who I am, what I do, and where I work. I can't really avoid that. The point of this blog is actually just to vent. I also hope that this will serve as a source of information, maybe even inspiration, for nurses who plan on working in the acute care setting.
At the time that this blog is being written, I will have been serving (working) at this particular hospital as a Clinical Coordinator for about 6 months. The Clinical Coordinator position has a few job descriptions, one being the charge nurse of their particular unit, in my case the ICU and CVICU - two separate critical care units with different staff and different cultures.
Right now I actually want to just talk about employee independence. It is interesting watching how employees work from a leadership/middle management standpoint. When I was a staff nurse, I was often just focused on my patient assignment (usually 2 patients) and took little heed to the work of my peers other than when they were in obvious need of help, in which case I would try to make a point to provide assistance wherever I could. In the end, I took pride in my ability to independently take care of my patients. That being said, I do not want to claim that I would have been able to do my job without the support of my peers, but I will say that the care of my patients was under my direction and control. If I felt that I needed help or that I was getting behind, I would assign specific tasks to other nurses who had the time and were willing to help out. Eventually, in recurring situations, such as an admission or an open heart recovery, certain coworkers learned my routine and the specific tasks that they would perform were no longer "assigned" but rather they were understood. This relationship grew over time working with a specific nurse whom we performed at the same level and were able to react to each other's needs without verbalizing them. The relationship that I describe is similar to that of a basketball team who has been playing together for a long time. With experience, you learn the next move of your teammate and are able to react to it in order to improve the functionality of the team as a whole.
What I described should be contrasted with a situation in which an individual expects for tasks to be performed without any context other than that they appear "busy." They often have a difficult time functioning without someone checking on their work and picking up the loose ends. These situations require for the other members of the team to perform the expectations of another and often begin to overcompensate the amount of assistance they provide. This happens in large part because the struggling team member does not effectively communicate how they can be helped, but rather just start flailing their arms in distress and hope that someone can come to save them. The reaction from the team members is usually to assume that to "take over" miscellaneous tasks would help their struggling teammate. To bring it back to the basketball team, it would be like a power forward taking the role of the point guard because it looks like the point guard is dealing with a strong defense. The power forward is leaving his role to perform the duties of another teammate because the point guard is unable to perform it himself, rather than waiting for the ball to be passed to him while remaining in the power forward position as expected.
In a critical care unit, teamwork is important. I would venture to say that the teamwork in the critical care units and emergency room sets those departments apart from many other healthcare areas. As a clinical coordinator, I depend on good teamwork for my unit to perform well. What that means is that each member of the team is able to perform all of their tasks without requiring another teammate to take over and do things for them. It also means that when another teammate is in a position to be helped, that person is ready to be delegated when asked. It is the same concept that describes how the whole is greater than the sum of its parts. If the whole is equal to the sum of its parts, it means a couple of things: synergy is not present in the system and certain individuals are required to fill the void left behind by others.
In the realm of critical care nursing, a lot of this boils down to how we educate and foster growth of new critical care nurses. When we are orienting/precepting new nurses to the critical care areas, it should always be the goal of the orientee to be able to perform all of the tasks of their role independently, not requiring the assistance of anybody, but understanding how and when to delegate. It should also be a goal to perform on a team by appropriately being delegated. As a nurse, you are expected to know many things about your patient, especially in the critical care units, such as what meds they took this morning, how well they tolerated lunch, how much urine they made each hour, what their vital signs are and how they have trended, etc. You also have to be able to defend this in court, should you ever be put into that situation. Therefore, your documentation should be your own. Documentation is one task that I believe (and have been instructed by legal nurse consultants) should never be delegated. As a nurse in a leadership position, the unspoken expectation that I have for my team is for everyone to be able to perform their duties independently. If you are not able to perform all of your tasks as a nurse independently within a timely manner by the end of your orientation, you may not have received proper instruction, your goals may need to be reviewed and adjusted, or you might be better suited for a lower acuity unit/assigment until time management and clinical skills are dialed in.
I can already hear it..."But Sean, don't forget how much help you needed in the beginning." "Remember how much I helped you?" "How do people learn? You have to help them while giving them more challenging patients and situations."
I know. As the acuity of your patients increases, you will probably need more help. However, it is expected that within a reasonable time period you should be able to learn and adapt to those acuities so as not to become dependent on the assistance provided by your peers, but rather perform to the level of those around you. You can expect to one day not have all of the help that you are used to receiving and are still expected to perform at the same level regardless. You should always be prepared for that situation. If you find that you consistently cannot perform all of the tasks of the day, including patient care and personal breaks, without another nurse doing part of your work, it may be wise to request for changes to be made in the better interest of the team and the patients being served.
