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In an amusing article a few weeks ago, another Scrubs contributor pointed out the things that differentiate a new nurse from an experienced nurse. The line that caught my attention—and garnered the comment “This list makes me look lazy!”—was this one:
“A new nurse will spend two hours giving a bath. An experienced nurse will ask the CNA to give the bath.”
Lordy lord, how that brought back memories. I distinctly remember rushing around as a new nurse, looking at the more experienced nurses on the floor, as they did crossword puzzles or caught up on other work, with a mixture of confusion and resentment. Was I slower because I was a better nurse? Were they better nurses because they were faster? Would I ever get to the point where I wasn’t chasing my own tail on the floor?
Those feelings came back when I transferred from an acute care unit to the critical care unit, and again when I transferred from surgical critical care to stroke-focused care. This time, though, I knew something I hadn’t known at the start: that experience does make a difference in how fast you move and how efficiently you get things done.
Take the bath example: It wasn’t long before I realized that not only was I not as good at bathing a patient as our techs were, but it took me longer. The job of bathing patients was something I delegated early on, because, frankly, either a tech or an RN can bathe a patient, but there are some things only an RN can do. And if you’re not as good or as thorough as somebody who does it every day, why kill yourself trying to prove that you can do it badly? (There are exceptions, of course, but as a rule, if you’re not as good as a specialist at something, it’s best to let the specialist handle it.)
Honestly? I didn’t get good at bathing patients until I worked overnight in the CCU. Baths there were done at night, and I’d generally bathe both my patients by myself and then help out on a couple more. Repetition made the difference in terms of both skill and speed.
Another example: Nurses routinely double-check the drug calculations for critical-care titrations. I learned pretty fast that my talent for doing fractional math in my head was a benefit not only for me, but for other people who had to get out a calculator, pen and paper, an abacus and the higher maths department of McGill University to manage a dose conversion. I’d double-check their titrations and sign off on the paperwork, and they’d do things for me like check vent settings or double-sign settings on the dialysis machines. It saved everybody time and played to our individual strengths.
The point is this: If you are bad at something, it’s worthwhile to practice until you get good at it, but remember—there will always be somebody who can do it better or faster or more cleanly than you can. Likewise, if you have a talent, make that talent freely available to others in exchange for their exercising their talents on your behalf. That practice will save you whole minutes of time on the floor.
Another lesson that comes with experience is learning to let well enough alone. If a patient is able to walk safely to the bathroom by himself, you don’t have to be there every single time he gets up. You can use the time you’d spend with him to walk the hip-replacement patient or make sure the dude with the occipital stroke is eating enough. Likewise, people who got two pain pills 45 minutes ago are probably already asleep: A quick check on their pain level is often enough (our pain-assessment tool even has a box to check for “patient sleeping; left undisturbed”). And the person with specific focal deficits from a brain injury who is otherwise stable doesn’t need to be put through an entire neuro exam every two hours; focus on what’s likely to change instead.
Again, with experience, you’ll learn what can be done quickly and what takes a little more time. You’ll also learn what to focus on and what’s important when it comes to warning signs. All of this makes you more efficient as a nurse, and therefore faster.
Finally, a word about charting: It’s true that new nurses chart “too much”—that is, they double-chart things that other people have already put in the medical record. Computerized charting makes it easier to figure out what you can leave out; for instance, if a doctor has charted that she was at the bedside from 10:30 to 11, you don’t really need to make a note that Dr. Feelgoodette was at the bedside from 10:30 to 11.
It’s also true that experienced nurses “don’t chart enough” in most cases. Findings that are normal to an experienced nurse but that might be worrying to the patient often aren’t charted as normal, or at all. Likewise, things like transport services and tests done fall by the wayside. Again, as you gain experience, you’ll learn what you can not chart and what you cannot fail to chart.
Eventually you’ll get there: to the point where you have a little extra time to do comfort care or sit and listen to a patient, or joke with the family. Eventually you get enough experience to be able to puzzle over that six-letter word, starting with “a,” that means “two of a kind.” It doesn’t mean that you’re lazy or better or worse. It just means that you’re more experienced.
recently i have found that it is the new nurses that will take the time to walk all the way down the hallway to get the cna to assist room 1 to the bathroom!!!! many of the nurses i see coming to us are getting into this profession for the money and job security. just a handful really pitch in as a team player. as a charge nurse i find myself running more now than i did before because i am the cna, unit secretary, pr go go, and lastly(is that a word?) a nurse to my own patients. but as with anything in life, there is good and there is bad….. i still love what i do….
Interesting that you never once mention the role of LPN’s as Nurses in this….
I am a PCA on a very busy floor and a full time nursing student. I understand both sides of the coin. It drives me nuts when a nurse walks out of a room hunts me down to tell me the pt needs to go to the bathroom, needs water, or vomited and to clean it up. While not all nurses are like this, they do exist. They are the ones that I strive NOT to be! Knock on wood, I will graduate and become an LPN, which IS a nurse and will not treat my assisstants with disrespect. Afterall, they can make it or break for you…just remember that;)
Interesting that it seems you are indeed saying experience is equal to being lazy! I was appalled reading this blog, just appalled. NO ONE should be doing a puzzle during a shift. There is always SOMETHING that can be done for a patient or family member, no matter WHO YOU ARE. Puzzles are for break, lunch, or home.
You are a TEAM… and should not designate all tasks simply by the letters at the end of your name. We all know what PRIMARY role belongs to whom, but when that is done… there is plenty more to do. Always a pole that needs wiped down, or a drawer rearranged. You get paid for 8 (or 12) hours. You should WORK those 8 (or 12) hours.
I do NOT identify with this blog, and I am an experienced nurse. Wow.. I sit here amazed by how ridiculous this just made experienced nurses look.
1) Comparing bathing a pt to a specialist in something? Really? You’re ‘bad’ at giving a bath? That speaks volumes to your ‘experience’. 2) I am a wonder with math. I, too, can do it in my head. HOWEVER, I *ALWAYS* double check. We are dealing with life and death, and meds that can affect a person’s life! A construction worker lives by the motto “measure twice cut once.” He is only dealing with a piece of wood. 3) Really? This is an issue? Even student nurses know this one. It is common sense. BUT, you’d better at least take a break from your crossword puzzle and lay eyes on your patient, sleeping or not. Otherwise – you’re charting illegally just because you “assume” a patient is sleeping. 4) IMHO you can never chart too much. It can get tedious, but always cover yourself. If it isn’t charted it didn’t happen. I would rather chart TOO much than not enough. I’d rather review my notes for accuracy than figure out that 4-letter-word that begins with a letter ‘L’ that means, “I’m done with my RN duties, so now I can sit here and do a puzzle while the CNA bathes 10 more people, because she is more proficient at it.” 5) If Dr. Feelgood is at patient’s bedside from 1030-11, you don’t need to chart it, UNLESS YOU WERE THERE! Then, you need to chart YOUR activities – that YOU were with Dr. Feelgood and what was discussed. After all, if Dr. Feelgood went over the consent form and you have the patient sign it, when asked in court – Did you go over this with the pt? You say No, Dr. Feelgood did while he was with the pt, they’ll say, how do you know, you didn’t chart Dr. Feelgood was with the patient, and that you were in there with him (and what was discussed). These are NOT examples of experience, they are examples of shortcuts – some not so great shortcuts at that.
I hope I just misunderstood this blog because of the disconnect of the written word. Otherwise, I hope I never have the pleasure of you being a part of a team I am part of. There is a problem in nursing today. People are losing their work ethic in a field that you absolutely cannot do that in. People put too much stock in the little letters at the end of your name allowing those letters define your job duties much more than they are meant too. It is very sad what I see happening to my profession. It is very sad that a nurse stated (basically), “I am not good at giving a bath (so I delegate that duty).” Profound.
I too believe that there is a loss of work ethic in nursing. I also believe that by allowing each team member to operate to their full scope, we can get more done. Bathing is part of everyone’s scope, but medication administration and assessment are not.
I definately DO NOT agree with the comment “doing what you are good at, and letting others do what they are good at.” MY Pt is MY responsability. I learned the hard way on that one. I got fired because I trusted a tech to give me an accurate CBG, when she had not been doing them at all. My Fault, as I could have easily walked down the hall and checked. It ruined my career, just when I was starting to feel proficient. My confidence was blown, and I was no longer trusted. It was a terrible experience for me, and I have not worked in nursing since..am still mentally recovering from the betrayal. Yes, tech’s will make or break you.
But you Damn welll be sure that it will NEVER happen again.