Nursing New Year’s Resolution
I have made a New Year’s Resolution for my nursing career. It flows from the fact that I get so incredibly caught-up in the details of my patient care that I frequently neglect to see the “big picture.” I run around all day in a task-oriented daze, fascinated by dressing changes, new procedures, interesting medications, and complex pathophysiologies. But when someone asks me a “bigger” question about a patient, I am often dumbfounded.
I thought I would provide a couple examples from the past week:
1.) I am aware that my patient has gone through several set backs. She had a Tubal ligation, then a perforated bowel, and later, a ruptured spleen. While giving report, the oncoming nurse asks, “why did she have a tubal ligation? She’s in her 60s? And how did she get a perforated bowel and ruptured spleen?”
I am caught; I hate that feeling; I just don’t know. I get so focused on the individual issues, that I fail to understand how they are all interconnected. I miss the big picture. Sure, I do a damn good job of taking care of that ruptured spleen–but why does she have a ruptured spleen?
2.) A gentleman has a long history of admissions on my unit. I have been there for all of them. I know most details of his admissions, including the big picture of how they are all interconnected. I look after him holistically from head-to-toe trying to truly understand the big picture. I even do an amazing job of keeping my patience with him, after all, he has the cognitive abilities of a five year old. In fact, it is because of this cognitive disability that he continues having difficulty at home and is often readmitted to our unit.
At shift change, I am asked many details about his medical condition–I know all the answers. Then I am asked, “Why is he cognitively impaired? What happened to delay his development or reduce it?” Once again, I am caught. I simply accepted the fact without trying to discover the reason. I missed another piece of the “big picture.”
Now, I feel like I take very good care of my surgical patients. I diligently dress their wounds and milk their drains. I ambulate them and ensure proper nutrition. I advocate for them when the doctors are progressing them too fast, and push them when they are not progressing fast enough. I catch the subtle changes and treat them before they become dangerous problems. When a patient is in real trouble, I know what actions to take.
But we can’t forget that the “big picture” or “upstream thinking” (perhaps) is equally as important. Working with big picture items helps in the long-term treatment of the patient. The knowledge I gather is good for the “here and now,” but I need to work harder on looking to the past and future.
It actually takes awhile to get a handle on the details. And to be honest, I think it’s the details that allow us to do our jobs adequately every day. However, to be great at our job, we need to fill in the rest of the puzzle. And this is my nursing resolution for the next year. I want to struggle every day to look past what I am doing at the moment, and see a better, improved way to care for my patients.
It takes a lot of hard work to better oneself, but in this profession, particularly, it is extremely important.
Nurse Sean
Sean, beautiful sentiments, and a great resolution. I think I’d take you for my nurse any day of the year. Happy New Year to you, and may all your resolutions be realized.
Thanks Terry
Sean - great insight into your own development as a strong RN. Remember that global thinking comes from experiences. Like the experiences you have detailed in your post, you will begin to provide a relationship between all the details and pretty soon, your global thinking picture will mature and you will have the skill you are discussing in your post. Keep your passion - it is very evident in your writing and impressive. I agree with the other poster - I would rather have you as a nurse because you have a passion to learn more! BRAVO!
Sean:
Great resolution! I need that one on my list, too, but alas, I forgot it. I will add it to my own mental list, though.
I feel like I never learn enough during the day shift, because, if they’re like last week, I barely have a moment to myself to do anything, unless I stay overtime.
Keep on working at it…a few others, like me, will be with you!
We move so fast in ER, it’s hard to get the “whole story” on my patients so I make it a point to pull up their old discharge summary or history and physical on the computer and print it out.
It helps give me an overview of the patient for report to the floor - lord knows we are task oriented in ER and don’t always get the “big picture”!
So why did a 60-year-old woman have a tubal ligation? The suspense is killing me.
Very usefull post, i think i will use it.
Thanks.
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