Learning to Observe, Observing to Learn

Street Art, unknown artist. photo: jparadisi

Here’s a collection of loose observations I made last week:

  • People who lie or cheat believe that everyone else in the world does too.
  • People who feel paralyzing guilt over a mistake they made believe they are the only one in the world who’s made one.
  • Nursing students and new grads still believe in patient centered care and patient advocacy (Thanks Nurse2be for writing about one of my posts. I feel relevant).
  • Precepting is an opportunity to develop a colleague I love to work with.
  • I am a preceptor even when I don’t have an orientee. What do I teach coworkers about nursing culture through my nursing practice and behavior?
  • A patient and I commiserated over frustrations with health care. I said, “I’d like to change it, but they won’t let me be queen.” He touched the ring on my left hand under the nitrile glove I wore, and said, “You have this ring; you’re somebody’s queen.”
  • Nursing is my profession, but it does not define my entire life. Good shifts, bad shifts, when I leave the clinic I return to the life I create.
  • It’s all about choices.

Popcorn Lung?

Twice this past week, I arrived at work to the noxious odor of burning popcorn wafting throughout the infusion center. What is it with nurses and microwave popcorn? We save lives daily. We keep critically injured patients from circling the drain into certain doom. We safely medicate patients and do complex procedures, but as a group we are notorious for our inability to pop popcorn in microwaves without burning it. I can’t remember ever smelling burning popcorn in a movie theater. Statistically speaking, you’d think burnt popcorn occurs more often in a movie theater than a hospital, based on the sheer volumes of popcorn popped at movie theaters. That isn’t the case. I wonder why.

You think I exaggerate? Using the search words popcorn microwave hospital fires today resulted in 93,200 results in 0.22 seconds on Google. My favorite is this YouTube Video about a pediatric ER nurse named Stephanie:

Stephanie, you are not alone among your nursing peers. I found an unconfirmed reference online that said Seattle, Washington has made it illegal to pop microwave popcorn in its hospitals because of the fire hazard.

When I signed up for nursing, I expected exposure to many unpleasant odors, including “code browns” (poopy messes), emesis (vomit), and blood. I can handle all of them, but burnt popcorn makes me gag.  Also, fumes of microwave popcorn containing diacetyl, burnt or otherwise, may cause Popcorn Lung, according to this article (dated September 2007). I wonder if this is covered by workman’s comp?

I love microwave popcorn, and it makes a quick, tasty snack that is easy to share with coworkers. Let’s preserve this simple pleasure. If we can save lives, surely we can learn to pop popcorn without burning it.

How to be Scary with Your Body, Win Games, and Lose Coworkers

     Last Saturday, I sat on a bleacher, watching my favorite 10 year-old play baseball. He is the catcher for his team. He has the proportions and beauty worthy of a Renaissance sculpture, but he is compact and a little small for his age. Looking at him, I guess he weighs in around 60 pounds.

     I was startled watching him play.  He wore bulky black body padding from ankle to neck, and a red metal, helmet-like mask covered his face. In his catcher’s gear, he looks like Iron Man. He chased the players trying to run home back to third base by holding the baseball in his right hand as if it were a weapon, shaking his shoulders back and forth with the ferocity of a miniature Robert Downey Jr.

     After the game, I asked him about his aggressive style. He told me that wearing a mask makes it impossible to use his facial expressions to intimidate his opponents, so he learned how to be scary with his body. 

     It reminded me of a story told by a friend about a performance between two nurses discussing a clinical matter. One nurse pointed her finger like a gun at her coworker. She did not let the other nurse get in a sentence, blocking her attempts to speak without listening.  All hope of productive communication was lost, and the other nurse sulked back to third base. My friend said that watching the bullying nurse use her body to be scary reminded her of this Pink Floyd lyric:

And it’s too late to lose the weight you used to need to throw around.

     Little Leaguers and nurses are not the only people who use their bodies to be scary. I’ve had fingers shaken at me by doctors too. I’ve been threatened with rolling eyes, words launched in tones of sarcasm, even yelling, at work. While it’s unpleasant, these behaviors send up a red flag signaling to me this person is probably telling me to do something that is against policy or unsafe. Or, they might be covering up a mistake they made. They may be afraid of revealing something they don’t know. Whatever, I stay focused on the issue, while directing the conversation towards policy and scope of practice. Sometimes it works. 

     The thing is no one wins when communication at work breaks down to this level. At its worst, patient care suffers. Who hasn’t seen the code from hell when a team leader lost control of the situation by intimidating the rest of the code team? How many errors occur because someone says, “just do it”, when you know the “it” is against policy or safe practice, and no one effectively stands up to him or her?  

     Aggressive body language is a strength on a sports field, where it assists in winning games. In the workplace, there is not an opposing team. We are all there to take care of patients. Chasing coworkers away by intimidation might make you feel good in the moment, but you won’t have a team covering the other bases when you need them.

Consensus and Majority Rule are Siblings not Twins

     Just because you are not in charge, it doesn’t mean you are not a leader.

Anonymous

         I’ve thought a lot about working in groups and leadership lately. I think it’s important for nurses to respect the skills necessary to do either. In a perfect world, all nurses, or at least all the ones I work with would.  In my dream team-nursing unit, every nurse communicates his or her needs and patient care concerns clearly and concisely. Every nurse stays focused on the present situation, without bringing past history or personal issues to work. My first-rank draft pick teammates respect each other and never say anything hurtful about a coworker. In my dream team unit, passive aggressive behavior doesn’t exist, because nurses speak openly about their feelings and concerns. My dream team colleagues and I would never have a lapse in judgment or make a mistake.

     Anyone out there know where I can find a job like that? Anybody? Bueller?

     I was speaking with someone about leadership in the workplace. She says she goes along with the majority’s decisions, even if it’s not what she believes in, because that’s consensus.  That feels wrong to me. While I admire this person’s willingness to put her own beliefs aside to move her department’s work forward, I have concerns. First, what if the majority is wrong? Second, why would a group lack concern for the feelings of one of its members, if the goal were to develop a team working effectively together? Lastly, what are the effects on a team member’s performance and psyche that regularly has their needs and concerns ignored? At what point will habitual sacrifice transform a willing team player into a nurse whining, “No one ever listens to me”?    

     News Flash: No one will ever listen to you if you don’t speak up. You have to speak your mind. I know it isn’t easy for everyone, but like learning to start IV’s, it gets easier with each attempt. It’s tempting to go to your “nice” coworkers for help with uncomfortable staff dynamics instead, but eventually you will wear out these people too.

      As for leaders, if you say things like, “The problem with you…” or “This is your problem, not mine…”, you are promoting passive-aggressive behavior. Eventually, this coworker who appears weak, will consciously or unconsciously create a situation that may sabotage positive clinical outcomes. No one wants that.

    Majority rule says, “This is how we’re going to do it, and you will do it this way or else we will __________ (fill in the blank). Common nursing punishments for peers who don’t comply are shunning, refusing to help them (leaving patients at risk), rudeness, and belittling them to other coworkers.

         In comparison, consensus is the voice of reconciliation achieved through sincerity. Consensus says, to the minority, “This is how most of us want to do it, but we don’t want to alienate anyone on our team. What can we do to make the way we are going to do things easier for you? What concessions can we give you to make the work flow well for you too?” 

     I do not work with my dream team, and neither do my colleagues. Our patients depend on us, so we work together as a team to move each shift forward. Some shifts move easier than others do. Each morning we start the clock over, leaving the past where it belongs, and play a new game.