Writing to The So What?

First of all, I apologize to my friends and family on Facebook for the uncharacteristic political updates.  Thank you to those  who continue to follow me, whether or not we share   viewpoints.

xxx

Detail/artist: JParadisi (2009)

Since I began publishing JParadisiRN blog, I strive to maintain a balanced voice. Drama is not my thing, not as a nurse, not as a blogger (with the exception of The Adventures of Nurse Niki). Before hitting the “publish” button, I use my So What? filter, as in “Why did I write this, and so what?” It is my practice to write to the So What?

At least part of this instinct as a writer is traceable to my former role as a pediatric intensive care nurse, where I learned to report my concerns about a patient in concise, direction-oriented sound bites, in the middle of the night, by phone, to a doctor I’d just woken. For instance, if I assessed fluid overload, and suspected the patient needed a dose of furosemide, I presented the numerical values of fluid intake, urine output, central venous pressure, blood pressure, heart rate, etc, sometimes finishing the report with, “Would you like to give an extra dose of Lasix?” Most often the answer was, “Yes,” and I received an order for the desired dose before the doctor went back to sleep.

So what, all nurses do this to some degree,” a reader might respond. They are right.

However, there’s another kind of nurse-call to a physician. It’s born of anxiety, a feeling that something isn’t right; that an otherwise stable-looking patient is on the verge of  downward spiral. Their vital signs are within accepted limits, the lab values unchanged. But, standing at the bedside, “eyeballing” the patient, a subtle change is noted: they’re just a little dusky, a touch mottled. Sometimes those are the only signs warning a perceptive nurse of her patient’s declining status. It’s intuitive: The heart monitor still beats a normal sinus etching across its screen. The numerical values of pulse, blood pressure, and respirations remain unchanged. You keep a watchful eye on your patient, perhaps pulling a bag of normal saline, and a bottle of albumin to keep at the bedside, just in case.

As I grew into my PICU role, I learned to trust this intuition, my nurse’s gut. It saved more than a few lives. I joined the ranks of my more experienced colleagues, nurses who, when they call a doctor and say, “You need to get in here now,” the doctor does just that. He or she can’t explain our intuition either, but once they know a nurse has it, they listen, regardless of what the numbers say.

“So what?”

Here’s what: My nursing intuition is going berzerk in the current political climate. I can’t shake this feeling of impending doom. I am not an anxious person by nature; it’s my training to maintain order and calm. But I can’t shake this feeling: Where there’s smoke, there’s fire.

So what?

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.