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CASE
I was on a regular med/surg unit to see a cancer patient we were following and greeted a nurse I knew had been working for a little more than a year. Many would have considered Stephanie to have exited the “new grad” phase of her practice. She leaned forward and glanced around before she whispered her question.
“Can I ask you a question?”
“Sure. What’s up?”
She pointed to one of the rooms. “Do you remember the patient who was in room 82?”
“Mr. Anderson? How is he?”
“He coded last night. I took care of him yesterday. I think I missed something.”
The communication challenge in this circumstance was twofold. Stephanie was asking for my input on how to address a specific nursing situation. She trusted me enough to be vulnerable in her practice, to say I’m not sure I handled things the best way. We walked through all of the pertinent information, her assessment, etc. All of the nursing stuff. I did not tell her what she did or failed to do, rather I guided her to an objective self-assessment and helped her draw her own conclusions about what she might have done differently. She appreciated my input and would have left things there, but I knew there was more.
I asked how she felt, asked her to walk through her assessment of her feelings about the case. The forensic analysis of her nursing care was easier to tackle then the second part. That was the bigger communication challenge. She felt a need to hide her professional vulnerability and was anxious over potentially being judged as incompetent. When a new grad is afraid to ask for help, is worried that he/she will be viewed as not good enough, not strong enough, then he/she is at greater risk of making mistakes and at greater risk of personal and professional distress and anxiety, even a greater risk of burnout.
DISCUSSION
When I was in nursing school I had a sense of knowing a lot, of being competent — I got good grades, my professors told me I was a great student and would be a great nurse. But when I started as a new grad and faced the complexity of doing the job on my own, I suddenly felt like I knew nothing. Transitions are difficult. In that most vulnerable time, support and mentoring is important.
I don’t think that Stephanie had been overtly bullied. I know enough of the staff on that unit to know that was unlikely. Instead she was looking for a mentor, someone to bounce things off of, to help her look at the situation objectively. When I started as a nurse, there were many nurses who had been in practice for 10 to 15 years or longer. But over the last 2 decades demographics have shifted. Fifteen to 20 years ago the workplace had opened up many other possibilities, and people moved away from pursuing nursing. The middle layer of nurse mentors is thinner than when I started. As I age, in life and in my nursing practice, I am more interested than ever in passing my knowledge along.
I welcome the questions. I seek them out. I want to be seen as approachable. Mentoring is an essential part of passing our knowledge along.
In the end, it comes down to 2 concerns: one professional and one personal. On the professional level, I am proud to be a nurse and want to be sure the novice nurse is given the opportunities to grow into his/her practice. And on the personal level, I want to ensure that the nurses I encounter are the best they can be. After all, who will take care of me someday when I am in a hospital? What will their skills be like if they haven’t been properly mentored?
Ann Brady is a symptom management care coordinator at a cancer center in Pasadena, California.
Reference
1. Colduvell K. Nurse bullying: stand up and speak out. Nurse.org website. https://nurse.org/articles/how-to-deal-with-nurse-bullying/. Published April 14, 2017. Accessed January 4, 2019.
