Doing more with less

Wow! This year is so different! I think I made a mistake last year and assumed that the way I was learning to do things was the way nurses do it, when really it was the way that 1st-year nursing students do it. Last year the focus was really broad and we had to thoroughly research diagnoses, drugs, and pathophysiology. I got really good at covering all angles and considering all possibilities, and now I have to change my focus! This year we are supposed to incorporate the gobs of information we learned last year and filter it down into what's most important NOW. The instructor's always ask, "Why is this patient in need of nursing care TODAY? What do you need to worry about at this exact moment in time?" It totally makes sense, but when you are so used to a broad focus, it's hard to narrow it down. It's not second-nature yet. Each instructor has had some fun analogies about the transition from first to second year... here are my favorites:

• Second year is time for you to "fly the nest" and learn to think on your own. You may fall a few times and that's natural. But by graduation, you WILL be flying!
• During first year, you learn how to do a lot with a box of eight crayons. Second year, you get to work with a box of 64 crayons, but you need to know which crayons to choose!
• During first year, you were taught to create the "entire buffet." But second year, you need to be able to look at the buffet table and know which items to select.

Clinical is still stressful, but the most refreshing change is that we aren't micromanaged to the extent that we were last year. We have so much more freedom! Last year we were supposed to adhere to a strict policy of "three checks" for each medication administered, and if you missed a check, you risked being written up. This year, the instructors are telling us to not let multiple med checks become a crutch and a hang-up. The new advice is, "Trust yourself!" I'm so much happier in this environment because I feel like I can do my work faster without worrying so much about arbitrary details. (But I totally see why this system was a necessity last year, don't get me wrong.)

The same philosophy is applied to our patient preparation requirements before clinical. Last year we all trooped to the hospital the day before clinical and spent a good hour and half pouring through our patients' data in the computer and chart. We then went home and spent another two hours per patient working up the diagnoses and meds and labs on a least five sheets of paper (each) that we had to bring with us the next day. Now, we get ONE sheet of paper with which to prep, and we are told that it shouldn't take more than 5-15 minutes. Again, "Trust yourself. You know this stuff." At first we balked a little bit, clinging to the security of all that data, but the truth is, does knowing EVERY SINGLE THING about a patient make us better nurses on the floor? Not really... nurses don't even know who their patients are until they get to work in the morning, and then they only have about 15 minutes to review data for a minimum of 4 people before getting report from the night nurse and hitting the floor running. They have to be able to filter through a ton of information quickly and determine what's important to set their priorities. Last year we had to learn where all the information was and what it meant. This year we have to decide what to pay attention to and how to use it. I like this! I'm not very good at it yet, but it feels really good to be here.