Errors as Opportunities

I really like the quote that our instructor shared with us this week: "Your best teacher is your last mistake." It is really so true, especially in the medical field. I'm sure that all of us have made mistakes that we don't want to repeat ever again, so they are ingrained in our brain as a teaching moment. One thing that I have allowed mistakes to teach me is a very simple lesson-- that is, everyone makes mistakes as a nurse at some point and if you are lucky enough to work with supportive coworkers, then you should not feel like anyone is looking down on you for an error. I have a great example from my unit. It did not happen to me, but with a few of my coworkers/friends. The majority of our postoperative patients are prescribed IV Toradol after surgery to aid with inflammation and pain. There was a patient who was over the age of 65 that had received three doses of 30mg of Toradol after surgery. Anyone over the age of 65 should receive only 15mg of Toradol at a time per dosing recommendations. The medication was ordered by the doctor, verified by pharmacy, and then given by the day shift nurse, and the following night shift nurse. The error was finally caught by the next day shift nurse and was corrected at that time. The nurse who caught it immediately stepped up and identified the problem and did not try to hide it or act ashamed because of the error. Instead, the problem was dealt with and the patient was thankfully not harmed because of it. The nurse could have easily tried to hide the mistake, but instead we all were aware of it and it offered us a great teaching moment. We are now all very diligent about checking the patient's age and the dose ordered.
I would say this was a "sloppy mistake" (Briceno, 2015). All of the nurses knew the dosage recommendations, but lost concentration and made the mistake due to not paying enough attention.
It made an impact on all of us to be more aware of medications being given. Thankfully our charge nurse is very easy to talk to and she did not belittle anyone or make anyone feel stupid for the error. Instead, she used it as an opportunity to talk to her staff and also to the pharmacy. The doctor's nurse associate was also notified and a change was made to the standard post op order sets. I would say that my charge nurse handles errors with a positive approach and is also never ashamed to let her staff know when she has made an error herself. Knowing that our leader isn't perfect helps me to feel more comfortable speaking with her when I have concerns or have made a mistake.

However, I also have worked with a leader who handled conflict very poorly and I lost a lot of respect for her. On a unit that I worked on prior to the one I'm on now, one of the charge nurses pulled me aside and asked how I liked working with a specific patient care technician. She did not give me a chance to answer before she jumped in and told me how she felt about him. She let me know how little she thought of him and made some very rude comments. I really enjoyed working with this PCT and thought he did a great job and I told her that. The whole situation left a bad taste in my mouth. I found it to be very unprofessional for my charge nurse to ask me about a coworker and then egg me on to hopefully say something negative about him. This situation has helped me to decrease my gossiping and keep mean comments to myself. Let's be honest, the hospital is full of gossip and rumors spread like wild fire there. I have been actively trying to distance myself from the gossip and act more like a leader by making positive comments and offering constructive criticism in hopes of building up our team, not breaking it down.

The video "Interruption Awareness" was very eye opening in my opinion.

 I know that nurses deal with a lot of interruptions from patients, family members, doctors, other nurses, alarms, etc, but the exercise of counting by 4's showed just how those interruptions can disrupt our thoughts from an easy task. Just this week I was speaking with a patient about discharging home later that day and she asked me about insulin and if diabetes management would come talk to her again before she went home. I told her that if they didn't come by a certain time that I would call them and make sure they talked to her before she discharged. She asked me "How do you keep track of all of this? How do you remember everything?" I remember smiling and thinking "Because I'm awesome." I didn't say that of course, but it did get me to thinking about how many requests from patients nurses get in between the every day tasks that need to be completed.
I think that a good leader will recognize when a nurse is struggling with keeping up with all the interruptions and will step in and take charge. Even just answering a few call lights while that nurse takes the time to catch up with charting or making phone calls is so helpful. I work with a very dear friend who is always saying she is fine and doesn't need help with anything when she is asked, even when the rest of us know that she could use the help. Instead of shrugging my shoulders and saying "okay", I have learned to just jump in and take some of her responsibilities off of her plate when she has a lot going on and I don't. Something so simple as just starting IV fluids on a new post op patient can help tremendously when there are a lot of other things going on.

I do believe it is true that errors are sometimes made when staffing levels are not adequate. The unit I work on has increased the number of surgeries each week by discharging some of the patients a day sooner than they would have a year ago. Because of this, the staff has felt quite overwhelmed with the increase in patients and we have asked if there will be another nurse or PCT hired to help with the increase. I'm not sure if that will happen or not, but in the mean time my charge nurse has made some changes to help us out throughout the day. The main way is by assigning the surgeries to the staff in a staggered fashion. Meaning that hopefully the same nurse will not get 2 patients back from surgery at the same time.
On other units the staffing is never adequate, which leads to a lot of float staff being used. I think that it is an endless circle when a particular unit is known for giving one nurse 6 patients, and they are not able to retain their staff because of it. I do feel pity for the leaders in charge of those units who have not been approved to hire more staff as I think that sometimes that is the only way to stop the revolving door of nurses in and out.

References:

Boynton, B. (2012, January 3). Interruption awareness: A nursing minute for patient safety. [Video file]. Retrieved from https://www.youtube.com/watch?v=PGK9_CkhRNw

Briceno, Eduardo. (2015). Mistakes are not all created equal. Retrieved from http://blog.mindsetworks.com/blog-page/home-blogs/entry/mistakes-are-not-all-created-equal

Understanding Preferences & Personalities

I enjoy surveys and tests like the personality test that we had to do for class this week. I think it is interesting to see if the result is in line with my personality. This personality test revealed that I am a Defender (ISFJ/T). Here is a link to the Defender definition if anyone wants to read about it in more depth, but I will give a quick overview of some of the qualities.
https://www.16personalities.com/isfj-personality

Defenders are considered to be sensitive, reserved, have strong people skills and social relationships, conservative, but open to new ideas. I believe I have all of those qualities, so I was pleasantly surprised that the test described my personality so accurately.
Some strengths of a Defender include being supportive, reliable and patient, imaginative, enthusiastic, loyal and hard working, and having good practical skills. The only one that I cannot really identify with is being patient. I am an impatient person when it comes to things that I really want or want to accomplish. However, the rest of the strengths do fall in line with how I view myself.
Some weaknesses include being humble and shy, taking things personally, repressing feelings, overloading themselves, reluctant to change and being too altruistic. Again, most of these qualities describe me very well, especially being humble and shy. I was talking to my mom about this test this morning and I shared an example with her about my shy and humble personality. I have ridden horses for almost 17 years and I have competed for the past 8 or 9 years. I have goals and high standards for what I like to accomplish during my horse shows. When my friends ask me how I did at a show, I do not like to brag or boast about how I accomplished a goal or did well. Usually I will respond with "I did pretty good, but I still have a lot to work on." The same goes for my work and school life as well.

One of the comments made on the website about a Defender's personality in the workplace had me nodding my head in agreement. It states that Defenders want a friction-less environment and a tight knit group of people who work together and help each other. This ties in to the next topic of conflicts. I have a perfect example of a conflict in my workplace right now due to personalities and preferences clashing. At work I am task oriented and focused and like to check things off my list when I complete them. I have a coworker who is the complete opposite and will often times forget to do certain job duties and responsibilities, resulting in me getting frustrated and having to do the work myself in order for it to be completed on time. Due to my aversion to conflict, I often take on more work than I should and get stressed out because of it. Rather than just setting aside my fear of conflict and asking my coworker to do her part, I take on extra responsibilities and get stressed, which leaks into my home life. Understanding personal preferences may help me to solve this issue in the future. Now that I have fully accepted the type of personality I have, I can work to set aside my fear of conflict and ask for help, rather than getting frustrated and angry. I cannot change how another person works, but I can change my reaction to it.

I very much enjoyed Susan Cain's talk about embracing introverts.
https://www.ted.com/talks/susan_cain_the_power_of_introverts
I liked her story of going to camp. It seemed that no one there could understand why this girl would want to read books at camp. They were supposed to be getting "rowdie" and having lots of camp spirit. In fact, this is the reason why I hated going to camp, the very few times that I did. I didn't want to have camp spirit with a bunch of other kids who I didn't know. I certainly didn't want to embarrass myself in front of others for acting silly or "rowdie."
In her talk she states that it is now her job as an introvert, to talk to others about introversion. As a nurse I don't have to talk to my patients about being introverted, but I do have to go into a stranger's room, often times with a group of family members around, and present myself as a leader and as a healthcare professional, even if I want to run and hide in my comfort zone. After hearing her talk I am determined to embrace myself as an introvert and not try to change it, but to be comfortable with it.

Pat Ebright's definition and explanation of Complex Adaptive System Theory was very easy to understand and I really liked the example she used about trying to explain an awful day at work to a spouse or friend who was not there.

It is difficult to convey the emotions and everything that goes into a day as a nurse when it just didn't go right. There are so many small and complex situations, attitudes and scenarios that all come together as one to make the day go bad, but it is difficult to explain it to someone who was not physically there.

I find myself being a leader in my place of work all the time. I can especially say I am a leader when it comes to my patient's care. However, when it comes to my colleagues I don't always feel comfortable being the leader. When a change arises in our area of the hospital, I struggle with embracing it quickly unless I can imagine the immediate positive change it will bring to me, my patients and my coworkers. So when asked how I model embracing change to my colleagues it is difficult for me to give a clear answer. I find that it also depends on the work week we are having. There have been so many changes recently on my unit, that I have been struggling with modeling my embrace to my colleagues. The best way I can say that I am being a leader in those situations is by having a positive attitude about the changes and trying my best to overcome the negative aspects. I am always open to listening to my coworker's frustrations and complaints. Often times this will bring about a new idea that can transition the change more smoothly in the long run. I present these ideas to the charge nurse whenever my coworkers and I feel that it would benefit everyone. I believe that feeling like your voice and opinion has meaning can greatly increase work morale and the embracing of change.

References:

mentorsgallery. (2010, February 2). Pat Ebright - Complex adaptive system theory. [video file]. Retrieved from https://www.youtube.com/watch?v=VNFFEJqz9YA

TED. (2012, February). Susan Cain: The power of introverts. [Video file]. Retrieved from https://www.ted.com/talks/susan_cain_the_power_of_introverts

Understanding My Why

I think it is important to understand what my "why" is in my personal and professional life. I think it is important for anyone who wishes to be successful and passionate about what they do. When I decided to become a nurse I didn't know what I wanted to do or even really why. After I graduated from nursing school I thought I wanted to work in Labor and Delivery and Post Partum. I started my first job at a critical care access hospital and got a small sampling of many different types of nursing. At that job I played many different roles. I was an ER nurse, a swingbed nurse, a labor and delivery nurse, a medical surgical nurse, among others. At that time the qualities or words I would have used to describe myself would be confused and frustrated. I saw the different sides of floor nursing, but nothing that seemed to call my name or that made me feel like I had a purpose.

Fast forward to now and I feel that I have grown and found an area of nursing that interests me greatly. I now work on a Total Joint Center unit that enables me to see the progress in my patients on a day to day basis. I very much enjoy orthopedics and find it fascinating to see the changes in my patients from the surgery day to post op day one or two. The change is sometimes so dramatic that you wouldn't believe it. Of course there are always people that struggle more than others after surgery, but more often than not the patients we work with are motivated and excited about their new joint that leads to more activity and freedom in their personal life. That motivation carries over into their recovery and the people with the positive attitudes tend to do the best. 

If I had to describe my qualities now I suppose I could still throw confused and frustrated in there every once in a while, but they no longer are the dominant characteristics. Now that I have found an area of nursing that I enjoy I feel that I am organized, calm and realistic. These qualities help me on my busiest days. Even if I feel frazzled or overwhelmed, my organization and calm demeanor overrule the inner turmoil I may be feeling during the hectic times. 

In my opinion, the concept of enjoying what you do ties in very well with the idea of finding and understanding "my why." The Michael Jr. webcast is a perfect example of that. 

The man had a job to do. It was simply a task he was instructed to accomplish. Once he put more thought and feeling and passion into the task, the outcome changed dramatically. It no longer was just a job to do or a "what", but it was a goal that was accomplished through knowing his "why." I can bring that back to my own personal story of finding a job in the nursing field that intrigued me and that has brought me more happiness and success than previously. 

Lastly, the video titled "What is Leadership?" really opened my eyes to another way of thinking. 

Often times I think that nurses feel that we are there to take orders and accomplish certain tasks in order to tell the leader "I did it! I finished what you wanted!" There will be times in healthcare where the big decisions will not be left to the direct care staff to decide on. However, I do believe that as a bedside nurse we do have a lot of leeway and autonomy to make decisions based on past experiences and factual evidence. I for one do not check in with my charge nurse before I make every decision throughout the day. That is why it is so important to have healthcare staff that management can trust and rely on. Confidence and experience comes with time, but those in a leadership role need to trust in their staff to make their own decisions (and sometimes errors) in order to shift into more of a leadership mentality themselves. When everyone starts acting like leaders, such as in the video, the end product will be much better than having one central person making all the decisions with a group of followers never questioning why. 

References:

(2015, September 10). Michael Jr.: Know your why [Video file]. Retrieved from https://www.youtube.com/watch?v=LZe5y2D60YU

Leadership Nudges. (2014, May 17). What is leadership? [Video file]. Retrieved from https://www.youtube.com/watch?v=pYKH2uSax8U