What you really want to know is why bedside nurses do things differently from how you are being taught, right? Let’s explore!
Having worked in many settings and in many hospitals, I have seen some things I am sharing here. I am about to make some over-generalizations to make a few points. So read these with that in mind, okay?
The Nursing Staff of Characters
The new-ish nurse
Some nurses have not been clinicians very long (around 1 or 2 years). Did you see a nurse pull all 9am meds for 5 different patients at one time? Maybe the nurse starts a new IV site very near a recently infiltrated IV site that is still red?
In some instances, they haven’t been nursing long enough to have made an error with consequences.
These nurses are trying to portray confidence in their role while separating out what they should do, what they must do, and what they should not do. Often, this nurse does not fully understand the dangerous situations they have potentially created.
Just remember, we are ALL learning, all the time.
The getting-by nurse
The less forgiving possibility is that you are witnessing something that might be termed “lazy nursing.” Most nurses have been guilty of some form of this from time to time, though it should never be considered normal—at all.
These are the nurses who you watch auscultate lung sounds anteriorly only, seeming to not care that they are missing lateral and posterior sounds. Maybe they decide to saline lock a patient, even though they have an order for fluids to run at 100 mL/hr, reasoning that the patient is drinking plenty and does not need to be ‘hooked up’ instead of just calling to get the order changed.
The established nurse
Some nurses have been doing this nursing thing for a very long time and will continue to do things their way no matter what comes down the evidence-based pike or through the institutional policy and procedures chain-of-command.
These pioneers have a system in place, and it has worked for all these years. They aren’t messing with their success — even if that means that they use their bare fingers to start an IV 😮 because they need to be able to feel the veins.
The professional icon.
These are the nurses that you see and aspire to be. You watch them and secretly wonder if nursing is for you because you think you will never be like them — the nurses who do everything excellently, efficiently, intuitively, and competently.
They will always perform better than the students, and probably better than the instructors. They live and breathe nursing on this unit, in this hospital, in this moment in time. It is truly part of their DNA, and it shows.
What’s a nurse to do?
*Some of these examples are things that should never be done. Some of these things just represent a variation in practice that is acceptable.
How do you know what to do? Everyone seems to do something different, teach something different, say something different! ARGH!!!
- Unit educator
- NCBI (National Center of Biotechnology Information)
- NIH (National Institutes of Health)
- Professional nursing organizations (WOCN, ONS, AORN, etc.)
- Facility resources (Up-To-Date, Clinical Pharmacology)
- Institutional policies and procedures
Be curious and cautious always. People can seem very sure of themselves while giving you a very incorrect answer to your issue. For a long time, the nurses that you work with will definitely know more than you do, but it is always up to you to ensure that your care delivery is something you can defend based on what you know to be correct, and that it is the very best you have to offer your patients.