Thursday, February 01, 2007
Idealism vs. Realism
A reader posed a very interesting question in a comment thread on a recent post. I had said that “idealism is what brings people to nursing in the first place, but realism is what keeps them there,” and Not Nurse Ratched asks: “how do you practicing nurses handle this clash between idealism and the real world?”.
I think it’s a great question. I'm not sure I have the 'right' answer, but I'll see if I can distill my version. My clash came from having come through a very heavily holistic yet evidence-based BSN program - we're talking the epitome of Ivory Tower Nursing - and then starting as a new grad in a very much inner-city ER, sixth-busiest in the nation at that time (we've fallen to 8th, I believe). Before I hired on, I had spent two eight-hour clinical shifts in an ER across town at one of the private hospitals, cushy as they get. Think the difference between Chicago Hope and "ER"'s Cook County General, if you're old enough to remember when both those shows were playing. I remember starting out in that environment thinking "Holy shit, this place is a zoo" yet loving every minute of it. I knew that a hectic, fast-paced, crazy environment was what I wanted. And for me, the disparities sorted themselves out one-by-one because I tried really hard to take it all with a grain of salt.
You learn in school that pain is subjective, "pain is whatever the patient says it is." You learn in real life that it's hard to believe somebody's having 10/10 abdominal pain while they're laughing with friends and asking repeatedly if they can get something to eat.
You learn in school that first you have to establish rapport with your patient, and you practice and practice that. You learn in real life that it's much, much easier than that: as simple as changing the way you introduce yourself, adjusting your speech pattern to be more comfortable for whatever type of patient you're talking to. It takes about ten seconds, most times.
You learn in school when to use clean technique and when to use sterile. You learn in real life that in a critical situation, lots of times clean is just fine.
You learn in school where the basilic vein is, and textbook IV start technique. You learn in real life to palpate the veins wherever they are, who cares what they're called, and you learn to recognize that 'tink' that lets you know you're in.
You learn in school that it’s terrible to label “drug seekers” or “drug seeking behavior.” In real life, you start to see the connections and visit patterns of a number of patients who are oddly all allergic to Tylenol, NSAIDS, Toradol, Stadol, and Tramadol, and then you start to change your mind.
You learn in school that restraints are thought of as inhumane, only a last resort. You learn in real life when a 250-pound psych patient pops you in the jaw, restraints aren't all that bad sometimes.
You learn lots of facts in school. In the real world, you learn tried-and-true pearls like: "Sick people don't bitch." "Never trust a diaphoretic patient." "End-expiratory grunting is always ominous."
You're groomed in school to think your license and your paycheck put you above paramedics and EMT's. And you learn in real life, that some of them have volumes of expertise they're happy to share, and you're wise to ask for. (And I don't just say that 'cause I'm in love with one of 'em.)
By the time you finish school, you'll have gotten a pretty good feel for where your comfort zone is. (My first year of med-surg clinicals, I remember thinking 'oh my god, i've chosen the wrong career' because I knew then that bed baths and 9:00 med passes weren't my bag. You'll know.) Once you find that comfort zone, it’s up to you to formulate your own practice philosophy: you keep the pieces you learned, that work for you, and you chuck the pieces that don’t jive. As long as you start it all out with an open mind, you’ll be fine. And an idealistic attitude won’t hurt a bit. I still have most of my original idealism too, wedged there in my little nursey heart. It’s good to tap into on crummy days when you ask yourself why.
But the most important thing, I think, once you settle into a workplace - is to keep life balance in order to stay professionally balanced. Way, way, way easier said than done. (If you read my blog often enough, you'll see that some days I flat out suck at balance.) Listen to that little voice that tells you you're working too much, if you're picking up extra shifts left and right like I do. Do things you enjoy and remember to be a whole person and not "just a nurse" - I find that when I have days like the one that spurred this lively discourse, it's usually because I'm flirting with burnout or some other poor self-care issue. Absolutely true this week, the stress of hoping for my transfer to the new hospital vs. stress about my own health vs. stress about management scapegoating me and making my life miserable vs. stress of a personal life that's gone through oceans of change in the past 6 months... you get my drift.
And now, speaking of balance… I’m going to go clean my brushes so I can finish that darn painting tonight, and then I’m gonna go pick up my kids. And I’m gonna *not* set foot in the hospital until Monday, though I’ll see half my co-workers (in cocktail attire, as opposed to the usual scrubs) at the ER Holiday Party on Saturday.
Comments welcome – I love the lively discourse that other post generated!