Beng - Change a Constant in Nursing

Beng -







Nursing practices have changed in many ways since I first entered the profession. One of the changes involves the time we have with a patient. Years ago when I was in orthopedic nursing, patients who had hip surgery would stay in the hospital for 15 to 18 days. Now it's two days, which means we have to do everything within that time frame, including blood transfusions. We used to wait three or four days to give transfusions; now we do it the day after surgery. Care has become compressed into a smaller time frame, which makes it harder for the nurses.

Nursing is becoming more demanding because of new technologies. Nurses are not fully benefiting from some of the positives advances. For instance, in my unit, we still use pen and paper for almost everything except entering an order for a lab or ex-ray. Nursing care plans are not on the computer, even though that would help make our work more efficient.

In addition to integrating new technology in our work, it would be useful for nurses to learn better communication skills. I hear nurses complain about work situations, but I don't see them negotiating their complaints. They just let them go. Nurses need leadership training and interpersonal communication skills, but hospitals don't usually pay for that kind of educational experience.

Communication skills would improve the situation during union negotiations with management, because the two sides often end up attacking each other, then time runs out, and a decision has to be made in a hurry, which isn't necessarily the best one. I am frustrated by how often this happens.

I was involved in a situation where negotiation skills were helpful. We lost a business secretary position, which made the nurses' work very stressful. We had to answer the phones, then run to the patient, and back to the phones. It was a destructive working condition for the nurses, and for the patients as well.

I decided to step up and negotiate the matter with the manager, which was quite a process. I thought about the issue, wrote it up, and took the petition around to get signatures. Finally, we got the secretarial position back.

We have to take the initiative if we want changes, and that takes energy and commitment. The administration will listen to us, but we need to present good reasons and specific evidence.

I have a lot of ideas about technology, negotiation, and professionalism in nursing, but most important to me is the satisfaction I get from caring for patients. It is so good to see someone who is really sick get better, because of what we did for them. They come in to the hospital feeling miserable, and two or three days later, they can smile. After all my years as a nurse, I feel that I know how to help people with my expertise.

When I first went to oncology, I saw many people die."We have to take the initiative if we want changes, and that takes energy and commitment." It made me feel really bad. I even thought to myself, "I hate nursing." But I started moving to different floors, like orthopedics, where I could see patients improving and going home. So I felt better about nursing. And eventually I began to come to terms with my feelings about dying.

Now I work in neurology, and people do die, of course—from brain cancer or a stroke. Still, I can help them, even in their last days, or moments. I can help emotionally just by talking to them, connecting with them. And they can be made comfortable with medicines that are available.

I grew up in Burma, where attitudes toward death and dying are very different from here. Over there, when someone is obviously dying, doctors don't try to resuscitate. People accept death as something natural, both the dying people themselves and their families. Everyone knows that when death is inevitable, it's time to let go.

But here, sometimes a family member wants the patient kept alive, no matter what it costs. Even though the doctor explains the patient's condition and prognosis, often families don't want to hear it. We have to respect their feelings and values. Sometimes I talk to family members, away from the patient, and I talk to them from my experience with similar situations. Of course, they make the final decision.

I'm not afraid to take the initiative in those conversations, because I know that sometimes family members were absent when the doctor explained things, and sometimes the doctor did not explain things fully in a way they could understand. And, frankly, sometimes family members just have a hard time hearing … and that’s also my way of caring for them. … helping them hear.

Power Strategies: Leadership, Clarity, Care
go back to main page