Now, a Personal-Drama Free Post That's Actually About Nursing!


Crazed Nitwit wrote in with a link to her blog, in which she asks one of those important questions that they never address in school:

How do I respect the older nurses I work with, and yet keep using current techniques? (I paraphrased, CN, sorry.)

That's actually a stickier question than you'd think. My first response was to think, "Well, that's not that hard. You just keep washing your hands and not mixing your drugs and ignore what the other nurses are doing."

Here are a couple of real-world examples: I work with a nurse practitioner of the Old, Old, OLD School (meaning that she's been in practice for years, not that she's ancient). She's an expert in her field: kind, knowledgable, irreverent when it's called for, fantastic in the clutch.

And she never wears gloves.


Think about that for a minute. Her practice includes things like dealing with recently-Roto-Rooted prostates and crazy-ass bladder reconstructions, but she never wears gloves when she's seeing/treating/removing things from and sticking things into patients.

What to say about that? Well, you gotta notice that her patients never get infections. I mean, they just don't come back to the clinic or the hospital with infections, period, because she's a maniac about hand-scrubbing and teaching her patients to do the same. I'd wager that her fingernails are cleaner than the gloves in the box.

So, despite the fact that I shiver every time, still, even knowing what I know about her standards of care (insanely high) and her infection rate (nil), I do not say squat.

Because frankly, it wouldn't help. She would either not wear gloves, or wear them only around me and be annoyed, and nothing would change except our working relationship.

Real-World Example Number Two: Another nurse I work with is textbook perfect. She's also of the school that studied on engraved stone tablets.

The difference between the two nurses is stark, though, when you start to look at practice: even though Nurse Number Two knows all the latest research and parrots all the latest rules, her patient care sucks rocks. Unfortunately, she's also the person most likely to have a screaming fit at the station if a younger nurse (ie, all of the rest of us) questions her or corrects something she's done.

The trick we have, then, is to keep complex patients the hell away from her interventions. Dealing with her wackiness is not our job; it's Manglement's, and I wish them much luck in the endeavor. *Our* job is to look beyond the HIPPAA (sic), TJC, AJCCN-published bullshit and make sure that everybody who's on a ventilator gets mouth care every four hours. I guess if you look at it one way, we're respecting her skill level and autonomy and giving her patients she will mesh well with; looked at the other, we're keeping the people who are either really critical or who actually need some help out of her grasp.

At the end of the day, it all comes down to tact and people skills. I mean, if you see somebody doing something (or about to do something) that's really and truly dangerous, you ought to speak up. (" that IV push supposed to be crystalline white?")

If, though, upon thought and consideration, you can balance outcomes against practice and have outcomes come up the winner, it might be best to keep your mouth shut, listen, and learn. *I* have some unconventional ways of doing stuff, as do nurses that've been in practice twenty-five years longer, and nurses who've been in practice for two months.

Styles differ. Unless there's an imminent danger, keep on wit' yo' bad self and yo' bad self's way of doing things. And if you have to correct somebody, no matter if they're older or younger in nursing terms than you are, doing it respectfully and kindly will never, ever hurt.