COMMENTARY

Nurses' Questions Answered: Bedside Manner When Training

Diane M. Goodman, BSN, MSN-C, APRN

Disclosures

March 03, 2022

Teaching Moments

Diane M. Goodman, BSN, MSN-C, APRN

Nurse: I am an experienced nurse on a telemetry unit. I often work as a preceptor for new nurses, which requires me to shadow them in patient rooms, assuring safe practice while they are in orientation. I am never sure what I should reveal while we are at the bedside.

One of the new nurses has been making mistakes which require me to correct her. She set an IV pump incorrectly while I was watching her, and in another instance, she totally messed up a PICC line dressing, which had to be replaced. How do I approach this when the patient is watching us? I hesitate to let patients know when corrections are needed.

Goodman: Although patients understand that all nurses require education and training, they may prefer to have an experienced nurse provide their care. A bit of bedside maneuvering is required to keep patients educated and calm when these instances occur.

Whenever I was training my students in front of the patient, I would explain to the patient that having me there ensures that they still have the best care possible. With this as a preliminary explanation, I would gently instruct the student to recalibrate the IV pump (while I watched) or start anew with the sterile dressing, while I showed them what to alter. It could be that the student was nervous or not completely prepared for performing the bedside task. If so, this discussion needs to occur away from the bedside.

Maintaining a gracious attitude that keeps the patient engaged works. In these scenarios, the preceptor nurse has two goals: to assist the student in becoming the best they can be as a technician, and to assure the patient that they are in the best of hands. A sense of humor helps. I often warned patients that I was a perfectionist who might ask for a sterile dressing to be reapplied ahead of time.

Being a Team Player

Nurse: I work on a busy orthopedic unit. We've had multiple joint replacement and trauma patients, even during the pandemic. I have an upbeat colleague who works during the day, but he is frequently sick. He has a chronic illness and suffers from joint impairments that preclude him from transferring patients when needed. He is a reliable resource for newer nurses.

While we do not mind helping with transfers, he is not picking up other tasks to help the team. Additionally, he will also page unlicensed personnel for simple tasks, such as moving a tray closer to a patient, or freshening a drink, even though they are busy with baths. How do we (gently) light a fire under this colleague? The boss says he is protected by the Family and Medical Leave Act of 1993, and that we need to deal with this on our own.

Goodman: Getting to know this colleague may be the start of a great, cohesive team. Find out what you can about his medical condition, without prying into personal details. If he is frequently working with injuries, he may be fearful of further injury on the job. He may also suffer from chronic pain or fatigue, which could affect work output. Be compassionate and supportive. As you open a dialogue, conversation can progress to tasks you witness him performing well. Are there paperwork or computer tasks (data entry) where he excels?

Once you identify where he is skilled and what his contributions are to the unit, he may be willing to step up a bit in these areas.

There is also the possibility that he is working to the utmost of his limitations and that no changes will be forthcoming. Getting to know this colleague better will be a teaching moment for all.

Back to School?

Nurse: I am a young nurse on a small oncology unit. One of my peers has initiated education with plans for an advanced degree, nurse practitioner (NP). I may be paranoid, but suddenly everyone around me is focused on obtaining grade transcripts and talking about a bachelor or master of science in nursing degree (BSN or MSN).

I have weathered rumors that my unit would be all baccalaureate nurses at various points, but thankfully, that conversation has waned during the pandemic. Although I try to stay current in my field, the talk about nursing education has me feeling "less than" my colleagues. How do I cope? I have zero interest in going back to school.

Goodman: I have two concerns with your question. The first is that you may be feeling uncomfortable surrounded by nurses discussing advanced education. Do you feel left out of the conversation? Is there a way you could contribute to the discussion without being interested in the plan yourself?

Chime in occasionally with support for those who are choosing this path; it will cement your role as part of the bigger group. As a nurse who pursued further education, I can say that the learning process is all-consuming. I also believe that your bedside experience may be helpful with assignments or topics as they progress through coursework; I really relied on my peers for help with issues to pursue in my research papers.

The second concern is that this process makes you feel "less than" your peers, which should not happen. Evaluate your contributions to the unit. Is there a committee assignment that requires filling or a task you can expedite? For instance, is there a family communication board to volunteer for or disaster drills that need updating? If your work and activities are solid, there is no reason for you to be intimidated. You have made the right decision for you.

Diane M. Goodman, BSN, MSN-C, APRN, is a semi-retired nurse practitioner who contributes to COVID-19 task force teams and dismantling vaccine disinformation, as well as publishing in various nursing venues. During decades at the bedside, Goodman worked in both private practice and critical care, carrying up to five nursing certifications simultaneously. She is equally passionate about her dogs and watching movies, enjoying both during time away from professional activities.

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