5 tenets for 21st-century nursing

By Leslie Wright-Brown, MS, RN, NEA-BC The following are my notes on nursing for my 21st century colleagues: Tenet 1: Accept challenges as learning opportunities in disguise. Six months after I obtained my RN license, my head nurse told me, "Lt. Wright, you are going to be the staff development officer for the floor." I responded, "But Maj. Ward, I don't know how to start an IV or insert a Foley." He said, "Lt. Wright you will learn it and you will teach it." I discovered I liked critical care and teaching. I adopted Michael Jordan's attitude -- "I can accept failure. What I cannot accept is not trying." Tenet 2: Listen to your patients. One night in the ICU/CCU I admitted a 45-year-old man with a heart attack. While obtaining his health history, he asked, "Do you have a red cart here?" I responded, "Do you mean the code cart?" "Yes," he responded. "Is it close? You are going to need it." Then the cardiac monitor alarmed. I looked up and saw ventricular fibrillation on the monitor. This was his third heart attack in one year. I learned first-hand what the "feeling of impending doom" meant. Tenet 3: Trust your gut. Ten years later while caring for a 63-year-old quadriplegic patient in her home, I noticed strange facial twitching while she slept. She woke up agitated and disoriented. She insisted I call her husband to come home from work. Her behavior reminded me of someone suffering from hypoxia or an electrolyte imbalance. I called an ambulance to take her to an ED, even though her private physician thought I was incompetent. I knew I was looking "impending doom" in the eyes. Once there, her anxiety continued. The next morning I called the private duty agency to check on my patient. She had died of a massive heart attack at 3 a.m. I am glad I trusted my gut. Tenet 4: Embrace silence. Fifty-year-old Mr. Nicholson was seven hours post-op when I noticed he was not following commands, nor moving one side of his body. After neurological testing ensued, his family was informed. I wanted to find the right words to comfort them. I remember saying it was good he made it through surgery, to which his wife replied, "Yes, but he had a stroke." I learned sometimes family members are not looking for profound answers. Being a good listener speaks louder and is sometimes more sincere than any spoken word. Tenet 5: Be supportive and take care of each other. If at 7 a.m. I walked into a disaster zone, I would immediately ask the night shift nurse, "What can I do to help you?" My colleague felt comfortable enough to accept help without guilt. When many patients required complete care, we huddled to discuss how we would work together to get the patients bathed and repositioned. We also enjoyed each other's company when we weren't at work. When we worked together, we worked hard. And when we "played" together, we played hard. The focus of the profession is the patient. Getting out of one's comfort zone can facilitate professional growth, advocacy, critical thinking and teamwork. In order to ensure the profession not only survives but excels, never lose focus. Leslie Wright-Brown, MS, RN, NEA-BC, is nursing education manager at Saint Barnabas Medical Center, Livingston, N.J. To comment, email [email protected].