Thursday, October 25, 2007

Why sometimes I don't like nursing school....

Just so you know I haven't always had a thrilling time in nursing school. First, I didn't expect to become a nurse, when I first entered university it was the last thing on my mind in terms of a career. Yes, I have to admit, I was a medical school wannabe. A few attempts later and a couple of degrees further, I realized that I needed a job, and that nursing would provide me many opportunities within the field of health care, and after 1.5 years of nursing school I feel as though I will be a confident, and competent nurse in the future. I'm looking forward to pursuing nurse practitioner after a few years once I get some experience under my belt. I don't' regret going into nursing school whatsoever.

Today was a very frustrating day in nursing class. My classmates and I are in an accelerated program: we have done 2+ years of university prior to entering this program, and are almost all mature students. For the most part, they are very open minded and not quick to judge. However, today was a different story, and it made me sad to think that these people are not willing to necessarily put oneself out there for the sake of the patient.

We were discussing abortion today in class. I'm not talking therapeutic abortion, where the patients choose to have a termination of pregnancy. What we were discussing was the medical term abortion, or in other words, a loss of a child in utero from all causes (both therapeutic as well as spontanious). One of my classmates had mentioned a clinical opportunity she had for which a medical resident asked questions about her patient's previous obstetrical history. This patient had a TPAL* of 1-0-2-0. She was shocked that the resident had brought up the abortion history, as it is a sensitive topic. I'm not 100% sure, but perhaps this resident had brought up the topic during an inopportune time or around the husband, which the student nurse thought was inappropriate. Anyway, after this, my classmates went on a bit of a rant about medical students and about residents and how 'socially stupid' they are.

** TPAL is used for obstetrical histories. It is an acronym for Term Premature births Abortions and Living children. Each number represents the amounts of each. A first time mom with a premature living baby would have a TPAL of 0-1-0-1.

I think her story and subsequent rant was in incredibly bad taste. This resident was asking RELEVANT patient history as the patient was about to give birth, which I quickly mentioned so I could stop the discussion about "inappropriate docs/med students". This quickly caused ripples and more adamant doctor-bashing discussion.. most opinions were pretty much thinking that I was wrong with agreeing that he needed to know the information, yet making the patient uncomfortable. However, I did quickly mention that I agree that perhaps the way that the resident was approaching the patient may not have been ideal, but as a medical professional, it was their responsibility to ask those questions, despite the possibility of awkwardness or uncomfortable-ness for the patient.

This goes for nursing as well. If I have a 13 year old patient in front of me complaining of abdominal pain, spotting, and frequent urination, I will ask the patient if she is pregnant. In addition, I will ask if she has been pregnant or had an abortion in the past. This is relevant history taking! Yes, this may make her a bit uncomfortable, but how are we to do what is right for our patient if we feel that asking the questions makes them squirm? In my mind, we're doing our patient a disservice by not asking these questions, and assuming that the patient would be uncomfortable. What if the other nursing student's patient had a therapeutic abortion, and was willing to talk about it? How are you supposed to know until you ask? Perhaps it wasn't a therapeutic abortion, and the patient had a history if placenta preva leading to a still birth at 19 weeks? This is VITAL information as it would determine more specific monitoring patterns as well as increased risk for both the mother and baby.

My other question is this: Why do nurses feel that it is their right to bash another professionals' practice? This does not just happen in my nursing class, this also happens on the nursing floor, where some nurses are very vocal on how "Dr so and so" can be such an idiot. Oh and don't worry, I have seen firsthand that nurses oftentimes eat their young, as well as criticize social workers, personal support workers, and pharmacists. Each profession is skilled in a different area. Why do some nurses feel they could accurately judge the professional practice of a doctor? Did they go to medical school? Unless the other professional is about to harm the patient, and their practice goes against everything the nurse learned about that particular condition, who are we to judge how the person approaches their work? Note it, and mention it to their supervisor, don't gossip to other nurses! As nurses we are taught to look at ourselves and try to remove our bias before we work with a patient. Perhaps we should do that with ourselves and with other professionals too!

Nurses are experts at nursing. Social workers are experts at their job. Why can't docs be experts at their job?


License Pending said...

I can relate to your situation.

So often in post-clinical conference, one or another of my fellow students will get to nurse bashing. They will discuss something a nurse did or didn't do and become self-righteous and gushing "how could he/she do something like that?"

I always answer "wait until you're a nurse and you will find out."

I had a student become very angry with me for saying this, but I stood my ground. It is easy for us to evaluate others from our textbook perspective, but until we are actually practicing nursing, I feel we have no right to criticize another nurse.

Jen said...

I think you've hit on the biggest problem with interprofessional practice. People just don't understand what other professionals do and how they do it. Nursing seems to be the most sensitive about both being put upon and then dishing it out (but then maybe that's just my impression as a nursing student being around other nurses and students...).

What really gets me is when my classmates dish out about stupid/insensitive doctors freely then when I critisize GREY'S ANATOMY for being a ridiculous peice of crap they get all up in arms! So wait a sec, you are going to be unprofessionally judgemental about actual people that we really work with, but when I point out that the "docs" on GA are glamourising nursing work to the masses and I think that's a problem you get defensive? Gimme a break!