My Nursing Mastery
My Nursing Mastery
Friends of Flo - New Nurse Joining A Team Of Experienced Nurses
This episode of Friends of Flo is brought to you by NCLEX mastery. If you're a nursing student and you're about to take your NCLEX, you need to go to the app store right now and download NCLEX mastery.
Douglas:All right welcome. We are just about to start our first official podcast, Friends of Flo.
Tess:Friends of Florence Nightingale
Douglas:Ooh, I like that
Tess:Friends of Flo.
Speaker 3:I am definitely one. I'm not a nurse, but my name is Douglas Calvin. I am nothing as far as these guys go. They're going to introduce themselves here next
Andrew:You're Dougie C
Douglas:It's going to hang with me forever. I accidentally introduced myself as Dougie C to be funny on the Facebook live we just did. And I'm going to regret it forever so that's great. Andrew why don't you introduce yourself first.
Andrew:Yes, I'm Andrew Whitters, I'm a DNP prepared family nurse practitioner. I've been practicing for the past five years as a nurse practitioner and I've been a nurse for the better part of 10 years over ten years now.
Tess:I'm Tess Judge-Ellis and I'm a nurse practitioner I'm in family practice and I am in psychiatry both. Have a doctorate in nursing practice I also teach at the University of Iowa College of Nursing and I'm also uhh...I can't remember...an associate lecturer for Fitzgerald Health Education Associates. Yeah, I have a lot of titles.
Rebecca:Hi I'm Rebecca Porter. I was a bedside nurse for a long, long time in Canada and then I became a nurse practitioner. Did a master's degree in nursing science at Simmons College in Boston and practiced as a nurse practitioner for about ten years and then when the ethical issues became more than I could understand and bear I returned to school I to do a Ph.D. in nursing with ethics both religious studies and healthcare ethics as my focus. I created a job for myself as an Ethics Resource nurse at the University of Iowa hospital and have been there for about five years working part time and I....
Douglas:So if we get off course and we start going the wrong direction you'll ethically bring us back.
Rebecca:I will bring you morally to the ground
Douglas:Good. Alright. Well thank you so much and Andrew. Again we just did this Facebook Live and you thought there was a question we really should touch on
Andrew:I think we should give a little shout out here to Cynthia Durante's and forgive me if I'm butchering your name there Cynthia, but she has a great question. Any tips on starting as a newbie grad with experience nurses. I think this is perhaps a concern that a lot of people have. I know it was one of mine. I personally started at the University of Iowa Department of Pediatrics and the PICU and NICU's I think one of the best things a newbie could do using Cynthia's words is to ask your experienced staff questions. Ask how they how they prioritize their day, how they prioritize their duties for the patient and duties and when I say duties I mean the clinical responsibilities on a day to day basis. I think this will ultimately lead to your own way of prioritizing your actions throughout the course of a day being a bedside nurse and it will also increase your confidence as you make those habits your own and you can learn from sometimes just observing what an experienced nurse is doing or not doing for the better or for the worst. And I think that...
Tess:Andrew, did you get any pushback from that from the nurses. I mean you're one charming guy, right? I mean how is that hard to do.
Andrew:I feel for me I think initially it was. I remember starting off being really shy, frankly and I remember feeling introverted with my approach to my colleagues.
Tess:So were they nice to you? I could see people being afraid that they're not going to be nice.
Andrew:Actually in some cases it was just the opposite effect.
Rebecca:So how did you know who to trust?
Andrew:I didn't. So I think it was important. Whoever I saw helping take care of my patient I would just asking them well hey can you teach you more about your respiratory therapy. If you saw a respiratory therapist. But then if you saw a nurse assisting with say administration of a drug, hey can you show me how to do that...what are the things that you look out after. I've read X Y Z. You know this might be what happens. But what have you seen in your clinical experience?
Rebecca:One of the things I encountered, sorry to interrupt Andrew, was I really like your idea of going to other people to going to the respiratory therapist and asking a question.
Andrew:Yes, indeed.
Rebecca:And I who I learned the most from was a nursing assistant and I followed her around. I was working in a very tiny rural hospital in Alberta. And this nursing aide as we called them had been there for, I think, 40 years. She knew everybody in town. So she knew the story of every person that was there, but she knew how to be a nurse. And I followed her around and I would always watch her and ask her questions and so I think it's really important when you're new to really watch a lot of people. And know that some people aren't going to give you a good answer. Some people are going to be tired and burned out.
Andrew:Right. Right.
Rebecca:And so you have to be able to figure out. Who is going to be"safe" to nurture me and to mentor me.
Douglas:So is there a way to find that person who's like...is there symptoms I should be looking for for burnout, like I'm not going to ask them. Look at their hair it's frazzled
Andrew:And perhaps like this touches on the psychology of just interaction, but people who are generally coming to work smiling, excited to give report. Those are the people I latched on to because they were generally open to my questions. They wouldn't attack my humility, my humbleness and not knowing something. Instead they would say well hey this is what I do kiddo you know and those are the people I enjoy being around and...
Tess:They probably also picked up on the fact that you admired them a bit, you know?
Andrew:Well, there is something flattering about being a nurse. And now that I'm in I mean that we are in the position that we're in and we get questions from younger nurses. I love that nurturing that you can influence someone's thinking
Rebecca:And that's being a mentor. And also you learn when you have a student or a new graduate with you it keeps you grounded it keeps you current in the literature. And too see how your own practice. Or for me how my own practice was...was I always most current with what...but back to your question Doug about the attributes of a good mentor. I liked your comment Andrew about watching how people come to work. Yeah and I would not hang out with the people that are sitting at a desk gossiping. I would I would for the attributes of a positive attitude of how people are presenting themselves to the patients how engaged they are with your patients how well they seem to know about the person who the patient is exactly.
Douglas:So in that going back to the original question from Cynthia about how do I step in it seems like maybe that's some good advice as well as how to present herself in that same way that you're saying, the good mentors look.
Andrew:I think that that has to do with internal confidence. I don't know if there is a great way to present yourself other than saying, hey I'm brand new. I went into it openly wearing my heart on my sleeve which I think worked to my advantage for some people, but other people it just kind of as we were talking about earlier just sort of ate me out. But I think what I gained from...
Douglas:What do you mean ate me out? I keep hearing that, eat their young.
Andrew:Yes, that's right. I think to Rebecca's point, I think those are typically like you're burnt out nurses who they might have had just enough of mentoring. They may have had well you should just know this, you should've learned this in nursing school.
Rebecca:What are they teaching you?
Andrew:When indeed it might be an attribute that just comes with experience rather than from a textbook or from a lecture. And so again I guess back to before we go down the rabbit hole of you know the horizontal violence, lateral violence. I think Cynthia...just having the humility to express to other professional and other nursing professionals that hey, you know I don't necessarily know this right now, but can you show me you know X, Y, Z, whether it be a medication. Maybe something about a procedure that a person had just gotten back from the operating room from or maybe a question about a disease process they might be unfamiliar with. What kind of nursing interventions can we do here. How do you make this patient feel comfortable after a chemo treatment?
Tess:You know and I want to interrupt because I'm just flashing back Andrew to when you were a brand new nurse practitioner student and you spent time in my clinic...
Andrew:That's right.
Tess:One of my practices in a rural community south of Iowa City so we would drive down. I'd pick him up at the mall and we would drive down together 45 minutes and you would chirp, chirp, chirp, and ask questions the whole way down and then we would talk all the way back. But what I was noticing about is the way that you phrased your questions you know is not this like, what do I do now? Or, how do I do this? But you know it's not about you it's about asking somebody else on how to how did you make that look so easy. How did you know or...do you know what I'm saying. Like his questions didn't reflect his anxiety and like, oh my god I'm going to make a mistake. It reflected his, I want to learn from you because I see you're the best. And you know maybe that's why we're still in touch...like most of us if we love what we do we want to share that. And that's what you did when we were together, Andrew.
Andrew:Thank you
Tess:And it was a way to just pull out the best in me was for him to ask me not just like, oh my gosh I don't know what to do now, but like to change in the tone of the question to, how did you do that? How did you know that this wasn't that you needed to use this? And now in the way sometimes I'll say Andrew go to the damn book you know. Or get your book out and ask me a question that's really...that I don't have to spout off what I know. But you know this kind of like process oriented stuff and that's a curiosity.
Rebecca:I wish Andrew that we had a chance to work together it would have been such fun. But I remember back in those years Tess and I when I first met as relatively new
Tess:Pretty new nurse practitioners
Rebecca:Within the first couple of years of being a nurse practitioner and our exam exam rooms at the V.A. we're next door to each other and there were frequently knocks at the door and and asking each other for verification or did I hear this right.
Tess:We need another brain
Rebecca:Need another brain on this and so it was developing a relationship with other people is well who were of similar experience and just saying, hey, let's go look this up or yeah, this is what I learned I think you're on the right track. Cynthia your question is so good. And I really like Tess' answer in showing your curiosity that is embedded with respect for the person that you're asking.\
Andrew:That's a good point.
Rebecca:You know we respect is earned. And from one another. And so after having watched some of the nurses you've worked with you begin to see those attributes that we spoke about earlier.
Andrew:Yes
Rebecca:And then you can begin to develop a relationship with people that you trust. To ask the questions, that they're not going to gobble you up.
Andrew:Right
Tess:I think to just to finish I think to notice that about yourself if you find as a new grad you're retreating more and more and isolating more and more and not wanting to reach out. That would be a red flag in my book. As a new nurse you have something to offer. They want you to stay around hopefully...so don't ever feel like you are...you might feel like you're the lowest person on the totem pole, but you have value and worth and you need to acknowledge that. And if you're not getting what you need make sure that you ask yourself, am I asking the right person? You know am I getting shut down in a in a negative way. And then a lot of us I mean you struggle so hard to become a registered nurse. Don't waste your time sinking and shrinking away from situations. Move forward and seek help. And if it's not...if it gets too overwhelming then you know you need professional help to sort through a situation. There's a lot of overwhelming feelings when you're a new grad and a new system and all of that sort of thing. And I guess a red flag for me would be if I stopped seeing my friends, if I stopped reaching out, if I thought I had to do it all by myself and I couldn't access care for myself and for patients if I didn't know who to turn to then. And we were talking earlier about questions that you should be asking when you're interviewing.
Rebecca:Thank you for bringing that up
Douglas:Yeah. Well I think this is a great time for a break and then we're going to come back and answer this next question here.
Narrator:Here at NCLEX Mastery we love nurses and especially nursing students, but we need your feedback about this podcast. If you have ideas on topics or questions you want us to answer, shoot us a message, leave a comment, go to our Facebook page and just tell us what you think because we want to help you in the most specific way that you need that help. Thank you so much.
Douglas:And we're back and we were just talking about the red flags of when you know that you're isolating yourself, you're not finding those mentors to ask questions of as a new nurse surrounded by experienced nurses and Rebecca you had just said it brought you to something about the interview process of looking for places in the first place.
Rebecca:I think it's really important to realize that the health care market is in the favor of registered nurses wherever you want to practice. There will be a job. It always hasn't been like that and many years we had to just take whatever was offered out there. What kind of place do you want to work in. That's a really important question to ask yourself. Do you want to work in a big medical academic center? Do you want to work in a small county hospital? Do you want to be a community health nurse? What's drawing you to what kind of nursing, do you run to do oncology, do you want to do adult or pediatric, do you want to do O.B. where do you want to be. As Tess was talking about earlier is to really know what kind of person you are so that by knowing your self and understanding who you are and what your strengths and weaknesses are you begin to want to look for the kind of environment you want to work in. So what kinds of questions do you want to ask.
Tess:My question is what's the hallmark of an effective unit and effective team and effective environment. What would be some hallmarks of that. Like if you were in a unit that was bragging about itself and wanting to sell itself what would you look for on the unit.
Rebecca:I would look for a beacon award. I would look for positive evidence of strong cohesion, that the people who work there have worked towards a goal, an achievable goal and have received that award for their work and striving towards that goal. That said I want there to be evidence that there aren't cliques or little gangs of nurses that are roving around. But really looking for cohesion and what's the vision. I would ask a nurse manager, what's your vision for this unit and how does that match what your vision is for this job?
Tess:That's a great question, I think
Rebecca:And what's the mission. I know the mission of the hospital, I know the mission of the organization. Is it just keep your patient alive when you receive them at the beginning.
Douglas:That's not a bad one
Rebecca:Well except if you're wanting a good death, you may not want to be alive. You know it's reaching the patients and what I want to know from a unit is whose goals are you working towards. How does this unit strive for helping people who are patients on your unit find out what their own goals are for that hospitalization and to understand what the human's goals, the patient's goals are and how does that fit with what the unit vision is and how they operationalize that and what their their mission is on that unit.
Douglas:So one of the things you had asked about was the exit of nurses from the bedside. Is that something that you're kind of touching on here that you want to see if is this something that is a priority to this unit in that interview process.
Rebecca:Yeah, in the interview process I would be asking how long do people stay here.
Andrew:Yeah, I think that's a good question and I don't know whether you would get a complete answer is asking why did the last five people leave.
Tess:That's not a bad way to look at it
Rebecca:And to see whether you can get an honest answer like well you know it's so busy here it's really, really busy here and we ask a lot of our staff. There's overtime, there's extra time. We are short staffed. And we ask a lot of our staff. And this is a really hard busy unit with multiple admissions and discharges every day. That won't give you a sign whether that fits who you are. I know I could not work in a really busy unit with a lot of admissions and discharges because I like to focus on one person at a time. So ICU really was my fit because I could get to know a person and that family very well and it could have a sense of control. Other people really thrive in an emergency department of just constant flow, busy and sick and I do not thrive in that kind of environment.
Tess:I think maybe even practically speaking how many traveling nurses do you have on your unit.
Rebecca:That's a reasonable reasonable question, but why nationwide are there so many nurses who like to travel? And I'm wondering if it's the new normal. That when I was in my early 20s I got kind of pumped into a job because the market was so narrow that I needed to get a new job and it was not a good fit for a whole bunch of reasons and then I ended up moving far, far away from home and staying in a place that I really loved. I think the world is changing so quickly that people don't have that sense of commitment to being in one place for very long. Gosh if I were younger and didn't have the life that I have now there's some attraction. There's attraction to working somewhere for 3 weeks and then going to a rural place just to live in a quiet little place. And then moving to Boston and Los Angeles. I would be all over the place because I love to travel and experience.
Douglas:When you asked that question was on the positive side of the negative side of a department saying yes we have 17 or no we have 2, which one's good?
Tess:I think that your point to commitment is interesting you know and I think it's changing with generations that this idea of how nurses show commitment and how units develop committed employees. So one of my best friends is a manager of an emergency department out near Boston and how do they get commitments? So how do you, like, someone's going on maternity leave. How do people suck it up and move past that knowing that it's going to be them. How do you get commitment to the overall goal. So I think that travel nursing. I love the idea. I think I would have enjoyed it too. For a time in life. But then how do you get to a unit where that first line manager. I always think that the first line manager is such an interesting position that's so under recognized as a position and I used to joke that you know the reason I can stay at big institutions. So like I can stay at the University of Iowa and I could stay in the Catholic Church is because I have a good first line manager. Like I might not agree with what the Regents say at the university level and I might not always agree with the pope or the structure of the Catholic Church, but I love my parish priest and I love my first manager at the University and I love the people I work with so you know there's always crapola in a major system do you know if you're going to work in a hospital system. You always answer to the man. Do you know what I'm saying? So if you've got someone in that first line manager who can buffer because I like to think that I have something to offer. Like so the bishop in the Catholic Church has to answer to a higher up. I mean he's a company man, but he also has to have happy parishioners, right? But the parish priest is that person who says hey these people don't like to do it this way or whatever and they don't like this and then we can translate the same at the College of Nursing or at the university. If I have a great manager who can say, well we have to follow these rules and they and I think that they're listening to me then I feel like I can stay in that institution. So I think that whoever the first line manager is is really important in a nursing setting along with your co-workers.
Rebecca:And I think another way is to right away get involved in the governance. Share governance and become an active member in shared governance if you go to an academic hospital. To be involved in your professional organization, to join the American Nurses Association, to join the Iowa Nurses Association, to be involved and have a voice
Andrew:Well even at the unit levels I mean just joining the committee I mean for a newbie especially it would be a nice way to develop those leadership qualities.
Tess:You know they never think new grads never think that they're their leaders.
Rebecca:Not everybody is a leader. There have to be followers, too. I was never a leader.
Tess:And that's leadership though. Being a good follower is leadership, I think.
Rebecca:Well then define leadership?
Andrew:I think perhaps being involved, just the act of being involved and concerned for the goals of your unit puts you in a responsible role. A widely defined perhaps definition of leadership.
Tess:So when I was in the military it was a long list of characteristics. I mean first of all could you do enough pushups and god-dang run the two mile run. OK. And pull ups too. You had to look good in your uniform. That was a really good quality of leadership. You have to be decisive. You had to be somewhat of a outgoing personality. I mean like you had to be competent or expert at what you do. You had to not make too many waves, but you had to make enough waves you had to make some impact. This is a whole list of things. And I think that's kind of not where leadership is now. Now I'm trying to shift from doing everything or thinking I have to do it all to say it's OK if my fingerprint is on something, you know, that's leadership.
Rebecca:I think that's being a follower, it's being a good follower. You can be a cooperative. I am not a leader.
Tess:Oh, Rebecca. Well I would disagree with that vehemently.
Rebecca:Really?
Tess:But I do like the idea of having...
Andrew:Well look at the credentials behind your name
Rebecca:Yeah, but those are just things behind my name.
Tess:That's why we're doing this though is because nobody else will listen to us talk about how things should be, right.
Andrew:But doesn't that give you...don't those credentials at least give you the credence to talk about something that's in your field of expertise.
Rebecca:You know what happened when I first got my Ph.D.? Well no...for a long time your name badge it says student and it's a very safe place to be.
Andrew:Sure it is.
Rebecca:And then they put RN behind your name, you get RN behind your name nobody puts it there you earn the RN and then remember we were talking earlier the Gallup poll puts nurses the most trusted profession. So you walk into a patient's room and you've got RN behind your name and they immediately trust you. So you don't wanna mess up. Well then what happened to me was...I decided after twenty five years of being a nurse to become a nurse practitioner and I was terrified. I was terrified that I could prescribe drugs. I was so afraid of making a mistake. I was terrified that people would think I knew something when I felt like I didn't know anything. And then I got this PhD thing and people think you know a lot more. You know I know a tiny little tiny bit about one thing. Over the years I've learned how to learn more a lot more.
Andrew:Sure
Tess:So and that's where I think nursing is that ultimately we're listening to patients. Ultimately we are with the patient and we are being with them in the most vulnerable time frames of their lives.
Rebecca:And it goes back Cynthia's question about what to do as a new grad and a new person on a unit.
Douglas:All right. So while we're talking about Cynthia's question I'm going to give you each one sentence as like your final thought of how you would give advice to Cynthia based on her question we have it up here. Well you remember it at this point. But what is your one minute one sentence answer to this. Andrew I'm going to start with you again.
Andrew:A one sentence answer to her question and that is...
Tess:I'm gonna start us off cause I'm ready and I say you're worthy to be there and you're legitimate to be there. Keep that in mind and the humility Andrew spoke about and then watch for concerning signs of your own mental health. So exercise, eating right, sleeping, making sure that you're reaching out to your friends and getting support. And if you start to become angry or scared or something. Get some what I call couch time go to a professional. Why not? Everybody needs a little couch time. All the cool people have had couch time. And by that I mean a good sounding board therapist a lot of times friends can do it. Don't start drinking too much alcohol to cope. And so take care of yourself. That's my first advice.
Douglas:That's a run-on sentence.
Andrew:Specifically to the clinical success of joining a new practice with experienced nurses: be confident enough to ask questions and be humble enough to get advice. Period. That's my one sentence.
Tess:Brilliant Andrew!
Rebecca:OK you guys have taken all the good answers.
Andrew:A run on sentence and a short sentence.
Rebecca:I think that I my best advice would be to trust yourself and be who you are. And remember why you went into nursing. Always keep that. Why am I here. And the answer to that question will change over time.
Andrew:I agree
Rebecca:Is that wise or what? I think we all added something and I hope I help Cynthia
Andrew:Yeah I mean I think being a nurse you have to be dynamic and a lifelong learner
Tess:It's such a god-danged good field.
Andrew:Yeah, it is because I reflect on my 10 year career which I think is arguably on the short end of this panel. But it's changed so much in my short time in this profession. And I I feel like I've grown and my priorities have certainly changed.
Rebecca:One of the great questions to ask long tenured nurses whoever that might be...what keeps you here?
Douglas:It seems like this could be a great topic for the next time. Something for all of us to be thinking about, wherever we are, what keeps you here? Well thank you so much and we hope that you all enjoyed listening and we will see you for many more of these.
Andrew:Thank you everyone
Rebecca:Thank you. Bye bye.
Narrator:Friends of Flo is brought to you by NCLEX Mastery go to the app store right now, download NCLEX mastery. And before you leave, if you could just share this with your nursing friends, tell them about us. Leave us feedback, go to our facebook page, tell us what you liked, tell us what you didn't love so much, be nice; but thank you so much. We really appreciate you.