Tuesday, February 19, 2008

I am not a fan of Blackboard discussions.

But yet I soldier on.

Here is the epistle that I have constructed for a recent assignment re: professional socialization (which means how nurses learn to become nurses from other nurses, I think).

The Hinshaw-Davis Model of Professional Socialization really fits my experience of nursing school so far, and it relates directly to defining nursing.

Initial innocence is the definition that I entered the program with, which was not very detailed or well-thought out. I knew that nurses do more that people give them credit for, that as a career, it’s not a straight path to burn-out but that with the current staffing levels at most hospitals you have to really be careful where you take a job, that they are the people who are with the patients through the shift while physicians dash in and diagnose, and that they eventually end up wearing scrubs with kittens making snowmen whether they want to or not.

With the incongruities stage, I think of sitting in Fundamentals and being so frustrated while she was attempting to explain the nursing process. I know these words, I thought! Surely I should know what she means! It was so much easier to practice sterile gloving than to try to figure out how to integrate this broad definition of nursing that we were being given.
That definition of nursing seemed a bit contradictory – because on one hand, there’s the caring is the heart of nursing, but on the other, the point that nursing is a science and isn’t just about hand-holding and being a good person was being made. Eventually, what I decided is that valuing nursing really requires a shift in the world-view for most folks; caring must be as important as scientific data and the two must not be seen as mutually exclusive.

Dissonance is something I experience at the beginning of every semester – thank goodness, it seems to be getting easier and I’m getting over it faster. I think that the dissonance of the information we receive in the classroom about how to be a nurse and the information we gather in clinical about how to be a nurse is one of the biggest hurdles student nurses face. It’s crazy-making to hear that nurses must work closely in a multidisciplinary team and should always ensure pre-medication for painful procedures, and then see residents come in and do a major dressing change without any pain meds on board while the patient yells and writhes. It seems that one of those must be wrong or that it’s useless to learn the ideal when it’s not what we’ll actually see in practice. It’s like hearing – Don’t tell women in the second stage to hold their breath and push – in the classroom, and then the very next clinical day, hearing three separate nurses say to women in labor, “Hold your breath and push”. Why did I even write down not to do this, when it’s what everyone does in practice?

Identification happened for me with the first clinical instructor. When I heard her talk about how she defines nursing, and saw her practice, I saw clearly several behaviors and attitudes that I wanted to integrate into how I work as a nurse, how I define nursing by my own actions. Role simulation is what we’re doing every time we go into a room by ourselves after having dealt with that patient with an instructor or preceptor present. I also think that a lot of the care plans are sort of role simulation, since we don’t have the time to implement those interventions, nor the ability to do so, in many cases, so we’re acting as if we were in the role of the RN.

Vacillation is what I imagine that dissonce experience is like as a new graduate nurse. Our professors say that we will be the ones to change things, that we will redefine nursing. Vacillation will be when I don’t pray in my car before each shift that nothing horrible happens.

Internalization is how I will define nursing when I am at Benner’s proficient stage. After actually doing it for a while, what do I think “it” is?

1 comment:

Emory Student Midwife said...

"Don’t tell women in the second stage to hold their breath and push – in the classroom, and then the very next clinical day, hearing three separate nurses say to women in labor, “Hold your breath and push”. Why did I even write down not to do this, when it’s what everyone does in practice?"

You've got it! Why is there such a disconnect between what we learn and what is actually done? Why the discrepancy between what is evidence-based and clinical practice? Books, articles, etc. = evidence based; Valsalva pushing = not evidence based.

I'm glad I'm not the only one harumphing about all of this!