Tuesday, October 24, 2006

addressing personal inadequacies to better assist others

Once again I’m feeling miserable about this job. I feel as if I can’t do it, I don’t know what to do, I’m not supporting the graduates sufficiently, I should stop pretending I can do the job and make way for somebody else who really can. I’ve been sitting staring blankly at my diary, trying to figure out a way to change my situation, but mostly just feeling dejected and wondering why I’ve circled back to this place again. I think there are a few things at the root of my unsettled feeling.

I’m still finding my way in terms of how best to support graduates. The longer I puzzle over this, the more I realise that there is no one answer to this great dilemma! Every graduate is unique, individual, different. It would be futile to approach each RN in the same manner and offer the same support. The key to success is to individually assess the graduates and tailor support to their individual needs. It’s hardly rocket science, but when one starts out in a new area a simple formula for success is highly desirable. It’s unnerving to realise that there is no simple formula and no easy answer. The only solution is to approach each situation with an open mind and respond to what is in front of you.

Recently someone I know applied for and was offered an educator position in another area of the hospital. I’m excited for them, because they have worked hard to reach this place and they deserve the position. (Congratulations if you are reading this!) They are full of enthusiasm, as well as having a great grounding in education. I personally think they will do a fantastic job.

I think deep down I’m feeling somewhat threatened by this. Here I am with no specific training for my role, struggling to find the best way to do it, feeling ineffective and there they are with lots of skills and training and ideas. What if they do better than me and everyone sees how poor a job I am doing?

OK, a positive twist is that this person can be a resource and support person for me, and I can be for her in some ways too. We can help each other to be better educators.

Another source of angst is one of the graduates. They have been mildly verbally aggressive in their approach to me, bombarding me with complaints - the graduate program is not very good; they aren’t given opportunity to express their grievances regarding the program; and they are not being supported in achieving their goals. They constantly point out the faults in other people’s practice, and blame their lack of progress towards objectives on the system and thus on me. This all comes on top of their initial comment when we met that I was ‘very young’ – ie you aren’t old enough to do this job properly and I’m not going to respect you because of your age.

Their manner immediately gets my back up – I don’t appreciate the aggression and they win no favours from me with that approach. I also don’t appreciate people who refuse to take responsibility for their own progress. And it might be worth them examining their own practice and looking for the faults there before they start slating everyone else.

Having said all that, their attitude has shaken me. Someone sees through my subterfuge! Their lack of respect has latched onto my lack of respect for myself and I feel small and insufficient.

This has to stop. I need to take some practical steps that will restore my faith in myself as well as improving my professional performance.

1. Rest confidently in who I am and what I bring to the position. Halt the feeling of being threatened by this graduate. Instead of reacting defensively, take the time to listen to their grievance and offer support.

2. Embrace the new educator and be delighted for their success. Offer my ideas and experience and be open to their ideas and experience and knowledge. Develop two way sharing with them.

3. Seek out knowledge. Read and research about assessment and education. Take time to reflect on my interactions with each graduate and identify support strategies that will work for them.

4. Above all be positive and encouraging to myself! I am my own worst enemy!

Monday, October 09, 2006

meaningful support in the quest for professional development

I’ve been making a concerted effort to work with every graduate in the last few weeks. This allows me to observe their practice and provide feedback – something they don’t seem to get a lot of.

Each graduate is allocated a preceptor on the ward for their whole placement, but the reality of heavy workloads and differing rosters pushes observation and feedback to the side. The grads head into their room and get to work, and the preceptors do the same in their room.

Nobody really knows how the graduates are working, or whether their practices are excellent, fair or poor because there is no time to observe them in the nitty-gritty of care provision. Charts, nursing notes, patient comments and the questions they ask provide some insight into their practice, but it isn’t the same as observing how they work for a whole shift.

So at the risk of feeling a heel, I attach myself to a graduate for a day, follow them around and watch what they do. I pay particular attention to infection control measures, medication management, documentation, knowledge and application of knowledge, communication, time management and provision of care.

That’s a fair bit to take in, and when I’m also trying to keep up with the patients’ conditions and needs it all becomes a little overwhelming. This is compounded if a graduate is struggling – I become very frustrated when I identify needed interventions that the graduates do not recognise or do not consider a priority. Often it is easier to intervene myself rather than talk them through the assessment, prioritisation and intervention required. Best case scenario when I step in is that they view me as a role model worth observing and learning from. Worst case scenario, the graduate feels undermined and demoralised when I hijack their plans for the day. It’s a tricky one – sometimes the day is very busy, and talking it through just takes too long. The patient needs action NOW so I take the speedy option and takeover their care for a moment or two.

Recently one graduate in particular found my intervention unhelpful. I had arranged to work with them for the day, and turned up after the shift had commenced. Things steadily became worse as the day progressed – time management was almost non-existent and the graduate missed IV medications, failed to complete fluid balance charts, omitted important observations and didn’t document care in a timely manner.

I stepped in and did quite a bit of the work and made suggestions to the graduate. At the end of the day they were disappointed with their performance as well as feeling that I had invaded their working space. If my role is all about support then for them to feel so demoralised, I mustn’t have provided much!

It was a revealing moment. This tactic didn’t work with this graduate. Sometimes it does work (and is absolutely necessary for the patient's wellbeing), but in this situation it was all wrong. This grad needed me to stand back, leave them to work their own way, intervene only when absolutely vital, and provide feedback on everything they did. We discussed this at the end of the day. I have since worked with this person again, and we had a much better day! They worked, I observed and they appreciated the feedback I provided.

One aspect of support is observing practice, making assessments and intervening appropriately. That means evaluating the intervention a graduate requires: What is their learning style? What support would they like me to give? How can I assist them in providing a high standard of care? Do they even need assistance, or should I simply stand back, observe and give feedback on their practice?

Lesson to learn – always ask the graduate what they want to gain from my presence! It might not match what I want to offer, but this is about them and meeting their needs. My task is to listen, identify their needs and tailer my intervention to their unique requirements. Then I will be providing worthwhile support that can help them develop professionally.