violins and nursing errors

I had a violin lesson with my teacher this evening and, in between the making of music, our conversation turned to teaching methods. Strangely I found a parallel between this and nursing.

As a child I learned the piano, and I remember practicing long and hard in order to attain the 'tick of completion' on a piece of music. This was no easy task, requiring nigh on perfection, at least in my mind. Since I commenced learning the violin as an adult I've noticed 'the tick' is much easier to attain - despite playing far from perfectly, my pages of music are littered with golden ticks!

I decided the difference lay in being an adult learner. Adults have little time to practice long and hard, so the teacher awards 'the tick' more liberally in order to prevent us from becoming discouraged. When I floated this idea past my teacher she laughed and explained the real reasoning behind the liberal tick.

When learning violin there are many techniques to master. As a student plays a certain piece of music, their performance sits in the context of their overall progress. It is unrealistic to expect a beginner to play perfect music when they are only just beginning to manage basic techniques. 'The tick' indicates that, in view of their evolving mastery, they are playing the piece to the best of their current abilities. Perfection is not the goal, only continuing development.

My teacher's explanation struck a chord with me, since the principle has relevance to evaluating the practice of graduate nurses.

Recently I observed a graduate making a significant error in their care of a patient, since their actions were in direct contravention of medical orders. I rectified the problem and educated the patient before speaking with the graduate. They struggled to explain the incident since they had not realised they were doing anything wrong until I came into the room.

Admittedly when I make an error on the violin I do not place anyone at risk, where a clinical error can have grave consequences. But putting this aside, along with the fact of the graduate's failure to work within their scope of practice, and their lack of responsibility for their actions, I have begun pondering my response to the situation.

On the surface I remained calm and measured, reassuring the patient and educating the graduate. Internally, I was exasperated: How could they not have known about this? What a terrible graduate they are to make such a mistake! Can they be trusted with anything? How poor is their clinical knowledge?

Right at this point I need to take a leaf from my violin teacher's book. Let's put this incident in it's proper context! They are a graduate - they're new, they're learning, and chances are, if they've never seen something before, they don't know about it! Cut them some slack. (Remember we're ignoring the fact the graduate should have known their scope of practice and not stepped out of it!)

Just as I am on a journey towards becoming a violin virtuoso (allow me to dream), so this graduate is on a journey towards becoming an experienced practitioner. Along the way we both make mistakes. Just as my teacher encourages me with the golden tick, so I am to encourage the graduate and congratulate them upon their successes. At the same time I can teach them new skills, helping them to develop.

I feel challenged to broaden my outlook on graduate mistakes. It would be helpful if I overcame my initial judgmental reaction, instead seeing each graduate in context, seeking to nurture them, and valuing the whole of their practice.

I did speak further with this particular graduate, explaining my concerns, feeding back on excellent aspects of their practice and encouraging them to know their limits and ask more questions! The patient is fine and all is well. I shall continue to learn the violin and the graduate will continue to develop their practice, and over time we will both move closer to perfection.