The Challenge of Keeping Up

Sometimes I feel overwhelmed when I realize everything that I do not know. Sometimes I feel like I have not even scratched the surface of everything that I think I should know to be a great registered nurse. Over my few years of experience I have come to realize that being a registered nurse necessitates keeping up to date with the latest practice guidelines and trends. This means reading the research, going to conferences, participating in education sessions about the latest products and practice and reading the policy and procedure as it is changed and updated in facilities and health care regions. This is not an easy task. In fact, I am starting to realize this is a huge challenge in an age when funding dollars are being cut for educators and education. When I embarked on my journey into HIV nursing I definitely viewed it (and still view it) as an opportunity for new learning but four months into this new job I feel like there have not really been proper supports to engage in adequate learning. Since the beginning of my career it seems as though any learning that needs to take place is something I need to facilitate on my own. I need to identify my learning gaps and learning needs but seems I need to figure out the means to meet them as well. This seems daunting because any time I have at work is spent on direct client care and any time I have at home is spent on my children. I understand more and more each day why nurses specialize in the same way that doctors do; it seems impossible to keep up to date with the changes in health care that implicate nursing practice. And for some reason clients, any maybe the general public, think that as a registered nurse I know everything about every area. I don't. In fact, until yesterday I do not think I realized what now seems like a profound disparity between my area of expertise, mental health and community addictions, and the setting in which I now work, HIV residential care.

Yesterday at work I found my level of medical nursing practice being criticized by a client. This shook my confidence. I must admit that there are many practical medical/surgical nursing skills that I have never had practice with because I decided to specialize in mental health and addictions upon finishing my undergraduate nursing degree. As I am now employed in a place that is more focused on the medical side of nursing I find I sometimes feel like a fish out of water. This causes much anxiety for me. This anxiety is compounded by the fact that I am the only RN on shift and this is a residential community-based facility, meaning that I must rely a great deal on the knowledge of my shift co-workers. This is not an easy place for me to be, more than four years after graduating with my nursing degree. I suddenly feel incompetent.

I have encountered many challenging clients in my time in psych and addictions settings. However, yesterday, for the first time I found myself speechless, taken aback when I openly admitted to a client that I had not engaged in the skill before but I could likely figure it out with assistance from them. The task was seemingly straight forward and the client verbally communicated that he was okay with this. However when I was actually doing the skill and asked the client a question the response was, "I shouldn't have to tell you that. It's something that you should have been doing since nursing school". And although I wanted to respond, "well they don't teach you about everything and how to use every piece of equipment in school and things also change over time," and "you're the one who said that you were okay with this when I openly told you I was not familiar with this equipment," instead I apologized and empathized with the client's frustration.

The skill is simple. The tasks are easily learned. The best thing that I took away from my undergraduate and graduate nursing degrees is my ability to critically think about things that happen at the bedside but also things that happen in health care and health. How to use a specific IV pump or tube feed pump, the latest and greatest product to use for specific types of wounds, the specific product that are client uses for a medical piece of equipment changes. These are things that can be learned but I always thought the awareness of the knowledge gap was the most important thing. It's pretty easy to read the instructions that are included in the bag if you give a nurse enough time to do it. But nonetheless the words of this client deeply affected me because I am still thinking about it 24 hours later. And I know the only way to work through this is to just keep going to my job and asking questions when I don't know. But I think that it is important for the public to understand that as nurses we are just people. We don't know everything but it doesn't take that long for us to find the information to help the client if we are given that time.