Good communication and teamwork are the foundations of quality patient care. Amelia recounts her first year as a junior nurse and highlights the inter-and intra-disciplinary challenges common to all health professionals.
Today marks the completion of my first year as a registered nurse. As of tomorrow I will be an RN2. It’s intimidating and yet it prompts me to look forward, as well as back.
Upon reflection of the past 365 days, there were moments of undeniable joy, as well as moments of wondering whether I had made a dire mistake in taking on this role. Approaching the last weeks of my year I began talking to my junior colleagues – nurse, doctor and allied health alike. We swapped stories about challenges, and pivotal learning experiences. It became clear that the most prominent themes in my make-or-break moments related to teamwork. Specifically whether I perceived myself to be a member of a well-functioning team, as opposed to feeling that I was an outsider to something that operated under rules I simply didn’t understand or identify with.
I was fortunate enough to have commenced my career riding the wave of theoretical enthusiasm for evidence based interdisciplinary improvement strategies. A period of supposed upper-management focus upon the importance of the ‘multidisciplinary team’. Along with implementation of positive workplace interactions, and the empowerment of the individual – patient, carer or health professional – in response to the Garling Report. I remembered my university days punching out essays pertaining to the golden nature of interdisciplinary communication, and collaborative care approaches. I thought nothing of it when I welcomed my patients to their ward with a brief summary of the importance of maintaining agency during their stay, of voicing concerns and recognising themselves as contributor to their care trajectory.
I remember feeling immensely positive when I finally started. I commenced my rotations with a naïve sense of community and purpose. I envisioned myself as the superhero nurse, with her trusty sidekicks, forging a path through the dirty world of death and disease. The theory of teamwork and concept of workplace harmony for the creation of a safe, productive patient care environment to me seemed entirely feasible, and was no less natural than groaning when continually rostered a long series of nightshifts.
Across the year, this idea of ‘high-fives all round’ wasn’t entirely far from the truth. Certainly in most rotations, the sense of camaraderie was strong, even if slightly less glamorous than first envisioned.
Unfortunately, a time came whereby I moved into an environment with what I felt was less team functionality. The individuals were friendly enough, though I perceived them to be somewhat unenthused by the presence of junior staff. Ward routine and expectations were acquired by observation and repetition, as opposed to explanation and orientation. New skills were haphazardly taught. There seemed also a more obvious divide between nurse/medical officer/allied health. It felt unwelcoming, and overwhelming.
Where I previously developed strong professional relationships, I now struggled. Previously, I knew the names of everyone I worked with, was invited to observe and even assist in supervised procedures, and had multiple other learning opportunities typically reserved for medical students. Now in my new environment, nurses and doctors alike barely gave me a nod of acknowledgement. In one instance, a staff member openly scoffed at my lack of familiarity with a particular patient condition. Communication was less frequent, and acronyms were rife – with explanations few and far between.
Not long into my time there, an incident occurred. It was on a particularly busy day. I was juggling patient discharges, preoperative preparations and routine cares. The day was a very demanding one, and I was still feeling the pressure of being new to the area. Excuses aside, I stuffed up royally. I completely omitted a step in a routine patient procedure and nearly landed an individual back in theatre, or worse. I removed an intercostal catheter in a way that resulted in air entering the chest cavity.
I gave my patient a pneumothorax.
The second it happened, the very moment I heard that gut-wrenching rush of air, I knew what I’d done and how. Luckily, I identified the error quickly, and a rapid chain of fortunate events meant the issue was resolved with nil adverse outcomes beyond my immediate distress. Regardless, I felt like I had failed: failed my patient, my colleagues, but most of all failed myself. I prided myself on being diligent, thorough and cautious, yet in this event I simply forgot.
To add insult to injury, as soon as my patient was stabilised, I was rushed to my tea break. I was told that by running behind on time I was inconveniencing remaining staff. Missing my break to catch up was deemed unacceptable. I left the ward feeling stormy – cheated, disappointed, concerned and deflated. I was unable to eat or sit still. I paced the hospital aimlessly. I considered going home. Just leaving. I wanted out. But finally, I resolved to get some fresh air, and on the way I bumped into a JMO from a previous rotation. He simply greeted me with familiarity and I burst into tears.
Despite being obviously busy, he offered me a moment of time and I’ll be forever grateful for that support.
Following a very rapid reflection of the reasons for my distress, I was encouraged to return to the ward and raise the issue. I spoke with my senior nurse and expressed feelings of being unsupported in the incident – by nursing and medical staff alike. I described feelings of concern for my patient, and distress at forgetting something so routine. Together we agreed upon a self-managed re-education plan for the procedure. I handed over the incident to oncoming staff, and remained open and honest about what occurred and why. I was surprised by the results. The patient expressed gratitude for my openness, and staff disclosed times they also made errors in their practice – big and small. Overall a sense of closeness with the team developed, and I gained an unexpected level of self-respect. I owned my error, and I opened up to my team and allowed them to support me in not having the same mistake repeated. This improved my overall experience and more importantly, enhanced the safety of my patients.
I feel that the incident allowed me to recognise the importance of teamwork in the context of myself as an important member of that team. In the time immediately prior and post incident, I was not being a team player. I allowed myself to become overwhelmed in my work environment, and I neglected the fact that I was a junior. What occurred during that brief chat with my JMO friend was a shift in my perspective. As a junior member of a complex network of individuals, I needed to recognise my professional responsibility. As juniors, we need to remember to not only communicate our lack of seniority, but also regularly provide opportunity for our team to support us in the manner needed.
Teamwork is the recognition of each individual in his or her capacity to contribute. This includes the self. I discovered through this negative experience that the team I work within is the one I create. Via openness, humility and a genuine desire to be a stickler for best patient care I am now able to use professional assertiveness in my communication with colleagues, when seeking support in my workplace. Interactions with colleagues are now grounded in a sense of knowledge that teamwork and good communication right now is not about me the nurse, and you – the doctor, fellow nurse, or allied health worker – but rather it is about our patient.
Moving forward in my career, I will start as an emergency nurse in a brand new part of the country. I will be working in a hospital I have hoped for from when I began my studies. I am particularly excited to form professional bonds with like-minded individuals, and problem solve the many nuanced patient presentations. I expect a prolonged period of adjustment, as with any new work place. I can only hope that I do this alongside a collective of fellow new starters and long-termers alike, who see all those who stand beside them as allies in our chosen line of work.
You might argue that this is an idealistic and naïve stance to take, but a large part of me figures – why the hell not? I feel strongly about the importance of teamwork: for patient safety, for workplace functionality and for my own personal sanity. The worst thing that could happen would be to encounter some less enthused colleagues in the process, but it’s these differences in human interaction that keep us challenged, and maintain continuation of professional and personal growth. So bring it on. I’m a nurse now, and in my opinion, medicine is a team sport – one which I intend to be an active member of.