Sunday, 26 April 2009

Failure et al.

As the title suggests, my performance has been evaluated and has been awarded a failing mark. And I'm miffed, pretty much.

If I have failed this placement then it is only fair to reason it has failed me, too.

I'm irritated about the feedback given, more than anything. I have not worked with my mentor very much. Less than once a week in real terms, so that's less than a tenth of my time on the ward. My mentor aimed second hand anecdotes as reasons as not to pass me. Not only were these anecdotes second hand, they were recycled, mostly, from the past 'little chat' which now, the way she phrases it in my paperwork today, was more of a disciplinary meeting. Little did I know.

To say I spoke to relatives about a complex procedure and gave them the wrong idea sounds terrible, but it's not as simple as it sounds. For example: The nurse I was working with had already discussed the procedure (the removal of a JP drain from the patient's head) earlier in the day. I went out to fetch the relatives from the waiting room, and they asked me whether the drain was out. I told them yes, since I'd took it out, and explained what I did. A week later, when my mentor told me this wasn't on, I said I would stop doing it. Which I did. My lips were sealed to next of kin and friends alike. Yet I was still taken to the cleaners with it at my final meetings.

Another occasion, on which I asked a doctor to prescribe our patient some potassium due to a dip in the patient's potassium levels, after discussing this with the nurse I was working with (who was there when I asked) was brought up. Again, I thought I was being useful but the ward didn't think so. That's fine. I didn't do it again.

I don't mind making mistakes, or being taken to heel because of them. I learn from my mistakes and don't do them again. If I do this, and am still criticised for them... what's the point in changing?

Although it was said that I was clearly keen and a hard worker, I was essentially told I should've been doing /less/. It wasn't documented how I helped various members of staff pin down violent patients when I should've been doing less. I wasn't even thanked much at the time for helping out. But that's as maybe...

I was told that, although my skills in basic care have progressed, they haven't progressed enough. There was no quantitative level indicated, so I'm not sure where I should've been. It was implied, for example, that I should've been quicker doing my drugs. I know people on the unit who, working on their own, perform their drug administration at slower rates than I did. This is ignoring the fact that I have to wait for two nurses to check the drugs, which often takes a while. I don't mind being told I should be more efficient with it, but if speed was the problem, there should've been goals set and targets to reach, in my opinion. And I'm not at all convinced not being very quick on the draw when it comes to NG meds counts as unsafe practice. Ditto for my time management skills. They've progressed, but not enough: how much is enough? Especially when there are a lot of things I, myself, cannot do on a shift.

The thrust of her criticism was also pretty flawed in my opinion. I was told I was too keen to do things and get involved in things I may not have a huge amount of experience in half way through my placement, so I adjusted my practice to be less forward. I get told at the end of my placement that I'm too cautious and taking too long to do things, like give meds. Seems contradictory to me...

A major part of the criticism revolved around my mentor not feeling I practised safely. One event in particular, actually, in which I gave closed, tracheal suction to a patient. At the time I was not aware I was breaking any rules. I had, in fact, been taught the technique by one of my associate mentors. I was innocent and foolish enough to think this meant I could... do it.

Another example of this: Bottom bags of catheters, when full, need to be emptied. With my associate mentors (who I spent the other 9/10ths of my time with) I was doing this quite simply by turning the tap and emptying them into a cardboard receptacle to be disposed of. I did this with my mentor, and was looked down on for not using an alcowipe on the exit port, which is apparently trust policy. I witnessed one of my associate mentors doing it the former way, no wipe, after this telling off. I informed her of policy and she just laughed.

Similarly, one of my associate mentors criticised me one day when I was leading the planning with a patient because I didn't listen to the patient's chest, via stethoscope, at the start of the shift. She said this would be a good exercise in getting used to chest sounds, linking what physios said to actual sounds in your head. 'Good idea!' I thought, and have started to do it when I get a spare minute.

Today, my mentor pulls me up on it. She says I'm not trained to do it, that I wouldn't know what I was looking for and basically implied I was being pointless. When she asked who advised me to do it, I took a little amusement in telling her it was one of her own nurses. Just a little.

I could bring up other examples of this, as it happened a lot. In hindsight I think I should've been less diplomatic and, when given a telling off for doing something I'd learnt from someone else, just pointed the finger.

The bottom line is: I should've kept my head down, spoke when spoken to and generally been a gutless whelp. If anyone was to ask me how to get through ICU, that's what I'd advise. Sticking your head above the parapet is not appreciated. As it has been in all my other placements. And I don't think I'm going to change what I do, overly, in the next placement I have. I have to get retrieval marks now, for the 5/20 areas which I still have 'difficulty' with. I can do that.

I could go on about how the feedback was unjust, but I'll be doing that to my personal tutor tomorrow. As well as planning my future acts to make up for this slight dip. My mentor has already contacted Uni with her concerns and to get guidance on what to do. I have my turn to speak to the institution tomorrow, it seems. And I'm positive about it. My chin is utterly up.

I'll end this ranty post with the point that, near the end of the interview, my mentor said: "If you were on any other ward, you probably would've passed..." which, to me, demonstrates a sense of arrogance or disregard for other clinical environments (Probably why some people don't like ICU staff, I'd venture). This mentor hadn't read my first placement of this year, never mind the other three, all of which I've passed. Quite a pertinent point to end on.

ICU is different to anywhere else in a hospital. This doesn't make it better, in any sense. There's no qualitative judgement to be made in that case. Student nurses can't be as involved as they can be in a normal ward. That's par for the course. And I ruffled a few feathers as I adapted to life on ICU. They act as if you're supposed to be an observer and yet complain when you don't make any progress within seven weeks. Or they did to me. Maybe I just didn't /get it/. 7 weeks isn't a long time, in my opinion, and I think I made some progress. I will take on board some of the ideas levelled against me, and attempt to improve. I am in no way saying I had a flawless placement. But that's their fault, as well as mine.

1 comment:

forget_me_nots said...

While reading your post, many thoughts began to twirl through my head.
In life the sort of person who without intention goes out of my way in a job, enthusiastic to be involved, assist and learn.

An yet recently I have come across the same attitude (from management) as it appears you were faced with on your placement.

‘The bottom line is: I should've kept my head down, spoke when spoken to and generally been a gutless whelp’

However, I myself was not in a clinical setting but in the retail sector for a charity organisation. I had never questioned or considered my status in the ‘workplace’ before.

I do not wish to insult you, I have recently been employed as a Health Care Assistant Band 2, I have come across student nurses who take great offense when their role is compared with that of a HCA, which I do not intend to do.
I just am concerned as to how to approach my job when I start, in relation to that of the and the student nurses, RN, and matrons of whom I shall co-work with, I don’t want to ‘ruffle and feathers’

When you are like ‘us’ vivacious, an eager to be of help.
How do you establish that invisible line, of going to far, when you think for yourself before it is not appreciated?

My manager took great offense at my initiative; it was something very small yet to her it was colossal.

I thought maybe we could debate this issue, or perhaps offer advise and help each other with this ‘little’ issue we seem to both have.