We only get one chance to set our standard of care
I remember when I was just a beginning student nurse, the facility manager for my first placement sat down with me and the other 3 students on placement with me and introduced us to not only the facility, but also how aged care works, and how to be a good nurse in general.
One of the most important things he said has stuck with me ever since that day, and it pops into my head every time I encounter questionable practices in my nursing work. He said that we only get one chance to set your standard of practice, one chance to draw the line in the sand, and if you fail to do that, you’ll struggle as a nurse. At the time I didn’t really think much of it, after all, it was my first placement, I didn’t have a standard of care yet.
But I didn’t realise what he meant until it happened, the point where I needed to draw the line in the sand, and decide what was happening was not an appropriate standard of care. My fellow students were faced with this same moment much sooner than myself, within the first few days of their placement, however I too found myself drawing that line on my second week.
I was assisting another staff nurse I had never worked with before in the aged care facility to change an immobile dementia patients pad, and get them dressed for the day. The plan was to do this before hoisting them into a chair so they could be moved to the dining room for breakfast. Pretty straight forward. We gloved up, donned the appropriate PPE and headed in. This is where things started going wrong. The staff nurse walked straight into the room and started moving the back of the bed down from a semi-fowlers position, without introducing herself or even acknowledging the resident. I was a little shocked, but I’m just a student, what do it know?
The staff nurse proceeded to undress the resident quite roughly, and would simply drop the resident’s limbs when she had done what she needed to do with them, I just stood back in disbelief as I watched this nurse manhandle a resident, who was getting a little bit distraught by this point. She didn’t even ask for my help and was so rough that at one point pulled the resident’s shirt off with such force, she ended up hitting me as I stood next to her.
I’ll spare you the horrible details of what else went on, but I clearly remember thinking to myself; this is not an appropriate level of care. This is in no way acceptable. But even so, I’m ashamed to say, I did nothing. I certainly didn’t participate in this task, leaving the staff nurse to hurry through the procedure while I watched. It wasn’t until a few hours later while thinking over the incident that I realised that was the moment the facility manager was talking about. That was the moment I needed to draw a line in the sand and say this is unacceptable. I should have intervened, or even taken over the procedure from the staff nurse, but I was a student and was too naive to know where my authority began and ended. After all, I’m sure all nurses have been in that situation where your preceptor or buddy on placement does something questionable, and you get uncomfortable about it.
In the end, I reported the incident to the both my facilitator and the facility manager who followed their disciplinary processes and informed me that they would deal with the situation. I never found out what happened to the nurse in the end, but I do feel good that I didn’t allow myself to stand for such an unacceptable standard of care.
While we are students we don’t usually feel as though we are in a position to question our superiors, but the reality is that we have been trained in the best practices, and if something doesn’t feel right, it probably isn’t. We only get one chance to set our standards for care, and if we fail to do that, we will let the worst of nursing practices slide straight under our noses.
You can find out more about patient abuse, and the nurses role in advocating for their patients here: AORN.org