Senior Nurse Mentor

Loyalty to Nurses

While writing this book, I asked myself why, just after I got off work that day on the teen unit, I didn’t go to the nursing administration and ask to talk to whoever was in charge of nurse training. I could have suggested they teach about air embolism and point to my own experience that very day. It wouldn’t have been that big a step. I already knew those responsible for CPR training. Whoever I’d talk with probably already knew about me as one of its instructors.

Why I didn’t matters because, as we will see, the reasons I did nothing are reasons nurses today often remain silent and also why  hospitals need the senior nurse mentors I am describing. 

One reason I did nothing was the loyalty I felt for the nurses that I worked with. People who work together, supporting each other and dealing with common problems, often develop intense loyalties. That's good and should be encouraged.

That was particularly true in this fourth case. The day nurses on the teen unit had it rough—really rough. They were expected to do far too much. When I first began to work there, I wondered why every nurse on the unit was young and pretty. Later, I understood why. Only a nurse that was young, trim and athletic could keep up with the brutal work load. Most were in their mid-twenties and only one was approaching thirty. Those traits almost guaranteed they’d be pretty.

On nights, we had a lot to do, but except for emergencies, circumstances rarely changed. The situation at the start of the shift was identical to that at the end. The fact that nothing had changed in the night was for me an indication I’d done my job well. Because these were serious, long-term illnesses, there were no middle-of-the-night admissions or discharges. Only occasionally did we get a late-night admission with some other illness, and that only happened when we had rooms to spare and thus less to do. That predictability made my work easier. I knew at the start of a shift when a child needed extra attention and could adjust my work accordingly. 

Days on the teen unit were never like that. Often, it seemed like the rest of the hospital was conspiring to make our day miserable. There was a steady stream of admissions and discharges. Orders changed. Patients had to be transported for tests and treatment. All might be going well, when suddenly I’d be expected to help with a procedure. Precious time would disappear when I could least afford it. Nurses had it even worse. While a nurse could cover my responsibilities, in the more legalistic world of days, I could not pick up as much of her work as I had done on nights. 

Making matters still worse. Tensions between the nursing administration and nursing staff were steadily worsening. You’ll find that described in more detail in My Nights with Leukemia. On the medical unit, I’d written off the early signs of those tensions, seeing them as confined to our unit and due to an ill-tempered head nurse and two older nurses who resented the newer and more talented second set of night nurses. 

That seemed confirmed during my first months on the teen unit when all went well. Little did I know that the gentle nurse who was filling in for the assigned head nurse was shielding us from administrative pressure. 

When the permanent head nurse came back, the situation turned sour. She claimed that all was not well on the unit. I suspected she was playing a bureaucratic game. She had been gone, therefore, she had to claim that matters had been bad in her absence. She was back, therefore the situation had to appear to get better. That’s one way to impress administrators.

I disagreed. I could see little that was wrong other than an almost impossible workload. Her hints that some nurses would be fired and her efforts to get me to inform got nowhere. I made a resolution not to say anything negative about a nurse come what may. They were doing their best in a difficult situation. None deserved to be fired.

Her efforts to scare me also got nowhere. She even claimed that nursing assistant positions like mine were to be eliminated. That made no sense. As assistants, we were busy doing what was expected of us. Would the hospital eliminate our positions and assign our work to more highly paid nurses? I didn’t think so. Fear was becoming destructive.

Worst of all was the indirect impact of all that criticism. The nursing administration seemed to feel that nurses weren’t motivated. I disagreed. During my time at that hospital, I never ceased to be amazed at just how dedicated all but a few nurses were. They varied in training, skill and experience, but only a few of the many dozens that I worked during those 26 months weren’t doing their best. 

Looking back, I realize that sufficient on-the-job training was a major issue. There wasn’t enough of it, and the situation was getting worse. The lack of air embolism instruction that I’ve mentioned was a symptom of a much larger problem.

Those tensions had another harmful impact. Motivated nurses want to do good work and don’t respond well to criticism. Unfortunately, all that criticism meant more stress and more mistakes rather than less. Fear is a very bad motivator.

There was another factor with that fourth embolism I discovered. The nurse that I was working with that day wasn’t on the teen unit’s staff. She was a float, there only for a few days. That increased my sympathy for her. Her mistake—she was the reason for that air embolism—was easily explained by the unaccustomed work load. I knew I could not bring up the problem to administrators without bringing up her mistake. That I did not want to do, so I chose to protect her. Keep in mind that I liked the nurses I worked with.

I hope your are getting a hint that a senior nurse mentor would work outside that nursing chain of command and thus not be subject to its pressures, particularly the often dysfunctional requirement to record and punish mistakes rather than use them as teaching opportunities. In that environment, the mistake this nurse made wouldn’t become a black mark in her official file. It’d be a learning experience. Not repeating a mistake is what matters, particularly one where on no harm is done, as with that sixteen-year-old girl.

If the hospital had a senior nurse mentor like the one I’ll be suggesting, I could have talked with her in private, told her what happened, and suggest she ensure that nurse learned about air embolisms. The nurse would learn what needed to know without getting a bad mark on her record. It’s be a win for everyone, especially patients.

Instead, my response was weak and tepid. Yes, I told that nurse what I’d done to respond to that air embolism, but neither she nor I had time to walk through the steps and make sure she got them down right. 

A senior nurse mentor would be different. She could contact that nurse and suggest a meeting, perhaps during lunch or before/after work. For her part, the nurse would know that the training was off-the-record and for her benefit. What mattered was that she learn and not that she be punished for a mistake that was only partly her fault. 

I’ve described my failure to act in this chapter. In the next I’ll illustrate the limitations I was working under. Pushed to the limit by my assigned responsibilities, I did not have time or energy for much else. There was just so much of me.