Attitudes

I often start my morning at 0730 on St. Monica, the female medical ward, helping out the nurses and tagging along on the ward rounds with the doctors to ask questions, learn, and offer any input I may have on patients. Mornings are usually quite busy until 11, which can be a great way to start a day if you are efficient and have a good team working with you. Sometimes, it can be a bit overwhelming, if you’re short-staffed, or have staff that would rather sit at the desk and watch things not happen.

Often in the mornings I come across things that have been missed from the previous shifts, so I try to organize a bit and bring everyone up to speed. It may be a diabetic patient who has not had any glucose checks since admission, and is now nearly unconscious after her morning insulin, it may be a young woman in renal failure who is hugely edematous and currently receiving her third liter of fluid, it may be a gasping pneumonia patient lying flat on her back with no oxygen in sight; any of these situations (and more) are possible when you report for the early shift. So you quickly prioritize and send for the oxygen concentrator, draw up some IV dextrose, and stop the fluids, then survey the ward again to see if there’s anything else you missed. After/during this, I pull the first year students aside, drag them with me, and quiz them on nursing care, and help them out with some lacking information. ‘What do you think is our top priority here?’ ‘Tell me about diabetic management’ ‘Why is fluid balance important in renal failure?’ Really, some days I just want to yell at them and the night nurse for missing such obvious, basic things, and failing to call for help when a patient is deathly sick…
Which brings me to a question. What motivates us? I’m asking this because I’d really like to know the answer. I’m not sure how many people read this, but please offer any insights you have on this.

Why do we do things the way we do? What makes us want to do things well; what drives our pursuit of excellence? Why do some of us always strive for more, while some of us are more than happy to settle with ‘enough’ or average’?
Are our motivations based solely on incentives, or is there some greater, more noble reason? Or perhaps some balance of the two?

Here are some observations I’ve made, and I have to stress that these are personal opinions, and you are more than free to disagree with me, as I realize that I still have a lot to learn.


a) 49 first-year nursing students. On the whole, this group shows a lot of ambition and enthusiasm for the nursing profession. They are eager to learn, always looking for opportunities to apply theory in practice, asking questions constantly, and studying in their spare time. They are super inquisitive and absorb as much as they can in this short time they have of being students. When the students are in the hospital, the wards are spotless, the patients are bathed, and treatments and orders are done (usually) on time. They are starting to think outside their procedure manual, asking me thoughtful ‘why’ questions, showing that they are beginning to think critically.

b) Staff Nurses. Although there are wonderful shining exceptions to this, on the whole staff nurses couldn’t be any more opposite. They trudge through their shift, taking 2 hour breaks, falling asleep with head in hands at the nursing station, getting up to give medications or take a couple blood tests. I hear a lot of complaints about nursing care (from other hospital staff), lack of clinical judgment and reasoning. It seems as though once you have completed school, once you are a qualified nurse and have your white uniform, you don’t have to learn anymore (after all, you already know everything), you don’t really have to try anymore. You’ve landed a government job, and even if you occasionally miss something (even if that something is BIG), you won’t suffer any major consequences, and you definitely won’t get fired.


I asked a student about this, after she finished telling me how she wakes up at 3 or 4am to study every day, then works a full shift and comes back later to do extra procedures. “Maybe nursing isn’t their calling,” she told me, “maybe they just don’t have a passion for it.”

Okay, that makes a bit of sense to me, though I still struggle with the fact that human lives are in play here. But maybe that’s because I care about my job, I have a passion for it. Maybe if I was stuck in an office typing Excel spreadsheets all day, I’d do the absolute minimum I had to, because I really don’t care about Excel spreadsheets, even if the success of your business depended on it.

As Mrs. Seya, our nursing administrator, keeps telling me while we hammer out an Action Plan for nursing workshops and try to overcome the incentive obstacle, “Attitudes are hard to change.” Hard to change, hard to understand.