As each placement progressed and as each year passed by I became more and more skilled as a nurse.
I learnt by watching and working with some fantastic role models. I learnt to work with multiple different teams and then to lead them.
I learnt by doing things over and over again, getting better and better at them slowly and incrementally.
I learnt how to do some technical stuff I never imagined I would ever be able to do.
I also learnt how to talk to and listen to patients (even when they couldn’t talk) and their families and my co-workers.
This was my everyday.. my ‘work as done’…
Care for my patients, whether it was one very sick child or the whole ward. Care for them in every way. Their physical and psychological needs. Care as I had been trained to do but also as I grew in experience.
Observe them – really observe them. Through sight, touch, and smell. By listening, watching and counting. By measuring things that could be measured but also noticing things that couldn’t. Sometimes the monitors bleep would change imperceptibly but my brain would register that something was wrong before the numbers changed.
Adjust. Adjust my care to fit the patient need, adjust my choices and actions depending upon what I observed. Adjust my day depending upon the workload and the staff around me.
Inform. Inform patients and families what was happening and when, inform colleagues of status and changes.
Treat. Make sure I (or others) administered the right treatment at the right time in accordance with the individual plans.
Most of the time the basics were the same. Occasionally a new technique or new drug or new practice would be introduced and our skills would be ‘updated’.
We worked hard but we were also cared for. Told to take breaks, urged to eat and drink properly to keep ourselves well. And there always seemed to be someone to go to to ask for help or ask a question or to hear a concern.
This is what I mean when I talk about the fundamentals for patient safety or ‘working safely’.
I don’t recall doing quality improvement projects or filling out incident forms or being constantly scrutinised by investigators or regulators. I don’t recall being constantly aware of failure in fact the opposite. I recall us being constantly focused on success. Not just success in improved outcomes but success in beautifully caring for someone dying.
Does that mean I was any less safe? We will never quite know because the data we collected then and the data we collect now doesn’t really tell us whether we are safer today than 30 years ago .
I worry that we want to progress without doing the time. That years of experience are seen as secondary to promotion. That the experts quickly move on and the role modelling they are so important for is lost.
I worry that we have forgotten to enjoy the everyday and that we think we are making a difference by our obsession with small scale projects.
I worry that we feel we have to focus on the bad and not the good. If we were to believe the safety research we would think that staff are failing constantly when they are in fact doing the opposite.
We need a different conversation. A movement around a shared purpose centred on supporting everyone in healthcare to:
Care with compassion and kindness
Gain and value experience
Observe easily and effectively
Inform and communicate well
Treat people using the best evidence based practices
Look after those that care by meeting their basic personal health and wellbeing needs and maintain a positive workplace
Ensure there is always someone to turn to