Learning Plans and Yearly Performance Reviews

Nursing school was full of learning plans. Learning plans for a class, learning plans for clinical placements and learning plans for group projects. Now that I’m in the ‘real world’, learning plans continue to be made and revised each year – usually when there’s a yearly performance review scheduled by the manager. I’m somewhat torn on the issue of learning plans. On the one hand, I think they’re a useless waste of time. I always end up scrambling to write down something that might fit with learning goals that were written when I had no idea what I was getting into. However, they can also serve as a checklist for the things that I did want to learn and/or improve upon as well as documentation of ongoing professional development. Invariably, when I meet with my manager this year, I will have to justify why I didn’t accomplish a single thing on my learning plan written last year when I was not allowed to work in certain areas of the department that I do now. That is not to say that my professional growth has stagnated for the entire year – I have taken several courses, applied that learning to my work and have informally learned much more than can be summarized in 150 words. On top of all that, I have never been a very details oriented person. I like to have a general outline with lots of room for maneuvering and improvising because in my experience, things hardly ever go as planned. I won’t be too upset if I learned things that I didn’t know before instead of learning what was strictly written on my learning plan. Regardless of how I feel, I will be wasting a beautiful afternoon writing inane BS to appease the powers that be. And the real kicker – my yearly review is scheduled on the last effin hour of my shift before I scramble to get to the airport!!

Signature Drink at Last!

I was recently in a dilly of a pickle because I decided to give up my Starbucks addiction and could not think of alternatives. After a month or so of experimenting with different beverages during my shifts, I have to say that lychee pear green tea with honey has slowly earned its way into my heart and most importantly, my gut! I like that if it’s a mind numbingly hot, humid and hazy day, I can throw in some ice cubes and voila – it’s ICED lychee pear green tea! A close second for night shifts is a strawberry banana smoothie with pineapple juice – keeps me filled up and keeps the night shift bloaties at bay. The great thing is that I can buy a huge box of tea and honey and leave it at work so it’s a lot cheaper. The smoothie requires some planning ahead but worth the time. I’ll still visit Starbucks and get myself an iced coffee occasionally but our relationship has cooled considerably. My beverage choices are earning me some strange looks from the diehard caffeine addicts but the peace and calm of my GI system is far too great for me to care. Oh how grand my troubles have been…

Being Called into the Boss’ Office

I walk into my assigned area, take report and miss having my signature drink (which I still have not managed to replace just yet) and start providing excellent care (ie – making sure all is well and my peeps are breathing) when my boss asks me to come into her office. After visiting the loo to make sure I don’t wet my scrub pants in her office, I resign myself to my fate and prepare to accept whatever happens. I sat down shivering and realized that two of the charge nurses were in her office as well. Then I was really happy that I peed before. My boss’ steely gaze settled on the chocolate stain on my scrub pant and then she told me, “congrats Maha, you have the best attendance record of this year” and then she shooed me away to a violently vomiting patient. I was bewildered and then saddened because I didn’t get a gold star and a raise. What an odd day.

When the Patient Makes the Wrong Choice...

Informed consent is a tricky thing sometimes. The doctor and nurse can explain the risks in minute detail that would bore even the most meticulous of medical ethicists but the patient Just. Doesn’t. Get. It. The most visceral feeling is to smack them upside the head until they start making sense but that doesn’t work because that might precipitate a head injury and create more work and the nursing licensing bodies frown upon that sort of behaviour. So what is a nurse to do when the patient has multiple facial fractures from a bar fight and a broken arm that needs to be surgically repaired but won’t stay for highly necessary treatment because “I’m not sitting around here all day bitch”? He stayed for a head CT and there weren’t any signs of cranial bleeding – asshat was probably his baseline. Many nurses and doctors told him and his girlfriend that he would be at risk for some pretty serious complications if he didn’t allow himself to be treated but our advice was not appreciated. He ripped out his IV and left. Much of the staff (including myself) was happy to let him rot away somewhere when he kicked a chair as he left the department and expend our efforts and energy on patients who wanted our help. “Whatever, we told him the risks, he’s a big boy” was the common phrase heard for the next half hour or so. Now this particular patient was informed of pretty much everything that could go wrong with him but he still chose to leave. After I calmed down and decreased the use of highly creative expletives, I actually felt pretty bad about he was treated. True, he pissed the entire department off and his attitude left a LOT to be desired. But I feel that had I held onto my ‘nice nurse persona’ a little longer, he might have agreed to stay and be treated – or at least revealed why he was so unwilling to stay despite his serious injuries. It was hard to watch him leave the department knowing that he would be in a lot of pain and face many complications but he was aware of the risks. I still wonder though if he was truly listening or heard, “blah blah blah you suck stay and get better” from us. Hopefully he did come back and get treatment even if he was a jerk.