Tuesday, June 19, 2007

Not Knowing

So often in the course of my work as a nurse, the notion of "not knowing" rears its head. In many circumstances, my level of knowledge and clinical acumen is challenged, if not entirely overridden by the 10-ton Mack Truck of my own ignorance. Signs and symptoms make themselves known to me. I probe for further details. I use my limited assessment skills to elicit the information I wish to glean. And at many turns, my lack of knowledge and skill stops me in my tracks and I am faced with the need to climb the chain of medical command, seeking out mid-levels (Physician Assistants or, most likely for me, Nurse Practitioners) to assist me. Failing that, I seek out a doctor, as challenging as it can sometimes be to corner a doctor and command his or her attention long enough to receive a satisfactory reply.

In my current position, I'm expected to manage patients' care with a very generous amount of autonomy, working at the very edge of my scope of practice, but never so much that I feel I am putting myself, my patients, or my license at risk. When it comes to "not knowing", that is a fine position to assume, as long as hubris or stress don't cause me to make decisions which should otherwise be made by someone more skilled and knowledgeable than I.

In my personal world of knowing and not knowing, it's always better to err on the side of caution than to later regret one's actions and decisions. And that is the fine line we often walk on the clinical front lines, and perhaps it's that sense of urgency and adrenaline that keeps us doing what we do. But when one comes up against one's limitations and there is a human life eagerly awaiting your decision on what to do next, humility and an acceptance of one's ignorance is the most important thing to remember.
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