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.
1 comment:
I see that no comments have been submitted on this one. Can I take a guess about why that would be?
If you admit that you don't know, that is "transparency". Transparency and humility open you to criticism, at the least and to blame and ultimately litigation, at the worst. (Although a recent poll discussed on another medical blog, Unintelligent Design a few months ago, I think, demonstrates that when it comes to litigation, patients become more understanding and less likely to sue when transparency is demonstrated by their healthcare professional. However, lawyers typically advise against transparency.)
So we may go on pretending--that is our public personna, anyway. It is a game we play.
Students and newbies struggle with whether they should ask a question, thus admitting to not-knowing--which may make them appear stupid. Of course, they SHOULD ask. It is smart to ask, because it is a failsafe for the patient's safety. (I, myself, work with students as well as at the bedside.) Better to risk embarrassment than risk the patient's well-being.
This is a wonderful post, because it is a back-to-basics kind of thing, that we may compromise because we have gotten so enmeshed in playing the game. IMHO.
Chris and Vic
Post a Comment