Looking back on a missed moment when caring for a stabbing victim has third year student nurse TRISTIN SLATER reflecting on patient advocacy, autonomy and how learning between nursing students and registered nurses doesn't have to only be one way.*
As a student nurse, my experiences in practice have shaped me into the nurse I am. One of the greatest lessons I have learnt is the importance of reflection. This article describes one of the most influential events that I experienced as a nurse. Through it I will comment on the misconceptions that exist regarding the student nurse, the role we have and the responsibilities we carry.
My experience with 'Amanda'
When I think about my time as a student nurse, there is one experience that sticks out above all others. That day I realised being a student didn’t mean that I was without responsibility. Amanda (pseudonym) was only 14 years old when she came into my care at the emergency department. Although it wasn’t really my care but the care of the nurse I was assigned to for the day, or so I thought at the time.
Amanda had been stabbed, three times. Because of her injuries, she needed a tetanus injection, an idea she strongly opposed. As I approached her, needle in hand, she winced, then cried, screamed, swore and pushed me away. It was at that point that my nurse took command of the situation. She took the needle from my hand, administered the injection and briskly left the room, apologising for interrupting my learning experience.
I have to say at this point, looking back on the event, it seems quite wrong. But in the moment it can be too easy to get caught up, and to convince yourself that the nurse knows best and that there are no other options.
As nursing students, we are taught to reflect. We discuss and write about our learning experiences – good and bad – and we are encouraged to continually improve our practice.
When I reflect on what happened with Amanda, I often return to the concept of autonomy. Autonomy is the code of ethics' principle that outlines how every individual has the right to make their own decisions about any aspect of care they will receive1. In New Zealand, each individual also has the right to respectful treatment, dignity, independence and informed choice2. With this in mind, Amanda’s hospital experience was poor. She was not in control of the care that she was receiving and her independence and choice were neglected at times.
In hindsight, I recognise that I was just as responsible for this outcome as the nurse I was working with. I had many opportunities to improve the situation, but I took none of them. At the time I was simply happy to follow the nurse, and do as she saw fit. I can now see though – what I had somehow forgotten in the moment – that treating her with respect was not a luxury but a right. Amanda deserved the right to refuse, as well as our empathy and kindness. Reflection has allowed me to identify this as my area for improvement. I will continue to learn and challenge myself so that in these situations I am capable of identifying when things are not going well, and push myself to speak up, to be the patient’s advocate.
As students, we are continually learning, like everyone else in this profession, and as a result, we can get things wrong. But, for the majority of the time, we are highly capable. As students we learn best practice, research key topics, study pathophysiology, familiarise ourselves with principles, legislation and codes, and perhaps most importantly, we are a fresh set of eyes. We have evidence-based practical skills that have been taught to us by some of the best in the field. We gain a holistic perspective on nursing through our exposure to different areas, and it is all fresh in our minds. We are an asset to the health care team.
I believe that sometimes there is a misconception that students have to watch rather than participate; that we don’t know what we’re doing and can’t be trusted on our own. As students we are placed in the clinical environment primarily to learn, but that doesn’t mean we cannot contribute or be helpful in more ways than one.
Indeed, I propose that registered nurses and students can all learn from each other. If this was more openly acknowledged by students and staff, the student nursing experience would exponentially improve and the clinical area would truly be a learning environment.
No question's stupid
So how can we move forward as students and nurses – in the most constructive way possible – to create learning environments that benefit the patient?
Students are always learning and we would be foolish to act as if we know everything, indeed misplaced confidence is dangerous.
With a career choice like nursing, you can’t just “fake it ‘till you make it”, when you are dealing with the health and lives of individuals. So my advice to myself and other students like me, is that there are no stupid questions. None. We have a responsibility to speak up, ask questions, be confident and to critically analyse our nursing practice and that of the professionals around us. Throughout my nursing degree I am learning to find the balance between being a learner and a critic of professional practice.
The same advice could be shared with the registered nurses we are learning from; there are no stupid questions. Don’t be afraid to ask us what we are capable of, what we’ve done before, what we want to try and what we need to learn. When the lines of communication are opened, we can create a professional relationship that will be beneficial for both parties. When you are aware of our strengths and weaknesses, we can be your ally and asset.
Students can be assets
Over my time as a student nurse, I have experienced misconceptions of my abilities, many of them contradictory, based on the uniform I wear. I have been faced with challenging situations that have shaped and advanced my practice. Through my experiences, I have come to the conclusion that the student nurse can be an asset to any health care team. We are well-researched, and keen to put our theoretical knowledge into action. But there is also a responsibility that lies with the student, to speak up, reflect and, above all, to learn.
*This is the full version of Tristin Slater's critical reflection. The shorter version published in Nursing Review's print edition can be viewed here.
1. New Zealand Nursing Organisation. (2010). Code of Ethics 2010. Retrieved from http://www.nzno.org.nz/
2. Health & Disability Commissioner. (1996). Code of Health and Disability Services Consumers’ Rights Regulation. Retrieved from http://www.hdc.org.nz