During my time as a nurse, I find myself often asking “how do you do this here?”, a question often used; yet, the frequency of this question seemed to quadruple while I was working in the USA. I guess it is a typical question asked at many new jobs; however, getting a reply of “that’s the way we do it here” was unsettling.
Healthcare is more than just fixing boo boos. And nursing is more than just “caring”. We are educated and should be using our brains with each assessment, intervention, or treatment we do. There should be evidence-based research that supports what or why we do things, and we must be cautious of not falling into the “that’s the way we do it here” attitude…
When we accept the “that’s the way it’s done here” attitude, we are not taking an evidence-based approach. Sure, potentially when the action was first introduced into the department, it was evidenced-based. And initially, nurses were taught the “why” related to the action; however, over time details become blurred and content becomes saturated with “I don’t knows” or “I don’t remember why we do it this way” until the telephone game is played for so long that we no longer remember the “why”.
One of the things that struck me while working in the USA, was the lack of specialty training for emergency nursing. Yes, eventually one could study the NENA (National Emergency Nursing Association) book and write an exam to be ED certified, but as we know nursing is more than book work. The norm for training USA ED nurses, in my experience, was preceptorships. Now, this is a changing field of study, and in 2017 there were some more formal education processes being initiated and developed to help establish some standards of education. However, prior to this point, nurses were hired into the ED, received approx. 12 weeks of preceptorship, and then were “ED nurses”. I’d also like to say, that I have worked with some amazing nurses whose knowledge base is/was tremendous; however, it’s a long road for some and no one can deny the gaps in knowledge discovered along the way.
As an ED nursing specialty certified RN (BCIT) and a grad student (at the time), I saw an opportunity to look at this issue deeper and found that very few schools in the USA offered specialty training but awareness on the lack of specialty training was gaining ground and specialty training was emerging as a new norm. The research indicates that patient outcomes, length of stay, and patient satisfaction are all improved with advanced trained nurses on staff. The numbers are significant enough to support advanced training for nurses and encourage employers to set this as a new standard!
Through developing these programs, even in-house ones, the field of emergency nursing can only benefit. Through standardization, nurses will receive the same education with smaller variances in information delivery, thereby increasing the understanding of why we do something verses the “just because” answers. Although, the USA is slow to introduce this level of education (in BC it’s been established since 1985), it is refreshing to know that it is in progress!
I am happy to share my research on this topic and encourage nurses to advocate for advance training in specialty areas! Keep up the brilliant work!
Well done my USA friends!
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