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All I need to know in nursing I learned in fundamentals of nursing

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By: Fidelindo Lim, DNP, CCRN

During a recent early morning rush hour subway ride, I spotted a child of about 6 reading a book. Amid the tussle and bustle of harried New Yorkers leaving and entering the train, the precocious bibliophile seemed absorbed in a different world. It annoyed me that I couldn’t see the title of the book because he was reading it from a Kindle. When I see children reading, it evokes a certain jealousy in me because I discovered reading for pleasure only at the age of 20, shortly after I graduated from nursing school. I imagine all the books I could have read if I’d had an early start.

The first book I ever read for fun was All I Really Need to Know I Learned in Kindergarten by Robert Fulghum. His epigrammatic and frequently humorous style made me ponder, with a smile, the existential questions of good living. Consider this insight: “Think what a better world it would be if we all—the whole world—had cookies and milk about three o’clock every afternoon and then lay down with our blankies for a nap. Or if all governments had as a basic policy to always put things back where they found them and to clean up their own mess.” Can you imagine?

I’m going to take care of you

Many nursing faculty observe that they like teaching students in their first clinicals, before bad habits and cynicism set in. There’s something positively endearing and refreshing in co-learning with students who’ve made an informed choice to become a nurse. Hearing themselves say and mean it, for the first time, to their very first patient, “I’m going to take care of you” is akin to declaring “I love you” to nursing, albeit tentatively.

The nursing role and professional identity are in a constant state of revision. What goes on paper is a triumph of redefinition rather than a substantive enhancement of the ontology of nursing. What we teach and learn in basic nursing remains the backbone of caring, and the scaffold to support the nurse when the caring gets crazy. Becoming a nurse is easy, being a good nurse is another matter.

Twenty seconds to think

Telling my students, “When you don’t know what to do, wash your hands. It will give you 20 seconds to think,” is my attempt to emulate Fulghum’s bon mots. The nursing profession has come a long way since 1859, when Florence Nightingale pronounced that the elements of nursing are all but unknown. We know so much (or too much) now about nursing. I wonder what Fulghum would write if he were to author a book for Nursing 101? I reckon he might call it Fundamentals in Nursing instead of Fundamentals of Nursing. The former is used for learning nursing, the other is nursing. By substituting of with in, we’re reminded that there are immutable elements of caring and professional comportment—the credo of being a nurse. Here’s what I’ve learned (a partial list):

  • Be kind to everybody. It’s good karma.
  • Smile, even when masked. It’s infectious and will give your soul a lift.
  • Show up. Opportunities don’t know your address.
  • Don’t be late. If time is money, you’ll be in overdraft if you don’t show up on time.
  • Ask questions. Try “What’s the plan for this patient?” at every huddle.
  • Listen to understand. This means don’t interrupt when someone is talking.
  • Practice honesty. The hardest person to lie to is yourself — you’ll always know the truth.
  • Count your blessings. Grateful people are more patient and resilient.
  • Avoid neuroticism. It will save you a lot of mental health and cardiac issues.
  • Hang out with successful people. By osmosis you might absorb something great.
  • Follow instructions carefully. There is a reason why there is five Rs (or is it 10 Rs?) of medication safety.
  • Sit down with your patient once a shift. Ask: “Is there anything I can do for you? I have the time.”
  • Trust your instinct. If you feel you should check a patient one more time, you probably should.

From basic to complex and back again

Some think the nursing care plan should be on a do-not-resuscitate status, and the arcane nursing diagnoses are declared dead on arrival after nursing school. It may be so. But basic nursing isn’t an archaic notion. The essence of good patient care is unchanged and well-known, both from the patient’s and the staff’s perspective. Where there is want of care, there the natural habitat of the nurse can be found.

Writing the above “lessons” gives me a pang of imposter syndrome—a cloudy feeling of inadequacy, given that I’m not a frontline worker anymore. However, ruminating on them is like a life review, to make meaning of my 19-year bedside career and thinking, “I wish I spent more time sitting with my patients.” Or saying, “Yeah, I did well by the patients.”

As a nursing faculty, I’m fortunate to have received many thank you cards from students over the past 26 years. A common theme in these handwritten notes is giving thanks for the little things: remembering their names, being flexible with office hours, making the time for random hallway conversations, cheering them for their success, authentic listening, and introducing them to others to expand their social capital. These are actions that come naturally to me because I had the good fortune of learning them from my own nursing faculty in my fundamentals of nursing year.

I keep all these thank you cards because I imagine someday, somewhere in a long-term care facility, in my reclining years, I’ll add to my diet regimen a daily reading of one thank you card to look back, to make sense of the basics. I’m certain this will sustain me. I hear, in nursing homes, one does not live by apple sauce alone.

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