CASE


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“I have a question for you.” I sat at the computer charting in the electronic medical record and had not heard Allison approach.

“Ok,” I turned in the chair to look her in the eye. “What is your question?”

“I have a patient with a long medical history. Diabetes, high blood pressure, heart disease. He’s had 2 cycles of chemo and was admitted with a fever. He gave a list of his meds to the doctor, but he forgot to mention 1 or 2, so they didn’t get ordered. Do you think I should call the doctor now, or is it okay to leave a note for him?”

What was the communication challenge in this interaction? What mattered was less about my answer and more about the question asked. Much of nursing practice evolves from experience itself. The action of asking a question, of making ourselves vulnerable by showing what we don’t know, should always be applauded. Creating an environment where it is safe to ask questions—even when it seems like the answer is obvious or the knowledge base for assessing the situation should be there—is vitally important in the nursing practice.

There is a saying, “There are no stupid questions.” I’m not sure that is wholly true. But some of the questions I hear are surprisingly uninformed. When you don’t know the answer, ask for help or clarification. That is the smart choice—far smarter than being afraid to ask and far smarter than pretending you know when you don’t.

I turned to Allison and asked several questions:

“What might happen if you don’t call the physician and you wait?”

“Is it safe to wait until tomorrow?”

“What might keep you from or make you hesitate to call?”

We then went through the patient’s med list and figured out which ones were missing. As we did, she was able to answer her own question. Just as it happened with my mentor, hearing it out loud brought clarity for Allison.

What does a question have to do with failure? There was no failure on the part of the question that Allison asked, but there was anxiety and uncertainty. There was a mental stalling out—a questioning of her knowledge. How do you know when you aren’t yet confident in your practice?

Allison looked embarrassed as we went through the critical thinking of decision making. As I watched her shake her head at herself, I offered a different story for her.

“Have you ever driven a stick shift car?” She shook her head no.

I wasn’t surprised, as there aren’t as many manual transmission cars as there used to be. When my kids were learning to drive, we had an older car with a stick shift that they learned to drive on. Mastering a stick shift when you are learning to drive adds an extra degree of difficulty. Throw a hill into the mix and it becomes even more challenging. For anyone reading this who hasn’t driven a manual transmission car, you have to shift the car and work the clutch at the same time, and when you shift on a hill, it is a tricky balance to keep from rolling backward. If you release the clutch too quickly, the engine stalls. One day my son wanted to drive me to the store so he could get more practice driving. It was only a mile away but it was downhill, which meant the return was uphill. As he tried to finesse the clutch, he stalled out repeatedly. The usually short drive home took us 30 minutes. In utter frustration, he rested his head on the steering wheel, “I am so stupid! A complete failure!” But I told him, “Think of it this way. You have to stall out 500 times before you master driving with a clutch. And you just checked off 100.”

At this point in the story, Allison took a deep breath and relaxed.


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