Teaching others the "why" or what we do

AORN Journal,  July, 2005  by Sharon A. McNamara

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In Eastern European Carpatho Rusyn countries, individuals decorate eggs as an art form. This handcrafting tradition, known as Pysanky, is similar to Eastern Indian batik, which is a decorated type of cloth. Pysanky artists from different villages develop favorite patterns and colors that identify their village and reflect meaning for their area. The instrument used is a straight pin, and the medium is melted wax applied with hundreds of strokes on each egg. The egg then is dipped in several dye baths, the wax is removed, and the result is a beautifully decorated symbol of tradition and culture.

Eggs are a universal symbol of life, and like eggs, life is fragile. As perioperative nurses, we experience the fragility of life daily. We are entrusted to be as creative and caring with our patients as the Pysanky artists need to be with the fragile eggshells. We are expected to make a difference in each patient's quality of life. I believe we are very good at caring for our patients, but I think we often neglect ourselves and our colleagues, and at times, we actually can be abusive to one another.

TOXIC NURSES

I would like each of you to think about how you use the art of nursing to nurture your colleagues at work, your fellow AORN members, other professionals, and your future successors. Ask yourself these questions.

* Are you seen as one of the experts in your unit or chapter?

* Are you often approached for information, guidance, or a sympathetic ear?

* Are you someone who will help and not judge?

* Are you someone who remembers what it was like to be a graduate nurse or just-hired staff member, overwhelmed with the newness?

* Are you the super nurse who has all of the formal and informal information, is considered highly competent, knows the politics of the unit and facility, and thinks that everyone should have gained all needed knowledge and skills by assimilation after the first week?

If you are one of this last type of nurse, I want you to know that you are toxic to the nursing profession, and I implore your colleagues to stop accepting your behavior because you are such an "excellent nurse." Toxic nurses are not excellent nurses. They do not create a positive environment for providing safe patient care. It is time to educate them about their attitude and performance and make them accountable for the negative culture they create.

Every student, new nurse, and potential nurse (eg, surgical technologist, patient care aide, instrument room technician) should be treated as if he or she is the Pysanky egg, and we are the artist. We need to stroke our replacements with knowledge, skill acquisition, and caring practices. As artists, we must model behavior that is expected to create an environment for safe patient care and safe practice for the nurse. The members of Generations X and Y will not tolerate the school of hard knocks or baptism by fire methods. They simply will leave, and they have a plethora of other options waiting for them. Stop thinking that because this is the way you were treated, you must perpetuate a disrespectful, abusive way of learning. Research has demonstrated that we do not learn under these circumstances.

BREAKING DOWN THE STEPS

How do you interact with an orientee? Orientation is an ideal opportunity to teach what you do as a perioperative nurse to provide optimal outcomes for your patients, not just to the orientee, but to every person in the OR. Show them how you make a difference. Verbalize what you are doing and the assessments you are making.

For example, one of the simpler routines nurses do with every patient is prepping the surgical site. Tell new nurses about the antimicrobial properties of the antiseptic you are using (eg, microbial kill times, cumulative effect). Discuss the patient's allergies and what foods might signal a potential reaction to the prep (eg, a shellfish allergy may indicate the patient will have an allergy to an iodine prep). Describe the correct process for pouring the prep solution into a sterile container without contaminating the sterile field. Allow the new nurse to do the pouring; it is a simple skill that can build confidence.

Verbally assess the surgical site. Are there any abrasions? Is hair removal necessary? Be sure to discuss why to use clipping not shaving for hair removal. Is it a clean site, or is there a dirty area like a colostomy involved? Discuss the importance of preserving skin integrity and preventing injury to the skin. Use diagrams from your surgical skin prep policy or a textbook to show the area to be prepped. Always accentuate patient safety aspects, such as fire hazards or chemical or cautery burns.

Apply drip towels and note that their purpose is to prevent pooling of the prep solution under the patient, which creates an opportune environment for chemical or mechanical burns. Remind the new nurse that the towels need to be removed before the patient is draped. Demonstrate the proper method for the prep by starting at the incision site and working to the periphery. Do not go back over what you have prepped. Discuss how important it is to have the prep solution dry completely before you drape the patient to prevent vapor build up and the potential for a fire if an electrosurgical unit is used.