5 of the most important lessons medicine nursing has taught me
Does anyone else get reflective around big congresses and veterinary events? I absolutely do!
At the time of writing this, I’m just home from the British Veterinary Nursing Association congress. I was honoured to be invited to speak this year, and it got me thinking back to my student nurse days. I remember attending BVNA, and looking up in total awe at the speakers - with absolute certainty that I would never be able to do that.
Fast forward quite a few years, and my career is in a place I never thought possible. I just didn’t think there was much opportunity for VN progression back in those days - I literally thought my career would go something like this:
Qualify
Work my way up to head nurse
Become a rep
Retire.
Sound familiar?
My medicine nurse role was something I NEVER thought I’d do - I didn’t even know such a role existed! But I’m so glad I found it, because it has taught me SO much. And not just clinically - but about how to deliver great care, work with others, and it’s taught me a lot about myself, too.
In this post, I’m bringing you the 5 most important lessons I’ve learned from my medicine nurse role. I promise they’ll apply to you too - and I hope they help you get more from your career, and help you to give the best care possible!
PS - If you want more tips, tricks and lessons when it comes to medical nursing, I’m putting on a free workshop on November 14th! For more details and to save your spot, click here.
Lesson One: Advocating for your patients is key
We always hear in social media posts, or VN columns, just how vital our role as advocates for our patients is. But if I’m totally honest, I don’t think I really ‘got’ what this meant until I began medical nursing.
Perhaps it was because I felt more responsible for my patients, as I followed specific patients from admission, through the hospital, and to discharge.
Perhaps it was because I got older and wiser.
Perhaps it was because I was dealing with complex diseases and began recognising what my patients needed more.
Perhaps it was because I trusted my gut and didn’t listen to self-doubt as much.
In reality, I think it was a combination of all of those things. A lightbulb went off, and I realised - we are the voice for our patients. It’s up to us to recognise what they need and ask for it.
There are LOTS of different ways we can do this - for example:
Advocating for additional analgesia or a change to the patient’s analgesics if they are painful
Advocating for using local anaesthesia prior to or during procedures
Advocating for anti-emetics in a nauseous patient
Advocating for a feeding tube in an anorexic patient
Advocating for a urinary catheter in a recumbent patient
Advocating for an IM premed in a stressed patient who would need forceful restraint for IV access
Advocating for a central venous catheter or sampling line in a patient who needs lots of bloods, or has difficult veins
Speaking up if something doesn’t feel right to you
The biggest piece of advice I wish I had heard as a student is to trust your gut, and don’t be afraid of speaking up. I spent a lot of time scared to do this, when I could have been helping more of my patients instead of doubting myself. What was I worried about? Being wrong. And the reality is that’s not the end of the world.
So don’t be afraid to speak up for your patient’s needs, and to trust that nursing intuition - it’s rarely wrong!
Lesson Two: Patient safety is paramount, and we all have a role in it
Patient safety is a topic that has become more popular in the last few years. It’s vital - because we’re human beings, and (though it can be tough to admit it) we’re not perfect!
We’ve all made mistakes in practice. From forgetting to do something (often because our mental ‘to-do’ lists are growing by the second) to miscalculating drugs, to picking up the wrong bottle of something… the risk to patient safety is always there.
Everyone, regardless of their role in the hospital, needs to work together to minimise this risk. And this is one area where we can really lead the change as nurses.
From enforcing the use of checklists prior to and after procedures, to double-checking drug calculations, bottles and IV fluid bags, to developing and reviewing SOPs… There is a lot we can do to reduce the risk of error, in turn improving patient safety.
It took me a long time to realise that double-checking, or making an error, didn’t mean I didn't know what I was doing. And now I want people to double-check me - because I know that when I’m running around the building, doing 348325435 things and being asked just as many questions, I can’t expect my brain to keep up!
Lesson Three: There is no such thing as over-communication
If there’s one thing emergency medicine will teach you, it’s the importance of communication.
Ever been involved in a really chaotic emergency? Or a crash? Where tons of people are all trying to say things at the same time and you’re not quite sure exactly what’s going on?
Yup. The key to managing these situations is with effective communication.
There are three communication skills I have found particularly useful with high-pressure procedures, situations, or when dealing with challenging cases. They are:
Closed-loop communication
Closed-loop communication is where you repeat back the instruction given to you - it’s a really effective way of making sure you’ve understood the instructions as intended. And the rest of the team then knows exactly what you’re about to do, too.
Top tip: If you’re giving the instruction, make sure you use the person’s name - it’s an easy thing to overlook, and makes a world of difference especially in an emergency!
Situational awareness
Situational awareness is keeping an eye on what everyone else is doing, as well as the task you are performing. The idea is that error prevention is everyone’s job, not just the person giving the instruction, or the person carrying that instruction out. If you notice someone doing something ‘wrong’ (for example breathing too quickly during a CPR attempt) let them know.
Communication structures
There are several communication structures we can use in practice - these can be especially useful for getting information across quickly in an emergency, and for things like rounds or patient handovers.
These work best when they are used consistently and by the entire team, as the more familiar you get with them, the quicker and more effective your communication will be!
Lesson Four: Don’t be afraid to ask to do things. It’s the best way to get more hands-on
I can’t tell you the number of times I wished I had done this.
When I was a student, I never did this - I sat and watched the other SVNs do the bloods and IV catheters, doing enough to get me through my portfolio, and that was about it.
Six months after qualifying, I went to a surgical referral centre as (mostly) an anaesthesia nurse. I had placed a handful of cephalic IVs, and no saphenous catheters. I felt so out of my depth.
If you want to do more, ask. It is absolutely the best way to do more practically, and it’s not as scary as it seems!
Not intubated anything for a while? Worried your skills are feeling a little rusty? Tell your vet and ask if you can intubate the next case you’re working on together.
Want to learn a new skill? Tell your team and ask if you can do the next one.
Better yet, get your team together and make a list of the common skills you perform in your hospital/department - then tick off when you’ve done them. This way they can be shared out between members of your team. I’ve just done this with our medicine nurse team, to make sure fun things like central lines, feeding tubes, nerve blocks and arterial samples are being done by everyone!
And if you’re working with a nurse on something they’ve not done before, encourage them to have a go! I get just as much from teaching my team and watching them nail a new skill, as I do from performing that skill myself - it’s all about collaboration!
Lesson Five: Work WITH your vets, not FOR your vets
Speaking of collaboration, this last one is so important.
It can be easy to feel like there is a real Vet > Nurse > Support team hierarchy. Yes, we have to work under the direction of a veterinary surgeon. Yes, there are certain skills and tasks that they legally have to perform and we cannot.
But that doesn’t mean a clinic has to have a vet > nurse hierarchy. It’s all about working together, vets and nurses, to provide the best possible care for our patients. So don’t be afraid to speak up if you’re concerned about a patient, suggest nursing interventions and treatments you think the patient would benefit from, and ask questions!
Don’t forget to remind your team how the nurses can help them, too! There’s a lot we can do to increase our skill set, whilst removing some of those non-vet-specific tasks from our colleagues’ plates.
So those are my 5 top lessons medicine nursing has taught me. How to advocate for my patients, communicate effectively, reduce risks to patient safety, work with my vet team, and perform more skills.
Really, a lot of this boils down to one thing - trusting yourself. Trust yourself to know what’s best for your patient. Trust yourself to ask for more from your career. Trust yourself to know that mistakes happen, and they don’t mean you’re a bad nurse. And trust yourself enough to know you make a huge difference for your team, and your patients.
If you want to know more about the skills you can develop with your medical patients, don’t forget to join me on November 14th for the free workshop. And if you can’t make it live, there’ll be a recording for you to catch up on, too! Save your spot here - and DM me on Instagram to let me know you’re coming!
