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Part I – Challenges in the Real-Life Clinical Setting

The clinical skills and science learned in the classroom are invaluable for the healthcare workplace, however, it is the soft skills, the art behind the science, that often needs to be applied in the clinical setting as well.  For a real example given to us by one of our graduates, please continue reading.  We will outline the issues that our graduate faced and describe how they continue to work and progress through these factors that impact patient care in a two-part blog series.

One of our nursing students who is now is working in a hospital in Dhaka, began working in April 2015 as a cardiac nurse and was later promoted to the position of Joint-Nursing Superintendent in January 2016.  She has expanded upon her skill set since graduation and has experienced a variety of both triumphs and tribulations. 

She writes, “I was excited to start my position as a cardiac nurse and was eager to work with both new and old colleagues within our ward and other wards.  Since ours was just a four-bed ward, we had a smaller workload in comparison to the other wards.  Nevertheless, it would be so hectic when 4 patients came at once for coronary angiograms!  We had plenty of time to apply the pragmatic knowledge we gained from IUBAT in practice – it made us stand out from the crowd.  We got a lot of compliments from the patients we cared for, from those who were undergoing the coronary angiograms, to the critically ill patients from the Critical Care Unit.  Our patients used to say that they would wait for us to start our shifts during their hospital stay.  The majority of the patients who were stable and getting moved to other wards used to demand for a spot in our ward; they remarked especially on how professional our ward was.  To this day, we have had more than 60 patients who have waited for hours just to say hello to us while they are in for a follow-up.  It really made me proud of myself!

While I was at bedside, I had many experiences that conflicted with my expectations that were formed during training.  I explored many ethical dilemmas and learned by being a curious observer and keen investigator of the physicians and nurses.  Some were very encouraging of our curiosity, but unfortunately, some preferred to neglect.  With Professor Karen Lund’s encouragement, however, I persisted.  We new nurses had many adjustment problems: physicians questioned our use of the stethoscopes, the need for our thorough assessments, and the senior nurses resented that the patients preferred our care.  Because of the intertwined nature of the nursing care, however, it was especially challenging to manage the attitudes and behaviours of the other nurses.  It was very difficult to work alongside some of the senior nurses, some of which had little respect and confidence for our methodology.  At the end of the day, we had argued, we had conflict, but we eventually accepted one another and finally, we mingled.  I learned skills, I developed confidence and I stood firm to my beliefs.  It became easier for me to initiate new ideas and standards once I felt “a part of the team”.

All the while, we were gaining the attention of higher management and the chairperson would often call me for help with translation and special tasks.  Soon after that, I was given an offer letter informing me that I had been selected for interviews for the post of nursing supervisor.  Initially I declined, but they insisted that I at least sit for it.  I did get promoted, however, to joint Nursing Superintendent, not supervisor!  I gladly accepted the job, but was so worried about my duties and responsibilities.  For the first few months, I was totally lost and felt horrible because nothing was clear to me.  I did not receive any guidance nor did I understand what my duties and responsibilities were because the previous Nursing Superintendent had resigned from the post a week before I was appointed.  I faced a worse problem than I had expected; looking after a ward and after an entire hospital was wholly different – I was bearing a huge responsibility.  To complicate matters, my reporting supervisor was not very cooperative; however, I got two newly appointed supervisors as helping hands shortly after.  Though I was well acquainted with this hospital since 2014, I saw things so differently the day after attaining the higher position.  That day I realized that a lot of things have to be changed.  I, along with my team, had to work so much to make things better.

There was chaos in every ward due to huge communication gaps between co-workers. Every day I used to go on rounds and see the things that I never saw before.  There was no proper handover system (which always creates a major challenge in quality care), no use of aseptic techniques for any procedure.  The patient ethics, rights, privacy and confidentiality seemed to be optional, and would take years of training to achieve.”

This graduate wrote to our faculty for recommendations and tips to help ameliorate the problems that she saw in the hospital in regards to nurses and their practices.  Tasked with improving operations, there were many aspects that she needed to work on, but it is always a difficult task to change fully entrenched patterns.  Nevertheless, with the goal of better patient care in mind, it is a worthy endeavour.  In our next post, we will revisit this case and reveal the progress and changes that have occurred at this alumna’s hospital.

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