Student Scene
 Tarayn Grizzard Photo by Jeff Cleary |
Letting Nurses Take the Lead in Teaching Hands-on Care
Despite more hours than I care to count inside a hospital, I still feel weird getting my patients ginger ale from the floor refrigerator or helping them adjust their bed. It's not out of fear of accidentally not following their dietary guidelines or not being able to figure out the buttons on the bed's remote, or any of the other issues that might seem reasonable. It's just that it seems so, well, normal: of course I should help my patients with whatever they need.
Yet as a third-year medical student, I was chided (or worse) for doing so, mostly by attending physicians who reminded me each time that those were "nursing duties" and I was there to learn medicine. In spite of how "normal" my urge to help out might have seemed to me, my medical teammates made certain that I understood that doing so wasn't considered normal for medical students. The conflict made me question my own instincts when it comes to patient care and took me farther from the bedside.
Finding a Better Fit
The result, for me at least, was a jumbled sense about my role in the hospital and a lingering guilt about my own impulses to help out (feelings that are dissipating slowly over this year). As a part of my research this year, I am spending a great deal of time working as a lactation support person, which places me squarely in a most non-MD setting: the postpartum floor. Doctors are rarely seen there--sure, the pediatricians come in to round in the a.m., but they tend to change weekly and work solo and remain pretty unobtrusive. OB/GYNs also come in on rounds, but briefly, and return to the floor only for active patient issues. Nurses, who dominate the landscape, are my main professional
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I think many of us graduate without any true understanding of what our nurse colleagues do, how a hospital floor works, or what it takes to truly care for the whole patient and his or her family in the setting of an illness. --Tarayn Grizzard |
It's been a fantastic experience so far. In addition to learning even more about breastfeeding and newborns, I've also for the first time really understood how a floor works. There's the daily flow of duties and the tensions and miscommunications that occur between staff members, especially those of different disciplines. I've seen how hard some orders are to carry out and what a physician order for X may actually mean in practice. I've gotten to follow families from delivery to discharge and even follow-up at home--another job typically done by nurses--and gotten to see my patients as part of an entirely different, more holistic paradigm.
Working on the postpartum floor has been so wonderful that at times this year (admittedly, when signing for my school loans or listening to my own biological clock tick-tocking away), I've wondered if I made the right decision at all, if I might be happier and more fulfilled getting to really care for my patients as an RN. But mostly I've been impressed with the impracticality of a lot of my own education. It has de-emphasized nursing duties to the point that I think many of us graduate without any true understanding of what our nurse colleagues do, how a hospital floor works, or what it takes to truly care for the whole patient and his or her family in the setting of an illness.
Nursing's Role in Care
We rarely if ever shadow nurses, infrequently spend time at the bedside unless there's any emergency, and never stay on a floor for more than a month or two at a stretch. We are left with skills and knowledge about patient care, but little information about how patients are served in the hospital.
This lack of knowledge about nursing and nursing's unique contribution to medicine seems self-defeating given how closely our disciplines work together. And while the pressure to add more information to medical school curricula despite a lack of faculty time and financial support is certainly an issue, I can't imagine that formally and respectfully introducing medical students to nursing would overly burden medical education, particularly given the potential benefits to patients, physicians, and nurses. For students, learning how to provide care for patients could be immeasurably enhanced by medical education that allows the experts in hands-on patient care--our nurse colleagues--to lead the way.
--Tarayn Grizzard, a medical student at HMS
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.