By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.
There I was, orienting to a busy medical ICU, perplexed over a bedpan. You’d think, since I was just graduating from nursing school, that bedpans would be my area of expertise. Critical thinking and vent strategies came easy; how could I possible admit I had no idea how to give a bedpan to a patient?
Frightening, to graduate from nursing school and a competitive externship program without this competency. Somehow, though, every unit I’d experienced offered patient care assistants, or patients who didn’t need this age-old tool. I’d certainly helped patients to the bathroom and cleaned incontinent ones. Despite the barrage of clinical learning, the basics of offering the pink plastic tool hadn’t sunk in.
Paralyzed, I stood with it in my hand, looking at my intubated, awake patient. I’d had the wherewithal to ask the family to step out, but couldn’t figure out which end went first. The horror of my preceptor finding it backwards would end me. Did the pointed end go towards the patient’s back? The larger end toward the feet for better coverage? Why couldn’t I remember?
Somehow, I managed to decide, and with heart racing, I urged the patient: “Turn to the side!” We both grimaced: I grasped the bedpan with one hand and his right hip with the other, while he reached towards the opposite side rail. His body, heavy with fluid, resisted my timid and inexperienced grasp, and he rolled back onto his back, without bedpan.
My preceptor, just passing by, or discreetly watching from her secret post behind the curtain, arrived just as I was about to start my second try. From the opposite side of the bed, she pulled his body towards her and I placed the bedpan where I thought it should go, praying to the ghost of Florence Nightingale that I’d positioned it right.
If it hadn’t already been so, this experience made it clear to my preceptor that, while I was confident in my nursing knowledge, my skills weren’t up to snuff. Instead of choosing a final clinical placement in a med-surg unit or intensive care, I had opted to spend my senior year working in public health. When I decided that I wanted bedside experience before specializing, I figured I’d just pick up what I missed on orientation.
For some reason, understanding when to intubate a patient came easily, but giving a bed bath? Terrifying. In our unit, we had no patient care assistants, and my preceptor’s goal was to teach me how to perform all patient care without any help. “I don’t want you to do everything by yourself all the time; I just want you to know how to do everything by yourself.”
So, we started slow: I’d begin the bath, washing the front, and then I’d call for her help as soon as trouble hit, or I needed to turn my patient over. But before long, I would be finished before she could even come to check on me—bath, turn, primp and all. Soon, bedpans stopped scaring me, and neither did feeding patients, readjusting bipap masks, emptying foley bags, or primping pillows.
A lot of basic nursing tasks are pretty logical to figure out. A bedpan is shaped like a toilet seat; it would be ridiculous to position the narrow end towards the back. Bed baths are actually chances to slow down and fully assess your patient’s every mole, wound, and toenail. They’re also a great chance to chat and make people feel human in a sterile, cold environment. Even intimidating skills like IV insertion can be practiced and learned until they are anxiety-free procedures for both patient and nurse.
But the hardest thing to learn when we’re first starting out is that these tasks of care are not lists to be followed or steps to be taken. In school, we practice them in unison and in the same order, but real life has a funny way of adding unique twists to their course. Flexibility and an ability to tailor each uniform task to a unique patient is part of the process of grasping basic nursing skills.
While delegation of these tasks is sometimes appropriate, we must not avoid them. Nursing at its finest is the stuff of bedpans and bed baths. These are the moments when our patients feel our intentional touch, rest under the gaze of our watchful eye, and know the quality of our care. Years later, I realized that the lesson my preceptor taught me—to be fully self-sufficient—was simply a cover for her belief that the littlest tasks can be the most important.