Ok, ok, I’ll admit it.

          Since this is my first blog post, I want to come clean. I’m the girl sitting in the front row with her long, wiggling arm permanently raised. There, I said it! That wasn’t so bad. I want you guys to get to know me, just as I hope to get to know all of you over the course of my blogging for the ANA. See, setting the context to my personality (which I bet you can infer a lot just from that description alone) is going to help you understand where I’m coming from throughout this experience. I’m animated, knowledge-hungry, tenacious, and constantly doing whatever I can to get the most out of any experience placed in front of me. I feel honored to be a part of the nursing profession, and have made the choice to take each experience that comes my way and make the most of it.

                    That being said, I want to tell you all about an experience that shaped my nursing career completely. I had a patient, we’ll call him Mr. Z, whose history was notable for a left nephrectomy in 2009 (he gave it to his brother-nice guy!); he presented to us with right flank pain and hematuria. We discovered he had kidney stones, and he was one of my seven patients for that busy Tuesday. After checking the afternoon vitals, I noted that he had a mild fever of 100.5F. Nothing to write home about, but still, it had to be dealt with. I notified the provider, gave him Tylenol, rechecked his temp to make sure it had gone down in exactly 45 minutes, and finally (and perhaps most importantly!) sat down to stuff my face with a sandwich.

          10 minutes later, as I was walking at my usual abnormally brisk pace, I quite literally ran into (oops) an unfamiliar doctor. Clearly not noticing that I had just accidentally whacked him in the hip (oops again), he recognized my name from my badge and exclaimed,

"Thank god you called!" he exclaimed. "I was able to secure an OR spot for tonight,” he continued.

“You can never be careful with patients like these. When my outpatients like him have kidney stones

and want to ‘grin and bear it’ at home, I always tell them to meet me in the ED if they spike.”

…What?

          Apparently not noticing the blank look on my face, he proceeded to give me a firm pat on the back and walked away, leaving me standing there, utterly confused. What on earth was he talking about?

          A few minutes later and I got it. When I had paged the Medicine team about the (what I thought was a very) low-grade fever, they had, in turn realized the severity of the situation and contact urology immediately. Since I was the one who had discovered said fever, I guess that made me the hero of the hour? Here’s the thing, though- I didn’t get why  I was the hero.

And that was a huge, scary problem.

          As I thought back to what had a happened, I realized that I had done nothing wrong. I had done everything just as my hospital’s protocol dictated; I noted the fever, called the provider, administered Tylenol, rechecked said fever, and documented perfectly. But what the hospital policies don’t tell you is to think of the bigger picture, which, of course we should always be doing- but when you have seven patients, and haven’t eaten in roughly the same amount of hours, that’s sometimes difficult to always do. And that’s exactly where I screwed up. I let an interaction become mindless, and didn’t see the bigger situation. What I did in that situation is what I would have done in any situation for a fever. What I didn’t do is think about what that fever meant for that patient. And then I realized- I had no idea. And that scared me.What if it wasn’t just that you were rushed, but that you just didn’t know?

          So, I did what any normal six-month old baby nurse would have done (ok, please keep in mind that this is the annoying person in the front row)- I walked right out to an attending that looked friendly enough, and said,

“Hey. Do you want to start an education program with me?”

          And so began a two year whirlwind of brainstorming sessions, staff recruitment, nursing involvement, and flying to much sunnier places than where I currently live to present this program at conferences across the country, all to display this idea that had come from a patient interaction that had really stuck with me.

          The point of this blog post isn’t to shamelessly  promote my program; it’s to present an interaction that is an example of how simple it is to do something to promote change in your workplace. I happen to work at an incredibly nursing-supportive, Magnet-designated institution that is constantly looking for performance improvement ideas. It’s not because we are doing so terribly that we have to dig ourselves out, but because there is always room to improve and modify areas that aren’t working so well. Even in a horizontal, spread out democratic nursing society, bedside nurses aren’t the ones signing the checks and making the multimillion dollar decisions that govern our hospital system- but that doesn’t mean that we can’t be a part of it. It’s our job to be the scouts on the front line, to be the eyes and ears of the administrators whose job it is to make those important changes. We can’t be frustrated with decisions our hospital systems make for us if we have done nothing to tell them that they should act otherwise.

Now we get to the real crux of this post: to encourage you all to do more.

          Yes, even you, who could be anyone from two weeks fresh on the job to five years and on your way to becoming an expert in your area. We're all tired of being yelled at because our monthly HCHAPS are low, when we genuinely are trying our hardest. At the same time, while each and every one of you signed up to become a nurse, for some people, performance improvement may not be a huge part of that. But that fact is, we signed up for a career where we must be on top of our game at all times- that’s just the nature of the field we work in, and the direction our government has led us in. And when there comes a point where we are seeing a problem and doing nothing about it, we are potentially endangering our patients and ourselves. That’s why taking the initiative to make a change is so important.

Sometimes, you just need to take a step back and think of ways to create change, instead of trying to fix what may already be broken.

          If that reasoning still isn’t doing it for you, let me present one more: do it to stand out. There may be a point in your career where you want to make a move, and nursing is like any other industry where a diverse resume is important. From the employer’s perspective, having experience in problem solving in the setting of group meetings, being on a committee, and taking the initiative to create a project to spark change shows that you’re not just any old employee. You’re giving the message that wherever you work, you’re invested in making it better, and even at the best hospital, there is always, always, always room for improvement. I’m giving you permission to be selfish here; think of your future, and what would attract different employers.

          Creating change is a topic I could clearly discuss for hours. But for now, I’ll leave you with this: just start to notice things at your workplace that could use a tune-up. I’m not talking about a slow computer or leaky sink, but more so about old rules and policies that need to be tweaked to accommodate your daily practice. Or, perhaps rules don’t exist where they should, and you see unnecessary problems arising from a place that no one really thought much about before. Talk to your co-workers; don’t expect them to spill out a numbered list of things that need to be changed (although some might!); instead, consider setting up a suggestion box, so people have time to think about it and won’t feel afraid of being stigmatized for their ideas. Once you’ve met with your team about it, see if there are any hospital or practice-wide committees that would appreciate a project like yours (ex: patient safety, quality, etc). Having broader input into your plan will give you give you diverse options, and will allow your to network with other professional areas of your hospital that you may never before have been exposed to.

          It doesn’t matter where you are in your career; I can say, without a doubt, that each and every one of you had come across an aspect to your practice environment that could use a change. Complaining to co-workers certainly has its place, but use that time to figure out a solution. It’s easier than you think to spark change- and you don’t have to be the annoying girl in the front row to do so.