Does my experience make me look lazy?

In an amusing article a few weeks ago, another Scrubs contributor pointed out the things that differentiate a new nurse from an experienced nurse. The line that caught my attention—and garnered the comment “This list makes me look lazy!”—was this one:

“A new nurse will spend two hours giving a bath. An experienced nurse will ask the CNA to give the bath.”

Lordy lord, how that brought back memories. I distinctly remember rushing around as a new nurse, looking at the more experienced nurses on the floor, as they did crossword puzzles or caught up on other work, with a mixture of confusion and resentment. Was I slower because I was a better nurse? Were they better nurses because they were faster? Would I ever get to the point where I wasn’t chasing my own tail on the floor?

Those feelings came back when I transferred from an acute care unit to the critical care unit, and again when I transferred from surgical critical care to stroke-focused care. This time, though, I knew something I hadn’t known at the start: that experience does make a difference in how fast you move and how efficiently you get things done.

Take the bath example: It wasn’t long before I realized that not only was I not as good at bathing a patient as our techs were, but it took me longer. The job of bathing patients was something I delegated early on, because, frankly, either a tech or an RN can bathe a patient, but there are some things only an RN can do. And if you’re not as good or as thorough as somebody who does it every day, why kill yourself trying to prove that you can do it badly? (There are exceptions, of course, but as a rule, if you’re not as good as a specialist at something, it’s best to let the specialist handle it.)

Honestly? I didn’t get good at bathing patients until I worked overnight in the CCU. Baths there were done at night, and I’d generally bathe both my patients by myself and then help out on a couple more. Repetition made the difference in terms of both skill and speed.

Another example: Nurses routinely double-check the drug calculations for critical-care titrations. I learned pretty fast that my talent for doing fractional math in my head was a benefit not only for me, but for other people who had to get out a calculator, pen and paper, an abacus and the higher maths department of McGill University to manage a dose conversion. I’d double-check their titrations and sign off on the paperwork, and they’d do things for me like check vent settings or double-sign settings on the dialysis machines. It saved everybody time and played to our individual strengths.

The point is this: If you are bad at something, it’s worthwhile to practice until you get good at it, but remember—there will always be somebody who can do it better or faster or more cleanly than you can. Likewise, if you have a talent, make that talent freely available to others in exchange for their exercising their talents on your behalf. That practice will save you whole minutes of time on the floor.

Another lesson that comes with experience is learning to let well enough alone. If a patient is able to walk safely to the bathroom by himself, you don’t have to be there every single time he gets up. You can use the time you’d spend with him to walk the hip-replacement patient or make sure the dude with the occipital stroke is eating enough. Likewise, people who got two pain pills 45 minutes ago are probably already asleep: A quick check on their pain level is often enough (our pain-assessment tool even has a box to check for “patient sleeping; left undisturbed”). And the person with specific focal deficits from a brain injury who is otherwise stable doesn’t need to be put through an entire neuro exam every two hours; focus on what’s likely to change instead.

Again, with experience, you’ll learn what can be done quickly and what takes a little more time. You’ll also learn what to focus on and what’s important when it comes to warning signs. All of this makes you more efficient as a nurse, and therefore faster.

Finally, a word about charting: It’s true that new nurses chart “too much”—that is, they double-chart things that other people have already put in the medical record. Computerized charting makes it easier to figure out what you can leave out; for instance, if a doctor has charted that she was at the bedside from 10:30 to 11, you don’t really need to make a note that Dr. Feelgoodette was at the bedside from 10:30 to 11.

It’s also true that experienced nurses “don’t chart enough” in most cases. Findings that are normal to an experienced nurse but that might be worrying to the patient often aren’t charted as normal, or at all. Likewise, things like transport services and tests done fall by the wayside. Again, as you gain experience, you’ll learn what you can not chart and what you cannot fail to chart.

Eventually you’ll get there: to the point where you have a little extra time to do comfort care or sit and listen to a patient, or joke with the family. Eventually you get enough experience to be able to puzzle over that six-letter word, starting with “a,” that means “two of a kind.” It doesn’t mean that you’re lazy or better or worse. It just means that you’re more experienced.