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This one of a series of blog entries on the interface between nursing school and work. Every new grad needs to make the big leap. Past blogs have addressed issues of resumes, cover letters, etc. Future blogs will address issues of how to make the transition to critical care. You are invited to subscribe. Click HERE and enter your email address to subscribe.
Worked at McDonald’s, ever?
Nursing school admission is competitive these days, and you need to have a good GPA in order to get a seat in the class. There is a difference between the nursing students from ten years ago, and the ones nowadays. When studying is the main goal to the exclusion of everything else, it’s less likely that the student has had a part-time job outside of school in the past, not even at a McDonald’s.
This means that when we teach beginner nursing students, we also need to teach them about work behaviors. Oh, I believe in focusing on the illness the patient is experiencing, but the faculty would be missing something important unless we spent time saying what it means to have a job and be part of a team. Nursing is labor intensive and twenty-four hours a day seven days a week.
Unwritten rules for any job
The odd thing is that there is always a set of unwritten rules, things that are so common-sensical that a person who has been in the workforce takes them for granted. But when I have a kid who is just twenty years old and not had a time-clock type of job, I go over “The Rules.”
Nursing is eclectic, and draws from a wide variety of sources for inspiration. Don’t disrespect McDonald’s – it’s the entry-level job for many a sixteen-year-old around the USA - they teach people how to have a job.
The Few, The Proud, the Brave
You may laugh, but there is another large organization in USA which has been around a long time, and which has gained a lot of experience giving responsibility to young people. They hire a lot of eighteen- to twenty-year olds every year, and teach them how to behave at their first job. And so, I have borrowed the minimal job description from them. It’s – The United States Marines. Every Marine is required to memorize a set of Rules during boot camp.
Here is the Job Description for a sentry in the Marines:
“The Rules”
• 1. Take charge of this post and all government property in view.
• 2. Walk my post in a military manner, keeping always on the alert and observing everything that takes place within sight or hearing.
• 3. Report all violations of orders I am instructed to enforce.
• 4. To repeat all calls [from posts] more distant from the guardhouse than my own.
• 5. Quit my post only when properly relieved.
• 6. To receive, obey, and pass on to the sentry who relieves me, all orders from the Commanding Officer, Officer of the Day, Officers, and Non-Commissioned Officers of the guard only.
• 7. Talk to no one except in the line of duty.
• 8. Give the alarm in case of fire or disorder.
• 9. To call the Corporal of the Guard in any case not covered by instructions.
• 10. Salute all officers and all colors and standards not cased.
• 11. Be especially watchful at night and during the time for challenging, to challenge all persons on or near my post, and to allow no one to pass without proper authority
Let’s break them down one by one and comment on what they mean when they are applied to a nursing unit.
1. Take charge of this post and all government property in view.
Be on time, and be very specific about which patients are yours and which tasks you will or will not do. Introduce yourself to all other persons present and communicate.
2. Walk my post in a military manner, keeping always on the alert and observing everything that takes place within sight or hearing.
Don’t sit down on the job, make frequent rounds and check on things regularly. Don’t lose sight of the Big Picture.
3. Report all violations of orders I am instructed to enforce.
Learn what the orders are in the first place, and have a plan for every “order” whether you understand it or not. Know who to call when you need help.
4. To repeat all calls [from posts] more distant from the guardhouse than my own.
Help the people around you as much as you can.
5. Quit my post only when properly relieved.
Don’t ever leave the floor without telling anybody. Don’t go to the rest room without telling anybody. Don’t hand off a pateint without giving a report as to how your day went. Always share information.
6. To receive, obey, and pass on to the sentry who relieves me, all orders from the Commanding Officer, Officer of the Day, Officers, and Non-Commissioned Officers of the guard only.
see report, above. check in with your nurse frequently in case the “orders” change.
7. Talk to no one except in the line of duty.
don’t use FaceBook on the job. Turn off the mobile phone. Keep frivolous talk to a minimum.
8. Give the alarm in case of fire or disorder.
Have a CPR card, get help when you need it.
9. To call the Corporal of the Guard in any case not covered by instructions.
This is about teamwork and communication. Ask questions when you don’t understand something.
10. Salute all officers and all colors and standards not cased.
Your faculty member, the staff, the housekeepers, every one else who works there – deserves your respect. If somebody tells you anything, write it down and try to follow it. Yes, there is a pecking order, but that does not mean you should disrespect those who might be further down on the hierarchy. You can not do your job unless the housekeeping staff does theirs!
11. Be especially watchful at night and during the time for challenging, to challenge all persons on or near my post, and to allow no one to pass without proper authority
pay attention to the activities of the patient even if they do not involve you directly. who is seeing your patient and what are they contributing.
Read them, Learn them, live them
Sometimes I am met with incredulity when I talk about these rules with beginner students. They ask “how can this be? aren’t nurses independent professionals?” They are surprised to learn that there may be any regimentation in nursing. The answer is, we need to have structure and a plan in order to accomnplish anything great. An experienced nurses makes all his or her activities look like they just unfold naturally and there is a sense of flow; but there is an underlying structure, always.
I suppose that discipline gets a bad rap when the indoctrination is mixed up with intimidation, such as the stereotype of a Marine Corps Drill Sargeant would present. Nursing education is conducted with a lot more finesse than a USMC boot camp.
The fact is, we all need to work together as a team, and nobody will give you more responsibility unless you have shown that you can deal with the simple responsibilities. As Atul Gawande and others have described, sometimes excellence is a question of diligently working on the same thing every day and having good habits.
Joe Niemczura has been an RN for 32 years, split evenly between adult critical care and teaching. He is the author of the book “The Hospital at the End of the World.”
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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