Integrity & Clinical Judgement: You Can’t Buy it at Walmart

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Price check on integrity, please.

I’ve always been an advocate for my fellow-man. I expect the most out of humanity and do my best to remain optimistic in most situations, especially those involving innovation and technology. But it happens, more often than I’d like unfortunately, that my fellow-man disappoint me in their lack of effort to rise to a challenge.

Nurses Are Human Too

Unfortunately, nurses are human too. Well, it’s not so much unfortunate that they are human, as much as it that humanity has flaws. We are not perfect. Even nurses are not the angels in comfortable shoes that we are often painted as. Many of us are. I would argue that most nurse are compassionate, caring, smart, critical thinking, awesome specimens of human beings that want the very best for their patients. I strongly feel that most of us see the bigger picture in the care we provide and the work that we do. For us it’s not just about a paycheck.

…Just Come Here to Do Their Job

My former nurse manager often had conversations with me expressing that “some nurses just come here to do their job and that is all.” I was also so flustered by this. I could never grasp why she didn’t want to set the bar high and ask nurses to rise to the challenge. Did she not have faith we could do it, or was sure convinced after so many years in healthcare that we just wouldn’t do it?

Nurses Who Rise to the Challenge

I’ve met many nurses who rise to the challenge daily. They rise and meet the challenge, take it out to dinner, and show it around town. They go above and beyond the call of duty. This is their routine. It’s not out of the ordinary for them to do more than what is asked of them, and they are often frustrated they cannot do more.

I adore these men and women. They’re an inspiration to nursing and proof that my optimism and faith in mankind are not unjustified.

Bare Minimum Nurses

However, there are those nurses who are there to “do their job.” Any detail that should be documented, any task that must be accomplished, or any goal that is the be attained has to be spelled out clearly and often written in a policy. When changes come down the pipe they are the ones who make statements like “I won’t do it until the boss tells me herself I have to.” They stifle growth and innovation healthcare and they do not go out of their way to improve patient care. They do the bare minimum and often complain the most.

These are the nurses that I don’t want to work with. These are the nurses that the nurse informaticists dread because you know they are going to challenge every potential improvement or modification to the EMR. They are thorns in the side of healthcare because they forget the bigger picture. They are selfish and closed-minded.

Wisdom From a Director of Nursing

So when I had a conversation once with a DON about an improvement in the EMR, and an enhancement to patient care that would benefits all levels of the clinical team, her biggest concern was with whether or not we could require a nurse and a physician to document something. I hate mandatory fields on clinical assessments in most cases. They cause delays in workflow and irritation among all who are subjected to them. They are a cruel form of punishment to diligent and prudent clinicians. So my response was that nurses and doctors should have integrity and use clinical judgement in their documentation. Her response was “They don’t sell that at Walmart.” I don’t believe I had ever heard it put so clearly before in my nursing career.

Expectations of Integrity and Good Clinical Judgement

You expect a nurse to have integrity and use good clinical judgement, but not every one does. It’s even possible that not everyone can. Judgement is subjective, and even though the it is the goal for any prudent nurse to give the same level of care as another, it just doesn’t always happen that way.

Walmart, Listen Up

So this is a plea to the Walton family: Please package integrity and clinical judgement and place it on your shelves retails sales. Put it in the pharmacy section. Nurses know drugs. I need to know where to tell nurse managers to go find it for their employees.

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3 thoughts on “Integrity & Clinical Judgement: You Can’t Buy it at Walmart”

  1. Pingback: Is Medication Timing More Important Than Good Patient Care? | The Nerdy Nurse

  2. This is a great blog and a great post. As a researcher who is interested in health care quality, we all wish that everyone could purchase clinical judgement and integrity at Walmart. 🙂

    1. Thank you.
      I was really inspired by her statement. It made me think a lot about how minimal the requirements to become a nurse really are when you think of just how much responsibility we are faced with. Integrity isn’t always a personal standard and it would be very nice to be able to gift that to people.

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