I’ve been a nurse coming up on 30 years, with over a decade of experience as a critical care nurse practitioner. In that time, I’ve come to know some things about myself. One of the habits I have that goes back many years is explaining my orders. I realized to my horror that despite the care I take with the tone of my statements, perhaps I was participating in something similar to another social phenomenon with quite a negative reference. Was I “nurse-splaining?”
Allow me to explain…
As a nurse, I would receive orders that sometimes I didn’t quite understand. Why was I doing this? Why wasn’t I doing that? Often times, I would be met with defensive explanations when I would ask the ordering provider. I vowed that I would never do that. There are some orders that require no explanation: vital signs, neuro checks, acetaminophen… But how do I choose one pressor over another? Why are we doing this CAT scan? As a critical care nurse practitioner, I have found myself explaining some of my orders to the nurses not for justification, but to involve them in the process. I feel it’s important for them to know why I’m asking them to do certain things, or why we shouldn’t do certain things. What are we looking for on that CAT scan? Why is it important that we go now? I like to close the loop on the communication so we’re all on the same page.
Here’s a good example.
A patient with liver failure comes in with cirrhosis and hepatic encephalopathy. His ammonia level is elevated and he needs lactulose. We all know what happens next. Many times, I will be asked for an order for a fecal management system. Many times, I am not able to order it because the patient has severe portal hypertension and known esophageal varices. But instead of just saying no, I explain why, “There is a high likelihood that the patient will also have rectal varices which could rupture if we placed a large balloon in the rectum.” Sometimes I’ll recommend a rectal pouch that is non-invasive.
Is this nurse-splaining? Am I offending someone by doing so? Or am I merely providing the rationale for the orders? I posed this question to the nurses that I work with.
Feedback from Nurse Colleagues
Most nurses felt that they were a part of the decision, and actually were able to learn something from what I was explaining. There have been times when I have learned something from them or been the grateful recipient of more information that might change the plan of care. I have not yet been advised that I have offended anyone, but I can’t say that it hasn’t happened. I truly feel that we were all a team and we’re in this together, and the last thing I want to do is offend anyone.
One of the benefits to having this exchange, is that sometimes the nurses have a different perspective. I feel that open dialogue between all providers is important. This can only improve patient care and achieve better outcomes. What are your thoughts?