Module 4 question 1

I must admit, when I first read the title of Carl Thompson's article "Clinical experience as evidence in evidence-based practice" I thought back to the time I was a relatively new nurse. When I had a question, an older nurse would rattle off an answer. There was little thought or discussion of doing a literature search. Rather, the practice question was dealt with quickly, or given to the nurse manager to research, who later came back with an answer.

After reading his article, I recognized times when I have observed, and even made inappropriate clinical decisions due to overconfidence. Many of these times were during times I was the only oncology nurse on the unit for the entire shift. Having to be a constant resource to agency nurses is exhausting, and a time to be vigilant, not overconfident. In the recent past, our unit has had many changes in the culture. Many of the y ounger nurses feel the older ones are too abrupt, and not as nurturing as they would like. When exploring specific examples, I find the seasoned nurses are not simply making decisions on "gut feelings", they, as experienced as they are, still take the time to verify protocols, policies & procedures. When they discover a newer nurse is not following policies, and when questioned cannot support why they wavered, this creates a knowledge gap. This gap can grow if the younger nurses are more interested in protecting thier feelings, and not venturing to understand the rationale for clinical decisions.

Another example of the heuristic of hindsight is seen frequently on the unit. This involves the nurse forgetting to open the roller clamp to infuse IV medications. The clinical practice council was asked to determine ways to prevent medication errors due to the roller clamp concern. Recently graduated nurses tend to be hypervigilant, while the ones with 1-15 years experience tend to create the bulk of errors. Seasoned nurses, who have seen these errors time and again, are well aware of the risk, and make personal habits to verify the roller clamp is open and delivering the medication as ordered. These same nurses are the ones who ask appropriate questions to assure a thorough assessment of the patients when they suspect an acute change of condition. The y ounger nurses wait until the patient's clinical condition is grossly apparent. We have begun the task of having a debriefing after any unexpected acute change of condition, especially one that requires urgent transfer to a higher level of care. The debriefings are serving as a way to help overcome the bias of hindsight to better help the inexperiences nurses learn from one another.