On practice

I don't routinely do port access.  I once had a bad experience in which a frequent flyer gastroparesis patient, who was also fond of drinking alcohol and was just, in general, a gross individual, sat bolt upright to vomit (spit into a vomit sack) just as I was pushing the needle in.   Scarred me for life.  Seriously, I have port PTSD.

I CAN do it.  I CHOOSE not to.

So when my patient asked me if I was good at ports, I had to tell the truth.  "It's not my best skill", and hit up my zone mate to do it for the second time that day.  I was willing to try it because it looked like an easy one.  She wasn't willing to let me practice.  I was fine with that.

We call it nursing "practice", but when it comes to patients, nobody really wants us to actually PRACTICE on them.

You don't always get the best wherever you go.  You might expect it, but it is a statistical improbability that you will always get it.   Not the best meal, not the best mechanic, not the best teacher.  Not the best hospital. Not the best doctor.  Not the best nurse.  Sometimes you get adequate or mediocre but working on it, or just enthusiastic and learning.   Sometimes you get adequate or mediocre... and just happy to get by.  Even the best role models can't do miracles with the material they have to work with.  The nurse/doctor/lawyer who graduated dead last in the class and passed the boards or the bar is STILL a nurse/doctor/lawyer.

Think about it.

Every nurse on the planet has practiced on patients. Every.  Single.  One.   First patient, first injection, first IV, first code.  First birth.  First death.  First everything.  You don't get better at something unless you do it repeatedly, over and over and over until there is a comfort level.

That said, nobody in health care these days is working in an environment in which actual practice, with the goal of improvement, is encouraged.  Speaking from that place, we all know that perfection is expected from patients and mandated by administration, office dwellers,  and keepers of clipboard minutiae. These folks sequester themselves in their spic and span patient-free ivory towers with the sole purpose of writing how-to's, decision trees, step-by-step procedures, and check- off lists.  All of which serve to create distance from fall-out, (or create a fall guy) when things go off the rails and something untoward occurs. Their work is never done, for there will always be some scenario that was not considered.  Also, shit happens.

Practice does not necessarily make one perfect.  That is impossible.  Practice might make one competent, or safe, or prove that more practice is necessary.  It might even prove that the teacher is not right for the job.  There is lots to learn, but the biggest lesson is that no amount of preparation guarantees perfection.

Nothing is perfect in health care.  That is the only absolute.