Nov 25, 2019, By: Caitlin Fenton
Take away messages:
- Nurses have the opportunity and prerogative to share knowledge- and it is a gift. It is useful to reflect on the benefits of asking good questions in clinical practice.
- In a healthy work environment, questions—and even dissenting views—are valuable and encouraged.
- Make the most of your first year of nursing and learn how to ask quality questions.
When I was in Nanaimo, BC for the national conference of the Canadian Nursing Students’ Association in 2018, I had a day off between meetings to see the city. With a latte and nanaimo bar (of course) in hand, I climbed the 409 stairs to the top of the University of Vancouver Island campus to look over the beautiful city and coastline on a breezy January day. On my way down I passed one of the cool water hatcheries and looked into the open pools. But I wanted to know more. I approached a lab tech, swallowed my trepidation, and asked if I could come in and see the facility. “Y’know,” he said, “I think we have a research student who can give you a tour.” Thus I met a wide-eyed young woman, keen to share her project with me. She explained not only her research, but even the basics of salmon reproduction. When I joined my team for dinner I told them how eager this student had been to share her interests, and how much I was rewarded by asking for something.
Now as a new grad in an acute care hospital facility, I reach out to my trusted team of experienced charge nurses daily for help. And they provide all the assistance I need—glad to have been asked, and reassuring me of my practice. Nurses—myself included—are such givers, it is hard to remember to ask for things sometimes.
When I was doing a summer research project as a student, I found an article behind a paywall that I needed. While I was debating whether or not to hand over the cash, I reached out to my mother-in-law, a researcher with a PhD. She told me that she is always pleased to share her research with anyone who asks—for free. Sure enough, the author of the article I needed was flattered and helped me download her paper, as well as her validated tool, for my project use. When my engineer husband creates a tool for site reports, that tool belongs to his employer. Nurses are fortunate to work in a profession where intellectual property is valued as a shareable resource to improve our understanding of our clients and patients and, indeed, the world, rather than hoarded as a commodity to be bought and sold.
These stories illustrate the power of asking questions. Whether seeking information, clarification, or a favour, good nurses learn to ask good questions. There are two basic kinds of question: closed and open-ended.
Closed questions are highly specific. Prepared well, they can be a great source of quality communication in an acute area. We use them so regularly that we have acronyms for them—SBAR, PICO, STAR: tell us about the patient, tell us what’s happening, what have you assessed, what happens next? With closed questions, an experienced nurse can ask for a specific order, and a novice nurse can communicate an issue with less risk of missing an important piece of the puzzle. With telephone triage becoming more common, nurses can take a lot of responsibility and accept a leadership role in the patient’s health care team—not only as the physician’s eyes and ears, but as a critical analyst of a changing situation.
Open-ended questions can uncover information for new situations and foster innovation and new sources of knowledge. Asking “What are the risks of labouring with cervical varices?” brings up a literature search with relevant information. Asking “How can I help my patient find publicly funded transportation services while she recovers?” leads to talking about shared experiences, support systems, and relationships. Asking “What is the best fetal health monitoring practice for my patient with a combination of well-managed risk factors?” inspires a discussion that can incorporate clinical judgment, basic science knowledge, and practice standards into an innovative plan to support safety, patient ambulation, and preferences of the family and the medical team.
So how have I benefitted in my new RN job by reaching out and asking for something? Of course I benefit in knowledge—getting better at my job is deeply satisfying. Through my experience both at first hand and by observing other nurses’ actions and responses, I’m detecting changing signs and symptoms in my patients’ condition, and I’m able to notice when something is different even if I don’t yet know what to make of it.
Novice nurses sometimes express the fear of appearing ignorant before their colleagues, and this may cause some to hold back from asking for more information. But it’s the novice nurse who doesn’t ask questions that is the one to worry about. My biggest gain from the first year of practice is how to report to my charge nurse when things are normal, and when they are not. Asking questions has also enabled me to take advantage of some valuable opportunities. I taught my first prenatal class last month to a few dozen first-time parents and surprised myself with how I was able to confidently address their questions and help equip them to enter this changing time in their lives. When I asked to attend a conference on research implementation and policy, my manager approved it as an education day and I was able to hear about the innovative ideas in health care and health systems in Canada from the people who did the work.
Gaining the trust of my team has been a rollercoaster journey of confidence highs and lows. But asking for things has been beyond rewarding every time I do it. I firmly believe that there are many positive leaders who want to help every keen novice nurse succeed, and will give above and beyond what is requested.
When I spoke recently at a new grad panel for my alma mater, I told the fourth-year nursing students about my experience in a fast-moving, ever-changing hospital environment. They were afraid of entering practice and not knowing everything. I assured them that it was okay to ask questions. In fact, an experienced charge nurse would be concerned if they didn’t ask questions! The onus on them was to communicate their questions well.
Into the future
Reflecting on a year’s experience, I believe that one of the most useful outcomes of my generalist BScN education was learning the basics of assessment and communicating to “paint a picture” of a situation. Even working in a highly specialized unit, when I speak to a doctor to ask for a plan of care for a poorly controlled diabetic patient, I know better how to describe their demographics and their history in context, and to have my assessment results at hand. Being prepared to ask a good question saves time, develops trusting relationships, and shows that I know what to expect.
I know I will commit myself to becoming a trusted team leader who encourages discussion about patient care and provides a trusted space where colleagues can ask questions and receive feedback. I have been fortunate in having the benefit of high-quality learning experiences that have encouraged me to scrutinize and reflect and improve my understanding of nursing. In a healthy teaching environment, questions—and even dissenting views—are valuable and encouraged. All staff can be involved in questioning and developing systems-based solutions.
Creating a collective strength can quell the fear of asking questions or making suggestions that can arise in new members of a unit who may have other valuable experience. When I, as a new grad, can trust my team to have my back, and to answer any question, I am able to grow and share, and I can model that conversation to the even newer grads and students who come after me.
Caitlin Fenton is a novice nurse working in labour and delivery in Edmonton. She was the president of the Canadian Nursing Students’ Association, and has spoken to and proposed a number of resolutions provincially and nationally.