I mentioned last week that I’ve been applying for a Clinical Ladder promotion at work. Basically that means that I’ve become involved in the life of my workplace through committee memberships and leadership activities and demonstrated aspects of advanced nursing practice at a level that merits a higher level of pay and requires a higher level of practice. If/when I get the promotion, I have to do additional activities to maintain my higher status.
In other words, if I don’t use it, I lose it.
Unfortunately this has been a frustrating process for me. I’ve jumped through the hoops because a) I think I deserve the promotion and b) man, I would really love to make more money! But before I started my application, I spoke with many co-workers who thought there was too much red tape to make the process worthwhile. And now having gone through it myself, I have to say I agree.
I won’t get into the nitty gritty details, but one of my most disheartening experiences was writing up a patient care exemplar that was supposed to demonstrate advanced practice. My story involved working with a patient who had advanced cancer and whose doctor had broached the subject of hospice, a subject for which the patient felt totally unprepared. After many, many shifts I helped this patient get to the point of actually being excited about what hospice had to offer. In four years of practice, I have never been prouder to be a nurse.
And my exemplar got shot down by my advisor.
Despite praising me for going “above and beyond”, she didn’t believe the exemplar demonstrated advanced practice nursing. She said I should use the criteria of what would have happened had I not been present. Ummmm, the patient would probably still have been discharged to hospice. But would she have been at peace with that decision? I really don’t know. Probably not. As a nurse whose professional goals include advocating for better, more proactive palliative care, having this story turned down made my blood boil.
I understand that clinical ladder committees are probably looking for those life-saving moments in which we catch something out-of-the-ordinary and change a patient’s illness trajectory as a result. The exemplar I ultimately submitted was along those lines. Woo me.
But it’s the advocacy, the education, the being there at 2 am to answer the hard questions – that’s what keeps me coming back. And that to me is what nursing is all about.
Saving lives has many embodiments. And I feel that as a profession we tend to forget that.
What about your experiences? Have you ever felt that you fought for a patient in a way that went unrecognized or was even dismissed?