In post-conference my student said, “I got to watch them insert the chest tube. But after the doc got all gowned up and got his sterile gloves on, I literally saw him reach down and touch the side of the table to reposition it.”

The other students, having been repeatedly beaten about the head by us as to the importance of maintaining a sterile field, looked horrified.

“Did you say anything?” asked another.

“No,” replied the first student. “The patient was struggling to breathe and it was happening really fast and I wasn’t sure if it was my place to say something.”

“You should definitely NOT say anything,” I said. “In other situations, routine procedures, things like that, you should absolutely speak up and advocate for your patient. But not there. Not on that unit. Not in a situation like that.”

And the post-conference moved on to other topics and other events of their day, but I only listened with half an ear. I was lost in thought, reflecting on the statement I’d just made.

Was that the right advice?
Should they have kept quiet?
Should I have told them to speak up?

I knew why I’d given the student that advice — I was trying to protect them. It’s tough enough, stressful enough, to be a nursing student in a large hospital, to have your every action watched with a critical eye, your every move analyzed for possible mistakes.

To speak up in an emergency procedure for a break in sterile field, and to have a doctor snap back in anger, frustration, stress, possibly to have the student tossed out of the room — that would ruin their day. I didn’t want them to have that experience.

Or….

….maybe I didn’t want ME to have that experience.

Who was I really speaking for?

If I was speaking as an instructor, then my answer should have been YES, call out the break! Let the MD know the field is broken! That’s the right thing to do.

If I was speaking as a professional, as an emergency RN with a decade of experience, my answer should ALSO have been YES, call out the break! The patient is at risk! It’s no big deal to change out a pair of sterile gloves!

But if I was speaking as myself….as a peacemaker, a non-confrontational human, a nurse who tends to hold back more than treat aggressively…I think I would also have stayed silent. Justified it in my head somehow (“it’s only a small break, the table is probably clean, the patient will be on antibiotics anyhow”).

And that bothers me down to my very core. It’s bothered me since the minute I spoke that sentence, more than three months ago.

Because it was the wrong advice.

So, to my (and all other) nursing students:

I cannot possibly teach you everything there is to know about nursing before you graduate.

I can give you a solid foundation.
I can teach you how to think.
I can teach you how to listen, how to hear.
I can teach you to see the human beneath every diagnosis we heap upon them.

But I think I must also teach you to be brave.

You must be brave enough to speak the uncomfortable words that are desperately needed. You must be brave enough to tell the truth that nobody wants to hear.

You must be brave enough, strong enough, to bear the weight of someone else’s anger, frustration, fear, terror, heaped upon you in an avalanche of abuse, and yet still continue on and finish your shift.

I must teach you to be brave.

Which means that I must learn to be brave.

So, nursing students. Get your official scrubs out of your closet (or out of the bottom of the laundry basket). Unearth your stethoscope from your bag. Go find your white shoes and your pens and notes and reference books.

I will teach you what I know.
And you will continue to surprise me by teaching me about myself.

And we will be brave in this brand new year together.

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From “Practical Nursing,” published 1911