Sudden insight on a late Friday afternoon

It never fails. I've promised The Husband I'll leave work by 1500 and it's now 1515. A nurse comes in to talk to me about an idea.

"Why don't we have a senior corpsman designated for each shift to check the work of the other corpsmen? That way all the I's and O's will be done, vitals will be recorded, and everything else will be covered."

"That's a good idea," I say. "Unfortunately, I only have two corpsmen scheduled for most shifts. You're asking one corpsman to essentially do double work. This might also develop resentment in both corpsmen as one does extra work and the other feels he or she can't be trusted to get the work done. I think the nurse should double-check the work of her corpsman."

Silence falls as we both ponder these ideas.

"You're probably right," he finally admits. "I hadn't considered only two corpsmen on each shift."

I then explained that our highly trained and motivated corpsmen would be transferring to other units within the hospital over the next few months. "They only have two years here, so we get them for a year and then they go somewhere else for training diversity."

All the corpsmen we currently had on the floor had arrived between late June and August 2006. I'll be losing them soon and getting a fresh crop in to train. My senior chief keeps me maxed out on corpsmen with the understanding that when he asks for one by name, I have to give him or her up. He will ensure I have a body waiting in the wings and I have to trust him on this. If I stubbornly hold on to that corpsman until the last minute, there may be no body waiting and I am now short-staffed.

"I never realized that," the nurse said.

I suddenly understood that I don't communicate the pressures I face in my daily Division Officer juggling. Maybe I'm doing such a good job I make it look effortless. I doubt that. Perhaps, as in Benner's Novice to Expert, my nurses are not proficient yet. The sole measure of success for them is completing all nursing tasks. For some, it's simply surviving another shift. I realized I do an abysmal job of mentoring and leading these nurses. On a med-surg ward where nurses have no desire to be med-surg nurses, this is a particularly difficult challenge. I guess it's time to implement the "Bloom where BUPERS plants you" strategy. And time to talk with these nurses one-on-one.

"I'd like to sit down with you to discuss what you'd like to get out of MSU while you're here," I tell the nurse. "Let's talk when I get back from leave."