The messages we get in our nurses’ training have long-lasting effects on our practice. In my hospital-based program, our nursing instructors believed that it was their job to “break you down and rebuild you as a nurse.” Servitude and perfectionism was built into my training. I don’t blame my instructors; but they were repeating what they had experienced without questioning the impact on students. The issue was really the culture of nursing that was being perpetuated generation after generation through the belief that we were built to follow orders, perfectly. The adage that nurses eat their young may be born out of fear of making mistakes.
I remember in my training that I often felt like a machine, a compassionate one, but a machine nonetheless. The danger of feeling like a machine is that you don’t put your own humanity into the equation, you put yourself and your needs last. It was an intense experience and while my training prepared me to be a responsive nurse, it reinforced messages of perfectionism and left no room for human error. Granted, when nurses make “errors” it could have dire consequences, so that was always in the back of my mind, and still is.
I graduated from nursing school in the summer of 1985 and prepared to sit for the boards. I waited patiently for my “entrance ticket” to come in the mail after sending in my application to the NJ Board of Nursing. The letter I was waiting so anxiously for never arrived that summer and as the date moved closer, I became more concerned. I began to hear from classmates who had already received their entrance ticket for the exam and my worry moved into high anxiety. There was no email, no Twitter, no internet, only corded phones and snail mail. So, I called the Board of Nursing to inquire about my application. It was then that I learned that I had made my first nursing error.
The application for the exam was a bubble sheet that required a number 2 pencil and many questions, one of which was a coded numerical testing site. Apparently, I transposed the number of my testing site and instead of sitting for the boards in NJ, it was coded for PA. I was never notified of the error and an entrance ticket for the PA Boards was not sent. My application was flagged as incorrect and the NJ Board of Nursing said that I was to be penalized for making this mistake. Their rationale was “If you can’t follow simple directions, how can you be trusted to follow doctor’s orders.” I was penalized for my human clerical error, transposing two numbers on a bubble sheet, by excluding me from sitting for my Boards for 6 months. The test was given twice a year at that time, so I was told I could not sit for the exam until the following January. I was devastated and confused, but activated.
With not a penny to our names, my new husband and I somehow managed to scrape together $500.00 to hire an attorney to sue the Board of Nursing for the right to sit for the exam. It was only weeks before the test, so everything had to happen very quickly. The attorney contacted a Judge to hear our case, but first we had to request a formal hearing before the Board of Nursing. The morning of the hearing, we had a meeting in the Judge’s chambers to review the complaint. The Judge was stunned to learn that my error was clerical. He had believed that I must have done something egregious in nursing school to be penalized by delaying my exam. Once he understood that it was a clerical error on the bubble sheet, he became quite frustrated with the waste of time and resources and reassured us that we should go to the hearing, keep him apprised of the results, but was sure it would be swiftly resolved. The Judge was wrong.
The hearing was held in the Governor’s conference room with a table that seemed to go on forever. There was a court stenographer and every seat in the board room was filled. My heart was literally and figuratively jumping out of my chest and I had to remind myself to breathe. It was an intimidating experience and I feared that my years of study were about to be ended because I transposed numbers on a bubble sheet. This was not a welcoming environment, it felt punitive and intimidating because it was that and more.
Once again, I heard the words, “If you cannot follow simple directions, how can you be trusted to follow doctor’s orders.” This was the premise of their punishment. I must learn a lesson about following directions. My grades, evaluations by instructors, and even the presence of the Dean of my nursing school did not matter because I had made a clerical error. Everything that led up to that moment did not matter because I did not follow directions and how was I to be trusted to follow doctor’s orders. My attorney gave an impassioned speech invoking Florence Nightingale and reviewing my otherwise spotless record of service and scholarship. Nothing mattered, the Board was intent on me learning a lesson about following directions. My entire nursing journey almost came to a halt in that boardroom, at that long, long table.
Relentless is in my DNA, I persisted, filed the lawsuit and returned to the Judge’s chambers that afternoon. He was incredulous that the Board would not reverse their decision. The Judge intervened on my behalf, the Board said that they would take it under advisement. Understand that the exam was less than 2 weeks away at this point, and I was in limbo, anxious and under tremendous pressure. I was working as a graduate nurse, but my job was dependent on my passing the exam in July not in January.
In the end, the Board did reverse their decision, I was given an entrance ticket which arrived only days before the exam. I passed my boards that July of 1985, but never forgot the weeks leading up to the test or the lessons learned. Even nurses are human, we make mistakes and are not machines, we do our best to first and foremost provide compassionate, holistic care.
Nurses are scientists, clinicians, and researchers. We have a code of ethics, follow evidence-based guidelines and work within a scope of practice that is unique to each specialty. Nurses are 4 million strong and are the largest segment of healthcare professionals in this country. We are found in the halls of Congress, in the C-Suite and in the classroom. Ask a nurse what happened at work today, you may be surprised what you learn.