Your Ideas Aren't Bad Ideas

I find the smallest new experiences in clinical rotations exciting - enlightening, even. This week, I was taking care of a young patient on the peds floor who was losing weight because they simply hated hospital food. They would have no part of the macaroni and green beans, or the pepperoni pizza, or the chicken sandwiches. What this patient did like, however, was sweets.

The dietitian was working on trying to figure out how to get some nutrients into this child - to put some weight back on their bones. She ordered a new multivitamin, but was more concerned about working with the child's eating habits to get some real nutrition in. Where do you even start with a picky eater who needs to gain weight to get better?

While I was listening to the dietitians recommendations as we were chatting at the nurses' station - something which I finally, in my third semester of nursing school, had the confidence to do with other members of the care team - an idea hit me. Should I bring it up? I almost started tuning out of the conversation and tuning in instead to my own internal debate of whether or not I should mention it. I'm a student. A nursing student. I took one nutrition class, what could I possibly have to say of substance to a dietitian? Just keep quiet. Don't make a fool of yourself.

But I've been taking care of this patient all day, the angel on my shoulder says. I know what this patient likes, what they are willing to do, and how they like to be approached. Maybe I should just mention it. Very casually. What's the worst that could happen?

"How about a milkshake?"

At first, the dietitian seems to be a little taken aback, and I realize I needed to qualify my statement a little.

"I noticed with another patient, they mixed a can of Pediasure with some ice cream and called it a milkshake, and the patient loved it," I say, still feeling incredibly unsure of myself. "Our patient really likes sweets. It could be a start."

There's a moment of quiet, and I feel awkwardness start to creep up. I'm probably blushing at this point. I'm never going to speak to anyone ever again. I'm a student, of course it was a silly idea --

"We could try that," the dietitian says with a nod of approval. "Maybe try it once a day and see if it helps our patient keep some weight on."

And sure enough, later in the day, I open the patient's chart and my Pediasure milkshake has been added in the orders on the dietitian's note. My idea. My silly idea about a milkshake is in a note.

Of course, inside, I'm disproportionately excited. I suddenly feel so validated that my recommendation, based on what I know about a patient, was something that a professional felt was worth mentioning, and better yet, worth trying out.

The moral of the story is that you're going to have jitters. You're going to have hesitations. But don't let the little devil on your shoulder saying, "Don't say it, you're a just a student!" keep you from being a real part of your patient's care team for the short time that you have with them. Trust your knowledge, and trust what you have learned from the time you have spent with your patient. Part of being part of the team is engaging in that back-and-forth. Sometimes your ideas will be on the right track. Other times, someone else's ideas will be on the right track. If you just insist on keeping quiet, then you'll never know - your ideas could be the ones that make a difference for a patient in your care.