Why

Gotta always keep in mind the why.

This has come up repeatedly this week. People so fixated on how a task must be accomplished, they seem to lose sight of why it has to be done. The process takes over the utility.

I love knowing why, and it's the only way I can remember the swathes of information I need to do my job well. I do not do much the same way I was originally taught. Working in so many different places, sticking to a particular how would have hobbled me, leaving me looking like an idiot.

And, well, it's not harder as I get older. I just have more in my repertoire. IF I know why.

Example. Started making OR tables, blue sheets, all the same size, so the second sheet was folded in half lengthwise and laid across the table, then folded up with the edge near the edge where the gurney would meet it. So when the patient moved over, it would be held in place by their movement, not flipped off onto the floor. Which is what would happen if the folded up side was on the far edge. Trying to get a nurse to fold it this way could sometimes be very difficult, even with the explanation. I was taught the other way, then this way, and it worked better, so I always did it, since it generally saved me a step, and kept the sheet off the floor. Keeping the length because of the way we tucked arms with foam pads, a functional local phenomenon, and the easiest and safest way involved a slightly diagonal technique learned from an anesthesiologist, that protected the ulnar nerve very efficiently.

Such draw sheets also need to be between the shoulder girdle and the pelvic girdle, since those are the two twisty bits framing the center of body mass. Move those two as a unit, and everything else just rides along, safely. Many nurses put the draw sheet down too low, more or less waist to knees, and it just doesn't work as well.

In Boston Hospital, the sheets were different, no issue of the draw sheet being too long to go width-wise, so I never bothered folding it up at all. Without the same kind of foam pad, tucking was rare, done differently, usually armboards were used instead. I got good with armboards, never made any comments about tucking.

When I got back to Old Hospital, I mostly worked Ortho, which doesn't need to tuck arms, the sheets had changed, and I learned a new way again. All white sheets do look wrong, but that's esthetics, and I can be dogmatic there, if also resigned.

New Ortho Hospital does draw sheets differently, different seatbelts, different foam pads, never tucks arms, a new set of positioning equipment, and I say "How do you use this, here?" Real draw sheets, but they fold them in half width-wise. Gives extra strength, and more than sufficient width for movement, good for a lot of larger patients. And keeps the fabric from getting in the way of handboards, leg holders, or suspension arms. Functional, I like it. I learn again, keeping in the front of my mind how to keep an anesthetized patient safe, ask why this works well.

I still see, often, that nurses don't know why they do as they are taught. I challenge gently, insisting on rationale as I adjust to local preference, and find new ways.

Sometimes, when it doesn't matter, it's a matter of what people expect. Habits that we rely on when everything is chaotic. And that is as good a why as any, once in a while.