Most nurses leave school and enter the work force feeling incompetent and scared to death that they don't know everything they need to know. The truth is you'll never know everything and you'll continue to learn something new each day. However, there will also be things you feel very sure of.

You may feel that your goal as a nurse is to spend as much time with each patient as he needs and to ensure that he leaves your facility or care with a full understanding of his health status and his role in promoting wellness. Your patients will never go home feeling as inadequate as you did when your grandmother had her stroke last year. Those nurses were just incompetent and you will never be that way.

This is a terrific goal, but you'll quickly learn that it's one that isn't always possible to meet. You should always strive for it, but you can't beat yourself up when someone calls in sick and a patient codes just as you were preparing to try to cram in extra teaching with your discharge instructions and the patient gets discharged before you can get there.

You may have learned a specific technique for a procedure in school or learned that this technique replaces one commonly used for years. When you observe a nurse using a different or possibly an obsolete technique, please don't rush in with an attitude of “this is the way it should be done!!” The “this is the way we did it in school” attitude is not always welcome. Neither is “this is how we did it at XYZ,” when you move from one area to another or change jobs.

Of course you need to advocate for the patient if someone is doing something you know to be harmful or risky, but you must use discretion and tact in doing so. You also don't want to alarm the patient or to cause her to lose confidence or trust in your coworker.

This is where your P&P manual comes into play. Perhaps your facility has guidelines for a procedure that are different than the way you learned something. Maybe these guidelines are outdated. Bring this to the attention of your supervisor for clarification or revision. Remember, never bring anything to the attention of your supervisor in an accusatory manner!

You can also use this opportunity to discuss the guidelines with your coworker by saying something like, “that's a different approach; would you please teach it to me? I learned it another way.” This gives your coworker a mentoring opportunity and helps you to learn new tips and tricks.

If you know that the guidelines for the procedure have been changed, you can tactfully bring this up privately. You can say that you learned a new way to do that and ask if you could demonstrate it next time. Nurses should all be aware that health care advances occur all the time and should be willing to learn something new, but don't make accusations and comments in front of patients.

As long as there are several acceptable ways of doing something, none of which pose risks for the patient, your way is what you are comfortable with and someone else's may be very different. If the patient asks, you should always explain that there are different methods to accomplish the same thing. If the patient expresses a preference, don't take offense if he doesn't choose your way and don't make a big deal about it if he likes yours better. Respect your coworkers for their diversity.