Learned Helplessness

There seems to be a culture of letting the experts make the decisions in healthcare... and it's to the detriment of the critical thinking skills nurses have learned and developed in their educational and experiential programs. I recall Seligman's idea of "Learned Helplessness" as a theory that explained how people seem to give up/allow others to make decisions. Although a good portion of this is in relation to depression, it also applies to how people learn from others who model the behaviour.

Nurses generally work in groups and my observation is that the "new" nurses to the unit want to fit in, and want to develop a style that is congruent with the overall style of the unit (often not an official style, but the way the natural leaders of the unit behave). If it's the norm to defer to the expertise of others, then that's the way it works. While this is fine if the nursing knowledge might actually be limited, I find it puzzling that for chronic wound care, nurses will wait for the MD to write orders before even looking at the wound.

This strikes me as odd, since nurses need to assess the whole patient in order to identify nursing-relevant plans of care & to wait for the doctor to open/assess the wound implies that the nurse can't do this him/herself. Last time I checked, this was within the realm of practice of nurses (in Ontario, anyway). So, why not do it?

I think it's that sense of not really knowing what to do...that someone else has more expertise--even when they actually don't, or when the nurse does have enough knowledge to figure out what might be an appropriate treatment (unless it's a particularly complex situation). But I've had nurses say to me that they "need" an order for a chronic wound dressing, as if they are unable to make observations and suggestions themselves.

Not that I'm trying to work my way out of a job (although that would be gratifying, if every nurse knew what needed to be done, and felt comfortable/confident to do it, for those garden-variety chronic wounds). And I guess, if we could get over the feeling that somehow we just aren't quite capable...