10 Nursing School Interview Questions and Expert Responses
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Like many professional programs, nursing school applicants generally must go through an interview as part of the application and vetting process. Whether this is a traditional one-on-one interview, a MMI Interview (Multiple Mini Ingerview), interviewing with a panel of experts, or any other interview type, you will likely face some tough questions. In an interview, the admissions committee gets a chance to understand who you are as a person – what your strengths and other assets are, what values you maintain, whether you’re a mature professional, how effective a leader or communicator you are, and so on. Generally, interviews that explore such qualities are part of the larger process of “holistic review”, whereby candidates are evaluated on much more than their academic scores, like GPA or standardized tests (though these are still very important). Even your extracurriculars, work experience, volunteering and other efforts have already been examined to some extent at this point, via your application package, so your general interpersonal skills and overall demeanor are under particular scrutiny in the interview component of your evaluation as a candidate.
As such, the questions asked at such interviews are often very challenging; they are meant to probe your sense of ethics, your priorities, your ability to adapt and persevere in the face of adversity, and so on. If you’ve made it to the interview stage, then you are likely one of the stand-out candidates, and this is your chance to demonstrate why you have what it takes to succeed in this program and this profession. Questions can be related to the field of nursing in particular, often via hypothetical scenarios, though they will also explore more general aspects of your personality – your successes, weaknesses, goals, and so on.
These are 10 common nursing school interview questions, with a variety of question types – personal, attitudinal, hypothetical, and policy-based. While you can never know exactly what questions you’ll get in an interview, understanding different question types – and strategies for approaching them – will help you think through your approach to any question. Below, we’ll give you some tips and expert responses to these questions, explaining the considerations behind the answers, but you should note that multiple answers would be considered acceptable. There aren’t necessarily “right” or “wrong” answers to these questions, but there are absolutely more and less effective ways to answer, regardless of your own individual position or experiences. The answers here are strong because of the reasoning they employ, not just because of their content. Your answers will be individualized to reflect your experiences, priorities, and values, but these strategies and considerations should be kept in mind as you think through your own position.
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Here are the questions we'll cover. Scroll through or click below to jump ahead, if you're interested in a particular question:
“Tell me about yourself ” is likely the most common “question” interviewees face. It is quite vague, and intentionally so! This open-ended prompt can be taken in any number of different directions, and the interviewer(s) want to see what comes to your mind when prompted with such a vague request. Everyone’s answer to this question will be completely unique, based on their own experiences, values, and priorities. However, there is a good rule of thumb to keep in mind:
It’s not a list, it’s a story.
You may be tempted to simply recite your CV or information from your application. Do NOT do this! It is, of course, absolutely fine to discuss things you’ve mentioned in your application, but you must avoid a dry recitation of your activities, scores, presentations, etc. The interviewer(s) will already have access to this information, if it’s an open interview. Even if it’s a closed interview, where the interviewer(s) won’t have access to that specific information, you still shouldn’t simply run down a list of factoids or trivia about yourself. You need to take this opportunity to let your best qualities shine through by telling the story of who you are!
That said, you can’t outline your full auto-biography – there’s simply no time for the entire Story of You. While a feature-length film may be out of reach, it is acceptable to take a few minutes for “Tell me about yourself”, 3-4 minutes should be maximum length. Any longer than that and you’ll risk losing your audience’s attention, so focus on the highlights that show your best self. This is a key reason to put a good deal of time and effort into thinking through how you’ll respond to “Tell me about yourself” – this is your chance to demonstrate for the interviewer(s) who you are at your core, and who you aspire to be as you pursue the path to becoming a nurse. But you must also do this in a concise and compelling way. You need to work with this prompt until you know you can cover the points you want to cover in 3-4 minutes (again, max), but you also don’t want your answer to sound over-rehearsed or wooden, as that may come off as inauthentic to the interviewer(s).
To compose an expert answer that is sincere, reflective, and that highlights your best qualities, you need to craft a compelling narrative, using anecdotes organized around 2-3 events, qualities, values, competencies, or priorities that you think best represent who you are at your core (and, of course, one event/story can embody multiple qualities at once - a time when you acted with compassion may also be a time that you did so in a leadership position where you engaged in conflict resolution, while maintaining the integrity of your position). In general, people love stories, and offering an answer that allows your interviewer to “see” you as a leader, educator, collaborator, compassionate caregiver, etc., will do much more for the impact of your answer than a loose string of events, benchmarks, or scores.
To understand the kinds of qualities you should consider, you should first think about the kinds of qualities typically sought in candidates for nursing programs. They generally want people who are empathetic to others, compassionate in the face of suffering, able to defend their ethical principles, attentive to detail, able to communicate complex information to non-specialists, leaders and collaborators with others, oriented to serve one’s community, advocates for their patients, etc. Think of times you've been able to act in line with such qualities, and use these as the "plot points" for your narrative.
As well, another great place to look for and reflect on such qualities is in the mission statement for the school where you’re interviewing. All institutions have a statement of mission, vision, and/or values, and demonstrating how you align with the institution’s mission, vision, and values means demonstrating that you’re a “good fit” – a key evaluative principle in interviews like this. As representatives of the institution, interviewers want to know that, when you graduate, you will act as a positive ambassador for their program, as you go out into the professional world and hang that university’s diploma on your wall.
Here's a great video on finding inspiration when preparing for an interview question like "Tell me about yourself":
So, draw on these resources and come up with three values, qualities, etc., that you think best represent you, and which you can support with anecdotes and narratives from your own experiences.
This question is meant to evaluate your priorities, your reasons for pursuing this profession, and the amount of mature reflection you’ve done in considering this path. It is critically important that you display intrinsic motivation to pursue this profession; that is to say, that you are genuinely motivated by the work and ideals you’ll be advancing.
Here’s an expert answer:
There are a number of reasons why I want to become a nurse, but chief among them is the importance of the nurse as a front-line representative of the healthcare system. In many healthcare facilities, from clinics to emergency rooms, nurses are the first medical professional patients encounter. Whether for routine care or on the worst day of their lives, nurses have the opportunity to ascertain how to coordinate resources in the patient’s best interest. As well, nurses play a key role as patient advocates, both in terms of ensuring each patient’s needs are effectively prioritized within the healthcare system, and by acting as representatives in the community, running CPR and first-aid courses, holding vaccination clinics, or in working for key healthcare organizations, like the Red Cross.
Being responsible for so many aspects of patient care and advocacy means that compassion, attention to detail, and a passion for life-long learning are required. As indicated in my CV, along with my coursework, I have worked part-time as a Nurse’s Aide at XYZ Retirement Center, and I volunteer at a methadone clinic and needle exchange two weekends of each month. Though these are two very different roles, often working with two very different populations, some of the demands of each position are similar. Both positions require genuine, invested passion for the work and dedication to continued learning. The needs of our aging population are changing as advances in medical treatments progress; likewise, our approach to addiction and substance dependency are changing as we move more toward a social and health-based model for understanding such challenges. For both of these groups, relying on assumptions from the past is ineffective, and as front-line care workers and care-givers, nurses must be well-acquainted with advances in care to act as effective members of any medical team. As well, both of these groups represent vulnerable parts of our society, people who are too often set aside because their problems are complex, and their challenges span the physical, psychological, and social components of health. Finally, I’ve seen first-hand that treating both groups requires precision and attention to detail. Managing treatments is a large-scale task, and nurses must be able to maintain their own standards of care while also acting as supports for all other members of a patient’s medical team. Nurses must be aware of the unique needs of each patient, and able to meet those precise needs in a variety of often-changing contexts.
Though I’m still at the beginning of this journey, I’ve seen that nurses often have a unique opportunity to foster relationships with patients – frequently having both more and more frequent opportunities to connect with those in their care than physicians. Nurses also have a unique role in any medical team, acting as the core support for all other members. The opportunities for compassionate and active support of others – of patients and other medical professionals – and to do so on the front-line of medical care is what draws me to this profession, in particular.
Nurses often complain about long shift work hours. In your view, what are some of the negative side-effects of having nurses work prolonged periods without rest?
Questions about “negatives” like this need to be handled strategically. You must demonstrate that you have thought through some of the challenges you will face in this profession. As passionate as you may be, that doesn’t mean that each day will be easy – you will face real and difficult trials, and you need to show that you’re ready to take these on. The key is to show that you know that this is an issue, and that you’ve already implemented stress-relieving tactics that work for you.
Here’s an expert response:
Any career that requires long hours with little rest is going to leave workers prone to burnout. This is a common concern throughout the health care professions, as well as other similarly stressful positions, like teaching. However, acknowledging this problem and tackling it head-on is the first step toward mitigating the effects of such stress. Many of us are passionate about our positions, and that passion is important, but it takes realistic, pragmatic efforts at self-care to keep burnout at bay. As someone who has been a full-time student while also working part-time, volunteering, and having my own personal life, establishing a balance and maintaining de-stressing tactics is already a key part of my schedule.
I’ve already spent some time working in health care establishments, and I’ve been fortunate to see first-hand some of the in-house steps some institutions are taking to counter this problem. The retirement home where I’ve worked part-time has implemented three yoga sessions a day, open to residents and to workers on each shift. They are scheduled right at the end of one shift and the beginning of the next, so employees are easily able to coordinate schedules to participate when it’s best for them (before or after their shift). This has also been supplemented by bringing our in-house nutritionist on board for employee meals, as well as resident meals, ensuring everyone is well-fed during their shift.
On top of this, I’ve developed my own self-care tactics. I have a very strong relationship with my partner, and my family and I are close. Though they don’t live here, we talk via Skype on at least a weekly basis (and my mother is a nurse, so she’s been a remarkable source of support). My partner and I love to go camping on long weekends; the time out in nature, with no devices, phones, electronic “beeps”, is great for refreshing and resetting my moods. We also have several pets that we love immensely, who help with daily de-stressing, simply by playing or snuggling each other.
If you were granted the opportunity to wake up anywhere in the world and pursue anything that your heart desires, where would you like to wake up and why? What would you like to accomplish?
Obviously, this question isn’t asking specifically about your future in nursing, and it would be easy to rattle off an answer without thinking carefully about it. Many people would instinctively say something about waking up in a beautiful location – maybe a beach or a rainforest or some other lush place – and thinking about the kinds of recreation they’d like to partake in while in such a location. However, you must remember that you’re being asked this in an interview, which means they’re asking this for specific reasons. They don't want to hear that you'd love to wake up on a beach doing nothing but sunning and sipping daiquiris all day. They’re looking for your intrinsic motivations, what you would be doing if you had full control over your options in life. You want to demonstrate that the work you’re pursuing now is something you’d be pursuing regardless of the opportunities you have – you’re pursuing it not because it is just what you want to do, but because it is part of who you are.
Here’s an expert answer:
It would be easy to say something like, “I’d wake up on a tropical beach and do nothing but surf for the rest of my life”, but that’s not very practical, and not being productive and helpful would honestly get boring after awhile! Instead, if I really had the opportunity to pursue anything at all, with no limits and no price tags attached, I would love to travel the rural parts of our nation [or wherever you’d like to go – the Global South, a specific country of concern, etc.] with a state-of-the-art, no-cost, mobile health facility. I would hire a diverse, rotating team of health care specialists whose entire job was to be on the road with this facility, bringing care to the parts of our nation where many are left without the medical attention they need. For far too long, our rural communities – including indigenous communities – have been severely medically underserved. On top of the progression of minor medical issues into major emergencies when health care or expensive diagnostics are inaccessible, this is also one key driver of the current opioid epidemic, which has hit rural communities with particular impact, as doctors and patients have to fill in gaps in care with medications that leave some people prone to dependency.
It would also be important to me to have multiple providers of indigenous backgrounds and/or trained in working specifically with indigenous communities, to ensure that any care provided to these communities is culturally appropriate. Diversity, overall, would be a key concern, so that we’re always attentive to each patient’s own goals and definition of health. Those without access or economic means to work towards wellness should still be active agents in the discussion around their own health care. Culturally competent care leads to better patient outcomes, so meeting this need would be a key concern for me.
To be able to bring complex diagnostics, costly medications and treatments, and – especially – preventative care to these communities, to do so without concern for overheads or funding, and with attention to the diverse needs of our patients, would be the most rewarding thing I could possibly do with my life.
The field of nursing consists of inter-professional collaboration and teamwork. Describe a time when you worked as part of a highly diverse team.
This is a very standard question about your own experiences, where you get to share more about your own history, with emphasis on a particular quality prioritized by this field. You should be honest about your experience, and able to reflect on the values and challenges of diversity. Speak to the ways in which diverse opinions and approaches strengthen a team, and the ways in which differences of opinion are respectfully navigated in such collaborative efforts.
Here’s an expert response:
In striving to maximize employee satisfaction, XYZ Retirement Center recently implemented a variety of wellness strategies, from yoga classes to nutritionist-devised meal plans for employee meals. As part of the meal planning, a steering committee was assembled from across all levels of staff: Nurses, Aides, Administrators of various sorts, Caretakers, and even Directors were recruited to contribute and ensure that the choices made reflected the diversity of our team at all levels. Not only was there diversity of roles, there was also diversity in terms of gender expression, economic class, cultural background, religion/philosophy, and age. There were 10 of us on the team, and we were each responsible for working together and relaying input from our respective spheres within the workplace.
This diversity brought a wealth of important insights, and also some challenges. For example, something as simple as a lunch menu became immensely complicated as we learned about various dietary restrictions, both health-based (allergies) and ethics-based (vegetarian and vegan, religious-based restrictions). Some were unable to see why accommodating all diets in the menu was advisable, suggesting that those with such specific restrictions should just bring food from home. However, other voices were able to encourage additional reflection on why this isn’t the most equitable approach; as nearly 40% of those on the steering committee had dietary restrictions that complimented each other, flipping the proverbial script and suggesting that the others bring their food from home quickly demonstrated why this wasn’t a fair request. Ultimately, a creative solution – a series of separate components with different protein options, cooked individually, served from individual hotplates into bento-style boxes – with a few agreed upon concessions (e.g., no nuts, ever) was ultimately able to keep everyone safe and maintain the values and preferences of the staff. Each of us offered our own ideas for possible meals, personal favorites and dishes from our various cultural backgrounds, and we came together with the staff nutritionist to work out the details to maximize nutrition and flavor, while minimizing cost.
As a result of this work together in overcoming such challenges while also valuing the important contribution we could make, our meals are cost-effective, healthy, and satisfying for everyone who works there, from those who sweep the floors to those who run the organization. It makes such a big difference in morale to come together and implement such a big change in the quality of our meals in the workplace. We no longer had to eat basic cafeteria fare (or spend personal time organizing our own workplace meal each day - something which otherwise cut into our free time to spend with our families), and the menus all have our individual stamps on them, highlighting a diversity of both people and cuisines.
What are your views on mandatory influenza vaccinations for nurses in hospital settings?
On the surface, this appears to be a pretty basic question about policy. However, at its core, it is a question of competing values: patient safety and personal autonomy. Being able to spot such tensions in seemingly straightforward questions is very important, as it shows your familiarity with key concepts in the field. You should already be reading up on ethics and tensions in your chosen profession, as this will help you spot such things. In your answer to policy-type questions like this, you must demonstrate your understanding of both “sides” of the issue, prior to offering your own response. As well, you need to represent each “side” fairly, even though you may likely disagree with one of them. Being able to acknowledge as valid the concerns of those with whom you disagree is the height of critical thinking. This is a key example of a question where there isn't necessarily a "wrong" answer - there are valid positions on both "sides" of the question. What's important is how you respectfully engage each "side", how you defend your own rationale, and whether you can think of any creative compromises or other ways of looking at the issue.
Here’s an expert response:
A policy like this is tricky, as it is clearly patient-centered in the effort to keep patients safe. However, the issue of personal autonomy must also be taken into consideration.
Patient autonomy is a hallmark of the medical profession, and nurses are – at times – patients themselves. The idea that patients should be active members of their own health team, and that they should never have a treatment imposed on them against their will is critical in ensuring we maintain ethical standards. While nurses have a particular occupation in health care, they are also people (and patients) outside of their labor, and those who come down on the side of autonomy hold this as central. As well, there are some people who are unable to receive the influenza vaccination for health reasons, and some nurses may be among these.
On the other hand, health care professionals aren’t necessarily just like any other person or patient, because of the close contact that they have with already-vulnerable people – those who are ill, vulnerable, or in a weakened state. The possibility of transmission can be higher for nurses and other health care providers, simply because of the nature of their jobs. When working with people who are immuno-compromised in any way, with infants and children, with the elderly, and so on, the safety of those patients must be maintained at all costs.
With that said, there are any number of viruses and bacteria that can be transmitted from nurses to patients, for which there are no vaccines. This is why there are such exacting protocols around sanitation in healthcare settings. In my opinion, we should try to maintain the autonomy of nurses, but every effort should be made to encourage the influenza vaccine. Reminders of the unique nature of nurses' work, and the ease with which influenza can be transmitted, must be made very clear, must come from places of authority that are respected in the workplace, and easy access to the vaccine must be prioritized each year. However, if someone is unable to be vaccinated due to specific health reasons or personal convictions, they should be able to opt out. Additional sanitation protocols should be enacted for such individuals, and they could perhaps be asked to sign a contract stating that, should they contract the influenza virus, they will voluntarily take time off work as they heal, to reduce the possibility of transmission to patients. This may not be viable in all contexts, for example the NICU or in nursing home facilities. Having an open conversation with nursing staff about their concerns and the needs of patients would likely be the best way to come to an agreeable solution for all.
“As a nurse, we have the opportunity to heal the heart, mind, soul, and body of our patients, their families, and ourselves.” (Maya Angelou) What does this quote mean to you?
Quote-based questions like this are quite common. It is important to note that the point of such a question isn’t to see if you know what the author “really” meant when saying it. It’s not a test of how well-read you are, so don’t panic if you’re faced with something or someone you’ve never read. Rather, questions like this are intended to see what kinds of free associations you make, what comes to mind when prompted with the words of others. Sometimes, the quotes will be related to your future profession, but they also may not be. This is just a way of seeing what values and qualities you can articulate when presented with moving or impactful words.
Here’s an expert response:
Two things come immediately to mind in hearing this quote. The first is the idea of biopsychosocial healthcare. To me, biopsychosocial healthcare refers to the idea that illness and wellness are not merely biological categories, and patients are not merely medical puzzles to be solved. Rather, wellness is impacted by disease as well as the psychological and social context of each individual patient. That is to say, a person’s ability to access care, follow through with treatment, and prevent relapse or additional illness is impacted by their own psychological environment and well-being, as well as social factors like economic status and gender identity. As well, members of some social groups are more likely to be underserved by the medical establishment – again, those in low socio-economic classes, those outside the binary of gender or sexuality, racial minorities, and those on the margins of society are more likely to struggle, due to social determinants of health. Caring for patients means caring for the whole person, which includes their social and psychological well-being, and understanding the social context from which they come.
The second thing that comes to mind is the vast scope of compassion nurses can embody and enact in their unique role, for patients and their families, as well as for their colleagues and themselves. Nurses fulfill a role defined by support: support for patients, for the medical team, for other nurses. Such a role allows them to have immense impact on everyone around them. Showing warmth and kindness to someone who is ill or injured helps them feel acknowledged as a person and not just a list of symptoms. Bringing care and comfort to a family with a sick or injured loved one helps make a very difficult time of trial a little easier to handle. Showing solidarity for other nurses helps the workplace run more effectively, and opens space for empathy around a shared set of standard difficulties on the job. Extending that support to oneself helps ensure that you are providing adequate self-care, and ensuring your own wellness, even as you work to ensure that of others. This complex set of intersections is unique to nurses because of the supportive nature of the work they do, and in such a role, the healing they do goes far beyond the merely physical.
A recent report by health authorities has revealed that there are more deaths due to preventable injuries and common diseases in rural areas as compared to urban settings. In your opinion, what could be causing the observed difference?
- Follow-up Question: What if another report showed the complete opposite findings? Meaning, that those living in rural areas have less frequent deaths due to preventable injuries and common diseases compared to those living in urban areas.
This question and its follow-up have a few goals. The initial question is meant to see if you are aware of current challenges facing certain populations – in this case, those living in rural areas. Rural areas have been historically underserved, and there are current efforts underway to try to remedy this, but progress is slow. The follow-up question is meant to gauge your judgment when faced with two opposing claims. How do you handle a situation in which you’re presented with opposing sets of facts?
Here’s an expert response:
One of the biggest challenges to our current health care system is the deeply underserved rural populations. Many rural areas lack access to advanced health care facilities, including diagnostics like MRIs, and those in such areas often have to travel great distances to access necessary care or even emergency services. For those with low mobility or no access to a car, in particular, this poses a significant hurdle to care, even for curable or preventable illnesses. As well, the jobs available in rural areas are more likely to be industrial or agricultural in nature, requiring use of large machinery and/or significant amounts of physical labor, which isn’t comparable to the office-based jobs more common in urban areas. With such physical strain and use of such machinery come additional risks for serious injury or death. Finally, in some rural areas, substance abuse is a significant issue, and this is in some ways directly connected to the previous two issues. Without access to necessary treatments and specialized providers, some have resorted to alcohol to cope with chronic pain from injuries, and the current opioid crisis is partly due to doctors having to fill gaps in care with painkillers, so that those unable to access appropriate care and physiotherapy are able to continue working. As these prescriptions stop without the root cause of the patient's pain resolved, some turn to the black market, where tainted supplies have led to thousands of overdoses. Finally, many in rural areas live at, near, or below the poverty line, and in nations without universal health care, this leaves them without medical coverage altogether. This means that minor issues are often left uninspected and untreated until they become major, possibly life-endangering conditions. Even a small injury or routine illness can easily transform into something altogether different without access to basic care. These are all significant causes for the kinds of increased preventable deaths suggested by the cited report.
The follow-up question poses the opposite, that those in rural areas have decreased preventable deaths from illness and injury. This flies in the face of most studies and even common sense, but it wouldn’t be wise to simply write this off, if it were coming from a reputable source. Rather, the first thing I would want to do is review the evidence being cited, and compare it to the evidence that supports the other side. If I’m hearing this report from a third party, there are any number of ways the report could have been misconstrued or misunderstood, so I need to go back to the data to understand what’s going on. While it seems unlikely, if it turned out that the evidence – from a peer-reviewed source that can be confirmed by other reputable sources – legitimately did show that the opposite actually was the case, then I would have to change my understanding of the situation. Regardless of our own assumptions about what seems like “common sense”, we have to rely on evidence-based studies for our foundation of knowledge.
In life we are bound to be faced with situations where we do not feel a strong sense of assurance and confidence and question our own abilities. As a nurse you will be faced with such situations. Describe a time when you were faced with a situation that challenged your confidence and sense of assurance.
Questions about weaknesses, limitations, failures, or lack of self-assurance are very common in interviews of all kinds. Talking about these kinds of things can make us very uncomfortable, especially in a high-pressure situation, where we’re being evaluated and want to only put our best face forward. We want them to see our strengths, accomplishments, and positive qualities, not our weaknesses or failures! However, there is still a way to do this, while answering the question honestly. The first thing to do is exactly that: Be honest. We have all confronted our own limitations from time to time, and succeeding at almost anything means failing at some point – nothing every goes off completely as expected! That’s okay; you’re human, and you’re allowed to be human in an interview. What’s important is that you show how you overcame that challenge, how you re-built your sense of self-confidence, and why you’re better now for having gone through such a moment of doubt.
Here’s an expert response:
At age 16, I was two weeks into my job as a Nurse’s Aide at XYZ Retirement Center, I’d gone through much of the preliminary training (having volunteered there for several years prior, and knowing the general ins and outs of the staff’s daily routine), and was working my first solo evening shift. I already had a good rapport with many of the residents, and everything had gone smoothly during training, so I was feeling fairly confident. One of my jobs was to bathe the elderly residents who were unable to bathe themselves. This involved transporting them to a special facility in the Center, with a whirlpool bath and a chair that raised them up from the ground and down into the tub. George, the elderly gentleman I was bathing, was mostly quiet, and I was able to get him into the tub and cleaned with relative ease. After the bath, he was in the lift chair outside of the tub and I was drying him off before putting him in his robe to wheel him back to his room. He muttered something quietly. As I was asking him to repeat himself, he had an accident, expelling a significant amount solid waste onto the floor and chair. I quickly reassured him, got him cleaned up as best I could in the moment, put his robe on him, and helped him into the toilet, doing my best to keep a calm exterior. Inside, however, I felt awful and questioned whether or not I was able to handle this situation, let alone the job.
As he was in the toilet, I called for assistance in cleaning up the floor and getting him safely back to his room. My hands were shaking, and I didn't know what to do. After a minute, George called to be helped out of the toilet, and I brought his wheelchair over and took him into the hall, so he didn't have to go back into the tub room, which still needed cleaning up. He was so upset and embarrassed, but I wanted to be sure that he knew that I understood this was out of his control, and that I was in no way upset with him or having any negative feelings at all toward him. Inside, all I felt was bewilderment - I felt so bad for him, but I didn't feel like I had the tools to handle this. Still, I got to eye level with him, put a hand on his shoulder, and looked him in the eyes. There were tears running down his face, and I put every ounce of compassion I had into my voice and said, "George, please listen to me. This was not your fault. This was an accident, and I understand that it is upsetting. It's okay to be upset. But I want you to know that no one is judging you. This is just something that happens sometimes, and there was nothing you could do to avoid it." Once he was safely on his way back to his room, I went into the bathroom and wept. I questioned myself and my own abilities, and I repeated every moment of the incident to myself, trying to see if there was anything I could have done to prevent this. I couldn't believe I'd maintained any composure at all, but even with that, I felt like I had failed him. I thought that there had to be something more I could have said or done.
This was a very difficult situation, and I was still quite young at this time - this would be a difficult situation for anyone, let alone a teenager with no life experience to prepare for such an event. I spoke with my colleagues and my mother, who is a nurse herself, about my self-doubt. They were all very sympathetic, and helped me understand that things like this really do just happen sometimes. There really was nothing I could have done to avoid this, just as there was nothing George could have done. Even if I'd heard what he said the first time - presumably that he wasn't feeling well or needed to use the restroom - I wouldn't have been able to get him to the toilet in time, as mere seconds had passed. I'd used every tool at my disposal to keep a calm exterior while the resident was with me, and called on others to help when I felt out of my depth. Through this experience, I learned that I know when to call on my colleagues for support, and that I can at least project calm when my mind is racing. As well, they remarked on my maturity – many grown adults, let alone teenage kids, would have had a very different and unfortunate reaction to a situation like this. I was still able to prioritize the resident’s dignity in a situation where he was very exposed and vulnerable.
I came to understand that if I could get through this, I could get through any number of complicated and delicate situations. The world of medicine is not always tidy, and patients are frequently very vulnerable. Having a nurse who has experienced such things (and at such an early stage in their career), who can acknowledge that accidents like this are in no one’s control, and who can take a calm and pragmatic approach while making every effort to maintain the patient’s dignity, is incredibly important. Looking back now, I’m glad I had that experience, as difficult as it was. It showed me a side of myself I didn’t know existed.
You have recently begun working in the paediatrics department. You find out that the paediatrician has refused to continue to act as a child's physician unless the child’s parents agree to fully vaccinate their child, as per her recommendations. Do you think the doctor is acting reasonably? Why or why not?
This question has two fundamental issues: withholding care based on a physician’s personal convictions, and your ability to approach superiors or others in a position of authority in a delicate situation. It is important to think through a question like this diplomatically and tactfully, as any “side” you take will likely put you at odds with someone else. This is a question about autonomy, about the responsibilities of physicians when they hold different beliefs than their patients, and about careful conflict resolution when all parties are deeply invested in the outcome.
Here is an expert response:
This is a very difficult situation, and one that requires both tact and open communication. The issue of vaccinations is a heated one on all sides, and there is a lot at stake for all parties in a situation like this. A scenario like this potentially puts a doctor’s core conviction at odds with parental autonomy, and it is important to respect all of these beliefs in approaching the situation.
The first thing I would want to do is gather more information. Assuming this is speaking of a particular case, I’d want to understand why the parents are refusing to vaccinate their child. There may be a specific reason, based on the child’s own medical history, and perhaps something has simply been missed in taking that history, leading to a misunderstanding between the parents and the doctor. If this isn’t the case, and the parents are choosing not to vaccinate because of their own beliefs, I’d like to speak with them about their reservations around vaccines. There are a lot of misconceptions about vaccines right now, so I’d want to ensure they have the most up-to-date, evidence-based information about the realities of vaccines, both the benefits and the risks. If it was possible to speak with them, I’d sit down with them in a private location, so that I could fully hear their reasons and concerns. I would be very aware of my own tone of voice, posture and body language, to ensure I don’t come off as judgmental or condescending. At their core, they are simply worried about their child and want the best for him or her. Even if I don’t think this is the wisest choice, I want to keep in mind their motivations, which are in all likelihood well-intentioned.
I’d also want to talk to the physician about her reasoning in creating a rule like this. I’d like to understand what led to this – whether it was one particular event, or the result of several things together? I’d also want to know if this proclamation applies across the board, or only to this family in particular. Regardless, there is surely a lot of background and history here that I’m simply not aware of, as I am new to this clinic. Again, I’d try to find a private place and convenient time to meet with the doctor, so that I could more fully understand the situation.
There is quite a lot at stake here. An unvaccinated child is obviously in danger of potentially contracting dangerous illnesses. We’re seeing this in current outbreaks of previously minimized illnesses like measles. As well, if the child comes into contact with other vulnerable, unvaccinated children – for example, those who cannot be vaccinated because they are immuno-compromised – this poses a very real danger to those children. That said, patient autonomy is a key value in our current understanding of medicine, and while the child is a minor, that autonomy is enacted through their legal guardians. Violating this means violating a core and hard-won principle of modern medicine. Yet, doctors, too, are humans with values of their own, and the evidence in the case of vaccines is quite clear – there are risks, but they are minimal, and the benefits far outweigh them.
Personally, I don’t agree with denying care to a child because of the choices of his or her parents. That is putting the child’s health in danger just as much as refusing to vaccinate. If anything, such children need more medical attention, to ensure they grow up healthy and strong. There are many containment and sanitation procedures we can follow to minimize the chance of exposure for other children who come to the clinic – the same procedures we’d follow for children who can’t be vaccinated for medical reasons.
If the doctor was firm in her refusal to see unvaccinated children (this one or others), I would want to find contact information for other pediatricians who will see such children and see if they are taking referrals. Upon gathering such information, I would have it on hand to give to parents who found themselves in this situation. Again, as above, I would try to speak with them privately and calm any fears they may have about vaccines, giving them pamphlets and other materials that carefully explain the evidence behind vaccines that can be easily understood by non-specialists. But, if they remained firm in their refusal, I’d want to try to connect them with health care resources that wouldn’t leave their child without a doctor.
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