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Friday, November 6, 2009

Improvisers in the (Medical) Workplace

Recently Liz Caradonna of e-liz, posted a blog entry about what assets an improviser might bring to an office workplace entitled "Beyond 'Be Funny!': improv at the office."

Some ideas covered in the piece include the value a good improviser places on trust, and the concept of not overlooking the obvious answers to simple and complex questions.

Her follow up piece How to Listen, expands on the idea of how (good) improvisers may listen differently than others. (I almost just repeated half of her entry here because I love her explanation of this idea so much. But she explains it so well that paraphrasing doesn't do it justice. Do yourself a favor and go read it.)

Because people are generally always asking me if my improv helps me as a nurse, I have had a chance to come to many of the same conclusions as Caradonna.
In fact, almost everything she said about being an improviser in an office job can be said of being an impoviser in a medical field.

I'd like to briefly expand on her ideas in the context of a health care provider's daily work.

1. Trusting/Teamwork. Trust or lack of trust can literally become life or death very quickly in a medical work environment. But even in low stake situations trust is essential to successful patient outcome. In an ideal situation every member of the team, from respite aide to attending M.D is out to provide the best patient care possible while also lifting up and empowering every other member of the team. It's not in anyone's best interest to do anything else. For an improviser, the concept of working with a large group of people towards one common goal is familiar and easy. The give and take of leadership and trust comes naturally, and is an area a good improviser absolutely thrives in.

2. Being a Good Public Speaker. Improvisers are good to have on hand at staff meetings. They have a good sense of how to gauge an audience which makes presentations more effective. But a good improviser is usually also good at private speaking. This means not being afraid to talk to patients, family members and to advocate strongly for their rights while encouraging their compliance with care. You shake hands, you introduce yourself, you make eye contact. You know the patient's history going into the interaction. You are sure of yourself and encourage others to be sure of you as well.

3. Don't Discount the Obvious. Caradonna has a great explanation of why this is an improv skill. My two cents on the medical end is that it's really easy to see a tanked oxygen saturation level on the screen of the pulse oximeter and start to flip out. You want hook them up to 02 2L via nasal cannula STAT. But first you should check to see that the sensor didn't just fall off their finger while you weren't looking!

4. How to Listen. A good improviser is always a good listener. And a good listener makes a good nurse. In nursing school we spent entire lectures learning how to listen. We role played. We took tests on listening. Every therapeutic interaction with a patient is based on how to listen and how to listen well. As an improviser you are trained to listen well, retain information, and reflect and mirror your scene partner. Moreover, you are trained to respond to your partner as fully as possible, by attempting to demonstrate your acceptance of their personal reality.* You seek to understand their perception of their illness in addition to seeing the disease process through a clinical and objective eye in order to gain insight into a much larger picture of the patient's wellness. Providing therapeutic care is going to come very easily to anyone who does these things as a natural part of conversation.

I really wish I'd had the right language to use to describe all of this years ago while I was doing my psych clinical. My instructor was dubious of my ability to be a performer and a nurse. I felt like I was constantly defending my art to her, despite my stellar grades. I was conferencing with her one day and made the mistake of explaining that I approach every interaction as though it were an improv scene.

"No!" she exclaimed, "no, you can't do that. This isn't a joke. These people are sick."

What I meant of course was that I was going to listen to my patients, validate their experiences by accepting their reality, trust my co workers and keep my mind grounded at all times in the truth of the nurse-patient relationship. Which I tried to explain, too late and a bit lamely.

I felt like from that moment on she was watching me as I made my rounds on the homicidal-suicidal unit where we worked, just waiting for me to mime a paintbrush, or burst into free style raps about Prozac so she could report me.
But time soon told what my fumbling words could not: that an improviser's instincts are some of the finest assets an employer can ask for, in any field.

* "...these responses go a step further than "what I hear you saying is..."; they say, "I hear you. I understand the universe that you're living in... and I'm living in it, too." This is the message that radiates from an exceptional listener. "We're in this together." (Caradonna, How to Listen)

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