Today was a Two-Zero Day

March 31, 2006
Some rules are meant not to be broken; our professional accountability depends on it.

By Diane Chandler, RDH

For one student in my dental hygiene class, it was a two-zero day. The student was angry with me, and clearly not taking responsibility for the choices she made. Just because everything turned out OK, she felt justified in some way and angry with me for disagreeing with her.

This, of course, disappointed me in two ways. As a registered dental hygienist in a community college program, I realize that I am not only there to teach, but also to serve as a role model for the next generation. Two fundamental elements of my role are to convey the rules of safe care in the program and to be accountable in the safe delivery of these standards by the student. These elements of practice are important both in and out of the classroom.

This particular student obviously did not feel the same about the rules that govern the program and the practice. Rules give order to chaos, and in a classroom setting some think these rules apply only to the other person or only when time permits.

The first zero was for the student's failure to get a faculty member's signature on the temperature, heart rate, and blood pressure readings of the patient. Even though, as the student said, "Everything was fine!" she failed to secure the signature.

The faculty signature was not a rule to be ignored. The student failed to realize the ramifications of not getting the signature. The student not only put the patient at risk, but she put me at risk as well. She needs to realize that the legal responsibility of HER actions rest with ME, the RDH instructor.

Both young and old alike can be health-compromised, and the documented readings were my proof of accountability if anything happened to the patient. If something went wrong during the procedure, those readings were my assurances that protocol had been followed. On the surface it may seem trivial, but the instructor's signature signifies that a licensed professional supervised the procedure. Just because nothing bad happened was no excuse for poor practice.

Granted, sometimes students are just in a hurry and take "relatively" small risks. They are fearful that they will not complete their clinical requirements, so shortcuts may seem to make sense even though they know better. However, I can assure you that by doing things in a step-by-step routine, students can complete the requirements in a timely manner. The bonus they receive is the ability to develop a time-management model for themselves.

Rushing ahead may get you there faster, but at what cost? Skipping steps now will get you a zero in school, but in practice it may cause irreparable damage. Even if the student is behind, it is always better to be safe than sorry.

Students must realize that their learning behaviors will eventually be translated into work behaviors. In every office there is something called office protocol. This set of rules keeps team players on the same page. Everyone in the office needs to follow the protocol, and the classroom setting is no different. Clinical experience attempts to emulate the actual office setting. Procedures must be done in order and correctly. Bending the rules only leads to problems in the college clinic and in the office.

The second zero was for professional judgment. This is a hard one because it is a subjective evaluation that can be based on me and the behaviors I modeled. When I was a student, I followed the rules. I tried to match the behaviors of my instructors, and I carried these traits into my professional practice. These traits are really the accountability I have toward my patients, my practice, and my role as an instructor.

To be any less would not be beneficial to my students or to me. In the hygiene program, a certain level of competency is expected from second year, second semester students who will soon be graduating. If there is anything we as a faculty can insist on at this point in their education, it is good clinical judgment. When new graduates believe they are qualified to decide what they will or will not do, they usually become disillusioned and are not happy with their career choice.

The students of today may someday return as the instructors of tomorrow. Even though they may not believe this, their actions should reflect their readiness to fill the role in the future. Through the hands, eyes, and judgment of their students, instructors may experience some of the same frustrations they had during their own training years. Through years of experience, the validity of their training will emerge and give them the confidence to accept the role of instructor with enthusiasm and professionalism. It is then that they realize that accountability, judgment, and professionalism have truly been woven into their value system.

Diane Chandler, RDH, is a part-time instructor at Wayne College Community College District in Detroit.