Do you know what you don't know?

AORN Journal, August, 2007 by Nancy J. Girard

"If you don't know where you are going, any road will get you there." (Lewis Carroll, Alice's Adventures in Wonderland)

professionals and experts know a considerable amount about their areas of specialization, and perioperative nurses are both professionals and experts. Regardless of their accomplishments, however, I am frequently told by perioperative nurses that they do not need any more schooling and that they only take continuing education because of a requirement from their organization or to renew their nursing license. This attitude is based on a terrible misconception. When a person thinks he or she knows all there is to know, cognition becomes stagnant and the status quo becomes the accepted modus operandi. This can result in complacency as well as danger to patients and the nurse.

How many nurses have worked with managers or other health care providers who didn't know what they didn't know? A lack of knowledge quickly becomes obvious to all except the persons in question. They simply don't seem to know what information they are missing and are often considered incompetent by others.

I once conducted a survey in a large hospital, both in the OR and on the units, to see what physicians thought about nursing documentation. At that hospital, members of each health care profession documented on their own form. Nurses recorded vital information about the patients, but I did not often see that information being used by physicians to improve care. What I found was that many physicians did not even know that nurses chart the way they do, didn't know separate documentation existed, and thus never looked at the nurses' notes.

LEARNING WHAT YOU DON'T KNOW There are four levels of knowing:

1. You don't know that you don't know. (You don't realize you are ignorant.)

2. You know that you don't know. (You are aware of your ignorance.)

3. You don't know that you know. (You are not aware of the knowledge you have.)

4. You know that you know. (You realize what knowledge you have and how to use it.) (1)

Frequently, one does not want to know what one doesn't know. This became clear to me as I moved through my own educational experiences. I originally graduated from a diploma school. It was an excellent school, and it made me the nurse I am today. I thought I knew it all, and I resented that my diploma wasn't enough. Some years later, I got information about a baccalaureate program and enrolled, but I thought to myself that it was just going to be a waste of time and money (an attitude I often see today in RN students who are returning to school to advance their education). I was already a good nurse. What else could they teach me?

I learned just how much I didn't know when I almost failed pediatrics. It became very scary to me to think back on some of the clinical practice actions I thought were correct that I had been doing wrong or had been doing right but for the wrong reasons (like the nursing assistant who once told me, in all seriousness, that she had to turn patients every two hours because they got bored looking at the same wall all the time).

I had to admit to myself that I learned many new things that I didn't know I didn't know. A short time after that, I decided I wanted to teach, so I had to go back to school again for my master's of science in nursing degree. Again, I entered with the thought that I now probably knew most of what I needed to know, except maybe how to teach. It didn't take longer than a few weeks to find out there existed a considerable amount that I still didn't know in every area. Then I went back for my doctorate, and I found out that nothing is ever written in stone and that everything should be constantly questioned, tested, and retested.

Even Socrates questioned what he did not know. Although many consider him to be one of the most intelligent beings who ever lived and a great teacher, he did not think that of himself. His wisdom lay in continually questioning the "why" of everything. (2)

REASONS PEOPLE AVOID LEARNING

Why don't people want to know what they don't know? There are as many reasons as there are people, but some of the most common are:

* Association of the learning process with past public humiliation and shame;

* Perfectionism, which makes it difficult to accept exposure to the initial "not-knowing" and the uncertainty of getting to know, underlined by a fear of not being good enough;

* Self-consciousness, fear of being seen as foolish or ignorant;

* A belief that others know and understand and you don't, leading to feelings of inferiority;

* Fear of the consequences of not knowing or understanding--failure, lack of control of your circumstances. (3)

KNOWLEDGE IS THE BEST TOOL

Everyone is capable of finding out what they don't know. To do this, they should

* want to know what they don't know,

* not be ashamed to admit they don't know,

* seek new learning,

* keep an open mind,

* never get too comfortable in the status quo, and

* not try to fake their way through.

Knowledge is the best tool a nurse can have to provide the safest, highest quality patient care possible. The importance of gaining knowledge is pertinent in any area of life, from school to clinical practice to home. Stay inquisitive!