A Spoonful of Sugar

jadelpn, LPN, EMT-B

This is an interesting debate. One that can have multiple pros and cons. In essence, can one be a nurse and view it as just another day, a job, a paycheck, a means to an alternate end? Can we care for patients without really caring about them?

There are more than a couple of trains of thought on this subject. Most people do not "automatically" think of nursing when planning a career that doesn't encompass a level of interaction with people that one is not likely to find in a number of occupations. One has to deal with people who are at the most vulnerable states of mind. Who have lost a great deal of control. That their function depends on what a nurse does or does not do. But can a nurse just do what they need to, cut bait, and move on? Do facilities care about the numbers, or do they care about the patients? Do facilities want a nurse to take on greater and greater assignments of higher and higher acuity and do it all with a smile and kind words?

With that being said, does one have to be compassionate, caring and "this is my calling" attitude to accomplish the goal of the facility? If you ever look at or read a facility mission statement, it would be interesting to see if nurses have the time or energy with ever changing staff patterns and responsibility to do what any given facility claims that they should be doing.

With the introduction of HCAPs and the questions that it entails, there is a strong argument that yes, in fact, unless one is a really, really good actor, you need to have some essence of caring. HCAP has a number of questions at least one of which is usually along the lines of "did the staff care for you as a person". I am not a gigantic fan of such subjective questioning, however, it has come to a point where re-imbursement is dependent on it. Caring looks and acts differently for every single person, every single interaction. It is not easy to be able to complete tasks, and have a heart to heart at the same time, all whilst a nurse's 7 other patients are all waiting for their turn. (Which another line of questioning on HCAP is about waiting). Essentially, one could say that with staffing, a nurse could be set up to fail.

But the focus is not on nursing, it is on the patient "experience". Some refer to it as our "customers". Customer denotes to me that one chooses to have a service or buy a good. Unfortunetely, at least a fair number of patients are not in a facility because they choose to be. Not many patients are into the fact that they can not live at the level they are accustomed. That they have functional decline. That they need to have a bunch of stuff done to them and for them. So many nurses are finding themselves walking a fine line.

Some facilities have scripting. I believe I have been pretty vocal in my general distaste for this type of communication. I don't think this is the be all and end all of patient satisfaction. Most adults can really tell, especially after the 4th nurse comes in a says the exact same thing as the prior 3, day in and day out, that nurses can not stray from a set script. On the other hand, this can assist a nurse who is not in it for anything other than a means to an alternate end to touch key points to have patients satisfied, and not get too involved in the fluff.

With this in mind, one could say that schools of nursing can teach in an alternate way. Stay focused on the science of nursing as opposed to the art. Which is an interesting theory, however, what would that do to critical thinking skills, which can be thought of as the most important nursing skill? But can one think critically, while following a script, not stray too far off course, and still clock out on time?

Nursing is dependent on assessment. Assessment is partially dependent on asking questions. Scritping is asking open ended questions. If a nurse can not react to the answers to the questions--critically think--then a nurse is set up to fail. And there's a whole lot of patients that a nurse has to repeat this scenario with. All while being mindful of customer satisfaction.

So to provide the act of caring we at least in part need to act as if we care. And most nurses do care--to a certain point. It is worth noting, and a point of interest, that most acute care facilities are going away from LPN/ADN/Diploma nurses. These areas of study can be considered more of the art of nursing at the bedside type education initiatives. One could argue that higher degreed nurses at bedside are more in tune with the science of nursing, therefore, are more in tune with the actual goals of a facility, regardless of what any mission statement may say.

To be a nurse who is not committed is a complicated scenario--as it is an occupation that one has to think about if they can accomplish to the satisfaction of the patients they take care of.

A Spoonful of Sugar

About jadelpn, LPN, EMT-B

More Like This