Be a Real Nurse: Compassion is the Key

[jeastridge]

The three siblings stood woodenly to the side in the ICU room, trying to stay out of the way while they waited for the doctor to make her early morning rounds, and fighting the tears that kept creeping into their eyes making it so that they couldn't see clearly, and somehow even affecting their ability to hear and understand. The tears filled their throats, silencing all the questions that had no answers. Just twenty four hours prior, their dad had been active and able, always serving and busy doing good for others. Now he lay comatose and on a vent, his brain overwhelmed by a massive bleed.

The shift nurse came in and made a point of setting them at ease by introducing herself and going over to the whiteboard to jot down her name. Then she explained that she would be doing her daily assessment. She moved smoothly about, a gentle expression on her face as she familiarized herself with the patient. When she finished, she took just a moment to ask if they had any questions and to learn their names and relationships. Her manner suggested patience and compassion and the three relaxed just a bit, their shoulders less tense. They answered "yes" when she offered to bring another chair and then followed through.

The nurse, if asked, would say she didn't do anything particularly special. But she did. Her attitude, her bearing and her words communicated that she saw them in their pain and that she not only felt for them but also would do what she could to put action behind her feelings.

The definition of compassion given by some is: "a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering." So it starts with a feeling but the nebulous emotion is then joined by action. Together, competent action and caring make up the twin bases of excellence in nursing beyond providing basic care.

How does true compassion differ from pity and sympathy? If words are kin to one another, then compassion and empathy are cousins who walk around in each other's shoes helping one another out, while pity and sympathy feel bad and sit side-by-side and don't do much.

Can you think of a time when you received compassion from a medical professional? What did it mean to you? I remember meeting the nurse in the ER after our son had a bike wreck with a possible head injury. He was in the CT scanner, and I was panicked. She put her hand on my shoulder and make eye contact with me and said something reasonable like, "We are taking care of him right now, and we will let you see him as soon as he gets back." The combination of the human touch and the calm tone of her voice, brought me down from my desperate perch just a notch of two, but enough so that I could take a breath and hold myself together. A few days later, he was fine (save some teeth he lost on the bike trail!), but I never forgot the compassionate touch of the nurse's hand and the even, calm tone of her voice.

Compassion manifested through physical touch is key to effective nursing practice. Everyone needs physical contact, but people who are ill are especially vulnerable to its absence, as are their close family members. Along with touch, people note the tone of our voices, the words we chose and even the body language we employ as we communicate. Together, these components merge to further define how our patients see us. Is compassion easy? Never.

So here is the tricky question: do these nurses that practice caring and compassion burn out faster than those that stay detached and keep a distance from their patients? I am not sure there is a scientific answer to this question (how to you quantify compassion?) but we can all decipher plainly the results of living out of loving compassion and pulling back into our protective shell of doing the job technically well without getting too attached. We all know the glowing satisfaction of working hard, and doing good. However, notice here that being appreciated or recognized doesn't come into this equation. True compassion in nursing often means offering ourselves in a caring relationship even when the other party doesn't deserve or appreciate it. It's nice when they do, but that is not what feeds compassion.

Compassion is an interior state of the heart; an overflow of the Good that resides within. Compassion is not easy, but living and working without it, is not being fully alive to all that we can be as nurses and has human beings.

Being a fairly new grandmother, I am reading children's books all over again and loving the experience. One of the ones that I never "got" as a kid was The Velveteen Rabbit. How does getting all banged up and pulled apart, make you "real?" The concept was beyond me as a child, but now it makes me weep. Because the truth is, unless we give ourselves away, to be used up in loving one another, then we are never truly real. As nurses, compassion takes us to a new level, to the place where we become the best we can be-REAL nurses.

[cagjlg]

I'll never forget having a flex sig and not being able to have any medication due to other conditions. The male nurse held my hand and told me to squeeze all I needed. He never whimpered although I clearly saw marks on his hand afterward. I honestly don't think that I could have survived without him.

[Aristillus]

Ohboy, can I ever speak to this! After a long career as a bedside nurse, I retired a couple months ago. Two weeks into my retirement I suffered a serious injury requiring surgery and hospitalization. Unfortunately I also experienced a serious lack of compassion from many of the nurses who cared for me. They were competent, they were respectful, they answered my call bell in a timely fashion and offered plenty of pain meds. They even mustered up a certain amount of sympathy for my predicament but I wouldn't call saying "I'm sorry for what happened to you, sweetie" compassion. They reminded me of a young nurse I worked with, to whom I described my toileting routine for patients on flat bedrest...explaining that I placed a bedpan on a fresh chux under a bedpan and then used the chux to clean their bottom. This nurse haughtily declared, "Well I'm not going to wipe anyone's butt for them!" I've always known being hospitalized puts a patient in a vulnerable position but had never experienced just how vulnerable it feels until my accident. May I just say that a little kindness and empathy, a touch, an anticipation of a need without having the patient ask for every little thing...can make an unbelievable difference. If being kind and showing your humanity is going to lead you to a burnout, maybe you're in the wrong profession.

[jeastridge, BSN, RN]

I don't know. I'm not one of the called yet I've grown more satisfied with each passing year, in a field where there's a whole forum of exhausted nurses doing what I do.

I don't have the answers why one can grow more compassionate and feel purposeful while another feels used and battered. I'm sure much has to do with where one is in life, it certainly helps when you don't have to burn it at both ends and you have something left over at the end of the day.

I do know it didn't happen overnight for me, it's been a 30 year journey and I have kicked rocks and have had some big cries over the years.

Thank you, Libby, for your nice comment. You sound like a person that works on keeping life in balance. I'm so glad that you continue to find satisfaction and fulfillment in your work. Joy

[jeastridge, BSN, RN]

There has to be a balance somewhere between giving and giving yourself away. I haven't found it yet, but I'm working on it. Good point about burning out quicker. I'm trying to "recover" from that extreme right now. I'm twenty-five years in. Maybe I will find balance before I retire. I hope so.

I appreciate you comment and life you, I know that the line between giving and "giving myself away" is fine but definite. It separates compassion and resentment and we all know when we have put even a big toe over that invisible space. Like you, sometimes I have to pull back and "recover" from times when I go too far, but compassion resides well to this side of the line and makes the nursing profession so much more meaning--full.

[jeastridge, BSN, RN]

Dinosaur here, 37 years and counting. Your essay takes my breath away, particularly your characterizations of compassion and empathy as "doing", and pity and sympathy as "sitting and feeling bad".

There is an NLN video from the 1990s titled "Critical Thinking in Nursing. Lessons from Tuskegee". In this video, the nurse who represents Eunice Rivers tells of her nursing instructor, in the 1920s, saying "You give all you can, but you don't ever give any more than that. Need never ends".

When I've asked my students to interpret that statement, they eventually are able to drill down to the meaning of "giving of oneself in one's role as a nurse", but realizing that it is necessary, for our own emotional health, to hold back some reserve of compassion for ourselves - because "need never ends" - there always will be more and more individuals and families who require not only our nursing expertise, but also deserve that spirit and spark which define us as nurses.

Nursing is and should be more than impersonal performance of tasks carried out between clocking in and clocking out.

Well said! (applause, applause). I love your discussion about "need never ends" and appreciate the way you expressed the importance of holding something back for our very selves and our families.

[jeastridge, BSN, RN]

Nursing is mentally and emotionally the hardest thing I have ever done. I went from being a task oriented new nurse to a nurse that can emotionally and mentally be in the moment when people need me. I do have boundaries, though.

Thank you for your comment. You outline well the way proficiency in task-oriented nursing skills gives us freedom to be the compassionate nurses we long to be. Way to go!

[jeastridge, BSN, RN]

Ohboy, can I ever speak to this! After a long career as a bedside nurse, I retired a couple months ago. Two weeks into my retirement I suffered a serious injury requiring surgery and hospitalization. Unfortunately I also experienced a serious lack of compassion from many of the nurses who cared for me. They were competent, they were respectful, they answered my call bell in a timely fashion and offered plenty of pain meds. They even mustered up a certain amount of sympathy for my predicament but I wouldn't call saying "I'm sorry for what happened to you, sweetie" compassion. They reminded me of a young nurse I worked with, to whom I described my toileting routine for patients on flat bedrest...explaining that I placed a bedpan on a fresh chux under a bedpan and then used the chux to clean their bottom. This nurse haughtily declared, "Well I'm not going to wipe anyone's butt for them!" I've always known being hospitalized puts a patient in a vulnerable position but had never experienced just how vulnerable it feels until my accident. May I just say that a little kindness and empathy, a touch, an anticipation of a need without having the patient ask for every little thing...can make an unbelievable difference. If being kind and showing your humanity is going to lead you to a burnout, maybe you're in the wrong profession.

Thank you for sharing from your personal experience. Being a patient is the hardest and the fastest route to understanding the true need for compassion in our profession. What we do truly matters. Every little thing that we do.

[KatieMI, BSN, MSN, RN]

What I would like to add is that "compassion" is frequently wrongly understood by nurses AND patients alike.

I saw innumerable times that a nurse who was presenting almost direct threat to patient's health due to her lack of clinical knowledge, assessment skills and critical thinking was praised to the skies, collected all sorts of awards and even made a preceptor and "unit role model" because she was very well fitting into "compassionate nurse" role. In all cases, it was not an image or play, it was how that nurse understood "nursing" and she acted strictly within it. She knew the intimate details of patient's family life, sat in room, held hands, chatted about life, was very careful and exact about basics of care, never let things like turning and toileting to fall through the cracks, etc., and felt that by doing so she was "fulfilling her role as a caring nurse". Patients felt the same. They had no idea that their "so sweet, compassionate, listening" nurse had no idea what was really going on and relied on others in clinical decisions. The other "sharp, rude, not listening" nurse who suddenly interrupt the idyll and yelled for crash cart saved the patient's life; nobody praised her.

I would like to add that, not always but pretty often, that nurses of that particular type are obscessed with policies and protocols and tend to become "preceptors from hell" for smart and knowlegeable new grads. Just my observation.

It looks quite similar with patients' perception of "kind, understanding, listening" doctors who in fact, as the best practice CYA medicine and, at the worst, knowingly and purposefully make them addicted to drugs.

[jeastridge, BSN, RN]

What I would like to add is that "compassion" is frequently wrongly understood by nurses AND patients alike.

I saw innumerable times that a nurse who was presenting almost direct threat to patient's health due to her lack of clinical knowledge, assessment skills and critical thinking was praised to the skies, collected all sorts of awards and even made a preceptor and "unit role model" because she was very well fitting into "compassionate nurse" role. In all cases, it was not an image or play, it was how that nurse understood "nursing" and she acted strictly within it. She knew the intimate details of patient's family life, sat in room, held hands, chatted about life, was very careful and exact about basics of care, never let things like turning and toileting to fall through the cracks, etc., and felt that by doing so she was "fulfilling her role as a caring nurse". Patients felt the same. They had no idea that their "so sweet, compassionate, listening" nurse had no idea what was really going on and relied on others in clinical decisions. The other "sharp, rude, not listening" nurse who suddenly interrupt the idyll and yelled for crash cart saved the patient's life; nobody praised her.

I would like to add that, not always but pretty often, that nurses of that particular type are obscessed with policies and protocols and tend to become "preceptors from hell" for smart and knowlegeable new grads. Just my observation.

It looks quite similar with patients' perception of "kind, understanding, listening" doctors who in fact, as the best practice CYA medicine and, at the worst, knowingly and purposefully make them addicted to drugs.

This are important and pertinent observations. As you point out, the truly compassionate AND competent nurse does what is best for the patient, not necessarily the most pleasant or popular thing. As I pointed out in the article, the compassionate nurse is not doing it for the praise; often he/she is not praised at all...but there is a great deal of long term satisfaction in practicing nursing with true compassion as the plumb line. Thank you for your comment. Joy

[dec2007]

What I would like to add is that "compassion" is frequently wrongly understood by nurses AND patients alike.

I saw innumerable times that a nurse who was presenting almost direct threat to patient's health due to her lack of clinical knowledge, assessment skills and critical thinking was praised to the skies, collected all sorts of awards and even made a preceptor and "unit role model" because she was very well fitting into "compassionate nurse" role. In all cases, it was not an image or play, it was how that nurse understood "nursing" and she acted strictly within it. She knew the intimate details of patient's family life, sat in room, held hands, chatted about life, was very careful and exact about basics of care, never let things like turning and toileting to fall through the cracks, etc., and felt that by doing so she was "fulfilling her role as a caring nurse". Patients felt the same. They had no idea that their "so sweet, compassionate, listening" nurse had no idea what was really going on and relied on others in clinical decisions. The other "sharp, rude, not listening" nurse who suddenly interrupt the idyll and yelled for crash cart saved the patient's life; nobody praised her.

I would like to add that, not always but pretty often, that nurses of that particular type are obscessed with policies and protocols and tend to become "preceptors from hell" for smart and knowlegeable new grads. Just my observation.

It looks quite similar with patients' perception of "kind, understanding, listening" doctors who in fact, as the best practice CYA medicine and, at the worst, knowingly and purposefully make them addicted to drugs.

Wow, I thought I was the only one that had noticed this!!!!