Have we lost the "art" of nursing?

Nurses General Nursing

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As a member of the "aging baby boomer" generation, I have often wondered where has the "art of nursing gone"? There is little doubt that medical science is an integral part of nursing. However, it is often difficult to see if the "art of nursing" is practiced. In fact, I find myself asking if this unique art has been lost. Is it being taught to nursing students in the 21st century, or is it simply a lost art? What is the art of nursing, you may ask? Simply put, in many ways, the art of nursing has to do with the logical and common sense approach to nursing.

In other words, doing the little things that brings relief to a patient without having to get a doctor's order. For instance, back in the day, when I was in nurses' training, we gave patients back rubs at night before they went to sleep, or fluffed up their pillow and turned it over to help them get settled down for the night; even sometimes washing the pt's feet (if time allowed). You know, the little things that provided comfort, and often appreciated by a patient. I know you are probably thinking "wash feet, back rubs, who has time to do those extra things?" By the time you finish doing meds and treatments there is no time for the little things. Believe me, I can relate! But again I pose the question, has the "art of nursing" been lost?

Specializes in Critical Care.
...I am a nurse practitioner and as a provider, the biggest pet peeve I have is getting paged in the middle of the night by a bedside nurse calling me about a panic lab value. The conversation would go like this:

Nurse: "got a call from lab about an ABG, pCO2 is 70".

Me: "do you have the rest of the numbers, you know his pCO2 has always been in the 70's because of his high ventilatory deadspace from ARDS, how's the pH, should I be worried?".

Nurse: "that's all the lab gave me and I should call you about this to cover me that I informed a provider".

Why is it that nurses are made to act like robots in the guise of covering their behinds?

That's usually due to a bad policy written out of laziness, or a Nurse who either doesn't understand the policy, or is so "cover my butt" focused that they go well beyond what they policy requires, to the point of working against patient care.

The Joint Commission has actually gone out their way to make it clear that critical value reporting policies do not have to require that a provider is notified of a value that was already critical in a previous test, or if the provider has already left orders for how to respond to a particular expected/potential critical result, or if the Provider has changed the critical threshold for this particular patient or even an entire patient population.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
That's usually due to a bad policy written out of laziness, or a Nurse who either doesn't understand the policy, or is so "cover my butt" focused that they go well beyond what they policy requires, to the point of working against patient care.

I think it's the latter. The hospital does not have a policy against nurses uses their own critical thinking and there is no significant delay in care if a nurse waits for the rest of the ABG numbers to appear on the computerized chart prior to calling the provider.

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And there's the point. It was not too long ago that an entire critical picture was given to a provider. Not small snapshots that don't give enough information for the provider to even give an order.

However, with a newer way of thinking, nurses are taught to respond following the rule. So it is not unheard of for a nurse to make multiple calls to a provider as values come in, as opposed to the old school way of one phone call, all of the pertainent information.

Gone is the critical thinking. The 5 phone calls to talk about one critical lab each time as opposed to one phone call to discuss the results of labs, current assessment, heck, even what the vitals are looking like.

It is training to the policy/regulation without the critical thinking skills to go with it. Current nurses are not paid to critically think, they are paid to make sure the unit is compliant 100% of the time. Critical thinking doesn't get the facility paid. Oh, unless you start not getting reimbursed for re-admits, (and some don't) then this is a nurse's fault--even though the current line of thinking is in oppostion to elaborating on anything.

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The last time I was able to fluff and buff my patients was a night when I miraculously had 3 patients. For one particular patient, I was able to rub lotion on his itchy back not once but twice.

The lost art is 100% to be blamed on the financial bottom line of hospitals. Sure there are nurses out there who haven't a compassionate bone in their body and will never be a "good nurse".

I once worked for a world famous institution, who had more money than God. My ratio was usually 4 or 5 to one on night shift, but we also had hard working PCTs with 7:1 ratios, 24 hour phlebotomy, and a charge nurse without a patient. I always started my shift with a quick intro and assessment of each patient, and then at med pass, I was able to spend time getting to know my patients, taking care of their mental and physical needs, and safely passing meds, and I was also ableto document in the room while doing this. By midnight, I was 100% done with my charting and med passing, and my patients did not feel ignored. We believed in continuity of care so I usually had all of my patients for all 3 days. This wasn't an easy floor, it was 1 day post op CABG, fresh thoracotomies, carotidendarectomies, fem pops, etc. We had tubes and drains and drips. I clocked out every morning at 0708, after doing bedside reporting/rounding.

Now, in the crap facility I work in, I put out fires all night long and can barely keep my head above water. I just barely keep this hospital from killing my patients, and I clock out late every day so that I can finish documenting. It isn't me, its the facility, and their cheapness.

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This is why I love hospice. I can spend as much time as I want with a patient. Will I have to re-arrange my schedule? You bet. But I freely give out hugs, back rubs, hair makeovers, make-up sessions, manicures, etc. I am one lucky nurse :)

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Specializes in Pediatrics, Emergency, Trauma.
The last time I was able to fluff and buff my patients was a night when I miraculously had 3 patients. For one particular patient, I was able to rub lotion on his itchy back not once but twice.

The lost art is 100% to be blamed on the financial bottom line of hospitals. Sure there are nurses out there who haven't a compassionate bone in their body and will never be a "good nurse".

*I once worked for a world famous institution, who had more money than God. My ratio was usually 4 or 5 to one on night shift, but we also had hard working PCTs with 7:1 ratios, 24 hour phlebotomy, and a charge nurse without a patient. I always started my shift with a quick intro and assessment of each patient, and then at med pass, I was able to spend time getting to know my patients, taking care of their mental and physical needs, and safely passing meds, and I was also ableto document in the room while doing this. By midnight, I was 100% done with my charting and med passing, and my patients did not feel ignored. We believed in continuity of care so I usually had all of my patients for all 3 days. This wasn't an easy floor, it was 1 day post op CABG, fresh thoracotomies, carotidendarectomies, fem pops, etc. We had tubes and drains and drips. I clocked out every morning at 0708, after doing bedside reporting/rounding.*

Now, in the crap facility I work in, I put out fires all night long and can barely keep my head above water. I just barely keep this hospital from killing my patients, and I clock out late every day so that I can finish documenting. It isn't me, its the facility, and their cheapness.

I remember working like this in the mid 2000s...those WERE the days! *sigh* :down:

If anything, we MUST return to these days...the watering down of healthcare WILL end...it can't sustain any longer :no:...whether the nursing outcomes model gives us a tool to make sure pts are getting the utmost care, to the head of CMS being a nurse, we have to make sure those aspects of nursing return, or at least have a chance to survive. :yes:

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Interesting thread.

I think that some of the lack of compassion shown BY nurses is a reflection of the lack of compassion shown TO nurses.

Sometimes I want to scream at people whining and moaning and complaining and taking everything out on me or dumping on me... I AM A PERSON TOO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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