Nursing: The Caring Profession

by Ruby Vee

8,380 Views | 48 Comments

You don't have to have a calling to be a good nurse, but you do have to care. I'd go so far as to say FIRST you have to care. Lots of great nurses are in it for the money, but one characteristic all great nurses share is that they care about their patients. I would argue that someone who doesn't care should not even BE a nurse!

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    Nursing:  The Caring Profession

    I’ve gone on record as vigorously opposing the idea that one must have a “calling” to become a nurse, or even to become a good nurse. Even someone who is just in it “for the money” can be a fabulous nurse, and someone who has a calling can be totally incompetent. To be a nurse, you need to be able to communicate well in English (both oral and written form), understand enough mathematics to calculate drug dosages, memorize that a PT goes in a blue tube and a Chem panel in a gold top (or whatever color coding your institution uses), be able to make assessments, plan care and you must be able to utilize your critical thinking skills. (And myriad other things that I could spend all day enumerating without ever getting to my point.)

    But the smartest person in the world won’t be a good -- or even half bad -- nurse if he or she doesn’t CARE.

    I’m not talking about warm blankets and fluffy pillows and bringing sodas from the vending machine and attending your patient’s funerals or their children’s bat mitzvah’s. Most of us don’t have enough time to do as much of that as we’d like to. I’m talking about caring about your patients enough to advocate for them, protect them and do your very best.

    In the past few days, I’ve seen a few threads that trouble me a great deal. There’s the CNA whose patient fell in the bathroom. While the patient was still in CT, the CNA was on allnurses.com wondering what this fall would do to her record, how it might affect her future plans. She listed four concerns and not one of them was a concern about the patient. The fall serious enough to require a CT, and her first concern was for herself. In fact, it seems that her only concern is for herself. It was only after attention was called to her list of concerns being about herself and not her patient that she responded with: “Let's simmer down, ladies. Of course I was concerned with how she was and it was obviously implied. No hemorrhages were found in the CT. “

    Then there’s the student who was “kicked out of clinicals for a HIPAA violation.” He went on to describe a series of egregious errors including a near miss with an insulin dose that was 10 times the ordered dose and concluded with a litany of excuses for his mistakes and complaints about the unfairness (to him) of the situation. Again, this person expressed no concern for the patient he could have harmed or even killed ; his concern was that he had no advocate for the disciplinary process, that it was totally unfair to him, cost him an extra semester and tuition money and that he didn’t think there was a HIPAA violation anyway. (For the record, I don’t think so either. I think he was asked out of the clinical for “reckless and unsafe behavior.)

    Again, it was only when it was pointed out to him that his first concern should be for the patient, that he responded with “you have no idea how I grieved because of the insulin error or how much it affected me. “ And in a later post, added: “They were really after me that day,” and “Perhaps you didn't read the part where I said that it severely affected my psyche. “ Again -- all the concern expressed is for himself and none for the patients he could hurt.

    Caring isn’t enough to make a good nurse, but without caring you cannot be one. Everyone makes medication errors -- I’ve made some whoppers! The difference between a caring nurse and an uncaring one is that the caring nurse’s first concern is for the patient who was harmed or potentially harmed, not for himself or herself. I remember an error with a heparin drip that had the patient’s PTT in the stratosphere and his urine cherry red. I don’t remember being concerned about whether the error went on my record or whether I’d be fired -- I was devastated by the harm I had done to that nice old man. And that’s what I told the physician, the charge nurse, my manager, the pharmacist, my husband and the colleague who noticed the error. No one had any reason to question whether I understood the enormity of my mistake or cared about the patient involved.

    I was the nurse caring for the patient who went down half a flight of stairs head first. My immediate concern was for the patient -- calling the doctor, getting the patient off the floor and to CT, watching him like a hawk all night long. Of course I was concerned for the potential damage for my career, but is was way far down the list of my concerns. WAY far. For some of these folks, their ONLY concern seems to be for themselves and their grade, possible disciplinary action, a bad mark against them.

    The nurse who really doesn’t care about the patient first isn’t a good nurse and I would argue that they shouldn’t even be a nurse at all.
    Last edit by Joe V on Oct 22, '13
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  3. About Ruby Vee

    Ruby Vee has been a competent nurse for over three decades, and while she's never been known as a "pillow fluffer," she puts her patients first.

    Ruby Vee joined Jun '02 - from 'the Midwest'. Ruby Vee has '38' year(s) of experience and specializes in 'ICU/CCU'. Posts: 8,301 Likes: 29,134; Learn more about Ruby Vee by visiting their allnursesPage


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    48 Comments so far...

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    LOVE THIS!
    mrsmamabear2002 likes this.
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    Well said.
    mrsmamabear2002 and OCNRN63 like this.
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    While I agree wholeheartedly with the points you make, I have to wonder if AllNurses skews how much the OPs of such threads care. I know which threads you are referencing, and while part of me did think at first, "Why don't they sound more worried about the patient?", my next thought was that this is a board where people come for advice because they assume we have been through similar/familiar situations. They might just want a question answered (which doesn't necessarily mean they don't care about the patient, but just that, well, they wouldn't ask us if the patient was okay. How much can we know without being there? But professional questions seem like a more reasonable thing to ask of this board.) Perhaps this is just me giving people too much credit, (which I tend to do to a fault ). I also don't know if I'm explaining myself clearly, but I'll try...

    For instance, I'm someone who cries at the end of clinical days, not because of mistakes I've made, but just for my patients because of the horrible and sad situations some of them are in, and if I have to stress myself out to make their day just a little bit better, you bet I'll try in a heartbeat. I've lost family due to medical errors and poor care so I'm very much invested in my patient's care because I know how much of an impact quality of nursing can make. I lost sleep all throughout nursing school wondering "Why didn't I know how to do X better? Did I miss giving Y in report? I wonder where my patient is now and how he/she is doing... etc." And if I made a mistake, I wouldn't be coming to this board to ask "Will my patient be okay?" because obviously, I would know better myself having been there. Yes, some people use this board as a sort of cathartic release or a place to find some empathy, but many use it as just an informational resource. In other words, some might be more liable to post in AllNurses "What are the professional implications of my actions?" as opposed to something like "OMG, guys. This is what happened and I feel really bad." Maybe the former would come off as callous, but for me, it's a given that I care about my patient, and I might not explicitly state it because it's such an obvious fact in my mind and may not be directly related to a question about something like institutional policy. And if I want an answer to a situational question, I might try to lay out what happened in a very cut and dry way so that it's very clear and not full of laments and regrets that turn a two-paragraph question into a twenty-page novella.

    I just think some people will get flamed on here for not caring enough, because they didn't explicitly state "I feel very badly about what happened", but I wouldn't have assumed that such a statement was a prerequisite for receiving kind and honest advice here. Perhaps it's my own bias of knowing I care that I am giving other people too much credit by assuming they do too, but I feel from reading all these threads lately that, in the future, I will have to explicitly prove how much I care about my patients first just so that other people don't immediately assume all I care about is personal implication.

    DISCLAIMER: I am not trying to dispute how much the OP of either thread referenced in the article cared about their patients, I am simply trying to discuss general cases of people coming to AllNurses for advice who may get web-scolded for an apparent lack of caring despite actually caring about their patients.
    Kipahni, ktliz, neemo, and 11 others like this.
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    I feel like it's kind of rude to call out other members this way. Don't you think? I've read both of the posts in question and you absolutely cannot know how much those people cared or didn't about their patients. And based on one thread from each of them, you insinuate that they don't care and therefore shouldn't be nurses? I hope you're wearing a safety harness for that giant leap you're making.

    We've all made mistakes during the course of our schooling and careers. We all respond to and process grief, shame, guilt and sadness as a result of those mistakes differently. Some of us don't wish to do that publicly. I don't think that just because those two members in particular weren't falling all over themselves to sob on the internet about the fate of their patients means that they are cold, unfeeling jerks. I was disappointed about how those two threads devolved so quickly from a question ("what do you think might happen to my employment as a result of this?") to accusations of uncaring.
    Last edit by yesnoyes on Oct 21, '13 : Reason: Clarity
    Sammie7, ktliz, FlorenceNtheMachine, and 8 others like this.
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    Quote from dorénavant
    I just think some people will get flamed on here for not caring enough, because they didn't explicitly state "I feel very badly about what happened", but I wouldn't have assumed that such a statement was a prerequisite for receiving kind and honest advice here.
    I understand where you are coming from dorénavant, however my personal interpretation from reading both posts as they unfolded was that the first concern was for their own personal consequences and not that of the patient.

    Compare these two possible first sentences of a hypothetical post: “Guys, I’m really shaken right now because I missed something and as a result someone could have been seriously hurt or even killed. I want to learn from the experience so that it never happens again and find out the next steps I need to take so that I can make appropriate amends. Here’s what happened..”

    As opposed to (in essence), “Crap! I made a mistake and now I’m really worried about <insert possible consequence here> might affect my <career/job/clinical>”.

    For me personally there is a difference between the two reactions and calls for advice. One is remorseful and repentant, seeking remediation and concerned about another’s welfare. The other simply is worried that there is going to be dire consequences for them personally.

    I think that is what Ruby was trying to emphasize – at least that is how I personally read and interpreted it.
    GrnTea, Gyane nurse, amoLucia, and 6 others like this.
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    Quote from yesnoyes
    I feel like it's kind of rude to call out other members this way. Don't you think? I've read both of the posts in question and you absolutely cannot know how much those people cared or didn't about their patients. And based on one thread from each of them, you insinuate that they don't care and therefore shouldn't be nurses? I hope you're wearing a safety harness for that giant leap you're making. We've all made mistakes during the course of our schooling and careers. We all respond to and process grief, shame, guilt and sadness as a result of those mistakes differently. Some of us don't wish to do that publicly. I don't think that just because those two members in particular weren't falling all over themselves to sob on the internet about the fate of their patients means that they are cold, unfeeling jerks. I was disappointed about how those two threads devolved so quickly from a question ("what do you think might happen to my employment as a result of this?") to accusations of uncaring.
    I am with you 100%. I have been on Allnurses for almost three years and have always looked here when I have a question or concern. I think that this has always been a great site to learn from others experiences and share our frustrations. When another member calls out an individual who is posting, it discourages others from asking questions for fear of getting flamed.

    I read both of these posts and while their questions pertained to what would happen to their careers or how unfair they are being treated, I don't think it means that they don't care about the patients they are serving. I guess in the future I'll need to make sure I preface any question I have with how much I care about my patient.
    Gyane nurse and Irish_Mist like this.
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    Compare these two possible first sentences of a hypothetical post: “Guys, I’m really shaken right now because I missed something and as a result someone could have been seriously hurt or even killed. I want to learn from the experience so that it never happens again and find out the next steps I need to take so that I can make appropriate amends. Here’s what happened..”

    As opposed to (in essence), “Crap! I made a mistake and now I’m really worried about <insert possible consequence here> might affect my <career/job/clinical>”.
    Well, right---but that's exactly my point: the two statements you presented are two completely different questions. Are we assuming that a question of professional implication means automatically a lack of remorse and caring? A poster may only be going to AllNurses about something like job security because perhaps the "how to be better and learn from this" question has already been addressed.

    For instance, a person who let a patient fall may already know now what he did wrong and what he should do in the future. In fact, this is even likely, as his institution has probably already chewed him out for it quite a bit (thereby causing him to worry about his job) and likely also that they have reviewed what he should have done instead. So now, what he may want from an 'anonymous' forum is not the answer to 'How do I grow from this and prevent it from happening again?' but rather 'How will it affect my job standing?' Does wanting to know this make him a selfish uncaring person? And is he only allowed to ask this after a long prelude that satisfies our judgment of how much he cares?

    I do agree with you that some posters show a clear lack of understanding of what they did wrong (and some do quite arrogantly as well ). Whereas a question of "How do I better myself?" may be something a poster chooses to ask their own institution, it makes much more sense that they would go to an anonymous forum for a question of "How will this affect me professionally?" where the anonymity may offer some more honesty.

    Again, I think both situations we're discussing could be true. There are selfish, uncaring people out there who only think about themselves first. But there are also good, caring people out there who maybe only want advice on certain things because they already have other sources for the questions that are less affected by workplace politics and etiquette. I just always thought this board was more for advice and support than for some of the shaming I've seen people jump to immediately. I choose to err on the side of "I don't know exactly how they feel/handled the situation based on a few sentences on the internet". I give people the benefit of the doubt (especially on the internet where things are typed and their tone perhaps not fully thought through) and I try to reply politely, as you have done for me.

    I mean, tl;dr---if I ever mess up big time, I would definitely work through what I did wrong and how I can learn from it, but honestly, I would probably do that with nurses on my own unit and the other resources my own institution offers me. Truthfully said though, I might also wonder about my job, and social savvy tells me that's not the first thing I want to ask my boss, so maybe I might come ask here (except now I might not haha.)
    Last edit by renardeau on Oct 22, '13 : Reason: Unclear who I'm replying to sans a quote (just added).
    Mulan, anashenwrath, Orca, and 1 other like this.
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    I like to give people the benefit of the doubt. Just because they didn't preface their questions or comments with how much they care about their patients before going into how they are concerned for their careers doesn't mean they are awful lousy nurses. If you're someone who has ever posted a snide remark about one of your patients you have no room to talk. People who care about their patents don't make comments about their appearances or some other thing that gets under your skin.
    Irish_Mist, Orca, JesusKeepMe, and 1 other like this.
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    When it comes to posters posting about pt falls, med errors and all that, I think they're coming here to ask specific questions. Questions like: what is my liability?, what did I do wrong?, what's going to happen to me?, etc.

    I'm not sure that one needs to include a statement declaring their concern for the patient's well being. I'm going to give them the benefit of the doubt and assume they figured that was implicit.

    The OP is right, of course, that when a poster posts a topic where they don't even mention any concern for the harm their actions caused, it makes them seem cold and narcissistic. And when they only do so when it's pointed out to them, it just makes them seem disingenuous.

    But the key word here is seem. One of the drawbacks of online message board communication is there's so much opportunity for misunderstandings. People seem callous when they're just being to-the-point. People are taken literally when they're being sarcastic.

    I think this is more a miscommunication issue than anything else.
    Sammie7, slschakel, prnqday, and 8 others like this.


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