Real Nursing

Nursing interventions are created moments. To me, "real nursing" is a moment created to identify and intervene, to connect with a patient and influence that patient to modify a behavior or an erroneous thought that holds them back from healing.

It's one of the most satisfying activities that my job entails.

Last night, I noticed that an A-Fibber had refused Coumadin. That's bad, because A-Fibbers are at a very high risk for stroke and MI, so anticoagulation is crucial to their therapy. I stopped what I was doing to talk to my patient about microemboli and how they form and what can happen. Patient was impressed. My explanation was clear and easy to grasp. I finished with, "Look, it's certainly your decision, but I just wanted you to know that without proper treatment, you're putting yourself at risk for a heart attack or a stroke."

Patient agreed to take her Coumadin.

Stuff like that is the stuff that we nurses are instrumental in delivering to our patients. Stuff like that can save lives by increasing or initiating compliance with treatment regimens. Stuff like that is the stuff that gets booted to the bottom of the priority list when we're engaged in passing pills, assessing, admitting and discharging patients.

The patients don't know what they're missing. But I am certain that because I took 15 minutes to develop a rapport with that patient, she will be compliant with the treatment and live many years with an intact brain and heart.

Those intangible interventions cannot be measured, they don't count when the staffing grid is being done, and they never appear on yearly evaluations. But you know and the patient knows that if not for that education, that concern, that time that you took to help the patient understand what was happening to her pathologically, she might not be alive in a year or two.

With that teaching, I saved a life and kept a family from grief just as surely as if I'd jumped on a dead patient's chest and did CPR.

But had that moment interfered with my charting, or had it put me behind in my tasks so that I clocked out a few minutes late, the significance of what I did for that patient would not have mattered--I would be labelled negatively by my boss and by my coworkers.

I stand by my choice and absolutely believe that my nursing skills in educating patients are as important--if not more so in some cases--than physically administering medications and treatments. It's only one of the critical interactions in the nurse-patient relationship that sets nursing apart from other professions.

I have less and less time to educate my patients and help them learn about their conditions. It's very frustrating. It disturbs me to think that months from now, when I care for a stroke patient who's in a vegetative state, I will wonder if the attempt was made to educate him way back when he was diagnosed with having A-Fib. As we all know, it takes more than a "Here, read these pamphlets" and moving on to the next task. Sometimes the time management directive needs to be temporarily suspended.

I want to urge nurses who work in hospitals that are understaffed to conform a little less, to stay a few minutes longer, to perhaps take the ding on the yearly evaluation that results from a few minutes of "excess overtime." I want to remind you all that the time spent educating the patient is nearly as critical as a Code situation. You might get a reputation for being "slow," as I did, but at least you'll rest easy knowing that your teaching saved someone's life.