do you care about your patients?

[Rhee]

I have noticed on a lot of our lovely press gainey comments that our patients say that they don't feel that we nurses care about them. This got me to wondering what exactly patients expect from a nurse.

I work in postpartum, and I try really hard to make sure that my patients have a good positive experience and receive the best care that I can give. In that sense, I care about them, but on a personal level, I don't really care about them in the way that I care about my friends and family. It just seems like it would suck a person dry to be emotionally invested in every single patient. There have been several patients that have kind of stuck with me who I think about now and then, but this is definitely the exception. I don't want anything bad to happen to anyone, but I feel that way about any person that I come in contact with, be it a work, or the guy who delivers the pizza, or the mailman or whoever.

I just started to wonder if I'm weird or what.

[TheCommuter, BSN, RN]

My friend is also a nurse, and here are some of the interesting statements that she has made to me over the years:

1. "I've got a degree. I don't wipe asses. I don't give baths."

2. "I didn't accrue all of this student loan debt to end up passing meal trays."

3. "I want to make the largest amount of money while doing the least amount of work."

4. "I was a CNA for 5 years. I've paid my dues. I'm not changing any more briefs."

5. "All I care about is my license and my money."

6. "I don't give a ____ (insert profane word)."

She will sit at the nurses station and read the newspaper or send text messages while 5 or 6 call lights are ringing. If a visitor approaches the nurses station asking for help for their hospitalized loved one, she'll charm them with smooth talk and divert attention away from the fact that she will not assist with the more 'menial' and basic tasks. If anyone needs toileting, cleaning up, or basic cares, her reply is, "I'll find the aide." She's been able to get away with this behavior for so long due to an outwardly pleasant personality. However, she's told me the truth about how she feels about her patients.

If I was the patient and my call light was ringing for 45 minutes, I would certainly conclude that nursing staff didn't give a hoot about me.

[PMFB-RN, RN]

Yes I care very much about my patients, while I am at work and they are under my care. After I report off I stop thinking about them and stop caring. I even find it hard to remember my patient names by the time I have driven home after my shift.

Once in a while a certain patient will "get to me" and I find myself worrying about them when I am not at work and trying to take that same patient back as long as they are in my unit but these are the exceptions.

I care very much about my reputation as a nurse. I have a rep for giving good patient care and I value that rep very much.

[Zookeeper3]

I give professional expert care, always.

my coke addict patient whom had an MI just accused me of being uncaring as I would not let his HO bring in KFC, close the curtain and let her sleep in his hospital bed.

Nope, I don't care. You can't eat KFC or you'll die, you can't have your HO bring your your drugs and you can't have the curtain closed.

Or... I don't care... have your KFC, bring the HO on, take your drugs while your in the ICU and have sex.

Either way.. you'll be dead soon and I simply don't care... I can fight the battle with you and loose for PRESS GAINEY... or nurse and do whats right, but harder.

No I don't care that you've demanded a third different nurse tonight because the first two aren't willing to call the cardiologist at 1am to give you dilauded for your fake pain with no EKG changes.

I don't care, plain and simple about some, it doesn't make me less of a professional to deal with it, I'm always professional.. but I don't care.

Johnny... that is on his 87th DKA admit... don't care.. can't ... it he doesn't have the will to live... I can't give it to him.

Billy with the perforated bowel surgery crashing, whom might not make it through the night? Got your back... and working on it hard.

I'll do everything possible for all of the above, everything... but care????? Are you crazy? It's asking too much.

They will all receive the same level of nursing, caring from the heart is independent, and spent on those that will not burn me out. I'm wise enough to know the difference. Anyone that says otherwise with your speeches has never walked the walk..

I'm an expert I do my job well, but caring... happens intermittently... and you need to be ok with that. That's what saves us from burn out from these other folks.

[Ellekat]

Perhaps the real question is how the question is worded. A poor question can yield poor results. We'll probably have a survey regarding the Press-Garney survey to worry about soon.

[IowaKaren]

Caring is one thing, codependent caring is another.

[SaltyNurse]

My friend is also a nurse, and here are some of the interesting statements that she has made to me over the years:

1. "I've got a degree. I don't wipe asses. I don't give baths."

2. "I didn't accrue all of this student loan debt to end up passing meal trays."

3. "I want to make the largest amount of money while doing the least amount of work."

4. "I was a CNA for 5 years. I've paid my dues. I'm not changing any more briefs."

5. "All I care about is my license and my money."

6. "I don't give a ____ (insert profane word)."

She will sit at the nurses station and read the newspaper or send text messages while 5 or 6 call lights are ringing. If a visitor approaches the nurses station asking for help for their hospitalized loved one, she'll charm them with smooth talk and divert attention away from the fact that she will not assist with the more 'menial' and basic tasks. If anyone needs toileting, cleaning up, or basic cares, her reply is, "I'll find the aide." She's been able to get away with this behavior for so long due to an outwardly pleasant personality. However, she's told me the truth about how she feels about her patients.

If I was the patient and my call light was ringing for 45 minutes, I would certainly conclude that nursing staff didn't give a hoot about me.

:grn:Geesh, maybe your friend should do her patients, colleagues, and ancillary staff a favor and go into administration.

Nurses are put in an increasingly tighter spot between a rock and a hard place. Nurses are expected to fill the roles of waitress, chambermaid, concierge, masseuse, BFF, go-fer, hostess, etc. to an increasingly self-absorbed, entitled patient population- all in the name of customer service and satisfaction. Is this what Press Gainey is supposed to measure?

At the same time, this customer service endeavor is contemporaneously undermined by the enormous patient load that many nurses must juggle, being on top of each patient's minutiae, charting redundantly, keeping the crazies from ripping out lines and falling out of bed, checking items off the ever growing task list (that defines standard of care), conscientiously observing each patient individually swallow each of their forty five pills, spoon feeding them dinner, bite by bite, saving the patient from the fifth code brown of the day, and dutifully creaming that booty, being the middleman for the hospitalist and the neurosurgeon because the hospitalist is afraid of the neurosurgeon, being the middleman for the pharmacist and the hospitalist, because the pharmacist prefers that the nurse take the flack for questioning orders, explaining the plan of care to each of the patient's 10 family members/baby mammas (because none of them get along with eachother), coaxing/cajoling/threatening the patient to use the IS/take their meds/get up to the chair/do PT, paging the doctor for the third time because the patient is crumping..... really, need I go on? You know I can!

Yes of course we care about our patients. We don't pee, eat, or sit down very much though.

[LouisVRN, RN]

Press-Gainey and all the similar surveryors aren't concerned if we actually do care or not, just the patient's perception of if we do or do not. I've found the only way to "show" my patients I care is to listen to their concerns and if they relate to their care in some way "deal with them". This may be as simple as a patient saying "I haven't been sleeping well" I take the time to ask why. Is it not dark enough? Not enough pillows? Too warm/loud/etc? Then I make my best effort to fix it. Pain management is a big one on my floor. Some people I feel have legitimate pain concerns, some don't but it is not my job to judge or prescribe, but I can if this is a new issue call the doctor and make a recommendation. Sometimes its switching from IV to PO. Sometimes adding something like Toradol to the mix for a bit of relief if only to get them through the worst, sometimes just telling them "I called, the doctor would like you to continue with the current pain management regimen until he/she can re-evaluate you in the morning but can I get you some more pillows/ice pack/heating pack/help you reposition to see if that helps?" is all that is needed. I show I care by acting like a waitress and making sure water pitchers aren't below half-full and that they still have ice if that's the patient's preference, that I offer a snack, if pt is not NPO, with anything that may upset the patients stomach and that I educate my patients on everything possible.

[Ruby Vee, BSN]

my friend is also a nurse, and here are some of the interesting statements that she has made to me over the years:

1. "i've got a degree. i don't wipe asses. i don't give baths."

2. "i didn't accrue all of this student loan debt to end up passing meal trays."

3. "i want to make the largest amount of money while doing the least amount of work."

4. "i was a cna for 5 years. i've paid my dues. i'm not changing any more briefs."

5. "all i care about is my license and my money."

6. "i don't give a ____ (insert profane word)."

she will sit at the nurses station and read the newspaper or send text messages while 5 or 6 call lights are ringing. if a visitor approaches the nurses station asking for help for their hospitalized loved one, she'll charm them with smooth talk and divert attention away from the fact that she will not assist with the more 'menial' and basic tasks. if anyone needs toileting, cleaning up, or basic cares, her reply is, "i'll find the aide." she's been able to get away with this behavior for so long due to an outwardly pleasant personality. however, she's told me the truth about how she feels about her patients.

if i was the patient and my call light was ringing for 45 minutes, i would certainly conclude that nursing staff didn't give a hoot about me.

i'm sorry -- if my "friend" behaved that way, i couldn't respect her. and if i couldn't respect her, she would no longer be my friend.

[Ruby Vee, BSN]

i care about my patients for the duration of my 12 hour shift. i do the very best for them that i can. and then i go home and forget them.

[Scrubby]

I care that I provide nursing care to my patients to the best of my ability. I care if I am unable to provide for their needs due to staffing/resource constraints.

But caring on a more personal level? 95% of the time I would have to say no, I forget about them the minute they leave the OR. This may sound a little harsh but it's the truth. Most of the surgery I deal with is lap chole type cases where we're improving the patients quality of life and they'll go home, get well and get on with their lives.

But every now and then a patient will come along with a really poor prognosis or come from a sad background and I find myself caring. For example, a few years ago this patient came in for a free flap for floor of mouth cancer (huge operation) and this poor guy had unstable diabetes, bilateral below knee amputations, his father had died the week before, he had 3 previous failed kidney transplants. Pretty depressing stuff really.....and he came into the OR pleading 'don't let me die!' over and over again. This was hard for all of us. So yes I'll say that there are times when I really do care.

[gentlegiver, ASN, LPN, RN]

In LTC it is a bit more difficult to draw the line between Nursing Care and heart felt feelings. I have a few patients who have no family members, get no visitors, no phone calls, no gifts on holidays or birthdays. These patients come to look at the staff as thier family. We provide the love & care a family would. It is very hard to watch these people slip slowly into the deep sleep. However, if I could seporate my feelings and treat them only with Nursing skills, these poor people would feel completely alone in the world. I have had a few I cried for when they passed, but most I am glad that thier pain and suffering has ended. I believe, sometimes, we have to be more than Nurse.

[bagladyrn, RN]

Yes I care about my patients. I care enough to not give a second thought to what the Press Gainey says if what they really need is not what they "want".

I will make them get up and walk post-op (because I never again want to see a postpartum mom hauled off to ICU with a pulmonary embolism). I will make all the rowdy little teenage friends leave rather than see my PIH patient seize from overstimulation and I will use every persuasion I can to make her stay on the magnesium even though it makes her feel like crap. I'll get right in the face of a laboring mom and insist "Stop screaming and push now!" when her infant is stuck at the shoulders and has a heart rate in the 40's even though I know that panic and fear are making her think I am a torturer. Live baby trumps hurt feelings any day.

I'll be just as unpopular with the doctors when I insist "You must come in now - and I will keep calling back until you do", with ancillary depts. when I insist "My patient needs this now" and with families when I explain that "Yes I understand that your sister-in-law's neighbor had it done that way but it's not what we consider best for your family member".

None of this will win me any kudos as the "nice" nurse or any "5's" on the Press Gainey, but I can live with that. I could not live with thinking that my patient had a less than optimal outcome possibly because I did not give the best care I knew how to give.