In the novel, "The Lazarus Project", one quote comes to mind-- "There are moments in life when it is all turned inside out--what is real becomes unreal, what is unreal becomes tangible, and all your levelheaded efforts to keep a tight control are rendered silly and indulgent." It is an effort for any nurse to be able to do what is needed for a patient, while keeping in mind that the patient has a need and a want to be in charge of their own care. I fondly call this "patient directed care". To say that nurses are undeniably busy to the point of almost overworked is a huge understatement. We have a great deal of pressure to chart on time, give meds on time, assess, give prn's, and the list goes on and on. Most often, with that little voice in one's head continuing to repeat "smile, introduce, as about pain, what can I do for you...." and the numerous other "key questions" that are supposed to make a patient feel as if they are well cared for. To put another thought process out there, is it ever feasible to let a patient lead their care, within some guidelines that are subtly put forth by the nurse? For example, "Today, our goal is to get you walking. I KNOW, sounds scary, right? What I would like to try first is to get you into the chair. Would you like to do that now, or after breakfast?" Or, "We need to get you into a shower. CNA Mary is here today, and she is AWESOME, will be just like a spa!! Think about what time you would like to do that, she is here until 3, so I will send her in to discuss this with you". If we make patients part of their own healing process, given a couple of viable options, can nurses get to the goal that they need to get to for their patients? Can nurses be able to timeline activities so that it is not 5 minutes before the end of one's crazy shift and THEN a patient wants to ambulate, shower, have a long discussion about their 58 year marriage, or perseverate on how they will "never feel any better?" Yes, sometimes this is all unavoidable. And we all have patients who are impossible to please, who's loss of control is so acute that they will not do ANYTHING, EVER and FORGET IT. Get me my dilaudid and leave me alone types. That takes thinking outside of the box, with a number of more disciplines than just yourself. One wonders that with the push to not re-admit, if something will change in the discharge process to ever make it any different. Most notably, chronic pain sufferers are one of the more difficult to reach goals with. Pain is exceedingly real. Few can imagine, who have not had chronic pain, what it is like, topped off with being not in control, scared of their function, a circle that never ends for the patient. (and seemingly for the nurse). There is a real need for a number of pain management clinics that can and do take a whole health approach to how specifically someone is to function. That is definitely something that should be brought up for inservices, what the hospital's policy is, what it can be, what is should be. Putting bandaids on an issue (unless there's a cut involved) is never the long term solution. As nurses, we can get involved in a policy change within your unit and/or your hospital to brainstorm solutions to how to balance the expectations of practice, and the patient's need to control portions of their care. Is this a realistic option?