A Spoonful of Sugar
Does it help the medicine go down? Can one be a nurse and view it as just another day, a job, a paycheck, a means to an alternate end? Can we care for patients without really caring about them? Is it necessary to fluff and buff while clinically following treatment plans?This is an interesting debate. One that can have multiple pros and cons. In essence, can one be a nurse and view it as just another day, a job, a paycheck, a means to an alternate end? Can we care for patients without really caring about them?
There are more than a couple of trains of thought on this subject. Most people do not "automatically" think of nursing when planning a career that doesn't encompass a level of interaction with people that one is not likely to find in a number of occupations. One has to deal with people who are at the most vulnerable states of mind. Who have lost a great deal of control. That their function depends on what a nurse does or does not do. But can a nurse just do what they need to, cut bait, and move on? Do facilities care about the numbers, or do they care about the patients? Do facilities want a nurse to take on greater and greater assignments of higher and higher acuity and do it all with a smile and kind words?
With that being said, does one have to be compassionate, caring and "this is my calling" attitude to accomplish the goal of the facility? If you ever look at or read a facility mission statement, it would be interesting to see if nurses have the time or energy with ever changing staff patterns and responsibility to do what any given facility claims that they should be doing.
With the introduction of HCAPs and the questions that it entails, there is a strong argument that yes, in fact, unless one is a really, really good actor, you need to have some essence of caring. HCAP has a number of questions at least one of which is usually along the lines of "did the staff care for you as a person". I am not a gigantic fan of such subjective questioning, however, it has come to a point where re-imbursement is dependent on it. Caring looks and acts differently for every single person, every single interaction. It is not easy to be able to complete tasks, and have a heart to heart at the same time, all whilst a nurse's 7 other patients are all waiting for their turn. (Which another line of questioning on HCAP is about waiting). Essentially, one could say that with staffing, a nurse could be set up to fail.
But the focus is not on nursing, it is on the patient "experience". Some refer to it as our "customers". Customer denotes to me that one chooses to have a service or buy a good. Unfortunetely, at least a fair number of patients are not in a facility because they choose to be. Not many patients are into the fact that they can not live at the level they are accustomed. That they have functional decline. That they need to have a bunch of stuff done to them and for them. So many nurses are finding themselves walking a fine line.
Some facilities have scripting. I believe I have been pretty vocal in my general distaste for this type of communication. I don't think this is the be all and end all of patient satisfaction. Most adults can really tell, especially after the 4th nurse comes in a says the exact same thing as the prior 3, day in and day out, that nurses can not stray from a set script. On the other hand, this can assist a nurse who is not in it for anything other than a means to an alternate end to touch key points to have patients satisfied, and not get too involved in the fluff.
With this in mind, one could say that schools of nursing can teach in an alternate way. Stay focused on the science of nursing as opposed to the art. Which is an interesting theory, however, what would that do to critical thinking skils, which can be thought of as the most important nursing skill? But can one think critically, while following a script, not stray too far off course, and still clock out on time?
Nursing is dependent on assessment. Assessment is partially dependent on asking questions. Scritping is asking open ended questions. If a nurse can not react to the answers to the questions--critically think--then a nurse is set up to fail. And there's a whole lot of patients that a nurse has to repeat this scenario with. All while being mindful of customer satisfaction.
So to provide the act of caring we at least in part need to act as if we care. And most nurses do care--to a certain point. It is worth noting, and a point of interest, that most acute care facilities are going away from LPN/ADN/Diploma nurses. These areas of study can be considered more of the art of nursing at the bedside type education initiatives. One could argue that higher degreed nurses at bedside are more in tune with the science of nursing, therefore, are more in tune with the actual goals of a facility, regardless of what any mission statement may say.
To be a nurse who is not committed is a complicated scenario--as it is an occupation that one has to think about if they can accomplish to the satisfaction of the patients they take care of.Last edit by Joe V on Nov 4, '16
Jan 15, '14One does not have to be Mother Teresa to be a good nurse. You can get away with not caring a lick about your patients, but that is not the majority of us. Nurses generally knew what they signed up for, and quite a few got weeded out in clinicals once they saw what was coming. That being said, it protects us to keep a certain distance. If you were emotionally committed to your patients every shift, you'd burn out. I try to express my empathy in a professional way with my patients... but some, man, they get ya.Jan 15, '14It's possible to take care without caring a lot. You can be civil and mindful without significant emotional involvement. BUT it's difficult not to feel some kind of empathy when other people are hurting or injured. Otherwise, you might be a sociopath.Jan 15, '14O you are talking about Propaganda; yes nursing is all about disseminating Propaganda, we are trying to get patients to do what we want. Not what the patients wants to do and make the patient, family members, and any other person in hearing range feel good about what we are trying to get them to do or not do.
Can one be a nurse and view it as just another day, a job, a paycheck, a means to an alternate end?
Yes it is just about the pay check, the hospital wants and only cares about numbers, whether it's staffing or patient happiness scores. I play the numbers game, and as a side note, I take care of my patients.
Usually I can play the numbers game pretty well, taking care of my patients and laying down the fog of customer satisfaction. "Yes, I heard that too on the news or read it on the internet, Did I tell you I'm French model , Bonjour! , someone else told me the same thing the other day, be sure to mention that to your doctor when they come in the see you later"
Can we care for patients without really caring about them? Is it necessary to fluff and buff while clinically following treatment plans?
Yes we all have our special repeat customers who keep coming back despite what we do for them, or How much education we provide, because when they leave they go back to making their own choices in life. How many times does your favorite DKA patient come in with a PH under 7.0 or a non-compliant COPDer, or some other repeat offender? It's all about manipulation,
YES, I do care about my patients that are part of my assignment that day. I take care of my patients under my care on my shift to the best of my ability. When my shift ends I turn over there care to someone else and count my day as either a good day or bad day, but mostly just another day.
I make a difference because I chose to be a caregiver.Jan 15, '14Can we care for patients without really caring about them?
I hope so. I don't automatically care about every person walking down the street. Or every person who walks into my clinic and gets on service. I do however try to treat each person as I would want to be treated myself. I have learned to care for others without involving myself by caring too much. To many differences in people to care. Present the facts, provide the professional care, and move on. Can only care about them in the context of that they are human beings on the planet and deserve the same care and respect as all humans, that is were I draw the line. I cry when I watch commercials for christs sake, I can't allow myself to care to much for pts.Jan 16, '14Wonderfully encompassing article, jadelpn, that approaches a worthy subject! Great comments, too, that are subjective, yet have a good air of consensual reality about them!
Some of the great things about this Nursing Profession are the opportunities we are afforded that can allow us to interweave our basic tenets into our work.
For example, we care about our fellow beings, so we merely need to find a way which comprehensively involves our belief system into a particular Institution's goal.
I have had the great benefit of working with some outstanding Professionals who have shown me the way. Years ago, one Supervisor gave me some words of direction that I continue to repeat in my head under certain circumstances.
One direction was, "When you come through that door, you're 'on'. Leave your private life outside of those doors and do your job- even if you have to act the part".
This direction helped free me from having to put my heart into my job. I only had to act the part, and I knew my job, so the process was not a difficult one.
Another direction entailed responsibilities. The Supervisor compared our jobs: "My job is no more important than yours. We just have different responsibilities. One of my responsibilities is to supervise the staff and delegate duties. You don't have to like those duties. You only have to do them".
Again, this direction helped to free me from my own opinion of a particular duty. No matter what I thought of the duty, whether I disagreed with it or liked it, or whatever, I merely had to do it.
This process was helped tremendously by the fact that I held my Supervisor in the highest esteem. It takes a lot more work and energy to perform duties to a high standard of completion when the Supervisor is not respected or liked.
However, not liking or respecting someone is a personal belief. And always putting "principles before personalities" is a worthy endeavor that will further any cause.
Thanks so much for your great article, jadelpn. And for allowing me to consider and comment on it.
DaveJan 16, '14With all of the waitressing and retail jobs to pay for nursing school it has provided me the art of customer service. It all starts with a smile. It's my game face, I say hello to everyone, ask "is there anything else you need?", etc
I may go home not even thinking about it but when 640 hits for shift it's game on. Hair in place, lipstick and smile.
I know it's numbers but numbers mean my job and I'm good at it. I like it. I need it. I do what needs done to keep it. So smile on I go!Jan 16, '14Interesting article. I wrestled with this when I first went into nursing. I don't think you can or should care too deeply and personally about any of your patients, or you'll go nuts. As nurses, we do care -- that's why we take the time to situate someone comfortably in bed, or remove dressings carefully so as to cause the least amount of pain. But this job demands a detached attitude if you're going to do what's best for the patient.
I learned this on my first fasciotomy patient. He had long open wounds up each leg, and I had to change his dressings. It was, as you might imagine, a very painful procedure to undergo. I was so distressed by the patient's obvious pain that I wasn't quite as efficient at the job as I should have been -- my empathy made it take longer than it had to. If I'd been more detached -- less in tune to the pain I was causing -- the job would have been over faster and been less difficult for the patient to go through.Jan 16, '14In today's corporate health care it is all about the act. Customer Service reigns supreme!
Fortunately I know how to play the game. Smile on, fluff the pillow, re-position, offer the pain meds. have them wash up. Tell them "How about when you walk after b-fast I have your pain meds ready " set appropriate boundaries. talk with respect but firm tone. Ask them if they need anything else. Rinse/ Repeat.
I look at my job like I am the worlds greatest actress. Because when my feet are sore, my back is tired and I haven't had a break I am still able to give great, efficient care by playing my nursing role. At the end of the day I get a paycheck. It can be draining at times but I have learned to re-energize myself outside of work. I use that paycheck to fuel the things I truly care about (My family, my travel, my hobbies....)Jan 16, '14I've resolved to the fact that the practice of competence and respect can equate to empathy and caring to the population and this business.
I've decided to state my job is to be a "healing manager"; that is, we give our patients the ability to manage their health; we are able to provide the hands on experience, and we pass the information along; we educate and counsel to get to the root cause, especially for the chronics; each visit can e approached like a 12-step program; working to "heal", meaning, getting to a point where "healthy" can be meeting a patient where they are and going from there each step.
It is not easy, but can be very creative...one has to like whether remotely or piqued in interest of critical thinking, detective work, philosophy and or life planning to interact and manage people in their vulnerable, sometimes flaming, car crash type of life that could potentially appear at any shift-sometimes they do get better, and sometimes they don't, but that comes with the territory, and I respect that part of the business as much as I respect my patients and above all, my practice; everything else goes from there.Jan 17, '14Yeah, competence and civility trump caring and empathy every day of the week.
Still, I care about my patients' pain level, comfort and dignity beyond simply my professional obligation to do so. I don't get emotional about it nor am I demonstrative, but I agree with the poster who said not caring at all is called being a sociopath.Jan 17, '14In my opinion nursing is the hardest job there is. It requires knowledge,skill, patience,and always having to deal with the unexpected. How you choose to do your job depends on how you perceive the job Everyone is different in that respect.
That nursing is the most respected profession goes to the public perception of what nurses are asked to do mentally and physically every day. Patients often have to share their most intimate secrets and have you witness them while in pain,fear,and disability.
Let us not forget we are there to serve, but not be servants either to patients,families or physicians.
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