Have we lost the "art" of nursing?

[Barbara Hunter]

As a member of the "aging baby boomer" generation, I have often wondered where has the "art of nursing gone"? There is little doubt that medical science is an integral part of nursing. However, it is often difficult to see if the "art of nursing" is practiced. In fact, I find myself asking if this unique art has been lost. Is it being taught to nursing students in the 21st century, or is it simply a lost art? What is the art of nursing, you may ask? Simply put, in many ways, the art of nursing has to do with the logical and common sense approach to nursing.

In other words, doing the little things that brings relief to a patient without having to get a doctor's order. For instance, back in the day, when I was in nurses' training, we gave patients back rubs at night before they went to sleep, or fluffed up their pillow and turned it over to help them get settled down for the night; even sometimes washing the pt's feet (if time allowed). You know, the little things that provided comfort, and often appreciated by a patient. I know you are probably thinking "wash feet, back rubs, who has time to do those extra things?" By the time you finish doing meds and treatments there is no time for the little things. Believe me, I can relate! But again I pose the question, has the "art of nursing" been lost?

[kjrobinetteSN]

Today our whole class period was on compassion and that nursing is not only a science but is also an art. Our instructor showed us a beautiful video called Communicating with Compassion. I was in awe of a study that was repeated multiple times on rabbits who were fed a diet high in fat and cholesterol. A lot of the rabbits ended up with CAD, but there was one group of rabbits who did not have as negative an outcome and it was determined, that these healthier rabbits were in better condition because their keeper was caring, spent time petting and talking to the rabbits and showed them love. Compassion has healing power!

It really meant a lot that our instructor took a whole class period to reiterate the importance of acknowledging your patients feelings and creating a rapport that the patient will not likely forget. I was an RN student once upon a time (LPN student now) and it really shocked me how little time was spent on compassion and putting yourself in the patients shoes. I am 29 years old and like you said, a lot of the people from my generation have no compassion at all. I pledged today to make sure that my patients know that I am genuinely concerned no matter what they may be going through.

[BlueLightRN]

I think the "art" has to be something you just know to do. If a 105 year old diabetic woman who is very sick is dying and wants some ice cream, I'm giving it to her. Why suffer if you can enjoy your life a bit? A bowl of ice cream won't kill her as fast as an aggressive lung tumor leaving her in pain all of the time. If a family wants you to pray with them when their baby is sick, you stop for 5 minutes and do it, whether you are religious or not (No religion for me, sorry, but if that's what my patient needs, you bet I'll do it) and if a patient needs a hug, give it to them. I can tell you stories about patients I hate and people who are jerks all day ling, but the fact is that everyone is a person and sometimes, you just need someone else to care about you, and that someone might have to be your nurse. I often am so busy I don't have time for the little things that aren't legally required but sometimes I can tell that I have to stop and pause a moment to do this for my patient. Maybe they are scared or grieving. I would want someone to give me a minute of their time and to care. "Be kind, for everyone you meet is fighting a hard battle." (Doesn't mean I'll put up with any nonsense, but I try to be mindful that everyone has feelings and issues.)

[gcupid]

Ain't nobody got time for that....

[jadelpn, LPN, EMT-B]

I have written more than one article on this very subject (shameless plugging haha)

In all seriousness, If a nurse comes out of school and is put into their first job, most of the time they are taught to follow scripts for communication, patients are numbers, and the only "compassion" a nurse is to "show" a patient is so that they will "feel" well cared for and understood as to fill out the survey appropriately and positvely.

Bottom line--patients can be big business--as long as everyone follows the script. The art of nursing doesn't bring in the money. The illusion of the art of nursing does. Because effective canned communication, check boxes for charting and no sense of a patient's comfort beyond pain control is time effective, and the more patients one can churn out the better the nurse with the latest line of thinking. Otherwise, really, no one cares. Skip the details, get to the point. And that is beyond sad for the nurses who truly enjoy the art vs the science.

[Palliative Care, DNP]

I left floor nursing because I felt like I was no longer able to be a nurse. I felt like I was working a Burger King drive thru where every patient "Got it their way". It has become ridiculous everything comes down to patient satisfaction scores. Some patients and the 10 closest members of their family will never be satisfied.

[HouTx, BSN, MSN, EdD]

Ah yes - "PM Care" - I remember it well & my clinical practice has been 100% critical care.

Not too long ago, I had my first 'patient experience'. During the admission process, I was asked about bedtime habits/practices. Subsequently, each of the 4 post-op evenings that I was on that unit, a staff member came into my room at 9 pm to offer a snack, freshen/straighten my bed, help me with washing up, tidied my room, adjusted room temp, made sure that everything I needed was close at hand, ensured my pain was well managed & adjusted lighting so I could use my Kindle. No, I didn't get a backrub - but that may have been because I was ambulatory. They also hung the "I'm trying to sleep" sign on my door to minimize noise & interruptions. The entire process didn't take longer than 15 minutes or so. So - it CAN BE DONE. BTW, that facility is long-time Magnet & consistently awarded top national honors in a number of clinical services.

Yep - I did take the time to complete my post-DC survey & gave them major Kudos.

[dudette10, MSN, RN]

I don't think the art of nursing is lost, but maybe we don't recognize it as such. I enjoy the "reconditioning" nursing interventions of a deconditioned patient. Getting them up to the chair, taking a stroll around the unit, etc. Seeing them get stronger is very satisfactory to me. I also enjoy medication education, and I've often requested changes/reconsideration of meds based on the patient's feedback. To hear a patient say that the new med is working or an intolerable side effect is gone is great! Pain management of musculoskeletal issues can be addressed through repositioning in conjunction with pain meds. When a patient states he/she is feeling less pain through a two-minute reposition, I can't help but smile. I also like when I'm able to liberalize the diet of someone who has lost his/her appetite and to see them actually enjoy the food being eaten.

No, the art of nursing is not completely gone. I bet most of us do it, if we think about it.

Interesting thread.

I think that some of the lack of compassion shown BY nurses is a reflection of the lack of compassion shown TO nurses.

[CodeteamB]

The art of nursing, in my opinion, is so much more than pillow fluffing and back rubs.

[Altra, BSN, RN]

I think our current culture has different expectations of personal space and convalescence than in the past. It is widely understood that discharge from acute care will occur as soon as possible, and true convalescence will take place at home. Visitation of hospital patients is often open-ended now ... so family/visitor presence & companionship can fulfill some of the needs for personal attention and social interaction that used to be provided by nursing staff when visitation was more limited.

It goes without saying that staff assistance for those who cannot ambulate or reposition themselves is needed and necessary.

I'm pretty sure we've discussed the back rub/foot care issue before here at allnurses.com. I personally would not feel comfortable doing these for an alert patient who was not severely debilitated, except possibly for a short period of time as a means of distraction during an uncomfortable procedure.

[RNperdiem, RN]

In the nursing magazines I read, the focus seems to be on the evidence-based practice, patient safety goals and compliance. These give ''hard" data and are very quantitative in nature.

The art of nursing is the "soft" side of nursing and it is often not publicized. It does exist where nurses can fit it in.

Managing the image of nursing that we project to the public has always been a balancing act between the rational, professional and the caring.