Jay Leno slams nurses!

rn/writer, RN · Oct 29, 2005

this issue of "care" has been what we are attributed with, as nurses, in providing...but, still remains vaguely ill defined by our profession. care?...what is it?
it has been what the theorists have been wrangling around with for years. however, the catch 22 is is that the more it is defined, the vaguer it becomes. nurses provide care...but, what does that really mean? the general public doesn't know and, most of the time, we think we actually do know what this means. but, the long and short of it is, the phrase of "providing care" hasn't served us very well as a profession. the danger of this is, quite often, is that we have left other disciplines to define who and what we are...most noteably, medicine and management.__________________

not an easy thing to define care. i suppose it's more of a question than an answer.

i think i know what you're getting at. but i don't want to see the definition of nursing get turned into some long-winded, pseudo-profound mission statement that buries core values under a lot of corporate hype or academic jargon. yes, we want to be taken seriously but not at the expense of being real.

so how do we begin to define care and caring? i think part of the problem is that we all--nursing and the rest of the world--confuse care, the practice, with care, the emotion. while there is often considerable overlap in that we can end up caring about those we care for, and while one can very easily spring from the other, it's unfortunate that these two meanings reside in the same word.

when i think of the kinds of caring that nurses do, i first think of communication and connection. people see nurses before they see doctors or any other practitioners (with the exception of ems). whether a patient presents at a clinic, an ed, a school, or anywhere else, it's likely to be a nurse who will greet them and establish a connection. it's the nurse who will ferret out the patient's concerns and gather the information the doc needs to make the medical moves. and afterward, it's the nurse who will translate whatever remains unclear and assist the patient in implementing the plan of action.

in this kind of scenario, nursing is patient-focused and concerned with meeting the patient where he is and helping him to navigate the pathways that will get him where he wants to go.

maybe we make this too complicated. i remember when myriad definitions of pain were scrapped in favor of the simple dictum, "pain is whatever the patient says it is." maybe nursing is whatever the patient needs it to be.

i know that is probably simplistic rather than just simple, but how else do we express the plastic nature of the role? nurses do such an enormous job that our adaptability is a big part of who we are. one nurse might counsel volatile teens about self worth and safe sex while another does home care for vent patients. i work in postpartum now, but i used to be on a sub-acute unit in ltc.

the common denominator is that we all morph into whatever our patients require. our roles are determined by their needs.

i really shy away from symbolic cliches but i can't help but see how nursing is like a light that passes through a prism. any meaningful definition of nursing is going to have to include both a description of the light itself (and won't that be fun to pin down) and the refractive nature of our roles in relation to our patients' needs.

we become who our patients need us to be.

the next question, then, is how do we define "we?"

Thunderwolf, MSN, RN · Oct 29, 2005

You describe the art of Nursing very well.

The "we", I assume you mean, are those who provide this art, which you stated most excellently...

with meeting the patient where he is and helping him to navigate the pathways that will get him where he wants to go.

Although the process is indeed patient focused, the science of Nursing also recognizes that the patient may NOT know how to make this come about for him/herself. The nurse or "person providing the art of caring" may also need to utilize "how am I" going to help him/her to navigate there towards this goal of health. The dilemma here is that most anyone can "care", not just nurses. But stop for a moment, "blind" caring can be supportive and can also be injurious. Effective caring requires, however, rationale. Holding a patient's hand is a very small act in the art of caring, but the nurse also needs to have some rationale to go along with it. Does the act of holding the patient hand benefit the patient or the nurse more? When are times of a hand hold perceived as intrusive, patronizing, or unwelcome? When is it seen as kindness, supportive, or empathetic? Also, to make this more "realistic", the idea of "context" needs to be embraced. Now, broaden this scope of approach to the myriad of things that nurses do and say with patients as they interact. Due to this complexity, it often requires the ability to perform both (art and science). This is what sets us apart from other we's.

rn/writer, RN · Oct 29, 2005

although the process is indeed patient focused, the science of nursing also recognizes that the patient may not know how to make this come about for him/herself. the nurse or "person providing the art of caring" may also need to utilize "how am i" going to help him/her to navigate there towards this goal of health. the dilemma here is that most anyone can "care", not just nurses. but stop for a moment, "blind" caring can be supportive and can also be injurious. effective caring requires, however, rationale. holding a patient's hand is a very small act in the art of caring, but the nurse also needs to have some rationale to go along with it. does the act of holding the patient hand benefit the patient or the nurse more? when are times of a hand hold perceived as intrusive, patronizing, or unwelcome? when is it seen as kindness, supportive, or empathetic? also, to make this more "realistic", the idea of "context" needs to be embraced.

i was trying to address these very concerns when i wrote the following in my earlier post:

so how do we begin to define care and caring? i think part of the problem is that we all--nursing and the rest of the world--confuse care, the practice, with care, the emotion. while there is often considerable overlap in that we can end up caring about those we care for, and while one can very easily spring from the other, it's unfortunate that these two meanings reside in the same word.

meeting a patient's needs does not mean providing comfort at the expense of effective treatment. nor does it mean giving him everything he wants or avoiding what he doesn't want. connecting with someone where they are means you acknowledge their state of mind, their goals and fears, the impediments they wrestle with, and every other factor that separates them from their optimum state of health. but you don't, in the name of the emotional sense of caring, leave them there. you use the art and the science of nursing to challenge, inspire, educate, bargain, remind, affirm, and empathize with them to do the things necessary to make their own lives better (never forgetting that the patient is still entitled to make choices contrary to their stated goals).

"blind" caring can be supportive and can also be injurious. effective caring requires, however, rationale. holding a patient's hand is a very small act in the art of caring, but the nurse also needs to have some rationale to go along with it.

this is where the semantic confusion about caring muddies the waters. nursing care, while it may include hand-holding, can never be "blind" or without rationale. by its very nature, nursing care has to address what the patient needs (not wants) and work to achieve the best outcomes possible within the context of patient choice.

i think the crux of all of this is that we want everyone--nurses and non-nurses alike--to reach the understanding that the very definition of nursing care implies the combination of art and science. i can hold your hand as you're waking up from surgery while i monitor your vital signs, titrate your need for medication, and remain alert to possible complications. i can sympathize with the difficulty of post-op coughing and deep breathing even as i explain to you why they are important and how they will speed your recovery.

for too many years, the public perception of nursing has emphasized the hand-holding aspect of nursing. i'm concerned that, in the name of insisting upon respect, we'll peg the meter to the opposite end and focus mainly on the scientific facets to the detriment of compassion.

in my book, any definition of nursing that leaves out either the art or the science will be incomplete. it is this combination, above all else, that distinguishes nursing from other disciplines. we are the ones who help the patients assemble the pieces they get from everyone else into a cohesive whole. we are the ones who advocate on their behalf when there is confusion over what the respiratory therapist said or how often the pt wants the exercises done. we are the ones who serve as the alarm when one physical system or another starts causing problems. perhaps, we really serve as the patient's alter ego, holding out for what he himself would insist upon if he were in a position to do so.

how's this revamped statement? nursing is care that combines art and science, compassion and education, connection and skill, to meet patients where they are and help them navigate the pathways that will lead them closer to where they want to be.

whew! didn't mean to be so long-winded. i just worry that because "caring" is such a loaded (and admittedly feminine) word, and because we want so badly to be taken seriously, we'll opt for a new image of nursing that is steeped in science but devoid of humanity.

i'm stepping off my soapbox now and going to go looking for some dark chocolate. it tastes yummy (art) and studies say it can help to boost hdl levels (science).

MissPiggy · Oct 29, 2005

I agree; I also heard the comment and took it more as a poke at those brainless wonders who really believe that way. I also remember the time that he said it in all seriousness that we nurses are the hardest working profession and THAT time he wasn't joking.

llg

MissPiggy · Oct 29, 2005

I couln't have said it better. For heaven sakes the man is a comedian, he makes fun of everyone. I guess it's ok to laugh until it's your turn.

I agree; I also heard the comment and took it more as a poke at those brainless wonders who really believe that way. I also remember the time that he said it in all seriousness that we nurses are the hardest working profession and THAT time he wasn't joking.

llg

Thunderwolf, MSN, RN · Oct 30, 2005

How's this revamped statement? Nursing is care that combines art and science, compassion and education, connection and skill, to meet patients where they are and help them navigate the pathways that will lead them closer to where they want to be.

My goodness, rn/writer. You are indeed a sister of my heart and mind regarding this issue. Very well articulated. You captured the essence of my thoughts exactly. Your above quote condensed our conversation and our meaning perfectly. We are of like minds and hearts regarding what Nursing and Nursing CARE is! Sometimes, a discussion of concepts ARE long winded in nature before it can be broken down to its simplest definition.

I had a great time in our discussion.

We can and do learn from each other.

This is a very good example.

Thank you.

rn/writer, RN · Oct 30, 2005

Oh, Wolfie, you made my day. I just came home from work (with the extra hour last night) and read your post. Thanks for the kind words. It DID take a lot of rambling to distill the essence, but I feel like having talked through this (with your thoughtful challenges), I can better articulate to someone else what distinguishes nurses from other disciplines and defines our care. Would that all discussion on this forum were as civilized and fruitful. (Yeah, that'll happen.)

And to think this arose out of Jay Leno cracking wise about nurses.

Thanks for your input. Have a great day,

Miranda

allnurses Guide · Nov 3, 2005

Miranda and Wolfie - absolutely great posts!

Thanks so much.

steph