Nursing: The Caring Profession

You don't have to have a calling to be a good nurse, but you do have to care. I'd go so far as to say FIRST you have to care. Lots of great nurses are in it for the money, but one characteristic all great nurses share is that they care about their patients. I would argue that someone who doesn't care should not even BE a nurse! Nurses Announcements Archive Article

I've gone on record as vigorously opposing the idea that one must have a "calling" to become a nurse, or even to become a good nurse. Even someone who is just in it "for the money" can be a fabulous nurse, and someone who has a calling can be totally incompetent. To be a nurse, you need to be able to communicate well in English (both oral and written form), understand enough mathematics to calculate drug dosages, memorize that a PT goes in a blue tube and a Chem panel in a gold top (or whatever color coding your institution uses), be able to make assessments, plan care and you must be able to utilize your critical thinking skills. (And myriad other things that I could spend all day enumerating without ever getting to my point.)

But the smartest person in the world won't be a good -- or even half bad -- nurse if he or she doesn't CARE.

I'm not talking about warm blankets and fluffy pillows and bringing sodas from the vending machine and attending your patient's funerals or their children's bat mitzvah's. Most of us don't have enough time to do as much of that as we'd like to. I'm talking about caring about your patients enough to advocate for them, protect them and do your very best.

In the past few days, I've seen a few threads that trouble me a great deal. There's the CNA whose patient fell in the bathroom. While the patient was still in CT, the CNA was on allnurses.com wondering what this fall would do to her record, how it might affect her future plans. She listed four concerns and not one of them was a concern about the patient. The fall serious enough to require a CT, and her first concern was for herself. In fact, it seems that her only concern is for herself. It was only after attention was called to her list of concerns being about herself and not her patient that she responded with: "Let's simmer down, ladies. Of course I was concerned with how she was and it was obviously implied. No hemorrhages were found in the CT. "

Then there's the student who was "kicked out of clinicals for a HIPAA violation." He went on to describe a series of egregious errors including a near miss with an insulin dose that was 10 times the ordered dose and concluded with a litany of excuses for his mistakes and complaints about the unfairness (to him) of the situation. Again, this person expressed no concern for the patient he could have harmed or even killed ; his concern was that he had no advocate for the disciplinary process, that it was totally unfair to him, cost him an extra semester and tuition money and that he didn't think there was a HIPAA violation anyway. (For the record, I don't think so either. I think he was asked out of the clinical for "reckless and unsafe behavior.)

Again, it was only when it was pointed out to him that his first concern should be for the patient, that he responded with "you have no idea how I grieved because of the insulin error or how much it affected me. " And in a later post, added: "They were really after me that day," and "Perhaps you didn't read the part where I said that it severely affected my psyche. " Again -- all the concern expressed is for himself and none for the patients he could hurt.

Caring isn't enough to make a good nurse, but without caring you cannot be one. Everyone makes medication errors -- I've made some whoppers! The difference between a caring nurse and an uncaring one is that the caring nurse's first concern is for the patient who was harmed or potentially harmed, not for himself or herself. I remember an error with a heparin drip that had the patient's PTT in the stratosphere and his urine cherry red. I don't remember being concerned about whether the error went on my record or whether I'd be fired -- I was devastated by the harm I had done to that nice old man. And that's what I told the physician, the charge nurse, my manager, the pharmacist, my husband and the colleague who noticed the error. No one had any reason to question whether I understood the enormity of my mistake or cared about the patient involved.

I was the nurse caring for the patient who went down half a flight of stairs head first. My immediate concern was for the patient -- calling the doctor, getting the patient off the floor and to CT, watching him like a hawk all night long. Of course I was concerned for the potential damage for my career, but is was way far down the list of my concerns. WAY far. For some of these folks, their ONLY concern seems to be for themselves and their grade, possible disciplinary action, a bad mark against them.

The nurse who really doesn't care about the patient first isn't a good nurse and I would argue that they shouldn't even be a nurse at all.

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