Life is full of choices both large and small and some have long reaching, unforeseeable impact. Sixteen years ago, a young woman named Nancy decided that nursing was a career with the ability to provide for her growing family. Nine years ago, she chose to leave the bedside in order to have greater control of her hours. Seven years ago, she almost left because healthcare wasn't what it used to be. I remain grateful she decided to stay.
The face of healthcare is changing. This is news to no one.
Now granted, it's been changing ever since I joined the ranks back in none of your damn business, thank you very much. But now, more than ever, fueled by further healthcare reform and the introduction of "Obamacare", we are being urged to do more with less or, worse yet, leave out certain things altogether.
But ultimately, when it comes right down to it, what is being whittled and the manner is which it is done is a choice. No one is forcing us to forgo hand holding or back rubs. We choose to in order to meet the more important and higher ranking, acute needs of our ever growing ranks of patients. I am not one to say whether or not this is right or wrong so much as to say that I see it happening and it is what it is.
And as much as we feel this push from our managers, our companies, and our providers to develop and maintain a lean practice at the bedside and across the board, so too are providers feeling the pinch in the form of reimbursement. They, as we, are being told to redefine their practice standards and many are even opting to simply do less.
But, as each of my rambling articles inevitably weave their way into, there is a story.
I have been sick. Dun dun Duuuuuuuunnnnn!!!!
Not like horribly sick....but sick in such in a way and for such a duration that it had become apparent my body needed a nudge to get with the bacteria kickin' and macrophagin'. So after much internal dialogue and a very convincing argument involving cookie dough ice cream as a reward, I crawled out of my toasty hibernation den, bundled up in my sleeping bag-like winter coat (which is lovely because, should I ever fall into a snow bank, I can just sleep where I topple. Very handy, that.) and oozed my way to my doctor's office.
Turns out he wasn't available. Decided to go on a last minute cruise to Jamaica. Because you know....that's normal. Some people get up and make the choice to eat a poptart for breakfast and apparently others decide they will be in the tropics by lunch.
But his lovely NP was in and just so happened to be able to see me. I admit I was a little gun shy and hesitant given that I have had bad experiences with NP's before. Something about a speculum and pinching something not meant to be pinched.
Ugh! Digress again!
So off into the office I go.
Nancy (yes, the one from the intro) did her exam and talked to me a bit before, with angels sounding in the background, she handed me a script for something sure to beat the tar out of the devil residing in my sinuses. All is right in the world until, with a narrowed eye and a lightly cocked head, she retracted the script and placed it on the desk.
I'm bewildered even as she asked if I "do that often". And by that, she meant clearing my throat. I answered that it was a recent thing but I passed it off as being part of the cold or flu or Ebola that I was suffering with. With a gentle shake of her perfectly coifed head, she asked if I would mind if she examined my neck.
If I would mind.
The answer was very much no, of course. And this, my friends, is where a series of choices were made with an impact which, to me, will remain absolutely immeasurable.
She chose to perform a neck exam when my immediate need and reason for the visit had been resolved. She chose to take the time to perform the exam properly and thoroughly and with hands which were skilled yet careful. She allowed for the words, "I think I feel a mass" to settle and when my hands darted to my own neck, trembling, fretting, wrought with worry and the need to feel, to find, to poke, prod, dig, she chose to guide my fingers to where the small protrusion lie before softly bringing my hand away and back to my lap. She took the time to talk, to answer questions way too advanced for the what the situation merited, before sending me over to diagnostics for an ultrasound.
No, it is nothing serious. Yes, it will be watched.
In an era when each patient is truly only allotted a set amount of face time with a provider, when more with less is the name of the game, it then falls to each of us to make choices on what is truly important. It gives me hope for the future of healthcare whenever I encounter individuals willing to take back control of their own practice.
We, as nurses, of all shapes, sizes, degrees, backgrounds and specialties, remain a powerful force in healthcare. We ought to remain mindful of our influences not only over developing better ways to provide care, but in our impact with each patient we encounter. Yes, times are changing and we are going to be forced to once again adapt. In essence that is what has driven medicine and nursing --adaptation and continued survival-- and often brought into being heralded by one voice. We must be careful not to minimize our own impact --heaven knows its easy to get beat down by the system. One may be the loneliest number, but it remains a force to be reckoned with.
Because of Nancy and those like her, I am well on my way to healing. In case you were worried, the kraken residing in my sinuses is withering and my ears have popped--finally!--after three weeks of coping with fish bowl audio effects and the overwhelming, thunderous sound of my own gum chewing. And now that I am hearing the world in ultra high definition, I wish the record to reflect that I had no idea my television was so damn loud as to be heard in the back yard. With the door closed.
And because a nurse made a choice to flex her practice outside the confines of an ever tightening system and deliver truly excellent care, I am able to sleep easy.
And not watch TV with earth shattering volume at 2 am.
And for that, my neighbors thank you, Nancy.