Fledgling Nurse, Part 12: Patient Cares v Patient Tasks

I would not claim to know every nurse's reason for getting into the field.  However, I have taken a small sampling and found some similar themes that include (but are not limited to) the following:

• A loved one (or that individual themselves) went through a hospitalization and/or needed care at home that the individual participated in; they found that they had an affinity for it
• A notable nurse had touched their life in the past
• Biology is hella cool, man, in all its grossness
• It seemed like a good idea at the time, and now "I could never think of being anything else"
• A desire to demonstrate compassion for persons by direct care

That last one, I would say that many of us need to have this in at least some degree, whether or not it was the key driving force.  There has to be a degree of willingness to serve others, to work toward alleviating suffering where possible.  The job entails service and advocacy for others.  Sometimes that involves a bit of tough love and hard, direct questions.  Sometimes it is a painful dressing change on a wound.  Sometimes it is a nagging to get up for yet another walk.  Sometimes it's a timely delivery of pain medication.  Sometimes it is a gentle washcloth on the chin after feeding the patient.  

One of my favorite spaces, though, is when I am able to stop and listen to patients, honor their emotional processing through whatever else is going on and see them as a person.  This is not every nurse's particular desire nor skillset--some nurses prefer their patients anesthetized (e.g. surgical nurses), and there are definitely days where I see the wisdom in that.  However, there are days where that space simply is not possible.  This can be for a number of reasons:  

• The patient and I have some kind of communication barrier, most frequently because they are hard of hearing but sometimes language (the translation tablets are supposed to be used primarily for communication related to their care specifically)
• The patient does not feel like talking
• The patient has their own visitor(s) or is otherwise already engaged
• The patient is confused and/or with low memory, participating in their own world only

The most common reason, though, is that I simply do not have time.  From eight to ten in the morning is an absolute flurry of activity.  I have received report from the night nurse, gathering my bearings on these patients, introducing myself, and setting goals with them for the day while also performing an initial assessment on them to form some of my own conclusions; then I am checking, retrieving from the correct location, preparing, all of their medications for five separate patients (one after the other, since all at once is a logistical nightmare, particularly with some patients that need pills crushed, swallowed one at a time, cross-checked with another nurse, etc.).  At the same time, I'm getting calls from lab, physical therapy, occupational therapy, respiratory therapy, patient family members, case management, social work, my tech, physicians, and, of course, the patients themselves needing to go to the bathroom or other morning routine elements.  

In the rest of the day, I am also expected to round on my patients every other hour (their tech on the other hours), turn patients that need turned, administer timely medications, troubleshoot and/or start new IVs, discharge appropriate patients (calling nursing homes or home health for the handoff, sometimes scheduling appointments that haven't already been made), admit new patients, teach patients about their care, perform dressing changes, notify the physician of any major concerns, and respond to any other issues in the day.  

My internal self in the morning med pass

Oh, and document it all.  

In other words, my goal might be to be with the patient as a person, but sometimes my reality is that I have a series of tasks I have to perform with that patient, and this may be all of the space I have available to them.  I leave those days feeling a level of frustration, that I was so busy performing patient cares that I may not have been able to care for the patient.  

I don't like it when my patient becomes a list of tasks rather than a person, but, again, sometimes that is all the space there is, particularly when other patients on my load simply need more, in one way or another.  There are times, though, when a patient is a list of tasks partly to protect myself--perhaps they are lashing out against their situation by making snide remarks to staff members:  I will minimize my time in those spaces, clustering my obligations together and perform the bare minimum of interaction. I am not neglecting them by setting a boundary, as their tasks are still addressed, but it feels different.  It's an interesting cognitive dissonance, to know that I am caring for people by actions even if I am not engaging with them emotionally.  I do not need to be "friends" with a patient in order to feel fulfilled by the day.  I can know that I am advocating them while I'm not being present in the room; I can know that I'm simply a part of the "holding pattern" before other decisions are finalized and know that this effort is not strictly needed (I cannot make insurance approve pieces any faster).  

In the end, it is all a balance of resources.  What emotional space I have to offer depends on how much has been used toward all of the task elements that must be completed.  I prefer to have the time to see to their emotional needs, but it cannot be at the compromise of someone else's safety needs.  What's left is to make peace with that.