May and June-it is that time of the year when nursing programs proudly send their graduates forth to promote health, to care for the sick, and to launch their careers. Below is an excerpt from a graduation address that I had the privilege to give. The story and lessons are from experiences on the other side of care-the patient/family side and make for important lessons for new graduates.
THE STORY
My 99-year-old father broke his hip and wrist last year in a freak accident. His surgery was successful, his rehabilitation is progressing, but a few of my experiences with nurses left me disheartened. First day postoperation, I visited early and found my dad sitting in a chair, in the buff. He is old and he was picking at his gown, which had fallen to the floor. He was also pulling the batting from his wrist cast and had unraveled much of the cast tape. After I put his gown back on, I went to find his nurse who did not seem all that busy. In fact, I checked the number of patients on the unit on the assignment board and quite a few beds were empty. I stood at the unit station counter for at least 3 minutes before anyone acknowledged that I was there-no one looked up and in fact a few folks changed their body position to get out of my line of sight. Finally, I found my father's nurse. I explained how I had found my father, that he had mild dementia, which the anesthesia probably had compounded, and that he needed to be watched. The nurse promptly blamed the physical therapist who she said had just completed an assessment of my father's mobility. "She should have told me that she was leaving. After all your father is very quick." "All the more reason to be more vigilant," I said.
Lesson 1: If someone is standing at your counter or in the hall waiting to be acknowledged, ask if you can help. Look up, even if you are on the phone, make a gesture that you will respond. Commit to addressing the need in as timely a way as you can and follow through on the commitment. I am hoping for all of nursing's sake that every time you have the urge to act busy, to pretend that the patient or the family member is not really there, a voice in your head will tell you to respond. Nurses respond to patients and families, and that is our professional obligation.
Lesson 2: Never blame other professionals for the condition of your patient, even if it is their fault. Family members are also in your care and need to have their anxieties addressed competently and caringly.
Lesson 3: Listen to family members. What they have to say can help you to avoid errors, have a deeper understanding of the patient, and ultimately produce better patient outcomes.
And the story continues: I also asked the nurse whether I could talk to the attending physician about a consult. In 20 minutes, he appeared. We discussed the referrals, and as the doctor was leaving he said that he wanted me to know that the nurses were working very hard and were very busy and that the physical therapist had left the unit without informing the nurses-"That is why you found your father the way that you did." I acknowledged that mistakes happen but that I had high standards when it came to nursing care, since I am a nurse. However, I explained, "Today I am the daughter of a frail 99-year-old man and I am trying to get the best care possible for him so I will continue to be his advocate."
Lesson 4: Do not whine to physicians or other personnel about family members' complaints or requests unless they are menacing or security risks. When you are asked to do better, think about it and find ways to improve. Apologize for shortcomings. Do not get defensive; you are the professional. You are not as vulnerable as that patient in the bed or that concerned family member.
Lesson 5: Do not tell patients and families how busy you are. It is not their problem. You can tell them when you will be in to see the patient and what you will do to improve the care. You should ask patients and families what would make them more comfortable. In the final analysis, the nuances of nursing care are in the details, the little things you say and do to allay fears and the principles you apply to create safe environments. After a relatively bad start, my father's care did improve and the nurse was more approachable.
I can tell you just as many stories, both positive and negative, about nurses who have touched my life, like the nurse who sat with me in supportive silence as I waited outside the cardiac catheterization laboratory while my husband had a stent put into his right coronary artery, or the nurse traveler who took the time to comfort me as I was lying on the floor in the Orlando Airport after I broke my arm in a freak fall, or the emergency room nurse who did such a great assessment and was so attuned to my pain that I got exactly what I needed when I needed it. I do not remember their names, nor do I know anything about their lives or points of view, but I do remember their competence, professionalism, and kindness-the 3 essences of holistic nursing practice.
-Gloria F. Donnelly, PhD, RN, FAAN
Editor-in-Chief