Friday, November 12, 2010

Beware Animal Lovers

     As a nurturing person how could I not love animals?  But what I didn’t realize was how becoming a home health nurse would put me in many situations I would rather not see.  Often times, I remember certain patients by the pets they have in their home.  A nurse will ask me a question about someone and I’ll say “is she the one with the two cats and adorable Chihuahua?”  It is then I remember exactly which patient we are referring to.  I have animal control programmed into my phone and have notified them on a few occasions of animals in distress who have come across my path.  There has been many times I have been forced to just turn my back and drive away leaving a litter of kittens or puppies to fend for themselves.  This goes against everything I was ever taught or believe in, however the sad truth is we have an epidemic on our hands.  On a daily basis I see dogs and cats roaming free on the streets.  Who knows where or who they belong to….probably no one. 
  A responsible pet owner must have limitations and I have met mine with three dogs in the house already.  My latest, Little Girl, who found me one afternoon, is a beautiful yellow lab mix.  I was “positive” she belonged to someone.  She was housebroken, crate trained and the perfect lady.  Who would let such a well-behaved dog just go?  The plan was to take her in, find her owners and get her back home.  Flyers were posted, ads were placed and after two weeks of no response I had my answer.  She belonged to no one.  In the meantime, I spent my evenings listening to sad songs, crying, worrying over what would happen to this precious animal.  I decided to take her to the vet and much to my disgust discovered she had heartworm!  Please, if you have a dog be sure it is on heartworm prevention!!!  If you don’t you are risking spending a lot of money or watching your dog die a terrible, slow death. 
 So, with great hesitation (and the support of my understanding husband) I decided to have Little Girl treated.  This is a long (as in months), painful process for the dog but we made it through.  After about 3 months and an amount of money I am embarrassed to admit, Little Girl made a full recovery.  I promise I did make an effort to find Little Girl a home.  I called every rescue league in the area, advertised her “to good home only.”  All the shelters were full and the couple calls I did get for her were people who wanted to keep her as “an outside dog.”  To me, there is no such thing.  If your dog isn’t welcome inside your home why do you even have one?  Dogs are social creatures that at one time lived in packs.  It is totally unnatural to expect a dog to be happy tied to a dog house alone day and night, except for an occasional outing.  I would not let this be Little Girl’s destiny.  So, that was it, my husband finally agreed and she joined our family where she will live for the rest of her life.
Just the other day, I went to see a patient way down the bayou.  It was a very run down house.  As I stepped onto the porch and pushed aside the piece of plywood door, I saw a sight that still haunts me.  There lays a tiny kitten covered in flies barely moving.  I thought it was dead until I heard the tiniest of meows.  When it noticed me it struggled to stand and managed to rub it’s frail body on my leg.  I couldn’t touch it, yet, because I had a patient to see and who knows what kind of germs the kitty had.  I took care of the patient and asked about the cat on their porch.  It wasn’t theirs and they didn’t want it around.  So many thoughts ran through my head.  Am I crazy to take in yet another stray?  Is my husband going to divorce me?  I had other patients to see and I didn’t even have a cat carrier in my car so now was not the time for a rescue.
 I drove back up the bayou with tears in my eyes.  How can this be happening to hundreds of thousands of God’s creatures?  It is everywhere and I cannot save them all.  I saw my last two patients and went home to do my notes.  As I entered the house Little Girl greeted me with her big brown eyes and wagging tail as if to say “look at me, I was worth it wasn’t I?”  And with that I grabbed my carrier, drove 20 miles back down the bayou and plucked that kitten off the front porch without a word.
     I wasn’t sure whether the kitty would make it through the night.  Her eyes were literally glued shut with infection and she was skin and bones.  My ever-forgiving husband (and closet animal activist) immediately set up the big kennel and the kitty was finally safe.  I was relieved when she ate and began to show a little life.  My original plan was to take her to the animal shelter where they informed me she would be promptly euthanized.  I planned on taking her there first thing in the morning, after all, the kitty was suffering and even if I did get her to the vet I absolutely cannot keep her.  As I said, responsible pet owners (even animal fanatics like me) must have limitations.
     There was only one hope and I knew the chances were slim to none.  In desperation, I emailed a woman by the name of Tracy at an aweome no-kill shelter called My Heart’s Desire.  Was I ever surprised when she immediately emailed me back and said they would take the kitty into their shelter!!  I scooped up that precious cat and let her know that it was going to be okay.  The next day I took her to my vet who examined her and gave me medication for her eyes and two antibiotics.  He estimated her to be about 8 weeks old.  She weighs 1.7 pounds.   
     So, I guess the message to my fellow nurses is beware of home health if you are an animal lover.  You will see things you do not want to see.  I have been forced to let so many abandoned animals go and will continue to as long as I do home health because of the sheer number of them.  But somehow this little kitten pulled on my heartstrings just hard enough and now she at least has a chance to be healthy and happy thanks to a wonderful rescue league.
    I am calling her Cocoa because I found her in Cocodrie, LA.  She looks like a Siamese to me.  Two days of love and medicine and she is already a different cat.  She will make someone the perfect friend.  I pray she is adopted by someone who really cares and is as dedicated to her as any member of their family.  Please wish her luck!


Friday, October 15, 2010

Under the Covers

     As a home health nurse I have seen quite a few interesting things.  Things that you will probably never experience, even in a hospital.  There is one particular case that I will never forget and got me really thinking about the plight of some people.
     It was your typical low income apartment building, nothing scary or too gross from the outside.  I was to see an older woman to take care of some wounds she had on her legs.  I knocked gently on the door, no answer.  I knocked a little louder, no answer.  So I did what I hate to do, but I checked the door.  It was open.  I hate just walking into a total stranger’s home but I had spoken to the woman just a few minutes ago on the phone and she knew I was on my way.  I opened the door and peeked my head in, “Hello?  It’s Jennifer, the nurse,” I said.  I heard a very faint, “I am in here.”  Following the voice I made my way through piles of “stuff” toward the back bedroom. The house was a mess and smelled awful.  I saw a sink full of dishes…and flies?  Was that my imagination?  I decided not to use their sink to wash my hands and used my trusty hand sanitizer instead. 
     I found my patient in bed under a mound of covers.  It was at least a double bed and she filled most of it.  We met each other with a smile and I wasn’t surprised to find she was a very sweet person.  After we talked a few minutes I began to perform the dressing change.  I lifted the bottom of the covers up high enough to reach her wounds.  Her legs were enormous with lymphedema oozing onto the sheet.  I cleaned her all up, performed the wound care and was getting ready to pack my bag when I saw something moving under the sheet on the other side of the bed! 
     I got a little nervous for a minute.  What is under there with her and what could stand such a smell?  Out popped the head of a beautiful little girl.  Probably about eight or nine years old if I had to guess.  “Surprise!” she said and laughed.  I smiled back and laughed along with her and her Grandmother.
     It was Monday morning, a day a young girl like her should be at school.  I wondered to myself why this little girl was not at school.  As I gently probed a little further I came to find out that she stayed home to take care of “Maw Maw” because she wasn’t feeling well that day.  I also discovered that this little girl also was the person to dress, bathe and feed this patient.  As morbidly obese as this woman was, it was close to impossible for her to even get out of the bed.  How this little girl managed was beyond me, and I will say, she was doing a mighty fine job.
    My heart ached for this little girl.  Even though I could see the love she had for her Grandma the burden she has undertaken at such a young age just should not be.  How do we expect a young child in this situation, living in these conditions to be successful and productive at school, if she even goes?   I am not saying she can’t be, it’s just that the odds are against her. 
     You never know what another person’s life has been like or what they have been exposed to.  What kind of role models they have had.  What kind of a living environment they were raised in.  How can we expect kids who have had parents who literally just don’t care grow up to be any different?
     I don’t know the answer to any of these questions.  All I know is never to judge, no matter what.  I know, I know, people can get out of poverty if they want to and work.  I have heard it.  But until you look into the eyes of a beautiful young girl like I have, already with so much worry and responsibility and tell her go to school and get good grades.  And when you get home, no one will say “You did great at school today,” after all, Maw Maw’s sheets need to be changed again, and “Oh, what’s for dinner?”
     Now, I know this story sounds dramatic but it is some kid’s reality.  Yet again, nursing has taught me to think deeper about people and the outcomes of their lives.  I pray for each child who grows up in a difficult home that they find someone or something, some example, that inspires them enough to better their lives. It is just SO hard when lack of education, poverty, filth, anger and abuse is all they know. 
     I just wish I knew a way to help change this cycle.

Sunday, September 19, 2010

Home Sweet Houma

     I was excited to explore an entirely different area of nursing when my husband was stationed in southern Louisiana two years ago.   Growing up a New Englander, I knew I was in for quite a culture shock.  It just so happens that I landed the perfect job at a small home health agency in town.  I was able to work days, no nights or weekends and I could be home in time to pick up my son from daycare. 
      After a few weeks of orientation I was given my first assignment.  As I looked through the patients’ charts I felt quite comfortable with what my job was to be, how to care for the medical needs of these patients.  Now, I would just have to actually find them.  I hadn’t yet invested in a GPS (big mistake) and as I drove around town lost, I began to feel like this just might be too much for me.  I had never even seen a ‘bayou’ before, now I was driving miles up and down the bayou searching for my patient’s home.  
     It is a very unique landscape down here, very flat and lots of water and bridges.  There are beautiful birds and plenty of alligators.  There are so many boats; fishing boats, tugboats, huge cargo ships that somehow manage to make their way miles up these narrow waterways.  There are some gorgeous “Acadian style” homes and some homes that barely look livable.  I have seen many blue roofs left over from hurricanes past.  Down the bayou most houses are raised high in the air because of frequent flooding.  I wondered how my 80 year old patient climbed up and down the steep stairs to get in and out of his house.  Come to find out, most everyone has an elevator!  It isn’t the kind of elevator you are thinking of.  It is more like a small metal box on the outside of the house that fits one person and goes up and down.  Pretty cool. 
    If you want to experience the true culture of an area work as a home health nurse.  I have had the privilege to get to know the people of southern Louisiana in a way unlike any visitor and probably even more than some who have lived here their whole lives.  These “Ragin’ Cajuns” are honestly the nicest people I have ever met.  They have welcomed me in their homes and showed a genuine interest in me.  I don’t know how many times I have heard, “We are so happy to have you here,” when they learned I was new to the area.   It seems as if the people of this area have mastered the art of enjoying the simple things.  I sure could learn a thing or two from the people down da bayou.
       Being in home health, I have entered some homes that many would not believe.  I have been in some really beautiful homes but the homes I enjoy the most are the ones you would least expect .  No matter what the condition of the home I love that once inside I am able to look beyond the mess and just see my patient and be in the moment.  What I have discovered is, often it is those with the least that teach me the most.  Even though I am a total stranger to these people I have been shown so much love.  It’s hard to describe.
       How many nurses can say they have fed a wild alligator, was handed a hunting rifle and was serenaded by an Elvis impersonator all in a day’s work?  Well, I can.  I have also been kissed, hugged and fed.  Of course there have been a few grumps and complainers along the way but honestly, very few.  
     I still love New England and always will, but as they say, “life sure is good on the bayou.”

Sunday, August 22, 2010

Behind The Mask

      Every day I enter the revolving doors here at Mass General Hospital, I am presented with a new set of challenges and experiences different from the last. Little did I know that on November 20th I would have the opportunity to care for a very special person who was facing the most challenging crisis of his life.

     In report I listened to words like, "tough," and "not very friendly," and quite honestly I was a little apprehensive to enter the room of this angry man. "Bob" is a man in his mid 40s who has spent the greater part of the last five years in the hospital. Diagnosed with cancer and AIDS he has endured more testing and operations than most of us will experience in a lifetime. Bob was admitted with a high fever and cough to rule out tuberculosis and had been assigned to the isolation room on the unit.

     I entered the anteroom, gowned and gloved. I peeked through the glass to see a frail man covered up to his chin in a mountain of blankets, shivering. I put on my respirator and entered the room. While I realize the importance of wearing the mask, there’s something about it I hate. It creates one more barrier between the patient and me. Facial expressions, especially smiles, are hidden away. There is something so impersonal about caring for a patient on precautions. Being "locked away," as Bob called it, being approached by people protected by shields so they can’t catch whatever infectious disease is suspected. All of these thoughts came to mind as I knocked gently on the door and entered the room.

     The room was cool and the whir of the ventilation system was enough to drive anyone crazy. Bob barely stirred as I touched his arm with my gloved hand and introduced myself. It was quite apparent I was looking at a gravely ill man. Emaciated and weak, Bob reluctantly cooperated and allowed me to complete my assessment.

     When breakfast arrived I made sure that I brought him his tray right away. Often, patients on precautions get overlooked as their trays wait in the anteroom getting cold. Bob didn’t have much of an appetite, but he asked me for some extra jam for his toast. Although he didn’t say anything, he seemed surprised when I returned a minute later with three different kinds of jam. A few minutes later, he called me in again. He needed to be washed and have his linens changed. As I washed him, I could see the disgust in his eyes. This was not something he wanted or something he did for attention.

     As the morning wore on, I sensed that I was gaining Bob’s trust and began to try to talk to him about his treatment. It was obvious from the beginning that Bob was beyond frustrated; he was losing all hope. He was fed up with hospitals, blood tests, doctors and nurses. He just wanted to go home. But he lay motionless in his bed, "a prisoner."

     After lunch, I entered the anteroom and looked in on Bob. He sat staring at his full lunch tray. I was wearing my usual attire that day, some silly scrub top with cartoon characters on it, my hair in a ponytail. I knocked on the anteroom door, surprising Bob, and gave him a silly wave and a smile. No mask, no gown, no gloves. Through the glass, I saw a hint of a smile. I motioned for him to eat... eat... eat! He responded by lifting his milk and taking a sip. I felt I had made a bit of progress.

     I had been away for at least a half hour when I saw a commotion at the nurses’ station. Three Security guards were outside of Bob’s room! I immediately felt a surge of adrenaline and rushed to see what the problem was. Bob had called the local police from the phone in his room and threatened to commit suicide.

     I was far from shocked, however, I was slightly disappointed that he hadn’t confided in me. We had spoken earlier of his discouragement, but never to that degree.

     As I entered Bob’s room, the guards went on their way and I was once again alone with Bob. I sat close to him on the bed as I had earlier that morning. He sat on the edge of the bed, bent over, head down. He was so frail, so sick, so thin. I didn’t know where to begin so I just sat. I sat in silence with him for a couple of minutes with my gloved hand atop his cold, bruised, hand. Finally, I said "Bob, why didn’t you call me? I would have come right away." He just repeated over and over, "I didn’t know what to do. I just didn’t know what to do."

     When a person threatens to commit suicide, it is very serious, no matter how unrealistic the threat is. It didn’t matter that Bob didn’t even have the strength to lift a fork. His threat was real. I stayed with him for for a long time, gowned and gloved from head to toe. As the beads of sweat began to form beneath my mask, I was finally able to begin to gain a better understanding of Bob. The bitterness and anger he had been displaying to the other nurses seemed almost justified.

     Bob had come to grips with the fact that he was going to die. It was inevitable, and it was going to happen sooner than he had allowed himself to believe in past hospitalizations. He had already refused any treatment for AIDS, and he was now beginning to refuse treatment altogether. We talked about this and what it meant, not only to him but to his family. After all, it was his 81-year-old mother who was "suffering the most," being forced to watch him wither away. He said he wanted to "go quick," so that his mom wouldn’t have to watch him suffer. In fact, he was not afraid to die; he was more afraid of the pain he was causing others.

     Shortly thereafter, Bob was seen by a physician who ordered that he be placed on one-to-one supervision, meaning someone would be with him at his bedside at all times for his own safety. I completely agreed. The physician pulled me aside and told me she felt it was necessary to put Bob in soft restraints so that he would be incapable of physically hurting himself. A sense of anxiety came over me. Was I going to have to go back in that room and tie an already hopeless man down? What would happen to the relationship we had formed? I could not and would not do it. I told the physician how I felt, and together we discussed alternatives. I told her about my experience with Bob and the behavior he had been exhibiting throughout my shift. I told her I didn’t think restraints were the right therapeutic intervention for this patient. If the physician felt it was necessary to apply restraints, she was going to have to go into that room and put them on herself, because I could not bring myself to do it.

     We entered the room, and I have to admit, I was starting to get emotional, even angry. Thankfully, Bob was able to make a verbal contract with us, assuring us that he would not attempt to harm himself. It was that easy. The restraints were put away and I settled down.

     Bob stayed for the rest of my shift under the watchful eye of a sitter. Before I left for the night, I stopped in one last time to say good-bye. I wouldn’t be back for a few days, and I thought Bob would be moved to another unit by the time I returned. I asked the sitter to take a break so Bob and I could talk like we had earlier in the day. Bob asked if I would be back tomorrow, and I honestly felt a bit of sorrow when I said no. I could tell he was disappointed, but I knew I had made a difference that day. I put my arm around his shoulder and gave him a squeeze. He looked at me and said, "Thank-you, Jennifer." As I left the room, I heard the thud of the heavy doors and turned and waved good-bye.


     Whether novice or expert, there is one skill a nurse is forced to embrace from day one of her nursing practice. In fact, although I believe it can be learned, there is a sense of innateness about it, and that is the art of patience.

     Mrs. G. was an 88 year old patient who recently spent a solid three weeks on my unit after what was a “routine” cardiac catheterization. Being a somewhat frail woman to begin with her recovery wasn’t what I would consider routine. It wasn’t as much her medical condition that challenged me, but more the patience it required to care for her. I can’t help but think of words like demanding, needy, helpless, unmotivated and annoying to describe Mrs. G., however, sharp and particular.

     Things began in the usual fashion, post-cath care, EKG, telemetry, vitals and meds. These are the more concrete tasks which require some degree of patience to complete. Most of these things are completed quite quickly; they are objective, things that are required. You may encounter a few small setbacks (an EKG machine out of paper, a missing med) or much larger setbacks (recurrent chest pain, bleeding), all of which require different degrees of patience. But yet, still in my eyes this is the small stuff on the great curve of patience.

     Mrs. G is settled neatly in bed, she is comfortable without chest pain or shortness of breath. She is alert and oriented times three, appears calm, in fact she is hungry. I promptly ensure she has her call bell to ring, bed is down, side rails up and phone within reach. I leave her; after all, I have 3 other patients to attend to. In less than five minutes I discover Mrs. G has successfully operated the call bell as I am back at her bedside. Her dinner tray has arrived. The usual meal of finger foods post-cath “just will not do.” I offer her what is available and she just sighs with disgust. “I guess I’ll just have to eat this,” she says. Meanwhile, I hear a grumble in my stomach. I have been here for the last eight hours and have yet to finish my morning coffee never mind eat. But this of course is secondary; there is yet more work to be done before I can get to that.

     Soon to follow, a barrage or requests, complaints, and needs come over the intercom from Mrs. G.’s room. Mrs. G. has been joined by her two daughters who bear a striking resemblance to her in both looks and personality. I enter with my usual smile and approach them calmly and with concern. I reassure them that their mother’s procedure has been a success and she should be back on her feet by morning. My explanation of the procedure itself or the optimism I share for her recovery just doesn’t seem enough. After all, her cable t.v. has yet to be turned on, the room is too cool, she will need another box of tissues, and by the way “I need the bedpan.”

     I take this all in for a few seconds….where to begin. It is not the actual doing of these things that gets to me but the attitude or tone of voice used in the requests. At this time neither the patient nor the family members is just taking a moment to relish in the fact that their mother has just received what will be a life saving stent in one of her major coronary arteries…..”Wheel-of-Fortune starts in 15 minutes and Mother cannot miss that.”

     I have come to recognize the symptoms I experience when my patience wears thin. The heart starts pumping faster, I feel my face flush. In fact, I feel a little anger and anxiety inside. It never changes and comes in varying degrees. The key is to never let it overwhelm you.

     I have yet to lose my cool as a nurse. I feel as if I have been tested to the max and virtually every time I feel like I cannot fulfill another patient request I find myself gritting my teeth, taking a deep breath and going all the way down to room 38B one more time to fix that lead that keeps mysteriously falling off. I attribute my success, partly to genes, but more so to accepting the challenge. After a full 12 hour shift caring for a woman as demanding as Mrs. G. I go home exhausted but in a sense exhilarated. No matter what the trivial request, I did not succumb to the temptation to rebel. I must remind myself that Mrs. G.’s requests were important to her and the “service” she received from the nurses is what she will tend to remember most about her hospitalization.

     Mrs. G. had a long stay with us on the unit, waiting for a rehab bed. I purposefully put my name on the assignment board to designate myself as her primary nurse. I did so with hesitation and eventually saw her off to rehab. I wasn’t necessarily happy to see her go but I wasn’t sad either. I never got as much as a thank you when she left. Not all of our encounters with patients will end all warm and fuzzy I guess. As I remember this experience I think the exercise in patience was thank you enough.

     There are very few professions that if in taking the time to appreciate will shape you as a human being. I will no doubt continue having my patience tested, both at work and in life, but I will continue to succeed because my profession provides me with plenty of practice.

Thursday, August 19, 2010

The Room at the End of the Hall

     It was not unlike any other typical day on the busy cardiac unit. All of the staff buzzing around dispensing morning meds, completing their assessments, when I realized a bit of commotion in a room at the end of the hall. Since I seemed to be ahead of the game with my assignment I decided to take a peek and see if they needed any extra help.

     As I entered the room it was obvious the patient was in distress, gasping for air with a look of terror in his eyes, a look we as nurses quickly identify. It was apparent the situation was being attended to quite diligently with doctors, nurses and respiratory therapist all on hand. I asked the nurse in charge what I could do to help and quickly ran to get the supplies needed. When I returned, I discretely took my place at the bedside, listening, watching, and learning. I am doing my best to pay close attention to the actions being taken and absorb all that I can under the chaotic circumstances. Yet, I am drawn to the look in this patient’s eyes and feel the need to make my way through the crowd to the head of his bed.

     I reached out and gently placed my hand within the patient’s. His skin was like ice, clammy and pale. Beneath the ambu-bag his eyes blinked back the tears. I held his hand tight for a minute offering the few words of comfort I could conjure up. He hasn’t taken his eyes off of me. Then the most courageous and memorable moment of my career began. The then dying patient, struggling to breathe, reached out to me and began stroking the top of my hand. Amongst all the chaos, the noise and fear the patient seemed to be reaching out in an effort to comfort me! It was as if in a time of his greatest need he was finding some comfort in comforting me. It may sound so minute, almost silly to the average person, but this simple demonstration of courage and pure human spirit moved me beyond words.

     Within a minute or two the doctor injected the sedation and the patients grip grew limp. He was fast asleep, unconscious for intubation. I held tight to his hand thinking to myself, as if in prayer, “be strong, be brave, we are here with you.” The next thing I knew he was whisked away for emergent cardiac catheterization and the room was once again quite, so very empty. I don’t think I ever even knew that patient’s name, in fact, that was the only encounter I ever had with him but it is one I will never forget.

     Yet again, on the short “T” ride back to Somerville that night I begin to replay the day’s events over again in my head. I look beside me and see a woman engrossed in her Wall Street Journal. She looks a little disheveled, even upset. It is less than a week after September 11th and the stock market has felt the effects. The woman writes feverishly in her notebook. She too has, no doubt, had a long hard day.

     I am immediately brought back to the room at the end of the hall and that brief moment in time I shared with a stranger. I smile, remembering a very special connection I had made that day. I wanted to share my story with this woman on the "T" to somehow ease her worries but the train stopped and she scurried off.

Nursing Guidelines

Quite a few years back, as a relatively new nurse entering a big city hospital, I was happy to discover that my philosophy of nursing still holds true. I will admit I was a little nervous that I wouldn’t have the knowledge or skill to be successful on such a highly specialized unit like the cardiac access unit. After all, I came from a medical unit in a tiny community hospital with no cardiac experience to fall back on. However, I was relieved to discover that no matter what area of nursing you practice in there is a very simple concept that guarantees success every time. That is the concept of caring.

Many years ago when I first became employed as a nursing assistant in a hospital I remember one of the R.N.’s saying to me “You’re too nice to be a nurse. Don’t worry, after a few years you won’t feel the same.” That comment has always stuck with me and I often wondered if it would hold true. Would I become hardened, indifferent? Day in and day out of responding to every patient’s beck and call “can do that to a person.” So I pressed on, going about my business of nursing, doing what comes naturally to me. At the time I still considered myself a novice but found I had discovered what every nurse knows but not even some of the most seasoned nurses can commit to. A genuine sense of caring. In general, patients have very basic needs. And while each patient is an individual there are a few simple guidelines that if adhered to promise success 99% of the time.

Smile! Greet your patient’s with enthusiasm; it often catches them off guard. Be friendly; take an interest in not only their current medical condition but what their life is like outside of the hospital. I think this kind of personal interaction puts the patient at ease and makes the patient feel on equal ground with the nurse.

Listen. Believe me; I realize this can be difficult when you are pressed for time. When you do have time pull up a chair and really get to know the patient. Also take the time to personally talk with family members, especially if they call. Family members want to hear more than just “the patient had a good night.” I find they really appreciate any information you can provide (within HIPPA guidelines of course!). 

Be Smart. Perform your nursing care with confidence. When a situation becomes challenging I do my best to appear calm and in control. This helps the patient relax as well. Most importantly, if a patient asks me a question and I don’t know the answer I find someone who does.

Educate. Taking just a few extra minutes to explain a procedure or test results with a patient puts them at ease. Keep it basic and don’t scare them with words they will not understand. Don’t just assume they know what’s going on because most likely they don’t.

Be Punctual. I find this to be one of the most important guidelines. This is an area I have made a conscious effort to always maintain. If a patient rings for you and asks for something respond as soon as possible no matter what the request or send someone who can respond promptly if you are tied up. I don’t care what the patient needs, from chest pain to filling a water pitcher, I always do my best to ensure that the patient or family’s request is tended to asap. I find this builds a strong sense of trust between you and the patient. I want my patients to know that when they call I will be there.

Care. This, of course, is the essence of nursing in my eyes. If you don’t truly care, why are you there? I am not sure where or when people develop empathy but out of empathy comes caring. I have been blessed with a great sense of empathy. I am always asking myself how I would feel if I were them. If I were faced with their situation, how would I respond? In having the ability to “put myself in their shoes” I find I am better able to understand their point of view.

Not too long ago, I was assigned to care for a gentleman who had been on the unit for a couple of days prior to my arrival. It was well known he and his wife could be challenging, in fact, there had already been a meeting with staff, supervisors and the patient care rep regarding the patient’s care. It was documented that only “experienced” nurses care for the patient. I was a little caught off guard when I was assigned this patient and by the outline of rules I was to follow that was handed to me as I received report that morning. As I read these “rules,” neatly typed on a piece of paper, I realized how silly it all seemed. Essentially what appeared on that paper boiled down to the basic concept of caring. The same kind of caring I provide all of my patients, whether they are a lawyer or an inmate from the local prison.

So, I entered the private room of this prominent man a little tentatively, and was pleasantly surprised. I proved to myself what I always knew. As humans we all have very basic needs especially in times of stress. In taking the time to prove to this patient and his wife that I truly cared by meeting some pretty basic needs, I was able to develop a trusting relationship with them. In the end, they were still quite demanding and it was then that I had to care the most and be empathetic to their situation.

Later that night as I was walking to the “T” in Boston after a long twelve hour shift, I found myself smiling. At first I wasn’t exactly sure what I was smiling about. Then I remembered how one simple act of kindess  had made one of my patients so happy that day. I had found the time to help an 89 year old woman wash and set her hair. She was so pleased as she shuffled over to the mirror and saw her reflection. I continued to smile that day because it was then that I realized the nurse who had spoken to me so many years ago….was wrong. I haven’t become indifferent or hard, quite the opposite, I have found a profession that suites me quite well.