The Nurse, the Martyr, and the Oxygen Mask

Over the years, I’ve known a plethora nurses. I’ve known new nurses, seasoned nurses, frightened nurses, burned-out nurses, and nurses who were so jaded they couldn’t even see their patients if they were right in front of their noses. I’ve known nurses who clocked out at the end of their shift and never looked back, and I’ve known others who consistently clocked out two hours late and then were up all night hoping their patients were OK. It takes all kinds, and some suffer unnecessarily more than others. 

Explaining What Nurses Do

This post about what nurses do and how nursing is perceived by the general public was originally posted in 2012. It's been updated and republished for your enjoyment and edification. 

When I tell people that I'm a nurse, they will often innocently ask, "So, how many hours do you work at the hospital?" While such questions are well-meaning, they belie the fact that so many people make wild assumptions about nurses and nursing, and most everyone has little idea what nurses actually do. I've expounded on this topic before, and will no doubt do so again.

If we're put in boxes by others, do we also unthinkingly put ourselves in boxes, as well?

Nurse, Whose Shoes Are You Wearing?

As nurses, we're often in the mode of "doing". We hang IVs, check vital signs, give treatments, dole out medications, and tend to multiple tasks, whether in the hospital, nursing home, school, patients' homes, or other venues. And when we're doing those tasks, we're generally wearing our metaphoric---and literal---nursing shoes.

Nurse Keith on Emotional Labor

Emotional labor is a concept that's new to me, and potentially new to many nurses, as well. In a nutshell, emotional labor is the emotional regulation that we as nurses and healthcare providers have to practice in order to be present with our patients. Suppressing our emotions can take a toll in the short term and the long term. As a nurse, how do you care for yourself emotionally? Please watch this short video and leave me a comment. I'd love to hear from you!

Of Flu Season and Nurse Martyrs

Nurses are often notorious for being martyrs, caring for others when they really need to be caring for themselves. And when flu season strikes, many nurses may heed the call of duty rather than the call of their own bed.

The Story of Malcolm: Nursing and Grace

I've written a guest post for the blog of Karen Ingalls, a writer and author who is a five year survivor of ovarian cancer. Her book, Outshine: An Ovarian Cancer Memoir, is an inspiring account of the challenge of living with such a diagnosis.

My post is the story of "Malcolm", a patient from early in my nursing career who taught me many lessons of living well in the face of the vicissitudes of life. I hope you enjoy Malcolm: Gratitude and Grace.

I thank Karen for the opportunity to share my story with her community of readers. If you'd like to hear Karen's recent interview on RNFM Radio, please click here.

Nurses: Compassion For The Self

Nurses, when you consider the level of compassion with which you treat your patients, do you also consider the possibility that you can treat yourself with that same compassion? Do you feel that you deserve it?

And So It Was....

She breathed her last breath in her own home, surrounded by family, held in the bosom of love.

And so it was.

The Nurse Listens

Today on the Facebook page for Nurse Keith Coaching, I posted a question about listening that really got me thinking. Listening is a skill that all nurses need to develop and hone over the course of their career. But what does it really mean to listen well, and what if we think about listening metaphorically rather than literally?

Book Review: "The Craft of Compassion at the Bedside of the Ill"

Disclaimer: As always, I received no payment for this book review, only a copy of the book from the author in order to facilitate the writing of this post.

"The Craft of Compassion at the Bedside of the Ill" is a poetic and moving discourse on compassion by nurse, author and medicine man Michael Ortiz Hill. In this stirring book, Mr. Hill presents his view of compassion as a craft that can be learned, honed and developed, a notion that many in the nursing and medical fields would be wise to heed.

Nursing, NPR, and Where to Go From Here

Nurses and nursing are consistently in the news these days, and with issues surrounding health care continuing to come to a boil in the U.S. and elsewhere, we can expect more stories that include nurses to bubble to the top.

I Should Only Be So Lucky

I walk into the home and am welcomed warmly by the client's two sons, as well as the home health aide that I'm ostensibly there to supervise. The client sits in his wheelchair, quietly fingering a towel that was previously placed in his lap as a diversion. I greet the client---John---and then take a seat on the couch, late morning sun streaming through the living room window.

Happy Patients vs Healthy Patients

Recently, I published a blog post entitled "The Disneyfication of Nursing" wherein I examined the relatively new practice of "scripting" nurse-patient interactions, demanding that nurses communicate with patients in a specific manner.

The reality is that hospitals now want to provide care with an eye towards positive scores on patient satisfaction surveys upon which Medicare will soon begin basing some of their payments. While this is an understandable---yet short-sighted--reaction on the part of facilities that receive payments from Medicare, it is clear that there is a slippery slope that may very well backfire when it comes to achieving desired patient outcomes.

The Disneyfication of Nursing?

A recent article on Boston.com describes efforts by hospitals to offer specialized training to nurses in customer service and courtesy. According to some reports, many hospitals are hiring outside consultants in order to boost customer satisfaction surveys in response to Medicare's new ruling that they will begin basing a small percentage of payments to hospitals in accordance with facilities' "patient experience" scores.

What We Leave at the Door

As nurses, when we are preparing to walk into an exam room, a hospital room, or a patient's home, we bring with us a veritable toolbox of skills, ranging from biopsychosocial analysis to keen physical assessment skills. We are trained to look at the whole patient, the family system, and the multifaceted aspects of patients' lives.

However, we can also walk through that door with judgments, suspicions, preconceived beliefs, fears, projections, and a host of other "baggage" that may or may not serve the therapeutic relationship---nor our patient's chances of healing.

In my own work, I have witnessed patients and their families engaged in drug addiction, prostitution, child neglect, elder abuse, financial exploitation, and numerous other social conditions or actions that could often make my skin crawl. I also witnessed patients simply making poor choices, living in squalid conditions, refusing treatment, and otherwise choosing chaos over order, illness over health, and hell over healing.

When possible and necessary, I would intervene, and sometimes that meant calling the police or the local protective service organization. Sometimes it meant just listening and trying to get to the root of the behavior. At others, it was a call to a therapist, a psychiatrist, or a drug counselor.

No matter the situation, we health care providers bring to the situation our own life experiences, our own traumas, and a unique personal history. In this line of work, transference and projection are not just quaint vocabulary terms memorized during a requisite Psych 101 class, and if you're a nurse and you can't tell me what projection and transference are, then it's time to do some brushing up. (Perhaps that Psych 101 textbook is still in your garage somewhere.)

No matter where you are in the course of your career, you are subject to the same psychological forces as a novice nurse, and at times it is exactly our experience as seasoned nurses that can harm us the most. Cynicism, jadedness, and a sense of "I've seen it all before" can actually get in the way of our seeing the patient for who they are in the first place, so looking beyond our experience with fresh eyes and an open heart can work wonders for actually "seeing" the patient or situation in front of our very noses.

Before you walk in that door, think about what it is that you bring to the therapeutic relationship and the situaton at hand. What is the baggage that might get in the way? What are the stresses and worries from outside of work that need to be set aside? And once you're in that room, keep a sharp eye out for those projections, that sneaky transference, and the judgments that undermine your ability to be objective and most clinically effective.

And remember to ask yourself: What am I bringing to this encounter? What are the skills that I most need to activate at this time? And what do I need to leave outside that door?