What Does it Really Take to be a Good Nurse?
I’ve often heard the complaint that nurses aren’t handmaidens and shouldn’t be treated as such. Head Nurse does a great job of addressing this in her post Handmaidens, Helpmeets and the Problems of Nursing. As much as I want to believe this, though, I have never been able to convince myself that this isn’t true.
To illustrate my point, I’ll give you a day in the life of working in the recovery room:
The charge nurse hands me a paper with a very minimal patient report. It usually includes the name of the procedure the patient had, any outcomes of the procedure, current vital signs, sedation and any other meds the patient might have received.
The patient is rolled in to the recovery room. I hook them up to the monitor and do a very minimal assessment (Are they awake? Are they in any pain? Are their vital signs within normal limits? Is the incision/puncture/drain site dry, clean, and intact? And most importantly, do they have a ride home?)
When I’m finished, I call the waiting room and let the family member(s) know they can come in.
I record vital signs and check on the patient’s site every 15 minutes for an hour. Sometimes this is extended to every 30 minutes for the next hour, sometimes it isn’t. If the patient is hungry or thirsty I’ll give them a beverage, perhaps some crackers, maybe even a turkey sandwich. Sometimes I will help them on to the bed pan. If the patient is nauseous, I call the doc and ask for some phenergan. If the patient has pain issues, I call the doc and ask for some Tylox.
If the patient’s vital signs fall out of wack I page the appropriate MD. If they fall precipitously out of wack I will have someone go to the procedure room of the appropriate MD and grab him or her. If they have no vital signs I will imediately call for help and start ACLS (this has never happened.) Sometimes the patient will bleed, or develop a hematoma at the puncture site. If this occurs, I hold pressure until it stops and notify the MD.
If the patient is being admitted I call report to the floor nurse. I unhook the patient from our monitor. If the patient is going to a monitored floor, then I hook them up to a transport monitor and take them to their floor. If the patient is going to a non-monitored floor, then I arrange to have a patient escort take the patient.
If the patient is going home, I give them some pre-printed discharge instructions, verbally explain them to the patient, and answer any questions. Then I remove the patient’s IV(s) and send them on their way.
Is what I’m doing skilled and technical? Yes.
Am I using autonomy or intellect? No.
Am I using my skills of compassion and care? You bet I am. One of the only things that make the tedium of nursing bearable for me is when I get a patient who is anxious, or has questions, or wants to talk about their disease. They talk, I listen. I might even hold their hand. I answer questions. Sometimes I ask them questions because I know that they just need someone to talk to. They want someone with medical knowledge to help them process what is happening to them. I’m happy to be that person.
To further illustrate my point I’d like to say that some of the best, most effective, and knowledgeable nurses I’ve seen are either diploma nurses or associate degree nurses. It doesn’t take a bachelor’s degree to do what they do. So why is there this big movement to “intellectualize” the profession of nursing? At the university level they like to teach about the politics of the profession, and what nurses can do to gain more power. If that’s the agenda they want to push forward, fine. Maybe some day they will gain power and change our healthcare system for the better. But I think it does future nurses a disservice when they find themselves in their first hospital job, expecting to have all these autonomous, intellectual tasks but instead find themselves doing all the skilled, technical, and menial stuff. Sometimes I think that what the nursing shortage really comes down to is that there are these tasks surrounding patient care that need to be completed around the clock, and there aren’t enough nurses willing to do this kind of work.
But if the nurses aren’t going to do it, who will?