I saw something on Oprah yesterday that really bothered me.
(And it pains me to admit that, for I love Oprah so.)
Yesterday Oprah's guest was a physician who had, at some point, suffered a debilitating stroke and had been in the hospital for, I'm guessing, several months. (I'm guessing a lot, as I only really caught the last 25 minutes of the show and could only get snippets of the conversation as I was chasing after Zoey. So perhaps I'm taking some liberties here, but so be it.)
Anyway, the guest was saying how important it was for all her nurses to come in and "make a connection" with her, even if they were only in the room for a brief moment. It could be as simple as touching her foot, looking her in the eye, whatever. She said she felt frightened of the nurses who would enter her room solely to perform a task, without taking the time to "make that connection" with her. Oprah immediately jumped on the bandwagon, talking about how it really is a nurse's job to make a patient feel important and cared for.
While I agree with this in theory, as a nurse, I have some issues with the practicality of making a connection with every single person I meet at every single moment of every single day.
Perhaps the real issue here is that nursing, sadly, has been flung far, far away from the actual art of caring for people, and has been tossed instead into the pool of government bureaucracy--that horrid tangle of redundant regulations that puts the emphasis ON paperwork and OFF human contact. We, as nurses, have many, MANY hoops to jump through in order to make sure our paperwork is in order and all the proverbial i's have been dotted and t's have been crossed. Government agencies, chock full of people who rarely if ever actually PROVIDE patient care, dictate what we will do and how we will do it and how much time we will have allotted to do it. And if you fail to meet all the paperwork criteria and are audited by any of these awful agencies, penalties are issued. Maybe they give fines. Maybe they pull some insurance funding. Whatever it is, it isn't good, and it usually leads to MORE charting and MORE paperwork to be done to ensure the mistakes don't happen again. Believe me--if you have five minutes to run in to a patient's room and you have to choose between emptying their catheter and stopping to chat and "make that connection", you're going to choose hurrying through emptying their catheter, because God forbid you should forget to accurately chart your patient's intake and output before the end of your shift.
I'm not trying to condone the actions of nurses who are negligent on the job and I am certainly not making excuses for those who simply don't know how to make a connection with their patients. What I am saying is that our system is broken, and that until we start valuing the art of putting our patients at ease, we will continue down this slippery slope of task-oriented instead of human-oriented care.
Perhaps another problem here is that people in general fail to see their healthcare providers as fallible human beings who are often just doing the best they can with the little resources available to them. Atul Gawande wrote a fabulous book titled "Complications: A Surgeon's Notes on an Imperfect Science". In it, he writes:
"You have a cough that won't go away--and then? It's not science you call upon but a doctor. A doctor with good days and bad days. A doctor with a weird laugh and a bad haircut. A doctor with three other patients to see and, inevitably, gaps in what he knows and skills he's still trying to learn."
His point, throughout the book, is that we look to doctors and nurses to be perfect, and quite simply, they are not. We have good reason to want perfection, sure--our lives are often in their hands and we can not bear the thought that they will make a wrong decision or treat us in a way that is purely clinical, with no trace of human kindness.
But consider this. That nurse who just hurried in to her patient's room to adjust a monitor, then quickly left, may be worrying about her child who wasn't feeling well this morning, but who she had to send to daycare anyway, because she can't afford to take a sick day and stay home. She may have been called in to work in the middle of the night to perform some non-emergent procedure with an egotistical doctor, a procedure that could have waited until morning; only to have to get up two hours later and come back to work for her regularly scheduled shift. She may have unexpectedly had to spend extra time "making a connection" with any of her other six patients and now must hustle to finish her rounds and her charting, in order to be out the door on time for her son's football game.
She's probably doing the best she can.
Maybe you're surprised to be reading this post from me, since I spend so much time blogging about how much I hate my job. The truth is that I hate the people and place where I work NOW. However, I love what I DO. And, as previously posted, my work situation will take a dramatic change for the better come February 27, 2009.
I don't want to take away from the experience the woman was describing on Oprah. I feel for her--truly, I do. But my first reaction is not to demand more of the nurse--we as nurses have so little left to give, as it is. Until we, as a country, start valuing the art of "making a connection" with our patients, nothing will change. I believe the nursing shortage we are experiencing now is a direct result of nurses going in to the profession intending to care for their patients, finding they must quickly lose the "care" aspect and become focused on red tape, then burning out and leaving the profession in frustration.
No wonder so many of us go crazy.
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