The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (48 page)

“We’ve got to get away from the doctor–nurse game. Today’s world of healthcare is all about teams; nurses work with a lot of other decision makers,” Norman said. “Nurses need to be comfortable in their own professional skin, and we’ve got to be able to appreciate everybody. We have to be able to appreciate the physicians’ position, but they’ve got to be able to appreciate nursing and that the nurse’s role has changed drastically over even the last five years.”

“Never give advice unless it’s asked for and always give it when it is,” said Judith Karshmer, dean of the University of San Francisco School of Nursing and Health Professions. While some nurse faculty members tell students never to give advice to families or patients, Karshmer had a different take. “People take advice from a lot of different sources. When patients or family say, ‘What do you think I should do?’ if they are asking for expertise from a nurse, it is your responsibility to provide that.”

“The best coping resource is my fellow nurses. We are dragged through the mud together during these tragic events; who better to debrief with? And my boyfriend, who listens to me go on and on, particularly after a really hard shift,” said a New York pediatric ICU nurse. “I think that’s one of the most important things for a nurse. You need to figure out who your A-team is outside of work and allow yourself to rely on them, because you can’t hold this stuff inside your chest forever.”

One popular resource for nurses is the social-networking site
allnurses.com
, which offers several discussion forums. “It’s a platform for nurses from around the world to come together with like-minded people, share experiences, get support, and ask questions,” said founder and CEO Brian Short. “A lot of nurses come home from working a tough shift (a patient dies, something bad happens). They don’t really have support systems at home that understand what they just went through. On
allnurses.com
they can jump on and find thousands of people who understand.”

“The point of the profession is to improve the overall health of society. One way to do that, which I have found particularly satisfying, is volunteering with a health organization,” such as on an interprofessional board, Terri Weaver said. “It’s an indirect but effective way to impact a population of patients. Being involved in such organizations also showcases what nurses can do. Volunteering is a way to influence the perception of lawyers, businessmen, and other leaders, so that they witness the critical thinking and font of knowledge associated with nursing and realize that nursing is more than the stereotype.”

“To be a good nurse you have to have ‘tits,’ the female version of
cojones
,” a Texas advanced practice nurse advised. “It’s not about you, it’s about the patients. What do you need to do to get their needs met? That requires self-confidence and lack of fear of humiliation by MDs (and PAs, who can also be horses’ patoots). You have to be able to tell a physician that their orders aren’t safe, or the patient’s allergic to X, or that they need to come assess the patient.”

“Many times patients wanted to connect more closely to me, but I held back after the first few times I invested emotionally” in patients who died, said a Washington State nursing professor. “It’s hard to be caring and not give up part of yourself. My solution was sharing one or two things (over and over again) that seemed to meet the need of personal investment for the patient without surrendering my whole self. I learned how to use my ‘polite face’ with patients getting bad news, so I don’t show emotion. I teach it now to my students: eye contact, relax face, and breathe. It works when they are angry at you, their illness, pain, or death, and helps the caregiver be the bridge to comfort for the patient.”

Nurses nationwide told me how valuable their mentors and mentees have been to their development as a nurse. A Virginia nurse practitioner said she thinks of her mentors as “second moms.”

Seasoned nurses offered several tips for being a good mentor. “I think the key components of good mentors are (1) patience: allowing a nurse to struggle and not to expect an answer immediately; (2) challenge: teaching a nurse to think out a process, task, or situation by reviewing the pros and cons; and (3) interest: helping a nurse both professionally and personally as she deals with new stresses and responsibilities,” said a clinical nursing instructor in the upper Midwest. “Learning to be a nurse is like learning to be a mom. It’s holistic, complicated and requires desire, knowledge, and a willingness to accept criticism. These are hard for some people, but so very important.”

A Missouri clinical instructor said that mentors should be open to the idea that a mentee might have different needs than a mentor expects, and that those needs might change. “So be adaptable. Have a sense of humor, listen attentively, give the learner a chance to problem-solve or identify the possible options,” she said.

Flight attendants remind passengers to secure their own oxygen masks first before helping others. Similarly, nurses should remember to take care of themselves, even if only to take better care of their patients. This can help them to find joy or comfort in even the toughest weeks. “After a bad day, I go home and take twenty minutes all to myself. Sometimes I sit and cry and sometimes I just reflect on the day. After those twenty minutes, I let it go,” an Oklahoma LPN said.

If you or a coworker have a substance abuse issue, check with your state nursing association for peer assistance, alternative-to-discipline rehabilitation, or diversion programs. For signs of an impaired colleague, and treatment recommendations, see
www.aana.com/GettingHelp
. For resources searchable by state, visit
Webapps.aana.com/Peer/directory.asp
. While the AANA’s comprehensive directory is intended for nurse anesthetists—and the Peer Advisors volunteer only for CRNAs and student nurse anesthetists—many of the resources and state assistance programs can help all nurses. The AANA’s pages provide one of the best one-stop shops for nurses seeking help.

The ANA’s Impaired Nurse Resource Center also includes some links to organizations specializing in addiction:
Nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/Work-Environment/ImpairedNurse/Impaired-Nurse-Resources.html
.

The Massachusetts Nurses Association’s guidebook on interventions advised colleagues to begin this delicate conversation with: “I am not asking you to confirm, deny, or explain the reasons for the observed behaviors. I am here to share concerns and offer possible resources for your consideration.” The guidebook added: “It is important that the nurse understands that his/her options will become limited and their license will be in jeopardy if substance use continues.” Coworkers can then inform the nurse about the availability of family medical leave and direct her/him to a peer assistance program.

Canadian nursing professor Beth Perry studied exemplary oncology nurses to determine how they avoided compassion fatigue. She found that the nurses who created and appreciated “moments of connection” were energized by these occasions: “Those meaningful connections occur in moments often created by shared humor, therapeutic silence, touch, keeping the promise to never abandon—small gestures lovingly given that change the patient’s sense of well-being and have a positive effect on the nurse as well.”

When Martha Griffin, director of nursing education and research at Boston Medical Center, taught a group of new nurses how to recognize lateral aggression and what to do about it, every nurse who was bullied confronted her aggressor, and in every case, the bullying stopped. Educating staff about what constitutes lateral aggression both empowers the victims and alerts the bullies to the ways their colleagues might be interpreting their behavior. This awareness and preparation can improve nurse retention rates.

In some cases, alleviating hostilities among nurses could be as simple as making an effort to bridge generation or seniority gaps. “Experienced nurses can feel threatened by new nurses and resistant to changes recommended by new nurses. At the same time, new nurses don’t recognize the significance of experience,” said a Midwestern nursing professor. “As a Clinical Nurse Specialist, I was the one to orient new employees, and found that having sharing sessions off-the-clock, whether at coffee, lunch, or after work, decreased this. Unless nurses are allowed to share their understanding of how and why things are being done, the not-understanding becomes anger and disgruntlement. Both sides need to learn how to bring up something new and be willing to work together on change.”

At Barnes-Jewish Hospital in St. Louis, part of the program to mitigate compassion fatigue includes an exercise in which participants share verbally with each other the reasons they chose their career. Similarly, it might be helpful for other nurses to remind themselves why their field is rewarding. Here are some perspectives on why nursing is wonderful.

“I absolutely love what I do. When patients and families come into the hospital, they are at the very least concerned, and at the most extremely frightened. There is nothing more satisfying than sitting down with a patient and discussing their diagnosis and what they can expect from their hospital stay. You can see them relax; they are so thankful that you simply took the time to sit and listen to them. I also love helping patients recover from surgery because you can directly see how your care helps them make a full recovery.”

—a Minnesota travel nurse

“Helping someone fills up that part of me that makes me able to give some more. I love figuring out what the matter is, that collaborative effort to make a nursing diagnosis and plan. I like that I have never been unemployed. I will always have the dignity of work that is fulfilling.”

—a Washington State nursing instructor

“There is not a day at work where a life is not changed by something I do, whether it’s a decision on how to staff the floor, answering another nurse’s question so she can understand what to do, or helping to settle a family issue.”

—an Oklahoma clinical supervisor

“Nursing is that challenge which can make you a better person than you could have imagined being. It is a continuous education requiring curiosity, flexibility, ingenuity, resourcefulness, faith, compassion, and humor.”

—a Missouri clinical nursing instructor

“I think nursing is the only occupation that is ridiculously crazy, challenging, and sometimes out of control, while at the same time the most rewarding, fulfilling, and inspirational occupation. It amazes me how many people’s lives I have been able to touch in a meaningful way.”

—a Maryland oncology nurse

“I love working in an environment where I can see the effects of my work in real time—instant gratification! I never leave feeling like I wasted my time at work. I like the mental puzzle of trying to figure out what’s going on, but I also really appreciate the physical aspect of working with my hands. I learn something new every day; no day is ‘just another day at the office.’ ”

—a California nurse practitioner

“I strive never to let my patients die alone. If family can’t come, I do my best to stay and be their final companion in life. We are aware of the enormity of this journey. Our job is to help them not be afraid, feel alone, in pain, or anxious. I think nurses do this job well. There is joy in nursing, too: to see a patient’s pain or infection disappear; a patient and their family’s joy as they walk several feet for the first time. How can you not love nursing?”

—a Washington State cardiac nurse

“There are very few jobs that each day some or most of the things you do for your clients make their day better. You always make a difference.”

—a Missouri public health nurse

“My favorite times in nursing are when I’ve been able to help the spirit of the patient, from letting a kid cover me in Silly String to rocking a baby who was taken from her birth parents for maltreatment. It’s the moments where I feel a connection between souls that I love the most. I also love to share my knowledge. When I teach a family something and I see the lightbulb of realization click on, that’s a very rewarding feeling.”

—an Arizona pediatric oncology nurse

“As a nurse, you wake up every morning and say to yourself, ‘Today I’m going to do the work of my life.’ Behind every great doctor is an even greater nurse.”

—an Ohio outpatient nurse

“I have never had a boring day as a nurse. Mostly I feel privileged to be involved in the lives of others and to work with them toward a better future. I have practiced for thirty-nine years, and I still have so much joy and energy every time I go to work. That’s truly the sign of being in the right profession! We’re like a secret club because we’re privileged to share intimate life stories with our patients, and this level of awareness makes us a bit wiser about the true nature of people. There isn’t much that surprises us about the human body, and we feel free with each other to discuss topics that are clearly off limits in other social groups. Our shared tragedies and losses help us deal with our own grief and sadness. I would say we are a hardy group.”

—a Michigan nurse practitioner

“I love some of the stories I get to take home with me. It’s also pretty cool to see some of the amazing things that medicine can now do. I’ve seen people brought back from the dead (Code Blue that ends well). Once, I got to have my hands inside a man’s face, literally, like opening a real-life anatomy textbook. Where else do you get to do things like that?”

—an ICU nurse in Canada