Amanda Anderson, BSN, RN, CCRN, is a critical care nurse in New York City and enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. She is currently doing a graduate placement at AJN two days a week, working on a variety of projects. Her personal blog is called This Nurse Wonders.
Nurse and writer Theresa Brown wrote a piece for this past Sunday’s New York Times on the dilemmas physicians face when their patients want to stop aggressive treatment (the latest installment of Brown’s quarterly column, What I’m Reading, is in the September issue of AJN [paywall]).
Brown’s Times column talks about physicians who have trouble letting patients go and instead push for more unnecessary and often unwanted treatment. She describes a case in which—after palliative care has been decided upon by the patient’s family members, the palliative care team, and even the heartbroken oncologist—the patient’s primary care physician intervenes and pushes for still more futile treatment. (Much of the article delves into the broader issue of palliative care and the benefits it has for patients in many stages of chronic illness.)
Have you ever disagreed with a physician’s choice to continue treatments in a situation where you thought these treatments were against a patient’s real desires or best interests? Have you felt cornered in your care? What conversations did you start—or want to start but maybe felt you couldn’t?
Many times, we nurses at the bedside are afraid to speak openly with our patients about end of life, especially when physicians have different views on what should be the patient’s treatment goals. The situation feels thorny, fraught. Moral distress—when you know the right thing to do for your patient but don’t feel you have the ability to do it—can lead to burnout, high turnover rates, and many emotional stressors among nurses. Often, we simply can’t say what we want to say, despite a duty to our patients to accurately educate them on their care and conditions. Read the rest of this entry ?