Hui-Wen (Alina) Sato, MSN, MPH, RN, CCRN, is a pediatric intensive care nurse in Southern California and blogs at http://heartofnursing.blog. Her Reflections essay, “Intimate Strangers,” appeared in AJN‘s August issue.
I’ve had opportunities to sit in peer interview panels for new grad nurses looking to start their career in our unit, an experience which prompted me to consider what it takes to be a good nurse.
The obvious qualities were, well, obvious: critical thinking skills, strong communication, compassion, teachable, team player. But I’ve had a sense for a while that we nurses have been missing something when we consider what it takes to be a good nurse. While this something is strongly tied to empathy, it’s still a bit different. I tend to think of it as the nurse’s recognition and embrace of his/her own brokenness, even as the nurse looks to take care of others who are in some manner broken.
By brokenness, if the term is unfamiliar, I simply mean the awareness that we all know what it is to suffer, to struggle, to feel lost or wounded or weak. So in speaking of brokenness, I don’t mean it as a condescending lens through which we view everyone as objects to be fixed. I use the term brokenness to acknowledge the humbling reality that every person will crack a bit under enough pressure; every person who has been tossed around enough by difficult circumstances will know some level of pain, be it physical, emotional, or both. It’s our common humanity; we all know what it feels like to one degree or another. And while boundaries certainly have their place in keeping our personal issues from negatively affecting our professional nursing practice, recognizing and embracing this common ground of brokenness can transform our nursing, for the benefit of our patients—and ourselves—if we allow it to.
How brokenness transforms what we ask of our patients
When we forget our own brokenness, we forget our own times of physical suffering, of being anxious about the future, of wishing someone would have prepared us better for what we’re going through. From our perspective as nurses, we may be subconsciously inclined to focus on our own comfort and need for control. When I am practicing from this internal stance, I am more apt to label my patients as “needy” when they become anxious. I often find, in these moments, that I just want my patients to trust what I say about their experience, and I wind up listening less to what they are actually experiencing.
When we remember brokenness is our common ground, we can be more gracious towards our patients’ needs. We can stop using blanket statements such as “You’re okay!” or “Just try to relax and rest.” Instead, we can approach their needs and fears with a greater openness to letting them inform what kind of nursing care they would actually find effective, within reason.
A coworker once asked me to stay with her patient who was having an anxiety attack that was not calming with her dose of Ativan. As my coworker caught up on charting, I went to the patient’s bedside and quietly held her hand, at the patient’s request. She closed her eyes and we stayed like that for about 10 minutes. I watched her muscles relax and her breathing slow. My gaze also drifted to the patient’s family member in the room, who was sleeping, and also quite frail with illness. The patient had many reasons to be anxious, but she herself knew exactly what she needed beyond medication—a quiet, compassionate presence.
How brokenness transforms what we ask of our patients’ families
Can we speak honestly for a moment about how much comfort a nurse feels on his/her shift when the patient’s family is calm, understanding, and cooperative? We would love for this to be the demeanor of every patient’s family. But when we become frustrated with a seemingly overcontrolling or outright angry family, we have forgotten that brokenness is our common ground. We have forgotten our own road rage when everyone seems to be getting in the way of something extremely important to us. We have forgotten our own long days as parents when our kids didn’t do what we wanted and then another person came along to push the wrong buttons, adding the proverbial straw that broke the camel’s back. We have forgotten how easily rattled we ourselves can be by less-than-ideal circumstances.
When we remember brokenness is our common ground, we can be more generous in inviting family members to tell us what is most important to them in the care of their loved one and how we might come together to address those factors. We can ask them about their anxieties because we know from our own experiences that high pressure in a contained system just needs somewhere to go. We can ask ourselves how we as nurses can provide a safe space for that pressure to be relieved, without taking it personally.
How brokenness transforms what we ask of ourselves
When we forget our own brokenness is everyone’s common ground, we push ourselves to be tough, sometimes at the cost of a valuable vulnerability. The danger is of living in denial of or escapism from our grief—an approach that only holds up for so long. I can’t help but wonder if some of the nursing burnout and turnover we see around us and read so much about has to do with our resistance to allowing ourselves to join the company of the broken.
When we remember that brokenness is already our common ground, we look for ways to revisit and use our own brokenness in a redemptive way to more effectively come alongside those who are in our care. We find ways to say, “My own brokenness doesn’t have to be all for naught in my life; there is something I learned, something I gained, some way a friend cared for me in my time of need, some way I changed—such that I can offer empathy and hope to the broken person before me.”
The sooner we remember brokenness is our common ground, the sooner we can start to ask something different and much kinder of our patients, our patients’ family members, and ourselves.