Nurses spend more time with patients than most other types of providers and have unique insight into patient care and the the healthcare system.
Most eventually learn the skills and knowledge they need to succeed in the profession. But some may struggle more than others with the emotional intensity of the work. A question that seems to come up a lot when nurses write about their work goes something like this: How do you keep caring as a nurse and not get burned out? How do you develop a resilient professional persona?
This month’s Reflections essay, “How I Built a Suit of Armor (and Stayed Human),” by Jonathan Peter Robb, enumerates the challenges faced by a sensitive new nurse and the ways he found to protect himself over time. Here Robb, a district nurse for the National Health Service in London, England, describes one kind of challenge he faced:
The weight of being responsible for a person’s health wasn’t one I had prepared for. Sitting in lectures doesn’t train you for the moment when you’re standing at the end of a bed looking at a patient who is struggling to breathe, semiconscious (but who just last week was sitting up and talking), and thinking: Did I miss something? Is this my fault?
As Robb writes, “caring hurts.” Gradually he found himself building defenses that helped him to continue doing the work. Robb calls the development of these defenses “building a suit of armor,” one he can take off when he goes home to his family—but as he describes the process, it seems clear that he’s never allowed himself to slide into callousness about his patients. […]
Yesterday was the 15th anniversary of the September 11 attacks. On my way to work in Manhattan on Friday, I listened to a radio program about the lives of some of those who were involved one way or another in the tragedy of that day.
I heard the shaky voice of a Boston airport ticket agent who had assisted one of the hijackers to get on one of the flights that struck the World Trade Center. He’s met some of the victims’ family members and say that he still feels tremendous guilt and suffers from bouts of depression, especially on anniversary dates. He now works for Homeland Security. […]
By Beth Toner, MJ, RN, senior communications officer, Robert Wood Johnson Foundation
Inaccurate Representations in Popular Culture
Many critics and fans delighted in the release of the “reboot” Star Trek in 2009; the film, after all, breathed new life into the franchise, and introduced a whole new generation to its beloved characters—including Kirk, Spock, and the inimitable Dr. McCoy, better known as ‘Bones.’ A lifelong Trekker (I was born just weeks after the series launched in 1966), I was delighted, too. Yet I was exasperated at the notable invisibility of a minor recurring character: Nurse Christine Chapel.
Many of you may be asking: “Really? What does a fictional science fiction nurse have to do with real, professional nurses?”
Symptom of Broader Invisibility
The lack of emphasis placed on Nurse Chapel’s character is symptomatic of what I believe is a larger problem: the absence of nurses’ voices in key positions—not just in pop culture, but more importantly in boardrooms, community and nonprofit organizations, and in policy making. Furthermore, where nurses are present, there is a general misunderstanding of what it is nurses do every day—and how our presence is vital to building a society in which all have the opportunity to live the healthiest lives possible.
Which takes me back to Nurse Chapel. In her 1960s incarnation, she was played ably by Majel Barrett, yet most of what she did reflected none of what nurses really do. In fact, her most memorable character trait was pining after the inscrutable Mr. Spock in displays of wildly unprofessional behavior.
The show’s creators had a chance, in the various movies that ensued over the years, to correct the public’s misperceptions of the role of nurses and the integral role we play, but a strong role for Nurse Chapel never materialized. Nurse Chapel remained largely invisible, mentioned in passing at one point by a harried Dr. McCoy, who calls out to her to ask her to hand him something as casualties pour into the sick bay. (Interestingly, in the 1979 movie Star Trek: The Motion Picture, the audience briefly learns that Nurse Chapel is now Dr. Chapel, apparently a “promotion” of sorts.)
Who’s Making Decisions Affecting Public Health?
This, of course, is only one small instance of popular media getting it wrong when it comes to nurses. From Nurse Jackie to Joy Behar’s stethoscope slight on the television show The View, it’s an all too familiar story. But these gaffes pale in comparison to the real life absence of nurses where decisions are made that affect the health of our nation, from school districts reducing the number of school nurses on-site to city councils voting on urban design issues affecting the availablity of walkable parks and safe sidewalks and bike lanes.
Getting Nurses’ Voices Heard
How do we make sure that we, as nurses, not only have a seat at the proverbial table—but that our voices are heard? […]
The first sentence from Leo Tolstoy’s novel Anna Karenina is one of the most famous in literature:
“All happy families are alike; each unhappy family is unhappy in its own way.”
It can easily be applied to patients. Happy patients tend to love their doctors, feel they received the best possible care, and consider their nurses invaluable.
Unhappy patients are unhappy in their own way. The challenge for busy nurses is resisting the temptation to turn a deaf ear or feign listening, in effect reducing patients’ concerns to “waa, waa, waa.”
A common thread among unhappy patients is unmet expectations.
Sometimes the patient’s expectations are unrealistic because they’re based on incorrect assumptions—but they do not know this. Responding requires a willingness to listen and the patience to tease out why a patient is unhappy with their care. Let patients tell their stories. Most bedside nurses have limited time; it’s okay to enlist help from a case manager, social worker, or nurse navigator if necessary. However, investing time up front to improve communication with a patient may pay off in dividends by smoothing the rest of your shift.
Begin by listening. Sometimes, I’ll take a seat, and write what the patient says while they talk. This simple act conveys their complaint is taken seriously, and helps defuse the situation. Having an open mind while a patient explains why they are unhappy with their care has taught me a lot and improved my communication skills. […]
The September issue of AJN is now live. Here are some articles we’d like to bring to your attention.
CE Feature: “Original Research: Predicting Injurious Falls in the Hospital Setting: Implications for Practice”
Despite years of research and increasingly evidence-based practice, falls continue to be the most commonly reported adverse events experienced by hospitalized adults. Yet most of the relevant research has focused on predicting and preventing falls in general; there has been little focus on injurious falls. In an attempt to identify which patient factors are associated with injurious falls in hospitalized adults, the authors of this retrospective study analyzed 10 variables. Their findings may help hospital clinicians to identify at-risk patients and create better fall-related injury prevention interventions.
CE Feature: “Military Sexual Trauma in Male Service Members”
The experience of military sexual trauma (MST), which can result from assault, battery, or harassment of a sexual nature, may jeopardize the mental health of service members. This article discusses the unique ways in which men may experience MST and examines how social stereotypes of masculinity, myths surrounding sexual assault, and military culture and structure often influence a man’s interpretation of an attack and his likelihood of reporting the incident or seeking treatment. It also describes current treatments for MST-related mental health conditions and addresses implications for nurses and other health care professionals.