Compelled by Professionalism

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

“Ah, Julianna.”

This greeting from a physician marked my arrival at work. I assumed he was about to give me information or an order about one of our patients. I prepared myself for the forthcoming shift—”Ready or not, here it comes.”

Instead, he did something completely unexpected. Quickly retreating to his office, he reappeared, extending towards me a bright blue envelope with my name neatly written on the back.

It contained a greeting card. Not the generic kind hospitals provide managers in bulk for staff recognition. Not the “You’ve Been Caught Doing Something Fabulous!” quarter page–sized certificates available in the staff lounge for coworkers to fill out in recognition of their peers. This was a genuine, bona fide greeting card, the kind you have to go to a store and select from a rack and purchase. Inside, he’d addressed it to me again, with a personal note in handwriting, shattering the long-held belief that physicians cannot write legibly in cursive.

Being thanked by a physician for an act of nursing I had provided for his patient isn’t what caught me off guard. During my years of practice, many physicians have verbally expressed appreciation for my nursing skills. A half-dozen have even apologized for disagreeing with an assessment of mine (only to find out later I was right). But never has a physician given me a thank you card he or she had taken the time to purchase and inscribe with a personal note.

(For the sake of accuracy, I need to insert that two other coworkers also received written expressions of gratitude from this physician for their support of the same patient.)

For some reason, this thank you card brightened my entire day. I put it in my purse in the drawer next to my computer station, pulling it out to read again on my lunch break. I showed it to a couple of coworkers. They had never received such a card from a physician either. I showed it to my husband when I got home. He was also impressed. He works with doctors too, and has never received a handwritten thank you card either, although they likewise make it known through comments that he is a respected member of their team.

My reaction to the card bothered me: Why did this common gesture of gratitude feel so special? Because it came from a physician? It’s very unlike me to be impressed by hierarchy, so I knew that wasn’t the reason.

Like most long-time nurses, I have a collection of similar cards from patients thanking me for their care. Small gifts or photographs accompanied some so I would not forget them. These are very meaningful, even years later, as I remember the names and faces attached to each. But the feeling isn’t the same.

So why did this thank you card make such an impression on me? The question continued to bother me, so I revealed the card, and my feelings about it, to a selected friend, also a nurse.

“Oh, that’s easy,” she replied. “He thanked you as a professional recognizing another professional’s contribution to patient care. You weren’t asked by a manager, given a financial incentive, or feeling guilty because your unit was short staffed. You and your coworkers recognized a need, and stepped up to the plate to fill it, even though policy would have excused you from the responsibility. Professionals do what needs to be done because it’s the right thing to do, not because something external compels them to do so. Your physician recognizes this, and acknowledged it. That’s why it feels so meaningful.”

I think my friend is on to something. Thinking back over the years, I realize how many things I do as a nurse require filling out of forms, and the meeting of deadlines, in order to receive a promised form of recognition or reimbursement from every employer I’ve worked for. “Fill out this form by (fill in the blank) date in order to receive a certificate on Nurses Day,” or certification reimbursement or a bonus . . .

Even annual reviews for nurses depend on us keeping a list of specific examples marking our contributions to patient care, our units, and the larger organization in order to receive recognition for these achievements, because no one keeps track for us.

I’m okay with it. I am the best-qualified keeper of this information, better able to keep track of it than a manager with 50 or more nurses with like achievements. No one has the time or ability to see the good work done by every nurse on every unit.

However, this physician took it upon himself to recognize a few colleagues he witnessed doing good work, in the moment, without compulsion. I didn’t have to fill out an application.

Like a professional.