Noticing small changes in what’s possible.

I worked for many years in infection prevention and control, and loved it. Still do. But I loved bedside work too, and it was always in the back of my mind that I might one day return to staff work. That is, until I took care of a family member during the last year of his life.

While I think I provided him with reasonably good care—let’s not get into the emotional connection that made me a less objective caregiver than were his fantastic CNAs—there was no fooling myself any longer. After years away from the bedside, my assessment skills have slipped. I’m not used to working while wearing glasses (without which I can’t read labels or check for reddened skin or cloudy urine). And arthritis in my wrists meant that those bed-to-walker transfers were not optimally safe.

What about multitasking, 12-hour shifts?

My difficulty in providing physical care made me wonder whether my cognitive skills, too, might not be up to managing the pace and pressure of floor work today. I may still be good at supporting and teaching, but can I multitask through 12 hours of nonstop problem-solving and decision-making?

In “When Is It Time to Leave Nursing?” in this month’s AJN, nurse Janet Blake (a pseudonym), for decades a mentor and role model for students and other nurses, shares her reaction to what she thought might be signs of her own mild cognitive decline.

“I’d grown concerned about recent deficits—short-term memory loss, diminished word recall, and difficulties with multitasking. My judgment and nursing knowledge remained intact, and for a while I tried to ignore these issues. Then I attempted to compensate for my memory problems by writing down all details. But this did not improve my organizational skills nor time management.”

A patient safety issue.

Blake muses about whether we in nursing need to look more closely at the issues that even mild cognitive decline may raise for nursing practice and patient safety. A few hospitals have already instituted mandatory or voluntary assessments of the competence of older physicians.  Should nursing be doing the same? She asks:

“How can we address this issue without opening the door to ageism or other forms of discrimination? We need to explore ways to offer nonjudgmental assistance to colleagues struggling with the question of whether it’s time to leave nursing.”

Physical decline: less of an ‘existential threat.’

Physical decline that interferes with our day-to-day functioning may be easier to acknowledge or accept. The development of Parkinson’s disease or other mobility problems that compromise our ability to perform the hard physical work of nursing are not easily ignored, whether by colleagues or ourselves. And physical limitations don’t seem to present the existential threat that can come with cognitive changes.

Blake offers some suggestions for how we might go about assessing the safety of our practice, or that of our colleagues. You may have your own ideas or experiences to share. Join the conversation here; you can read the entire article in this month’s AJN.