The Bittersweet Reality of a Nurse’s Limits in Providing End-of-Life Care

Three young patients on the same trajectory.

Image by strikers/pixabay

I have recently spent time with a few young patients all on the same sharp trajectory towards their final day of life. All had different diagnoses, and on the days I had the privilege of being their nurse, they were each at different points on that trajectory.

M. was just four days away from dying, though he and all his medical caretakers thought at that point that he had at least a few more weeks.

J. was a couple of months away from dying, and on my shift with her, she knew her situation was bad but remained hopeful for some last-ditch interventions.

R. was well-appearing outside of an unsteady gait and slight sideways drift of her eyes. She maintained levity and a hopeful innocence in the first few hours of my shift with her before I took her to her MRI scan. As I watched her MRI images appear with a clear and tragic diagnosis, I heard the physicians outside of earshot from the MRI table discuss the inoperable, inevitable turn this would take for her in the very near future. R. didn’t know yet that her budding dreams for adulthood would not come to pass, and it felt […]

2021-04-02T15:27:22-04:00March 31st, 2021|Nursing|1 Comment
Read More

No Country for Old People

In my editorial in the March issue, I ask, “Where do we go from here?’” in thinking about what’s next for nursing. In particular, I wonder if we’re going to make any strides in improving the quality of how we care for older adults who need long-term care.

Disasters give rise to assessments of what went wrong.

After prior disasters like hurricanes, heat waves, and flooding, there has often been a flurry of initial concern, with many committees convened to look at the deaths that occurred.

More recently, the New York Times has reported on the fate of nursing home residents during the Covid-19 pandemic in relation to the deterioration of quality in nursing homes once they are owned by for-profit entities—as 70% of nursing homes now are. So here we are once again, this time decrying the conditions revealed by Covid-19. Will things change this time?

In answer to this question, I’m especially pleased with the article in our March issue by 22 nurse gerontology experts. They issue a call (a challenge?) for the Centers for Medicare and Medicaid Services (CMS) Coronavirus Commission for Safety and Quality in Nursing Homes to rewrite standards to finally address under-resourcing and ensure residents get the care they […]

2021-03-15T15:33:48-04:00March 15th, 2021|COVID-19, nursing roles, patient safety, Patients|1 Comment
Read More

What Do Nurses Need?

“Covid-19 Is ‘Probably Going to End My Career’” is the title of my recent column in the New York Times. The nurse who made that statement spoke to me on the condition of anonymity because her hospital doesn’t like having nurses speak out. So—nurses are afraid to publicly complain about their difficulties on the job, struggle with a lack of PPE and short-staffing, and are overwhelmed by the number of deaths they are seeing. All this has led to the nursing profession being in crisis.

The six ideas below could help nurses drowning in difficulties imposed by Covid find their way back to solid ground.

  1. Staffing legislation. This could mean ratios, or some other way to insure that nurses are not expected to work short. The legislation should also require robust nursing float pools and keep secretarial and nursing assistant support at their usual levels. Units have to be staffed in a way that maximally benefits patients, not just to help balance a hospital’s bottom line.
  2. Mental health support. Nurses as a group are not always open to counseling, but during Covid nurses have spoken out about the emotional toll of the work and their ongoing PTSD. They have recognized their need for mental health support. Hospitals must give nurses health insurance that covers individual counseling, and have mental health resources available on the job for nurses. “Covid broke me” is being said by too many nurses, too often.

    3. […]

2021-03-05T09:52:27-05:00March 5th, 2021|COVID-19, Nursing|1 Comment
Read More

AJN Articles from 1910 to 2020 for Inspiration and Perspective During Black History Month

Bernardine Lacey (middle) and classmates in 1961 at Gilfoy School of Nursing, Jackson, MI. Photo courtesy of Bernardine Lacey.

February is the month designated for remembering the contributions of Black people to our nation and our culture. It’s a good reminder that in nursing, too, we have benefited from many strong Black women (and at least a few men), who often persevered in the face of discrimination in obtaining education and jobs.

The AJN archives have many articles worth revisiting.

This article from 1976, “Black Nurses : Their Service and Their Struggle” (to read, click on the pdf), describes the struggles of several of our profession’s notable Black nurses, including Mary Mahoney (the first Black nurse to be licensed).

This article from our August 2020 issue, ‘You Don’t Have Any Business Being This Good’: An Oral History Interview with Bernardine Lacey,” shares Black nursing leader Bernardine Lacey’s experiences with racism in her education and career and explores some of the difficult truths about racism and the culpable role of nursing in this history:

Building on this perspective, read a conversation from our September issue with nurse, activist, and […]

2021-02-03T09:54:28-05:00February 3rd, 2021|Nursing|1 Comment
Read More

DNR Does Not Mean Do Not Treat

Nurses and the meaning of DNR.

I recall a patient I had as a very new nurse who was designated as do not resuscitate, or “DNR.” The patient had suffered an intracranial bleed and because of his advanced age and untreatable cancer, his family had agreed that no CPR should be used. I remember the nursing supervisor asking me why the patient didn’t have a footboard and foam heel protectors on (that’s what we did back then); my answer was that he was a DNR patient. She basically handed me my head and said that his DNR status had nothing to do with good nursing care.

I never forgot that incident, and when I spoke with the authors of a mixed methods study with direct care nurses on three different units that found that “varying interpretations of DNR orders among nurses were common,” I immediately said yes. Their article is the original research article in AJN‘s January issue, “Nursing Perspectives on Caring for Patients with Do-Not-Resuscitate Orders.”

Families and providers may understand DNR differently.

And it’s not just nurses who may have different ideas and think differently about what should or shouldn’t be done for these patients who hover between life and death—other health care providers and families need to be clear on what that designation […]

2021-01-27T11:35:45-05:00January 27th, 2021|Nursing, nursing research|1 Comment
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
Go to Top