Patricia - We Answer the Lingering Questions

Patricia -







Nursing is part of who I am, not just what I do. It's a calling. I retired last November and after being retired for only about four months, I decided to return to nursing part-time in a home healthcare office. I learned I'll be a happier person if I can continue to do nursing in some capacity. I knew I wanted to be a nurse from the time I was nine years old, and I never strayed from that vision of myself. I worked as a nurse's aide through high school because I wanted the background.

Later, when I was experienced enough to provide counseling to newly graduated nurses, I'd tell them it's good to get to know each patient in their care. Identify one thing you really like about that person. Even if there's something you don't like, focus on the part you can understand be empathetic about.

A lot of people fear the healthcare system. They're afraid of being taken out of their home. We try to support their having choices. I teach other nurses to give them things they can be in control of, and the barriers will go down. I did have patients who were tough to win over, but when I did, it was very special. I felt I was putting my whole heart into winning those souls over.

Some of the patients I've cared for in their homes have been hermits, people who don't like other people, don't want to be bothered. They want to be left alone. I've learned they may seem gruff and unfriendly at first, but I can win them over in a couple of visits. They begin to see that you're not there to hurt them, but that you genuinely care.

I had a lady who lived in the house her parents had lived in before her. She had never lived anywhere else and now she was very elderly, in her 80's. The house was in a rural area and had not been maintained. There was no indoor plumbing; you had to go outside to get water. There were lots and lots of cats. So this woman was a hermit, and though she didn't want anyone from the outside to come in, she was so sick she had to have help. I worked hard to earn her trust and respect, and eventually I got very fond of her.

It was a gift to be with that lady at her bedside when she was dying. It is a gift to be with a dying person and help them be as calm as they can be, or to fight it the whole way, whatever they want. They have to finish the journey by themselves, but you can be their companion as far as you can go.

Even in my administrative job, I continued to see patients periodically so I could keep that connection to the patient and what they really want. That's what nursing is all about. I'll keep that connection as long as I'm physically able.

I talk to young nurses about the question of choice. People are free to make their own choices even though we may not agree. We have to help them get the information they need and then let them make the choice. And not coerce them, or try to force them."The beauty of nursing is that our job isn't to cure everyone; our job is to support what they decide, no matter what it is." Quality of life versus quantity of life is a big debate. Once patients who are competent understand the choices, their decisions should be honored. Sometimes nurses are the ones who have to advocate for the patient's viewpoint. If they want to fight, fight, fight--great, we'll help them do everything possible. But if they want to be kept comfortable and go a less invasive way, then we should support that too. The beauty of nursing is that our job isn't to cure everyone, our job is to support what they decide, no matter what it is.

Many doctors do a great job of talking with the patients about their choices, but not every doctor does. So the nurses are the ones who answer the lingering questions after the doctor has left the room. Sometimes we can see that the patient doesn't understand the medical information, so we can clue the doctor in on that. Or the nurse can share educational information and go over it with them. If the nurse hears the family and patient discussing what to do, the nurse can remind them that they do have choices. It's much easier now than it was 20 years ago.

I think there's more of a partnership between nurses and doctors now. Most of the doctors I've worked with honor nurses as partners. I've had nothing but respect from most of them. Doctors want patients to have the information they need, and they are willing to spend time answering questions. But sometimes the patient is intimidated by the doctor's presence, and can't process the information quickly enough, so that's when the nurse can fill in the gaps.

There are exceptions among doctors. Some seem brusque and in a hurry, because they have time pressures, and they work long hours. I always try to let the doctor know what I'm thinking in a concise way. Sometimes I begin by asking the question: What do you think is going on with this patient, Dr. Jones? I say that I'm concerned and want to understand. I respect them, but I don't back down if it's something I think the patient needs. And they usually respect that. It doesn't take many contacts with a doctor before they figure out whether you're working in the patients' interest, or just trying to cover your own butt.

If you believe the doctor's instructions are not correct and are going to harm the patient, then you have no choice but to advocate for the patient and take it to the next level. But the best way is to work it out yourself by being direct and respectful. And don't take everything personally! The doctor is worried about the patient too, and you get on the receiving end of that at times. If you need to vent, go to a senior nurse or a mentor. You have to take care of yourself first, or you can't take care of anyone else.

Power Strategies:  Dignity, Compassion, Respect
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