Nurse's Story: Julie - Listen

Julie -







I feel I’ve been called to promote a higher standard of nursing care. It gives me great satisfaction to be an instructor in a nursing program where I can make an impact on future nurses, and provides meaning to my own life. I am also fortunate to have a clinical practice where I can make a difference in the lives of patients. The opportunities that nursing has given me, and the interactions I’ve had with people throughout my career, make me feel truly blessed.

My commitment is to produce the best nurses, and make sure they not only have a strong skill set, caring behaviors as well. I think it’s imperative for nurses to have a conscience. I impress upon my students the value of learning good technique and their responsibility to maintain the high standards we teach.“I think it’s imperative for nurses to have a conscience.” When I see that light bulb turn on for them, I feel as though I have truly accomplished something. There are those individuals who are inspired by motivations other than healing and are less likely to uphold the standards of nursing. They tend not to care about developing good technique, either. So quality of care slips a notch and it’s because they think nobody’s watching, or they conclude no one else holds up the standard, so why should they?

One skill I especially emphasize teaching is communication, primarily listening and questioning. Nurses need to know how to listen well to their patients, to hear their stories, to be compassionate but also to detect evidence of discomfort, symptoms and other clues to the whole patient. But also because sometimes you can’t do anything else for a patient other than just listen.

In my clinical practice, I saw a gentleman who has experienced the gamut of back surgeries, and despite the large amount of narcotics he takes still has excruciating pain. I took time to just sit with him while he cried. Afterwards, he told me it was more important for him to have someone just listen than to have any other procedure done to him. It was clear he hadn’t felt heard by anyone up to that point; most likely the caregivers felt they had nothing more to offer him.

Communication is more than just listening and expressing compassion; it also requires asking the right questions. If you don’t, you may miss important clues about circumstances in patients’ lives that affect your ability to help them heal. As nurses, we need to be aware of those circumstances. I once discharged a patient with pain medications only to find out two days later that things weren’t going very well because this patient couldn’t afford the prescription. Had I persisted in my discharge planning a little deeper, I might have been able to get the prescription changed and the person wouldn’t have had to experience such prolonged discomfort.

Back pain is complex. I once saw a patient whose diagnosis was eventually ovarian cancer. That diagnosis came about as a result of asking the right questions about her symptoms and then thinking critically about the responses. I was able to rule out the back as a source of her pain and referred her on to a provider who then moved forward with the diagnosis. No time was lost in her case, but the consequences of not listening, of not questioning, are scary to contemplate. The worst thing that can happen is to miss an intervention, so the worst-case scenario is always in the back of my mind.

Nursing is just like any profession, filled with people who just want to do their jobs and who think on a day to day basis. They don’t want to think about the long-term effects of the way our country finances health care. They don’t want to get into management or the political debate of insurance versus care. They either have found an avenue of nursing that completely suits them or they are flying under the radar, just punching the clock, hoping no one will notice.

So we have to listen to each other, too; ask good questions to detect the symptoms of our own burnout individually and any slips in our professional standards. We not only have to advocate for the patients, but for nursing as a profession. There is a need for nurses who will speak out on public issues and open the door for change.

In looking at communication, we as nurses have to be aware of our own bias that we carry with us. I had a patient whose religious beliefs did not allow her to receive blood products. She was involved in a motor vehicle accident and broke both femurs. We took care of her nearly 50 days because her lab values were too low to safely proceed with surgery. Had she taken blood, she would have been out of the hospital in seven days. I had a really hard time reconciling my desires to heal her, to be efficient and to respect her beliefs. In the end, by being patient-focused and ignoring biases, a plan of care was developed. I tell my students that with all their knowledge and experience, one of the highest attributes of a good nurse is respect the patient’s beliefs.

Power Strategies: Connection, Curiosity, Order
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