The Best Nurses are Empathic and Analytic

by Laurie

in nursing

My friend Carol, an ICU nurse in her fifties, told me about one of her patients, a 62-year-old real estate agent who had been hospitalized for seven months. He asked that ‘older nurses’ be assigned to his care. As an ‘older nurse,’ I wanted to hear why Chuck had this preference. Carol got the OK from Chuck and I was soon talking to him by phone.

“I was thinking about their talents and capabilities, and that their bedside manner was mothering,” he said. “Most of them have raised children. They are more sensitive. Maybe I was giving up nurses who were trained in new technologies. Maybe I was sacrificing something for having that mindset, but I don’t think so.”

Yes, many of us older nurses have the nurturing thing down. For better or for worse, even the name of our profession is etymologically entwined with nurturing children. Like children, patients often feel vulnerable, frightened, and powerless. They fear disability and death. They may also be in pain. For these reasons, behavioral and emotional regression is normal during hospitalization. Empathic nurses sense this vulnerability and respond accordingly. Over the last few years, advances in neurobehavioral research support what nurses have always known: providing care and comfort helps patients heal.

Although the public associates the nursing profession with nurturing, most people do not associate nursing with thinking. With patients being admitted sicker and leaving quicker than ever, nurses need to be able to observe, assess, analyze, and act decisively. They need superior organizational skills and excellent communication skills. They need to know the doses, actions, and side effects of hundreds of medications. They need to know when to closely monitor changes in symptoms, and when to sound the alarm. Dissociating nursing from thinking is a critical misperception, one with serious implications for patient care and for recruitment.

Nursing has a long history of being devalued, in part because of our association with frailty, vulnerability, and intimate bodily processes. Doubtless, some of this misperception is traceable to the portrayal of nurses in the media. Unlike real life, nurses in most medical dramas play minor roles in patient care. Physicians are shown saving lives, spending time with patients, holding their hands, and looking deeply into their eyes. Nurses are often invisible.

Patients are hospitalized because they require 24-hour nursing care. In real life, physicians see hospitalized patients for a few minutes in the morning and maybe a few minutes in the late afternoon. That’s it. Nurses are the ones at the bedside most of the time. While caring for a patient—bathing her, dressing her wounds, feeding her, medicating her—the nurse is also evaluating her mental status, assessing her respiratory status, looking for signs of infection, interpreting information on cardiac monitors, checking intravenous sites, observing the patient’s mood and coping capabilities, and monitoring fluid balance—all the while maintaining a calm, empathic presence. It takes a long time for a nurse to learn to meld multitasking, critical thinking, and nurturing responses and make it look easy. I bet this is what my friend’s patient, Chuck, was responding to in his request for “older” nurses.

While the media’s portrayal of nursing is problematic and inaccurate, nurses themselves contribute to the problem of devaluation and invisibility by avoiding opportunities to speak publicly about what we do. Relatively few nurses write about nursing for the general public. To the frustration of many of us, our profession still can’t agree that a four-year degree should be the entry level to nursing practice.

In light of the serious nursing shortage looming as boomers—including boomer nurses—age and retire, we need to recruit smart young men and women to our profession. To do that, we need to shed our cloak of invisibility and reveal the mental competence that nursing requires. And, as Chuck does, we should value the seamless blend of mothering and thinking that our best nurses have mastered.

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