After a string of respiratory infections and low-grade fevers kept me out of school for much of my first grade year my pediatrician decided, as was common practice in those days, that my tonsils needed to come out. My parents agreed, so very early one morning I found myself en route to the then Children's Memorial Hospital in Chicago for the big day. My memories of the experience are spotty, but include being most uncomfortable with a little boy as a roommate, as well as receiving the highly coveted Mr. and Mrs. Potato Head toys with which I happily amused my post-operative self, real potatoes and all, in my hospital bed. Indeed, it was only recently that I learned that the Potato Head folks now come with phony spuds, a no doubt neater but otherwise most unfortunate turn of events, as there was nothing quite like jabbing those little plastic parts into honest-to-goodness potatoes. God bless the nurses who apparently never so much as blinked at the spectacle of a seven year-old fresh from the OR with a bed full of potatoes and plastic!
But as day's end rolled around, and with it the end of visiting hours, a question arose about whether I might be discharged home with my parents, or kept overnight in the hospital. My opinion was clear and strong, and perhaps not what one would expect: "Let me stay right here, thank you!"
It wasn't that I was enamored of the hospital by any means, and it was many more years before the notion of one day working in such a place and feeling a part of its milieu first crossed my mind. Certainly I was eager to escape proximity to that boy separated from me by only a curtain, and of course I wanted to be with Mommy and Daddy.
But that day had been different from any other, and although I had no idea what a "tonsil" was I knew something had been surgically extracted from my body, with a wicked-sore throat left behind as a souvenir. This surgery stuff was something new, as were the uniquely odd post-operative sensations that went with it. While everyone assured me I was doing just fine, children know better than to believe every blanket reassurance adults offer, and I could understand that there remained room for Something to go Wrong. And while Mommy and Daddy were fine parents and handled the ups, downs, and "normal" crises of daily life with aplomb, if Something indeed did happen to go Wrong in my newly post-operative state, I wasn't sure that they would know how to respond. We would be home, by ourselves, miles away from the hospital, and they would have to call someone, I supposed, someone who wouldn't be there and who might offer strange guidance of a sort that mere parents might be unable to carry out. No, thank you; I preferred to stay overnight right there in my hospital bed, even with that boy on just the other side of the curtain, because if anything happened the nurses would be right there, and nurses know what to do.
Today finds us on the heels of another Nurses Week, that annual seven-days-of-awkwardness when employers endeavor to show appreciation of their nurses, spending little or no money in the process, and to make themselves look good for having such talent on the premises and for being aware and grateful bosses. There usually are signs posted around hospitals and in other healthcare settings, and the recruitment rag that attempts to pass itself off as a respectable professional publication is multiple times its usual size, chock full of ads from every employer in the region, all touting their extraordinary nurses and, by extension, themselves. Meanwhile, the nurses suddenly become walking advertisements, sporting lunch bags, coffee mugs, pens, umbrellas, tee shirts, or other similar items, all bearing the employer's name and logo. Sometimes nurses simply receive an email from the boss, a real cost-saver and a gesture that spares them the embarrassment of feeling like something that might adorn the side of a bus. Yep, when Nurses Week rolls around most of us shudder a bit and then wonder what bit of tokenism might come our way in acknowledgment of the previous fifty-one weeks of professional service.
While an extra umbrella to toss in the back of the car, under the dirty dog towels and behind the sports gear, isn't necessarily a bad thing, the realization that when people decided to acknowledge lives immeasurably bettered and often saved, errors averted, and the ship steadied in the rockiest of waters time and time again, what they decided to offer was of the ilk of that umbrella or a cheap pen, this realization does give one pause. In return for the respect and compensation rightly due those who work as nurses every day I suspect we all would be delighted to forego a lifetime of coffee mugs and tee shirts. But we all were raised right and understand that gifts and gratitude are not entitlements, so we smile and say "Thank you," just as our mothers taught us, as we take our new lunch bags and stash them in the back of a closet.
What perhaps is most troubling is the verbiage that accompanies the token gestures, or that stands alone in the email from the boss. Indeed, if I hear one more time that nurses are set apart by their caring and compassion I do believe I'll explode. Most human beings are caring and compassionate; that does not make them nurses, and nurses have not elevated those two qualities to heights unmatched by any others. So to say nurses are caring and compassionate is to say, in effect, nothing in particular about them at all.
The realtor who gently but firmly guides elders in divesting long held possessions in preparation for putting the family home up for sale is profoundly caring and deeply compassionate, and a darned good businessperson. But she or he is not a nurse.
The Little League coach who teaches athleticism and teamwork while correcting errors and safeguarding young egos is caring and compassionate, but not a nurse.
The accountant who smiles warmly while accepting five years of data for unfiled tax returns along with a stack of unopened letters from the IRS and says calmly, "Let's take care of this," with no shaming or fear-mongering, that accountant is caring and compassionate, but not a nurse.
The friend who didn't know what to do twenty-plus years ago when my elderly father walked in one morning, announced that he didn't feel well and fell over, the friend who "tried to hold his head up," instead of initiating CPR, that friend was deeply caring and compassionate, but not a nurse . . . and she did the wrong thing. Dad died on her floor; care and compassion couldn't save him. Whether bystander CPR could have made a difference, and what that might have meant for his quality of life had he survived no one ever will know. I have been grateful that he went quickly and without suffering, and wouldn't have wanted to change that outcome. But care and compassion didn't save him. Indeed care and compassion never do.
What makes the difference in healthcare is knowing what to do, as captured on a recent billboard for Shriners Children's Hospitals:
And the problem is that when the work of professional nurses and others is seen as only care, compassion, dedication, warmth, and general likability, without concurrent recognition of expertise, the risk is great that patients and their loved ones will confuse a pleasant demeanor and attractive appearance with sound judgment, good skills, and high quality care. Just last week I heard of a well-liked cardiologist allowing a patient to sit in the Emergency Department for hours, until the patient sustained a major heart attack early the next day. The standard of care would be to send such a patient to the cardiac catheterization lab as soon as suspicious test results were known so that action could be taken to restore and maintain circulation to the heart muscle and prevent or minimize a damaging heart attack. This did not happen, but the patient later told the Nurse Practitioner that she will return to that doctor because she likes him, he's nice. And just this week I saw an email from a CEO commending several therapists and nurses for receiving high scores in "patient satisfaction." I know two or three of those clinicians, and wouldn't want them anywhere near my patients or my family, but they're "caring" and "liked," and that's worth points for them and, sadly, ultimately dollars for their employer.
Indeed, given a choice, I'll take the grumpy surgeon with an ego as big as Jupiter if she or he skillfully performs just the right operation in just the right way. I'll take the tight-lipped nurse who never seems to hear or say "Good morning" if he or she catches the medication error that the pharmacy missed or has a remarkable knack for managing an awkwardly placed ostomy and for showing patients how to do it themselves, too. I'll take the Physical Therapist who seems to push patients to physical and/or emotional breaking points, backing off at just the right time, and suddenly they're moving better than ever and are stronger than they thought possible, despite the therapist being "mean."
Of course it's rarely an either/or proposition. Most healthcare providers, like most people, are caring and compassionate, and also skilled in their work. Truly, there's no need to be obnoxious, to be cold and closed off, to be arrogant, judgmental, aggressive, or even fearful. But care and compassion can't stand alone in 21st century healthcare, any more that the deep devotion of Mommy and Daddy over a half century ago could substitute for the hospital nurses who even a seven year-old recognized as knowing what to do, no matter what happened.
In fact, in any healthcare setting, and that includes city streets, private homes, offices and industry, schools, clinics, and more, no matter what happens, if there are nurses on hand it's a sure bet that they'll know what to do. That doesn't mean that we know everything or do everything; it means that we know how to assess a situation, stabilize a person and keep him or her safe, summon the needed resources or assistance, start the ball moving in whatever the right direction happens to be, and convey an air of, "It's cool; I've got this."
There's a point somewhere on the path from novice nurse to expert practitioner where nurses suddenly realize that they no longer go to work with more or less trepidation somewhere in the recesses of their minds, and instead have reached a point of knowing that they'll handle with confidence and grace whatever awaits them. I remember my early days of driving around with virtually my entire professional library in the trunk of my car, worried that something might present itself that I didn't understand and didn't know how to manage. I remember the early terror of answering the phone in the nurses' station, afraid some doctor would start barking orders I couldn't make out or someone in the lab would spew a string of numbers that were test results whose meaning I was supposed to know and on which I should act. At the time I wouldn't have believed that a day would come when I'd remember those moments fondly, and I wonder now if my youthful self could have anticipated the coming years of solo practice in settings with no resources or support met with a curious ease expressed as an easy smile and, "Let's have a look." It's a road we all travel, and if we stay the course we arrive at that destination of confidence and skill.
So while the saccharine air of Nurses Week leaves me wanting to duck and run, the underlying niggling concern remains, that those who tout such qualities as nurses' care and compassion are missing the point, seeing only the good hearts that characterize people of every walk of life, and not fully realizing that the reason that nurses' particular care and compassion feel so good is that underlying them, no matter what transpires, the situation will be managed and movement in a positive direction will begin, because whatever their practice throws at them
Nurses Know What To Do.
