Honoring where you are...maybe
Have you ever had someone tell you to honor where you are now? If you haven’t been in therapy or in a coaching situation then maybe not but it is a skill that we apply to our patients all the time, maybe without even realizing it. Looking at it through a patient care lens can help clarify why it may be a skill that nurses need to nurture for themselves.
Let me explain.
A patient comes to you (inpatient or outpatient) after having a fresh mastectomy. Maybe she has JP drains that seem completely overwhelming to care for. What do you do?
Do you tell her that taking care of drains is no big deal and she should just pay attention and learn how to do it?
Do you tell her to look on the bright side that surgery was an option?
(I hope you feel as appalled reading that as I feel writing it.)
Of course not. As a nurse, you honor where the patient is at that moment. You acknowledge that she is frightened and overwhelmed. You acknowledge that no matter how prepared she may have been, she just underwent not only major surgery but body disfigurement. You understand that know matter how educated she is, the trauma of the situation may interfere with her ability to learn or cope.
We know patients can thrive after mastectomy (or other medical challenges), but it’s not the time to bring that up.
It’s time to sit with understanding, to go over the steps of post-op care multiple times, in different ways and with patience, until she can start to do it herself. It’s the time to take into consideration her learning level, her support system, and her other medical conditions. Before we start moving, we need to honor where she is now.
It’s not the time for platitudes. It’s not the time to expect things to just “click”.
So how do we honor where we are now? What does that look like?
First it takes evaluation of where we actually are (genius, I know).
Let’s start with strengths. I asked a group of nurses this week “what makes a good nurse” and was surprised that they struggled with articulating the characteristics of a good nurse.
Are you kidding me?
And then I realized that as things become more routine, we may stop seeing just how much we are doing. We are too busy actually doing it.
So I am going to list some of the things here to honor where you are in your role as a nurse. As you read through it, take a moment to think about how much effort and learning you put into each item, either through school, on the job training, or life experience.
Physical exam: establishing the patient’s baseline and noticing the nuances of abnormals
Assessment of patient knowledge deficits: What do they need to learn? How can they best learn it?
Coordination of care: communicating with the members of the care team and pulling in other people as needed.
Interpretation of labs and tests and adjusting care accordingly.
Pharmacology knowledge: understanding the mechanism of action of each medication, potential side effects, risks, and drug interactions.
Understanding of the pathophysiology of disease and how this affects the patient’s current condition and future needs.
Providing end of life care, and then post-mortem care.
Charting all of this so that care can be consistent and safe.
I’m just getting started. These are “just” the skills and knowledge base of nursing. These are the things that we do all the time, often without pause or overthinking.
And then there are the other skills. I WILL NOT call them the softer skills. Let’s go with calling them the POWERHOUSE VALUE skills.
Witnessing a patient’s suffering in a way that validates their experience while giving support.
Being the sounding board for their frustrations.
Believing in their ability to heal and thrive even when they can’t see it.
Creatively offering alternative ways to approach something they are struggling with.
Being willing to explain things as many times as it takes, in as many different ways as needed until they understand.
Being with them when they grieve, when they celebrate, when they struggle to accept.
Hearing about their dog and realizing sometimes that IS the most important thing at the moment.
Thinking outside the box.
Looking for what other providers may have missed, considering the WHOLE person.
Showing compassion and empathy, even if they are aggressive or difficult to deal with.
Saying the hard things, if that’s what they need to hear, with compassion.
Gently, but sometimes emphatically, getting patients out of their own way (read: forcing them out of bed).
Communicating with, educating, and supporting the patient’s family.
This list is not exhaustive, it doesn’t even scratch the surface. The point is that nurses do ALL of these things even when staffing is bad, even when they haven’t had lunch, even when their team is burnt out and suffering.
There are a lot of components to patient care, each of which have taken dedication to develop and learn. Some days we may do all of them, some days maybe just a few.
Honor where you are now, as a nurse.
The problem isn’t just lack of acknowledgement from administration, the problem is lack of acknowledgment of ourselves.
We don’t appreciate the work we are doing. We acknowledge the long hours, the emotions we feel, the physical stress of the job, but do we give equal airtime to all the good we are doing? Do we sit with the knowledge and satisfaction that what we did today was important? Can we feel like a “good nurse” not just from an intellectual perspective but from a feel-it-in-your-bones certainty?
Feeling purposeful feels good.
Feeling satisfaction in your work feels good.
Feeling like a good nurse, really feeling it, can restore us and protect against overwhelm.
Sure we can always grow, always do better. But that doesn’t mean that where we are now is inadequate.
Sometimes we are too busy doing our jobs to give this some thought.
That’s the real tragedy. How can we have the comfort of being a good nurse if we don’t even identify what that means?
Honor where you are now. It’s an important part of healing,
and even better, the first step to thriving.
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