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  • Writer's pictureMegan Filoramo

How the noble idea of good patient care can destroy your life.

How do you define yourself and your value? For many of us, especially nurses, a key part of our identity is our profession. Even the general public would agree that a nurse is a nurse whether she is at work or not.

One of the core values of nursing is the dedication to caring for people. Regardless of what role you work in, this is the guiding principle for everything we do. So how then, can this noble idea be the catalyst to sucking the joy and fulfillment out of our lives?

What do you say when you are understaffed?

When you are rushing between patients?

When the EMR isn’t working?

When the medication you need isn’t on formulary, or needs prior authorization?

What do you say when the people around you are not doing what you think they should be or when you need to ask for help 5 times?

What do you say when you get out of work 2 hours late for the 3rd day in a row, frustrated and exhausted?

When you question whether you even want to keep this job?

We say, “I can’t even give good patient care because (insert any reason) .”

As people who have dedicated their lives to giving care,

this is the most damning thing we can say to ourselves!

It rocks us to the core of our being, the hideous gremlin of “not good enough” takes hold and not only makes us feel like a failure but worse yet we believe this to be true based on whatever our circumstances were that day.

So we can’t win, our work lives are pointless, and we have no control or power for change. A job we loved turns into a huge source of stress.

Are you sweating yet?

Here’s the life saving truth.

We can still give great care and feel fulfilled at work even if all of those above circumstances are happening simultaneously. We don’t have to feel like work is sucking us dry. We just have to stop linking our ability to provide care with our circumstances. I know this may sound like a stretch but there are a few ground rules that can help.

First, remember that care is inherently good. According to Merriam-Webster, the definition of care is “watchful or protective attention, caution, concern.” There is no such thing as “bad care”. Bad care is a misnomer and using the term just confuses our brains. There is care and then there is neglect (defined as “a disregard of duty resulting from carelessness, indifference, or willfulness.”) Even on my busiest/worst/short-staffed day I never choose to disregard or neglect my patients.

My ability to care is independent of my circumstances, I just have to remind myself of this.

Of course, this is a good place to take a quick detour to recognize that medical treatment and nursing care while overlapping, are not synonymous. It is frustrating to not have the tools we need to provide the best medical treatment, and sometimes this tool may just be time. If we have 8 patients and 2 are in crisis, the other 6 may not get the antibiotic on time or the wound care education done until our next shift. Does this mean that by prioritizing we didn’t provide care? We didn’t show protective attention or concern? Do we believe that medical professionals who provide care in third world countries are “not enough” because they have too many people to care for and too few supplies? OF COURSE NOT.

This can be true in other parts of our lives as well. It may be separating the accomplishments of parenting (read, making homemade cupcakes in the school colors) from being a good mom. Can a good mom buy packaged cookies, or even (gasp) forget the class party and send in nothing? Can a good mom not have the money for cupcakes? Yes, because her value as a mom comes from being the mom.

Can a student be a diligent learner and still get a bad grade? Or oversleep? Or forget an assignment? Can they have a professor that simply doesn’t like them and treats them poorly? Does any of that change their value?

Maybe you don’t provide direct patient care in your current role, but what circumstances (that are out of your control) do you tell yourself need to change in order for you to be fulfilled? Staffing? Attitude of your coworkers? Maybe your pay?

If we latch our sense of fulfillment to the circumstance we have no power. If we have no power, defeat can seep into the rest of our lives and then we find ourselves seeking comfort in ways that may be counter productive to our other goals. We comfort ourselves with food, binge watching netflix, shopping, surfing social media, complaining to everyone about work… and then we get up and go into work again, to be pummeled by frustration, made powerless by the belief that we are unable to provide good patient care.

Here’s the key. If the circumstances at work aren’t great or change in some significant way (like maybe in the midst of a pandemic),

redefine how you measure “good patient care.”

If I have plenty of time, good care may look like spending extra time with each patient, good care may look like helping my colleagues catch up with their day, good care may look like working on some project to improve workflow. But if I use this standard on a day where I don't have plenty of time, I will come out feeling like I failed myself and my patients. So when the circumstances are not prime, maybe good care looks like being present to whoever I am with at the moment. Maybe good care is going to be defined by doing the best work I can with the tools I have, like the nurses in third world countries.

Before you decide you aren’t giving good care, decide what good care is going to look like today and make sure it only includes variables that are within your control.

Work is always going to have some challenges. I may struggle with making a correct diagnosis when I am unable to do a proper physical exam when“seeing” the patient virtually due to mandated quarantine. But I can ask the right questions and do the best I can. Telling myself that I can’t give good care in this case is simply not true. I can give as good care as anyone else with the same tools. Would an in-person physical exam be better? Of course, but that isn’t the reality I am in right now.

The best I can do has to be enough because I don’t have the capacity for more than that. I can’t expect myself to work beyond what the circumstance dictates. It is like expecting penicillin to do the job of a broad spectrum antibiotic, it doesn’t make sense to be mad at penicillin when it doesn’t work. So why would we degrade ourselves, choosing to feel unfulfilled, when we have done the best we can, when we have truly given “protective attention” to something.

The last portion of this is to remember that feeling happy and feeling fulfilled are not the same. You are not going to feel happy when someone calls out sick or a patient is given a diagnosis of cancer or when all the medical treatments for your patient’s chronic pain have been exhausted. But you can come home fulfilled, feeling like you did a good job, not only because you cared for your patients but because you didn’t hold yourself to some fictitious standard of good care that wasn’t supported by the reality of the circumstance.

I can be a good nurse practitioner whether I have the right staffing numbers or not, my value lies in my willingness to care and my ability to figure out how.

I am not always going to be happy going to or coming from work, but whether or not I feel fulfilled, valuable, and determined to keep going is up to me. Giving good patient care sounds noble, but not if we are going to use it as a weapon against ourselves, not if we believe that it comes from anywhere outside ourselves.

As Ralph Waldo Emerson wrote

“ Nothing can bring you peace but yourself. Nothing can bring you peace but the triumph of your principles.”

And that is always up to us. Always.

Share this with the nurses you know are doing a great job but may need some reminding!

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