Living With Dying articles
Behind the Hospital Curtain - online extras
By Leah Carey
Sept. 27, 2016
Nurses and doctors are juggling a lot more than just the care of the patients on their roster. Everything they deal with adds another layer of stress onto their already-overloaded plates.
Here are a few of the things that Theresa Brown shared in our interview – in her own words, edited for length and clarity.
Caring vs. cost
Wanting to keep labor costs as low as possible, [we get more patients than we can effectively juggle.]
A nurse I worked with said, With three patients you have time for the little things. I thought that was so perfect. With three patients, you really can see them as whole people. They live within a social context and our job is to treat not just their body but their soul. The more patients you add on and the sicker they are, then the less you’re able to see the soul, because the task of the body just takes up more and more and more of your time.
I feel like the pure caring aspect of nursing is not prioritized. It’s the way that we look at value in health care.
To call or not call the code
You don’t want to call a code if you don’t really need to because you’re going to look ridiculous. Say you call a code on a patient and then there can be a kind of rumbling – why was that code called? There can be a judgment that goes on.
A lot of it comes back to not getting good and helpful feedback at work. In health care we’re really bad at giving the kind of work feedback that business schools teach workplaces to do. If someone makes a small mistake, if they’re confused, it seems like it would be completely normal for a manager to take them aside and say, Look, this happened.
But say you called a code on a patient and it really wasn’t needed, it doesn’t seem like managers come and talk to you. There’s no processing of that experience. Or say you don’t code someone and they go down quickly, there’s also no processing of that experience.
Learning from mistakes
We’re not good in health care at owning up to mistakes. I think there’s often such a strong element of criticism in the profession. We’re not good at sitting down with people and saying, What did you see happening? Let’s try to understand this.
I’m a big believer in learning from mistakes.
Training vs. reality
Sometimes in health care we’re not as empathetic as we could be.
Empathic listening is a huge part of our training. Talking about empathy and talking with patients is a key part of what we’re taught to do. Talking to patients is also a way of assessing them – are they having trouble talking because they’re short of breath? They say they’re not in pain but they’re wincing and grimacing.
The problem is that we hear all these lessons about empathic listening, but in the hospital we’re so busy and you end up having to prioritize that. It’s really hard.
Modeling good behavior
Model the behavior that you want to see – especially in the hospital. I feel like it’s good if we all live like that. It’s so easy for people to get in the habit of being short and being snippy. I get that, but I feel like you’ve got to put that extra effort in to address people in a civil manner – to ask questions, to not be passive aggressive. And also to say, yes I will help you if you need it even if I don’t have time.
Charting care vs. providing care
On every patient you see, you have to chart how likely they are to have a fall. In the time I worked in the hospital, the assessments got more and more elaborate. All of a sudden you’re doing a 5-10 minute fall assessment on the computer for every patient.
It would be so much better if there were five criteria that you could score and say, Your patient may be a fall risk. Go into their room and talk to them! Tell them they’re at risk for having a fall and engage them in preventing it.
We’re not so good at working with patients that way. It’s not something we assume we can work with them on. We chart it and we do our thing and they’re doing their thing.
Same team or opposing teams?
I would promote a degree of knowledge and trust and civility between doctors and nurses so we would see ourselves as colleagues, not bitter enemies at worst. Now we’re often people who have to work together but don’t really know each other and don’t want to work together.
Neither group is as open to the other as would be great or as you would want in a work relationship.
I think doctors definitely do have hearts and they care, but the model that they have now is that you go in and give your news and leave. Then the nurse has to answer the questions and clean up the mess. But the nurse may be too busy, or the nurse may not even have heard the news.
Make money less important
There’s many ideas about how you can do it, but the role of money in our health care system is out of control. There are so many vested interests.
Our system is now so complicated and so tied up with money and all the different rules and incentives, it’s very limiting. You’ll get a lot of lip service to treating the patient as a person and patients rights. But the reality is that a lot more nurses feel even more squeezed.
We’ve made tremendous progress in so many things. We can save people who 20 years ago would have died. Miracles happen all the time. But then there’s the bulk of people who just need the best care possible and I don’t always know that we’re thinking so holistically about what that means.
If I could wave a magic wand…
I would have more nurses so every nurse could have a little more space.
Put the patient first and then sort out the details later.
I tend to be an optimist. I think we could change tomorrow if we wanted to. We could say, Let’s focus on what matters.