A nursing colleague came to me a while ago and shared with me a particularly hard, grieving situation with a patient with a very bad prognosis and how hard it was to talk with her about making that transition, acknowledging the reality of her mortality.

She felt as if she didn't and couldn't do enough for this patient, the things she needed, the things she wanted to do for her. She felt like she had failed to support her patient.

I thought about it for a moment, and this was my response because in situations like this, my heart speaks louder than my stethescope and reminds me of the honor to be in this intimate circle with our patients, and how it can affect both of us.

Dear,

 I wanted to take a moment to think about this before I shared some thoughts with you…

 I think… that nursing is a two-edged sword.

On one hand, we are privileged to be witnesses to our patient’s inside sacred circle during the hardest and also the most joyest times in their lives.

With this chosen profession comes opportunity and responsibility.

And, if you are one of the few Nightingales that really sees both those things, then you also know, that sometimes… nursing hurts.

I think… that it only hurts when you have the heart-driven sight and presence of the moment that nursing can offer to help you see into other people’s lives. 

 It’s not just the theoretical and practical training that we do. That alone gives us the knowledge and skills of the trade that we need to technically do the work.

 But the spirit and water that flows through those skills and knowledge and puts it all together in the wisest, purest sense… is a golden heart.

We both know many nurses that are excellent technicians and do the work well… but how many do you know that really have a golden heart?

 Ones that realize that “moments” are opportunities to touch someone’s heart and soul.

True Nightingale opportunities include making eye contact, touching a hand, accepting a thank you from a hurting pure heart, and most of all, walking with a patient and their family through the hardest times in their lives… and helping them know that they are not alone.

 But… with the sight of a golden Nightingale heart, is also the pain of a hurt of knowing that we can’t fix everything in our patient’s lives.

 All Nightingales care, I think…

 I truly believe that all nurses come to work with the pure intent to do their best to give great care and ease suffering.

 I also truly believe that there are only a few that have the presence of awareness to move and work through the technical stuff and see the opportunities of special moments that can make a difference.

 Nursing was always hard – and not for the light of spirit.

 Medicine and nursing may have more technology now, but I believe that the struggles are the same throughout time… to provide specialized knowledge to promote health, ease suffering and see opportunities in healing that others may not see.

From the beginning of true nursing… which were male monks giving what we would only call first aid care now, to people hundreds of years ago, to Florence Nightingale teaching about cleanliness and healing and giving comfort, to Nightingales seeing opportunities in holes in healthcare, from clean and sterile techniques, to birth control, to healthcare for the poor to medical ships and teaching health promotion…

Nightingales are given opportunities in our chosen profession and are truly heroes when it comes to making differences in peoples lives.

Making a difference in someone’s life is not only the big stuff. 

And it is not easy.

And we don’t always win.

And we can’t fix everything.

And that is what hurts.

*****

Even during the earliest years of nursing…

 We could do a lot with making sure patients were clean, beds made, wounds cleaned and dressing changed, patient’s were fed and got fresh air.

But we couldn’t heal infections, limbs that needed to be removed to save lives, illnesses that were yet to be named…

And death… in all forms, kinds, ages, and situations

 But we could touch people’s lives with a healing that doesn’t happen elsewhere.

 And for those Nightingales that see both the opportunity and the responsibility of the sacred, inner circle that we have been invited into, in people’s lives…

We will never be the same.

 And at the same time…

That invitation haunts us

 Because we know the potential of what we can do and what we want to do

And, what our limitations are.

 In every age in nursing, there are opportunities and limitations.

 In our age, opportunities in nursing certainly include:

Higher education and technical skills, specialized care, variety of nursing opportunities of specialized populations, hours, places and travel and more.

 In this age in nursing, our limitations include:

Not enough nurses, poor staffing ratios, not enough CNA’s, highly complicated work on the floor units that ten years ago was in the intensive care units…

 Add in social expectations of perfect care, no mistakes, no pain, no suffering, instantaneous responses to call lights, family expectations,

And toss in differences in physician and nursing care and expectations, lack of physician respect for nurses and nursing care, long hours

And more.

 *****

 I know you are hurting about this patient’s care and what you think you didn’t do and that you failed her.

 I also know, from what I have seen of your care, that you, my friend, are one of the special Nightingales with a golden heart.

What I mean is… when you go into a room, talk to a patient, change a dressing or give a pill…

It is very evident how much you care about the work you do for your patient.

You can’t teach caring.  You can’t teach how to see opportunities in caring.

However, for someone who has that gift, I do believe that you can teach someone to be aware that this gift of seeing how much moments matter… is both an opportunity and a responsibility. 

And as nurses… both are things that we have chosen by choosing this profession.

 Only… only some will see opportunities in moments.

 *****  

It is hard to see our patients suffer… and especially this patient, in the situation she is in.

In the times I have taken care of her, it has been painful to me to see how alone she is, how she lays in the quiet and the dark day after day with her thoughts only and pierces my heart with her eyes when I know she asks why dying takes so long, and I have no answers to heal the pain of her life.

When I know her beliefs of caregiving is not something I can give her every time, nor is something as a nurse, I think is good for her… such as feeding her instead of helping her feed herself, engage for a few moments while she is eating and then being there and helping her when she can’t do it anymore.

 And it hurts when she rebuffs any effort to keep her engaged… turning her bed toward the window to see outside, only to find she has asked someone to turn it back by the next time I am in the room.  She refuses TV or music or chaplain or volunteers.  I don’t know if she answers her phone or talks to anyone, I have never seen it. 

And, her eye contact with me breaks my heart.  When I hold or touch her hand, she doesn’t want to let go.

 The dichotomy in her needs, wants and lack of acceptance of cares that I think would help her – in itself, is heartbreaking.

 And I couldn’t fully fix the odor in the room either.  Despite changing sheets, equipment, suction, and CVS cleaning, it was still there.

 As I sit here now, I can think of a dozen more things I could have tried, but at the time, as you, I had other “sicker” patients, was orienting a traveler nurse, and managing a GYN patient POD1 whose team thought I should have accomplished all post op markers by 0900 – when in the end, we almost called a Rapid Response on her and was dealing with the pros and cons of a void trial that did not then did happen, and which the provider called a fail and wanted us to re-cath, when we wanted to give it more time, after each of her 5 voids in a two hour period, which we called a success, but they called a fail…

In the midst of all of that… our mutual patient was sitting in a self-imposed darkness.

 *****  

My own struggle in nursing has been finding rationales in peoples struggles and pain that seemingly have no answer or, rebuff all attempts to heal.

 I don’t believe that suffering is “God’s Will”, and personally rebuff that rationale after seeing things that nursing has opened my eyes to.

 I do believe that we can be each other’s answers to suffering, and that nursing is in a special opportunity to affect suffering… to a point and a limit.

 It is those limits that are hard to accept.

 *****  

Nursing is hard.  And it is not for the faint of heart.

 I don’t think the death and dying is actually the hard part.  Sometimes I actually think dying is the healing part.

 I think the hard part is knowing that nursing hurts.

 It hurts when we can’t do as much as we want to do for our patients.

When we know there is so much more on our perfect list of ‘To Do’s that we want to do but can’t

For all kinds of reasons including staffing, priorities and time.

 And, the reasons we don’t want to really accept –

Which include, that there are some things we can’t heal.

 Nursing hurts.

Because we know what is possible, what we are capable of

What we want to do, hope to do

And are inspired to do

And can’t.

 But that is not an excuse to do less.

 That is a call to action to be more aware of the moments we can make into opportunities.

To do what we do best… take all the tools in our toolbox … to make a difference.

 *****  

I truly believe this about you…

 You make a difference.

 You see moments and opportunities in our everyday service to our patients… to make things better for them in ways that are beyond technology and medication.

 That is what makes you special.

 That is what makes you a Nightingale.

 That is what will change you in ways you never imagined possible – to achieve your highest potential not only in your career, but in your life.

 For your patients will never know the CE’s you accumulate, the skills you learn, the iCat’s you accomplish, the certifications you achieve.

 They will only know how much they felt cared for by you. 

 The moments you talk with them, teach them, answer their questions, soothe their fears.

Your eye contact. You touch. Your smile.

 You make a difference.

You are a Nightingale.

Remember who you are and how much you make a difference to the patient in front of you.

And know how lucky we are that you are a nurse in our world.

And how much you are appreciated.

 *****  

Here is the challenge to you as a Nightingale…

 Remember to see the moments in front of you as opportunities.

 And for every opportunity, we have options for actions.

Remember that some opportunities we can act on. Some we need to resource out. 

Some we need to encourage our patients to make the move themselves and give them the safe space to talk about it and plan an action.

Some we need to pray on.

And some we need to let go of.

And remember and understand this…

Your patient will see the moments and opportunities differently than you do.

When you see a fail in a moment,

They will see you as a miracle because you saw a moment and took an opportunity to heal something and you did.

Recognize moments.

Find moments.

Make moments.

 And make opportunities.

That’s what makes you different.

That’s what makes you special.

That’s why nursing chose you.

And that’s why you are a Nightingale.

And if you let it… you will never be the same.

***** 

So, Thank you, dear Nurse,

 For all you do for your patients.

For all you want to do and how you work to make those things happen to the best of your ability.

 And, thank you for sharing this with me.

Thank you for inspiring me!

 You are inspiring!

Inspire and Be Inspired!

Audrey