2014 Winning Essay
Oregon Health & Science University
On my first day of nursing school, I found my nursing tenet: Meet your patients where they are. I had no idea what a challenge that would prove to be. It's a common conception that nurses are so overworked that they don't have time for their patients' stories. But, as each of the nurses in A Nurse I Am show in their empathetic, patient-centered care, taking the time to meet your patients where they are is what makes all the difference.
As a student, I have the luxury of time. Time to research my patient's case, to practice my skills, to listen and understand their wants and needs. It is during this time as a student that I have the opportunity to develop the good habits that will inform the rest of my professional practice: skills, listening, and honesty. This trifecta is the key to avoiding shortcuts and becoming goal-focused, and instead staying patient-focused and doing my best work a nurse.
Mona Counts is a role model for me and my practice. From years of practice and a finger on the pulse of her community, she is inherently aware of her patients' needs, both physical, financial, and emotional. In her rapport, she is honest and direct, firm with her patients about what she can offer and what she needs from them. In her practice, she understands that her patients are doing the best they can and meets them where they are, even if it's on their own front porch. This is the kind of care I aspire to, where healthcare is as important and accessible as neighborliness, and the community is as much my patient as its individuals.
For my practice, meeting patients where they are means getting my skills efficient and streamlined, listening, and staying honest.
First, skills. When I gave my first injection, something funny happened: my patient disappeared. Not literally, of course, but in that moment, all I could see was the fat pinched between my fingers and the quivering tip of my suddenly-terrifying needle. What it means for me is that to give the level of patient-centered care that I strive to, I need to get my skills down so well that my patient can come back into focus. Mona Counts models this beautifully: she meshes her patient care with her human care, palpating a thyroid as she discusses barriers to care with a patient, and thus keeps all of her care patient-centered. It's not that the goals disappear; the patient simply comes first for her, the tasks are adjuncts to her care.
Second, there's the listening. Every patient has a story, and I've found that a few minutes of quietly sitting by can reveal key obstacles and access points to my patients’ care. While silence can be uncomfortable, it gives patients room to think, to process, to feel. Much of Bob Wilkinson's best care is just being there with his patients; some of the greatest comfort comes from simply knowing someone is there. Some people say that they don't have time for the listening. I say we don't have time not to. Every patient is a gestalt, greater than the sum of their past, presenting illness, and future, and in order to effectively, empathetically treat that whole person, you have to listen.
Lastly, there's honesty, with my patients and myself. When I’m tempted to cut a corner, I ask myself: What am I pretending not to know? The answer usually comes down to patient safety or comfort; taking the extra minute to double-check that call button will prevent falls and help my patient feel secure. This honesty also applies to my patient relationships: being direct with my patients about what I can offer, and giving them thoughtful, thorough information and care. This patient care has its foundation in self-care, often the missing piece when patient-centered care falls victim to goal-focused care. Being honest about my own needs, whether it's someone to talk to or just time to myself, helps me recharge and return refreshed, able to do my best work. Even Mona Count, whose patients stop to talk ailments at the diner during her family breakfast, takes time to herself.
At the end of the day, the work will never be done, the goals and tasks will keep on coming. My patients, however, are only here for a short time, and they're here for patient-centered nursing care. Assuring quality skilled care on my part, listening and staying present, and keeping myself honest will assure that I do my best work as a nurse by meeting my patients where they are.