What the nurses in my practice have taught me

This post is part of the series Wisdom

Other posts in this series:

  1. What the nurses in my practice have taught me (Current)
  2. What the teachers in my practice have taught me

As a profession, nurses present slightly less to my practice than other occupations. Nurses do, of course, get sick just like everyone else. I think that their “can do” attitudes possibly make them only present when things get very bleak, sometimes to their detriment.

They do come in higher proportions as the family member accompanying the patient to my practice. I get the sense that nurses often carry the “medical problems” load of a family. Which means that they will be the ones hauling loved ones in to get help.

I have found that certain professions change you as a person and as such you carry your vocation around with you even when you aren’t working. I have written a blog about what teachers have taught me. Nurses, too, bring their wisdom into the room:

  • Doctors aren’t always right

I remember this lesson right from when I was a newly qualified doctor. The person most likely to challenge your treatment plan was the nurse. As a young doctor, this could feel threatening. With time I realised how invaluable this sort of dialogue is. The nurse invariably knows the patient better, and a good nurse acts as a patient’s advocate. In my practice, when I have a nurse as a  patient, I have learnt that I will probably be challenged to back my thinking up with sound reasoning and evidence.

  • Everything is about the relationship

Nurses do not work for money or the glory of the bedpan. For them, the connection with the patient is the reward. They listen to the patient’s concerns and know what the family’s worries are. When treating nurses, they want to be related to. It is less important to come up with an astute diagnosis and far more important to hear them and bear witness to how the illness is affecting them.

  • Life is often cruelly unfair

Many of my patients struggle with the capricious nature of life. They rail against its injuries. Not so my nurses. Nurses know from experience that bad things happen to good people, there is no purpose or reason for it. The only reason for life is to live it.

I think that this may be some of the reason why they present less to my practice in response to a life stressor. They are phlegmatic about life’s burdens.

But if an illness is impairing their ability to fully function, they are impatient to sort it out. Often this means that nurses are quite hard on themselves. They have low tolerance for sedative or numbing side effects of medications.

  • Nurses work efficiently

As doctors, we take it for granted that once we are scrubbed up the nurse will have everything ready. It simply does not happen that a nurse will scrub up, forget something, disrobe and go and fetch it, rescrub. It is not efficient. The doctor often forgets something, but the nurse usually anticipates this and is ready.

Similarly, nurses make one side of a bed entirely, then move on to the other side. I have often wondered if this is part of their training, or if they are innately highly efficient people. What I do know is that they will not tolerate a woolly treatment plan from me that smells of inefficiency.

  • Nurses listen to their bodies

They eat when they are hungry, drink when they are thirsty and pee when they have to. They wear sensible shoes. It might seem obvious, but it is not. Many of the moms in my practice are so busy running after their families that they have these huge two-litre bladders. Several of my executives forgot what lunch or flat shoes look like. It is ground I do not need to cover with my nurses; they know it better than I do.

  • Nurses are straight shooters, almost to the point of being prickly

They know that there are many ways to say thank you and many ways to say f*** you, and are fluent in both. They are there when we are born when we die and sometimes when we poo. They never doubt a child who says that they are about to puke, but won’t buy it if you say your pain is a ten.

They respond best if you talk to them in the same way. These aren’t people who feel comfortable with sugar coating difficult truths.

Nurses are not “assistants to the doctor”. They are medical professionals at the front line of patient care. If I am to think of all the nurses I know, the most salient feature is that they never stop caring.

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2 Comments

  1. I agree with your assessment that nurses, especially psychiatric nurses, are often better diagnosticians than doctors. An accurate psychiatric diagnosis entails observing a patient’s behaviour closely over an extended period of time, if not days. Doctors doing their rounds scarcely have 10 minutes of face time per patient on any given day

    Also if you want to know if the nurse attending to you is specially trained in psychiatric nursing, look at the lapel. The dark blue, almost black stripe, will tell you that he or she has earned that stripe.

    • Thanks, David. In psychiatry, we usually have a good working relationship with the nursing staff. I usually get 20 minutes feedback from the nurses before I even see my patient.

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