September 25, 2006, 4:53 am

The Essence of Care

fugitiveWhere does she think she is running to in those high heels?

Was her shift so bad she refuses to come back from lunch?

Oh wait, nurses rarely get a chance to have lunch, so that can’t be it.

Maybe she’s running from a “Code Brown”, if you know what I mean.

Funny, how many nurses become fugitives when there is a “Code Brown” on the unit.

Why no, I’ve never run from “Elimination, un-impaired, secondary to unimpeded flow of feces and manifested by nasal assault”.

Why do you ask?


Essence: the intrinsic nature or indespensible quality of something, esp. something abstract, that determines its character.

At least that’s how my Mac dictionary widget defines it.

So….what is the essence of nursing?

  • You can state that nursing encompases the promotion of health and wellness through public health education and community health programs.
  • Nursing promotes the health of the public by promoting and educating future nurses.

But the essence of nursing is patient care.

What is patient care?

Providing physical and emotional support to those who are sick through hands-on bedside care and continual assessment of response to interventions (both medical and nursing) with the goal of restoring the patient to health.

Now there’s a textbook-sounding mouthful, but it is my own definition.

The operative words being “hands on”.


When nurses leave the bedside, when they are bombarded with so many administrative requirements or so understaffed that they can no longer do “hands-on” patient care, an important connection is lost.

Let me state here that excellent basic patient care can be, and is, provided by nurse’s aides and this post is in no way meant to denigrate hard-working nursing assistants.

I am, however, making a case for primary nursing care by RNs.

When a nurse has total responsibility for patient care, primary care, if you will, they are better able to sense subtle changes in their patient’s responses.

By primary care, I’m talking everything from bedbaths to commodes, saline locks to central line TPN, nutrition from intake to elimination – the entire patient.

Oh, you can assess a patient. I assess dozens every time I work.

  • There is a difference in auscultating lung fields vs. seeing the slight increase in respiratory effort when turning for a bed bath that wasn’t there the day before. Or watching a patient walking back from the bathroom sit down half-way back to the bed-actually witnessing a decrease in the ability to tolerate exertion.
  • There is a difference in noting the patient’s color and if they are warm and dry and having a head-to-toe assessment of skin integrity via a bed bath. How does the coccyx look? Is it red, is there breakdown. Is the skin dry, flaky? Is the patient dehydrated? How about incisions? Any unusual drainage? Odor?
  • There is a difference in just noting a patient’s intake and being there during mealtimes. Are they anorexic? Are they interested in eating? Are they able to eat without assistance? How much assistance do they require? Could a decrease in appetite be a side effect of a medication?
  • There is a difference in being told the patient’s output by an aide and visualizing it yourself.  Is their urine darker than normal? Stronger-smelling than usual? Are they developing diarrhea?  How much? Why? Could they be losing electrolytes?
  • Are they depressed? Anxious? Scared about what will happen after discharge? Do they have a flat affect? Are they engaging their surroundings? Are they taking an active role in their recovery?

I can go on-and-on.


If you are not able to spend time with the patient other than to do a quick eye-ball evaluation and listen to a couple of breaths through a stethoscope because you are:

  • running with ten (or more) patients or
  • required to do ridiculous amounts of paperwork/computer charting

you are missing out on the opportunity to know that patient completely.

And your patient is missing out, too.

They are missing out on your professional, educated eye and your ability to assess and evaluate what is happening to them shift-by-shift.

Your ability to see the whole person, not just a disease-in-a-bed.

  • That’s what nurses do, you know.
  • We care for the whole person.

We are the entire reason a patient needs hospitalization.  If you don’t need nursing care you can go home.  And even then, it isn’t unusual to need nursing care at home.

Doctors depend on our ability to catch subtle changes in our patients.  To note their reaction to medications. Changes in their nutritional status. Changes in their mental status.

BEFORE these changes become a major problem.

Sometimes I think we are here to care for JACHO instead.


Is it any wonder than nurses gravitate to specialty units instead of working medical/sugical floors/wards?

Even back as far as 1978, it was pretty obvious to me that the only place I would be able to give nursing care the way I was taught that it was supposed to be given, was in the intensive care unit.

No more than two patients, so I could give them what they needed from me the most.

Time enough to give them excellent nursing care.

Time enough to be their hands-on nurse.


Do you have to be a hospital based nurse to be a hands-on nurse?

Of course not.

Nurse practitioners are hands-on nurses.

Nursing professors are hands-on nurses because they have to train the next generation to be hands-on nurses.

Administrative nurses are indirectly hands-on nurses because the nurses in management are responsible for the working environment that allows nurses at the bedside to do their best care.

That means hiring, and retaining, the best nurses they can find.

And enough of them.


No matter what career path you choose, every single nurse begins at the bedside.

No, that is my opinion.

Every single nurse should begin at the bedside.  Bedside nursing is the foundation of our profession.

It’s our common denominator.

It’s what connects the new ADN and her colleague with a PhD.

It’s our common language.

We should be proud of that.

If we ever forget it, I’m afraid of what will happen to my profession.

Very afraid.


  • Mother Jones RN

    September 25, 2006 at 10:32 am

    Girl, I LOVE that book! That nurse is truly a wonder-girl for being able to run in high heels. I can’t walk in high heels without falling down. I had another thought about why she may be running. She heard a pharmaceutical sales rep was giving away Viagra pens and she racing to get her pen before they were all gone.

    I agree with you, Kim, bedside nursing care is the foundation of our profession.

  • wendy

    September 25, 2006 at 11:54 am

    I dont call it “basic” nursing care – to me its ESSENTIAL nursing care.
    Love your blog by the way!

  • Sid Schwab

    September 25, 2006 at 1:45 pm

    Most nurses I know are well aware of what constitutes good care; and are deeply frustrated that the realities of modern healthcare/cost control have pretty much seen to it that it’s no longer possible.

  • Crystal

    September 25, 2006 at 4:11 pm

    Wow, well put! I am currently a nurse aide, or tech, or whatever you want to call me. And in nursing school. I feel like I am my nurses’ eyes and ears. They truly depend on me to let them know about those subtle changes. It helps to have a “seasoned” nurse actually come out and say it. It would be great if every nurse I worked with had this same attitude. Will you come and talk to them for me? Even now, not even being finished with school, I can see that some nurses have lost their passion and desire for what they do. Those subtle changes that can be life or death to a patient don’t really seem to matter to them ~ and that scares me! Thank you, Kim, for a well put post!

  • Janet

    September 25, 2006 at 6:52 pm

    Once again, Kim, you have said what many of us are thinking. Basic, essential, bedside nursing is where we all begin and we should never forget it.

    A good nurse’s aid is worth her weight in gold and should be treated that way.

    Crystal, too many nurses have been disheartened by “the system”. Give them time and support to get back to what they were trained to do and they will brighten up again. IMHO we wouldn’t have such a shortage of nurses if we were allowed to BE nurses instead of jockeys for JACHO.

  • PaedsRN

    September 25, 2006 at 9:11 pm

    Nice one Kim.

    “We are the entire reason a patient needs hospitalization.”

    Y’know… that could be taken two ways 😉

  • Sharon

    November 15, 2006 at 3:31 am

    Kim, well said, but unfornuately we are part of the dying breed of “Old School” where Nursing was a dedication as much as a career/profession. Many of todays up and coming nurses are from a differant generation, a different work value. Bedside nursing is beneath them. Its the nursing aide’s job to give the bed bath, its not their job to empty the bed pan. Their goal is still to work for the best hospital in the area, but not based on patient quality care but on who has the best benefits/hiring bonus/pay. I fear for our profession when the “Old School” breed fades away. We will always have younger nurses with “Old School” philosophy but they will become fewer and fewer. A sad fact seen throughout every profession/career, not just Nursing.

  • nancy

    June 29, 2010 at 7:03 pm

    i really love nursing

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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