June 29, 2008, 9:06 pm

Give Me Empathy or Give Me…Another Nurse

Did you know there was actually a call for nurses in the Revolutionary War?

I found this blurb on the Women in the U.S. Army website, which is also where I found this poster.

I’ll reproduce it here, I have no actual author to credit, but the reference is the link above:

“Shortly after establishment of the Continental Army on 14 June 1775, Major General Horatio Gates reported to Commander-in-Chief George Washington that “the sick suffered much for want of good female Nurses.” General Washington then asked Congress for “a matron to supervise the nurses, bedding, etc.,” and for nurses “to attend the sick and obey the matron’s orders.” In July 1775, a plan was submitted to the Second Continental Congress that provided one nurse for every ten patients and provided “that a matron be allotted to every hundred sick or wounded.’ “

Hey – they actually had patient ratios back then (“one nurse for every ten…”)! I guess we don’t “obey the Matron” anymore. Now the “Matron” is called Joint Commission!

******************************

The title of this post is in keeping with Dr. Rich’s Grand Rounds theme of “Independence Day”. Of course the first thing I wanted to do was put up a pic of Jeff Goldblum, but he meant the actual holiday!

So, a paraphrase of Patrick Henry’s famous statement inspired the following post.

It doesn’t take a bit of government intervention to implement.

That alone is amazing.

***************

Empathy: the ability to understand and share the feelings of another.

*******

She’s in her mid thirties. First pregnancy, just found out she was expecting earlier in the week. Home pregnancy test; hasn’t even had time to make an appointment with her doctor.

Tonight she began spotting. Nothing major, but she knows something isn’t right. She is cramping. And she is shaking. Tearful. Her husband is at her side. He doesn’t know what to say, but he is worried. Asking a lot of questions.

What does she need?

She needs a nurse who can empathize with what she is going through. You see, we know that many, many pregnancies end in a miscarriage. We also know that you can have spotting early in pregnancy and still have a perfectly healthy pregnancy/baby. We know that if you are having a miscarriage, there is nothing in the world that will stop it.

But she doesn’t. She’s scared, she is bleeding, and will probably be grieving the loss of her baby within a few hours. She doesn’t need a nurse who rolls their eyes because she is “over-reacting”.

She needs empathy.

*******

He is in his mid-twenties. He vomited once (or twice) and has abdominal pain. Feels like hell, is pale and pretty sure is he is about to vomit again. He called his mom to drive him into the ER.

Pretty dramatic presentation. Dizzy when upright, mom wheeled him in via wheelchair.

He’s scared. He’s uncomfortable and honestly thinks he may be dying, or at least on the verge of dehydration. All he wants is to stop vomiting and feel better.

We know that vomiting is self-limiting. We know this is most likely a viral gastroenteritis. We know he’s in no danger. We know his symptoms can easily be allieviated with medication.

But he doesn’t. He doesn’t even know the term “gastroenteritis”. He just knows that it feels like something is horribly wrong. He doesn’t need a nurse who rolls their eyes and silently calls him a “wimp”.

He needs empathy.

*******

She’s in her mid-forties. She arrives in the middle of the night in sunglasses, holding her plastic garbage can in front of her face. Migraine. Three days. Vomiting. 24 hours. Photosensitive. Extreme.

She’s tired. Tired of being in pain. Tired of not being able to get on with life. She tried every one of her medications, more than once. Keeping them down is another story.

We know this is probably a typical migraine. We know that many people come in to the ER with the same complaint and are discharged after receiving some pretty heavy-duty drugs. We often see them many times in one month. We know the drill.

And so does she. She knows there will be some suspicion. She can hear it in the tone, she can see it in the face of the nurse who takes down her triage information. What she doesn’t need is someone who doesn’t believe her pain is a 10/10 and rolls their eyes because she is allergic to Toradol and Phenergan.

She needs empathy.

*******

Empathy is at the heart of our profession.

As in synonymous with “caring”. It’s what we do. It’s what we have to offer as nurses. We give of ourselves so that others can feel better. In the ER specifically, we work quickly to get them as comfortable as possible.

But we absolutely must have empathy. The opposite? Apathy.

And apathy is just another word for nothing left to feel.

God help us if we get to that point in our practice.

God help our patients when we get to that point in our practice.

They expect medical care from their doctors.

They need empathy and caring from their nurse.

It’s what we do.

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22 Comments

  • tammy
    tammy

    June 30, 2008 at 12:38 am

    Kim,
    Thanks for writing this, once in a while I do need to remind myself what being a nurse meant. I’m guilty of rolling eyes too at time.


  • rlbates
    rlbates

    June 30, 2008 at 3:54 am

    Very nice post, Kim. Very nice.


  • ernurse
    ernurse

    June 30, 2008 at 5:36 am

    Excellent post, very refreshing to read. The concept of empathy seems to have become lost somewhere in translation, and is not mentioned ofte in the ER blogs I read.

    I recently put up a poll on my website about the attitudes of ER nurses as perceived by patients, I only have 3 responses so far (my website is quite new) but they all state that they found ER nurses to be “helpful but didn’t seem to care”. So your post is spot on!! Thank you.


  • Onehealthpro
    Onehealthpro

    June 30, 2008 at 7:55 am

    Hi Kim,
    Thank you so much for this post. Many patients I know suggest they feel like an imposition to the staff when they are sick. How tragic!
    Onehealthpro


  • Candy
    Candy

    June 30, 2008 at 8:53 am

    Once again, your profession and vocation are merged into the miraculous — keep the melody coming, ’cause we all need to hear it until it gets deep inside all of us.


  • Tom
    Tom

    June 30, 2008 at 10:25 am

    Great post Kim! Sometimes we need a slap to the side of the head to get us out of the petty worries of our work (Joint Commission, understaffing) and reorient our priorities. Thanks for the slap!


  • Margaret
    Margaret

    June 30, 2008 at 11:35 am

    Nice post, Kim. Here, you voiced some of the thoughts I had when I read the comments to your post last week about the FOS diagnosis.


  • Cheryl B
    Cheryl B

    June 30, 2008 at 12:15 pm

    Very good posting. I try very hard to treat my patients as I would want myself and family to be treated. Unfortunately, my 2 experiences in the er have been less than stellar. (luckily, only 2 thus far) One, some 37 years ago (before home pregnancy tests). So very nauseated; hmm, do I have hepatitis from a pt,, why am I so sick? Encountered eyerolling; overheard “overreacting”.
    Then offered 100 mg of Vistaril in my (then) very skinny deltoid! I said, please, in the glute.
    Then, many years later, my husband (who had a ruptured appendix) had an extremely bad experience in the same ER. No compassion, no help, when we tried to get him pain medication, we finally interacted with a very annoyed RN who told us, “there was a code going on,she didn’t have time to do anything for him!” Unimaginable, and it was the hospital where I worked at the time! (Although I didn’t tell them that I was a nurse; it wouldn’t have made a difference). And, this was a nice suburban hospital, not the big city trauma center!
    We must always keep empathy in mind, and not make our problems become our pt’s problems.


  • 100 « As The Pump Turns
    100 « As The Pump Turns

    June 30, 2008 at 8:34 pm

    [...] over at Emergiblog has a great post up about empathy, something that all of us need to muster up sometimes.  I hope as I enter this field of nursing I [...]


  • Bianca Castafiore
    Bianca Castafiore

    June 30, 2008 at 8:34 pm

    Thank you!


  • [...] of Emergiblog reminds us in Give Me Empathy, or Give Me . . . Another Nurse, how, when we are sick and frightened, nothing can soothe us like the presence of a confident, [...]


  • disappearingjohn
    disappearingjohn

    July 1, 2008 at 10:51 am

    Great post! Empathy is important, but sometimes it can be oh, so hard…

    Every time I have a big internal discussion to make sure I am empathetic to everyone, I’ll have one of those nights that wear us all down, and have to start the fight with myself again…


  • edrnkaren
    edrnkaren

    July 2, 2008 at 6:58 am

    Very nice post. I agree wholeheartedly. I will say however, that most ER nurses I work with are very good at empathy for those who are the real deal, as described in your post. It is the ones who are drug seeking and obnoxious who get the tone and the eye-rolling from us. I think we get pretty good at being able to distinguish the patients who are truly suffering from those who are not, and I have rarely seen a lack of empathy when it is appropriate.


  • Cindy, RN
    Cindy, RN

    July 3, 2008 at 7:46 am

    Very beautiful post. However, I do not to comment on the above comment by edrnkaren. I do not think it is up to us to judge who is truly suffering and who is not…nor is it up to us to decide when empathy is “appropriate” and when it is not. Yes, addicts walk in the doors with their drug seeking behavior, but they deserve no less care than any other patient does. They too are hurting–maybe emotionally rather than physically, and it is hard to understand how any person would let them get themselves in that position. However, we need to realize that they have a past and a history, and we don’t know what led them down the long sad road they are on and it is not up to us to judge. often times what leads a person into drug abuse is sexual and physical abuse during the childhood and teenage years. Perhaps the touch of the nurse’s hand on their shoulder is the only touch of kindness they have felt in weeks or months. So, while we cannot enable the drug seeking behavior, so also we do not have the right to withhold kindness and respect.
    Cindy, RN


  • Dr. Mike Smit
    Dr. Mike Smit

    September 24, 2008 at 1:15 am

    Hi, Kim,

    I am giving a talk to trainee nurses at a Private Hospital, in Pietermaritzburg, South Africa. I will use your stories if that is OK as they come from their Colleague and not a 58 yr old Family Physician who does understand Empathy and would like others to as well.

    We do not have wide spread internet access here but I will advise them of your website.

    Best wishes and come and visit.

    Mike Smit.


  • Maureen
    Maureen

    December 16, 2008 at 4:58 pm

    Kim,

    I know this is an old post,but I found it through Grand Rounds at Laurie’s blog today. I am crying after reading it. You have described almost everyone one of my ER experiences. I can count on one hand the times I HAVE received empathy, too many to count when I haven’t. I have watched around me and seen other people being treated terribly too, so I know it isn’t just me, but boy when your scared and hurting, it feels like it sometimes.

    I know you have a VERY hard, demanding job, and I am so grateful that you’ve decided to go into medicine and work in an ER, but PLEASE know that no patient wants to be there, we are there because we have no where else to turn, and we are hurting and scared.

    THANK YOU for speaking for us, for recognizing the truth of what happens, and for reminding folks that it is their job to provide empathy.


  • Barbara K.
    Barbara K.

    December 17, 2008 at 8:41 am

    Your post brought tears to my eyes. Empathy can be the most powerful tool we have to bring to healing. You are a wise woman.


  • Kelly, Flywithhope
    Kelly, Flywithhope

    December 17, 2008 at 9:53 am

    I found your post through Laurie’s blog.

    From those of us who have invisible illnesses that are often hard to “see” when we walk in the doors of the ER, thank you so much for your post


  • amanda
    amanda

    December 17, 2008 at 10:14 am

    beautiful, kim… not sure how i missed this one but as a patient, i want to thank you extra for “getting it” and for sharing it as well. and as a nurse, thank you for the reminder. :)


  • Linda
    Linda

    December 27, 2008 at 1:39 pm

    Thank you. I just came across this blog while I should have been working harder.

    I have been a paramedic for 20 years. I have worked in Colorado, Wyoming, Illinois and Nevada. I had been doing this job for quite some time when fate (in some kind of flawed Karma) had me working in Las Vegas. As a new employee I had to have a Field Coordinator to observe me and make sure I was qualified to work in their system (which they were way to proud of). My FC was a young punk whose main reason for feeling that I wasn’t qualified to work in “his” system appeared to be that I was over 25 and had been a medic for more than 8 months. I knew my career had taken me down the wrong road when this young punk of an evaluator, in his search for something new to criticize me for, told me I was “too empathetic”. I didn’t know that a caregiver could be too empathetic. But he chose that criticism carefully in order to prove to me how VERY wrong I was for the job. He was absolutely right. If being nice to my patients and trying to treat them as humans, even if they were “just a bunch of drunks”, was too empathetic, then I definitely needed to get back to the real world. I was taught to be caring and to try to walk in the patient’s shoes early in my career by some very wise and seasoned EMTPs, and I certainly wasn’t going to give that up for this guy. Unfortunately for the rest of the world, he was in nursing school so he could get higher pay for being a jerk to people who needed his care and understanding.

    Although thinking of those days brings the pain back again like it was yesterday, I am always glad that God has given me some physical challenges of my own so that empathy isn’t such a tough thing to give to my patients.


  • Shauna
    Shauna

    December 28, 2008 at 1:41 pm

    Dear Kim,

    I am filled with so much emotion after reading about empathy!! I stumbled on this post through Grand Rounds…This may sound odd, and I am NOT ringing my bell…but I was simply given Empathy in large doses, (I didn’t ASK for it!! ;-) ) and have had it overflowing my entire life, as far back as when I was 10 and wrote in my scrapbook that I wanted to be a surgeon. Ahhh the best laid plans….

    When I asked my mom at that same age to see her stitches after she had a radical mastectomy at the Mayo clinic in 1967, (and I mean RADICAL back then, 2 ribs out, half her chest gone…)and she, after asking me, “Are you sure honey?”, about 20 times, she lifted her gown to show me 2 inch wide; what looked to me like Frankenstein stitches…I cried for her with so much empathy even at such a young age…

    Being now both a chronic pain patient and a nurse, I have a double reason to give my patients their due amount of my empathy. I do not understand nurses that don’t have empathy, I know we ALL get busy, and that is just our profession, we are overwhelmed, too much charting, interruptions constantly; but when it comes to our patients, the empathy they NEED just comes from my heart so easily, no matter how busy, no matter what they are in for….and I am so happy to see your post and that you are advocating the one thing that nurses should be giving every patient, and that you too, are full with empathy!!

    I have read your blog for awhile now, and just have never commented. I will be back and make some darn noise for you!!! ;-) You write beautifully and from one nurse to another….

    GO EMPATHY!!!

    Much luv, and Happy New Year Kim,

    Shauna <3


  • [...] at Emergiblog offers a post on empathy she is particularly proud of—and once I read it, I could see why. A must-read, [...]


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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