October 8, 2008, 12:21 pm

Are You “Just” a Nurse?

Whoa.

Excuse me while I get my smelling salts!

A veritable cornucopia of nursing caps!

I love it!

I see about ten I would wear, and some that are beyond the pale!

One looks like a gas station attendant should have it on (circa 1950s) and one looks like a paper airplane. There is one in the middle, third row from the top, that looks like conjoined caps. Methinks the designer must have been chemically impaired!

I still like my own cap the best!

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

My forays into recent BlogWorld and ENA conferences have left me with a plethora of ideas and inspiration. This post is one of them, directly inspired by the keynote speaker at the ENA Scientific Assembly in Minneapolis, Dr. Joseph Michelli, PhD.

**********

For some reason, I am occasionally mistaken for the doctor. I’ve overheard it happen to colleagues.

And if I hear the phrase, “Oh, no, I’m just the nurse” one more time, I am going to explode.

But then I started thinking, are you “just” a nurse?

***

“Just-a-Nurse” is competent. They come in, they do their job. They do it safely, they do it correctly and then they go home. They are on-the-clock until they are off-the-clock. “Just-a-Nurse” goes through the motions. They look like a nurse, they act like a nurse and they do the work of a nurse. Their goal is to get through the tasks of nursing. That’s their job. Whether they like it or not.

Or is it?

I guess it depends on your definition of nursing.

Nursing is something you do for and/or with a patient. It’s not something that you do to a patient. The former requires that you become engaged in what you are doing and engaged with the patient. The latter is simply the quickest way to complete a task so you can turn the bed over to the next patient.

My trust Mac widget dictionary defines “engage” as “establish a meaningful contact or connection with” a person. Is that not what professional nurses do when they care for a patient?

“Just-a-Nurse” cares about getting the work done. A professional nurse cares about the focus of the work – the patient.

The professional nurse engages the patient.

*****

It doesn’t happen spontaneously.

It takes an active, personal decision to commit to being engaged. As nurses, we are responsible for that commitment, because it makes for a better experience for the patient.

It’s not as easy as it sounds.

We are caught between two competing forces. On the one hand, we are supposed to work faster and move the patients through quickly to either save money or make money. On the other hand, a very high value is placed on patient satisfaction. Some may even believe that one leads to the other.

They’re wrong.

Patient satisfaction scores are related to the level of engagement of the nursing staff. Competence is great, but when you engage a patient, when you embrace the task at hand and tailor it specifically to that patient, you create an experience for that patient.

You make them feel valued. A patient who feels valued is a satisfied patient. Isn’t that our goal as nurses?

But, in engaging the patient, you are doing something else. You are engaging the profession. And when you engage the profession, you automatically engage the patient because that is what professional nurses do. It becomes a feed-back loop.

*****

This message resonated with me because I spent many a year of my career as “Just-a-Nurse”, and it had nothing to do with where I stood on Benner’s novice-to-expert continuum. Usually it meant the arrival of burn-out and/or time to make a change.

A professional nurse needs to be engaged with their profession, leading to engagement with their patients.

How much responsibility are we taking for the state of the nursing profession? The answer lies in how engaged we decide to be.

So…at this point in time, are you “Just-a-Nurse” who can’t wait to punch out for the day or a professional nurse engaged making your patients feel valued?

It’s a conscious decision.

A decision we make every day of our career.

20 Comments

  • Healthcare Today
    Healthcare Today

    October 8, 2008 at 12:22 pm

    Are You “Just” a Nurse? // Emergiblog…

    Are you “Just-a-Nurse” or are you a professional nurse? A look at what makes a professional nurse….


  • Candy
    Candy

    October 8, 2008 at 10:49 pm

    AMEN!
    For followers of Maria O’Rourke, DNSc, RN, FAAN, CHC, this idea is nothing new. It’s based on professional role development.

    She says you cannot change the standard of care if you don’t change the standard of practice. And you can’t change the standard of
    practice unless you know what to do when you show up. That can’t happen until nurses know their own professional roles, then act on that knowledge. Nures have to use their role and deliver their practice so the patient is better for having met them.

    She said, “If you want to change patient outcomes, you must change your conversations.”

    Sure sounds like being engaged to me!


  • Sukhee
    Sukhee

    October 9, 2008 at 12:12 am

    I have less than one year RN experience, and I gonna restart my RN career next Monday. Your questioning is really challenging my new start as RN. I don’t think I want to be a “Just a nurse”. So, I’m gonna keep the definition of your professioanl nurse in my mind. “The professional nurse engages the patient.” As you mentioned, I know it’s not as easy as it sounds. I believe that’s why our nurses’ role is important and valuable. Thank your for your challengeable questioning regarding “Just a nurse”.


  • angelomercy
    angelomercy

    October 9, 2008 at 3:39 am

    I loved the article. In my own personal nursing experience far too few nurses truly ingage and care about their patients. A whole lot of the care has gone out of health


  • Comedy Writer Jerry Perisho
    Comedy Writer Jerry Perisho

    October 9, 2008 at 7:31 am

    As a cancer patient who recently had his prostate removed, I want to tell you how much my nurses meant to me. They were caring and kind, and made a scary hospital stay quite tolerable.

    But, when pathologists discovered that my cancer had spread beyond my prostate and I began 18 weeks of chemotherapy, the nursing profession took on a whole new importance in my life. As quasi-psychologists, the oncology nurses I got to know were comforting, smart and skilled. Thank God that nurses have chosen this outstanding profession.

    On behalf of patients everywhere who forget to tell you, are too sick to tell you, or are too selfish to tell you, THANK YOU for your outstanding service!

    Jerry Perisho


  • James Hubbard, M.D., M.P.H.
    James Hubbard, M.D., M.P.H.

    October 9, 2008 at 8:01 am

    Nurses run hospitals. They are professionals who, not only save lives, but improve the quality of most they come in contact with.

    Not only are you not “just” a nurse, that thinking keeps you from being your best.


  • runningwildly
    runningwildly

    October 9, 2008 at 9:13 pm

    What a fabulous post. This was so inspiring! I love your description of what happens when you engage your patients. So fantastic. I try to emulate that too. Well said, all around.


  • Mary Lu
    Mary Lu

    October 9, 2008 at 11:18 pm

    Hey Kim,

    TO you and the rest of your nurses out there, today’s my day to say Thank you. You see today I had to go in and have surgery on a GI problem that came up about 6 weeks ago– Instead of going to the local hospital where Dr Doug is known, I opted for the new local GI surgical center which is owned and operated by a group of local doctors and nurses (yes nurses own a reasonable percentage of the center–) who found the local hospitals not up to their standards of care, which appears to be way beyond TJC’s standards.

    From the moment I put my foot in the door until the moment they loaded my fanny back into the car to go home, I couldn’t have asked for better care. Even Dr. Doug was a little surprised.

    This “team” took the time to ask about my previous medical problems and really wanted details. They asked if they could make me more comfortable. (Pain is a four letter word with these RNs.) All the precautions were taken to insure I was comfortable, safe, warm and secure. Even “my” RN who did my IV (and stayed with me through the whole proceedure,) took the time to give me the choice to pick the best site location for me and for her to administer the meds! And much to my surprise came back after surgery at least twice to make sure I hadn’t bruised or had any complications.

    And when my mind was still about as fuzzy as a mudpuddle and they were going to give me my discharge orders, I put up my hand and said, Please go get Dr. D! I won’t remember sh!t! They were more than happy to bring him back and go over all the details and bring the doctor back to go over the surgery with him– ALL WITHOUT ONE MUTTER OR BITCH! If I’d had a clear head about that time I’d have awarded them the Malcolm Baldrige Award for Customer Service on the spot!

    But it didn’t end there– four hours after I got home, they called to check on me and made sure Dr Doug had the 24 hour ER number (again,) should I have any problems.

    Every nurse there exhibited the type of caring professional attitude, and patient first mentality. If I were still in Michigan I would have hired all of them to work in my old hospital in a heartbeat!

    Thanks to all of you for caring!


  • annemiek
    annemiek

    October 10, 2008 at 5:06 am

    I don’t think there is ever a thing called ‘just a nurse’. Even if you can’t be as engaged with a patient as you like to be, because you you have 5 other confused patients climbing out of bed, it might look like you are just doing the basics, like keeping a patient from crashing, you are never just a nurse.


  • Joseph A Michelli
    Joseph A Michelli

    October 10, 2008 at 10:06 pm

    You are certainly not “just a nurse” Kim. You are engaged in your patients lives, and that is how you ‘set the standard.’ I am humbled that my presentation at the ENA conference inspired you. – Joseph A Michelli, Author “The New Gold Standard” and “The Starbucks Experience.”


  • T.
    T.

    October 11, 2008 at 3:54 am

    What a terrific post. Thank you for this, and for your engagement with your patients that surely makes all the difference. We get it in anesthesia too, usually from other people, though, rather than ourselves – “Oh, she’s just the anesthesiologist.” It burns me because I think the LANGUAGE we use, about ourselves and each other, both reflects AND defines our reality. Thank you for reminding us all of that.


  • Strong One
    Strong One

    October 11, 2008 at 9:05 am

    I never use the word ‘just’. I do answer, no i’m not the doctor, and I AM the nurse.
    Those who need us, know us. And those who know us, know the difference.
    🙂


  • anonymous
    anonymous

    October 11, 2008 at 4:14 pm

    Kim, how true your words. I sometimes observe nurses “interacting” with patients and I wonder why the heck they became nurses. They seem like task-completing robots who are there to take home a paycheck. Where I live and practice, because there is a nursing shortage and nursing is one of the higher paying jobs in the area, with a local college offering an inexpensive 2-year nursing program,people are attracted to nursing for not neccesarily the best reasons. Your comment on where you may or may not have been on the novice to expert continuum is right-on although I do think that it takes a new nurse some time in actual practice to understand and practice the engagement process. I agree 100% that a nurse has to be engaged with the profession in order to engage with patients. It clicked for me as a new nurse when I switched jobs from a small community hospital with “old school” nursing administration whose main concern with staff was getting bodies on the floor and keeping physicians happy to a larger academic hospital where nursing administration had true power in the institution, valued and supported professional nursing and had a strong focus on mentoring newer nurses. It was in that environment that I learned the skill of engagement and how powerful and important it is. I’ve been practicing as an NP for almost 20 years now, I practice both in the hospital and in the clinic and I believe that as a nurse, you cannot hope to help bring about positive change in a person’s life, whether the task is getting healthier or learning to cope in a positive way with a difficult prognosis unless you are able to engage with that person, communicating respect and the desire to know them as an individual, what their beliefs are, what they value, what their fears, challenges and goals are. We who know how to engage have a responsibility to our profession to mentor these abilities.


  • Tracey
    Tracey

    October 11, 2008 at 8:07 pm

    Kim,
    Thanks for this post. There are so many out there that are “just nurses” and many don’t know they are that! I see so many that I call minimalists…they want to do the least possible to get though their shift and to get to the paycheck at the end of the week. While not dangerous, not caring either. Not sure why they even are nurses.

    IMO nursing is a privledge and an honor. I’m glad to be one!

    Tracey
    nighttimenursing.blogspot.com


  • Carol
    Carol

    October 12, 2008 at 4:35 pm

    Institutions no longer support the professional nurse. I couldn’t be “just a nurse” so I chose to retire early.


  • kikam yun
    kikam yun

    October 13, 2008 at 10:20 am

    um…. first of all, this is a really challenging post for me. “just nurse” brings lots of things to me as a brand new nurse. I should consider myself as a professional nurse.


  • […] Nursing school instructors cringe when they hear the phrase, “I’m just a nurse.” Back when I was in school, it didn’t matter whether a nurse ran the hospital autoclave or worked in ICU. Everyone understood that we all played a vital role in patient care, and we took great pride in the nursing profession. Kim from Emergiblog isn’t a fan of the phrase either. Read her post and decide whether you are just a nurse. […]


  • Mer
    Mer

    November 12, 2008 at 4:42 pm

    Here’s a quote that I keep in my mind always. It applies to all of us, but I think nurses may find it especially inspiring. It from the famous German writer, Goethe:

    “I have come to the frightening conclusion that I am the decisive element. It is my personal approach that creates the climate. It is my daily mood that makes the weather. I possess tremendous power to make life miserable or joyous. I can be a tool of torture or an instrument of inspiration, I can humiliate or humor, hurt or heal. In all situations, it is my response that decides whether a crisis is escalated or de-escalated, and a person is humanized or de-humanized.”

    Nurse — Keep this quote with you always. You represent the foundation of patient wellness and safety. You’re an advocate and you can make all the difference. Never forget that — and don’t let anyone make you feel that you’re anything less than essential. Our very lives as patients depend upon you. When we enter hospitals we are often vulnerable, frightened, and naked in a world alien to us. You’re the people who have the power to help us feel more comfortable and safe.
    Goethe’s quote does represent a “frightening conclusion,” and you nurses are the “decesive element.” Never forget it.


  • Gayle
    Gayle

    November 12, 2008 at 7:32 pm

    Loved the post! It really made me think. The important thing for all of us is to realize when we are “just a nurse.” When I’m feeling this way I know it’s time to move on. This time (late in my career) I left the hospital to work in an outpatient setting and VOILA! I’m no longer just a nurse. Again, thanks for the thought provoking post.


  • […] Here are some of the recent blog posts concerning the statement ‘just a nurse’: Emergiblog […]


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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