There are a lot of things about the health care system in the US that are deeply troubled, as well as deeply troubling, and it’s a system in urgent need of actual reform to improve access to health services for all people. And usually, when I’m discussing health care, I’m talking about the things that are wrong with it, but for once, I’d like to talk about something right: nurses.
The quality of care offered by nurses in the US is exceptional, key to patient outcomes, and worthy of much more attention than it usually gets, and this was really brought home to me in the wake of my father’s heart attack last year.
In my father’s interactions with his medical team, as well as my own interactions, I was really struck by the focus on patient care and empowerment from the nurses, including those in intensive care, cardiac telemetry, and on the home health service. All of his nurses actually bothered to get to know him, listened to him when he talked, made sure he was as comfortable as possible, and, critically, advocated for him within the larger medical system.
When his home health nurse suspected he had Clostridium difficile after coming home from the hospital, she kept pestering the doctor until he agreed to test for it. And when my father’s first course of antibiotics didn’t work, it was a home health nurse who gave him her private number and said to call if he had any questions or concerns, to make sure he would experience continuity of care. It was home health nurses, not his doctors, who called to check on him while he was in recovery at home even when they didn’t need to, and it was nurses in the hospital, not his doctors, who provided him with concrete information about what was going on and helped him make empowered decisions.
In my own interactions with the medical system, I’ve been struck time and again by the attentiveness and focus I get from nurses, versus brusque, rapid interactions from other medical personnel. Part of that is structural; thanks in part to shifts in policies at facilities like hospitals, patients commonly get assigned a nurse to monitor them precisely because of the need for continuity of care, and because nurses are best positioned to provide it. Meanwhile, doctors are under pressure to see as many patients as possible, which limits time for individual patient interactions, patient education, and personal interventions. Likewise, technicians are expected to process patients quickly.
But there’s also something intrinsic to nurses as well, here, that I think goes unrecognised. Nursing is about providing consistent, stable care to people who are under great strain, and may not be at their best. Whether you’re working in an emergency department, handling rapidly-changing situations, a variety of cases, and stressed-out, terrified people, or a surgical unit, supervising patients as they prepare for and return from surgery, you are working with people in an extremely intimate setting. You get to know your patients and their bodies because you have to, and subsequently, you have to enjoy developing such intimate relationships with your patients.
The doctor checks your surgical site and signs off on paperwork and maybe answers some quick questions, if you’re lucky. The nurse is the one who helps you suction your mouth, who holds the bedpan, who offers an arm when you want to try shuffling across the unit on unsteady feet. The nurse takes your vitals, draws blood, puts in intravenous lines, brings you something to drink when you feel thirsty. The nurse checks in to see if you’re too hot, too cold, experiencing any abnormal sensations, and it’s the nurse who has quick tips for dealing with your experience, based on years of patient interactions and training.
It’s the nurses I remember, not the doctors. Lying on the operating table while the premedications set in, it’s the voice of the circulating nurse I hear talking to the medical team as the anesthesiologist prepares to induce. Waking up, the first face I see is usually that of a nurse, and that’s the first voice I hear, too, a calm, measured voice telling me where I am and what’s going on, asking me to breathe, checking on my pain level. It’s nurse practitioners who provide a lot of my basic primary care, who get to know me as a patient, who know the quirks of my body and the realities of my life and ensure that I receive respectful treatment. It’s nurses who laugh at my jokes, because the doctor still isn’t in the room; the doctor is with another patient.
The care that nurses provide is unique, as simultaneous medical providers and patient advocates. I always want a ferocious nurse on my medical team, because as long as a nurse has my back, I know things are going to turn out in the end, even if it takes a while. I know my nurse will keep a sharp eye out for my welfare, and that my nurse understands the importance of all aspects of my health and emotional well-being, not just the issue that’s brought me for treatment on any given day.
I know it’s nurses who will go above and beyond for their patients any day of the week, and for that, I have immense appreciation.