In these days of a health care system that is increasingly orientated to the world of business, then perhaps we all need to be indentifying our unique selling point. Services, including those which deliver care to patients are increasingly subject to competition, they need to be cost effective, evidence based and all of that important stuff. We might not like the way this is heading, but actually there are some positives, it means that services are starting to run according to what patients need rather than what health care staff think they would like to provide. There will in the future be less possibility that a service could be offered on the basis of a whim of one or two individuals. So as a nurse what skills might I have that no one else does. If doctors can apparently be replaced by nurse practitioners / nurse specialists / nurse consultants then we as nurses can also be replaced by a cheaper or as some would say dumbed down version.
A post by The Shrink over at Lake Cocytus about communication skills got me thinking. As is often in the world of the blog, he got the idea for his post from a medical student, this is one of the great things about this kind of media in my view. As a student nurse my very first experience with people on a hospital ward was not to take a temperature or blood pressure, it was not to do a dressing, no we were instructed to sit at people’s bedsides and talk to them. This was really hard. We were the most novice of nursing students, we had a uniform but we had no actual task to perform. But that day stays with me, and now that I reflect on it, I would be as bold as to say that it has helped to make me into the nurse I became and the person I have become. Communication isn’t just about speaking, it is about being able to give time, to meet a person’s eyes, to wait while they take in and digest a difficult piece of news. It is about being able to pick up those non verbal cues, it is about being able to sign post the patient to the right person and about being able to point the doctor for example to the problem as experienced by a patient.
A patient was admitted with anaemia, can’t remember the underlying problem (it was a few years ago). I admitted the patient, filled out his paperwork, did his obs. He reported that he was a Jehovah’s Witness. I knew some of what this meant, but said little at this point. The doctor saw the patient and came back to the nurses station and wrote up a blood transfusion. I asked the doctor if he had discussed this with the patient? He said yes he had mentioned it. I suspected that he had told the patient what was to happen and the patient might not have understood what was was meant by it. I approached the patient and sat and had a conversation with him about the treatment proposed by the doctor. Not surprisingly he was not prepared to entertain the blood transfusion, but did want to be treated and didn’t want to seem difficult. Nothing I did was better than the doctor on that day, it was just different. I had the benefit of having admitted the patient, but also that our admission process asked questions that encouraged the patient to tell things from their point of view.
When as nurses we think we would like to more exciting things, to diagnose and to prescribe we need to remember the essence of what a nurse is. By all means learn new knowledge, develop new skills. But will the patient benefit and in what way? Will you be applying your new skills plus using the ones you developed in nursing school? Will you still have the time for those high level communication skills? Will you be able to pick up the non verbals? I have been a specialist nurse, I have taken on skills that average nurses do not perform but at the heart of what I have always done has been that special thing that a nurse is best at – communicating with the patient, identifying what the patient thinks and what the patient feels rather than what we think they should think and feel.
I might not work at the bedside in my current job, but actually I use those skills every day. They are what makes me able to say even to this day; I am a nurse and proud to be one.
