The Intensive Art

I love the quiet solitude of the world that welcomes me as I take the bus to work at 10:30pm for night shifts. Wrapped in my favorite fuzzy jacket, backpack beside me, iPod soothing me, and Tetley tea in hand, I watch the dark world zoom by. The hospital rises above its citadel overlooking the blackened lake as I get closer, the empty scaffolding from the half done expansion is lit only by the bright sign that advertises, “Emergency.”

The unit is dim as I arrive; someone has turned off most of the lights to help patients sleep. Peace, and an obvious lack of chaos greet me. I begin focusing on tasks. As I approach the end of my degree, I have noticed just how much nursing is about tasks. The main concern as I start my shift is what I will be doing, when I will be doing it, and how I will be doing it. I have a peace of paper on a clipboard that I diligently fill out with patient information. I make lists on it of what I need to do overnight–little crooked boxes are drawn beside each task, waiting for my checkmark that signifies it has been done.

But I know my task list is a little more flexible at night. During day/evening shift, time is an extremely hot commodity, and everything must be carefully timed and prioritized to ensure that nothing is missed. Something is always missed. Time always seems to run out. You always feel as though you have twelve hours of work to fit into an eight-hour shift.

I think prioritizing is one of the hardest skills to learn as you transition from student nurse to RN. As a student we have such different expectations. We have no “wiggle room” for prioritization; we are expected to do everything by the book, no omissions, and no short cuts. We miss breaks because we have four bed baths to do when most nurses would delegate to nursing attendants, we stay late because our charting needs to be four times more detailed than an RN’s. Every moment of our shift is scrutinized and judged, every action is expected to be perfect beyond imagination.

But on night shifts, I feel free of these pressures. I feel that I can be creative in how I go about my duties. I can bathe patients, take them for walks, get them food, but none are expected of me. I need to do vital signs and assessments, but I can judge when is the most appropriate time–before bed, or in the mornings. There is freedom, and within this freedom is power. There is nursing as I pictured it before I began my degree, because for some reason I did not foresee nurses as slaves to clocks, schedules, and routines.

I suppose I am saying that during the days and evenings nursing feels like a job while during the night nursing feels much more like an art.

I always like to do an assessment and a set of vital signs when I start my night shift, particularly if this is my first time caring for a patient assignment. This first round of checks is slower on nights. I take my time to check all the IV bags and lines, I restock, clean, and organize.

As I went about my duties this particular night, I was stopped in my tracks by a patient after finishing my assessment and vitals. He simply stated that he was glad that the doctors had finally planned a procedure for him. I hadn’t mentioned the doctor’s decision to perform a certain procedure because I wasn’t sure that the doctors had discussed it with him at this point. So, I probed further, asking him to tell me about the procedure. I was interested in knowing how well he understood the process so I would know what I could help him with in terms of teaching and preparation.

But as he began to talk, I realized that he wasn’t talking of facts or treatments, but of emotions and feelings. He described the events that began his time in hospital and how it progressed. He described his family’s reactions and his own. He told me how his wife was coping, and how she helped him during the ups and downs of the process.

After about fifteen minutes, I began thinking about my other patients and tried to break away from the conversation. It wasn’t easy to put closure on our conversation since every time I thought I was free to leave he would begin talking again. I began getting increasingly frustrated.

At this point he started talking about how scared he was and about his wife’s fears regarding his long-term prognosis. My thinking and feelings were changed entirely. I remembered that it was a night shift, and thankfully it offered me the chance to be creative—to practice the “art” or nursing. My frustrations melted away as I began to understand my true priorities better.

I grabbed a chair and sat down. The unit was dark and quiet except for a soft light above his bed and the sound of his voice as he told me his “story.” I stopped thinking about my other patients, knowing they would be fine if I took half an hour to listen. I knew that my schedule and list of tasks wouldn’t be jeopardized. I knew that by sitting and listening I was doing something that was potentially more important than making sure there was an extra bag of IV fluids in the room.

In nursing we are so incredibly focused on tasks that we forget that nursing is NOT a job. It is a career, and it is (I truly believe) an art form. Night shifts remind me of what I want nursing to be. I feel so strongly that day and evening shifts should have the same feeling of freedom and creativity. I have yet to finish nursing school and I feel burnt out by the regimented style of most shifts. I am crushed by overwhelming expectations to complete tasks that seem to take priority over taking true time to “be with” patients.

My feeling toward nursing is that each patient does not have a diagnosis or a treatment. Instead, they have a story (or what I have heard called an “illness narrative”). The patient’s story must be put at the centre of our practice with effort put toward discovering how the patient perceives the story’s characters (nurses, doctors, family) and events. Being able to understand the differences between each patient’s experiences, and knowing how to treat each patient differently as a result really is the art (and the heart and soul) of nursing.

The challenge is learning how to let go of the details and “busy work” that fills the day, reprioritizing, while still living up to our expectations as members of our team. An even bigger challenge is leaving the hospital proud of the work we did on a shift, knowing we made a true and positive difference in a patient’s story, and letting go of our need to feel validated by compliments from other nurses. If I did not have time to restock towels and IV bags in the patient’s room, and the oncoming nurse is upset, but the patient had time to talk through his hopes and fears regarding his upcoming surgery—I will make no apologies.

On this particular night shift, I left feeling incredibly proud of my work, and my new understanding of nursing.

This entry was posted on Sunday, September 24th, 2006 at 23:48 and is filed under Insights, Nurses, Nursing, Nursing school. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.