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May 02

Is caring practice disappearing?

A nursing executive that I greatly admire told me a story the other day, and I have her permission to retell it here. She recounted to me how a newer staff member in her department sought her out to talk about something she had found upsetting and confusing. The staff member described a recent shift in the Emergency Department, where the triage nurse (a senior staff member) seemed to think it was acceptable to make people wait, even when they didn’t need to. When the newer staff member commented that she could immediately take a person with a small laceration back to a treatment area for suturing, the triage nurse instead told the person to “take a seat in the waiting room”, and admonished the other staff member for her behavior. She explained: “people can’t get used to using the ER as their personal physician office; it won’t hurt him to wait a while”.  The executive that related the story to me was most concerned that caring seemed to be disappearing from the profession, and we talked at length about the importance of nursing care, and nurse caring that can make such a difference in a patient’s experience, and in fact, in a patient’s overall health and recovery.

After our discussion, I wondered about something else. I wondered if this nurse felt justified in this behavior, because she is aware that one of the problems facing Emergency Departments is a scarcity of convenient, timely and responsive primary care. Punishing an individual patient for this system problem, however, makes about as much sense as trying to reduce unemployment by yelling at a homeless person (wait…didn’t one of our past premiers do that very thing? Don’t think it worked too well).  Not only is it a mean-spirited, unethical misdirection of energy and frustration, it actually has the potential to make the problem worse by reinforcing the public perception that our public health care system is not worth saving. We all work hard, and we all get frustrated at times because we feel that the system is under too much stress—even crumbling around us. But, just as the positive energy of caring has a beneficial effect on the health of the body, is it too idealistic to believe that perhaps we all have the potential to create positive energy within the body of the health care system? Is to too idealistic to believe that we could achieve positive system change by taking every opportunity in every interaction to preserve, protect and exercise the essence of nursing—human caring? Can we “care” for the system by directing our frustrations and energies in different directions? After 30 years in this profession–I continue to think that caring makes a small, and a very big—difference–at the individual level, and at the system level. 

I would really, really like to hear what you think.  Are the caring traditions of nursing quaint relics of the past? Is caring too “unscientific” to be part of evidence-informed practice? Can acts of caring influence the future of our system? Does “caring” have anything to do with health policy?

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