I went to NTI in Denver, Colorado this last week.  For those of you that don’t know, it’s an annual national conference for critical care nurses.  And it’s awesome.

I went to a lot of sessions.  Some on brain death, some on vasoactive drips, on sepsis, and hyponatremia.. but the ones that hit me the hardest were the ones about end of life conversations and palliative care.  Those were the tough sessions.

It made me realize something.  We’re the nurse.  We’re running the show.  We’re in charge.  And for those traumatic situations that we see every day, we have our Nurse Face on.  Our tough-as-nails so we can live to fight another nursey day face.  And because it happens so frequently, you sort of have to do that as a survival tactic. Between constantly juggling our time management so that we can get everything done and not wanting to emotionally go there with the patient/their loved ones, we get sort of stuck.  Stuck at the bedside.

So there we stand.  At the patient’s bedside.  We’re busy working on drips, turns, assessments, and documentation.  But we can get lost in that.  Standing at the bedside is not the only place our patient needs us.  Sometimes, they need us sitting down next to them, listening.  Sometimes, they need us sitting down right next to their loved one, supporting them when the patient cannot.  Sometimes, that’s all they want.

As I was pondering this “sit down to stand up for your patient” concept, I was flipping through my Twitter feed.  Mark Reid, MD (@medicalaxioms) tweeted this:

“You know who comes in your house and never takes a seat? Cops. Don’t act like a cop in the patient’s room. Unless you are a cop.”

What perfect nuresy timing, doc!

How intimidating it must be for the patient and/or their loved ones to have someone towering over them, asking them questions about their history and not what they want the future to be like, and not really paying attention.  All the while, cutting them off because w’re thinking about the next 43 things we have to do.

Good nurses + doctors are empathetic and walk through this journey of life with their patients + their families.  We all know life is not perfect, but do we actually believe it?  Or do we try to get through life, striving for it to be perfect, healthy, and fine even when it’s unrealistic?  Even when our patients are knocking on death’s door and no one has told them yet?

We do a disservice to them by not asking them their goals of care.  We cannot just assume everyone’s goal is for their health is to just get “fixed” by all of our modern medicine and technological advancements and go back to whatever they were doing before they came in.  Maybe they don’t want that.  Maybe they’re tired and just need someone to tell them that it’s okay to stop.

We all want to optimize our journey.  However, everyone’s optimal life journey looks different.  The 19-year-old with a terminal heart condition is going to have a very different optimal life than the 35 -year-old triathlete.. and theirs will look different to the 89-year-old with COPD living alone with four hospital admissions already this year.  Everyone’s goals are going to be different and we need to know this so we can not only support them appropriately, but also so we can just plain do what they want us to.  But we have to ask first.  Before they’ve been in the hospital for days, weeks, or even months.

I also think it is our duty as honest health care professionals to be realistic with our patients and their families, even if they are in denial.  We need to be their graceful and supportive reality check.  And for them to be able to hear about the reality of the situation in front of them, they need to trust us and feel a connection with us.  We can (sometimes even quickly) establish this relationship by being empathetic.  Not by trying to fix things or make them immediately feel better, but just by connecting with them.

For those of you that don’t fully understand the difference between sympathy and empathy, check out this 2:45 minute video that explains it the simplest yet most helpful way.  It really helped me differentiate between the two because I didn’t understand it before.

When patients and their loved ones know and believe that you empathize with them and are being truthful, that will enable them to make sound decisions for themselves and their loved ones, even in the midst of chaos.

And as stressed medical providers, isn’t that’s all we want?  To know that we’re doing the right thing?  We all know what the right thing is – it’s a mix between what the patient wants but it’s also what we truly believe is right.  And if we’ve built a trusting relationship with them and their loved ones and we have no doubt we are honoring their decision (that was made because they knew all of the facts and felt supported), it typically will align with what we believe is right as well.

If from the moment we meet our patient, we empathize, connect, and listen to them while gracefully explaining the reality of what’s going on – and immediately identify and agree on realistic goals, we will avoid doing a lot of unnecessary things.  We can all rest assured that we are all fighting the same fight, working together towards the same goal.

This will avoid moral distress for the nursing staff and medical team because we know we’re doing the right thing.  And not to play the money card, but we and our patients can avoid paying for a bunch of things they didn’t really need or want in the first place.

Truthfully, we can all benefit from this.  And I think it is our duty at health care professionals and human beings to provide it every single time.

Have you ever had a situation that could have been avoided by some goals and support from day one?  Are you a palliative care pro and have some insight?  Please, comment and share below!  I’d love to hear your story!