Jill wakes up at 5:00 am on Wednesday, showers, gets the kids off to school, and makes a 35 minute commute to the large metropolitan hospital where she works. 

By 7:00, she is reviewing her four patients’ electronic medical records for updates in their lab work, and x-rays.  By 7:15, she gets report from the night nurse.  Three of her four patients are stable, but the 42 year old man in room 370 began having chest pain at 7:05 and the oral Nitroglycerin and IV Morphine are not helping the pain.  Jill immediately goes to the patient’s room to assess him.  Blood pressure and pulse are stable and his heart monitor shows normal sinus rhythm.  But Jill has many years of experience as a nurse, and intuitively knows that her patient is not “stable”.  She orders a stat EKG and pages the doctor. 

The doctor arrives and reads the EKG report.  “The patient is having an MI (myocardial infarction or heart attack) and we need to get him to the cath lab.”  Jill starts an IV and readies the patient for the cath lab.  By 7:40, the patient has left and she turns her attention to her three other patients.

Mrs. M has just received word that the pain she has been having in her lower chest is pancreatic cancer.  She is relatively young, just 49 years old.  Jill walks in just as the doctor has left.  Mrs. M. is crying and can’t believe what she has just heard.  Although Jill needs to get all of her assessments done and pass the 8:00 medications, she quietly sits on Mrs. M.’s bed and holds her hand.  She asks Mrs. M. if she’d like to talk with the chaplain.  She calls in the chaplain and tells Mrs. M. to call her if there’s anything else she can do.

It is now 8:10 and one of her other patients, Mr. C. has his call light on.  He asks her, “Where are my 8:00 pills?  I always take my pills at 8:00 sharp.”  She tells him she will go them now but first she needs to check him over.  He then says “I need to use the commode, can you help me?”  She happily obliges, and while he is on the commode, the nursing assistant comes in and tells her one of her patients has just fallen while trying to get to the bath room.

She asks the nursing assistant to sit with Mr. C. and she goes to check on the patient that has fallen.  The patient insists she is fine, so Jill helps her back to bed and calls the doctor.  She then readies the patient for x-ray so the doctor can see if she has broken any bones in the fall.  She reminds herself that she will need to complete an incident report.

It is now 8:30, and the family members have gathered with Mrs. M. and they would like to speak with the doctor.  Jill pages the doctor and asks him to come and speak with the family.  The family has many questions, and Jill answers what she is able to until the MD arrives.

She then turns her attention back to Mr. C.  She brings him his pills and he begins to tell her story about his life during World War II.  She patiently listens and then tells him she needs to go check on her other patients.

The lady who has fallen has returned from x-ray, and thankfully, she has no broken bones.  However, the doctor was just in and wrote orders for orthostatic blood pressure readings to try to determine the cause of her fall.  Jill records the numbers and returns to the desk to start some charting.

At 10:05, she gets a call from the cath lab stating that the patient will need to have a coronary artery bypass tomorrow morning.  He returns to the room and is quite anxious.
She stops to reassure him and talk to him briefly about the surgery, promising to come in later and do the patient teaching in preparation for the surgery.

Jill then helps the nursing assistant with bathing, oral hygiene, and ambulation of her patients.  By 11:30, she is “starving” and goes to the break room to eat her lunch.  At 11:35, Mr. C. goes into ventricular fibrillation, and a Code Blue is called.  She rushes out to his room, knowing that this will be a “no break” day. 

This story is not an exaggeration.  It is part of every day life for a nurse working in a critical area. 

You can see why the job description is “Patient Listener, Assessor, Medication Administrator, Defibrillator, Teacher, Critical Thinker, Vital Signs Taker, Bather, Mother, Ambulator, Documenter, and Counselor,” and all before noon on a “regular” workday!

Prior to becoming a nurse, many individuals view the profession of nursing as an exciting and often alluring career. However, after years of practicing in nursing, the nurse often loses site of the true meaning of being a nurse.  With this loss, the everyday duties of passing medications, charting and procedures, in addition to the long hours become the primary focal point of “the job”. Yes, the profession of a nurse includes responsibilities such as bedpans and dressing changes, but there is so much more to this profession.

Being a nurse is one of the greatest privileges bestowed. A nurse is allowed into the lives and most inner thoughts and feelings of the patients, families and significant others they are entrusted to care for. Of course there will always be those days that are not so glamorous or attractive. But at the end of the day the nurse must ask themselves, what are the most important aspirations in life?

With this in mind, I am always brought back to the following poem:

Being A Nurse Means…..

You will never be bored.
You will always be frustrated.
You will be surrounded by challenge.
So much to do and so little time.
You will carry immense responsibilities
and very little authority.
You will step into people’s lives
and you will make a difference.
Some will bless you ~ Some will curse you.
You will see people at their worst
and at their best.
You will never cease to be amazed
at peoples capacity for
Love, Courage and Endurance.
You will see life end ~ and begin.
You will experience resounding triumphs
and some devastating failures.
You will cry a lot ~ you will laugh a lot.
You will know what it is to be human
and to be humane.

   ~ Melodie Chenevert

What a wonderful, rewarding and challenging profession!!! 

From co-Author:

Martha Hayton, MSN, ARNP-C, CWS
Director, Practical Nursing Program
Pasco County Campus

Nursing is such an interesting profession.  Sometimes it is filled with the tragedy and frailty of human life.  It can be so sad when a loved one dies, or a young person is permanently injured or scarred for life from medical treatments. 

I began my nursing career working in oncology.  My family didn’t understand why I would choose such a depressing place.  I never did find it depressing.  I found it to be full of caring people and funny people too.

I think it always helps to recognize that humans are funny and the medical profession provides great opportunities for humor.  I mean really, where else but hospitals would you share a room with a complete strange, wear a backless gowns and discuss bodily functions over lunch?

Some of my fondest memories in my career happen to also be the funniest.  Perhaps the one that can make me smile or chuckle on a really gray dismal day is how we coped with a really serious situation.  We had a young patient who had a rare type of cancer and it spread to the pericardium.  He was about to undergo placing a catheter into his pericardium in order to receive experimental chemotherapy.  He went off to surgery and we nurses prepared the room for his return; had an open surgical bed, oxygen, heart monitors and IVs at the ready. 

We got the phone call from surgery saying the “Heart’ was on its way up to us.  Everyone scurried to be ready to transfer the patient back to the bed.  Nurse’s were standing by the doorways and had the halls cleared because the “Heart was coming.”  You can almost hear the marching of the nurse’s feet as they pushed the gurney on to the unit: bappity, bap, bap, bappity bap bap. And there was my friend.  In preparation for the “Heart”, she had taken two oxygen masks, tied them together and draped them over her ears; she donned her shades, and grabbed two flashlights.  With her skillful direction as an aircraft landing technician, she waved the gurney onto the unit and into the room across from the desk.  Any airplane could have landed safely under her care.  The nurses and the surgeon could hardly contain themselves to get the chuckling patient into bed. 

I am sure other nurses can tell the tales of what they find to be funny.  That humor has a great way of reducing the stress during what can be a tense time.  Humor is sometimes a difficult medium to use when in stress because one has to be careful not to offend others or make them the butt of jokes.  Here is another example of how a stressful situation became less stressful.

I cared for a lady who had a colostomy as a result of cancer.  She was having problems getting her appliance to stick and her skin was an excoriated mess of raw red painful tissue.  To make matters worse, she had diarrhea and we while we worked on maintaining her fluids and electrolytes, she continued to have problems.  She put her call light on when the bag exploded in a mess.  I sighed and went to help her get cleaned up.  I worked hard and had her all neat and clean, fluffed and puffed when it happened. 

She exploded again.  She wanted to cry.  We started over yet again. 

Finally, I was preparing to leave the room with my armful of soiled linen, and you guessed it.  Explosion!  Massive amounts of brown goop everywhere!  She uttered a four letter word that begins with S.  I could only reply back, “Yep.  That’s what it is.”  The patient looked startled when I agreed with her assessment.  Pretty soon she was laughing out loud at how ridiculous it had become.  Soon she had the appliance on and I was through changing linen.  Fortunately for the both of us, it was the final linen change of the evening.

Nurses have to be able to remain calm in emergencies and able to be compassionate when the time is right.  Most importantly, they need to have a sense of humor in order to provide care across the continuum of human emotions. 

Laughter can reduce stress and lighten workloads.  It also provides a great way to make nursing a fun career.

From Co-Author:

Cheryl Pratt, RN, MA, CNAA
Practical Nursing Director
Mankato Campus

As nurses and nursing students, we take pride in being part of a helping profession.  As a former critical care nurse, I enjoyed the “adrenalin rush” of knowing that I had helped save a patient’s life.  The joy in nursing is realizing you have made a difference in someone’s life or the life of their loved one.

But what are professional boundaries, and how do we know if we have crossed them?

On Thanksgiving Day several years ago, I was working a very hectic day shift in the ICU.   Throughout the day, I was thinking about getting home to my family and enjoying turkey dinner with them.  As I spoke about this to another nurse during my break time, she told me that she was planning on staying late and eating dinner with a patient, instead of going home to her family.  When I asked why, she said that the patient’s family had asked her to join them, and she didn’t know how to say no. At the time I thought, “How could I be so selfish in wanting to spend time with my family instead of with a patient?”  It wasn’t until years later that I realized that my thoughts were actually “healthy”. 

Many times in nursing, we want to be the savior, and we want everyone to think we are kind and giving all of the time. But we need to realize, we are human, and we have our own needs.  It IS important to be professional, compassionate, dutiful, and competent at work, but it is okay to set limits. By denying our own needs, we can become resentful, “burned out”, and fall into the bottomless pit of feeling like we are in a thankless job.  A few years later, I learned that this nurse had left nursing all together.  I was not surprised.  She had a pattern of using patients to meet her own needs for approval and acceptance and felt that if she said “no”, patients wouldn’t like her.

Maintaining professional boundaries means practicing nursing in accordance with the Nurse Practice Act.  It has occurred to me many times throughout my career, that nurses may not even be familiar with the document that guides their profession.  As student nurses, you will need to follow the guidelines set forth in the Nurse Practice Act.  It will help you to understand your professional role as a nurse and how your behavior affects the vulnerable role of the patient.

But how do you know if you have crossed professional boundaries with a patient? 

As a student nurse, here are some questions to ask yourself: 

Do you give your home phone number or cell phone number to patients or families?

Do you tell patients or families details about your private life such as the state of your marriage or your “difficult” nursing instructor?

Do you ask your patient personal questions that having nothing to do with the medical care or condition you are treating?

Do you go above and beyond for a patient in hopes that they will tell you that “you are the best student nurse they ever had” or to put it another way, do you seek approval from your patients?

Do you think about a patient constantly when you are not at your clinicals?  Do you wonder if any other student nurse can give your patient the excellent care that only you can provide?

Do your actions do more to meet your own needs instead of the patient’s?

If you answered yes to any of these questions, I would suggest that you review the Nurse Practice Act as well as talk to a trusted instructor or nurse mentor.  You will want to avoid the pitfalls of going “above and beyond the call of duty”.  Without the “emotional baggage” of crossing professional boundaries, you can then become the competent, empathic, and most of all, professional, nurse that you wish to become!

From Co-Author:

Kathleen Wedin, RN, BSN 
Associate Director of Nursing 
Brooklyn Park Campus