Sandra M. Nettina, MSN, APRN, BC, ANP 

Topics in Advanced Practice Nursing eJournal.  2005; 5 (2):  ©2005 Medscape

What Nurses Do

Have you ever called another nurse to find a physician? We all do. It's a well-known fact that the best way to find a doctor is through a nurse! We know that another nurse will advocate for us to find a physician who practices excellent medicine as well as compassionate caring and healing. In fact, we use other nurses to help us find doctors who are more like nurses .

Nurses do this not just for their friends and other nurses; nurses advocate for all patients. We take those in need under our wings, we steer them in the right direction, and sometimes we carry them every step of the way through pain, fear, and hopelessness of illness. We do this better than anybody else in the healthcare system. We do it whether we like the patient or not, whether we get a thank you or not, whether we're having a good day or not. We do it because this is who we are and what our nurturing souls naturally do.

And of course we get discouraged when we only hear whining and complaining, among the patients as well as our peers, when we hear no thank you, when we aren't witnessing positive outcomes, or when we really need a day off. But then we look deeper and we find that we have touched the heart and soul of another person. What other job provides that -- the ability to ease pain, take fear away, and bolster hope? I think parenting may be the only other one. How many professions can say that their job is as important as parenting? I am proud to say that I have done this very important job for 27 years. When I stop and think of the ways in which I have touched people's lives, it definitely keeps me going.

An Advocacy Story

Consider this story that someone sent to me as a Letter to the Editor.

Dear Editor,

In the editorial "Should Patients Expect More From Clinicians,"^[1] you give the following advice to your colleagues: "...be proactive in patient assessment and motivate your patients to expect the world of their healthcare providers." I wanted to stand up and give a rousing cheer for those sage words!

My enthusiastic response is a result of my experience navigating the healthcare system during the past 14 years, as a person who has systemic lupus as well as a researcher in the field of chronic illness.

From the beginning of my diagnosis, nurses, in various ways, have played active, important roles on my healthcare team. On many occasions, nurses, through their keen observations and assertiveness, have made significant and lasting contributions to my care.

I can best show you what I mean by telling you about a nurse I will call Ellen. She works on the neurology floor of the teaching hospital where I frequently stay. For months, every time I was hospitalized, my potassium levels were so low that I needed IV potassium. The first 2 times it happened, EKG machines were rushed in to make sure my heart was not affected. But there were no cardiac complications; except for bad leg cramps, I seemed to tolerate the decrease in potassium. Therefore, every time I came into the hospital, I was just loaded up with potassium and sent home. I asked one physician about the decreases in potassium, but I was just told to eat bananas. None of my physicians seemed concerned or even aware that there was a persistent problem.

Finally, Ellen said to me, "Melissa, I've noticed that every time you come in here you get a potassium drip. That isn't normal for your levels to drop like that. Have any of your doctors told you why this is happening?" I said no. She took it upon herself to talk to my doctors, and send in a nutritionist, who said, as Ellen thought she would, that I could not take in enough potassium by food to get the levels to where they should be. My physicians caring for me in the hospital remained generally unimpressed by the low potassium level as a chronic problem that needed to be investigated, but vaguely agreed that it would not be a bad idea to see my internist about it when I was discharged. Ellen, though, took me aside and insisted that I should pursue investigation and monitoring of my potassium level with my internist when I left the hospital.

I did as Ellen suggested and was put on a regular potassium supplement by my internist. She continues to watch over the blood levels, which still fluctuate but are much improved. My internist also tried to discover why my potassium level drops. She concluded that there were several culprits. Chronic diarrhea, severe at times, was first on the list. Medications (which could not be taken away) were also to blame.

And the letter goes on to describe other benefits of Ellen's intervention, such as less frequent seizures due to stable electrolytes, and a GI work-up that led to better control of chronic diarrhea.

Sandra M. Nettina, MSN, APRN, BC, ANP , Editor, Topics in Advanced Practice Nursing , West Friendship, Maryland.