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When I was in nursing school, I used to think about what kind of nurse I wanted to be. My only previous experience with nurses before I stepped into my clinical rotations was my aunt and some other family members. As a guy walking into a female dominated profession, I really didn’t have too many role models. In my career thus far, I’ve been blessed to have worked with many I consider role models. Everyone from doctors to nurse’s aides, patient care technicians to paramedics have played a positive role in my development as a nurse. These may not all be nurses, but I believe that each person we come into contact with has some sort of purpose in our life. We can take positive qualities we see and internalize them for our own benefit. We can use them as models for good behaviors we want to develop.

I’ve often wondered what makes a nurse excellent. If we could look at the best and brightest RNs and compile all the qualities that make them excellent, what would we choose for ourselves? The question we should be asking is what qualities or intangibles makes a nurse “role model” worthy. What is it that makes a nurse, in your own eyes, someone that you want to be? In retrospect, when I place my role models side by side, I’ve tried to analyze what draws me to them. What do they have that I wish to be?

So, in Stephen Covey-like fashion (Stephen Covey is the author of the popular motivational/self-help book, “The 7 Habits of Highly Effective People”). These are the “habits” or at least, the qualities that I consider excellent nurses to have. Those whom I consider my role models are very different in a superficial sense, but at the core of their professional practice, they have these 8 qualities. Their practice, in my opinion, blends the art and science of nursing together and synergistically makes an awesome nurse.

Here’s my list of the 8 qualities that make an excellent nurse. Go on, feel free to debate and discuss. If you want to add anything or subtract anything, I welcome you to comment.

1. An expansive knowledge base of the hard sciences (i.e. chemistry, anatomy and physiology, pathophysiology, microbiology, etc) – At its core, the profession of nursing is grounded in the study of these hard sciences. This is the big stuff you gotta know! It’s how we are able to explain what happens to the body when a person has a heart attack or why having a low or high potassium level is serious or how squiggly lines make up an abnormal EKG. The excellent nurse is able to understand these hard sciences and make these complex terms easy enough so that a child can understand them.

2. Savvy of the soft sciences (sociology, psychology, etc.) – The academic world considers subject matter like sociology or psychology, “soft sciences.” However, these soft sciences present hard obstacles when taking care of patients. Understanding that illegal immigrants are a population of patients with external issues that contribute to their disease process is a sociological issue that can become a big time barrier in someone’s health. Understanding that addiction has many deep seeded psychological components ranging from depression to personality disorder allows a nurse to be mindful in the care of someone any other person would call a “junkie.” In my opinion the excellent RN is mindful of the principles these “soft” sciences teach and realizes that they are interwoven with all the hard scientific diseases people come with. An excellent nurse is aware and is able to navigate the challenges such issues present

3. Savvy of the legal and ethical principles of health care - Unfortunately, in this country and in these times, we are a lawsuit happy, litigious society. At times it seems as though the laws that govern health care aren’t really there to help people or regulate health care. They act more like barriers to than aides. Every RN, role model or not, from the day I first stepped foot onto clinical has told me to practice with three words, “cover your ass.” In the spirit of the times, we as nurses should take no chances with our license to practice. Every nurse has told me three things with respect to the legalities of health care; document everything, protect yourself through your documentation, and less is more (meaning the more you say, the more can be held against you). Those that I consider my role models have the strictest discipline when it comes to their documentation.

4. Savvy of institutional policy and practice – Plain and simple, the nurses that I consider to stand head and shoulders above the rest, know what their institution has in place when it comes to policy and what is expected of them when it comes to practice. More often than not, these nurses exceed expectations and go on to re-write policy and practice. These are the guys on the floor or on the unit who just get sh*t done! They know “how” to work. They know what management and administration expects of them and the administration goes to these people to champion their policies.

5. Establishes a balance between professionalism and friendship – I respect a nurse who has strong clinical skills and a heart for what they do, but if you follow professionalism to the letter you’re going to have the personality of a wet doormat and you aren’t going to go anywhere. An excellent nurse is also an excellent teammate. The bonds forged among nurses, especially in the ER, are very strong (that isn’t to say that being an L&D nurse or medical-surgical nurse means you don’t have a good team or strong bonds, this is just my experience). Look at the crap we have to deal with on a daily basis. We handle the front line of the hospital. We get people at their very worst! Sometimes, shifts drive us to drink, literally! Excellent is the nurse who can have a cold, adult beverage and share it with their colleagues while talking about how awful a shift turned out to be. The excellent nurse uses this time, not just to relax and unwind, but to find out about the person next to you on your shift. The person on shift with you isn’t just some nurse. He or she is a father or mother, with issues and complexities that make them unique. Being an excellent nurse means acknowledging the personal things that an individual brings to this profession. It can’t be all business. The nurses I consider the best always get invited by others to personal/family functions. They’re always invited out to stuff. It has nothing to do with their clinical and professional prowess, but everything to do with the fact that another person sees you as another person and values your individuality.

6. Knowing how to multi-task – If you didn’t learn how to do this when you graduated from nursing school. Please consider another career. This is about as self-explanatory as it will get. Whether you’re an excellent nurse or a crappy, half-ass nurse who got their degree from a cereal box, you better know how to do this.

7. Staying calm under pressure - You know in nursing school when they would say, a patient’s life is in your hands? When that moment comes, where life is literally in your hands you need to be poised and calm and most of all prepared. Situations can escalate to a level of intensity that can break you. The best thing anyone can do in a truly emergent situation is be calm. It’s a proven fact that the higher our anxiety level rises, our ability to function deteriorates. Those nurses I’m talking about can laugh through a code and display the morbid sense of humor we nurses sometimes have. However, it is their little chuckle or humorous insight into a situation that puts everyone at ease and allows us to save a life during a life-threatening situation.

8. A heart and passion for service – So, bold statement… You know why the phenomenon of burn out in nursing occurs. In my opinion, it isn’t because nurses are overtired, overworked, and underpaid. Nurses have been overtired, overworked, and underpaid since the days of Florence Nightingale. It’s because at some point their “why” wasn’t strong enough to withstand all the bad stuff that can happen to you in this profession. When I say “why” I mean the reason you decided to pursue this profession as a career. Most nurses lose what got them excited about this profession and gave them a sense of pride coming to work. If you don’t have the heart and passion to do this job, it will eat you alive. That is not a catch phrase, I’ve seen this happen to some nurses I thought were the best and brightest. They’d leave the institution and years later I would find them, reconnect, and find out that they quit nursing completely. To those people who are reading this and you aren’t nurses and think that nursing is an easy job, you’re dead wrong. I challenge you to put on a pair of scrubs and walk in our shoes for one shift. Knowing your “why” will outlast the amount of times a patient spills some type of infected body fluid on you. Your “why” will endure all the weekends you have to work when everyone is out on a beautiful spring day and you’re stuck at work. Your “why” will endure budget cuts, spending cuts, pay cuts, and layoffs and all the other administrative crap your institution deals you. If you don’t walk into this profession with the idea that serving others is your duty as a human being; if service isn’t your calling and you decide to walk into this profession, you are going to get run over. Having the heart and passion to serve others is what truly separates good nurses from great nurses. It separates workers on shift from those that heal with their heart and hands. Heart and passion is what brings together the art and science of nursing and it is how we should practice.

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For those of you that don’t know, I am a nurse, by day – blogger by night. Actually, I work nights now, so that would make me a blogger by day and a nurse by night. I know what you guys are thinking… Get your Ben Stiller, “Gaylord Focker” jokes out of the way, now! Regardless, I work in the Emergency Room and it would be an understatement to say that you see quite a few interesting things. I always say to anyone who asks the question, “what’s it like?” ; I always say on a daily basis, I see the worst of humanity, but I’ve also seen the best of humanity. I’ve seen babies come in that have been abused by their parent’s; the elderly neglected and basically, left to rot like food; and I’ve seen women who have been sexually abused and raped by people they consider their boyfriends. Just when you’ve had your fill of the crap that humanity can dish out; something positive actually happens. I’ve seen babies born to mothers and fathers who have so desperately wanted to answer the call of parenthood; I’ve seen help brought to the homeless; and aid brought by nurses during times of natural disasters. My profession really runs the spectrum of life.

The reason I say all this is because without fail, every shift I work, I am constantly reminded about the extremes of life and death. I guess it just comes with the territory, but facing these extremes really puts things into perspectives. I can think of two such instances that really hit me in such a way that it forced me to take a step back and put some sort of perspective on the gauntlet of life.

The first was this. It was about 5AM and if you know anything about the ebb and flow of the E.R., you know that at about 5AM is when the morning surge begins. One of the medical directors of the ER was on the floor that night and received a call from another physician in the hospital. She said that her mother, who was in a nursing home, was coming in. She had fallen back and sustained a laceration to her head. The cut itself was big enough that she was found by first-responders to have been lying in a pool of blood. The patient who came in was extremely emaciated (basically, looked like a skeleton). If this was any other patient, her wound would have been cleansed; she would have received a CT scan of her head (to make sure she didn’t have a bleed in the brain); and her head would have been sutured. The daughter stated that she didn’t want any of this being done, except for the cleaning and suturing of the wound. One would think; why does her daughter not want everything done for her mother? To answer that question, let me describe what was going on with her mother, further. My patient had breast cancer with metastases to the liver and this cancer, her doctors said, was in its very last stages. In addition to what I stated above, my patient was severely jaundiced and was as yellow as a banana. Because her liver had endured so much damage from the metastases, she suffered from something called hepatic encephalopathy. Her mental capacity was severely destroyed. She was non-verbal, making gestures randomly, and only responding to painful stimuli. This poor woman was basically a shell of herself or more appropriately a soul living inside the shell of her body. Her daughter spoke with the attending E.R. physician and stated that she only wanted her mother to be cleaned and be as comfortable as possible. A phone call was already placed to out inpatient hospice area for her admission. When the daughter got to the ER and saw her mother, all you saw on her face was a river of tears. All I could think to myself was, “what a gut wrenching situation.” We as a staff did our best to clean up the wounds of this elderly woman, give her some pain medicine for comfort, and made sure she was warm. Some staff who weren’t so busy even stayed with her at bedside. This is the kind of situation that forces you as a nurse to dig deep into your soul and stop being a nurse; to stop being a professional; to stop doing something because you should; and start doing something because it’s right.

The end of our life is a reality we all have to face. You may not want to think about it or even deny that it is coming. The one thing that I’ve found in my experience is that the people who face the fact they will one day meet the reaper, live life in the richest way possible.

The second was this. When I first became a nurse, before I was in the Emergency Room, I worked on a heart transplant floor. At this point, I had seen a great many patients who had been on the organ donor list for a heart. Now if you don’t understand the significance of this setting let me just say it like this, if your heart fails and the drugs and machines that can keep your heart going fail before you get that heart, YOU’RE DEAD! Talk about coming to grips with reality. Now, the hospital that I worked for was in a real urban, low income area (that’s political correctness for poor) and the patients I served had the slimmest means and a real lack of knowledge. What’s more, the culture of the people I served was also proving to be a barrier to them receiving treatment. I’m talking about religious ideology and beliefs that stated, “God, not this medicine, is the only thing that will save me.” One patient I had really sticks out in my mind. He was from Jamaica, a real devout Christian, and when I saw him extremely depressed. I couldn’t blame the guy. He was new to this country. He basically came here to visit his sister and came down with congestive heart failure while he was visiting. I guess his heart was in such bad shape and for sure, lacked any means to being fully diagnosed. His heart was so bad that it almost refused to pump any blood out of his left ventricle. He was put on a machine called an LVAD or spelled out, a Left Ventricular Assist Device. This device basically acted as his heart’s left ventricle, allowing it to pump blood to the rest of his body. They often use this machine as a “bridge to transplant.” When I took care of this guy, he had all the symptoms of despair. He wouldn’t eat, didn’t sleep, and didn’t care about his personal appearance or hygiene. He looked like a guy who was ready to die and really didn’t care to live anymore. He was miserable to take care of. He was one of those patients you ask your charge nurse not to put you with or, if you’re feeling generous, will take, so you can help your co-workers out. I left that day thinking that this guy really needs to die. It’s a horrible sentiment and extremely unbecoming of what a nurse stands for, but some people just need to go because you just don’t want to see them suffer. The next day, I looked to see if he was still alive, and his room was empty, I guess I assumed that he had passed away in the night.

About a week later, I came onto my shift in the morning. I walked into my patient’s rooms to introduce myself and did my morning assessments. I had one more patient to go before all of my assessments were done and I could go and chart my findings, when right there, the very last room I had to do was the same Jamaican man! He didn’t have any machines, or IV medication infusions running, it was just him. The first thing I noticed was the smile on his face. The second thing I noticed was the Bible he had sitting on his tray table. I was shocked and amazed! He said “good morning” to me. To which I replied, “…So, you do have a voice.” We sort of shared a chuckle after that. I asked him what happened when I left that night. He said that at about 3AM, the nurses started gathering around him and started drawing blood and running around. He said that the doctor came in early that morning and said, “…You’re getting a heart and it’s on its way. We’ve gotta prep you for surgery.” It was an amazing thing, to say the least. This guy, after months of waiting, hundreds of doses of medications, and a machine used to pump his heart for him, in just a few moments got a brand new life. The next thing I said to him was,”Congratulations!” He looked me right in my eyes and said this was a miracle. He was absolutely right, if you think about it, someone had to die in order for him to live.

For me, these two instances are forever ingrained in my mind because of the sheer impact it had on my psyche. I can boast; that as a nurse, the things that affect me in an emotional way are almost non-existent. However; situations like these, stop me dead in my tracks and force my eyes open to the greatness of life. What people don’t understand about our profession is that within the psyche of every nurse is a paradox that exists. We must learn to objectify, dehumanize, and remain aloof in order to be compassionate, service-minded, and human. If we weren’t able to set ourselves apart from the emotional mine field of everyone’s drama; we would be completely burned out by the time we got off orientation.

I think that these situations aren’t just exclusive to the profession of nursing or even to the health care field. A garbage collector or a computer programmer has just as much potential to experience these perspective altering situations. The problem, like almost anything in today’s “hustle-n-bustle” society is that we are so self-centered and task oriented that everything else doesn’t matter. Why should it? Having a family, a career to hold together, and everything else to do is enough! Who needs to pay attention to or even seek situations and interactions such as those I mentioned above? The answer is everybody! The point I’m trying to make is this – don’t be the person who has accomplished everything (success in your career, stable family, wealth, etc) and feels nothing. If you don’t “feel” life, you’re as good as dead. What is it worth to have all the success in the world and have no clue about the substance of living and dying? Isn’t that what matters? What good is all your success if you don’t enjoy it or use your success for good or to serve others? It is truly a sad thing when a person gains the world and remains empty inside.

Every time I think of the aforementioned stories, I take away two things.

1. Life is meant to be lived fully. Do not mistake this as a call to hedonism or an all out excuse for irresponsibility. Living life fully is best shown by people like the Dalai Lama, Mother Teresa, Martin Luther King Jr., and the like. These people face hardships, ridicule, threats to their own life, but fought for belief in positive change. They gave of themselves completely and got back so much more. From a distance, it may seem that these people and others like them, live such a hard life, but guess what? That’s what life is! It’s hard. You either live it with action or suffer stagnation. Can you just imagine how wealthy someone like Mother Teresa was to have seen a child in Calcutta smile, despite immeasurable hardship, because of something she has given? Life should be lived fully, with substance – real substance. It isn’t about money or power or things of a temporary nature, but the positive causes that drive change and require constant challenge to the human mind and human heart.

2. Life is fully lived, when it is lived for others. Look, I’m not saying you should join the Sisters of Charity or live the monastic life in some convent or monastery. All I’m trying to say with this is if you invest in someone who needs investing in; you’re return on that investment is multiplied. You’re the one that becomes wealthy because touching a human life is priceless. Service doesn’t have to be official (as in giving money to some charitable organization). Charity starts with your friends, your family, or people in your own inner circle. It doesn’t matter how small or big your investment as long as the investment is made. In the long run, you’re the one who gets the return.
So, I’m gonna close out with a poem written by Mother Teresa and I think it sums up what I’m talking about.

“Life is an opportunity, benefit from it.
Life is beauty, admire it.
Life is a dream, realize it.
Life is a challenge, meet it.
Life is a duty, complete it.
Life is a game, play it.
Life is a promise, fulfill it.
Life is sorrow, overcome it.
Life is a song, sing it.
Life is a struggle, accept it.
Life is a tragedy, confront it.
Life is an adventure, dare it.
Life is luck, make it.
Life is too precious, do not destroy it.
Life is life, fight for it.”

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