The Intangibles: The DNA of a Super Nurse

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.