Do nurses need bigger egos?

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Nobody but a nurse knows how far from reality the popular concept of nurse as handmaiden (handman?) really is. In pop culture, we range from snarky drug addicts to bubble-brained goofballs and back again to the mature foils for Peter Pan doctors. We’re helpful, we’re kind, we’re the angels in white (or ciel blue or forest green) at the bedside. Some of us, in comedies, still wear caps.

Which is why it’s so surprising for people to meet nurses in real life and discover that, generally speaking, we say things once, don’t waste motions and expect you to get the heck out of the way in a crisis.

Some nurses are born that way. Others learn the skills necessary to walk through a crowd of marauding Girl Scouts in February unscathed. Most have those skills thrust upon them, usually in a difficult situation, when they’re disagreeing with a colleague about what’s best for a patient.

Years ago I had my own training when I took care of a patient whose express wish was for palliative care, but for whom the doctor in charge insisted on “doing everything.” I learned really, really fast what it meant to put your concerns for yourself out of the way and concentrate on what’s best for somebody else.

And that’s why, when I’m asked “Do nurses need to be taught a God complex?” my answer is a resounding “Oh, heck yeah.” Maybe not a God-God complex, but at least we should be taught in school to trust our own instincts, not be afraid of confrontation and conflict, and to stand up for what we feel is best.

When I was busy gettin’ schooled, we didn’t cover difficult situations in any depth. We read over ethics case studies and talked about tough choices, but we didn’t role-play or practice or get down to nuts and bolts. It would’ve been really helpful to have learned, prior to getting into practice, exactly how to approach a resident or an attending with something he or she doesn’t necessarily want to hear, or exactly how to encourage communication between a doctor and a patient or patient’s family.

A few exercises on how not to lose one’s temper would’ve been good, too.

It’s something I work with the students I precept on now: We come up with a tricky scenario and work through as many variations as we can manage. We talk about the best ways, both physically and psychologically, to handle disagreements. I tell them what to expect if they actually have to send something to their ethics committee to review.

This is something we need in nursing schools: a class on uncomfortable discussions, led by a seasoned nurse with a big mouth and enough ego to have lasted 30 years or more. Maybe that could be a post-retirement option for those of us with sore feet.

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