I don’t usually post this kind of story submission, but it does ring a bit true.  I do know preceptors sometimes have a difficult time providing feedback to their preceptees at the end of the shift, only to spring problems and issues on them later.  Anne, RN writes:

It was toward the end of my orientation as a new grad when I got a message from my day shift preceptor, wanting to know “how orientation was going.”  When I called her back she proceeded to tell me a long list of everything I had done wrong over the weekend with my night preceptor.  I was at home on the phone and she was at work talking to me, so I felt backed into a corner.

Meanwhile, over the weekend, my night preceptor told me I had done a great job as she scrambled onto the elevator to go home. I had given an antibiotic late on Saturday night and I had acknowledged it and the next day made sure I gave it on time. My night preceptor told me when I acknowledged my lateness not to worry about it since nurses that have been working for 20 years forget things sometimes. So I thought nothing more of the situation, that is until I received this phone call.  On her long list of things I had done wrong was that I gave this antibiotic late. Her other criticisms included only giving IV pain meds when the patient had PO ordered, meanwhile my night preceptor had told me that since the patient was NPO i shouldn’t give them because it would make her sick.

Then she proceeded to blame me for another nurse’s needle stick, which she later apologized for. She also said that people were saying that I didn’t care and that I always looked bored, which is completely not true. Most nurses go into nursing because they DO care. After 8 weeks how do other people think they can judge you on something so personal?  I had a lot of respect for my day preceptor until that day when she backed me into a corner, since then I can’t think of her in the same light as I once did.

My night preceptor was awful as I am sure anyone can tell, always giving me positive feedback and going behind my back to tell others that I was awful. On my first night shift with her she was talking about sex half the night, which made me extremely uncomfortable and as a new person I didn’t think I could say anything. Luckily my night preceptor has since left my floor but I still have to see her on occasion and my day preceptor has an important position on my unit.  I wanted to share my story because I think it is a great example of how nursing eats their young.  There were many nights when I went home crying and wanting to quit nursing.  Nursing is harder than I ever thought in nursing school, but I am a tough person and I have since successfully completed 3 weeks on my own!

And since it’s been over a month since I received this submission, hopefully Anne is now off orientation and doing well!

Anon, RN writes:

I’m trained as an ICU nurse but lately I’ve been picking up these shifts in an outpatient pain treatment clinic. It hasn’t been an easy thing to get out of that critical care mindset. In critical care you stick with the ABC’s (airway/breathing/circulation). In clinic nursing the first question after the procedure is, “Does my patient have a ride home?”

So I’m working there the other day. Pretty much twiddling my thumbs all day and bored out of my mind because there’s really not much to do except take vital signs and fill out intake forms. But then one of the clerks grabbed me.

“There’s a patient in the bathroom that needs assistance.”

Indeed there was. I found a patient who needed me to help her out of a little situation, let’s just say. So I got her cleaned up and brought her in to the room where she would have her procedure done. I slapped a pulse ox on. Her oxygen saturation was about 70%. With a very good waveform.

Thankfully my critical care mindset kicked right back in. Step one, get her on some oxygen. Step 2, find out what the hell is going on.

Turns out she’s a COPD’er (Chronic Obstructive Pulmonary Disorder – like emphysema) who uses oxygen at home, normally 3 liters. She told me sometimes she just doesn’t bother with the 02 if she’s making a quick trip somewhere. I asked her what about today? This is a little more than a quick trip. She said she ran out of oxygen, and they should be delivering it while she was out.

I got her down to 3 liters and her oxygen sats kind of waivered between 82-88%, which is fine for someone with COPD.

She was completely stable so the doc did the procedure at the bedside. Which was all for the best because at that point she was really in quite a lot of pain.

I asked the charge nurse what we should do about discharging her. This is where the story gets really crazy.

“She only needs to be close to her baseline, in order to be discharged.”

“Yes, but her baseline is that she is on home oxygen, which she didn’t bring today and her 02 sats are in the 70′s without it.”

“It’s okay. We’ve discharged her with 02 sats in the 70′s before.”

!!!

I explained to the charge nurse that it’s not okay to discharge someone with 02 sats in the 70′s. Especially if they “forgot” their oxygen that day. It was at that point that I decided I really had no use for this “charge nurse,” and tried to come up with an answer on my own. First I tried to find out if the patient’s son could go to her house and get one of the tanks that was being dropped off. No dice. He had no money for a cab ride and we couldn’t even confirm really that the oxygen had been delivered. I tried to find out if there were any kind of social worker around that might be able to identify some resources for the patient, maybe give her a loaner tank to take home. Again, no dice. So the only other plan was to take this patient to the ER.

We arranged for a transport person to come, and I went to find a portable oxygen tank for her. The charge nurse asked the transport person if he could return the oxygen tank to the clinic. “No, I can’t,” he said. Then the charge nurse said, “Well you can’t take it, then. If it leaves our floor it will never come back.”

!!!

At this point I decided I would transport her to the ER (it was the next building over) so I could bring the precious oxygen tank back to the clinic. Also, the patient was getting a little somnolent, which is never a good sign when you are worried about hypoxemia/hypercarbia, so I figured it would be best if a nurse accompanied her. So I took her to the ER, and got her safely checked in.

When I got back to the clinic there was some talk about how we can avoid this in the future, blah blah blah, we never should have done the procedure on her, yadda yadda yadda, and the conclusion was that if she turned up at the clinic again with out her oxygen tank, we should just turn her away.

How about some patient teaching?

How about some communication with her PCP to find out why she thinks it’s okay to go anywhere without oxygen?

How about a better EMR system so we could “flag” her and alert her other providers that she needs better education?

If anyone thinks we are even close to fixing healthcare, well. I’ve got some land down in Florida you might be interested in.

Submit your own story!

Here’s a story submission by Michelle G, RN. My thoughts are in italics at the end.

I called first thing this morning to see if they needed me to work extra. Sure enough, a scheduled nurse was not coming in. I show up on my unit which is the medical floor to see that I have been assigned 4 patients. Wonderful! Great not to have 5 right off the bat.

Today I take care of a gentleman who I had taken care of just 4 months ago. He was diagnosed back then with liver failure and was not a candidate for liver transplant. This admission brings him in with End Stage Liver Failure which means he could have a few weeks to under 6 months to live. He is in denial and refuses some of the treatments/medicines/blood draws. Patient’s wife is excited to see that I will be his nurse again with this admission. Patient has been noncompliant and has not been following medical advice. He is on a 1500ml fluid restriction but doesn’t seem to want to adhere to those restricitons nor acknowledge them. I gently remind him about his fluid restrictions during the day which seemed to agitate him. I explained to the patient why the fluid restrictions…there was a reason for this.

Well, now he wants a wheelchair to go outside. I know exactly what he wants to do….smoke. We are a smoke free hospital but I am not security. I explained I am not going to babysit him nor police him. I explained to he and his wife that we can not cure him nor are we going to give him anything that will make him better. If the patient wants the extra juice or cup of ice than who am I to restrict a dying man?! Who are we to deny a dying man’s last pleasures…ice, a smoke, a visit outside on a sunny day?

Much of nursing is not only carrying out doctor’s orders and educating the patient why those orders are there…but looking at the BIGGER PICTURE.

At the end of my shift; patient and family were greatful to have had a nurse that took the time to explain the disease process and plan of care but also most importantly to treat him as a human being with respect and care.

What do you think?

I think Michelle is absolutely right. If the patient is able to get all the information he needs, then it’s up to the patient to make the decision. If there is no cure what what ails – heck, sometimes even when there is – a life lived with restriction after restriction with no pleasure at all is probably not worth it to many people.

“milly rn” writes:

Another day, another patient – of kuwaite nationality. No surprise I work in an icu in a private hospital in london uk. kuwaite families ship their loved ones out to london when given any kind of grim diagnosis in the misguided hope that we over here will be able to fix the problems! they usually arrive half dead having been rotting in one of their own country’s hospitals for weeks ( tip – dont get ill next time you visit kuwait) all paid for by the kuwaite government (nice lot arent they!)

Anyway mama m arrived, supposed to be very sick ventilated unstable blah blah blah……….. in a wheelchair launched herself into her bed on arrival with no assist (we didn’t have time to get near her such was the speed of her action all we saw was a blur of black cloth) and proceeded to mime the urgent need for food and beverages moi moi moi sista!!!( translation -water water water sister!!)

moi & munchies were obtained, mama was happy, family were happy. doctor not happy – mama had a K of 7 and no percievable kidney function at all.
cue bit of action…..insertion of 1 vascath, trundling out of 1 Prisma CVVHD machine….priming of machine ……..attachment of mama to said machine.
followed by 12 hrs of machine alarming constantly….. stopping constantly… generally not doing its stuff..mainly due to the fact mama was a rolling around in the bed…as you in the know will know, not good for flow in a vascath not good for attempting cvvhd (or to the uninitiated the sort of continuous dialysis thingy we do in icus for clapped out kidneys & clapped out patients)

mama could not sleep (nurses could not read gossip magazines), due to the godamned racket the prisma machine was making & also probably if im honest due to the nurses (me & collegue) stomping up to the machine cursing & restarting it approximately 500 times every hr…….for 12 hours……..

mama who supposedly spoke not one word of english apart from the term sista (nurse) announced wearily in the morning-’mama no sleep machine crap!’
i was very impressed! that woman will go far in this city of ours.

I wasn’t sure if I should post that submission, because it is a bit insensitive and because I don’t have the patience to edit it enough to read smoothly. It’s literally been in my inbox for 2 YEARS and every time I read it, the end just cracks me up. Because sometimes the CVVH machine is crap. -ed.

“Catheter Commander LVN” writes:

Having worked for 2 years in the ER, my experience became most helpful when I went into Correctional Nursing. You ask, “why do they fake a seizure?” They fake it for several reasons here: To get out of their cell when the facility has been locked down. To get the attention of staff. To get to an outside facility (hospital) where the women are much more abundant and prettier and the FOOD is sooooo much better.

We now on a case by case basis use the hand drop, pen across the nailbeds and brushing of eyelashes to determine validity of the “seizure.” We’re running about 95% on the FALSE side now. Before, we just tossed in an IV, threw on some O2 and out the door they went to the hospital. Since we started doing these checks, the seizure activity has slowed tremendously, go figure. Its nice to see them walk back to their cells, head hanging with a write-up for attempted staff manipulation.

And finally, “loved nursing RN” submitted this:

My mom, an active 83yo was fine till she got hit by the truck called CNS Lymphoma. Getting her admitted to , we thought she had a good chance at recovery. The last 7 months have been a nightmare with hospital acquired infections, 3 rounds of pulmomary edema, poor transfer of info at change of shift, blatant lies by staff from nurses up to and including administrators.

The infection control standards are appalling, compassion lacking in most of the doctors and NPs even knowing I am a nurse with a wide variety of technical skills did not put them on guard to do the right thing. No they would argue that keeping a used red rubber suction cath in a liter bottle of saline on the FLOOR was acceptable clean technique. Administration would never acknowledge a mistake. When I suctioned mom myself because of a 2 hour wait for the nurse, I was reprimanded and threatened with my license. The large medical centers are not what they should be.

Yikes.

Submitted by My Own Woman:

It was one of those rare nights on midnight shift where the ER was eerily quiet. The quiet and calm doesn’t happen often in the ER and the nurses try to take advantage of it when it occurs. After all the supplies were stocked in each room and the trauma carts and the Zoll monitors were checked to make sure all was functioning properly; the nurses sat down together for a rare moment of rest. It was 4 AM, the time on night shift where the wind starts to go from your sail before you catch your second wind about 5AM.

As we sat and talked about non-nursing related things in our lives the Ambulance phone went off. I got up to take the call. “This is A-1 Ambulance. We’re bringing in a 20ish year old male with severe injuries to both of his legs. He was hit by a car while riding on the back of a garbage truck. His heart rate and respiratory rate are within normal limits. His blood pressure is slightly elevated and he rates his pain in both legs at a 10 out of 10. He has an IV established with Normal Saline at 100 and we have him on high flow oxygen. We’d like to give some Morphine. He has no allergies. ETA 5 minutes.” I relayed the information to the ER doctor who authorized Morphine 2mg IV and we will re-evaluate upon arrival.

The patient arrives to the ER 5 minutes later without any relief from the previous Morphine. His legs are deeply cut and crushed at the level of the knees where the car clipped him while he was riding on the back of the truck to collect garbage. His vital signs were stable except his blood pressure was elevating probably in response to the increased pain. After an assessment by the nurse and the ER physician, Dilaudid 2 mg IV was ordered and given along with some IV fluids. X-ray came to the department for a series of xrays on his legs. The Patient Care Technician came into the room to draw blood and do an EKG. All the while the patient kept asking me if he was going to lose his legs. “Please, am I going to lose my legs? Please tell me.” I couldn’t answer him, I had no way of knowing at that time but the prospect of him losing his legs was a good probability. He had no pedal pulses and no sensation below his knees. I told him, “I don’t know right now, we have to wait to see what the tests tell us.” It was an honest answer. He turned to the Patient Care Technician and asked her the same question, she immediately responded, “No, you’re not going to lose your legs, quit thinking like that. Everything is going to be fine.” I wanted to scream at her but held my tongue and tended to his immediate care.

We cleansed his gaping wounds behind his knees and bandaged them with sterile water and gauze. We gave him repeated dosages of Dilaudid as we prepped him for surgery. It was horrible watching this young man with his whole life in front of him crying because of the pain and the uncertainty of his diagnosis that must surely have been going through his mind. After a short time we shipped him off to surgery and the Emergency Department was relatively quiet once again. We had added a few more patients in the time I spent in this man’s room, but everything seemed to be under control.

I couldn’t get the young man off of my mind and the scene and conversation I had witnessed between the Patient Care Technician and him. Finally, after wresting with my conscience, I took her aside and told her that telling him he was not going to lose his legs was not a very good thing to do. I told her that she could have very well given him false hope and that is the last thing you want to do to a patient. She apologized to me and told me “she just wasn’t thinking.”

The night ended without any more trauma and we all went home to our beds. I had the following day off and went about my normal routine. The following day I returned to work and my arm was grabbed by the Patient Care Tech that had helped me with the young man two days earlier. Her eyes were red and swelling with tears. “He lost both of his legs,” and as she spoke the words the tears rolled down her face. “They cut off both of his legs, they couldn’t save either one of them.” At first her words were not registering in my mind until I realized what she was talking about. The young man who she told would be just fine had lost the very thing he was so concerned about and wanted reassurance about. The tears welled up in her eyes more. “How could I have done that, how could I have said everything was going to be ok?” My heart went out to her. In her attempts to ease his mind, she let him down and herself. “How can I ever make this up to him?”

I shook my head back and forth and said, “You can’t do anything for him, but you can learn from him and never tell anyone things that you don’t know for sure. You learned, and learning is a good thing.” She replied, “Yeah, I learned, but I still have both of my legs.”

This is a very good lesson. However, I can’t help but wonder if despite her comments, the patient really knew deep down that he was going to lose his legs. Denial is a double-edged sword. It can keep one from seeing what’s really going on, but it’s also a highly effective coping mechanism meant to protect us from knowledge that we aren’t ready to process. I doubt that the young man took the tech at her word. I’m not condoning what she did, but really? Truly? Deep down, I don’t think he was surprised at the outcome. So tragic. -geena

I’ve updated the sidebar links again. My loooovely husband got me my Image Manipulation Program of Choice for Christmas and it’s been so very nice playing around with it again. I’ve added some blogs, deleted some, and in checking to make sure the links work, I’ve noticed that some of your blogs underwent a makeover. So if the mood struck, I went ahead and redesigned your button.

As always, if you don’t like your button please feel free to make one of your own and I’ll replace it. You need to stick it in a .jpg file that’s 90 pixels x 25 pixels. Yeah, it’s small.

Here’s a story submission from “traumanurse,” and she sent it almost an entire year ago:

I am a fun-loving person. I work in a Level One trauma unit. We have a lot of fun as all the RN’s and MD’s are great people and we make a great team. This helps a lot with all the drama in trauma.

We have a few resus’ every week. And these are fine – training and adrenalin take over and we actually manage to maintain a sense of humor before, during and after- but it’s going home that gets me.

How do I explain to my small children that I am not a mommy right the moment I get home? That I need a couple of minutes to myself just to become a mommy again? I am the highly professional person that has just witnessed the life seep away from someone’s husband, father, child, and now I have to be the referee in the fighting, dish up equal portions and put Barbie’s shoes on- so they stop slipping off. I think is the main reason I prefer night shift is because you get home when everyone is asleep – so I can do mindless things like water the garden or feed the cats – or just sit and stare into space.

To explain to a non-medical person what it’s like is very difficult. In a resus- it is not a human being. It is not someone’s dad. It is an airway, a chest, a blip on the ECG; a vein to put a drip up. A pupil that may or may not react to light. These are the patients that you leave behind when you go home – nonsensical and they don’t haunt your dreams. It’s the ones that grab your hand, that make you look at them, that make you SEE them, who make it difficult. How do you explain this to your five year old? That fine line between life and death. That fight to keep someone from going to the “light.” There is no light in the trauma unit/ICU – there is only the adrenaline taking over – the clear instructions, there is no pain – no emotion – until it’s over. Until someone said those words: “time of death”.

How do I explain this?

——————————–

I’ve sometimes found it very difficult to come home and act as though something emotionally earth shattering hadn’t just happened. Sometimes it’s hard to get back to “life” because whatever has your brain scrambled won’t leave your thoughts. Sometimes I’ve found that it’s because it doesn’t feel right to go back to normal life. After witnessing and being a part of a profound moment in someone’s life, it feels like you literally have to take some time and process it and honor it in a way before you can get back to your normal life.

I usually take the drive home as an opportunity to absorb events that happen at work. Sometimes it takes me a lot longer – days, even. There are some situations at work that still haunt me years later. I have a feeling it’s like that for almost everyone.

From “psychosis buster, RN:”

(For the longest time I kept reading it as “psychosis butter.”)

Way back in the eighties I was working on a 40 bed acute psychiatry ward in a fairly large Canadian city. One day, one of our repeat customers, a chronic paranoid schizophrenic patient, was admitted from Emergency. She hadn’t been looking after herself and she was covered in lice, as was her (expensive) fur coat.

Two of my co-workers figured they’d do her a favor and send the coat down to our laundry department for cleaning. Unfortunately, they thought it would be a really good idea to send it in a red “contaminated laundry” bag – this was before the advent of universal precautions. What they didn’t know was that the laundry department didn’t open those bags – they just tossed the whole kit and kaboodle in the washer, along with very hot water and strong soap.

The next day, a plastic bag arrived on the ward from the laundry department. It contained what looked like a hairy collar, with several strings dangling from it and some ratty fur, with a note asking “what was this?”

Well, it had been a fur coat valued at something like five thousand dollars. Fortunately, the hospital agreed to reimburse the patient. To this day, I don’t know which was funnier: the pathetic remains of that coat or the expressions on my colleagues’ faces when they saw it.

Suzi has a question for ya’ll:

I had a kidney stone episode January 2007 which took me to the hospital unexpectedly. My urologist could not remove the stone because there was massive infection caused by the stone rubbing up against the “wall.” I spent five days in the hospital with fever, passing blood, on IV antibiotics, oxygen, and with incredible “sweats” that required clothes and bedding changes several times in a 24 hr. period. I couldn’t get out of bed alone to use the bathroom. I was terribly weak.

After 5 days and under medical advice I was sent home to bed. I was to continue oral antibiotics, and a “stent” was put in place until the stone could be removed. A week or two later I did have the surgery and the stone was removed and another “stent” was inserted. My doctor told me I had been very very sick and I was to do exactly as he said, which was basically to stay in bed until the second “stent” was removed.

Now, heres the question: How long should I expect to be “recovering” until I am back “up to speed?” The doctor told me it would be about 30 days after the surgery. This estimate was way off!

It is now the middle of July and while my recovery seems to be steadily improving,
I continued to experience loss of strength and energy (I can now run up 15 steps X 3 without getting winded) But I cannot power walk the distances I used to. I also “break out” in sweats when I use physical energy. Have any of you had a similar recovery experience from a blood infection (sepsis) and if so, would you share it with me? I just want to know if I’m in the “normal” range.

I knew someone who had sepsis and was hospitalized. It took her MONTHS to fully recover enough to come back to work. At least 6, I believe. Any other experiences?

Donna, RN writes:

A young man died this weekend. He had a loving wife and a bouncing 10-month-old baby girl. Like all of us, he had a promising life, with many friends, many challenges, many opportunities and many wonderful dreams.

He came to us ill, but strong willed and hopeful. He had a medical team that was strong willed and hopeful. He had a family that was strong willed and hopeful, he had nurses that were strong willed and hopeful.

And yet, this young man died this weekend.

That day, amidst the turmoil and growing clutter of medical equipment crowding his ever shrinking hospital room there was a sense of collaboration, creativity, intelligence, hope and humanity.

It was the humanity that I clung to as we brought in the crash cart and began the final battle for his life.

He was young, maybe he could make it.

I let hope push back reality. Denial gave strength to our chest compressions. He was young, and his young daughter’s picture on the wall facing him gave that much more hope so I wouldn’t face despair.

We battled for him, with drugs, ventilation, compressions, anything and everything we had. We collaborated and encouraged each other. As I was getting exhausted from my turn at compressions, I felt the humanity in the room around me, and I heard myself saying, “Come on, M.” as I looked at his face and into his young eyes. The words felt naive and innocent, yet I had to give him the humanity and dignity of his fight. I knew I was saying goodbye.

This young man died this weekend. We all felt wounded as we were ripped from a delicate fabric, fraying ends weaving a bad dream. The nightmare for his wife and family had just begun.

It was cathartic to remove the signs of battle from that room, to restore calm and dignity to him and for his family. The emotional resonance of his death was palpable throughout the unit, as tears, anger, hugs and quiet sighs prevailed.

A young man died this weekend, and he put life and all its wonder into grand perspective.

I embrace the pitfalls, the pettiness, and the disappointments life can harbor, as the brighter, grander enlightenments of life prevail. The chubby hand of my granddaughter, the fighting heart of my biking husband, my dog’s warm, wet tongue, the “volunteer” rose that grew up amongst the lavender. These are what matters in life. This is the symphony that blends discord and harmony. Anything else is just so much noise.

A young man died this weekend, And he reminded me to let my heart sing.

Patricia, RN writes:

In nursing practice, I have found that a sense of humor is one of the most valuable instruments of healing. In a caring event, it provides relief and hope as an alternative to the pain and fear of the illness. For me, the nurse, humor provides a self-healing outlet from the intensity of focused energy needed to be fully present with the patient regardless of the outcome. The same healing instrument is used, although differently, to meet the needs in both the nursed and the nurse during the caring event. Drawing on the healing instruments of laughter and play within the midst of tears and high technology has provided me with some of the most memorable moments in my nursing career.

When I went home to care for my mother during an acute and potentially life-threatening phase of her illness, I took Ruggles, a large, soft, and very huggable therapy bear on the plane with me. Although we boarded the plane together, it was the last I saw of him until after landing. I seemed as though everyone, even businessmen, in formal three-piece suits, wanted a chance to enjoy a moment with Ruggles.

He was treated to his own ‘Pilot Wings’, given special treatment by the flight attendants, and asked to assist in the cockpit during the landing procedures. Due to his celebrity status, we were given BIP treatment through the airport to catch our connecting flight. The news of Ruggles and our mission had gone before us. After our final landing we were transported directly to the hospital in a special airline limousine.

The story of our most ridiculously fun flight experiences and the formality of our arrival, via limousine, brought back my mother’’s smile and a twinkle of mischief in her eyes. Fortunately, this was the perfect tonic to initiate the courage and strength needed to cope with the immediate health crisis. There was nothing within my training that could have provided a more positive healing environment than bringing her Ruggles.

Ruggles continued to enjoy his celebrity and healing status throughout her hospital stay. There were photographs, articles in the hospital review, and special visits to the pediatric, adolescent, and oncology inpatient units. One bear and a nurse, with a fun sense of the ridiculous, brought healing, love, and laughter to people from New York to Illinois. My mother recovered to the point that she could return home and continue at a more comfortable level of wellness for several more months.

My mother flourished in ways that would not have otherwise been possible and kept this piece of fantasy and fun as a charm to help her though the bad days. Her medical care interventions were completely met during that time at home by a wonderfully caring and competent Hospice treatment team. Although proud of my technical skills and knowledge, she didn’t need that part of my nursing practice. It was my ability to live nursing as an art form of care and caring that allowed her to share life, laughter, joy and healing during those last few weeks. My development into a highly skilled artisan within the caring practice of nursing intuitively allowed for the need to share tears of sorrow and loss as well as the hope there would be joy.

I am a nurse: I don’’t just provide nursing care, it is who I am. I became aware of the uniqueness that belonged only to nursing. I didn’t settle for nursing, I actively chose nursing as my vocation and profession. Florence Nightingale’s vision of nursing excellence enabled me to understand that no one can be what nurses are except a nurse. It was so easy, so clear. Nurses nurse. My nursing practice is an art form of caring within a highly scientific and technologically based health care environment. It is through nursing that I facilitate, enable, and empower the nursed.

In the final analysis, I believe a successful treatment outcome within our high technological care environment is ultimately patient defined and reflects how well the nurse’’s technical care was balanced by the interpersonal art of caring. This, from my perspective, defines nursing excellence in practice.