Close Enough to Change: What Primary Nursing can do to a Nurse’s Heart

He could not speak. His disease process barely allowed him to move any longer. But he was fully present, and he would smack his lips to get my attention. He could use his eyes and a slight nod or shake of the head to communicate his needs and desires. He was fully present, a little boy who had to face the span of life, the briefest childhood, and thoughts of death within too small a number of years. When his mom would leave the room, he would smack his lips. I looked up from my charting. His eyes would dart to the empty chair next to his bed. “You want me to come sit with you for awhile?” His head nodded yes. “You want to watch a movie?” A nod. “Toy Story 3?” Another nod. I walked over, took the seat next to him, and took his hand. “Alright buddy, let’s see what Woody is up to.” The movie started, and a big scene came on. The train was about to go over the cliff, and Woody was trying desperately to stop it in time. My little friend’s lips would smack. I looked over at him, and he was wide-eyed, looking at me, then looking up at the screen, as if to say, “Check out this scene!!” The train went over the cliff with a crash. A brief moment of silence. I looked at my friend, and his eyes were wide with anticipation. He smacked his lips again, looked up at the TV screen and slightly jerked his head up so that I’d look too and not miss the next scene. And suddenly Buzz Lightyear appears, train triumphantly lifted over his head. Buzz has saved the day! I look at my friend and we both have victory in our eyes. “Whoaaaa!! That was SO cool!!” My friend has a little smile, eyes still wide, and we share an exchange of glances celebrating a brief but precious moment when all is ok with the world again.

This is the first time in my young nursing career that I’ve asked to be a primary nurse for a patient, meaning that every time I go into work, I will be able to be this little guy’s nurse for as long as he is with us. The goal is to provide greater consistency of care for the patient, and hopefully as a result, greater quality of care.

I think, however, that it has to do with more than just having someone who is more familiar with his communication style and his preferences. Because I feel myself changing in deeper ways, in the ways I think about my patient. When patient assignments change after a shift or two, it is inherently easier to be less emotionally attached, less involved with the patients. Now that I am a primary nurse for this sweet boy, I find myself not only taking a stronger sense of ownership for him, but I find myself caring more deeply for him and for his family. I find myself thinking more about his journey, feeling more of his struggles and celebrating more of his joys. I go on that train ride with him to the edge of the cliff, and hope with him that maybe Buzz Lightyear will show up and bring some relief again to the fears.

When I asked our charge nurse if she could help arrange for me to be a primary for this patient, I told her, “I think he has so much potential to break my heart.” Nursing is a profession full of tensions and constant battles for balance. Not wanting to get too close or too emotionally involved to a point where it becomes unhealthy, yet wanting so deeply to be authentic, open, human in the best sense of the word, and a reflection of the heart of Christ in what I do as a nurse. Christ did not stay aloof. He got close enough to us to be broken so that love and healing could flow in ways that a careful distance would not otherwise allow.

God, grant me courage to get close enough to change, to be willing to be broken, to become more like You… so that my sweet little patient might know that You are Emmanuel, You are God with us. 

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