The Emotionally Intelligent Nurse Leader

“WHY DO YOU WANT TO BE A NURSE?” one might ask a little girl or boy with such aspirations. And the child might reply, “I want to take care of people and make them feel better.” There is something quite compelling about that possibility to a young person who has discovered her own ability to affect the well-being and feelings of others, and many nurses can recall a similar drive propelling them into their chosen career.

Where Did the Time Go?
A registered nurse who graduated from nursing school in the early 1990s remembers learning the textbook methods of giving back rubs, making beds, and turning and bathing patients. Accordingly, clinical experiences, at least the fundamental ones, required mastery of these and other skills involved in “taking care of people and making them feel better.” But when she emerged onto the cardiac step-down unit for the first time as a registered nurse, she salvaged very little time for these niceties. “I spent almost half of my time documenting,” she recalls, “and a good deal of that was done after reporting off to the next shift.” Time with patients was confined to the minutes required to do a head-to-toe assessment at the beginning of the shift, medication rounds every two hours, and confirmationthat intravenous pumps and other equipment were running smoothly. “If I spent extra time with a patient,” she says, “it was because that patient called me. If there was a problem that wasn’t quick to solve, it usually meant staying later to chart or being late with someone else’s medications.” On the anxiety-laden cardiac floor, time was at a premium, and the proverbial squeaky wheels eked out what little remained once the essential tasks were completed.

Gone were the minutes, or even hours, that the nurse once passed by the patient’s bedside, conversing and teaching in relaxed, nonstructured ways. Gone was the careful attention to how the patient was really coping with his illness. Gone also was the time to reassure, the time to get acquainted, the time to understand. But certainly the essential nature of reassuring, getting acquainted, and understanding is inherent in any nurse’s value structure. Nursing schools tout the emotional element of compassion as fundamental to bedside care.

In reality, there was once more time specifically allocated to compassion in health care than there is today. Nurses who have practiced for thirty to forty years can recall roles and responsibilities much different from those of their younger counterparts. Supporting the patient has taken on a different meaning, a meaning that many older nurses have found difficult to reconcile with the concept of care they learned earlier. Complicated treatment plans, intense drug regimens, and increasingly acute conditions have cornered the nurse between technological accuracy and bedside grace. The hospital is not the world it once was.

 

What Has Happened to Our Patients?

Not surprisingly, patients have also changed. They are sicker, confined only during the most crucial hours of their recovery. Because patients are sent home so quickly, planning for discharge begins during the admitting process. Patients are expected to independently accomplish in hours what convalescents of the past would have been led through over days or even weeks. They are wheeled in, wheeled through, and wheeled out amid an array of scans, pokes, prods, opinions, discharge instructions, and multiple staff. They are anxious. Their families are anxious. The fact is that patients and their families bring fear, apprehension, anger, and grief to the hospital, just as they did forty years ago. What has changed is nurses’ opportunity to deal with these emotions. The environment in which the emotions are experienced has changed as well.

The Emotional Cure

If one were to imagine the scientific advance most immediately needed in nursing, perhaps it would be a way to encapsulate and mete out a cure for the emotions that ail patients entering the health care system, just as we have streamlined and perfected many technical aspects of patient care. However, we could not expect this cure to come in a measured dose or a prescribed protocol. Instead, we would need to be able to

• Identify an emotional state almost instantly
• Understand what the emotion could lead to if unregulated or what it might represent in the patient’s recovery process
• Understand the emotion’s effect on the family, ourselves, and other caregivers
• Allow our own emotional state to maintain equilibrium in the face of intense emotions of others
• Help patients, families, and colleagues to manage and regulate their own emotions (Mayer, Salovey, and Caruso, 2000, 2002)

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