Jul 24, 2022
What Nurses Know
The Four Skills Nursing Taught Me for Navigating Life
I’ve been a nurse for forty years. I can’t help knowing what I know. And I have been a lot of kinds of nurses over that time: psych nurse, public health nurse, nurse educator, and nurse manager. (I have not been an operating room nurse, an emergency room nurse, or a bedside nurse.) I can tell you that every nurse I have ever met knows four skills that will get you through almost anything.
I repeat: Almost. Anything.
Here they are:
- Pay Attention
- Save the Patient
- Fix What’s Broken
- Manage the Pain
These four steps can be used to manage pretty much any emergent and non-emergent issue in your life. Usually, but not necessarily, in that order.
Here’s what nurses know.
Pay Attention
Nurses are trained to observe people carefully. As a person walks into a clinic and sits down the nurse is noticing small details that tell a story. The color of your skin, the way you walk, how fast and how deeply you are breathing, your heart rate, how well you are washed, your choice of clothing, the look on your face, the steadiness of your hands, or your ability to answer questions.
These observations and others tell a story about your state of mind, your level of discomfort, your ability to move about the world, your emotional reality, and whether you need immediate attention, or can wait. A good nurse knows how worried to be, and which doctor to call.
Save the Patient — Stop the Bleeding or Give them Air
Naturally, we expect nurses to notice and intervene in life-threatening situations. Whatever is going to endanger life needs the quickest sort of attention. First things first. If someone is bleeding, stop it so you can see what the source of it is — whether it will need stitches, whether it can be managed on the spot, or will need surgery. If the person isn’t getting air, get them air. A broken arm or a crushed foot will not matter if the patient suffocates or bleeds out. Save them first, then assess the damage. Stop whatever is threatening to kill them, then move on to the lesser, if difficult, injuries.
Fix What is Broken
When the patient is no longer in mortal danger, what’s broken can be fixed. It may take setting a bone, surgery to remove an appendix, placing a stent in a clogged artery, or prescribing a medication. Once the source of the trouble or the extent of the injury is recognized, it can often be put right.
Manage the Pain
When the observations have been made, the patient moved out of danger, and the damage repaired, then there is managing the pain. We spend a great deal of nursing time helping patients manage pain. So that they can heal; so that they can move; so that they can live their lives. It may be brief and acute pain management, or it may be an ongoing task to keep the pain at bay.
As nurses we might deliver medications, teach positioning, advise the doctor, or help the patient get their feet under them, all in the name of making them more comfortable. We can detect pain from a mile, and there are many ways to manage it.
These skills are part of my operating system. Not a day goes by when I am not using them. They have created a frame that gives me ways to approach every challenge I come up against. Everything from a struggling marriage to a child hurt on the playground. A grieving friend, or deciding who I will vote for. I can apply these skills, and decide whether and how to make a difference. I generalize them to all sorts of situations, and so can you.
We can detect pain from a mile, and there are many ways to manage it.
I pay attention.
I’m not an observant person by nature, so this one takes effort. It’s easy for me to ignore obvious signs of trouble, or to focus on the wrong things. I have learned to step back — not jump in with solutions and assumptions, but to assess “what is” before proceeding. If a grieving friend comes over for coffee, I pay attention. Is she fragile? Preoccupied? Tearful? Angry? Does it look like she’s been eating? Sleeping? I take it in. Information.
I do the same with a news story about war, a daughter who is angry at her boss, or a partner who is acting differently. What do I see? What are the facts? What do we know, and what don’t we know?
I save the patient.
After making observations, I ask myself, “do I need to intervene to assure survival?” If the answer is “yes,” I intervene.
Is my grieving friend suicidal? Or just sad? (I give my friend a lifeline — I listen.)
Is this war something that has been brewing? Does it seem necessary? Brutal? Damaging? Is it genocide or a border squabble? (How can I demand an end to this war — people are dying!)
Does my daughter need to talk about her boss, or get a new job? Is this threatening her well-being or just a glitch to handle because it comes with the territory? (If she needs to leave this job, can I help her survive?)
Is something threatening my relationship with my partner? Is it dire? (Does it need emergency care with a skilled therapist?)
I do what I can to save the patient.
Save the Patient — Stop the Bleeding or Give them Air
I fix what’s broken
While fixing isn’t always possible, sometimes it is.
Can my grieving friend find a way to stay connected to the object of her grief, even if they are no longer in her life?
If the war is happening and it endangers something I care about, who can fix it? Do I need to volunteer somewhere? Write my senator? Demonstrate? How can I contribute in a real and material way to fixing/restoring what has been damaged?
What does my daughter need from me? Can I help her with her resumé? What does she need to feel restored and able to work? How can I help?
Will my partner work with me to repair what is broken? Does it matter as much to them as to me? Is this a break that can be fixed?
When I have the skill or agency to make a repair, I do it.
I manage the pain.
Pain management takes so many forms.
If my grieving friend needs to laugh, I’m her girl. A glass of wine? A weekend away? If she needs to walk, or just cry, then that’s what we’ll do.
What pain is this war causing? Do I need to manage my own pain? Is watching the news too much for me tonight? Can I contribute to the relief efforts? What small thing can I do to lessen their pain or my own? I will do that.
Does my daughter need to manage this pain? Can she work with this boss? Is it too much to ask of herself? What are her choices? Will saying it all out loud to me help her see what would make a difference? I will just listen.
Will my partner hang in through a painful time? Can we repair this without continuing to hurt each other? We’ll manage the pain.
When my soul or my body is in mortal danger, I will stop the bleeding (of my time, my spirit, my emotional energy, my money or my attention.)
When I am the Patient
Nurses are notoriously bad patients.
But when I need to, I have learned to turn my skills on myself. When something rocks my world, I can be a nurse to myself.
I pay attention
What seems to be happening? What do I know? Is this familiar ground? Do I recognize what I’m seeing?
I save the patient.
If something is damaging or threatening me, I address it. I talk to the neighbor, or don’t pursue that friendship. Maybe I will have to leave that marriage. When my soul or my body is in mortal danger, I will stop the bleeding (of my time, my spirit, my emotional energy, my money or my attention.) Or I find a way to breathe. First things first.
I fix what’s broken.
A flat tire or a difficult relationship. I will do what is called for. Learn to use a jack. Seek counseling. Apologize.
I manage the pain.
Life will not be comfortable all the time. I will learn the difference between pain which means healing and pain that must be treated. I will create as much well-being as I can.
And I will do my best not to be the source of my own pain — yet another sort of pain management!
How About You?
These skills are not magic. They are a practice. They are “learnable magic.” We can be the triage nurses in our own lives, and we can be a source of healing. You may already be better at any of this than I am.
I’d love to hear about a time when you paid attention, saved the patient, fixed what was broken and managed the pain.
I’m all ears.
