When Being an Advocate Means Stepping Back

I’ve often said that nurses very uniquely walk the path with their patients, and I mean it exactly that way.  We’re not out in the hallway looking at the chart or sitting in a remote location discussing options with colleagues.  We’re right there, with the patient and their loved ones, physically and spiritually and otherwise immersed in the person’s care.

Nurses are with their patients in a most intimate relationship where we’re not only collecting private information, making assessments and assigning nursing diagnoses. More than developing action plans and monitoring outcomes.  More than cleansing wounds, administering medications, checking vital signs.  We’re hearing secrets, counseling, guiding, educating, training, comforting, bringing loved ones into the communication group, stepping in when needed to clarify a situation or to help our patients maintain position. We contact other providers, set-up interdisciplinary meetings, collaborate with colleagues – and bring it all back to the patient for informed decision-making.  We are, after all, advocates and healers. We know that any person under our care is special and worthy and entitled to our care. We know that true healing involves more than treatments and medications.  We are firm in our belief that the person is the owner of her or his own body and, except under extreme and defined circumstances, the person is responsible for any decisions made about their body.  We do what we can to bring the needed information to the table.

Comes the day, however, when the autonomy we promised our patients is put to the test because the patient’s decision is somehow painful or not what we were hoping for.  It’s a special kind of dance.  While suppressing our own feelings, we must hear the person’s questions and beliefs and desires, and hear the family’s disbelief and promises of support while in their own surreal state of shock, and resist any urge to stifle the well-meaning friends who launch into, “You can’t give up without a fight” that leaves the person feeling badly if they don’t choose the course of pain and nausea and vomiting.  We see the confusion, the guilt, the myriad emotions that come with the situation, and we think we know the best answer, but it’s not for us to decide.

The urge to take over and control the situation is strong.  We want to “fix” the person or make their last time in this life as pain-free and stress-free as we can make it.  We want to stop the people who seem to badger, pushing their own beliefs into the situation.  If not careful, we can cross the line between advocacy and paternalism, and strip the person of their own life’s decision-making in the name of “what’s best for everyone.”  Older nurses are well-versed in ministering to patients who were never told their diagnoses until their dying breath. We’ve been forced to be part of a well-meaning conspiracy that denied the person any chance of living the end of their life on their own terms.  Today’s nurses need not go there.  By the same rules, however, we also can’t decide for our patients.

Perhaps the most important role of the nurse advocate is in knowing when to step back. Once the patient indicates that they’ve got the information they need, and that they’re in full control of choosing their actions, we’ve done our job and it’s time to let go, at least for now. We may be called back.  Maybe not.  Painful as it may be, it was never our choice to make.