As we move through our respective careers, there are always a few patients we remember as if it were yesterday. I think the reason these patients hold such a dear place in our hearts and memories is because of the relationship that we were privileged to develop and share with them while under our care.

I remember the beautiful 16-year-old cheerleader who found out she was pregnant, only to be informed that, by the way, she also had leukemia. I was her primary nurse throughout her nine-month pregnancy, four relentless rounds of aggressive chemotherapy and her amazingly normal delivery of a healthy baby girl. We had to persuade her doctors to sacrifice her sterile laminar flow environment to let her baby stay with her during her last few days. She died the day after her daughter's first birthday and two weeks after she achieved her GED. For her, she met the two life goals she had set at the beginning of her treatments.

If there is one undeniable effect of managed care on nursing, it is that inpatient nurses no longer get the same chance at a "relationship" with patients with lengths of stay so short and 12-hour shifts dominating work schedules. I believe that this is one of the reasons why nurses have sought other care settings where they can establish and maintain relationships with patients over time. The clinical challenges and autonomy of these settings also are a compelling motivation for many nurses.

It is evident that nurses who choose to work in rehabilitation, hospice and home care have found settings in which they can establish more long-term relationships with patients and their families. Our cover story on Dolly Arro, private nurse to actor Christopher Reeve, shows the importance of continuity and relationships in the nurse-patient care contract.

Nursing would do well to explore creative care delivery models that allow nurses to develop and sustain patient relationships outside the normal constraints of the typical hospital stay. What if our home care visits were with the patients we saw in the clinic and in the hospital, etc.? I'll bet patients would love it.

Sidenote: Having had the honor of working at Rancho Los Amigos Medical Center, I am not sure who I admire more: the nurses, therapists and physicians who care for the spinal injured, head injured and other physically challenged patients there, or the patients themselves. To many patients, Rancho is almost home, and the staff, an extension of their families.

Never have I worked in a health care organization where the sense of mission was so palpable.

Unfortunately, the Los Angeles County Department of Health Services has designs on closing this internationally known rehabilitation center. We should hope and pray that this does not happen. The health care community in Southern California is not equipped to handle the large number of uniquely challenged patients that Rancho has cared for throughout the years.

Rancho is not alone in the county's planned cuts; the infrastructure of public health care in Los Angeles is at risk. Regardless of where you work, if you live in or near Los Angeles, the ripple effect of these proposed cuts will be felt by all.

Discuss this and other topics with your colleagues at www.nurseweek.com/rnvillage.