NurseWeek News

The Perfect Fit
Chronic care allows RNs to get to know their patients - and teammates

By Beth Ulrich, Ed.D., RN, South Central Editor
January 23, 2003

During much of my clinical career, I worked in nephrology nursing, a mostly chronic care specialty. While some nephrology nurses who work in hospitals are in acute dialysis units and some work in transplant units, the majority of nephrology care is done in dialysis units on an outpatient, chronic care basis. Chronic care is truly the place where you get to know your patients. If you have ever wished that you had more time to spend with your patients, then chronic care may be for you.

Working with a patient generally three times a week, four to five hours at a time, gives nephrology nurses, for example, time to learn pretty much everything about the patient and the patient's family. You learn patients' clinical idiosyncrasies, but you also learn about them as people. You know what foods they love and hate, their favorite TV shows, and you travel with them through the ups and downs of their chronic illness. To some nurses, the closeness poses an emotional challenge-how to get close, but not so close that you lose your clinical objectivity.

Getting close, as chronic care nurses do, also means becoming vulnerable. Chronic patients are living longer as we improve the health care we deliver, but nurses who work with chronic patients know that over time, they will lose many of these patients to co-morbidities and mortality. As a chronic care nurse, you walk a constant tightrope of closeness and caring.

Chronic care is also a great place to work if you like being part of a team. Nephrology was one of the first specialties to actively practice a team approach to patient care. Since the early 1970s, nephrology care has involved a team composed of physicians from various specialty areas, nurses, dialysis technicians, dietitians, social workers and-yes-the patients themselves. In later years, we have seen other specialties adopt this approach because it works so well. We all know that when health care professionals collaborate, patients do better.

In chronic care, we've also learned that involving the patient as a member of the team works. Patients who are taught about their disease and treatment can recognize changes in their bodies before most technology can sense those changes. Patients, too, see the whole of their lives, not just the part seen by the health care team. The disease may be the same, but in chronic care we've all learned that the individuals and their responses to their disease and treatments can be very different.

To be a good chronic care nurse, you also have to be skilled at helping patients see all the options and possible outcomes so that they can balance their lives between what is needed to deal with the disease and what is needed to make life worth living. And you have to learn to live with and support their decisions even if they aren't the ones you would make in your own life.
Each nurse needs to find the specialty niche that gives him or her the most satisfaction and joy. Chronic care isn't for everyone, but it is the ideal specialty for many nurses.

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