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Ah, the stories LaRae Huycke can tell. Huycke, MS, RN, is a clinical nurse specialist with a keen sense for the not-so-clinical aspect of nursing, the people side of science. For her work with Medicaid patients and people with disabilities, Huycke was a finalist in the clinical care category of NURSEWEEK's 2001 Nursing Excellence Awards (South Central region).

She admits that some stories are meant to tug at the heartstrings of nursing students at the University of Oklahoma, where she teaches that patients are not charts, diagnoses and treatments. They are real people, who judge their hospital or nursing home experience largely by their connection with RNs.

"I think that as human beings we're all connected," Huycke said. "I've seen some nurses who could pretend, but that takes a lot of energy and most nurses are not very good at that."

Huycke stresses connectivity in journal-writing assignments, telling students in her adult care classes, "Don't tell me how you gave an enema or started an IV or cleaned up after someone vomited. I have done all those things and I know how to do them. I want to know how you felt about caring for that person that day, how you think that person must have felt being a patient today."

As part of her master's thesis, Huycke interviewed more than 700 people who were trying to sue medical providers. The hardest part of a hospital stay, aside from any medical challenge, is loss of control, she said. Patients have strangers telling them when to sleep, when to wake up and when to eat. For some, if the nurse doesn't come, they can't go to the bathroom. If a nurse doesn't bring pain medication, they have to suffer.

"We need to be empathetic," she said. "We always have to see the situation from the patients' perspective."

Eyes, ears and talk
"What patients really connect with is a nurse who listens, makes eye contact and really hears what the patient says," Huycke said. "They say, 'I'm in pain,' and the nurse says, 'What can I do to make you feel better?' or 'I'm sorry you're not feeling well today.' "

The bachelor's degree in psychology that Steve Kresl-hotz, RN, earned from the University of South Dakota is never further away than a smile and an introduction as charge nurse in same-day surgery at United Medical Center, the regional hospital in Cheyenne, Wyo.

Kresl-hotz said he immediately tries to "figure out" patients, their communication styles and fears, sometimes breaking the ice with a joke and always with an invitation: "Let me know what I can do for you."

"Get them talking. Let them open up a little bit. Address the stuff that's going on with them currently. Try to figure out where their fears are. Everybody has them," he said.

"Check blood pressure and you can tell pretty soon who's really uptight," he said. "But it's amazing. If you sit there and jaw with them a little bit, you watch that old pressure come on down. The big thing is to be up-front and honest with people."

As a hobby, Christy Jones, RN, admissions nurse coordinator at Miami Valley Hospital, a 750-bed facility in Dayton, Ohio, collects first-person accounts of patient-nurse relationships and publishes them on a Web site, NursesAreAngels.com. Over and over, she said, patients say that it's the little things that count, that establish a memorable relationship with a nurse.

"Just taking an extra minute to sit down and listen when they've got something they want to talk about, or to brush their hair or rub their back, doesn't take a great deal of skill to do, but it means more to them than whatever technical abilities you have," Jones said. "Those are the kinds of things that make it meaningful to be a nurse."

Emotional risk and remedies
Kresl-hotz said that even after 18 years of nursing he's still susceptible to emotions that go along with patient care, especially when it goes beyond the medical to involve the chaplaincy or social services for patients who don't have a dime in their pocket. "You can emotionally get pulled in," he said. "Definitely the friendlier you become with people-especially if you've seen them a few times-when a bad outcome is occurring, you take a lot of that home."

That's true after more than 30 years' experience, too, said Huycke, formerly the exceptional-needs coordinator for CommunityCare, an Oklahoma City HMO.

"The patients I have connected with the most are patients who were maybe the age of my children or had a mannerism that reminded me of my children," she said. "If you connect too much with them, it's hard to send them back home. It's hard to let them go. When they don't survive or they don't do well, you just have to keep reminding yourself that you did the best that you could every day that you could."

Part of that "best" also is widening and strengthening bonds, encouraging families to connect, or reconnect, for example, with a terminally ill mother. Huycke said it's appropriate for an RN to intervene and tell children, "You've been given a tremendous opportunity to know that the end is coming. Maybe you need to tell her she was a great mom. Spend a few minutes reminiscing about some things you really remember about her that gave you pleasure. My guess is she will remember the same thing."

As for their own emotional well-being after becoming close to a patient, some nurses find solace on their RN teams, with co-workers who intimately understand caring, pain, loss and the occasional need to go behind closed doors and vent.

Although it wasn't always so, Huycke said she also takes comfort in prayer. At St. Anthony Hospital in Oklahoma City, she said, "We meet and get a morning report, the physicians and I, then we sit and pray for maybe two or three minutes. Pray that we will be wise, we will be clinically astute, pray for our patients.

"When I first started, that bugged me. I'll be real honest," said Huycke, who does not share the hospital's Catholic affiliation.

She said that changed, however, in the aftermath of one emergency room case. A 16-year-old girl committed suicide because she didn't have a homecoming date.

"Before she died, we did our checkout report and we prayed for her," said Huycke, who left the hospital with the girl clinging to life. "As I was driving home, I thought, 'I've done everything for her that I can do. Medically, I did everything I could do. Spiritually, I gave her family emotional support. I really poured out everything I had.' And when I prayed, it was suddenly like an epiphany, like 'I now have done everything I can for that little girl-I even prayed.'

"She ultimately died, but what I have to give myself-that I did everything I could-gives me comfort."