Trading Places
Nurses get a taste of their own medicine as they experience care from the other side of the needle – and find greater empathy for their patients

By Glen Fest
March 27, 2003

Kara Battaglino was having a rotten December.

She'd recently recovered from a mysterious six-month bout of muscle fatigue and soreness when she suffered a relapse of symptoms. Her doctors diagnosed the problem as an autoimmune disease, myasthenia gravis, and removed her thyroid gland in a surgery at University Hospital in Syracuse, N.Y.

Lying in her recovery hospital bed, the 31-year-old registered nurse had time to reflect on her postoperative pain, the extensive follow-up treatments she would need and that she'd have to take yet another leave from her job as a cardiac ICU nurse.

Battaglino ignored her own preoccupations, though, to focus elsewhere: her suffering bunkmate.

"She had a hip replacement … and was in a lot of pain and discomfort," Battaglino said. "So I would get out of bed, grab my IV pole and help her out with whatever it was that she needed help with."

Helping her to the restroom, getting a blanket or clearing a food tray-it was all in a day's work for Battaglino, even though she was as off-the-clock as a nurse can get.

Battaglino, who was among several nurses who shared with NURSEWEEK their experiences as patients, agreed that being on the other side of the needle was not a comfortable position. Most are wired for tending and providing, not being pitied and pampered. That they might be sick, injured or pregnant usually fails to readjust that perspective during treatment, several nurses said.

"That's a whole different role for most nurses," said Heidi Benoit, MSN, a Louisiana nurse educator who was hospitalized last year for an inguinal hernia.

The nurses agreed that the viewpoint of a nurse-turned-patient is different from that of the typical patient. A nurse may know many of the details about his or her condition, which can mean either added reassurance or a greater understanding of the risks. Bedridden nurses might be more cooperative and compliant with their bedside nurses, but they also can be unintentionally intimidating to staff members who fear appearing incompetent to a peer.

Most of all, nurses said the perspective of being the patient makes them better nurses when they revert back to their scrubs. They learn how to better read patient distress and realize how crucial empathy plays in a patient's recovery.

Benoit is a nurse who should be accustomed to the bedridden patient role. She endured several facial reconstructive operations throughout the past two decades following a 1979 auto accident in which she was thrown through a windshield. She had a second operation last year to have a floating, microscopic glass shard from that long-ago accident removed from an eye socket. Even with multiple hospitalizations, she admitted that she's never grown accustomed to the patient role.

"I personally found it difficult to stay in the bed. I just wanted to get up and go home, and felt that I should," Benoit said. "I felt like I also had to be the best patient … I don't know if I can explain why I had that expectation of myself, but I did."

Dot Mundy, MSN, RN, also was self-conscious when she was admitted to Mercy Medical Center in Baltimore for her acute, adult-onset asthma. She was worried more about burdening the staff than getting well. "I didn't want to be a bother," Mundy said. "I'm thinking they must have some [other] really sick patients to take care of. But they told me, 'You need to be the patient now,' and that was difficult for me."

Loss of control

Control is an important feature of the profession that many nurses said they find unsettling to lose. Bonnie Krueger, MHA, RN, manager of adult critical care units at Medical City Hospital in Dallas, recalled with mild embarrassment her actions as a young nurse hospitalized with a blood clot in 1971. Krueger refused to let any staff nurses or health care staff administer shots or handle her medications.

"You talk about a lack of trust … I had to give all my own injections, I had to start my own IV, I had to look to the IV bags to make sure everything was copacetic," Krueger said. "Everything had to be by the book and by the procedure, very much as a novice would do. Reflecting back, you have to let some of that control go. I would never give my own injections today."

Krueger came full circle in 1995, when she was hospitalized for five days with a pulmonary embolism in Oklahoma City. A few weeks after fracturing her foot, Krueger was suffering chest pains and shortness of breath at the end of her shift at Integris Baptist Medical Center. She fainted in the locker room and was rushed to the ER by her team members.

Being unconscious, she had no choice but to submit fully to the treatment and guidance of doctors and staff. But this time, she allowed her colleagues to do their jobs, she said.

"The staff that took care of me understood that [control] need, and not once did they assume I had knowledge of what was going on, or didn't need support or comfort," Krueger said. "Every hour, someone would come in and say, 'Is there anything we can do or is there anything we can explain to you?'

"A lot of people assume that you know, so they don't tell you, and they don't offer the comfort they would other people. But a nurse as a patient requires even more."

Only one time did she ignore her doctors' wishes. Before her discharge April 19, Krueger got out of bed to help prepare the hospital for possible victims when they learned of the bombing of the Murrah Federal Building 10 miles away. No victims were transported to Integris, Krueger said, but she was ready to assist even though she was still wearing her patient wristband.

Blessing or curse?

Krueger and other nurses may battle the urge to control their situations as patients largely because they know all too well the risks and conditions not apparent to lay patients.

Phoenix triage nurse Rita Fair, RN, who was diagnosed with lupus more than 20 years ago, knew what kinds of questions to ask about her condition when she became pregnant. She had so many, Fair said, her perinatologist had to schedule several off-hour phone sessions to address Fair's concerns.

Jill Bokern, RN, knew full well what she was facing last fall when she was diagnosed with breast cancer. As nurse coordinator at the Siteman Cancer Center at Barnes-Jewish Hospital in St. Louis, Bokern counseled patients daily on topics of risk factors, recovery issues and family impact. Her nursing knowledge gave her optimism about her prognosis.

"It was very treatable, since mine was in early detection," Bokern said. Her job made both herself and her family aware of how often women defeat breast cancer. When her disease appeared, the shock was cushioned because they knew 80 percent of breast cancer victims are women with no known symptoms (like Bokern).

Bokern was confident about her recovery, but this made room for smaller worries that perhaps only a nurse would go through. As a longtime employee of Barnes-Jewish, and now as a patient, she had to choose among a pool of highly qualified surgeons who would perform her mastectomy. Most were also close friends, and Bokern was concerned that choosing one would hurt the feelings of the other surgeons. "That was probably the toughest decision for me ... I felt they were all good," Bokern said. " 'Who do I choose, one or the other?' That's not a bad place to be in."

The relationship between a nurse patient and any attending medical staff can be complicated, some nurses admitted, particularly if the staff member is a colleague or a supervisor.

Patricia Kaldor, MSN, RN, was a senior vice president of St. Joseph Regional Medical Center in Milwaukee when she was first admitted to the hospital for breast cancer in 1997. Throughout the next year, she endured chemotherapy and eventually bone marrow transplant surgery. Kaldor had daily contact with oncology staff members who knew both who she was-a hospital executive-and what she knew as a surgical care specialist.

"I think probably most nurses might have been nervous about taking care of the hospital's chief operating officer. I'm also a nurse, so I know their trade," Kaldor said. She noticed some nurses who were apologetic over routine matters, such as sheet changes, but "I was always trying to be reassuring to them. I didn't want them to feel awkward," Kaldor said.

"We just had an affinity for each other," Kaldor said. "She was there on the night when my white cell count started coming up, which is always a gleeful day for the nursing staff … so to this day, when we see each other, we always ask how the other's doing."

Mundy, the Baltimore nurse, believes some of the support techs were nervous about dealing with her and appearing mistake-prone or incompetent. All nurses and technicians at the hospital know her because she serves as the orientation program leader at Mercy Medical. She had to reassure one tech, "Just pretend you don't even know me," after struggling to insert an IV into her.

New perspective

Knowing how a fellow nurse feels was natural, but most of the nurses said they were surprised about how much they learned about the patient viewpoint. "I know now … how vulnerable people feel, and how fearful of even some types of simple procedures people might feel," said Benoit, who is faculty coordinator of the Lafayette (La.) General Medical Center School of Health Sciences.

Benoit remembers recently visiting with an inconsolable patient about to undergo a routine angioplasty. "She simply needed somebody to sit by the bed and say, 'Hey, you're scared, tell me what you're feeling,' " Benoit said.

The patient was scared of dying, but also of simply becoming incontinent while under anesthesia. "Once she was able to talk about it … she got it off her chest, and we were able to get a move on."

Bokern, the breast cancer survivor, thought she connected well with the patients she's counseled and treated for most of her career at Barnes-Jewish. But she acknowledged that her experience as a patient has given her an added closeness to other patients.

Getting sick "gave me even better insight about how important it is to communicate. You're worrying about your life and your priorities. When I tell a patient what I've experienced, they look at me differently, like they really do know it's not something I've read about or something I know because I work in this field.

"They have a sigh of relief-'You're the real deal,' " Bokern said.

Contact Glen Fest at glenf@nurseweek.com