I’m A Nurse, Not A Caregiver: Defining the Difference

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Much of a nurse’s shift is spent in analysis of constant patient assessment; a skill that is specific to nursing but difficult to define. Photo by fineartamerica.com

I seem to be getting hung up on the linguistics of nursing lately. Last week, I wrote a post about the importance of titling oneself at the bedside. And yesterday, I ran across a piece in my Sunday paper that made me think pretty seriously about the nursing profession’s relationship with the word “caregiver.”

Nurses are often called caregivers. In fact, after posting my titling piece to Twitter, I struck up a bit of a conversation with some other nurse bloggers about the best way to introduce ourselves at the bedside; most of our brainstorming centered around the action of care.

“I’ll be taking care of you,” was filed straight into the garbage bin, and, “Hi, I’m your nurse, I’ll be caring for you,” my initial suggestion, wasn’t far behind. The general consensus seemed to fall on, “Hi, I’m the nurse in charge of your care today.” The act of claiming ownership of care seemed most important – much more powerful than “taking care,” and much more specific than “caring for.”

But what does that make us, then, as nurses? Are we caregivers, or are we care managers? If we are truly in charge of care, and we are claiming ownership of that specific authority to our patients, should we be lumped into the same nebulous cloud as nurses aides, techs, home health aides, and even, doctors?

Some of our work is care-giving, yes. We give baths, we give bedpans, we give medicines. But this kind of care overlaps with other unlicensed personnel, while too often used as our sole defining work. So much of our care is nurse-specific, and based on much more complex mechanisms of action than simply giving. Do our patients and our public realize this?

On any given shift, I’d say that the majority of my care is analysis. Dr. Diana Mason, the president of the American Academy of Nursing, and one of my professors at the Hunter-Bellevue School of Nursing, recently told Katie Couric & her viewers that nursing care is a “surveillance system.” We gather data about our patients silently and instinctively, using our assessment skills to ward off the predators of illness. Like a home security system, we silently prevent danger from breaking into our patient’s body, and we defend it when it does.

Do we communicate this care? Do we materialize our insanely complicated, instinctual and often silent act of caregiving into words? I think we must. We must label our multi-layered actions of nurse-specific care, and make them part of our dynamic introductions in order to set ourselves apart from other “caregivers.”

I wonder what patients would say if we started our shift like this:

“Hi, I’m Amanda Anderson. I’m a nurse. I’ll be in charge of your care today. You won’t be able to see most of the care I give, and you may not even realize I’m giving it. All day, I’ll be looking at you, your body, your vital signs, and your mood, to make sure that the condition that brought you here, under my care, doesn’t get worse, but better.”

Perhaps we should try it. Because the piece that got me thinking about the title “caregiver,” is by a geriatrician in California named Louise Aronson. It’s called, “The Future of Robot Caregivers,” and while Aronson doesn’t come close to inferring that nurses should be replaced by robots, she makes a pretty convincing argument for using these complex machines as caregivers in the homes of the elderly and disabled for comfort, companionship and care.

Yes, I agree, a robot that can read to a lonely patient and help her back to bed is pretty damn cool. But I have a hard time lumping what I do as a nurse into the same category, and I think if we don’t start dynamically and frequently defining our specific type of care – to ourselves, our patients, and our public – we might get dangerously lost in the caregiving cloud.

2 thoughts on “I’m A Nurse, Not A Caregiver: Defining the Difference

  1. Thanks for this important and interesting piece (I’m also a nurse, and writer.)
    FYI picky point: The speaker or writer implies. The recipient of the message, the listener or reader, infers, ex: Aronson doesn’t come close to implying…

  2. I’m a psych nurse, and that means there are other layers to speak through, and speak to, when introducing myself to a patient. It might start out like this: “I’m Pat, and I’m the nurse who will be working with you this evening. There are some goals that the treatment team is looking at, but mostly I’d like to know how I can help you accomplish what’s most important to you today.” Then it goes in a variety of ways. One way that’s tough is when I have to say, “I’m sorry that your doctor told you that you could shave without supervision” or “I know you were told that you could crochet while you’re here–it’s a great stress reliever–but. . .” And then the entire conversation takes on the unpleasant whiff of sadistic Big Nurse–who our patients “get” psychically and energetically even if they’re way too young to have heard of Ken Kesey.
    Thanks for your attention to these elements of nursing that demand to be examined, over and over again.

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