Tuesday, December 12, 2006

Nursing Theater

UNR's winter commencement was last Saturday, and the paper carried this story about the top nursing graduate:
"In addition to intelligence and self-assurance, Jamie Souba has another quality that will make her a great operating room nurse.

"'She has beautiful eyes,' said Peg Farrar, one of Souba's instructors at the University of Nevada, Reno's Orvis School of Nursing.

"'In the operating room, everyone is wearing a mask and all you can see are their eyes,' said Farrar, who was Souba's faculty mentor. 'You have to help people who are usually pretty scared, and you can't see all the usual facial expressions. You can't even touch patients because you have to keep your hands sterile, so you have to use your eyes to reassure them.'"
Reading this article made me think about something I'd only realized subconsciously: the extent to which good nurses very deliberately use body language, gesture and tone of voice to communicate with patients. In the ED where I volunteer, I've heard burly male nurses, people who might otherwise be intimidating, soften and lower their voices to reassure helpless patients. I've seen small female nurses adopt hands-on-hips fighting poses when dealing with confrontational patients. I've watched nurses switch from working a code (all business, emotions suppressed, each movement as economical as possible), to comforting a frantic family member (empathetic expression, arm around shoulder, voice that radiates compassion) -- and back again, all in a matter of seconds.

Good nurses, I've decided, have more than a little in common with good actors. They know how to use their entire bodies to reinforce their words, and they're exquisitely aware of the impression each gesture and intonation will produce in their audience. I've read several nursing-blog posts whose authors made rueful comments about deserving Academy Awards for their performances: for pantomiming concern when all they felt was exhaustion, for projecting calm when inside, they were panicking.

There's a lot to be said for knowing what people need and delivering it, even when it may not be 100% sincere. I've met some nurses who are excellent technically, but who simply can't adjust their self-presentation to circumstances: nurses who talk to frantic family members exactly the same way they talk to other members of the code team (noting with clinical detachment, "oh, yeah, these numbers are off the chart, really bad"), or who maintain a machine-gun conversational style even when patients are terrified and need to be spoken to slowly and softly. These nurses aren't bad people: in many ways, they aren't even bad nurses. They're admirably authentic, but they aren't good actors. And medical crises often call for good acting, rather than authenticity.

I've learned to recognize when nurses are acting, and I think many patients and relatives recognize it, too. But that's okay. We all appreciate the performance. I doubt that nursing schools including acting techniques in their curricula, but maybe they should.


  1. You're so right about how the tone of voice and words used influence the way a patient feels. When I had my surgery, and even now as an outpatient, I took and still take cues from how doctors and nurses approach me. The best caregivers are the ones who acknowledge that things are not ideal, but give hope for things to get better.

    Nurses who would say "I know this is burning" when they pushed morphine into my IV, but said that it should help with the pain were the best because they acknowledged my pain, but gave hope for it to get better, for example.

    I think in our acting, it's vital that we not act in a way that invalidates someone's suffering. I think you said this very well.

  2. Good post, I hope you submitted it to Change of Shift.

  3. Thanks, Nickie and TC! (And TC, yes, I did submit it to CoS; in fact, that's why I wrote it. Deadlines are good things.)


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