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The Business of Caring

“It’s been a pleasure working with you” is a phrase I hear people say all the time, but it is not something I myself say to colleagues or patients. As a boilerplate phrase, it can roll off the tongue in a paradoxically tongue-in-cheek manner. Despite its potential attempt to transmit cordial feelings, in my mind the phrase connotes only business. Though health care is the business of caring, caring is not a business.

The majority of clinicians are caring, and in my experience the “successful” ones show—not say—that they care. My definition of caring, successful clinicians was formed by my interactions with nurses who have been my teachers in the clinical setting. They have often said to me “It is a privilege to care for my patients.” As a more weighty and emotion-filled iteration of the analogous business phrase, initially I did not know what was meant by the “privilege to” part. A new nurse-in-training, I had yet to deeply understand how using the word “privilege”—a word encompassing “lucky,” “fortunate,” and “benefit from”—could be a fitting way to describe caring for patients.

Having now cared for my first patients, I understand more fully what the phrase means. A particular clinical experience I had strikes me as one of the first instances that made me realize, “It is a privilege to care for my patients.”

One day as a student nurse working paired with a staff nurse, I was assigned to care for a man in his 50’s with a rare autoimmune disease that was making his kidneys fail. In his frail condition, subsequently his liver was also failing and he was at the top of the transplant list for both organs. Jaundiced to the color of a rubber ducky, the critically ill man was surprisingly cooperative and pleasant when I introduced myself in the morning. He acquiesced to letting me help him get repositioned into a chair so he could improve his circulation and take his morning medications. However, no sooner had he and his achy joints and herniated, grossly distended abdomen made it into the chair did he begin to complain of having lower back pain and chills. Lacking any appetite and having been NPO-except-medication for three weeks, dutifully, he swallowed the first of his pills, only to begin heaving with nausea.

As his primary nurse rushed to get him a PRN dose of anti-nausea medication, I handed him a basin and grabbed more blankets to combat his chills. With the medication and blankets, he was less nauseous and chilly but still visually in pain from his lower back. Taking a cue from a caring, successful nurse I had once seen do this with another patient, I asked and received his permission to rub his lower back with my hand. The light massage relieved his pain, he began to look more comfortable than he had all morning, and I saw the tension release from his face. However, the instant my hand felt his hot skin, burning unmistakably with fever, my mind filled with tension, knowing that this sick man was becoming irreversibly sicker. 

The nurse and I consulted the team about his fever and went about beginning the infection workup. After gathering the supplies to take cultures and start antibiotics, the nurse and I entered his room to find the man whose anxiety had prevented him from sleeping for the past three days, now asleep, lulled by extreme sickness and pain. With the patient’s eyes closed, the nurse silently drew my eyes to the small whiteboard on the wall and scrawled, “He is very sick. His family has been called.” She erased the message as my heart sank. My first patient was going to die.

By the time I got back from a meeting later that morning, my patient’s room was empty. I never had a chance to say goodbye to him, to rub his back one last time, to cocoon the blankets around him before he was transferred to the MICU, where he saw his family before he passed away. At some point there is simply little that can be done, but in my last hours with him—some of his final hours—I rubbed his back and did what little I could do for him.

I could not change the fate of that patient, but caring for him changed me. He showed me what a privilege it is to care for my patients as a nurse.

In only the best scenarios is sufficient care achieved using the relatively narrow arsenal of medical interventions and treatments currently available to clinicians. Presently, and increasingly so, health care is facing problems that are stymied by conventional medicine and conventional thinking. This is where innovation has promise, and when we must balance the business of innovation and “the business of caring.”

Money, time, and expertise are the means allocated by business to solve problems. Although these resources can be managed, their potential is definitively limited in comparison to the boundary-pushing power of new ideas brought to the table by bright thinkers. Clinician innovators, those people who see clinical problems firsthand and also envision potential solutions, are the people working in the space where medicine and business can reach synergistic brilliance. These clinicians who venture to say “what I can do for my patients as a clinician is not enough… and here are my ideas for creating a better future of care” are pushing health care forward in the best way possible.

When I graduate from nursing school this summer, I will be pursuing a career as both a clinical nurse and a health care innovator. I have big dreams I want to accomplish in both realms, but my drive and inspiration will always have roots in individual patients and their stories. The patients—the people—who benefit from health care innovation are the reason that all of us who split time between being a clinician and being an innovator should remember that caring is not a business transaction. Caring is a privilege.

Hilary Ginsburg

Hilary Ginsburg

    Hilary Ginsburg is a proud future nurse, currently in school at the MGH Institute. She is aiming to become a nurse leader involved in health care as a clinician, thinker, innovator, and writer. Her clinical and research interests include palliative care, lifelong quality of life, interprofessional teamwork, and using innovation to optimize care delivery and the patient experience. One of her biggest pain points is the deficiency of nurse/doctor collaboration manifesting from the silo-ed growth of the medical and nursing fields. Her writing interests include innovation’s influence on the future of health care, giving voice to the patient experience, and capturing exemplary instances of clinical learning and patient care. She tweets as @Htotheinno

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