By Diane Goodman, APRN, BC, MSN-C, CCRN, CNRN
Recently, I was discussing "retirement" with a friend. Unfortunately, with global economic changes, many of us in healthcare may work years longer than originally intended. During the retirement discussion, my friend had several pointed questions I found difficult to answer. The most difficult was to define "quality" time, meaning what would I choose to do to provide quality in the time between cessation of work and onset of senility and/or death? Several days have passed since our conversation, and the word "quality" has remained foremost in my thoughts, nagging at me, and begging to be described and clarified.
What is quality time? Has quality become one of those words utilized so often in healthcare that it defies meaning? We have standards of care, evidence-based practice protocols and quality of life indicators for patients, yet for nurses and healthcare providers, could we require an alternate definition? Do we remember to add quality to our lives, or are we at the bottom of Maslow's hierarchy so habitually that we have forgotten what it is?
For many of us, work itself has become a measure of validation, with the next goal being seen as a gauge of success and time well-spent, no matter how much stress or sacrifice was involved. We cannot get through an appraisal of work without having measureable goals and checkpoints. If asked to slow down long enough to define quality time, how many of us would pass the test?
As I pondered the question of what would bring me joy and a sense of peace, I realized for me it is often seeing a patient previously in pain begin to relax, or a new nurse struggling with the fears/anticipation of her first years providing bedside care. It is the face of comprehension, when nursing associates understand blood gas analysis for the first time, or are provided with an arsenal of tools to care for difficult or challenging cases. It is not about watching Top Chef, Investigation ID or an Academy Award nominated movie. I love all these things, but I'm not yet ready to define them as "quality." They amuse, but do not excite.
If we are truly honest as nurses, we have a tougher time than most leaving work at work. We drag our gallows humor to almost every party we attend, and dinners out to socialize usually become another opportunity to vent work frustrations or revisit "the good old days" when doctors smoked at the nursing station before advising patients to quit. We became nurses and caregivers because it is in our blood, and like an ongoing infection, it may be difficult to treat.
Nursing has consistently been voted the most trusted profession; however it is also one of the most stressful. Drop-out rates within the first year of employment (for new nursing graduates) have remained elevated, with attrition percentages varying from 10-40% within nursing schools. As described by a recent article in the Los Angeles Times, what we've witnessed is more of a nursing crash than a nursing shortage.
Think about the concept of quality in your life. How do you define what gives back and centers you? Does the word have meaning ... or is it still in the formative stage? Think about what you would enjoy doing most in the years between work and the end of life. Does the word have definitive parameters, involving family time and hobbies, or is it blurry and lacking substance?
I am ashamed to admit I have yet to figure out what the word means for me. I do know that for myself, as for many nurses working in healthcare, applying our knowledge, skills and compassion on a daily basis provides a concept of quality for those who come within our sphere of influence. The inverse is also true; the less one sees a nurse, the poorer the potential outcome.
It's when nurses get in the car and head home that those same definitions become indistinct. If we are incredibly, impossibly lucky, we have those at home who need us to provide care and nurturing, good care, perhaps even quality care. If our luck prevails, we won't have to answer tough questions about how we will thrive once that is gone.