Nurses are a special breed. We like to care for peo-ple. When I tell people what I do for a living, I amproud of the reaction I receive. People usually feel atease and assume that I have a loving, caring nature.However, we run into conflicts when our most lovedones fall ill. It is my belief that, no matter what stagein life a patient is in, whether birth or near death, sim-ply being a nurse does not mean we are the rightnurse for our family members. That goes for anymedical professional. Sometimes we need to put ourmedical background aside and just be a supportive,loving family member. Here’s my story.

The water came out of nowhere, waking mefrom a deep sleep. Once my thoughts began toclear, I remember thinking, “I wet the bed!” Then,as I rolled to my side, I realized not just the bedwas wet; the bedcovers, the bed frame, myclothes, and the floor were all soaked with fluid. Iwoke my husband and said in a confused state,“Honey, I think my water broke.” He jumped out ofbed and started to put on clothes.

Then it hit me—this isn’t happening, I still have 2more months; the baby shower was just yesterday.Nothing was ready. All at once my 10 years of nursingexperience (including 7 in the ICU and the last 4 as anurse practitioner) seemed to fly out the window. Ilooked at my husband, a family practice physician forover 15 years, and said, “What does this mean?” Hegrabbed my face with his warm, comforting handsand said, “It means we’re having a baby—now!”

After a long and very difficult delivery, my babywas immediately taken to the neonatal intensivecare unit. The first time I saw my little boy, he hada breathing apparatus over his mouth and nose andtubes coming out of his hands. Little monitorpatches were stuck all over his tiny, concave chest.He was in a protective incubator and propped upon his side. Looking down at him, all I wanted todo was pick him up and take him home. As myhusband held me and tears fell down my cheeks,we listened as the doctors explained what washappening. My brain comprehended all the medicalinformation, but my heart couldn’t understand whyI was unable hold my son.

Nathan was not to be stimulated for longer thana few minutes, visitors could only be immediatefamily, and because he could not be off themachine or out of the incubator, I would only beable to pump milk, which would be given through atube in his nose down to his stomach. I would goback to my lonely hospital bed, longing to “fix”him. Two days later I was discharged from the hos-pital and sent home, empty-handed except for abreast pump and pamphlet on how to clean mywounds. Unfortunately, the wounds I felt could notbe cleaned with some antiseptic wipes or powder.

My routine consisted of going to the hospitalearly in the morning, staying all day, and pumpingmilk to try to feed my child. The best part of theday came when the nurses would allow me to do“kangaroo care”: I sat in a chair topless, just mybare chest pressed against his tiny bare body. Itwas like our hearts were lying on top of oneanother, his gathering strength from mine. Thislasted only about 15 minutes, but as I held him, hisheart rate slowed, his breathing became regular,and for that short period, both of us were content. Iwas forced back to reality when the nurse took himfrom me and placed him back in his mechanicalwomb, hooking the tubes back up and turning onthe ultraviolet heat lamp.

The nights became unbearable as my husbandand I walked out of the hospital, hand in hand,without our child. We asked each other why wecouldn’t just take him home and care for him our-selves—we were 2 medical professionals, after all!We could do it. But then my husband’s voice ofreason brought us back to reality as he explainedthat the best place for our little baby was in theNICU. The lack of control I felt was overwhelming

Stepping Aside: What HappensWhen a Loved One Becomes Ill

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IN MY OPINIONEmily Seiden Hinchman, ANP-BC

JNP

as I left another nurse, like myself, in charge of mychild. What if she wasn’t a great nurse? What if mybaby started to develop strong bonds with her? Ishould be the only the one caring for him, not paidstaff in some cold, sterile room.

After almost 2 weeks of living between the NICUand my house, we were able to take Nathan home.His outfit we had bought several months earlierhung loosely on his 4-pound body. In the weeks thatfollowed, my husband and I had many discussionsabout our experience and how it had made usstronger, both in our relationship and ourselves.Although it was extremely difficult to leave my childin the hands of others, we came to realize how won-derful the NICU had been. It was Nathan’s onlychance of survival, and, despite the combined 25years of medical experience between the 2 of us,my husband and I would not have been able to givehim the care ourselves. The NICU nurses weretrained in ways I wasn’t and specialized in newbornslike Nathan. This was neither my area of expertise,nor my husband’s, and we accepted that.

I now know that my son didn’t need me to behis nurse, or his father to be his physician. Heneeded 2 parents to sit by his side every day, kisshim, hold his tiny hand, and love him. What heneeded, in combination with all the machines, med-ications, and medical care, was a mother. That wasone thing I could give him that the nurses couldn’t;it was the one place where I could feel useful. Iwas his mother, and nobody could do that job bet-ter than I could. It didn’t even matter that I was anurse. By putting my profession aside, I was 100%available to be a mother to my son.

Sometimes stepping aside from your medicalprofession and allowing others to care for a lovedone doesn’t happen as readily as my story. Anexample of this is based on a woman who hasbeen in nursing for over 30 years but out of clini-cal practice for 10, then back in nursing over thepast 5. Her background includes geriatric nursing,breast cancer research, and hospice nursing. Hermother is a frail 91-year-old with dementia, hyper-tension, depression, anxiety, and severe osteo-porosis. For the past several years, she has beenmanaging her mother’s medications and homecare, despite several specialists and 3 differenthomes for her over the past 5 years. Her mother

has gone from independent living to living withassistance to a group home.

There have been home companions, certifiednursing assistants, home health nurses, and volun-teers to help the mother. However, her daughter,the nurse, always captains the ship. She recom-mends what medications she needs to take oreliminate, and basically, she directs all the medicaldecision making. Her relationship with her mother’sphysicians is “informal”—in that she often e-mailsto make recommendations on how her mothercould be better. Whenever questioned by her fam-ily members on whether or not this role is appropri-ate, her response is always the same, “Don’t doubtme, I’m a nurse.”

This situation creates an environment that presentssome potential risks for the patient and her daughter,the nurse. When a medical professional providescare to a loved one, his or her objectivity is obscured.The love the nurse feels for her mother impedesupon what is just and medically appropriate for thepatient. Can the nurse make an informed decisionabout medications when she herself is not a pre-scriber nor is current with polypharmacy issues? Forexample, thinking that an analgesic will work best forthe patient’s pain because that is her experience car-ing for hospice patients, without considering whatother medications the patient is on, like an antide-pressant, can create certain drug interactions that thenurse may not be aware of.

There is a very large difference between theknowledge of an RN and that of a medical providerwith prescribing privileges. Medications, especiallypain management, should be handled by a medicalprofessional with a prescribing license who pos-sesses current information regarding polypharmacyand the elderly. There is almost a “misuse” of thetitle nurse in this particular case. The nurse wearsher badge around her neck, whether she is at thegrocery store or at work. She comes to family func-tions with her RN badge around her neck, statingthat’s how she carries her keys. Perhaps that is thetruth, but does it really matter to others that she isalways “on”? Can she just be the aunt, sister, anddaughter that her family knows her as? By wearingher “RN” wherever she goes, it is as if her entireidentity is defined by those 2 letters. When doesthe sick mother get to see her daughter?

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Another risk of serving as a medical professionalfor a loved one is that the patient, near the end oflife, needs her family around her to provide loveand support. Through my experience and researchon end-of-life care, I have learned that those whoare dying need to know they have permission fromtheir loved ones to "pass on." They also need toknow that their loved ones have accepted theirfate. When it comes time for this nurse’s mother topass on, there is a strong possibility that the daugh-ter will be so involved in the mechanics of notwanting to let her mother go that she emotionally,and maybe even physically, will not be at her sidewhen she is dying. In other words, as other familymembers surround the mother and hold her hand,giving support to the end, will the nurse be on thephone with providers, getting her water, fixing herbed, etc, instead of just being there?

There comes a time when a line needs to bedrawn, when we must decide if we are defined byour profession or by family bonds. I have alwayssaid, “I am a mother, a wife, and then a nurse.”Yes, I may have a wealth of nursing knowledge andexperience, but my priority when a loved onebecomes ill is to be there for them, not profession-ally, but emotionally. A nurse who sees herself onlyas a nurse will affect other relationships she hasand will lose sight of what is really important andwhat the loved one needs most, to be at their side.

As nurses, we never want to find ourselves feel-ing helpless, especially because we know we havethe skills to heal and help the sick. However, justbecause we are nurses, we don’t always have theright to care for everyone, nor do we possess theskills to do so. There are skilled medical profession-als who will care for our sick and dying. Sometimesit is better to step aside and let them.

1555-4155/121/$ see front matter© 2012 American College of Nurse Practitionersdoi: 10.1016/j.nurpra.2012.02.005

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Emily Seiden Hinchman, ANP-BC, is an adult nurse practition-er at Scottsdale Adult Medicine, a practice she shares withher physician husband in Scottsdale, AZ. She can be reachedat emghinchy@cox.net.