What's the Secret Ingredient that Makes a Good Nurse, Great?

- and why is it a hard quality to keep!



What is it that makes a good nurse, great?  Is it one common quality or a variety of traits combined that makes a nurse special?  Could it be having good time management, being a passionate patient advocate, or an expert critical thinker?  Maybe a great nurse must be able to function effectively during an emergency or have a photographic memory of medication side effects and interactions.  

Most of these qualities are essential in order to function well as an RN no doubt, but they surely are not representative of what truly separates the good nurses from those that are great. 

Think of a baker’s recipe for a cake. He uses the same essential ingredients every time: eggs, flour, butter, baking powder, milk, and sugar - without them he wouldn't have anything that resembled or tasted like a cake.  In addition to those ingredients, there may be something special, "a secret ingredient" if you will, that the baker adds to make his cake unique and special.

Vanilla, a pinch of nutmeg, the zest of a lemon... whatever the secret ingredient is will enrich the flavor and quality of the dessert.  Without it, you just have a basic cake. - which is still good, but nonetheless lacks the ability to inspire.  Consider the secret ingredient is as simple as "stirring in a little love" - like our grandmothers use to anecdotally swear to when explaining why their cooking was always the best. Could the secret be as simple as preparing it with love?  Maybe that's the secret of what makes a great nurse.

Nurses who go above and beyond provide care with love and are patient, understanding, and curious.  They do everything they can to make their patients feel safe, well taken care of, and un-judged.  You could say truly great nurses "stir in a little love" to their care and have a certain "secret ingredient" that can't be easily learned or taught.

That not so secret ingredient is, empathy.

Empathetic nurses understand and share the feelings of their patients.  Empathy is having the ability to put yourself in the shoes of another and to have a personal concern for their welfare.   It is through this quality that nurses develop trusting relationships with their patients.  Which is no surprise that year after year, nursing is voted as the #1 most trusted profession among the public.

Not any one can be a nurse, and not any nurse can be a great nurse.

New nurses are living, breathing empaths to their patients.  Most often the empathy of a new nurse comes as second nature and is at its peak because they are untarnished, innocent, and idealistic.   They approach challenging patients with curiousity rather than judgement and acknowledge a patient's reality based on the comprehension of the non-verbal signals their patients exhibit.

As a shiny, new nurse you walk onto your unit for the first time and know what kind of nurse you want to be.  You worked hard in your clinicals and now is the time to prove yourself.   You lack experience but make up for it by your eagerness to go above and beyond for your patients in providing compassionate care.

Unfortunately, the empathy that nurses are able to deliver to their patients fluctuates over time and may be a hard quality to keep in the long term.  Providing empathetic care and developing trust among your patient takes a toll on even the best of nurses. 

I have found in the 13 years I've been a nurse that experience and the level of empathy a nurse has seem to have an inverse relationship.  As your time in nursing increases, the empathetic care you deliver waxes and wanes.  How much so depends on the demands that are faced at work and the support - or lack thereof - that nurse receives in her practice and in her career.

Burnout from the emotional and physical strain of patient care may be the culprit for diminished empathy in a nurse's practice.  I can speak from experience that nurses are very often overworked. We are buried under the large burden of changing protocols, documentation, and increasing acuity of the patient population. Hospital's are looking at patient satisfaction surveys as a measure of achievement and seem to ignore the good outcomes nurses and support staff work tirelessly to achieve.

We can work understaffed and perform expertly during a rapid response, yet get penalized by management for not properly filling out our whiteboards. The reality of nursing burnout is detrimental to the quality of care nurses can provide to patients.

Sometimes, as much as we want to be empathetic, we just don't have the time.

Possibly caregiver role strain is the cause for the decline in empathy in some nurses.  Caregiver role strain is experienced when a caregiver, a nurse in this instance, feels overwhelmed and is unable to perform her role to the best of her ability.  Often accompanied by feelings of stress and anxiety, it can present itself as that feeling of dread you have sitting in your car in the parking garage psyching yourself up to walk into work.

The nature of what we do as nurses can bear a heavy burden on our physical and emotional state. We manage the care of people when they are at their worst.  We do so while adhering to strict policy, protocols, patient safety measures, and detailed charting grids - many times without even taking a break.

Witnessing chronic pain, illness, death, and dying all take a toll on the nurse.  Naturally, human beings don't like to witness pain and suffering. As a nurse, in many ways that is our livelihood and it is very plainly what we signed up for. There are only so many places we nurses can hide our feelings when we want to cry with our patient who just lost her unborn baby, or with a spouse who's husband or wife just lost their battle to cancer.

Nurses are professionals and we must provide direct patient care - no matter what. We swallow hard and feel the anger our patient's feel and it comes with a cost. Where do the feelings go that we don't let ourselves feel? Is it possible to share and understand the feelings of your patients, as empathetic care demands, all while ignoring your own?  At what point does the weight of it all become too much to bear that you start to turn off that natural tendency to share in your patient's grief - at what point do you find that you have become numb.

After all, isn't it easier to disconnect from the emotional aspect of caring for other humans and just manage their care objectively?  Is that even possible?  In turn, empathy may be lost due to the development of unhealthy coping mechanisms to lessen the impact of the mental stressors nurses feel as a result of those disappointing or heartbreaking outcomes.

Think back to when you were a new nurse, did you have to stay sometimes one or two hours late making sure the charting was complete - because if it wasn't charted, it wasn't done.  Did the idea of a rapid response or a code give you nightmares knowing you wouldn't have the skills to be able to function as an effective team member?

In those early days as a new nurse you may have felt as if you were failing in time management, confidence, and expertise. Maybe you were right... at the time, but you had potential all the same because you showed up and you cared.  

You earned the trust of a patient with a traumatic social history by providing non-judgemental & non-discriminatory care... You made your lonely, elderly patient feel alive by listening to his stories of times past and the life he lived before old age took it's toll... You gave the feeling of security to your dementia patient by tirelessly reminding her where she was, what your name was, and that she was safe... You went over each medication your long term care patients were getting to make sure they felt empowered in their care - even if it did put you behind on your charting.

As a human with compassion you knew these otherwise small gestures were important even if not measurable in a flow chart or specifically in the doctor's orders.   Do you still take the time to do those seemingly small acts that demonstrate your empathy for your patients?

The art of nursing is illustrated in the empathy we deliver.  

Any nurse can learn the principles of nursing, the protocols and procedures...

Any nurse can develop time management, handle her assignment efficiently, and clock out on time after her shift...  

Any nurse can build the confidence she needs to delegate and perform effectively during an emergency...

In fact, most of the qualities that make up a good nurse can be learned with proper training.

Empathetic care, however, can't be easily learned.  It is a skill that develops naturally from human compassion and a desire to make a difference in other people's lives.  Empathy grows from our past experiences and our connections to our own emotions.

Truthfully, nurses can be at risk of losing empathy completely if we aren't careful.

We must not allow ourselves to become jaded to the grind of our job and the responsibility that goes along with it.   

Replace the "burden of being a nurse" with the "privilege to be a nurse" and turn the tables.

We have the privilege and honor to share moments of intimacy, celebration, suffering and heartbreak with our patients... a prognosis -good OR bad, the birth of a child, the loss of a loved one.  A window, more or less, into humanity that people in healthcare are entrusted to witness.  We share these moments with our patients and are charged with the sacred task to see them through. As Maya Angelou once said, "they may forget your name, but they will never forget how you made them feel."

Remember why you chose nursing.  Never lose that why and you will never lose your empathy.  Much like the baker who "stirs in a little love" to every cake he makes, be the nurse who adds her "secret ingredient" to every patient you have the privilege of caring for.  

For it is through the service of others that you will find yourself, and what lies within you are the makings of a great nurse.


What do you find as one of the main struggles to consistently providing empathetic care as a nurse?  How do you go above and beyond to provide compassionate care for your patients?  Leave a comment below or like Nurse/Forward on Facebook, I'd love to hear from you!

For more on the power of empathy in healthcare visit the Journal of the Association of American Medical Colleges and read E.M.P.A.T.H.Y:  A Tool to Enhance Nonverbal Communication Between Clinicians and Their Patients written by Dr. Helen Riess.

Dr. Helen Riess is a psychiatrist and medical educator at Massachusetts General Hospital and Harvard Medical School who developed novel empathy training based on the neuroscience of empathy at MGH.  For more on Dr. Helen Reiss and her Empathetic's Empathy Training for healthcare workers visit Empathetics.com.  You can find her book here, The Empathy Effect: Seven Neuroscience-Based Keys for Transforming the Way We Live, Love, Work, and Connect Across Differences.

Thank you for reading, please share with your friends to help spread this message to other nurses and healthcare workers!

7 thoughts on “What Makes a Great Nurse”

  1. Giselle Hargrove

    Hello, I sit here this morning enjoying a cup of coffee on my last day of rest before I go back to work tomorrow. I am a new nurse, What you have written leaves me speechless! I often wonder as I watch a seasoned nurse what happened to her compassion? Does it get that bad over the years? That’s scares me but reading your note makes me appreciate my past experiences that have made me feel such empathy for my patients. I pray I never loose sharing their pain. I pray I never stop crying with them as I close their loved one’s eyes. I am so thankful for having the privilege to care for others. I don’t know what else to say except I’m keeping this note close to my heart for sure. Thank you so much for sharing. Giselle Hargrove RN

    1. I can completely relate to your fears! We know what kind of nurse we want to be but it’s a constant battle to get the job done vs. be the best nurse we can be for our patients. I believe in always remembering what brought you to this profession to project you to where you want to be. Good luck to you in your nursing career and may you never lose your passion <3 Thank you for your comment!

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