My Mom And Sisters My Nurses

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My Mom And Sisters My Nurses
By: Roberta Young, MSN, RN, CENP, and Teresa (Terry) Anderson, EdD, MSN, NE-BC
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Define your role when a family member is ill, and then apply that experience in your practice.
My mother had experienced sudden-onset pulmonary edema after a complex cardiac procedure. I felt that her caregivers didn’t assess her accurately and acted on assumptions. We had previously negotiated very rough waters balancing her medications. The day after a transfer to a step-down unit, a well-intentioned but ill-informed provider stopped her cardiac medications, stating that “too many meds for old people often cause more problems.” This was done without consulting the specialists or communicating with her family. Within 24 hours, she was back on a ventilator in the intensive care unit. I was livid, a reaction interpreted by my kind, humble father as questioning the doctor’s authority and being haughty, a characteristic considered poorly in my family.
At one time or another in our careers, we become the “nurse in the family,” and sometimes we’re disappointed with our colleagues as we advocate on behalf of a parent or child. Other times, though, we’re in awe of the compassion and expertise we witness. Underneath it all may be turbulent emotions of love, conviction, and uncertainty mixed with our professional capacity as nurses to listen and react smartly while being held to unknown expectations.
Navigating this situation requires understanding nurse practice roles, defining your role with the family member, and learning from the experience. Taking these actions not only will help family members but also can help you cope with your emotions and improve your practice.
In Relationship-Based Care: A Model for Transforming Practice, the authors define six practice roles of professional nursing: sentry, healer, guide, teacher, collaborator, and leader.
Family expectations frequently are diverse, hard to discern, and sometimes unrealistic. Nurses are tasked by the American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements to promote health, ensure care in a dignified manner, and protect patient safety. This is hard work and may lead to conflict, feelings of failure or inadequacy, or being labeled as arrogant or a “know it all” by family members when you try to explain medical speak. Clarifying the inner conflict between your nursing and family roles and acknowledging that struggle to yourself and family members can enhance your ability to cope and your family’s understanding.
Your role as the nurse in the family extends beyond the high-risk, acute episodes of chronic disease exacerbations that become a reality with older family members. You’re also called upon to assist in ongoing care planning and coordination.
My mother was a retired nurse and very reluctant to delegate her health decision-making, even though she knew that her worsening cognitive functioning required her to have a safety net. Over her later years, my role encompassed teacher, guide, and collaborator. As her physical and mental status deteriorated, I was forced to navigate a shift to sentry and leader. The decisions I made as the daughter/care partner with ultimate responsibility for moves to assisted living, and subsequently memory care and hospice, were the most difficult of my 37-year nursing career.
The situations described here are no doubt familiar to nurses across the country. And although the role of nurses in the family probably won’t change, what can change is how you accept the role and take action to prepare yourself to be the best advocate for your family. Positive actions include defining your role and learning from the experience.
Preparing before acute situations occur makes it possible to implement a plan quickly and efficiently. Start by defining for yourself and your loved ones how you might practice each of the six professional practice roles as the nurse in the family. Your family may have an idea of what you do as a nurse, but they may not understand how you intentionally think and act. Explaining these processing and decision patterns can improve communication and help family members become more informed caregivers.
Determine the touchpoints or decision moments (for example, death of a spouse, fall or medication error, move from home, or change in financial/insurance situation) when roles might shift or be expanded. And be clear about your expertise. In some areas, you’re fully qualified to be the “know it all,” but in others you may be exploring options and needs along with the rest of the family. Keep the lines of communication open with the person receiving care and others (family members and healthcare team) involved.
Being the nurse in the family is exhausting and stressful, but it’s also an opportunity to learn empathy and compassion for the nurses who are family members and advocates of future patients you’ll care for. Understanding that nurses as family members are navigating a slippery slope with the extended family will create a path for collaboration. Include these nurses in care planning and implementation to enhance confidence in their decisions, which in turn can improve trust within the family and trust in your care.
The experience of being the nurse in the family also can be a catalyst to examine and improve your own practice. Ask yourself these questions and answer honestly:
To grow professionally and continue to hone your practice, you have to be willing to ask yourself the hard questions and then humbly listen and improve. Patients, families, and your value as a nurse deserve this. Out of love, you care for your family with a heart and mind that wants to do the right thing. The experience also can make you a better nurse.
Roberta Young is a nursing and healthcare consultant in Fargo, North Dakota. Teresa (Terry) Anderson is an independent nursing practice consultant and chief nursing officer at Nobl Health in Lincoln, Nebraska.
American Nurses Association (ANA) . Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD.: ANA; 2015.
Koloroutis M, ed. Relationship-Based Care: A Model for Transforming Practice . Minneapolis, MN: Creative Health Care Management; 2004.
Thank you for this honest reflective article. Having recently supported my parents in my father’s last days on earth, I had to carve out time for myself and really consider the role I needed to be as both nurse and daughter. That and setting time aside to grieve his eventual passing in advance helped me so much. During his final hours I was able to let go and let friends and the hospice nurse step in so I could be 100% the daughter.
When my healthy father was suddenly diagnosed with a glioblastoma last summer, there were many decisions to be made at a rapid pace with various emotions running rampant, but the most difficult part for me was to learn to separate being a nurse/caregiver, and helping translate medical terms and facilitate decisions, to then transitioning to simply being a loving daughter, and stepping away from the nurse role to enjoy my father’s final days as his daughter. Yes, I wanted to be his caregiver, but it was nice to have some hired help to provide the hands-on caregiving part so I could take a step back and maximize those final father-daughter days.
As the sole nurse in the family for many years, I sometimes felt burdened, not by my family’s need for information and clarity, but by my “failure” to be an expert on every medical calamity or malady. Once I let myself off the hook, and offered responses in terms of, “I’m not a critical nurse, but I would be concerned about…”
And, “I would consider asking these questions…”, I could feel comfortable in guiding them to one potential course of action.
Based on my experiences, I would suggest a role is missing; that of “interpreter”. I mean this in terms of translating provider messages that may be crafted in compassion but lack clarity. When my father was hospitalized for respiratory failure, the ICU physician explained,
“We think it’s time to transfer Robert to the palliative care unit. What do you want us to do if his heart stops?” Translation — “he’s dying. We’ve done all we can. Now we want to keep him comfortable.”
It was necessary but painful for me to deliver this message, especially to my mother. Months later, Mom still blamed the nurses because “he didn’t get better”. She expected to take him home, not to bury him.
I have been there and feel that because I’m the youngest of the family, how could I really know what was good for my family member.
Patience and listening to their concerns helped them understand that having me in the mix was a benefit and not a threat to their judgments.
We still have conversations that seem to go nowhere but at least we are speaking about how to approach these delicate decisions.
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I always thought any problems between my mom and me were my fault. Then my mother-in-law helped me through a rough time, and everything changed.
Looking back eight years later, I can see that something was wrong just moments after my daughter, Hope, was placed, pink and new, on my chest. Instead of love or joy, I felt panicked, worried we were already nursing failures two minutes in. Yet because my lead-up to motherhood had been nearly picture-perfect — a happy marriage, a wanted pregnancy, a birth so smooth my OB had said I should have a whole football team of kids — it took me several weeks to understand that while Hope was healthy, I was not. Eventually I could name it — postpartum depression — and begin to recover, but for a while it just felt like all the good parts of me had slipped away the day I gave birth.
My husband, Rich, returned to his long lawyer hours and two-hour daily commute a few days after Hope was born. My mother flew from Kansas City to my home in Los Angeles to help for three weeks, a period in which we both imagined I’d be getting better at this mothering gig, not worse. Mom was doing her part — changing Hope’s diapers and dressing her in gingham and florals with frilly socks and matching soft leather shoes. I, meanwhile, sat around a lot in my nursing gown and robe, crying or about to cry.
“I’m worried about you,” Mom said sharply one morning after she’d placed Hope in a bouncy chair festooned with teddy bears.
“I’m fine,” I responded quickly. “Lots of moms have the baby blues.”
Mom had steadfastly cared for my dad, my brother, and me since her early twenties. She rarely complained, but I thought I detected the toll this sacrifice took in the way she seemed happiest not with us, but at church or petting the dog or watching PBS. I tried to make things easier by hiding my troubles from her and sometimes even myself, but this time I was too weak to pretend.
“Maybe you shouldn’t have had kids,” Mom said on another one of those endless mornings after Hope was born, standing at my sink in her red capri pants and white Talbots short-sleeve button-down. She was mixing oatmeal for me, the spoon clinking accusingly against the ceramic bowl, her short dark hair falling just so.
Mom’s comment stung, but more than anything it told me two things: She was very worried, and she wasn’t going to be able to help me. Rich was concerned, but with him, as everyone, I didn’t know what was wrong or what to ask for. And I knew he needed to work, so I tried not to let on to him how bad I was feeling. I held out a glimmer of hope though that his mother, Teri, might somehow help return me to myself.
The same day Mom left, Teri arrived. At 53, just 20 years my senior, everything about my tall, dyed-blonde mother-in-law was soft — her body, her voice, her way of being in the world. The regular stuff of my life, from working at a magazine to the bright Gerbera daisy centerpieces at my baby shower, made her suck in her breath as if witnessing a mini-miracle. I found this both refreshing and naive.
That evening, Teri made soft clucking noises as she followed me around the house and in and out our sliding glass door to the backyard as I tried to nurse and settle Hope with little success. The next morning, I woke at 5 a.m., stumbled toward the nursery, and assessed from the doorway that Hope was still asleep. I walked a few feet farther to the small guest room. The crumpled white sheets next to Teri felt like an invitation, and even though I knew it was an odd thing to do, climbing into bed with one’s sleeping mother-in-law, it felt like it was either that or walk down the stairs and out the front door and never come back.
Teri opened her eyes, her thin hair strewn across the pillow, and smiled sleepily. “Well, hi, honey.”
“I don’t know what is going on,” I said quietly, running my fingers along the edge of the sheet, my eyes filling. “I don’t know if this is normal anymore.”
“It does seem pretty bad to me,” she said thoughtfully.
I was surprised both by what she said and how she said it. She was acknowledging a problem, a big one, but it didn’t feel like an indictment or even all that terrible, like it might with Mom. It was just the truth.
“I was depressed once,” she went on. “Before I decided to leave Rich’s dad. I would drive sometimes and think it would be a good idea to drive my car off Huntington Beach Pier.”
“I think about being in the hospital,” I whispered to the ceiling. “I think how great it would be to break both my legs because then someone else would have to care for Hope and no one would blame me.” I held my breath, waiting for the earth to engulf me for exposing this terrible secret.
Instead, Teri turned to me. “You’re going to get better, kiddo,” she promised softly, our blue eyes inches apart, as she rubbed my arm. “I’m not going to leave you until you’re better.”
I cried, this time out of relief, my tears soaking the sleeve of her white cotton nightgown with bitty blue flowers.
A few days later, my longtime doctor prescribed antidepressants and sleep, telling me that eventually I’d be OK but never the same because now I knew what it was like to be sick. Hope’s weight had dropped, so I switched to formula, which she happily gobbled up. Teri took the night shifts and she stayed awake all day, too, helping Hope and I find our way.
“Your mother is amazing,” I told Rich one night as we fell into bed at 8:30 p.m., giddy at the thought of several hours of uninterrupted rest. “When I married you, I never knew what a package deal I was getting.”
My mom was anxious for updates, and we spoke every day about Hope’s weight gain and our activities. Before she’d left, I’d asked Mom if she could return once Teri’s week was up. “I guess I can,” she’d responded wearily. But Teri told her boss she needed to stay another week, and that evening, I told Mom: “Teri can stay, so you don’t need to come.” Instantly, I regretted my words and the suggestion that I had Teri so I didn’t need her. “I mean, Teri’s OK,” I said lamely.
“Oh, I know,” Mom said matter-of-factly. “I know she’s nurturing like that.”
A year later, Mom’s breast cancer from decades past returned and I was pregnant again; it seemed that my Midwest roots and our moms were calling us home. My husband found work in Kansas City and we bought a house that was a 10-minute drive from Mom and Teri, our three homes forming an imperfect triangle on the map. Mom quietly began chemo treatments, and the grandmas traded off watching Hope and our new son, Gabriel, while I worked part-time as a freelance magazine and web editor.
I told myself a thousand times not to compare Mom and Teri, and then did it anyway. At 5 p.m., I’d drive up to Teri and her husband’s yellow house in the heart of a cul-de-sac and discover her and the kids in the backyard, dumping sand in a turtle-shaped sandbox. “We played cars and then were doing crafts at Renee’s and I looked up and it was 1:30!” Teri would exclaim, smiling at the memory of playing through lunch. “How was your day, honey?”
Mom, meanwhile, preferred to watch the kids at my house, and when I arrived home I felt myself tensing up. Something usually had gone wrong — the neighbor’s dogs barked during naps or Hope refused to wear socks or we’d run out of bread again.
I knew Mom was battling cancer and that was very hard even though she didn’t like to talk about it with me. And I knew things like sandwiches and socks were important to her. Part of me wished what I’d always wished when Mom was disappointed — that I could be a better daughter. But with Teri constantly offering up an alternate view in which me and my family were kind of like rock stars, I had what seemed a heretical thought: Could it be that the tension between Mom and me wasn’t entirely my fault?
I thought about talking about all this with Mom, how I loved Teri but I really wanted to love her better, too. But I didn’t know how, especially when we learned Mom’s cancer was terminal. I vowed to be more understanding toward Mom, to swallow my feelings for Teri because we had decades, after all, and Mom and I didn’t. Then, one early June day when Hope was 4 and Gabriel was 3, Teri turned yellow. The CT scan showed a mass in her pancreas and her doctor asked if he could pray with her and just like that, the fragile love triangle that existed between Mom, Teri, and I blew up. With both moms failing and up against the clock, I felt like I had to choose.
I told myself and others that I was so immersed in Teri’s care because no one else could understand Teri’s medical issues and advocate for her. Mom was a nurse, meanwhile, and had my dad, a radiologist, my brother, also a radiologist, and my aunt, a nurse, for support. But the truth was that I wanted to help and be with Teri more, and she wanted me with her, so I was. Whenever I thought about this, I felt equal parts warrior and betrayer.
Mom and I talked on the phone almost every day, and I saw her at least once a week, plus I talked or emailed frequently with family about her. But in the evenings, after the kids were in bed and the dishwasher hummed, my car drove mostly one direction: south to Teri’s. I’d show up in her doorway with McDonald’s shakes and we’d sit together on her bed, slurping and watching Big Brother or speculating about her oncologist’s personal life or laughing at the way Hope said “prentzel.” For a while, I thought I needed to save Teri — to find the right doctor, the right combination of chemotherapy — to prove that I really was the dream daughter she’d taken me for. But the more time we spent together, the more I realized that our kind of love was something you don’t have to earn.
I never knew who was going to die first, but in less than a year, Teri was gone. Two days after the funeral I felt exhausted and empty and ready, at last, to go to Mom. My family had been mostly understanding about my dedication to Teri, but occasional comments from my brother — “you only have one Mom, you know” — and my aunt — “You’re coming, right? Because I don’t think I can get her to the doctor
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