Creative Nursing, Volume 17, Issue 1, 2011

Nursing: The Skill and Art of Being

in a Society of Multitasking
Hans-Peter de Ruiter, PhD, RN
Jennifer M. Demma, MSN, CNM

Multitasking, a media-driven bias toward dramatic scenarios, and an emphasis on

meeting institutional goals in the form of documentation have led to a culture of actionbased practice, which interferes with nurses ability to simply be with patients. In order
for nurses to be fully present with their patients, the cultural norm of multitasking and
the emphasis on doing must be reexamined within the context of patient care.

ith the advent of technologies such as personal computers and portable

digital devices, multitasking has increased, especially by members of the
so-called Millennial Generation and Generation Y. Though reading while listening to music or writing with the television on is not new, the amount of simultaneous media use has increased, particularly for younger generations (Carrier,
Cheever, Rosen, Benitez, & Chang, 2009; Foehr, 2006; Rideout, Foehr, & Roberts,
2010). E-mailing, texting, and instant messaging, all while reading, writing, and
studying, in addition to listening to music or television, represents an increasingly
common experience of people today (Richtel, 2010).
From everyday living to the realities of nursing practice, a certain level of multitasking has become expected. Whether this constant stimulation of modern daily
life will ultimately prove to be an advantage or a disadvantage, especially for those
generations currently coming of age, remains unknown. Studies question whether
multitasking is actually possible (Rubinstein, Meyer, & Evans, 2001), and current
research is exploring the impact of multitasking on cognition and performance
(Ophir, Nass, & Wagner, 2009), as well as the potential impact of multitasking and
interruptions on safety and productivity in nursing care (Biron, Lavoie-Tremblay,
& Loiselle, 2009; Hall, Pedersen, & Fairley, 2010; Kalisch & Aebersold, 2010; Potter
et al., 2005).
As scientists explore the impact of such constant stimulation and as the use of
valuable simulation techniques and other strategies to give students and nurses
the skills necessary to successfully and safely manage contemporary nursing
practice realities are investigated, the question is: What is missing? We assert that
what is missing is the skill and art of being. If doing is the act of performing tasks
and activities, in which it is clear to the nurse what the outcome will be (e.g., distributing medications), and being is the act of witnessing the illnesses and human
2011 Springer Publishing Company
DOI: 10.1891/1078-4535.17.1.25

Hans-Peter de Ruiter,
PhD, RN, is an Assistant Professor at
Minnesota State University Mankato.

Jennifer M. Demma,
MSN, CNM, is an
Assistant Professor
at Minnesota State
University Mankato.
25

If doing is the act

of performing
tasks and
activities in which
it is clear to the
nurse what the

experiences of patients and their families, is the art of nursing and the ability to
be with patients compromised by the constant stimulation and the emphasis on
the act of doing? Is there a risk of replacing being with doing and if so, do nurses
perceive being with patients as not doing something? In an age of multitasking, if
there is not constant stimulation, then is there boredom? Furthermore, are nurses
expectations shaped by the never-ending pace and by other influences such as the
media, to believe that doing is better than being?

outcome will be
(e.g., distributing
medications),
and being is the
act of witnessing
the illnesses
and human
experiences of
patients and their
families, is the
art of nursing
and the ability to
be with patients
compromised
by the constant
stimulation and
the emphasis on
the act of doing?

26

TASK-DRIVEN PRACTICE
It is 2 a.m. in the Emergency Room. In Room 1, a pregnant woman is being resuscitated after an overdose of cocaine. In Room 2, a homeless man with a significant
mental health history is hearing voices telling him that the nurse is a CIA agent
and he is plotting to overpower her. Meanwhile a host of police officers, nurses,
and physicians are wheeling a young man, bleeding profusely and screaming, into
Room 3. A nurse is trying to put in an IV while the police officers hold him down.
Sudden gunshots cause everyone to dive to the floor; glass shatters. The nurse
looks up and sees that the patient has been shot.

This is an average day on the job on television shows such as ER or Greys

Anatomy. In 35 minutes, multiple dramas unfold, all with touching background
music; the most dramatic parts are displayed in slow motion for maximum impact on the viewer. At the end of the episode, the viewer is not just shocked and
touched by the tragedy but also exhausted. It is nursing care delivery on steroids.
In our work with nursing students and newly graduated nurses, we are increasingly confronted with expectations that everyday life in health care institutions should, at least to some extent, match what they have witnessed on TV. To
the students disappointment, the reality of everyday practice is very different.
Much of a nurses time is spent monitoring patients; documenting in the electronic
record; answering questions for patients, family members, and physicians; performing routine assessments; and other time-consuming tasks that are vital, but
not spectacular in a novices eyes.
Once the reality of what the work of nursing is truly about sets in, a feeling
of boredom arises. Boredom: An enemy of good nursing practice in which only
action and highly technical tasks count, and being present with patients is seen
as unfamiliar and uncomfortable. The current trend in nursing programs of replacing clinical time with simulation supports the belief that what truly counts is
performing specialized tasks. We believe that this trend is leading nurses away
from nursings core: Being with patients during their times of suffering. No other
health care discipline is with patients around the clock to witness every component of their being. The concern with simulation as the primary learning tool is
that it does not teach students to care for real, living patients with all their complexities and suffering.
The focus on task-driven practice is also supported by a health care environment that is increasingly centered on all interventions being evidence based, which
typically requires measurable outcomes. This view of nursing is supported by the
electronic health record (EHR), in which nurses are required to document the care
they deliver in drop-box menus and check boxes. The information requested by
the EHR, however, does not reflect the actual care that is given, but rather what institutions want to have documented for financial and risk management purposes
de Ruiter and Demma

(de Ruiter, 2009). In the process, much of the actual work that nurses perform becomes invisible. The actual caring for the patient has disappeared into drop-down
boxes that send the message that the tasks that need to be documented are the
essence of nursing care and create a checklist mentality. This has led to a culture
of action-based practice in which more and more time is spent on meeting institutional goals in the form of documentation, rather than on connecting with patients
by spending individual time with them.
The actual caring for patients has little to do with the nursing care on steroids image promoted in the media, nor with the series of simulated tasks that
a nursing student is required to master. It has more to do with the boredom of
seeing the patient clearly in his or her current condition and identifying areas that
could ease that patients suffering.

EVERYDAY NURSING CARE

Patients who are sick experience a deep sense of suffering in which there is grief,
loneliness, and struggling (Rholm & Lindholm, 1999). Being with patients in their
suffering is a core value of the nursing profession. Because nurses are present with
patients around the clock, they are part of the patients entire experience, be it
incontinence or pain, family conflict or loved ones saying goodbye to each other
at the end of life. Nurses witness patients as humans with all their quirks and attributes. Historically, the sickbed was a sanctuary, where conflicts within families
or society were set aside to be fully present with the patient (Bailin, 2008).
By 1909, Isabel Robb, one of the first contemporary nurse educators, pointed
out that
While in the hospital, the nurse should always make it her rule to think of every
patienteven the poorest and most unattractivenot as a mere case, interesting
only from a scientific standpoint, but as an individual, sick human-being, whose
wishes, fancies, and peculiarities call for all the consideration possible at her hands.
(Robb, 1918, p. 214)

It is within this context that nursing care is delivered and nurses perform their work.

Being with
patients in their
suffering is a
core value of
the nursing
profession.
Because nurses
are present with
patients around
the clock, they
are part of the
patients entire
experience, be
it incontinence
or pain, family
conflict or loved
ones saying

TEACHING BEING
Kennedy (2000) elicited from expert midwives and their patients descriptions
of those elements that helped create a model for exemplary midwifery practice.
These midwives described the importance of qualities and traits such as knowledge, judgment, and clinical skills along with elements such as intuition, observation, and the art of doing nothing well (p. 12).
Although this model is specific to midwifery practice, similar attributes are
required of all nursing practice. When the emphasis for the teaching and practice
of nursing is placed upon skills and doing and when multitasking affects the ability
to process information in a meaningful way, how do nurses acquire and maintain
those being skills of exemplary nursing practice? Teaching the skills and techniques
of doing nursing is vital. It is also tangible. Teaching students and nurses about
the value of being is more elusive. Nursing educators are faced with an important
challenge: how to teach students to be fully present with their patients in a society
that is filled with multitasking. How do curricula and simulated training teach

Nursing: The Skill and Art of Being in a Society of Multitasking

goodbye to each
other at the end
of life.

27

Traditional
Eastern
practices, which
have a more
holistic approach
and are more
focused on
being, have
gained increasing
attention in
North America
just as Western
medicine
has become
increasingly task
and outcome
focused.

students empathy and how to connect with patients? How can colleges graduate
nursing students who are not just driven to perform tasks well, but who are also
able to be with those who are suffering? In order for nurses to be fully present with
their patients, the cultural norm of multitasking and the emphasis on doing must
be reexamined within the context of patient care. Additionally, schools are challenged to teach skills that extend well beyond technical tasks.
International nursing study-abroad programs in places where multitasking
and the objective of doing is not as culturally pervasive can provide opportunities
to take students and nurses out of their comfort zone and away from the constant
stimulation to foster meaningful examples of being present and building connections with people (Zust, 2010). Helping students process their experiences through
journals, reflections, ethnography, storytelling, and discussions may also deepen
their ability to be present in the moment with patients. Readings that emphasize
didactic content could be balanced by readings that require consideration and
analysis of the lived experience of health and illness. Of note, traditional Eastern
practices, which have a more holistic approach and are more focused on being,
have gained increasing attention in North America (Barnes, Powell-Griner, McFann, & Nahin, 2004). Specifically, Eastern medicine has steadily gained more acceptance in medical communities in the United States just as Western medicine has
become increasingly task and outcome focused. Nursing may do well to look at
the successes of Eastern practices.
As a profession, nursing has the unique experience of being with patients 24/7.
With the ever-increasing cultural expectation to multitask and perform quantifiable procedures, the nursing profession must take a close look at what it offers
patients and the medical community. To meet the patients needs, the nursing profession must simultaneously educate students and nurses in doing clinical tasks
well, in addition to teaching them the skill and art of fully being present with
patients and to see them in their entirety.

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de Ruiter and Demma

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Correspondence regarding this article should be directed to Hans-Peter de Ruiter, PhD, RN, at deruih@mnsu.edu
or Jennifer Demma, MSN, CNM, at jennifer.demma@mnsu.edu

Nursing: The Skill and Art of Being in a Society of Multitasking

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