Beyond the Task List: What “Being With” the Patient Really Means

 There’s a certain kind of wisdom that lives in the in-between moments of a nursing shift. It’s that space between the assessments and clinical documentation, the medication checks and the purposeful rounding, between the hand sanitizer pump and the how-are-you-this-morning. It’s a wisdom that doesn’t get measured or calculated in “hours of care” or captured in patient flow spreadsheets. It’s about presence. It’s about being with the patient, not just doing things to or for the patient. The longer I stay in this beautiful profession we call nursing, the more convinced I am: this is the core of our work. It’s the core of our profession and  our discipline (and if you recently graduated from an undergrad nursing program or are deep into your MSN you are intimately familiar with that debate)​

The Quiet Work of Being With the Patient

It’s tempting, even seductive, to imagine that “knowing the patient” happens during a comprehensive assessment, or at medication administration time, or in the brief transaction of questions and answers that gets marked as complete in the clinical record. But deep down, we know better. To really know someone, to be responsive to moments when their world shifts, we have to be there in the quiet stretches. We have to bring ourselves, not just our skill sets. Reflect on that for a minute. Because this is sometimes a hard pill to swallow when a nurse transitions from school into the first few years of practice. 

I’ve watched patients transform, sometimes subtly, sometimes dramatically, between meals, or in that liminal space near midnight shift change. A furrowed brow. Silence where there used to be laughter. The sudden sting of tears at something that didn’t seem heavy yesterday. If I only drop in and out with a barrage of assessment questions and diagnostic data collection, these things slip by, unremarked, and unaddressed. But when I allow myself to be with them, to just be, even for a moment, there’s a different knowing. A different trust that starts to grow. Ways of knowing and understand the integral space these have in nursing may also be an esoteric pill to swallow for those new to practice, and a profession that might be consumed by completing tasks as a badge of honour. 

Rapport: Built in the Margins

When did we start believing rapport was something that we cross off a list? When did “therapeutic relationship” morph into a structured form, something to be documented in record time? This is not to say we don’t need to do timely comprehensive assessments and document them. What I am trying to hammer home is that, maybe we need to take a look around and see that rapport is sometimes built out of the leftovers: the cracks in the system, the shared story of pictures at their bedside, a joke about the weather, noticing when someone’s glasses go missing. This is the stuff that stitches us together, patient and nurse. It’s not flashy, and it can’t always be measured.

I’ve learned, most often from my patients, that trust blooms slowly, almost imperceptibly. It blooms when you remember how they take their tea, when you play the tune that they once told you reminded them of home on their phone. Trust is fostered in dozens of moments that don’t make it into the chart, but make all the difference when things get hard. In acute mental health, where stigma and fear too often silence people’s voices, these fragments of connection become the ground on which safe, authentic care is built.​

The Myth of “Knowing” Through Assessment

Let’s be honest, assessment is essential. We are nurses. This is what we do, and this is how we support patients through their health care journey. High-quality, safe care depends on noticing changes, collating facts, and being alert to risk. But to think that’s all it takes to “know” a person is a dangerous half-truth. Also, to think that the subjective judgements that we make about a patient and family without taking the time to talk to them and know them is the truth of the patient is misguided at best, and perpetuates iatrogenic harm at worst. There’s so much life that exists outside the interview, beyond the glint of the blood pressure cuff or the battery of risk questions.

If I’m only present when I have a job to do, I miss the ways trauma lingers, or the ways someone’s sense of safety might shift from one day to the next. I miss the signals that tell me now is not the time for a conversation, or that anxiety is mounting. Getting to know a patient is a practice, a vulnerable, ongoing act. It asks me to show up, to witness, to understand that part of the job is being changed myself.

Presence as Professional Practice

If I could wave a magic wand over our health systems, I’d grant us all a little more space and a lot more permission to value presence as true professional practice. Not as an afterthought, not as mere “bedside manner,” but as care itself. Every narrative, every best practice guideline nods to relational care, yet our processes rarely make room for it.

I want us to remember that being fully present is not only what our patients deserve but what we need, too. It is the job. It is the profession. It is the discipline. The privilege of simply being with someone, with nothing to accomplish but presence and bearing witness, protects us from perpetual moral distress, and reminds us why we entered this profession in the first place. In a field obsessed with measurement, these moments of presence may be the only antidote to burnout we have left.​

Returning to the Core

When I mentor nurses, I remind them: the job is more than the “code blue,” more than a head to toe assessment, or the medication checks, or the seemingly disconnected clinical documentation. Those things don’t have to be tasks. They an be engagement tools and opportunities to be with patients to walk with them on their health care journey. To be with the patient is our professional and moral imperative. It is both simple and radical, a daily refusal to see people as diagnostic puzzles or problems to manage. And that might be your a-ha moment that clearly distinguishes us as nurses from physicians. 

If you want to know your patient, find them not only at medication time, but in the everyday, in the lived and living spaces of the unit, the ward, the world. That’s where healing grows, in the in-between.