Time

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• Priscilla Ebersole, RN, PhD, FAAN

Time, as measured within this human dimension, is the only factor of existence that cannot be sold, bought, bartered, or altered. It goes marching along, measured, and inflexible. Most of the time we are its pawns, victims or champions. The gift of time is the most precious thing we can bestow on anyone.

Those involved in long-term care give time; in short snatches, in brief encounters over extended periods, and in lengthy sessions such as sitting with to honor the dying. And, although not taking place in long-term care settings, historically sitting shibah to honor the dead was an expectation. There is a long tradition of being with the suffering, dying, and dead.

When one says or thinks, “I don’t have time,” it clearly delineates priorities, measures of devotion, standards of performance; it can also be a dismissal. We consciously or unconsciously select at every moment where our time is spent. Attention is an aspect of time that is critical. We may be truly “with” someone, or in a situation in which we are not really there but instead allow our mind to wander far away or think of the next action on a pressing agenda. Being there with another is the most precious of all gifts. One of the geriatric nurse pioneers commented that there are some brief moments in which there is a true connection with another human being when both are present in the moment. These likely do not consume a lot of measured time but are those moments that one holds dear.

Time and love are intertwined. That which we really love will be given our time—whether it is duty, order, power, recognition, an individual, collective humanity, or aspects of each. One might add to this list peers, children, partners, and old people, but these are often stages in human development when time and attention are appropriately allotted. And these shift and change as we grow and learn.

Philosophically one may enter into deep discussions of physics and our limited perceptions of time. My father and brother spent long periods pondering the perception of time and whether there is any present time or all is either past or future. On a more mundane level, time with someone can be very present.

For those in pain or grief, time can feel endless. For a hungry child waiting for dinner, 10 minutes can seem unendurable. For those persons waiting in an empty and monotonous situation, time may be marked only by when the next meal is due. For those with dementia, perception of time is often skewed. Biorhythms are out of synchronization because they are in grief.

There seem also to be developmental shifts in time perception. When I was about 12 years old, I was distinctly aware that my time perception shifted, the days went faster; waiting time was filled to the brim with thoughts and activity. It continued to gain speed as I grew older and had more responsibilities. But boring jobs and situations continued to drag along; then the mind wandered about and focused on what I would do when the present boring situation was over.

Those caregivers involved in long-term care often find the demands on their time impossible to reconcile. It is then that the shifting of priorities becomes crucial. What exactly must be done to fill one’s own personal goals and to care for those in their charge? How important are these in relation to institutional goals? What can be altered, shifted, restructured, or eliminated to achieve the things deemed most important to you? Can these be discussed in focus groups or team meetings? Can the elders being cared for be involved; can they be asked what they are willing to give up or eliminate to be given more personal time?

Then there are, of course, the institutional, state, and federal regulations and expectations that must be addressed, the bureaucratic machinery that must be oiled. Is there any hope that one will ever have enough time? Only as we, the largest body of health care providers in the nation, insist that we must. We must continue to be adamant regarding a reasonable staff-to-patient ratio and refuse to work in situations where this goal is not met. Perhaps this should be the first question an applicant should ask when considering a position.

The plea that there simply aren’t enough nurses available is often used to decrease staffing costs. This is only because the position is not desirable, but it can be made so. There are many long-term care settings in which there is never a shortage of staff. It can be and is being done. We can decide how and where we use our time.