The Nurse Will See You Now

Thanks, Jerry Adler, for reiterating one of ???Saving Lives??? most important points: the public is not best served when intention trumps outcome. It???s a tragic, and embarrassing, fact that medical errors are the 8th leading cause of death in the U.S. This means that each year more people die as a result of medical error than die of breast cancer or AIDS.
As a nurse, my work is best when it is seated within a system engineered to produce the desired results in a reliable fashion. The same could be said of the work done by a co-pilot or first officer in the aviation industry, a group that made remarkable improvements in safety by re-examining rigid beliefs about professional hierarchies and best practices for communicating high-stakes information.
The magnitude of the intention-outcome mismatch in healthcare suggests that failures arise so regularly because of deficits in our work culture and organization, not to ???bad days,??? ???bad moments,??? or ???bad actors.??? Your piece goes a long way toward recognizing the importance of collegiality and valuing the professional contributions members of all disciplines make, moving us closer to embracing solutions that will deliver the results we???d all care to have.
Barbara Olson, RN, MS

Thank you for the acknowledgement. As a nurse for over 30 years and a family nurse practitioner I believe nursing has its unique contributions and perspectives to give to our patients. While medicine is quite focused on the structure of things and disease processes, nurses are focused on the function for our patients and how any change in function effects the lives of our patients. Then we address how we can help them to adapt and restore function. Both nursing and medicine have similar goals around health for our patients, but we achieve those goals by addressing different things. Both sets of skills and knowledge have value.

Physicans - and nurses - can save people in one "Golden Hour", but it may take a thousand hours of skilled nursing care to help that patient and their family through the whole recuperative or dying process. To add to Mr. Adler's example, I would confidently assume Christopher Reeve had 24/7 nursing care while living with his brain injury.

Any effort at health care reform must take into account the consequences of our technical decisions and change reimbursement protocols. The traditionally invisible work of nursing needs to be removed from the shadows of a "room charge," and openly accounted for with line-item recognition. In this profane, market-obsessed health care culture, the only way to get the bean-counters' attention is to make them realize nursing is a productive asset.
JLRabbers

How wonderful to pick up your publication and read about the PROFESSION of Nursing. I have been a Nurse for over 30 years. I have watched the dramatazations of nursing on TV and see them only as theatre/entertainment. Nursing is a real life drama. Once the TV is turned off, the rest of your shift/day or patient family situation or deterioration of your patients condition, continues. We all are involved in "patient care". Nurses are an intregal part that care that brings patients to their optimal state of wellness. We have been there to teach, comfort and advocate and will continue to be there no matter how much glamor we recieve.

Trish Chibbaro was one of my college roommates. She was a strong advocate for the nursing profession all throughout her college years, and to this day remains an excellent example of the valuable role nurses play in healthcare. On a personal level, she is someone I often turn to with my medical questions--not only because she is knowledgeable, but also because she takes the time to listen. She is caring, loyal and dedicated--I'm proud to see her get the recognition, personally, and for the nursing profession of which she is so proud to belong. Good article.

I stopped watching the medical television dramas a long time ago because they are so wrong in depicting reality. Thank you for recognizing and acknowledging publicly what nurses already know - we save lives every day.

The popular predilection for describing nurses in terms of the tasks we do overlooks the decisions made daily by nurses that affect the lives of the vulnerable. Opposition by groups like the AMA to nurse education is fed by this misconception of nurses as order-takers and bedpan-givers, not educated professionals deserving of respect. I am awaiting the day, 27 years into my nursing practice, where sexy nurse jokes are no longer considered appropriate, where nurses have a designated place to park at hospitals like physicians, where our work is quantified and paid for like that of other health care professions, and where nurses practice alongside our health care colleagues as equals. Thank you, Mr. Adler, for helping speed that day along. - Teresa T. Goodell,RN,PhD,ACNS-BC,CCRN

This author speaks poignantly about the current state of patient care.
Nurses work with doctors, and are on the frontline every day.
The media glamorizes physicians saving patients, yet how many patients do not need to be rescued because of the diligent work of nurses.
Raising up nurses should not however be done at the expense of physicians.
C.MacLean states "doctors treat diseases, nurses treat patients".
I have yet to meet a physician who truly does not see the patient for who that individual is.
As a profession, nurse should expect and receive credit while also providing respect and credit for the work of others on the health care team..

Let the nurses run the hospitals/clinics and care for the patients on all levels. Let the docs remain confined to surgery and invasive procedures. DrDavdRobinson4Health.com

This was a great way to describe what nurses can do. I am a nurse practitioner, and I am persuing my doctor of nursing practice degree. I have recently spent 2 months rotating with my physician peers in a residency type program. I definitely appreciate the skills that physicians learn in their residency programs. I must say that if I had 3-4 years of supervised experience after I received my doctorate, I too would have equivalent skills and knowlledge.

There were times when I did have more skill than my peers in the program, by virtue of my prior experience as a nurse. There were also times when they had more knowledge, by virtue of their training Working side by side with respect is a valuable feeling that I wish each nurse could feel.

As an NP I was expected to "practice" advanced practice "nursing" the day I graduated. I was held to the same standards as my physician colleagues. I thank the caring attending physicians who granted me the privledge to show patients and my peers, including physician residents, that a nursing path to patient care can include ordering and interpreting labs and xrays, diagnosing diseases, and creating care plans that embrace the whole patient, and as mentioned above also addresses the patients family and other case managment issues. I also found out I am "smart enough" to be a doctor. I'll just be a Nurse Doctor!. I still work on the floor occasionally while I am going to school, and I can definitly attest that it is easier on the prescribing side than the doing side. Kudos to all nurses, keep up the knowledge and skills, but don't forget what makes us different, the caring! Persuing lifetime learning can provide great benefits to our patients.

Your accolades are appreciated, Mr. Adler. And kudos to you especially for your "subtle" point, that of the problems created when nurses' sacrifice and compassion is emphasized to the exclusion of their lifesaving role and overall contribution to positive patient outcomes. Beyond contributing to the overall nursing shortage, your point begs the question: How can we meaningfully address health care reform until we take into account what nurses actually DO, as opposed to what what we might THINK they do?

Kkellys says she started nursing when abuse was still tolerated. Well, it still is. I went to nursing school to pursue a second career, and was shocked at the treatment of students by the instructors. As well, there is an expression "nurses eat their young," which is often, but not always true. Patients and their families scream at them. Doctors are condescending. How do nurses put up with it? Because they're tough and smart. Let's hope the profession of nursing gets more respect in the future. Thank you, Mr. Adler.

Saying that physicians are sometimes a problem for nurses is not the same as saying they are THE problem. Health care management is THE problem. They see nurses as overpaid waitress/maids that must be oppressed lest they ask to be paid what they are actually worth. Nurses are chattel right up until the moment one of us makes a mistake then suddenly management is reminding us that we are professionals.

When patients learn they have a serious illness, recover from life-altering surgery and go home to deal with all this ...it is the hospital and visiting nurse who does the difficult [ painful,sometimes] treatments, teach and give emotional and practical support. They do the mundane and high tech work. And lets not forget the CNA's who are probably the least appreciated of all. Every one has an important .... difficult and rewarding role. Elizabeth Whitmore,R.N.

Its really nice to see nursing get some recognition from the mainstream media. I once looked up the defination of RN on the ER website and it say we just follow the doctor's orders. That's untrue. RNs and MDs should ideally work together as a team. I have that experience in my ICU where I've called my home unit for almost 3 years. We're a teaching hospital so nurses are also teaching doctors because every day our intern and resident doctors ask us "nurses" how to do a task. Doctors don't just become doctors right after medical school. They must complete a 3 year residency and nurses are their main backbone of support in an ICU. RNs are the ones that catch them before they fall or before they do something to hurt a patient. They recognize it many times. We are patient advocates. We are not just nurses, its just an umbrella term for 'teacher, electrician, plummer, priest, counselor, etc'. Bedpans well that's just one of the millions of nursing task.

I enjoyed the article, and the many comments from my fellow nurses. I especially appreciate the comment about how much of nursing is not so much a collection of tasks, but the thinking behind it: a complex analytical process, in which data is collected and interpreted, priorities and goals set, appropriate interventions selected and implemented, and patient responses evaluated. The science behind the skills, the "why," rather than the "what," often gets missed. Nurses are usually portrayed performing fairly basic care skills-bathing, toileting, giving medications (all important, to be sure), rather than in more complex processes, such as case management. Many people have a very antiquated idea of what nurses do-menial tasks assigned by doctors, and who we are-people not smart enough for medical school (oddly, getting my PhD on a full fellowship while working full time and raising five children, I must have forgotten that part). Are we caring and compassionate? Frankly, we'd have to be to do what we do for so little money and recognition. We are the human face of a failing system. We bear witness to the things most of society shuts away-pain and disease, birth and death, blood and waste. We save lives, and comfort those whose lives cannot be saved. We know what we do, and we know that peoples' lives are better-immeasurably and incontrovertibly, because of it. Patients and families know it, sometimes physicians and other professionals even know it, but it's nice when the media acknowledges it, too.

Nursing is woefully devoid of research that describes what nurses actually do. Much of what a nurse does is not visible because it is related to the thinking that occurs prior to performance of any physical procedure. If nurses became more cohesive in regards to several issues, one of which is recognition, then it would become an awesome force of change.

Your gnius doctor can only save you if there is a nurse at your beside to recognize you are in trouble

As you can see from the comments your article evoked, nurses are grateful for even the smallest acknowledgement of their contribution. I appreciated your comments too. Your recognition of the nurses who cared for your son is a very personal tribute.

I think what the book posits, however, is that the media at large might benefit from an assessment of their bias in reporting, something seemingly completely out of their awareness. I look forward to a column that raises the question of the persistence of the media's problem, and their seeming inability to resolve it. Why not raise that question? Why do they use a stereotype of nursing when there are ample opportunities to demonstrate an accurate account of what nurses do?

I also noted your analog with lawyers and paralegals. While I admire the work of both groups, I would observe that your analog reinforced the very issue you were addressing. Paralegals are not required to be certified and function in an assistant role, doing tasks for lawyers that free them up to do the work of lawyers. Nurses are a legally licensed profession with educational programs extending from Associate Degrees to Doctoral Degrees in Nursing. Regulatory boards oversee the independent practice of nurses at the state level, starting with mandated licensure, adherence to standards of practice, and legal accountablility for their practice. Your analog implies that they are the helpmates to the physicians, the exact concern the Summers book addresses. Nurses do not practice medicine as assistants to physicians, they practice nursing. Perhaps you could Google nursing and paralegal and compare their roles. It might reveal the dissonance in your analog, and indeed, your inadvertent perpetuation of exactly what the Summers book addresses.