Nurses of bombing suspects

You are a trauma nurse unwinding at home after caring for patients horribly injured in the Boston Marathon bombings. Then you get a call asking you to come into work to care for a new patient who turns out to be Dzhokhar Tsarnaev, the suspected bomber wounded in a shootout with police. What goes through your mind in terms of professionalism, compassion, ethics, and concern about retaliation from people who think a terrorist should go untreated? Veteran Boston Globe health care journalist Liz Kowalczyk talked with the nurses who cared for Tsarnaev and explored the complex emotions they experienced.
<<Boston Globe:  For bombing suspect’s nurses, angst gave way to duty.>>

Nurse-Angels Never Die…. (although we wish they would)

Nurses Week has come and gone, but the insipid images this annual event engenders last forever. The print version of the Boston Globe’s 2013 Salute to Nurses advertising supplement (May 5) is a case in point. It is so full of clichés, it could be labeled, An Insult to Nurses.

At a time when nurses are poised for major leadership roles in health care, the lead headline on the supplement characterizes nurses as “Our Everyday Angels.” While nurses in reality do complex work, the supplement’s front-page article tells that these nurse “angels” are the ones who “smile encouragement when we’re on our way into surgery.” And how has professional nursing grown?  According to the article, “nurses have learned to use complicated equipment, read difficult printouts, and even do some of the work once reserved for doctors.” Wow!

I am not a nurse, but in the more than 20 years that I have been analyzing nursing imagery and teaching communication to nurses, I have learned that nurses definitely are not angels. They are humans who have studied and acquired extensive clinical, pharmacological, and psychological knowledge and who have mastered a range of medical, technological, practical, and psycho-social skills. As for the “complicated equipment,” it’s not unusual for nurses to teach physicians how to use it.

I’ve learned that nurses’ caring and compassion are part of their professional expertise. The nurse who smiles at you on your way to surgery may well be a caring, kind-hearted person. But she or he knows, along with other lifesaving things, that the smile plays a role in lowering your anxiety (and your blood pressure) and putting you in a better psychological and physical state to endure and recover from the surgery.

Angels don’t need to be educated. They don’t need to be paid. Angels don’t need meal and bathroom breaks, nor do they need to rest. But nurses need all of these things and more. Many work in complex systems under stressful conditions. Their ability to care enough to make sure that their hospitals don’t kill their patients, as one leading nursing theorist put it, and demonstrate compassion in the midst of incredible demands, comes from their skills, their courage to confront numerous obstacles, and their own self-mastery.

Everyone knows that modern hospitals can be dangerous places, but not everyone knows how central nurses are to positive outcomes and to the prevention of errors and complications. However, unlike angels, nurses cannot do their work without considerable resources, the major one being appropriate staffing. If we, as patients and prospective patients, don’t understand what nurses really do and what they need to provide safe care, then we are at the mercy of whatever hospital re-organization plan business consultants currently favor, even if it means replacing registered nurses with cheaper nurse substitutes.

You might think that hospitals—which actually can’t exist without nurses—would do a better job of overseeing the Nurses Week propaganda they pay for, at least to the extent of correcting sweetie-pie descriptions that ad copywriters (and the rest of us) have been trained to parrot about nurses. But then again, if you look at how most hospitals depict nurses and nursing on their websites and in other promotional material, you wouldn’t.

As research for the new 3rd edition of From Silence to Voice, my co-author, Suzanne Gordon, and I examined hospital websites and advertising to see what they had to say about nurses and nursing. We found that many hospitals seem to have forgotten that they have nurses at all when they describe their services to patients and to the public. Instead they vie for market share with heroic physician scenarios—a patient with a serious problem comes to the hospital, Dr. Expert discovers what is wrong, he (along with his team of specialists) employs cutting-edge technology and techniques, and voila! the patient is fixed. The fact that you could have the greatest physicians in the world, but without great nurses you would have patient tragedies right and left, doesn’t get mentioned. The incredible invisible nurse remains firmly behind the scenes. The esteemed Massachusetts General Hospital even managed to give credit for good patient care to “engineers and biologists who have never seen a patient” in its promotional video that not once mentioned nurses or nursing.

On those occasions when medical centers did present the face of nursing, it was literally a face—that of a young (never mind that the average age of employed RNs is 45.5 years), good-looking, smiling nurse positioned like a portal hostess for the website. She is a figment of the imagination of hospitality-industry consultants who have expanded their portfolio to include health care centers. The nurse-greeter is there to welcome you, to lower your anxiety about having to go there in the first place, to assure you that people at that institution really care “like family” about you.

Hospitality consultants are doing their best to make sure that you will encounter flesh and blood versions of the nurse-greeter by training working nurses to smile at “customers,” and to “put a smile in their voices” when they talk on the phone. All this and more supposedly contributes to bringing in business and upping the patient satisfaction scores that now play a role Medicare and insurance reimbursements to hospitals.

Nurses Week activities in particular illustrate a strange disconnect about nursing. When nurses talk to each other in seminars and classrooms, they discuss the unprecedented importance of nursing in contemporary health care systems, and the opportunities and need for nurses to play larger roles in designing and carrying out safe, effective, and affordable health care. They cite “The Future of Nursing,” an influential report by the US Institute of Medicine and the Robert Wood Johnson Foundation that, among other things, calls for nurses to “practice up to scope” and to participate as equal partners with physicians. Much of this discussion, however, remains in a nursing cloister.

When health care centers invite the public to join them in their annual ritual of “thanking” nurses, they rarely describe the actual work that we should be thankful for. Instead they too often present us with insipid images and sentimentalized anecdotes that produce a warm glow but little illumination about the support that nurses require to do their work. If anything, our latest research indicates that institutional depictions of nursing may actually be regressing at the very time that nursing is advancing.

It’s an interesting conundrum, and one that again confirms that nurses are, and must be, their own best advocates.