Changing how the world thinks about nursing

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Q:Nurses are just wonderful, but you really can't expect Hollywood to focus on them, can you? After all, popular media products have to be dramatic and exciting. Why don't you just focus on getting a nursing documentary on PBS or basic cable?

A: Because the work of nurses is at least as dramatic as that of physicians, and getting the wider public to understand that would be of great value in resolving the nursing shortage that is one of the world's most pressing public health problems. More than a few Hollywood insiders have expressed to us some version of the sentiments in the above FAQ. But contrary to the current popular and mass media image, nurses are expert professionals who save lives autonomously--that is, in pursuit of their unique nursing scope of practice, not physician commands. They confront some of the most exciting human, policy and technological challenges in modern health care. These range from the extreme high-tech of teaching hospital ICU's, to chaotic urban level one trauma centers, to major health policymaking and research centers, to small community health projects where lives are changed, to war zones and development and humanitarian relief projects around the world.

Perhaps the most telling evidence of the drama of nursing is that the major hospital shows on U.S. television today--ER, House" and Grey's Anatomy--actually do spend a great deal of time showing work that in real life is done by nurses, including fighting for better care systems, catching and preventing deadly errors, educating patients and giving them skilled emotional support, monitoring patient conditions, and performing exciting procedures like defibrillation. It's just that they inaccurately show physician characters doing it.

What do nurses do? Nurses, with their years of college-level training, are on the front lines of the health care delivery team. They assess and monitor patients, and taking a holistic approach, determine what patients need to attain and preserve their health. Nurses then provide care and, if needed, alert other health care professionals. Nurses thus coordinate care delivery by physicians, nurse practitioners, social workers, physical therapists and others. Nurses assess whether care is successful. If not, they create a different plan of action. Nurse are patient advocates, protecting the interests of patients when the patients themselves cannot. Nurses are educators, explaining procedures and treatments to patients, teaching them how to care for themselves and work toward full recovery. Hospital nurses are responsible for discharge planning, deciding together with other health professionals when patients can go home. Nurses work to prevent illness through education and community programs designed to decrease transmittable illnesses, violence, obesity and tobacco use, and provide maternal-child education--addressing some of the leading health problems of our time. Some nurses are independent scholars whose work is at the forefront of health care research. Many nurses obtain Master's and Ph.D. degrees in nursing, then work as scholars, educators, health policy makers, managers, or advanced practitioners such as Clinical Nurse Specialists or Nurse Practitioners.

What specifically do nurses do that a mass audience would care about? (links below are to specific examples)

  • Nurses catch and prevent the medication error that would have killed you.
  • Nurses diagnose an ICU patient's wide complex tachycardia, call a code, and defibrillate--saving the patient's life.
  • Nurses triage ED patients based on their own expert evaluation of how sick the patients are--saving patients' lives.
  • Nurses give powerful medications and vaccinations--saving patients' lives.
  • Nurses are the care givers most likely to be there when patients are screaming, crying, laughing, or dying.
  • Nurses manage that violent, intoxicated patient alone until security gets there--if security gets there.
  • Nurses are the hospital caregivers most likely to be assaulted.
  • Nurses persuade that psychiatric patient to stick with the program.
  • Nurses persuade a poor young mother to save her baby's life through prenatal visits and breastfeeding.
  • Nurses provide adequate pain medication for terminal patients and the opportunity to die at home.
  • Nurses provide expert support in your final hour.
  • Nurses teach you how to avoid contracting HIV, and how to live with it if you do--to prevent AIDS.
  • Nurses subtly show the sickest patients that it's worth trying, perhaps by discussing Harry Potter with the young leukemia patient, or watching a few minutes of the news with that despondent, elderly post-op patient.
  • Nursing students spend years in demanding science programs that test their sanity and cause some to quit or fail.
  • Nursing scholars struggle to get grants, publish groundbreaking research and get tenure.
  • Nurses serve as the chief executive officers of large hospitals.
  • Nurses spearhead efforts to help your teenage son not start smoking.
  • Nurses provide much, if not most, of the health care given by aid groups with names like Doctors Without Borders.
  • Nurses explain what that physician was trying to communicate--saving countless lives.
  • Nurses, as commissioned officers, manage complex military care operations around the world.
  • Nurses found and run new health systems for underserved urban and rural communities--saving countless lives.
  • Nurses train and mentor nursing students and new nurses.
     
  • Nurses kick intoxicated surgeons out of the OR and fight to have surgeons who are dangerous removed permanently.
  • Nurses refuse to give drugs that will hurt that fetus, or any other patient.
  • Nurses regularly have intense interactions with physicians about patient care. For instance, nurses may identify symptoms physicians have overlooked, and they may struggle to convince physicians that those symptoms exist.

Is that dramatic enough? We know it is, because we've seen physician characters doing much of the above for years. And the nursing tasks that physician characters are not shown doing would often make for equally compelling drama, if media creators knew that they occurred.

Unfortunately, the incorrect traditional assumptions about nursing have led to the matrix of physician-centric programming that has dominated popular media for decades, forming a persuasive but dangerous simulation of reality. Today, virtually every major character in the top three hospital shows named above is a physician--24 out of 25, to be exact, with the sole nurse being "ER"'s Sam Taggart. The combined viewership of new episodes of these three shows at the end of the 2006-2007 season was well over 50 million in the U.S. alone. Clearly, the idea that nursing is not dramatic must be overcome if we are to transcend the matrix, and help nursing gain the power it needs to meet the health challenges that lie ahead.

Last updated July 5, 2007.

 

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