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The Oregonian: "Fighting for life on Level 3"

September 21, 23, and 24, 2003 -- On these three days, the Portland-based Oregonian published a lengthy, melodramatic feature by Tom Hallman Jr. about a local NICU for especially critical babies, focusing on the heroic efforts of the unit's nurses to help patients and their parents, but probably leaving the impression that nursing is subordinate work that is more about comforting than saving lives.

The feature describes the nurses on "Level 3," a cutting edge NICU in North Portland's Legacy Emanuel Children's Hospital, as well as some of the patients and their families. The piece seems mainly concerned with conveying a sense of constant stress, emotional overload, and tragedy always potentially just around the corner. It succeeds to such an extent that it could be described as a non-fiction soap opera ("Death stalks this space."). But despite the heavy-handedness, many readers will be affected by the story.

The article's portrayal of nursing is mixed. The piece is nurse-centric. It paints the nurses as heroes confronting things that most people--including their spouses--could not, and doing so in a very sophisticated setting. (The author gets so carried away hyping Level 3's security that you begin to wonder if it figures in Secret Service contingency plans.) The nurses appear as emotional pillars, supporting parents at the edge of despair and in some cases forming relationships with them. At certain points, the article gives a sense of the nurses' substantive expertise, describing them checking the web of monitors for important changes, recording their observations, assessing through touch, and explaining to parents how far they can go in touching their babies. There could be more description of nurses actually intervening, but one passage does address the difficulty and critical importance of starting an IV line correctly in a NICU baby.

Overall, the story is so personal and melodramatic that readers may be left with the sense that NICU nursing is mainly about providing emotional support to devastated families and trying not to fall apart yourself. For a piece so overwhelmingly about the nurses, we don't get a full sense of all the highly skilled work they do for their vulnerable patients and how its keeps them alive. The overall impression is that the physicians and technology take the lead on that score. Nor do we get much of a sense of how hard the nurses are working; at many points, they seem to be standing around watching the drama unfold. Likewise, in the nearby maternity unit, "[r]elaxed maternity nurses lean against the front counter, chatting."

The piece gives the impression that nurses are lesser than and subordinate to physicians. The nurses are described only by their given names, a diminishing choice that would not have been made in an article about physicians. Indeed, the physicians who do appear here are described only by their surnames, even when they are named many times. At one point, Hallman notes that a baby's parents had asked a physician to "direct" the nurses to do whatever was needed to keep a child alive. The nurses come to feel that life support should be ended because this suffering patient has no realistic hope of improving, and they take it to the physician, who agrees. This is a good example of patient advocacy. But it's undercut by the presentation. The nurses don't discuss their concerns with the physician as fellow professionals; instead, they "rise up," as if nurses questioning a physician's plan were like slaves second-guessing the Pharaoh.

A piece mainly about physicians would likely have focused more on substantive discussions of diagnosis and treatment. Here, we get flashes of substantive nursing, but we also learn that "in keeping extremely early preemies alive, the personal touch could be even more important than technology. "Sure--without the technology and skilled nurses to use it, the babies would quickly die, but that would be nothing compared to a lack of the nurses' "personal touch. "We hear in great detail about why someone decided to become a nurse on the exalted Level 3, and how she feels about being surrounded by the death of innocents. We learn that Level 3 nurses work "on stage" in front of "worried parents, doctors and medical experts." (Do the "doctors and medical experts" work "on stage" in front of the nurses?) At least in the break room the nurses can "get off their feet, eat, chat and cry." Apparently, cutting edge NICU nursing is much like doing a school play in front of super-stressed grownups ready to pounce on you for, like, whatever.

See part 1, part 2 and part 3 of Tom Hallman Jr. 's "Fighting for life on Level 3" in The Oregonian.

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