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January 2004 -- The Center for Nursing Advocacy understands that some nurses have objected to a poem called "Learning the Bones," which was published in the "Art of Nursing" feature in the January 2004 issue of the American Journal of Nursing, of which Diana Mason, RN, PhD, FAAN, is the editor-in-chief. We have been asked to add our voices to those protesting the publication of this somewhat explicit poem in AJN, which some feel was an inappropriate venue. Though for resource and other reasons we focus on improving public understanding of nursing through the mass media, rather than nursing media, we will explain our views on this issue.

In this short poem, by Shanna Germain, a paramedic student's married lover reads a few entries from the student's anatomy textbook, including "Pelvis" and "Mandible." This leads the student to consider the differences between learning human anatomy and learning how humans relate. The student and his or her lover have just "had sex," and the student applies the anatomy terms to aspects of the lover's body. The student notes at one point that he or she "can still smell him on my sheets and between my thighs, can still feel his dead skin beneath my nails. I tried to take his blood." The lover walks to the kitchen and "calls his wife, tells her he'll be home as soon as he can." The speaker reads the word "Humerus" from the textbook, then concludes that while it took only six weeks to learn all the bones in the body, "[o]ther things are harder: who can remember which is the distal end, which is the proximal?"

Some may not find this poem to be especially subtle or well-crafted, but it is serious, thought-provoking and worthy of attention. The speaker's musings seem designed to highlight the differences between the human anatomy that health care workers must learn and the even more complex mechanics of human relations. The speaker has trouble distinguishing the "distal end" from the "proximal"--is my lover closer to me, or his wife? The well-defined anatomical entries contrast with the less substantial mysteries of human affection. The somewhat explicit nature of the poem has made some nurses uncomfortable, but we see nothing pornographic, exploitative or even erotic here. We do see a frank and not very happy comparison of two areas of human experience, one of which is largely the province of health care workers (learning technical aspects of anatomy) and one of which is obviously not (doubt and betrayal in close human relations). The animalistic account of these relations seems to underline the distance between the tangible aspects of life and matters of the heart.

But doesn't the placement of this poem in AJN's "Art of Nursing" feature mean AJN is saying nurses are exhibitionistic adulterers with a taste for S & M? We don’t think so. First, the speaker in the poem is clearly a paramedic student, not a nursing student. Second, the speaker is not the poet, and what the speaker says is not necessarily what the poet is trying to say, much less what AJN is. AJN and Dr. Mason can speak to why they published the poem, but the effect of their publication is to present nurses with a portrait of a human being caught between temporary pleasure and doubt about how his or her lover really feels, about who is really being betrayed, and perhaps about the morality of the relationship--a person who may long for love but speaks only of "sex." It's not clear to us that the poem has much to do with nursing per se, except to the extent that the central metaphor is the process of learning anatomy that nurses and other health care workers must do. But in a larger sense, nurses and other health care workers must often cope with the effects of these kinds of relationships on patients and those who surround them. So it does not seem inappropriate for health care workers to be asked to consider the nature and effects of adultery. And even they occasionally commit adultery, or so we are told.

Some nurses have labeled the poem "smut" and argued that its placement in AJN sends a negative message about nursing. We disagree. We understand why nurses may be uncomfortable with a work that they feel associates nursing and sex or adultery, given the history of harmful "naughty nurse" and "angelic nurse" stereotypes. But we see nothing like that in this poem, whose brief, harsh dissection of an affair is unlikely to appeal to any prurient interest. And of course, while the poem uses a health care theme and is being presented for nurses to read, as far as we can see it is not "about nurses" at all. So how is it the "art of nursing?" Well, it is art, and it does relate to nursing. We doubt that many lay people or potential nurses will even see the poem, and we doubt that many will conclude that it is saying nurses are adulterers.

We hope that a nursing journal can present a short work that addresses a relevant (if controversial) subject in a responsible (if provocative) way without tarnishing the nursing image. Even if this poem's speaker had been a nursing student, we are not convinced that that, in the context of a thoughtful poem about one student's personal life, would have made any general statement about nurses and adultery.

To some extent, the protests over the placement of the poem may reflect differing views of what a serious academic health care journal should do. Some may believe (as we do) that the focus should be on provoking thought about a range of important issues relevant to the journal's readership, even if they are not strictly clinical matters. Others may place more emphasis on presenting a positive image of nursing or on sticking closely to clinical issues, and still others may simply be uncomfortable with public discussion of intimate relations. We are a little surprised that some seem so upset about an adult nursing publication’s references to basic human relations, which nurses themselves must confront so closely and so frequently in their work.

We also urge those protesting the poem to consider what AJN has done to improve the image of nursing under Dr. Mason's leadership. Dr. Mason and her staff have published scholarly articles of the highest caliber, promoted them to the mainstream media with unprecedented zeal, run visionary editorials and compelling news items. AJN published a Viewpoint op-ed by our staff about improving the nursing image which appears in the February 2004 issue. Dr. Mason is also on the Center's advisory panel, and despite her heavy schedule she has made a serious effort to help us spread the word about our mission and ensure that we have the resources needed to continue our efforts. In our view, Dr. Mason is a talented, positive leader who is moving the nursing profession forward to an extent that few others are.

We are encouraged that this poem seems to have spurred so many nurses to advocate on behalf of a better nursing image. We hope that this will translate into equally aggressive advocacy with regard to the many grossly inaccurate mass media products that reach a far larger audience than the several hundred thousand nurses who receive AJN. For instance, each week, the NBC show "ER" is seen by more than 20 million people in the United States and hundreds of millions more around the world. This show, which has run more than 200 hour-long episodes, is the most influential propagator of the handmaiden myth. Please join our campaign to improve the show’s damaging portrayal. Another example is the notorious Clairol commercial. That ad really did present a nurse as an underworked twit who could not control her impulse to have a sensual shampoo experience in her patient's room, and the Center worked successfully to persuade Procter & Gamble to retire it. We view such popular broadcast and print media items--which misrepresent nursing to tens or even hundreds of millions of impressionable lay people daily--as far greater threats to the advance of nursing than a short poem in a nursing journal. We hope that everyone who wants to build a better profession will focus on improving these influential media products, so that the public can better understand what nurses do to save and improve lives.