The Nurses' View

March 14, 2005 -- Today the CBS television affiliate in Boston, CBS4, ran an edition of its weekly "The Women's View" segment that ostensibly was a discussion of "medication errors" with four local bedside nurses. The piece, featuring anchor Lisa Hughes, amounted to a compelling infomercial arguing that short-staffing has caused the nursing shortage and pushing proposed safe staffing legislation. While the complete lack of balance might undermine the piece's credibility for some who are familiar with the controversial issues involved, the nurses' presentation was a striking example of patient advocacy.

The segment apparently stemmed from a recent case in which a nurse at the local Brigham and Women's Hospital accidentally gave two newborns overdoses of Tylenol. The piece does not actually get into that case, but features Hughes asking the four guest nurses for their views and experiences as to medication errors generally, and their thoughts about the current state of nursing. In introducing the piece, Hughes says that their discussion occurred at the Boston College School of Nursing--a note that all by itself sends a commendable message that nurses are highly trained. The "veteran" nurses give viewers the impression that all medication errors are ultimately due to nurse short-staffing, and also argue that short-staffing is the main cause of the current nursing shortage. They note that the shortage is actually more of a shortage of nurses willing to work under the dangerous conditions that now exist in many hospitals, and that recent research shows that short-staffing affects patient outcomes. When Hughes asks what can be done, the nurses immediately recommend the mandatory staffing ratio legislation supported by the Massachusetts Nursing Association (MNA)--but without mentioning MNA. The nurses are very persuasive, stressing that they love their work, but conveying the psychic damage resulting from the realization that they may have made a life-threatening mistake. One suggests that her daughter does not want to be nurse because she sees how overworked her mother is. The discussion is not shown in "real time," but consists of a series of snippets edited together. Presumably this is done to include the best comments most efficiently, but the effect is also to make the nurses seem very poised and knowledgeable. There is no mention of any differing views as to the causes of medication errors, causes of the shortage, or the wisdom of the proposed staffing law.

Obviously, the orientation of "The Women's View" is to explore the perspectives and experiences of guests in a friendly way, and not to have a cable-style shoutfest, or even a balanced presentation of competing views, as might occur in a straight news report. Even so, the piece might have had more credibility with some viewers if it briefly touched on or at least acknowledged differing views, and if it conveyed a little more nuance. Nurse short-staffing is not the sole cause of medication errors; others include physician error, pharmacist error, nursing error not due to short-staffing, and poor communication between different health care workers. While many informed observers do believe that managed care-driven short-staffing is the primary immediate cause of the shortage, most believe that there are also a number of other factors, including the broad social devaluation of nursing that we believe underlies the short-staffing. Moreover, legislation mandating nurse staffing ratios is very controversial in Massachusetts. The piece might have included at least a comment about that, even if only as a set-up for one of the well-prepared nurses to argue that the state's hospitals could indeed afford to staff their units safely. Of course, it could be argued that the state's hospital industry and its friends in government have many opportunities to present their views in one-sided ways, including their recent "Patient Safety Pledge" campaign, and this was merely an effective counter. But it might have been even more effective had it at least addressed why opposition was wrong, or even included comment from an opponent.

Perhaps the most striking element of the segment was its failure to note that the most talkative of the four nurses, Karen Higgins, is not just an "intensive care nurse," as the piece identifies her. She is the articulate President of the Massachusetts Nurses Association, the driving force behind the safe staffing legislation and a major player in the legislative battle surrounding it. The failure to note this opens the piece up to credible accusations that it is little more than a biased political ad, which could end up undercutting the nurses' very real credibility on these key issues. That other news organs might present equally biased pieces taking the opposite view does not resolve this credibility issue. We were impressed that the piece at least did not post the phone number of the Massachusetts legislature at the end and ask viewers to call now--though the CBS4 web site does have a link to the MNA web site at the end of its summary on the piece.

In any case, this segment provides viewers with vital and compelling information about the nursing crisis, which is threatening lives. We salute the nurses who appeared and did such a great job in advocating for their patients and themselves, as well as CBS4 and Lisa Hughes for giving them an opportunity to do so.

To see the piece: click on "Women's View: Medication Errors" March 14, 2005