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Careless advice columnist threatens profession

June 2, 2006 -- Today the legendary syndicated advice column Dear Abby (now written by Jeanne Phillips (far right)) ran a piece headlined "Careless nurse threatens marriage." The main item is a letter from "Mike in Tucson" complaining about a nurse in a recovery room who reportedly told a patient's wife that patients emerging from anesthesia cannot lie. The patient's wife then asked her groggy husband if he had ever cheated on her, and when he said he had, she ran from the room. Mike wonders if he "should let the doctor know about his nurse's unwise remark." Abby responds "[a]bsolutely," and proceeds to opine that people coming out of anesthesia have no idea what they're talking about, so the "doctor needs to counsel his nurse for her poor judgment." Just how poor the nurse's judgment was would seem to require knowledge and analysis of a number of facts that we don't get here. But what's not so complex are the damaging assumptions Abby makes, namely that the nurse belongs to a physician and that it would be the physician's role to "counsel" her. Of course, hospital nurses report to other nurses, not physicians, and nursing managers and clinical leaders would be the ones to undertake any counseling needed. Even if the scene occurred in an outpatient setting in which the physician was an owner and thus the nurse's employer, readers are unlikely to see the above comments solely in that light, and very likely to have their sense that nurses generally report to physicians confirmed. Just an advice column? Dear Abby's daily readership is estimated at 100 million people.

Mike's letter begins with the assertion (echoed in the headline) that the possible end of the marriage he had witnessed in the recovery room "was because of a professional health-care worker's unwise remark." Mike says that his wife was among patients in a large recovery room following surgery, and that from behind a curtain he heard "a nurse" talking to the wife of the patient next to them. Mike reports that the nurse, in a "lighthearted," "giggling" way, said: "You know, you can find out anything from them when they're coming out of anesthesia. They are completely incapable of lying." A few minutes later, the patient's wife reportedly asked: "Bart, have you ever cheated on me?" Bart "moaned": "Yes, with Mary Helen." The wife reportedly choked back a sob, ran from the room, and did not return for the 45 minutes Mike remained there. Mike says he thinks it was "ridiculous" for the nurse to have said what she did, and asks if he should "let the doctor know about his nurse's unwise comment."

Abby responds: "Absolutely!" She goes on to state (without support) that people "have been known to babble all sorts of nonsense when coming out of anesthesia," and that Bart was not only "not responsible" for what came out of his mouth, but also "probably has no memory of it thanks to the new, improved anesthetics being used today." Abby admits that "a wife who would have to stoop to such behavior already has her suspicions or she wouldn't feel the need to ask." But she ends her response by stating that "[t]he doctor needs to counsel his nurse for her poor judgment."

The magnitude of the nurse's error here does not strike us as so simple. In fact, it's not really clear whether Mike knows the health worker to be a nurse, given the variety of health workers in hospitals today. But let's assume that the story is factually accurate as reported, since readers presumably will. Mike and Abby appear to assume that they know everything that this patient's wife has been told about anesthesia. However, do we know that no one has told the wife that what patients say when emerging from anesthesia cannot be trusted, assuming that's true? Do we know that the nurse herself has not? Moreover, can we really say that the wife has no responsibility to assess for herself her husband's credibility, especially given the nurse's "lighthearted" delivery and the presumably groggy demeanor of a post-surgical patient who "moans" his response? And the nurse did not say that you could necessarily trust the accuracy of what anesthetized patients say, just that they can't lie, a very specific, conscious act. Of course, the nurse has ethical duties to act in her patient's best interests within the scope of her professional care. If she has given the patient's wife credible but inaccurate information--the impression that patients under anesthesia always speak the truth--then she may have failed to meet her responsibilities.

But Abby and Mike don't seem to base their criticism entirely on the possibility that Bart's statement was inaccurate. Far from it--they seem to think Bart may well have been telling the truth, but that it was irresponsible for the nurse to give the wife a method of unearthing it that seems unfair to her husband. But is it part of the nurse's professional duties to protect philandering husbands from effective questioning by their wronged wives, or more broadly, to have foreseen that a general, casual statement about how people react to anesthesia would be used to conclusively decide a sensitive issue at the heart of a marriage? How does the nurse's action differ from if she had said "here's the number of a great private investigator," which the wife then used to develop the same information? You could argue that this was too sensitive a time in the patient's care for the nurse to have given his wife any information that had even a remote chance of imperiling his recovery. But the suggestion in the headline and in Mike's letter that the nurse herself may have destroyed the marriage is plainly absurd. The nurse did not cheat with Mary Helen. Nor did she create a relationship in which the first thing the wife asks when she thinks her husband can't lie is whether he cheated, then immediately takes his groggy answer as true and runs from the room. And of course, all Mike really knows about the future of the marriage is that the wife did not return for 45 minutes.

The more clear-cut problem with the column is the idea that the nurse reports to a physician, and that this physician would be the one to counsel her. Indeed, both Mike and Abby refer to "his nurse," as if the physician owns the nurse. We won't belabor the irony of the notion that physicians are there to tell nurses how to relate to the patients nurses care for 24/7. But we will note that the inaccurate assumption that nurses are physician subordinates is a key factor in the lack of understanding that continues to drive the nursing crisis. Assuming this happened in a hospital, the nurse reports to a nurse manager, who in turn reports to nursing executives in a chain of authority leading to hospital management. Nursing is an autonomous profession with its own ethical and legal responsibilities. If this nurse violated any of those, she would be responsible to the patient and to other nurses. But she would be responsible to the physician only in the way that he would be responsible to her for a comparable error--that is, as colleagues involved in the same overall endeavor.

Of course, if these events occurred in an outpatient setting, it is possible that the physician Mike describes was an owner of a practice that employed the nurse, and so it could be argued that she was "his" in the sense that she was his employee. But readers are not likely to make such fine distinctions. They are far more likely to simply assume that this is one more example of nurses reporting to physicians, which most already believe is how it works across the board. Since Abby does not know the organizational structure involved here, the proper advice would have been for Mike to approach the nurse's manager, whoever that is, and not to simply assume that it is a physician.

Incidentally, it's nice that Mike describes the nurse as a "professional," but any benefit from that is negated by the damaging assumptions at the end of his letter.

We urge Dear Abby to learn the facts about nursing, so she can avoid making such damaging misstatements about nurses in the future.

See the column in question here.

Please send Dear Abby your thoughts by entering them on her web form and then please send us a copy of your letter at letters@truthaboutnursing.org. Thank you!

 

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