Physicians save Corzine; other work occurs
May 13, 2007 - Today The New York Times ran a long piece by reporter Lawrence K. Altman, M.D., about the ongoing recovery of New Jersey Gov. Jon Corzine from a serious auto crash last month: "In Corzine's Recovery, Doctors Cite Grit and Luck." The piece is physician-centric. It includes many quotes from Cooper University Hospital physicians, but not one from a nurse. And it gives credit for things nurses do to physicians, to others, or to no one, through the "this happened"-type constructions the news media often uses to describe nursing work. Readers could be forgiven for thinking that physicians provide virtually all bedside care to critical patients who spend weeks in the hospital, monitoring and keeping them alive 24/7. Gov. Corzine spent 18 days in the Hospital, 11 in the ICU. Yet the only specific credit any nurse gets is for lip-reading his requests for medication and water while he was on the ventilator. We regret having to say "nurses did that!" over and over when the media presents the key care of a VIP as being provided entirely by physicians, as it usually does. But it is necessary if we want a world in which credit for health care outcomes, and the resources that go with that credit, are allocated based on professional merit and the facts.
Let's review all the specific references to nursing in the article. The piece says that on April 12 "a nurse" paged "Dr. Steven E. Ross," who "directs" the hospital's trauma center and receives significant attention in the piece (including two photos), to let Ross know that Gov. Corzine had been injured. Some time later, the article says that the reporter interviewed "doctors and nurses" who treated Corzine during his weeks in the hospital. One nurse is named, but not quoted: "In the coming days, with Mr. Corzine unable to speak because of the tube connecting his windpipe to the ventilator, David Donaghy, a nurse, read his lips as one way to respond to his wishes for more pain medication or ice water." Later, we hear that "Dr. Ross" waited for Corzine to arrive with, among others, "a trauma nurse" and "a nurse anesthetist." That's it for nursing.
The rest of the 2,100-word piece suggests that physicians did everything that mattered up until Corzine's April 30 release. There are extensive quotes from Ross and chief orthopedist Robert Ostrum, and lengthy descriptions of their activities. Only their views on Corzine's care are worthy of inclusion, even when the specific subject is the governor's physical, intellectual and emotional post-surgical recovery, on which nurses spend far more time and in which they have great expertise. Let's start with the headline: "In Corzine's Recovery, Doctors Cite Grit and Luck." Other examples abound. "The doctors said Mr. Corzine seemed lucid, coherent and sharp." "The doctors still did not know whether Mr. Corzine was paralyzed." "When he moved both arms and both legs, the doctors became more optimistic." "Mr. Corzine's doctors said they were encouraged that baseball and the Devils' playoff run were among his favorite topics." "Trauma doctors measure recovery in part by what patients want to talk about and do."
When nursing care is discussed, the reader often gets the impression that it was given by others, or that it just happened. For instance, the statement that "Dr. Michael E. Goldberg" was "the anesthesiologist who controlled" Corzine's pain medication suggests that this physician actually did everything to relieve Corzine's pain during the more than 400 hours Corzine spent in the hospital. Uh, not so much. We assume that this physician wrote prescriptions and checked in, but unless he stayed bedside 24 hours a day, it was the nurses who were controlling the pain. Typically, anesthesiologists prescribe which medicines to use and the general ranges for that use. Nurses monitor the patient for level of consciousness, heart rate, blood pressure, skin color and moisture, grimacing, and other signs of pain on a minute-to-minute basis to titrate the medicine. Nurses keep the patient comfortable--and alive.
At another point, a task requiring significant nursing expertise and effort is dismissed as being handled by transport workers: "Hospital aides wheeled Mr. Corzine to the basement for CAT scans looking for evidence of brain damage; tears in the aorta, the body's main artery; or damage to the heart, lungs, spleen, liver and intestines." In fact, it is incredibly challenging and complex to transfer a critically ill patient to and from CT scan. There are few things as difficult in ICU nursing practice. Nurses kept Mr. Corzine alive during that arduous journey; this was no casual wheelchair ride through hospital halls and gardens.
The piece gives the sense that some things simply happen, through the use of constructions that hide the real actor, a common news media practice that often seems to result in credit for vital nursing care disappearing. For example, readers are told that "Mr. Corzine received 12 pints of blood." And we hear about "the drugs that Mr. Corzine received in intensive care." Nurses' administration of blood and drugs is complex, and doing it well requires years of education and experience. It doesn't just happen as easily as pouring a glass of milk.
At another point, readers are told: "There were potential fatal complications: pneumonia; other infections; acute respiratory distress syndrome; blood clots in the leg that could travel to the lungs or other organs and cause emergencies, if not sudden death." Indeed, avoiding those complications was critical to Corzine's survival. The only thing missing is some indication of which health professionals took the lead in actually preventing and working to detect those. The answer, of course, is nurses, but the piece is so physician-centric that few readers would guess it.
Perhaps the most egregious single example of miscrediting is this: "At Cooper, doctors typically take turns caring for trauma patients every day." We get that the piece simply means different physicians are assigned to such patients on different days. But readers without a good sense of what really happens in hospitals will surely have the prevailing distortion they get from the mass media confirmed: physicians stay at or near the bedside and do all the important "caring" for critical patients like Corzine. Of course, physicians spend little time with each patient. That is what nurses do. Any fair calculation of the effort involved would reveal that nursing care had far more to do with Corzine's recovery over his weeks in the hospital than did physician care.
Of course, the Center is well aware that having to constantly demand credit for things is not an attractive position to be in. We seek a world in which nurses are not forced to jump up and down and say, "Hey--I did that! Give me credit for it!" (Indeed, that kind of thing does not come naturally to nurses, who have been taught to disclaim credit since the earliest days of the profession.) Our vision is for a world in which nurses, physicians and others can work collaboratively, because research shows that patients get the best care in such environments.
But this cannot happen when nurses' important care is ignored and/or physicians are relentlessly awarded credit for the work that nurses really do. Nurses and their patients pay the price for that. One of the key reasons for the global nursing shortage is the poor media portrayal of nursing. Influential media products have much to do with the way nursing and other health matters are perceived by society, as public health research shows. Any fair article on Corzine's recovery would surely encourage the best and the brightest to become nurses, because it takes top-quality nursing expertise to keep a patient like this alive. But we cannot imagine a 16-year-old reading this article and being inspired to become a nurse.
When nursing is undervalued this way, it is underfunded. And that is a key reason that a critical nursing shortage is killing people. Nursing researchers get 0.75% (less than one percent) of the total NIH budget for their work. Nursing education is woefully underfunded. The nursing shortage cannot be resolved without adequate funding for nursing schools. Yet US nursing schools turned away 150,000 qualified applicants last year for lack of faculty, facilities and clinical placement opportunities.
We urge Dr. Altman and others to consult with nurses before writing about their work, and to give the public an accurate sense of the role nurses play in saving lives and improving outcomes.
See the article "In Corzine’s Recovery, Doctors Cite Grit and Luck" by Lawrence K. Altman in the May 13, 2007 edition of the New York Times.
Send a letter to the author at:
Lawrence K. Altman
The New York Times
229 West 43rd Street
New York, NY 10036
Our executive director's letter to Lawrence Altman is here in pdf.