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Vice President Joe Biden explains��how nurses differ from physicians

Vice President Joe BidenJune 3, 2013 -- Today, during a speech about mental health awareness, U.S. Vice President Joe Biden spent about a minute paying tribute to nurses. That short part of his speech implicated issues including nursing skills, nursing autonomy, the nurse as angel, the profession's gender mix, and even the naughty nurse. Biden mentioned psychiatric nurses, and then, apparently departing from his prepared text, said that "if there's any angels in heaven, by the way, they're all nurses," referring to his personal experience with neurosurgery. Of course, nurses are not angels, but real professionals who save lives with education and skill--and unlike angels, they need the resources to do so. Then, in the remark that's gotten the most attention, Biden said:  "Doctors allow you to live, nurses make you want to live." Well, sort of. If he meant nurses focus on psychosocial care, motivating you to keep trying and showing you how, that's good, although he might have simply meant nurses are nice people who cheer you up. Unfortunately, the remark implies that physicians save lives and nurses don't save lives, which is false. And as titters from the audience alerted Biden, the statement can also be interpreted, though not fairly, as a clichéd reference to hot female nurses making sick men want to live for sex. Biden quickly noted that he was referring to "male nurses and female nurses." Finally, Biden said that during the two months he spent in the ICU, his neurosurgeon would enter his room and say (here Biden adopted a deep, somewhat pompous voice): "We gotta do this, this, this, and the other," and "my nurses would all go, 'yes, sir,' and then they'd do exactly what I needed." We appreciate Biden's suggestion that the nurses had the knowledge and skill to do "exactly what [he] needed." It's sad but plausible that the nurses felt they had to do it covertly, as Biden implies, presumably because they lacked the social power to simply discuss care with the surgeon as a professional colleague. We thank Vice President Biden for presenting some helpful information about nursing.

Biden's remarks were part of a 38-minute speech at the National Conference on Mental Health, held at the White House, which the White House website describes as "part of the Administration's effort to launch a national conversation to increase understanding and awareness about mental health." The relevant part of the speech went like this:

Those of you who are mental health providers know there's a reason why more people haven't gone into mental health fields. Doctors, psychiatric nurses. Because, not many people asked.  People go where the need is. Almost every doctor or nurse I've ever known -- if there's any angels in heaven, by the way, they're all nurses. [You're] speaking to a guy with two craniotomies because of aneurysm, one embolism. ... Doctors allow you to live, nurses make you want to live. And I don't ... [laughter] No no, they make ... Male nurses and female nurses. I love my ... my neurosurgeon would come in the ICU which I was in for 60 days, for two months, and he'd say, we gotta do this, this, this, and the other... And my nurses would all go, "yes, sir," and then they'd do exactly what I needed. You think I'm joking, those of you who've had significant health [issues] know.

First, we appreciate that Biden, in referring to mental health providers, included both physicians and "psychiatric nurses," who do in fact play a critical role in a wide range of mental health care settings, as a good recent PBS report on nursing care for veterans made clear. And we appreciate Biden's suggestion that his ICU nurses had the skill to do what he needed, regardless of what the neurosurgeon thought (though we assume the surgeon must have had some good ideas and that Biden does not mean the nurses ignored everything the surgeon said). save lives, be a nurse bumper stickersEven the "make you want to live" remark could be helpful to the extent it refers to nurses' holistic focus and psychosocial skills, as shown in the well-known story about the nurse who turned a despondent patient around by talking to him over two cups of tea. However, the remark could easily be taken simply as a statement that nurses are nice and cheerful, that they have positive personalities more than skills. And unfortunately, set against the "doctors let you live" part, it's pretty hard to avoid the implication that nurses don't save lives in the same way as physicians do, presumably in a highly technical physiological way. That's not true, since nurses have advanced life-saving skills that are especially critical in places like ICUs.

The account of how the surgeon and nurses interacted in the ICU raises issues of nursing autonomy. It's pretty obvious that Biden was suggesting that both the surgeon and the nurses acted as if the surgeon was giving them orders. Of course, Biden's ICU stay was in 1988, but this scenario remains plausible in clinical settings today. Although listeners--and nurses themselves--might be amused at the thought of those sneaky ICU nurses, proceeding to do whatever they thought best, subverting the pompous surgeon, it still sounds like the actions of servants. And it's no substitute for a healthy workplace environment where nurses and physicians can discuss care as colleagues. Nurses are autonomous professionals, and they were in 1988--they were in Nightingale's time!-- though clearly there remains a large and pernicious power imbalance, one that even some nurses mistake for a formally subordinate relationship.

Angel in heavenThe remark about nurses being "angels in heaven" is a tired cliché. It would be fine that people find nurses to be nice, devoted, and self-sacrificing--the popular conception of an angel--if that kind of sentiment did not go hand in hand with disrespect for nurses' clinical skills. And when nurses are seen mainly as nice and caring, it's more difficult for them to get the resources they need for education and clinical practice. Angels live in heaven and don't need advanced training, or adequate pay, or rest, or protection from mandation or abuse. Nurses don't live in heaven. As we have noted, too many people trust nurses to hold their wallets while they're in surgery, but not to save their lives while they're in surgery.

Finally, there are the gender and sexual overtones. Biden's statement that nurses "make you want to live" could be taken as a comment on female nurses being attractive or even offering sexual favors, but only if the listener chooses to interpret it that way in light of the naughty nurse stereotype. Biden's actual words are completely consistent with a comment on nurses' psychosocial focus, or at least their pleasant temperament, and although he might have made more clear what he meant, we have no reason to think he intended to raise or reinforce the naughty nurse image. Many statements could be interpreted sexually, including the famous movie quote that is the headline of this analysis. But there, as here, that would not be a fair interpretation.

Biden's response after the audience reaction to the "want to live" statement was also interesting. He might have explained that he meant nurses make you want to live by cheering you up, teaching you, interacting with you about life, and so on. But instead, Biden simply referred to "male nurses," presumably meaning that of course he was not talking about the naughty nurse image. Of course, men in nursing are subject to their own stereotypes, and many are not fond of the phrase "male nurses," although Biden's use of it here seems all right since gender was the issue, at least in part. Biden did remind listeners that there are men in nursing. On balance, though, it probably would have been better had he simply explained what he meant by "make you want to live."

Vice President Biden's remarks were clearly intended to convey respect for nursing, and in the more charitable interpretations, he paid tribute to nursing skill and authority. We thank him.

See the video on YouTube, on the White House site or below. On the embedded video below, start at the 20:04 minute mark to begin the relevant parts.