Judgment
Tribute to nurses on Katie features Diana Mason
July 16, 2014 -- Today, Katie Couric spent half of her syndicated daytime talk show Katie on a tribute to nurses that was based mainly on the just-released documentary The American Nurse. Most of the half-hour segment featured interviews with director Carolyn Jones and three of the five nurses profiled in the film. There were heartfelt salutes to nurses from Couric and Jones, and the three nurses were able to deliver some helpful information about nursing, particularly its psychosocial elements. The brief appearance of one of the nurses, a military officer, effectively conveyed that nurses can be health care leaders. It is true that there was also plenty in the segment to reinforce the angel image of nursing, especially in Couric's own comments, which focused on the caring and support aspects of the profession and not much on nurses' scientific education or skill. One bright spot was the appearance in the last five minutes of the nursing scholar and leader Diana Mason, president of the American Academy of Nursing. That portion of the show was presented as advice on what viewers need to know before their next hospital visit, a common way nursing knowledge is portrayed in the mass media, more as a set of practical "tips" or "secrets" than as the kind of scientific expertise physicians provide. But the savvy, articulate Mason used the appearance as a platform to deliver strong policy messages designed to improve public understanding of nursing and to advance the profession itself. She cheerfully hammered away at the need for better nurse staffing and for nurses to be more involved in health care decision-making. Particularly as a result of Mason's appearance, the segment included some helpful information about the tangible value of nursing. We thank all who were responsible.
Read more below the video.
The healing power of a nurse's touch
The entire July 16 episode was entitled "Celebrating Nurses," although it had several other health-related segments. Couric begins with a quote from Florence Nightingale: "I attribute my success to this, I never took or gave any excuse." Couric says it was that "work ethic and compassion that made her the world's most famous nurse." We actually thought it was more her fierce patient advocacy and health care innovations, and we have to say that the quote about excuses doesn't exactly say "compassion." Couric goes on to note correctly that nurses "do more than check your vitals" and that "as your first line of defense, in fact, they can help save your life." Actually, they can just save it, period, but this is still pretty . . . helpful. Couric then gives a "little shout-out" to a team of nurses at Memorial Sloan Kettering Hospital who recently gave "the very best care" to a friend of hers; she does not give any specifics. Couric says that nursing is "the largest health care occupation, yet nurses are often overworked and underappreciated." She notes that the need for nursing will grow "as baby boomers age," and "that's why The American Nurse is today's big conversation."
Couric explains that the show will start with a look at a new documentary by Carolyn Jones, "who learned first-hand the healing power of a nurse's touch." Yes, and also of a nurse's brain. There is a clip from the film in which Jones describes her own breast cancer, listing several physicians who "fixed" her, but noting that it was a nurse who actually gave the chemotherapy and "got me through it"--a good example of the vague helping imagery that limits the positive effects of both this television tribute and the documentary itself. Jones joins Katie on set and notes that she jumped when the idea for The American Nurse project was first presented to her by Fresenius Kabi (a major drug company, although that is not mentioned). Jones says she was eager because of her chemo nurse, who got her through her ordeal with humor and irreverence. Of course, those are also qualities many lay people have. Couric asks Jones to compare the care of physicians and nurses.
Jones: We need doctors, and I needed doctors for sure. I had an extraordinary surgeon and I had a wonderful oncologist and a great radiologist. But you know, all of that work was very kind of scientific that they did with me, and it was all very cut and dry. But then when I was ready for chemotherapy, that was a very emotional experience. Joanne, you know, nurses touch you and they guide you, and they help you emotionally, so it was very very powerful. It was a team, I mean it was absolutely a team that got me better. But the nurse got me through it.
We wouldn't argue with this, but it doesn't really present nurses as health professionals. Note the focus on physicians as scientific experts and nurses as emotional supporters who rely mainly on touch--as any super-nice person would, whether they had any health training or not. Similarly, after the three nurses from the film have appeared and as Katie is wrapping up the Jones portion of the show, she asks what takeaway message Jones would like viewers to have. Jones responds that in our "polarized society," she has found an "incredible pocket of people that face everything with no judgment and enormous amounts of understanding and they know how to listen. So I think the qualities that nurses have, we can find them in all of us." Here again, this is quite consistent with just being a really nice person, and it could even be interpreted as praising nurses for being a bit passive and compliant, with their focus on listening and not judging. It also seems to us that "no judgment" was not exactly a hallmark of Florence Nightingale. Katie wraps that part of the show by leading a round of applause for the many nurses in the studio audience.
There are some better elements in the appearances of the three profiled nurses. The one who gets the most focus, presumably because of the highly emotional content involved, is Johns Hopkins labor and delivery nurse Naomi Cross. Jones says she wanted to profile someone from Hopkins because it is regularly voted the best U.S. hospital, which at least associates Cross with that distinction. And Jones also explains that part of Cross's work is "perinatal bereavement," which Jones says is "very complicated." Couric asks Cross how she is able to help these mothers.
Cross: Well, at Johns Hopkins we have a perinatal bereavement committee, and we have a program, and that program consists of supporting the mom and the family, including the father, and letting them know first that we're here for them.
As Cross speaks, the onscreen identifier is "Naomi Cross, RN, Johns Hopkins, Labor & Delivery." That is a good identifier in that it presents Cross as someone with a credential and a specialty (as opposed to just "Naomi"). And we liked her gentle correction in noting that fathers are also affected. Zeroing in on the emotional payoff, Couric notes that one of Cross's patients has come by to thank her, and mother Monica Jackson walks out with her six-month-old baby. She and Cross embrace, and Cross kisses the baby. Jackson describes a stillbirth she had in 2010, when everything happened so fast, and Cross was there, calmly "listening to what my fears were, my concerns, in a situation where I really didn't know how to even advocate for myself, it was so important and so crucial." It might have been nice to get some detail on that advocacy. Meanwhile, Cross is playing with and occupying the baby, which is a nice subtle example of interpersonal skill, for those who notice it and don't assume nurses are just paid maternal supplements. Cross explains that part of the bereavement program is following up with women, with periodic contacts and an annual bereavement ceremony. These specifics are helpful. Sometimes patients don't respond to the contacts, Cross says, but "I want those people to know that we can help them, you're not alone, we're here to support you." Evidently Cross has inspired Jackson herself to volunteer at the hospital. Katie thanks Cross for all she does.
After a break, the show returns with Louisiana nurse Tonia Faust, the hospice coordinator at Angola Penitentiary, a maximum security prison with most prisoners serving life sentences. After clips from the film about how Faust copes in this setting, Couric asks about challenges she encounters. Faust points to the limited physical contact -- she can't do as much laying on of hands and hugging, although it is OK to touch to examine the prisoners. Couric asks why the hospice unit is important for these prisoners. Faust stresses that they are still human and her goal is to give them the best health care, not to judge them or punish them in any other way, because they have their punishment from the court. The onscreen identifier is: "Tonia Faust, RN, Angola Penitentiary." Her comments are helpful in that they highlight nursing strength, and there is the mention of doing examinations, although of course there is also the focus on touch, which may not be what most viewers would see as an advanced health skill.
The last of the profiled nurses to appear is, as Couric introduces him, "Major Brian McMillion," the commander of the "medical" unit for the U.S. Army Reserves in San Diego. McMillion works with homeless veterans, and there is a clip from the documentary about his outreach work with them. That clip focuses on why the work is important to him. Appearing on set, his onscreen identifier is: "Maj. Brian McMillion, Commander of Medical Unit, U.S. Army Reserves." That is a good signal of nursing leadership, despite the use of "medical," which tends to equate what physicians do with all of health care. The articulate McMillion explains that he mainly serves a patient population that has returned from the Iraq and Afghanistan conflicts, and he also provides outreach and a range of services for homeless veterans; some don't want to go to the hospital. Couric does not have much to ask and she thanks him for his service.
La grande fromage sur les tables
The last five minutes of the nursing segment are devoted to Diana Mason's comments on what viewers need to know before their next hospital visit. Couric introduces her as a nurse and president of the American Academy of Nursing, and so, Couric says with a disarming smile, she
must be a "grande fromage" in nursing.
Mason's onscreen identifier is: "Diana Mason, Ph.D., RN, President, American Academy of Nursing." Nice. Nurses are rarely identified by their academic credentials on screen. Couric refers to the 2010 Institute of Medicine study saying that nurses are not being used to their full potential. She asks Mason to explain.
Mason: This report is very important because it recognizes that we cannot transform health care in this country without tapping into the potential of nurses. And one of the recommendations for example is that nurses need to be at decision-making tables at all levels of health care organizations, and at all health policy tables. Katie, we need more nurses in the boardrooms of these health care organizations. Why would you not want a Brian McMillion on your board, right?
Katie: Do you think nurses are being treated with more respect? Because I've witnessed doctors kind of putting nurses down, and kind of shooing them away, and I feel like this nurse knows more about the patient because she or he has been with them so much longer than the doctor. And by the way, I like doctors too, and I think doctors are incredibly important, and I don't want to generalize about that, but sometimes there have been occasions where I've seen them be very dismissive of nurses. Do you think that's changing?
Assuming these comments originated with Couric, it's not surprising that a celebrity would see such shooing, maybe more than the average person. VIPs are often surrounded by a crowd of physicians in hospitals, so large that nurses are in fact shooed away in such settings. It is impressive that Couric would notice.
Diana: It is changing, physician by physician, and particularly for those who have to have health care themselves, they recognize the value of nursing, so it is changing. And it is a team effort. But we need to make sure that nurses' voices are welcomed to the table, encouraged at the table, and are taken seriously.
Couric asks Mason for tips for hospital stays, and the first is about the Magnet program.
Mason: If you can, choose a Magnet hospital. Magnet hospitals are designated as such by the American Nurses Credentialing Center because they have met high standards for excellence in nursing care. They have nurses at decision-making tables in the organization, they've removed the barriers to practice, they staff better, they have a more well-prepared nursing workforce. And all of this means better patient outcomes. And so I tell people, call and ask, is your hospital a Magnet hospital. And if not, I say write the CEO of the hospital, write the chair of the board, and say why aren't you a Magnet hospital, and I want you to demonstrate that you have excellence in nursing care in the hospital that's serving our community.
This is a great statement of what the Magnet program should be doing and why, regardless of how well it is meeting those standards. It's also an admirable call for action by the public to push Magnet principles. We do worry that with so much on the decision-making tables, they may break. Anyway, Couric moves to the next tip, which is to ask about nurse-to-patient ratios.
Mason: There's no one set ratio, but we know that adequate nurse staffing is crucial to prevent patients from dying and developing serious complications. A study in 2002 in the Journal of the American Medical Association found that if you have a nurse on a general medical-surgical floor, not an intensive care unit, and that nurse has 4 patients, for every patient that you add to that nurse's workload, you are increasing the chances of a patient dying by 7%, and you're increasing the chances of them having serious complications, hospital-acquired infections, falls, pneumonia, cardiac arrest. So staffing is crucial.
Couric notes that Mason refers to nurses as the "surveillance system in the hospital."
Diana: Yes, and most people don't have a clue about this. So while I'm in the room with you, I'm looking at what is the color of your skin, are you getting pale, how is your breathing, are you tense with pain or with anxiety, so I'm looking at are you stable, or are you doing what we call going down the tubes. Are you starting to really deteriorate? And if I don't intervene quickly, you're in trouble. So if I have too many patients, I'm not in your room very much, and so that's why staffing is so crucial.
Couric wonders if asking where the nurse is will not cause a patient to be considered "a pain."
Mason: Well, a good hospital should have a nurse walking into your room on every shift and introducing himself or herself, and saying I'm your nurse, how are you doing, and let's talk about what the goals are for your care on this shift. So, you're going home today, so we need to make sure you know how to care for this wound, or you had surgery yesterday and we got you up out of the chair, but we must walk you today or else you're going to get serious complications.
Finally, Couric asks about the nursing shortage, which she notes is not as severe as it once was, but is predicted to be worsen in the future.
Mason: It will be [worse in the future]. We don't have a problem right now. We have more applicants than we have positions for. [Katie wonders if that is because it's steady work.] I think as Carolyn's film shows, nursing is really meaningful, important work and people who, we have people with degrees in other fields like banking and business and architects, who've decided, I want to do something more meaningful with my life, and they are going into nursing. And they can become a nurse in about a year and a half or a little bit more. And these programs are proliferating across the country. So we have people recognizing the value of nursing care. And these nurses are ready to help transform this health care system in the direction it needs to go.
We like the strong statements about nursing as important work, not just steady work, and It's also helpful to stress that nursing is attracting new entrants from respected fields. We do note that the shortage question might also have been an opportunity to link back to the staffing issues mentioned earlier, which are also, in effect, a shortage of nursing, albeit one that results from conscious decisions by hospitals. In addition, we are always a little uneasy with unqualified praise for the streamlining of nursing education, which is not something that would be seen as an obvious good thing for other professions like medicine and law. Recent proposals to streamline those professions' educational tracks have been controversial, because people worry that perhaps such difficult, responsible work requires the full traditional course of training. Nursing education should be evaluated the same way. In fact, many of the streamlined nursing programs actually involve four traditional semesters of nursing taught in consecutive summer, fall, spring, and summer semesters, taking less time on the calendar but as much time in the classroom. Unfortunately, we rarely see that explained to the wider public.
On the whole, it is Mason's relatively short appearance that tells viewers key things about nursing that they really need to hear and do not already know. We thank all involved.
Educate the world that nurses save lives!
