Landmark JAMA study finds nurses to be autonomous, skilled; nation reels
April 1, 2005 -- Registered nurses are autonomous professionals with years of college-level training, and their clinical skills are critical to patient outcomes, according to researchers writing in this week's Journal of the American Medical Association. The massive study "Nursing: Who Knew?" was based on extensive research by physicians at the Harvard and Johns Hopkins medical schools.
For the "Who Knew?" project, physicians did field work in hospital locations ranging from so-called "nurses' stations" to the more rarely seen "patients' rooms." They also conducted the first detailed interviews with the recently discovered "nursing scholars" and "nurse practitioners." Among the key findings were that nursing was a distinct science, that many nurses had graduate degrees in nursing, that most nurses had no particular wish to be or to date physicians, and that nurses performed critical health tasks long thought to be the sole province of physicians.
In perhaps the study's most shocking conclusion, researchers found that hospital nurses did not serve or report to physicians, but to nurse managers in a separate line of command reaching to hospital leadership. "That was the killer," admitted principal investigator Jeffrey Kimbrow, M.D., reached at his Cambridge office, echoing the comments of physicians nationwide. "We had to run the data over and over, because no one could believe it."
"Nursing leaders"--whose very existence was only a theory prior to the study--said yesterday that they were not surprised by the findings. Some said nurses had long reconciled themselves to working in a kind of parallel universe functionally invisible to the rest of society. "Even we had pretty much given up on the idea that what people thought about us could have anything to do with reality," said Johns Hopkins nursing professor Susan Briscoe, R.N., Ph.D., who according to an appendix to the study is one of some 10,000 U.S. nurses who actually have doctorates in nursing. "Most of us just did our work and played along, wearing those patterned scrubs or whatever."
Leaders in virtually all sectors of society reacted to news of the study with astonishment and calls for urgent action. In Congress, leaders of both major parties promised televised hearings, expanded public sector care reimbursement, and a "nurse reinvestment" package of $50 billion, including massive demonstration projects they noted would probably work best in their home states. In response, hospitals vowed to increase nurse staffing and resources. One executive, insisting on anonymity, said: "Honestly, we had no clue what nurses did. The consultants told us we could probably use monkeys; we were actually looking at some pilot projects." Insurance industry representatives were unavailable for comment.
The White House directed Health and Human Services Secretary Mike Leavitt to evaluate the study and make timely recommendations, suggesting that the critical nursing shortage could severely impair the health of the nation's rapidly aging population. "We'll get to the bottom of this," vowed Leavitt, "and when we do, we'll know to what extent it was caused by wasteful Medicaid spending, and whether private health accounts are a key part of the solution."
Meanwhile, the Department of Homeland Security was asked to assess the national security implications of what appeared to be a critical failure of domestic intelligence. According to the study, huge numbers of nurses would be needed on the front lines to care for victims of any potential mass-casualty event--even if physicians were also there. "We knew nurses played some role, we'd heard increasing chatter linking them to patients and patient-related activities," said Secretary Michael Chertoff. "But essential to victim survival? Get out."
The nation's mass media confronted chaos. Editors and reporters at The New York Times, TIME magazine and other leading periodicals were frantically trying to adjust their reporting plans and priorities. "We're going to have to junk the whole thing and start over," said one editor, referring to a planned special issue on "health care" that had devoted every major article to the work of physicians and not used the word "nurse" once. By the end of the day, the lead headline on The Drudge Report's web site read: "Behind killer nurse deception: Al-Qaeda or Clintons?"
The major television networks planned to devote prime time specials to the study, which was dominating cable news channels. Talk show hosts pummeled guests with questions about the invisibility of nursing. Fox's Bill O'Reilly introduced a panel of "supposedly feminist" politicians and media leaders, then grilled them about their long-time failure to champion the cause of nurses, often meeting with little more than stunned silence from the panel, especially when he told guests to "shut up." David Letterman's "Late Show" on CBS ran a list of the "Top Ten Other Things You Didn't Know Nurses Were Doing" that included "colonizing Mars" and "taking care of that global warming deal."
Popular Hollywood dramas faced hard choices about how to salvage plotlines that the nation now knew to be ugly fantasies. Shonda Rhimes, executive producer of ABC’s new "Grey’s Anatomy," talked about having smart, tough, hot nurse characters save lives and then get busy in between shifts, in order to counter ideas the public had gotten "from somewhere" that nurses were "just a bunch of carping, servile crones." The makers of "House" released an upcoming "House-ism" on the Fox web site: "Why should we listen to little Nurse Betty here? Just because her holistic care model saves more lives in a week than our self-indulgent, pseudo-intellectual obsession with obscure diagnoses will in a year?" And though NBC's "ER" did not return calls seeking comment, one industry observer noted that "after showing physicians doing about 250 defibrillations that nurses would have done in real life, you better believe [lead producer John] Wells is embarrassed. Look for at least one of the ER docs to get fed up and hit nursing school."
Reactions on the street generally ranged from shock to can-do optimism that things could be made right. A man entering a fast food restaurant in Des Moines, asked to comment on the study, just shook his head and muttered, "First the Berlin Wall, now this." The news appeared to be simply too much for some. "Get away from me," snapped a well-dressed young man on Wall Street. "Nurses are whatever I say they are."
But one woman outside a Dallas office building was beaming as she made her way home to talk to her son, a college freshman wrestling with potential career options. "This is just the kind of work he'd be perfect for," she marveled. "Thank God it's not too late."
Warning. The above is a satire.
We hope that you have enjoyed our April Fool's Day satire. For clarity, nurses are autonomous and skilled, but the reality is that few other people besides nurses know this and it is severely affecting our ability to resolve the nursing crisis.