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Software operates as journalist!

June 17, 2005 -- Today the New York Daily News ran a piece by Robert Schapiro about a new software program that "operates as a journalist" by taking press releases and turning them into instant news stories...oh, we're sorry, that's absurd, isn't it? No major metropolitan newspaper would suggest that some piece of technology could perform the broad range of high-level, judgment-intensive human tasks involved in professional journalism. No, Mr. Schapiro's piece actually reported that the surgical robot Penelope had "operat[ed] as a surgical nurse" in a routine operation at New York-Presbyterian Hospital the day before. Despite at least making clear that the robot is "not meant to replace" scrub nurses, the piece still suggests that Penelope is pretty much doing their job by handing surgeons instruments. That is wrong. OR nurses perform a wide range of critical surgical functions that require advanced scientific training, including monitoring surgical practice, sterile technique, and the patient's condition, intervening in the case of an emergency, and advocating for the patient generally. Nurses use critical thinking to save lives.

The piece, headlined "Hard-wired nurse helps docs," flatly states that Penelope "operates as a surgical nurse." This appears to be based on the robot's ability to hand surgeons instruments "on command," then put them back. In the procedure, Penelope's first, the robot handed over instruments 37 times in an operation to remove a benign tumor from a woman's forearm. The piece notes that this was the first time a robot "took commands and independently performed actions based on a surgeon's instruction." However, the piece stresses that "[s]crub nurses have nothing to fear" because the robot "is not meant to replace them," but to "allow nurses to spend more time tending to patients' needs." The nurse who "assisted" in the surgery is quoted as saying Penelope was "like my best friend." Though the piece does not say so, Penelope is actually the creation of a team headed by surgeon Michael Treat, as described in a much lengthier piece by Marc Santora in the New York Times in January 2005.

The fact that Penelope can perform one task of the scrub nurse does not mean that she is "operating as" a nurse. The piece does stress that Penelope is not meant to replace OR nurses, and in this way it is an improvement over the earlier Times story, which included comments from Dr. Treat to that effect. The Center had extensive discussions with Dr. Treat about this in January, and we note with approval that, at least based on this Daily News piece, the "not meant to replace nurses" idea is now evidently a part of the product's promotional theme. However, other elements of the piece do little to counter the impression most readers will get from the headline and the "operating as" statement that Penelope is doing a nurse's whole job, or at least the part that matters. The "best friend" quote makes it sound like the nurse and Penelope are peers, and the statement about freeing scrub nurses to "tend" to patients' needs fails to convey that the nurses are doing anything of clinical importance. All of this combined with the robot's operation under the "command" of the surgeon also reinforces the prevailing but inaccurate impression that OR nurses report to surgeons.

Scrub nurses do manage the access of surgeons and other OR professionals to surgical tools, and Penelope may be able to assist with some of the more mechanical OR tasks. This kind of technology could provide real benefits, in part by preventing items from being left behind in patients, thereby saving lives and money. But scrub nurses in fact perform a variety of other critical functions. They monitor sterile technique, ensure that the sterile field is preserved, make sure all needed materials are available, ensure that the surgeon is doing the right procedure in the right place in the right way, ensure that patients get the proper medications and solutions at the surgical site, intervene when the surgeon is not up to the task for any reason (common ones include incompetence and intoxication), provide emergency nursing care if the patient crashes (e.g. cardiac arrest), assess the patient generally, intervene or recommend intervention for problems identified, and advocate for the patient generally. The OR circulating nurse, who--as the name implies--circulates in the room and oversees the nursing process, is not in a position to do much of this, as only the scrub nurse remains right at the patient's side. Critical thinking is what underlies many of these nursing tasks, and it is not clear to us that Penelope is equipped to do that. Nor does it appear that Dr. Treat's team is making any effort to enable the robot to talk. But OR nurses' skilled patient advocacy saves countless patients' lives. More information about the important work of OR nurses is available from the Association of periOperative Registered Nurses.

Mr. Schapiro and the Daily News owe nurses an apology for giving readers the impression that the only significant thing scrub nurses do is hand surgeons instruments.

Please send Robert Schapiro an email and educate him about the role of scrubs nurses and please blind carbon copy (bcc) us on your email so that we can follow your letters. Thank you!

See the article "Hard-wired nurse helps docs" by Schapiro in the June 17, 2005 edition of the New York Daily News.

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