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The nurses' station in life

March 10, 2005 -- Today NPR's Morning Edition broadcast the end of science correspondent Joseph Shapiro's extensive three-part report on the care and recovery of two U.S. Marines recently wounded in the Iraq war. The report, part of NPR's "Span of War" series, is a striking example of what we might call the "nurses' station" school of health care journalism. The report consists of more than 26 minutes of coverage of the Marines' care, from their wounding by Falluja insurgents through their lengthy stateside hospital rehabilitation, amounting to a virtual audio documentary. Listeners hear plenty about how "doctors" have been caring for the Marines, and even some good discussion of the work of their physical therapists. But no nursing is described, no nurses are mentioned or quoted, and the only utterance of the word "nurse" occurs in the second piece when one patient walks past "the nurses' station" at Bethesda Naval Hospital.

The series, broadcast March 8-10, follows Marine Sgt. Brad Kasal and Lance Cpl. Alex Nicoll from the time they are badly wounded by insurgents during a house-to-house search in Falluja through their arduous, ongoing rehabilitations at Bethesda and Walter Reade Army Hospital in DC. Among its themes are the lower mortality rate made possible by improvements in battlefield technology and post-battlefield care, and the corresponding increase in wounded survivors, including amputees, who must work to overcome their severe injuries. Nicoll has lost part of his leg, and Kasal is battling through an extraordinary number of operations and limb lengthening in an effort to keep his. On the whole, the piece is a dramatic and compelling look at the experiences of these two courageous men, who project an almost surreally good attitude about their injuries and future outlook. Some might question whether such a relentlessly positive vision is fully representative of such wounded soldiers, but we have no reason to doubt what the story is describing.

The problem is that the piece never says a thing about nursing. We hear that "doctors" are caring for the men, "doctors" are pushing the frontiers of medicine, "doctors" are trying to save Kasal's leg. Audio clips from the Marines include references only to the "doctors." Kasal's orthopedic surgeon appears in audio clips to discuss aspects of his condition, what is being done to address it, and larger trends in treating injured soldiers in the Iraq war. No nurses are consulted or described, none appears in audio clips, and the only time the word "nurse" even appears in the entire report is the "nurses' station" reference above. However, nurses would be central to the care and recovery of these men at every stage, and especially during their lengthy stateside hospital stays. Are we to believe nurses played no role in the post-battlefield wound cleaning one Marine describes, or in the daily efforts to regain functionality in the hospital? Do nurses play no significant role in the recovery of an amputee, or a man who has had many operations?

Ironically, the third part of the report does include a fairly good treatment of Nicoll's physical therapy at Walter Read, naming and including significant audio clips from two (possibly three) physical therapists, who have a chance to show their expertise. There is also a short clip featuring the person who made Nicoll's prosthetic leg. This shows that those responsible for the report can conceive of important health care professionals other than physicians. However, they have completely missed the profession that coordinates care from physicians, physical therapists, and others: nursing.

The complete failure to acknowledge the nursing role--maybe forgivable in a 30-second item--is a huge flaw in this 26-minute report, and it does a disservice to the nursing profession at a time of critical shortage. NPR is one of the nation's more serious professional news organizations, but Garry Trudeau's "Doonesbury" in 2004 presented a more balanced overall vision of the recovery of such badly wounded soldiers, in strips that included nurses, physicians and therapists. On the whole, this piece is yet another example of influential mainstream media products that reinforce the mistaken and increasingly dangerous public view that nurses are of little significance in modern health care.

Listen to Joseph Shapiro's pieces: Part I: "Caring for the Wounded: The Story of Two Marines", Part II: "A Soldier's Story of Recovery" and Part III: "Soldier Adapts to Life With Prosthetic Limb."

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