Your Aspiring National Nurse

May 20, 2005 -- Today The New York Times published an op-ed by Oregon nurse Teri Mills arguing that the United States should address the nursing shortage by "dethron[ing] the surgeon general and appoint[ing] a National Nurse." The basic idea is that while the nation's "head doctor" has failed to connect with the public, nursing's focus on preventative care and patient education would enable the National Nurse both to teach the nation about health and to highlight the daily achievements of nursing. Despite its somewhat half-baked quality and a few other problems, the op-ed is a punchy piece of patient and nursing advocacy with some good, common-sense ideas to improve public health. We salute Ms. Mills for writing the op-ed and The Times for publishing it (however serious its intent in doing so may be). Oh, we almost forgot--though the op-ed fails to mention it, Ms. Mills is a vocal supporter of 2004 presidential candidate and current DNC Chair Howard Dean who has promoted herself in the blogosphere as "your aspiring National Nurse" since at least 2003. Is that a kooky coincidence or what?

Ms. Mills' high concept op-ed, headlined "America's Nurse," begins by noting that although nothing has really happened as a result of Nurses Week, we could make a real difference for nursing through her brash nurse-for-physician switch. She argues that the surgeon general has been "all but invisible." She notes that few if any supermarket shoppers could name the current one (Richard Carmona), and decries the physician's "inability to connect with Americans." Nurses, by contrast, would be great at educating the public about health, because a recent poll shows that they are considered the "most ethical and honest professionals." It is the nurse "whom the patient trusts to explain the treatment ordered by the doctor," and the nurse who teaches people how to care for newborns as well as dying loved ones. In particular, Mills suggests, the Office of the National Nurse could promote prevention through 15-minute weekly broadcasts, decrease dependence on the expensive treatment system, establish a National Nurse Corps to promote health at the community level, and "give public recognition to the valuable work that nurses perform each day," which could help stem the shortage by attracting people to the profession. Mills admits that the National Nurse would not become a household name overnight, and that this idea would not solve all our health problems. But she argues that it would certainly help, and closes as follows: "America has a history of honoring great nurses--from Clara Barton to Susie Walking Bear Yellowtail. Isn't it time we did so again?"

Yes, it is. And we are enthusiastic about Ms. Mills' specific ideas as to what a National Nurse might do. Patient education is a major focus of nursing, and nurses are highly qualified to explain critical health care matters to patients in language they can understand. Some talented nurses, including Pat Carroll and Donna Cardillo, have been doing just this kind of thing very effectively through the mass media for some time. Ms. Mills' ability to get this op-ed published in The New York Times suggests that she herself also has a flair for public communication on key health issues. In particular, we would be excited about any major shift toward a more holistic, nurse-oriented preventative focus in the nation's approach to public health. And of course we would support any serious effort by the federal government to tell the public what the nation's 2.3 million practicing registered nurses actually do to save lives and improve outcomes, which could help the profession gain the clinical and other resources it so desperately needs.

We're not sure it was necessary to call for the "dethroning" of the surgeon general. It's not clear if Ms. Mills means this only figuratively, or if she means to actually eliminate the position. Some holders of the office (such as Everett Koop) have connected with the public at least to some extent, and we suspect that even a National Nurse might discover significant cultural and economic barriers to becoming a household name as a U.S. public health figure. Moreover, health education is only one of the surgeon general's main tasks. Others include managing the 6,000 member Public Health Service Commissioned Corps, providing health policy analysis to the President and the Secretary of Health and Human Services (HHS), and representing HHS in its dealings with various other governmental agencies. Would the National Nurse assume all of these responsibilities as well as his increased public education projects? Would it make sense to start by having the National Nurse assume the surgeon general's current patient education duties, and perhaps others? Could both offices work together? Or should the job of "surgeon general" simply be opened to the most qualified health care worker, which would often be a nurse, perhaps with a title change to underline the shift? Perhaps the National Health Coordinator--the health czar? The op-ed does not confront these issues. Ironically, Richard Carmona actually is a nurse and a physician, though it's not clear if Ms. Mills is aware of it. So how does Ms. Mills explain his alleged inability to connect with people? Perhaps he has practiced too briefly as a nurse, and too long as a physician?

We have a few other concerns. It seems to us that nurses are uniquely placed to educate primarily because of their skills and experience, and not so much because they are "honest" and "trusted." Nursing skill is a result of education, effort and experience, rather than virtue. In any case, Ms. Mills cites no evidence that people do not trust the surgeon general. Some might read the statement about explaining the treatment "ordered" by physicians to mean that all nurses' patient education involves translating what physicians do or say. In fact, though nurses certainly do play that critical role, their education goes beyond that into areas about which physicians know little. Moreover, the use of the word "order" is a dangerous misnomer; nurses implement physician care plans to the extent they are consistent with patients' interests, and their legal and ethical duties require them to resist plans that are not. In addition, we are less sure that the United States has a "history of honoring great nurses," though that certainly has a nice ring to it. We wonder if the two nurses Ms. Mills names would generate any greater supermarket recognition than Dr. Carmona. Finally, the piece has the same problem we see far too often when nurses do manage to make it into the mass media: "Teri Mills" is identified only as someone who "teaches nursing at Portland Community College"--no credentials, no degrees, no title. Would a physician ever be identified this way? In fact, we understand that Ms. Mills is an Adult Nurse Practitioner with a master's degree in nursing who has been a nurse for over 30 years. But given the public's lack of knowledge of how nurses are trained, it's not even clear how many readers will understand from the Times' description that she is a nurse. It might have said something like this: "Teri Mills, RN, MSN, is an adult nurse practitioner who teaches nursing at Portland Community College."

Is the New York Times laughing at Ms. Mills and her silly ideas? Maybe. We don't care. Nursing needs to find its public voice, and Ms. Mills' op-ed is a piece of patient advocacy that also raises nursing issues in a provocative, engaging way. And we think that's worth a big long SCREAM.

See the op-ed "America's Nurse" by Teri Mills in the May 20, 2005 edition of the New York Times.