Silly nurses! Your killer short-staffing isn't news. It's a chance to leave the bedside for legal consulting!

September 4, 2006 -- A short piece by Vickie Milazzo, RN, MSN, JD, appeared on August 21, 2006 on the American Chronicle site and elsewhere. The piece is "Why Are Nurses Leaving Clinical Nursing? Not Because of ER!" It rejects the Center's view that popular Hollywood shows are contributing to the nursing shortage. Milazzo, who is described as an "Inc. Top 10 Entrepreneur," argues that nurses' working conditions are so bad that nurses would be leaving the bedside regardless of what "ER" did. She notes that nurses are "understaffed, underappreciated, underinsured, underpaid and under-you-name-it." Milazzo does not ask why any of this has come about, or whether society's lack of respect for nurses might have anything to do with the information it gets about nursing. Instead, she reports with evident approval that nurses are "finding their own answers" to these problems. Those answers do not appear to involve saving bedside practice, but gladly leaving it to "develop new careers." Milazzo suggests that the Center ask "ER" to do a truly realistic episode about a "nurse who quits her hospital job to become a Certified Legal Nurse Consultant." Coincidentally, the training and certification of legal nurse consultants is the business of the Vickie Milazzo Institute. Today, Milazzo's entry in National Public Radio's "This I Believe" series made her lack of regard for bedside nursing even more clear. In this piece Milazzo describes how she escaped the bedside by overcoming her own "fear of becoming like the other no-risk nurses--tired, burned out and old before their time." Milazzo presents her shift from the bedside to legal consulting as a personal triumph, and she directly links nursing with soul-killing failure.

In her August 21 American Chronicle piece, Milazzo attacks the Center's "ER" campaign, noting that it started a "couple of years ago." In fact, it was close to three years, which Milazzo should know, since this op-ed is largely recycled from one she published in several newspapers in late 2003, following the widespread publicity the Center's campaign then received. Of course, "ER" is not the force it once was. Today, "Grey's Anatomy" and "House"--which combine massive popularity with an atrocious vision of nursing--are the main focus of the Center's concern about Hollywood. Perhaps writing about them would have required too much revision of Milazzo's three-year-old piece. But it might have saved her from stating that "ER" gets 20 million (U.S.) viewers, which was true in 2003, but hasn't been for quite some time.

Milazzo reports that we started a letter-writing campaign against "ER" in protest of the episode in which nurse character Abby Lockhart quit nursing for medicine. She notes that the Center "claims the TV show 'is perpetuating long-standing misrepresentations that are contributing to the nursing shortage.'" Milazzo argues that the show is "far from reality television," and that the "notion" that it's contributing to the nursing shortage is "simply untrue," since it "could depict nursing as the most glamorous career on the planet and real nurses would still be leaving their hospital jobs in droves."

Milazzo goes on to revel in just how awful things are at the bedside, noting that "[n]urses are quitting because they are understaffed, underappreciated, underinsured, underpaid and under-you-name-it." She says most nurses complain about inadequate respect from physicians, they're still "among the lowest-paid professionals in this country," managed care frequently "denie[s them] the opportunity to deliver the quality of care they expect to deliver," and as a result, "[s]ome patients die unnecessarily." "Yet when everything turns sour, nurses face more reasonability and liability than ever."

But don't rush off to nursing school yet--there's more! Many nurses Milazzo knows "endure nightmarish schedules, working 26 weekends and five holidays a year." They face workplace risks including "bloodborne pathogens, latex allergies and back injuries from those long shifts pounding hospital floors and doing more lifting with less help." Milazzo also invites readers to "look around at how many nurses smoke, drink and are overweight. Such symptoms of intense stress occur when people have too little time to properly care even for themselves."

Milazzo says nurses are "finding their own answers to these dilemmas," with recent research showing that almost one fifth of nurses do not work in clinical settings, and that 20% of nurses plan to leave their jobs in the next year. (Presumably this data is also three or more years out of date.) Milazzo argues that the significant development is not the fact that nurses are leaving the bedside, or even why they're leaving, because that's "obvious." Instead, the "news is where they are going." Because nurses are not valued in clinical settings, they're taking their "nursing education and expertise" and "develop[ing] new careers outside traditional healthcare settings." Milazzo invites the Center to "contemplate that fact," and perhaps "even [to] suggest that ER present an episode about a nurse who quits her hospital job to become a Certified Legal Nurse Consultant. Then those 20 million ER fans would really be watching 'reality TV.'"

One notable problem with Milazzo's piece is her confident assertion that "ER" (and presumably the rest of Hollywood's programming) plays no role whatsoever in the nursing shortage. Of course "ER" alone did not cause the shortage, nor would an improvement in the show resolve it. But to suggest that the impression of nursing we get from the media plays no role in how nursing is treated defies both research and common sense. Milazzo cites no research, but a 2000 JWT Communications study showed that youngsters got their most striking impression of nursing from "ER." Public health research shows that entertainment programming affects the way people think and act in health care matters, and the social attitudes toward nursing that the media drives are a major force in the litany of ills Milazzo describes. Hollywood itself has been glad to agree that it has changed the world, when someone wants to give it an award for doing so. To argue that the media doesn't hurt nursing because the real problem is poor working conditions is liking arguing that cigarettes don't kill people because the real problem is cancer. Why does Milazzo think nurses are "underappreciated?" Is that an immutable law of nature? Ironically, the notion that the media has no significant effect on public actions is contradicted by Milazzo's own relentless efforts to promote her business in media pieces like this one.

But what's even more striking about Milazzo's piece is the apparent lack of concern about the fate of bedside nursing and the patients who rely on it. Milazzo has done a good job of identifying many of the major issues bedside nurses face. And we've seen many pieces about the travails of modern nursing. But we can't recall a piece that went to this much trouble to show how awful bedside nursing is now without suggesting that there was anything left to be said for it, or offering a single idea for how the problems might be addressed. Apparently, the only thing nurses need to worry about is how quickly they can leave the bedside and pursue new opportunities, preferably as legal nurse consultants. If nurses heed this advice, not only will Milazzo and other trainers make more money immediately, but the entire legal consulting industry will explode, as fewer bedside nurses will probably mean more malpractice claims. Of course, there's all that extra death and suffering, and the nagging question of who will take care of us when we're ill. However, maybe that's just a concern for backwards types like the Center and Suzanne Gordon, whose Nursing Against the Odds had some strong words for nursing consultants who've pushed the idea that managed care is really a great vehicle for nurses to expand their horizons. We wouldn't blame any nurse for leaving the bedside under today's conditions. But to effectively suggest that the "willing nurse shortage" is of no consequence and that nurses should cheerfully bail out without a backward glance is irresponsible.

Milazzo does have one interesting idea, and that is that the Center advise "ER" to consider a plotline about a legal nurse consultant. A plot about a consultant trying to lure nurses away from the bedside by trashing every aspect of their work, while dismissing the idea that the shortage matters at all, could certainly make for good drama. And some people might even learn something.

Today, NPR aired Milazzo's entry in its weekly "This I Believe" series. This series presents personal declarations from various people and is based on a 1950's radio show hosted by the legendary Edward R. Murrow. Milazzo's "Stepping Out of Fear" segment is basically a story of how she has struggled to master the fears that have held her back in life. These apparently started in childhood. One year, she had to forego scrumptious Halloween candy because she could not bring herself to climb a flight of stairs to the house doling it out. Milazzo suggests that, in line with this childhood trauma, she grew up lacking confidence, which led to her choice of nursing:

The fear of stepping out took me along the safe, no-risk route through high school, nursing school and into a secure hospital job. After six years in nursing, unsatisfied with the career choice I had made, I woke up to a different kind of fear: The fear of becoming like the other no-risk nurses -- tired, burned out and old before their time. I faced a decision: Step out into the unknown or spend the rest of my life at the bottom of those steps, never tasting the best candy.

But Milazzo gritted her teeth and went into a lucrative business that evidently does feature "the best candy": advising lawyers about malpractice claims. Milazzo presents this as a heroic leap into success, and she wastes no time wondering why those "no-risk nurses" are such losers, concluding:

Success is not about the achievement. Every time I step out into the unknown, win or lose, I succeed. I might break a leg or invest in a losing business idea, but I won't end up at my 90th birthday with nothing more than stale white cake and regrets. Bad things can happen when we step out, but I believe worse things happen to our souls when we don't.

So nursing is not just the wrong career choice for Milazzo, but the wrong choice for anyone with drive or self-respect, anyone who wants to "succeed" in life. It does not appear to have occurred to Milazzo that nursing is itself a tremendous venture into the unknown. No one who has practiced hospital nursing in the last decade and paid attention could describe the work as "safe" or "no-risk." As for the thrill of the unknown, nurses create health innovations that change the world and improve countless lives, from primary care to forensics. All over the world, nurses take their lives into their hands every day in order to save the lives of others. We are less concerned about the souls of these nurses than we are about people who seem to care only about themselves.

See Vickie Milazzo's piece "Why Are Nurses Leaving Clinical Nursing? Not Because of ER!" in the August 21, 2006, edition of the American Chronicle.

Listen to Vickie Milazzo's This I Believe segment "Stepping Out of Fear" which aired on September 4, 2006, on National Public Radio in the U.S.

Feel free to email your thoughts on the nursing image to Vickie Milazzo at articles@legalnurse.com and please copy us at letters@truthaboutnursing.org. Thank you!