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The deadly virtues

September 5, 2006 -- Today the Liberty Times (Taiwan) ran an unsigned piece about a young nurse at Taichung Hospital. The piece reports that Chuan Ya-lan is an unusually devoted, patient, and hard-working nurse. We appreciate the effort to highlight the value of Chuan's work. Unfortunately, the piece focuses heavily on what Suzanne Gordon has termed the "virtue script," rather than on tangible ways in which nurses improve patient outcomes. And the virtue script--which asks nurses to endure unendurable working conditions without protest--is a factor in the life-threatening nursing shortage.

The piece notes that the 24-year-old Chuan, who is "of the Bunun indigenous tribe," "has become lauded by the Taichung Hospital as an angel for her service." While Chuan was a student at National Taipei College of Nursing, she earned extra money to support her family by working part time "providing extra service to patients." The head of nursing at Taichung Hospital, Chang Li-hui, reportedly says that the hospital hired Chuan, despite reluctance to take a nurse right out of school, because of the "devotion" the hospital had noted in other "aboriginal nurses." The hospital was "not disappointed," because Chuan "exhibits an extraordinary degree of patience with the patients, and everyone comments how nice she is." Indeed, Chuan is reportedly "a model in terms of having the compassion and expertise required of a nurse." Chang Li-hui also notes that many new graduates are unable to cope with the "heavy workload and stress" of handling at least eight patients at a time, and most "resign after a relatively short period." But Chuan has "never complained about the workload." On the contrary, the piece notes that earlier this year, she took it upon herself to provide additional care to an elderly stroke patient outside of her normal work hours, changing the patient's dressings, feeding her, and helping to bathe her.

This piece certainly offer a positive view of Chuan. Of course, devotion, patience and hard work are important qualities in a nurse. The piece also notes that Chuan went to college, and it refers to her "expertise." However, it focuses almost entirely on "angel" qualities, particular Chuan's willingness to do extra work without pay, and on tasks that few readers will realize require much "expertise." That may send the message to decision-makers and career seekers that nurses are in fact relatively unskilled spiritual beings who can be expected to make inhuman sacrifices, and whose work is praiseworthy but optional. This traditional "virtue script" suggests that nursing is less of a modern profession than it is a vocation for "nice" females.

One might see Chuan's willingness to assume an enormous patient load without complaint as an example of laudable devotion. However, one might also see it as a symptom of a profession that is too weak to stand up for its own needs and that of its patients. A nurse may be able to endure a patient load of eight or more, but his patients cannot. When a nurse has 8 patients instead of 4, one study found, his patients suffer a 31% increase in mortality. Many would argue that it is very difficult to give high quality nursing care in such circumstances. That care includes the tangible, life-saving nursing care that this piece says nothing about, such as catching medication errors, avoiding serious post-op complications, and providing meaningful input to other health workers. The piece does not discuss what happens to the majority of new nurses who soon resign under these conditions, or whether anyone sees that high attrition as a problem that should be addressed in the interests of patient care. Research also shows that nurses with 8 patients burn out and leave the profession more than twice as often as nurses with 4 patients.

We thank the Liberty Times for its coverage of the important work of nurses. But we hope future pieces will better reflect the profession's importance in patient outcomes, as well as the need for adequate nurse staffing.

See the article "Young nurse at Taichung Hospital cares for patients" in the September 5, 2006 edition of the Liberty Times.



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