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The Commander

October 25, 2007 -- This week's issue of TIME magazine included a short but fairly good profile of U.S. Navy Commander Maureen Pennington, the "first nurse to lead a surgical company during combat operations." Caroline Kennedy's "Beyond the Call of Duty" does not directly discuss Pennington's nursing skills or background. It does feature a lot of vague helping imagery, and apparently even a portrait of a military nurse would not be complete without discussion of her being "like a mom" to the soldiers. Still, the piece highlights Pennington's leadership, communication, and cross-cultural skills. The field hospitals she led in her 2006 tour in Iraq had an "unprecedented" 98% survival rate. We thank Ms. Kennedy and TIME for this generally helpful profile of a nursing leader.

The piece appears to be part of a series of profiles in courage called "The Power of One." It refers to Pennington as "one of the nurses and doctors who are putting their lives at risk to tend the wounded" in the war in Iraq. It says she earned the Bronze Star following her eight-month 2006 tour in part "for attaining an unprecedented 98% survival rate for her patients, many of whom were victims of severe blast wounds." Pennington was the commanding officer of three field hospitals "just behind the front lines in Fallujah, Ramadi and Taqaddum." There she was 

responsible for overseeing the treatment of mass casualties coming through the door of the surgical units, day or night, including U.S. Marines and Iraqi soldiers, civilians and insurgents; and transporting the most severely wounded on emergency helicopter flights in complete darkness to avoid enemy fire, all while maintaining the safety and morale of medical personnel under frequent attack.

The piece notes that on October 23 Commander Pennington received a Minerva Award, honoring California women who have displayed great "courage, strength and wisdom," at the "California Governor and First Lady's Conference on Women." The profile even includes some specific things Pennington did in Iraq, though it describes them as "small things that can make a big difference." The examples the piece offers are creating a special area where Marines could be near injured comrades and get regular updates, and washing the blood off transport vehicles so that soldiers would be spared that disturbing reminder of their friends' wounds. 

Unfortunately, the piece also includes a lot of the vague helping imagery that often dominates stories about nurses. The piece notes that Pennington, who has two decades of active duty, "offers living testimony to the difference one individual can make by building a career out of serving the needs of others." Pennington "credits her leadership skills to the inspiration she receives from others and her desire to give something back." She explains:

It wasn't always easy to balance a military career and raising a family. But I have always tried to do something for someone else every day. People inspire you, and you inspire them, and after 21 years I can look back and say, "Things are better because I cared. I know I made a difference."

Of course, that's all fine as a personal statement. But we have to say that in the context of a piece about a nursing leader, the familiar focus on inspiring, caring, giving back, and making a difference reinforces the prevailing sense that nursing is all about unskilled helping, rather than science and improving patient outcomes. We wouldn't ask Pennington to change how she accounts for where she is in life, but it's our job to analyze the likely effect on readers. And unlike professionals like physicians, for example, nurses cannot assume that when they focus on caring and inspiring in discussing their work, people will still understand that their work involves advanced technical skills.

The piece also quotes a physician's assistant who served with Pennington as saying the more intense the casualties became, "the calmer Maureen became." That's good, but this PA also says Pennington "was also like a mom to all of us. She was not afraid to give someone a hug when they needed it." However, nursing has long endured the stereotype that its practitioners are professional mothers. The piece does suggest that Pennington's status as a mother was actually the source of her toughness. She says she understands the Marines because they are the same age as her 26-year-old son, and 

being a mother, I know you also have to be willing to be hated in order to be loved. I knew it was up to me to make sure that there were rules and structures in place because people need those too when the world is falling apart.

Of course parenting involves many transferable skills. But even a tough, skilled mother does not necessarily have advanced science training, and it would be much better to say that Pennington was a "senior nurse to all of us," providing vital emotional support to the wounded and health care staff alike. Nursing does not benefit by being confused with motherhood, and this is particularly the case when it comes to the vital task of attracting more men to the profession. In fact, though we hear a lot about what kind of mom Pennington was, there seems to be no space for even a short note about her educational background. In fact, she has Bachelor's and Master's degrees in nursing.

The piece explains that Pennington is proud of having cared for wounded Iraqi soldiers and civilians, including children. She sees this as a key part of the U.S. effort in Iraq: "If you care for someone's children, they will love you." Pennington's current military supervisor in San Diego "attributes her success to her ability to communicate across cultures--military, medical or ethnic." These parts of the piece suggest advanced interpersonal skills, and it would have been even better had the article explicitly recognized that as part of the work of nursing. Indeed, because the piece never directly links Pennington's achievements, such as the survival rate, to her nursing skill, many readers may assume that she is a good leader who happens to be a nurse, rather than someone whose success derives at least in part from her nursing skills.

Despite these problems, we thank Ms. Kennedy and TIME  for showing readers what nurses can achieve.

See the article "The Power of One: Beyond the Call of Duty" by Caroline Kennedy in the October 25, 2007 edition of TIME.

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