I have been intrigued lately with what nurses are saying in public arenas and how it reflects our practices. Many nurses blog or journal about their work, and while some of it serves to accurately portray the workplace issues we face, some of it may also be damaging to our profession and our image, serving to keep us stuck and in need of emancipation versus moving us toward freedom and autonomy as a profession.
Take the following blog post, created by a nurse known only as Brownie3, which seems at first glance to portray some of the issues we face as nursing. http://brownie83.hubpages.com/hub/10-Things-Nurses-Dont-Want-You-to-Know
Despite it’s title of “10 Things Nurses Don’t Want You to Know”, the blog reflects a keen desire to begin to inform and partner with patients, creating a venue for discussing with the public what nurses do. Why is it that we would perhaps not want our patients to know our profession and our challenges better? In many ways the blog clearly reflects the face of modern nurse as somewhat distanced and harried, un-empowered, and it provides background for why we must act in a reductionistic manner with our patients; we simply have too many demands, too much stress to “perform”, and legal constraints, such as on the use of patient names. The issues with pain medication and the nurse’s desire for the patient’s to be “sincere” in their needs reads very judgmental. However, my greatest concern is that the blog fails to portray what I believe we charged with as nurses: to provide caring, non-judgmental, presence at the bedside that supports the patient’s healing journey. There is no inkling of the idea that the nurse is there to share the journey and no clue to the idea that nurses are guided in their decisions by nursing theory and evidence based practices. Of course, as one of my colleagues pointed out, this is just one person’s experience, but when the statements are broadly placed to all of nursing, it becomes a concern for all of us professionally.
The next entry I looked at this week was from an intensive care nurse who wrote the blog as a fairly new graduate nurse. Diary of an Intensive Care Nurse begins to reflect the many troublesome issues nurses face in providing care in the highly technological world of the ICU: http://nypost.com/2012/12/09/diary-of-an-intensive-care-nurse/
While Nurse McConnell makes a clear portrayal of the issues in ICU around the country, there is something lacking here. One thing missing is the use of evidence to back up some of these statements; for instance there is some great evidence out there about what harm the ICU does, but it is not included here and in some ways the personal experience, while very valuable, could be better validated with use of data. Also, there is a lack of a solution; while the nurse calls for change in ICU settings, what and how that change might be is unclear. Again, there is plenty of evidence to suggest earlier palliative care and use of hospice at end of life greatly change end of life outcomes, and many more patients are opting for these services. My thought is that perhaps the writer is not yet keenly aware that these options exist and we should be striving toward greater use of these options for all people, or incorporating some of these more holistic and caring approaches into ICU type care.
While we want all nurses to have a voice, we also need to support one another in developing the best ways to express our concerns for the profession, and our plans for creating change. One thing I think is for certain: as nurses, we all should ideally support greater levels of education for our nurses, so that every nurses understands how evidence and theory drive practice, they each grasp the ethical implications of their practices, and they all can be supported in meeting their true call to nursing. The greatest joy in our profession is in the supporting of each patient’s healing capacity across the lifespan and through the death experience.
NurseManifest 
Hi –
lighten up. it’s easy to critique, not so easy to make an actual contribution. the fact is, each of these other blogs speaks to a reality that is out there. blog writing style is not mediated by academic nurses – Thanks to God.
what is a leader? – can’t remember the source of this definition, but – a leader is a person who has followers. very simple. and those two blogs have more readers than yours does.
Merry Christmas!
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Hi, Joe, thanks for your thoughts, critical as they may be. Of course I too am glad that blogs are not mediated by academia, but my thoughts were more around the portrayal of nurses and nursing and our professional voice as related to transformation of nursing practice; though I used these two blogs as examples, my intention was to look at bigger issues we face as a profession, which I have been doing for some years now, so I am sorry if it came across to you as being critical or “heavy”.
I agree that both blogs speak to the individual perception of what is going in nursing, and I do know about the reality of what nurses face each day through both the ongoing work I do with students and hospitals and through my own experiences as both a nurse and a patient. It is wonderful that nurses are out there and writing, but as a profession we perhaps have not had a lot of strategy around how to support one another in this area. I also think we have not dialogued enough about the use of social media and blogs to advance the profession, create change, enhance leadership, and I believe these dialogues need to happen in the workplace, through our organizations, through venues like this, and in academia. This blog may be a platform for that dialogue, or not, and perhaps it will spur on some more dialogue, or not, but it has got me back to thinking about the need to delve into how our profession portrays itself in this venue.
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Personally, I think the greater concern by far is that nursing has far too much cheering in its public face.
Many of the biggest names in nursing who get the most attention love to go on and on about Magnet hospitals and university affiliated hospitals. This isn’t to say those hospitals aren’t top notch because many of them are. But there are a couple of hundred Magnet hospitals and several thousand non-Magnet hospitals and in many cases the differences are profound, criminally and lethally profound.
The truth is that nurses, in the broad spectrum, are simply not doing the things that the profession likes to think of nurses as doing. Nursing, like the general public is likely divided close to in half about the major issues affecting nursing: Should we have a national health insurer; Should undocumented aliens be cared for in ERs; Do patients deserve to all be treated the same or should nurses discriminate between the entitlements of self-pay and really good health plan patients and patients who have no ability to pay or are in managed care programs?
Nurses are divided along lines of whether patients are entitled to hear a pleasant voice, get care from a nurse that isn’t 15 hours into a 16 hour shift, and actually responds when patients ask for assistance.
Slip out of those thousands of second rate hospitals and take a walk through the tens of thousands of second rate nursing homes where 1-3 RNs may serve the needs of over 100 patients many of whom would have been in hospitals 20 years ago, in units where the patient to RN ratio was 6-8/1.
If nurses do not speak out about what is really going on in nursing: The impact of health care finance mechanisms, The paper work; The restricted access to supplies and equipment and The intentional under-staffing… how are patients going to grasp what is happening around them.
There is, of course, a dark side to being honest with patients – patients may not like what they hear. This, more than anything else is why few physicians are explaining to their patients that they, the physician, not some insurance company are choosing which tests and treatments to provide because once they signed up for managed care panels and accepted Prospective Payments from CMS, they became their patients’ insurers. If medical doctors and nurses start telling their patients the truth maybe we could cut a decade off the real reforms that are needed in nursing, health care and health care finance.
Instead, nursing often comes off as a bunch of Pollyannas – Seeing only good, reporting only the very best care they render each year, and nothing gets done about all the really inadequate care being rendered, the patients discharged prematurely, the patients whose needs have been largely ignored, the patients who were sent home from ERs and died, or the patients who die while lying on gurneys in hospital hallways, like my uncle at Bellevue in 1998. Lots of bad things happen every day and nurses do not do themselves or the profession much good when they turn a blind eye to it.
Personally I think it would be nice if TV shows stopped having cutesy episodes about how despite interference from managed care companies and insurers, the docs and nurses came through for the patient – and start having episodes that show finance people, doctors and nurses having discussions about how to get patients out of their facilities to improve the profit margin. If that started to happen maybe the American public wouldn’t continue to be as woefully ignorant about health care reform, health care finance reform and what they can expect when they are getting ill patient care – not healthy patient care.
Perhaps the greatest duty nurses owe themselves, the profession and patients is the truth.
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I encourage open and honest dialogue among nurses like we have here. And hope more nurses tell the public what we do, what we worry about in the current health care delivery model we have and what we think can improve care. We are the experts, after all, in keeping our patients healthy and safe in hospitals and also promoting a comfortable death when indicated. Keep the conversation going.
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Dear Carey and Tom: good dialog. Thank you. My own humble offering to the blog-o-sphere is http://www.joesar.wordpress.com and I invite you to check me out, even to subscribe if you see fit. I also have one which is devoted to my work in Nepal where I teach critical care nursing during summer break from the University. Above all, I think nursing as a profession could benefit from Suzanne Gordon’s advice, and speak more plainly about what we do. That has been my goal in my two books.
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Already been to your Nepal site – Neat work!
Will check your blog out – I can’t reliably blog – I think I have three going and if I am really good I remember a couple of times a year.
But I do have a website http://www.standarderrors.org – my lack of aesthetic dexterity being obvious…
Olga Jarrin just posted a link to a great article from a year ago that I think is germane. What it describes is yet another consequence of nurses not talking about what is really happening in an open enough way. If people understood what really happens in ICUs – when the fate of their loved one wasn’t the pre-eminent thing on their mind – I think ICU personnel would have an easier time helping family members adjust to the impending loss of a loved one.
When a loved one is suddenly rushed into an ICU it is not the time to start learning about the horrors of extended and futile end of life care.
Here is the link:
http://nypost.com/2012/12/09/diary-of-an-intensive-care-nurse/
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