Thursday, February 09, 2006

What do nurses really do?

From medscape:
"What do nurses do? They save lives, prevent complications,prevent suffering and save money.
So why do nurses have such a hard time explaining such compelling facts and acts?
It is because they have been educated and socialized to focus on their virtues rather than their knowledge and their concrete everyday practice."
"They've been taught to wear their hearts and not their brains on their sleeves as they memorize and then rehearse the virtue script of modern nursing"

"Although many studies, conducted by nursing, medical, and public health researchers, have documented the links between nursing care and lower rates of nosocomial infections, falls, pressure ulcers, deep vein thrombosis, pulmonary embolism, and deaths, most promotional campaigns and many stories nurses themselves tell about their work ignore these data."

"Instead, nurses focus on their honesty and trustworthiness, their holism and humanism, their compassion, and their caring. The problem is that when they focus on caring, they often sentimentalize and trivialize the complex skills they must acquire through education and experience. They often fail to explain that caring is a learned skill and not simply a result of hormones or individual inclination. After all, knowing when to talk to a patient about a difficult issue, when to provide sensitive information, when to move in close to hold a hand or move away at a respectful distance all are complex decisions a nurse makes. To make these decisions, nurses use equally complex skills and knowledge they have mastered. But all too often nurses make these skills and knowledge invisible or describe nursing practice in terms that are far too limited."

"Nurses are still talking about themselves -- or allowing themselves to be talked about -- in the most highly gendered, almost religious terms and allowing themselves to be portrayed with the most highly gendered, almost religious images. Indeed, as Nelson and I argue, with the best intentions in the world, many modern nursing organizations and nurses reproduce and reinforce traditional images of nursing as self-sacrificing, devotional, altruistic, anonymous, and silent work.[1] Just think of one of the jingles in the recent Johnson & Johnson image campaign:

You're always there when someone needs you
You work your magic quietly
You're not in it for the glory
The care you give comes naturally.

"Here is what I think nurses do. Using their considerable knowledge, they protect patients from the risks and consequences of illness, disability, and infirmity, as well as from the risks and consequences of the treatment of illness. They also protect patients from the risks that occur when illness and vulnerability make it difficult, impossible, or even lethal for patients to perform the activities of daily living -- ordinary acts like breathing, turning, going to the toilet, coughing, or swallowing.

Even the most emotional work nurses do is a form of rescue. When nurses construct a relationship with patients or their families, they are rescuing patients from social isolation, terror, or the stigma of illness or helping family members cope with their loved ones' illnesses."

Topics in Advanced Practice Nursing eJournal. 2006;6(1) ©2006 Medscape

So that is what nurses do. Yes it is true we sentimentalize our jobs but I think we do it because it gives us POWER. Nursing on the whole is a powerless profession.
We take orders from doctors, we take orders from patients and family and we take orders from management. We don't get to give any orders to anyone but housekeeping and hell, they don't listen to us.
By talking about how much care we provide and notice that a nursing action is always called providing care we promote the image of the gently smiling, handholding sweet little thing. People LIKE nice people, people respect the image.
Using and manipulating the image is what creates a form of power currency that gives us room to work, room to offer suggestions to the health care team.
I believe if nursing drops the pretense doctors would relegate us from the backseat into the trunk. I know some nurses and I am one of them who are not nice handholders, we are agressive tenancious advocates for our patients and we pay for it. Doctors will fight us every step because we are not deferential enough.
I respect the author of this paper , they want a change but change can only come when all the members of the health care team are on board.
Patients have an entirely different agenda, they want health care, they want to be cared for by compassionate professionals.
If I spent any time telling my patients hey! I am a smart,well educated , highly skilled professional they would nod and say hey!Get me a drink of water and some pain medication nurse.

Intellectually I am sure patients will feel better knowing we are highly skilled but the bottom line with patients is how quickly and kindly they are they cared for. They expect their nurse to be nice to them, to show kindness at every step even if they are angry,belligerent,violent,foul mouthed and hysterical.
You want to shock a patient? Tell them they have to treat their nurse with respect.
It nevers occurs to them that the person caring for them has any feelings at all.

I think the goal should be to educate the public on respect for health care providers.
Respect for them as living human beings, once they get that maybe we can slowly introduce the idea that nurses are highly skilled, highly educated professionals.

Baby steps here people!

Nursing is a cool job but there are limitations to it and knowing that is education.


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