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Tuesday, July 14, 2009

Nursing Stereotypes are Unhealthy. Period.

Since I am home from work with a sinus attack, I have slept more than 18 hours in the past 24 hours. If I go back to sleep now I'll never sleep through the night. And so, I suppose I should go back to keeping this blog.

Last week a nurse practitioner friend of mine sent me a link to this N.Y Times article: Why Nurse Stereotypes are Bad for Health.

I loved the piece, although I felt the author spent too much time giving examples of negative nurse stereotypes and not enough attention on what the title promised: how nursing stereotypes can negatively effect health.

Brown argues
The problem with how nurses are portrayed in the media is that it has the potential to devalue the way we view nurses in the real world. The result is less support for important policy issues like short staffing and nurse burnout.
I completely agree, but I can't help but feel like this can be expanded on even more.

Besides the fact that media is subtly brainwashing the general public to not really care about nurses rights or safety, I would wager to say that these messages actually damage patient care outcomes and end up costing tax payers more money in the long run.

Consider that the nurse's job is not actually to "help" the physician, but is, as Brown points out, to oversee patient care. Nursing is an "autonomous profession."

Nurses take orders from doctors and N.Ps but are independently responsible for administering medications and treatments. Nurses are accountable for medication errors, even those that can be traced back to mistakes in orders. They aren't just mindlessly carrying out orders from doctors, but instead are receiving and double checking medication orders to be sure that no harm may come to their patients. And if they question a medication, dose, or any other treatment they have a right to refuse to administer it. They oversee wound care, IV therapy, and in many cases PT, OT or RT in between visits to specialists. Nurses communicate with several different disciplines for optimal patient care (not just M.Ds), and organize the greater care plan for each individual patient.

They have a two to four year education under their belts which includes a knowledge of pathophysiology and disease process that allows them to make clear, evidence based decisions in their practice on a minute to minute basis. They have their own system of "nursing diagnosis" and interventions for plan of care, and measure outcome independently from other disciplines.

And so, imagine the problems that arise for me, your friendly R.N, when I ask a patient if I can take his apical pulse rate before administering his digoxin dose and he tells me, "just give me the pill, that's your job."

Patients who believe that nurses are only a pill-dispensing gate keeper for the doctor are not going to do as well as patients who understand that nurses keep them safe and keep them on the correct track. Consider my friend above, he's not going to get his medication. Because there's no way I'm giving it to him without knowing what his apical heart rate is. So he's going to go see the M.D or N.P who is going to send him right back to me. Later the patient will complain that the M.D didn't spend any time with him, and he has more questions. I will then be expected to take time away from my other patients to hunt down the provider since of course the patient won't even ask me the questions. "You wouldn't know, I need to talk to a doctor."

A patient who lets me take his apical though, he'll get his med if it's appropriate. But what if it's not, what if his heart rate is below 60bpm? Then I ask some questions to find out more. Turns out, he's dizzy when he stands up. So I do a set of orthostatic vital signs. In addition to bradycardia, the the guy has orthostatic hypotension. Then maybe he also tells me he's having dreams about his dead daughter. Or he needs help finding benefits for veterans. Bam - now I have case management and psych all flagged for him. By the time he sees the N.P he also has an appointment to see a psychologist, case management has gotten him in touch with a V.A, and we found out that the reason he's so dizzy is that his medications need adjusting. He goes to see the N.P and has a much more effective visit with him or her as a result of our therapeutic interaction.

Hey, whatever. The media has not been very interested in correcting stereotypes that hurt public health. Smoking is still bad ass and sexy, and binge drinking is normal (and hilarious!), so I guess nursing is going to have to deal with being shoved under the bus for at least a time longer.

Still, I think everyone would be a lot healthier if we ditched the stereotypes. Just ask your doctor. You know - the one who makes house calls and carries a black bag with him.

Now where is my white hat?

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