Nurses - book review

Steve · medicine forum addict Joined: 16 May 2005 Posts: 59

(NY Times Book Review)---Nursing Against the Odds: How Health Care
Cost Cutting, Media Stereotypes and Medical Hubris Undermine Nurses
and Patient Care, by Suzanne Gordon

Exhausted by heavy work, mandatory overtime, and stress, nurses are
leaving the bedside faster than they can be replaced.

The situation is so bad, Ms. Gordon writes in this gloomy assessment
of American nursing, that even nursing educators are leaving the
field, so nursing schools cannot accommodate declining numbers of
would-be students.

Ms. Gordon, a journalist who specializes in nursing issues, is hardly
the first person to make these points. The cost-cutting of managed
care has been notoriously hard on nurses, whose salaries loom large on
the hospital bottom line.

But these are not the only issues in her book. Issues of respect and
regard must also be dealt with if the nursing crisis is to be
addressed. And these issues will never be solved unless nursing as a
profession comes to grips with them.

True, some problems can be solved with simple infusions of cash -
money for more staff members brings vast improvement in performance
and morale. And she cites growing evidence that spending more money on
nursing is cost-effective, since it reduces patient complications.

But other major problems are less amenable to fiscal fixes. For
example, nursing as a profession does not answer with one voice this
basic question: Who is a registered nurse?

Recipients of associate degrees, graduates of diploma programs in
hospitals, students who earn bachelors degrees in nursing, and liberal
arts graduates who complete masters programs in advanced practice, all
can be registered nurses.

But their training is far different. Liberal arts graduates who train
for advanced practice nursing may lack crucial bedside skills, or may
even denigrate such skills as mere "technical" nursing, even though
there are numerous cases in which a nurse's bedside experience meant
life or death to a failing patient.

On the other hand, it is difficult to make the case that registered
nurses deserve respect as fellow professionals when they can enter the
field without a bachelors degree. This is a question nursing must
confront.

Ms. Gordon is obviously irritated by nursing's collective embrace of
what she calls a "language of virtue" to describe the noble
self-sacrifices of caring nurses who dedicate themselves to the
welfare of others with little thought of themselves. This tradition is
one reason nursing typically scores so well in surveys of the most
respected professions. There are many examples of nurses who live up
to this high standard.

But similarly dedicated people in other fields demand - and get -
reasonable working conditions, reasonable pay, and other compensation
for their skill and dedication. Until nursing makes these demands,
nurses will not get the respect they deserve.

She adds that the abandonment of starched whites, perky caps, and
scrunchy shoes may have made life easier for nurses, but their
wholesale embrace of pastel or flowered scrub suits is not helping
their image.

All of this is reflected in the news media, in which nursing's role as
a linchpin of medicine goes largely unreported. Here again, Ms. Gordon
indicts the culture of nursing - in particular, its habitual deference
to doctors and collective unwillingness to promote itself.

As an example, Ms. Gordon cites the difficulty a journalist faced when
the New York Times assigned her to report on the care of people
injured in a Rhode Island nightclub fire. It proved almost impossible
to find a nurse to interview, even though arduous, meticulous bedside
care is crucial to burn patients' recovery.

Perhaps as a result, Ms. Gordon writes, nurses on television or in the
movies are, with few exceptions, missing in action, "an
ill-distinguished mass of busy hands," or objects of pornographic
fantasy.

If nurses hoped the arrival of large numbers of women into the ranks
of physicians would change the deference equation between them, they
were disappointed. Now that women make up half the students in medical
schools, women who decide to become nurses are sometimes assumed to
lack the ambition or ability to become doctors. And nursing has not
done well in attracting men to its ranks.

Many unexpected health crises occur not when technology fails but when
a patient's condition changes and no one notices. A doctor who
parachutes in for five-minute visits once or twice a day may think a
patient is stable or even improving. Sometimes, it is only the nurse
at the bedside who knows whether the patient is recovering steadily or
teetering on the edge. So people who are interested in the health care
system or in their own health care should pay attention to the issues
Ms. Gordon raises in this book.

But nurses especially should read it. In many ways, Ms. Gordon's
message is directed at them.

http://www.nytimes.com/2005/05/17/health/17books.html?

Robert · medicine forum Guru Joined: 28 Apr 2005 Posts: 1700

"Steve" <sga@njh.inv> wrote in message
news:l3uj81hs89d4m3lfn0e2ut769707a6gvsp@4ax.com...

Google