Nurses: They Give Care, but Get Little in Return : Health: People who have been hospitalized know the worth of capable nurses, but policy-makers and the media still ignore them.
On a splendid sunny day, 50 nursing students and faculty members gathered on the lawn of the world-famous Massachusetts General Hospital last month. They were carrying signs and protesting the dismissal of Elizabeth Grady, director of the hospital’s Institute of Health Professions’ Graduate Program in Nursing for the past eight years.
Nurses from here to California have expressed their shock at the unexplained dismissal of a strong, popular nursing educator who represents a new, more feminist, autonomous and activist approach to nursing. The hospital insists that the “Grady matter” has been misrepresented, and that the hospital welcomes strong, independent-minded nurses. But nurses fear this episode is yet another example of the longstanding devaluation of a caring profession that is 97% female.
This incident highlights a much larger and more important conflict--the struggle that nursing has waged to determine its own future. Today, this means convincing medical, business and political leaders, the media, and the public that nursing is a clearly defined profession and that the health-care universe is, in fact, a marriage between care and cure.
Many members of the public now recognize that nurses are anything but physicians’ handmaids. Many people see nurses as well-educated and trustworthy health-care professionals. But few really understand the scope of what contemporary nurses do.
Nurses make up the largest profession in the health-care system. The nation’s 2.1 million registered and licensed nurses outnumber, by nearly four-to-one, America’s 585,600 physicians. Medicine and nursing are distinct professions. Physicians focus on disease, nurses on illness, or, as one leading nursing researcher, Patricia Benner, has written, on “the human experience of loss or dysfunction.”
In hospitals, nurses are at the bedside 24 hours a day. They provide highly technical care to patients in intensive-care units, neonatal nurseries, geriatric facilities and psychiatric institutions. They translate often incomprehensible medical information to frightened patients and families who are making decisions about whether to undergo invasive treatments. They also guide patients who are facing death through the difficult decisions concerning withholding or curtailing treatment.
Some of today’s most serious medical problems are, in reality, also nursing problems. Physicians cannot cure many human ailments such as AIDS, stroke, chronic illnesses, disabilities associated with growing older and mental illnesses. These problems require long-term care that helps people heal, cope and function as well as is possible.
Contemporary nurses are also pioneering programs for the emotional and physical treatment of the homeless, running outreach projects for low-income, teen-age mothers and their infants, delivering primary health care and anesthesia to rural Americans, creating models of restraint-free care for hundreds of thousands of elderly patients in nursing homes and hospitals and developing community-care centers for people with AIDS.
Nursing care is based on a blend of expert caring skills, technological know-how and scientific research. Nursing research, funded in part by the National Center for Nursing Research in the National Institutes of Health, is delving into problems that afflict millions; it is also investigating ways to prevent disease and promote better health.
These developments should have revolutionized the perception of nursing. But Americans still imagine the health-care universe to be one of either medical heroics or biomedical innovations to cure disease. Except for those who have had personal contact with nurses, nursing remains invisible.
One important reason is hospital and medical-center control of much of the information about what goes on in health care. The public-relations departments within many of these institutions have largely ignored nursing. Physicians’ and researchers’ activities are thought to provide the familiar elements of a “good story”--heroic enterprise, success against great odds, the dramatic struggle to vanquish disease.
In contrast, the wordsmiths don’t seem to have the words to describe nursing in an understandable way. Public relations staffs often regard nursing stories--except the occasional portrait of the “nice nurse”--as too vague, too soft and inherently unmarketable to the media.
The media have also reflected traditional cultural biases about who is and who is not important in the health-care universe. A recent study of three newspapers’ coverage of health care, (including coverage by this newspaper), sponsored by Nurses of America, documented that nurses were quoted less than any group that reporters sought out for information on health-care issues.
Nursing organizations are absent as commentators in the ongoing debate about national health policy and cost. When nurses do play a role on the media stage, it is almost always in connection with the nation’s recent nursing shortage. Nurses are far more frequently cast as extras in non-speaking roles--seen in countless photographs accompanying reports on health-care issues but neither quoted nor named in the articles.
Although the invisibility of nursing is a quintessential women’s issue, the one force--the women’s movement--that might have brought nursing into public view has generally reflected society’s ambivalent attitudes toward female caregiving work. Feminists have struggled to allow women to move into male-dominated professions, and the feminist movement has tended to celebrate women who have succeeded in doing so--those who have become physicians, for example, rather than nurses. Women who deliberately choose to remain in care-giving professions are often seen as lacking either the intelligence or ambition to transcend traditional female roles.
Because many women define “liberation” as the movement away from caring professions, they don’t consider the plight of nursing as a feminist issue. They don’t know that the development of modern nursing was, in fact, a feminist achievement.
The nursing profession, it must be noted, has sometimes spent as much time and effort in internal battles as it has in explaining its critical role in health care. Nurses, on the whole, have yet to learn what physicians have mastered so well--how to promote their profession.
Nonetheless, the conflicts that nursing confronts today encompass significant issues of concern to women, the health-care system and the public. How can women reach equality if the caring work that so many do is not valued as fully as the activities that men have traditionally engaged in? And how can this country ever hope to create a cost- and care-effective health-care system if we can’t respect and reward what really counts--the work of those who help people deal with illness, infirmity, aging and death?
