Saturday, February 26, 2011

Burn Nursing on

My newest article for Working Nurse Magazine, on the subject of Burn Care Nursing, is currently available for reading online. Please click here to read the article, and thanks!

Tuesday, February 22, 2011

Nurses' Voices, Nurses' Image: Nurses' Power

I am republishing this post from 2008 because this subject of nurses' image still seems incredibly timely and worthy of thought and attention. Enjoy!


(Note: This is my sixth post under the auspices of the
nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

I have recently been re-reading From Silence to Voice: What Nurses Know and Must Communicate to the Public, by Bernice Buresh and Suzanne Gordon. What I am most struck by is that nurses still have not necessarily found their collective voice, and despite the media attention given to the global nursing shortage, I still believe that Buresh and Gordon's thesis still holds true: the public still does not fully understand what nurses do, and until that day comes, nurses' real value as clinicians will not be common knowledge.

Buresh and Gordon touch on many themes and areas of interest vis-a-vis nurses and their relation to the public, to doctors, and to one another. While I will not provide a review of the book---nor a comprehensive enumerating of its content---there are certain area which pique my interest, and I encourage curious readers to order a copy of the book and explore some of these issues for themselves.

Doctors Cure, Nurses Care

When I first heard this phrase, I was moderately disturbed by it for several reasons. Doctors, by and large, receive the lion's share of praise and gratitude when a sick patient is cured of an illness. Granted, doctors undergo a great deal of training and education in order to offer curative treatments for a variety of diseases, yet all too often, the work of nurses is grossly overlooked when it comes to successful treatment. While nurses do indeed carry out many orders originated from doctors, nurses use their own brand of critical thinking and autonomous action in order to perform specialized patient care. The public may not be aware of this fact, but many actions taken by nurses are initiated by nurses themselves, and the professional clinical assessments performed by nurses will often lead to changes in treatment and greater overall success.

Sure, nurses care, and nursing is seen by the public as a "caring" profession. However, nurses utilize scientific methods, skilled observation, and keen assessment skills to monitor patients' progress. Nurses are not just "the caring eyes and ears of doctors"---nurses are skilled professionals fully involved in patient care---and patient cures.

The Nurse as Angel, Teddy-Bear, and Child

In their book, Buresh and Gordon make one thing clear: nurses' self-presentation says a great deal to the public, and images of nurses that instill themselves in the societal zeitgeist are difficult to dispel.

Somewhere along the line, the "angels of mercy" moniker became attached to nurses as a group. Granted, in the early days of nursing, nurses' ability to act autonomously was extremely limited, and we were, by and large, the handmaidens of deified doctors. However, as much as that regrettable history has largely changed, the image of the nurse as angel unfortunately persists quite widely in our culture and websites galore promote gifts and baubles that continue to diminish nurses' professionalism. Images such as this one drive home the point: nurses are childlike individuals with starched white hats who love teddy-bears. Adding insult to injury, nurses can actually be depicted as winged angel/teddy-bears, further enforcing the infantilization (and deprofessionalization) of our profession. Would doctors allow themselves to be thus represented to the public?

Rather than being perceived as cherubic angels and childlike creatures, this writer feels that being perceived as the valuable and skilled professionals who we truly are would allow the public to have a much more accurate perception of what we do, and our importance to the care of millions.

The Clothes on Our Back

Nurses' uniforms have certainly changed over the years, and as scrubs have become the norm for nurses in most clinical settings, many companies have capitalized on the popularity of such utilitarian clothing. Now, designer scrubs covered with angels, teddy-bears (there they are again!), and any number of cartoon-like images adorn the hard-working bodies of nurses around the world. If nurses want to be taken seriously by the public---and by doctors and other professionals---how does the wearing of such (in my opinion) unprofessional clothing help our cause?

Picture this: a team meeting occurs midday to discuss a patient on the adult oncology floor. Present at the meeting: a medical resident, a medical student, the attending doctor, the oncologist, two unit nurses, a social worker and a respiratory therapist. Of all of the professionals in the room, who would possibly be wearing pink scrubs covered with teddy-bears and hearts, and a pin on her chest saying "Doctors Cure, Nurses Care"? And what message does this convey about the nurse's self-image and how the other professionals present in the meeting should perceive him or her?

What's in a Name?

In From Silence to Voice, Buresh and Gordon make their case that nurses being addressed by first name only is also a major image problem when it comes to the public's perception of us a collective whole.

When doctors introduce themselves to patients or other professionals, they always do so by using the title "Doctor" before their name. This practice immediately creates an impression that the doctor is a professional, that he or she has a name that should be remembered, and a hierarchy of power and authority is clearly established from the start.

Conversely, we nurses almost ubiquitously introduce ourselves by first name only, ostensibly to break down the barriers between patients and nurses, assisting the patient in overcoming fears and anxieties related to their treatment. While this tactic may have some limited benefit, Buresh and Gordon argue that "if nurses introduce themselves by their first names only, they are asking to be regarded as nonprofessionals because that is the conventional way that nonprofessionals present themselves."

The "first-name only convention", as the authors have named it, makes it significantly more difficult for individual nurses to receive recognition for their work when only their first names are known. It also creates a hierarchical structure in which the doctor stands alone as a figure of authority, towering above the patient and nurse with (patriarchal or matriarchal) power and authority.

Interestingly, many nurses will argue that introducing ourselves as "Nurse Smith" or "Nurse Cadmus" is awkward at best, but also brings to mind the infamous "Nurse Ratched" from "One Flew Over the Cuckoo's Nest". Granted, Nurse Ratched is a mythic and hated figure in the pantheon of film and modern literature, yet do we see doctors eschewing their well-earned title due to historical figures such as Dr. Kevorkian or Dr. Mengele (of Auschwitz fame)? Absolutely not. Doctors use their title so commonly and so frequently that the word "doctor" simply holds too much cultural power to be diminished by one literary (or real-life) character who used that title for ill.

As for "naming practices" between doctors and nurses themselves, further examples of an unequal playing field emerge, with nurses almost continually subjugated to a diminished status by always being addressed by first name by both patients and doctors, whereas doctors maintain their professionalism and authority through the use of their title and last name.

Taking Credit Where Credit is Due

All too often, the work of nurses is diminished by nurses themselves. When thanked for their work, nurses will frequently say, "Oh, I didn't do much. The doctors really did the hard part." Or when a nurse is asked what he or she does, the answer will often be, "I'm just a nurse." This diminution of nurses' worth does little to cement in the public's collective mind the utter importance---the crucial presence---of nurses in the healthcare system. The "just a nurse" phrase---used all too painfully often---hurts nurses' cultural standing and diminishes the profession in the public's eye.

Nurses need to stand up and take credit for the work that they do. Buresh and Gordon urge nurses to say "You're welcome" when they are thanked. "I am so glad that I could assist you in learning so much about your diabetes, Mr. Smith" or "It was my pleasure to provide your post-operative nursing care, Mrs. Jones"---these are statements that take credit for nurses' actions, acknowledge patients' gratitude, and accept responsibility for providing crucial nursing care that directly impacts patients' recovery and health.

Nurses' Agency

Buresh and Gordon recommend that nurses discover their "voice of agency". According the authors, "the voice of agency is the voice that says: 'I helped the patient to walk after surgery so that she wouldn't get blood clots in her legs' or 'I taught the patient how to take his medications so that they would be effective and produce fewer side effects.' The authors further illustrate their point by reminding us that "the voice of agency is the voice that conveys the message, 'I'm here. I am doing something important.' "

For nurses to develop their own agency---their own power---nurses must first claim and recognize the importance of what they do. As Buresh and Gordon elucidate so clearly in their book, patients do not learn self-care skills in a vacuum. Someone must teach them those skills, and it is nurses who bring their knowledge and education directly to patient care. When recovering from surgery, it isn't doctors who monitor patients every fifteen minutes, using a lifetime's worth of learning to perform important expert assessments. Nurses use a wide variety of skills---often on an autonomous basis---to provide patients with the care and attention they need for optimal health.

While nurses are indeed held in very high esteem by the general public in surveys and polls, most members of that adoring public would be hard pressed to actually describe what it is that nurses do. As Bernice Buresh and Suzanne Gordon make so abundantly clear, it is up to nurses to claim their rightful place of importance in the care provided to patients in a variety of settings. Nurses need to proudly speak of their work with a voice of agency and power, and communicate clearly---to the public, the media, their families, their friends, and their colleagues---that nursing is important, that it is meaningful, and that what nurses do contributes to successful patient care and positive outcomes. We must forgo the teddy-bears, the hearts, the flowers, the useless diminutive statements and self-deprecation, and claim our professionalism for our own.

Nursing's voice must be heard, and Buresh and Gordon feel that the time for that voice to be clearly heard is now.

Thursday, February 17, 2011

The Fresh Air Fund NYC Half-Marathon

On March 20th, 2o11, The Fresh Air Fund is once again hosting its annual Half-Marathon, an amazing 13.1-mile course through beautiful Central Park, continuing on through Times Square and ending with breathtaking finish-line views of the New York City harbor. More than 11,000 runners, of all ages and abilities, finished the NYC Half-Marathon last year, raising over $100,000 for the cause, with almost $400,000 raised in the last four years.

The Fresh Air Fund has been providing free summer vacations for youth from the five boroughs of New York City since 1877. Thousands of children have benefited from the volunteerism and kindness of their host families.

The Fresh Air Fund is looking for runners and sponsors for the upcoming Half-Marathon, as well as host families willing to take a Fresh Air child into their home for two memorable and rewarding summer weeks.

If you'd like to be involved in the Half-Marathon, please click here, and if you'd like to find out more about becoming a host family, click here and read more about the program. If you'd like to find out if your child is eligible to be enrolled in the Fresh Air Fund summer program, click here.

Enjoy this video about the Fresh Air Fund experience!

Wednesday, February 16, 2011

The Sweetening of America

These days, it seems like sweeteners have made their sneaky way into almost everything. From soup to nuts, it's apparent that there can be no enlightened trip to the grocery store---or even the health food store---without the very careful reading of ingredient labels. Manufacturers are simply practicing the wholesale sweetening of America, and whether we like it or not, our food supply is increasingly infiltrated with useless calories and unnecessary sweeteners.

What's most maddening to me personally is my utter disappointment when shopping at the health food stores where I am dedicated to spending my money. The manufacturers of so-called "health food"---including companies that have always been at the forefront of the healthy eating movement---have jumped on the sweetener bandwagon in recent years, and everything from crackers to canned soups seem to be tainted with evaporated cane juice, and those extra calories are just adding to the American waistline, whether the cane is organic or not. The presence of these sweeteners is often lost on many consumers, who pull items from the shelves without a great deal of thoughtfulness. However, even a savvy health food consumer like myself can erroneously bring home an item that perhaps was previously sugar-free but is now chock full of sugar, much to my dismay and annoyance.

Like salt, one becomes accustomed to sweetened foods over time, and going back, for example, to unsweetened ketchup can be a huge leap after years of consuming ketchup loaded with sugar. It's a matter of taste, of course, but oftentimes the unsweetened versions are just as tasty as their sugary counterparts (with, admittedly, many exceptions---like soy milk, in my humble opinion).

Most recently, I have been trying to avoid dairy in my diet, so I've been looking for an unsweetened non-dairy creamer to use in my green tea, decaf coffee, or hot grain beverage. Sadly, every creamer on the market seems to be sweetened with evaporated cane juice or some other form of sugar, and I simply cannot fulfill this desire no matter how hard I try. (Do I detect a new market niche and business opportunity for an enterprising soul?)

With a personal goal of losing a few pounds this spring and a general desire to keep my diet as clean as possible, fishing for unsweetened forms of many common foods is a continuous exercise in patience and conscious shopping. Luckily, there are many products that I can count on to remain unsweetened, healthy and as unprocessed as possible. Sadly however, I am consistently dumbfounded as heretofore reliable companies decide to dump truckloads of organic evaporated cane juice into their manufacturing processes. Cane producers (both organic and conventional) must be rubbing their hands together with glee as their factories pump out more tons of their products each year. Want a good stock option? Try sugar futures---it's the future of America.

Tuesday, February 15, 2011

Online Nursing Degrees

I just took part in writing a short article for regarding the benefits and challenges of online nursing degree programs as opposed to traditional "brick and mortar" programs. Please click here if you'd like to peruse this brief article.