Today is National Nurses Day. As I have one sister-in-law, two ex-sisters-in-law, two nieces, and a cousin who are all nurses — not to mention the two good friends who recently became nurses, and the three CNMs (Certified NURSE Midwives) that delivered my babies — I thought this was a good opportunity to celebrate the nurses in my life — and to issue a challenge.
Nurses are at the front lines of health care in this country. One’s experience in a healthcare crisis is often largely dependent upon the quality of nursing care. I will never forget the generous and caring nurses in the hospital when my infant son died. We’d arrived at the hospital barefoot and hardly dressed, as our son had stopped breathing in the middle of the night. One nurse went out of her way to find us some slippers for our feet while we waited for news, and another nurse got me a chair so I could be comfortable holding my recently deceased baby — while the doc in charge of the NICU was in the next room telling my three-year-old daughter not to worry because her parents would “get her a new one.” I don’t even know those nurses’ names, but I will never forget those women for what they did for me in the worst hours of my life.
Of course, at the other extreme, are nurses who are more concerned with power over their domain than they are with the welfare of the patients entrusted to their care. My older brother died when I was twelve years old. He’d had open-heart surgery and was in Columbia Presbyterian Hospital for about six months before his body just couldn’t take anymore. He was six feet tall and weighed about 130 lbs. You’d think under those circumstances his life was plenty difficult already, but my mother would come home complaining bitterly about one particular nurse who seemed to think it was her life’s mission to make him miserable. And recently, my ex-husband’s girlfriend was treated very badly in a local hospital’s Labor and Delivery department, because she dared to say no to an epidural.
I sincerely believe that most nurses — certainly not all, but most — choose to become nurses because they really want to help people. Until recently almost all nurses said the “Nightingale Pledge” when they became nurses:
I solemnly pledge myself before God and presence of this assembly;
To pass my life in purity and to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug.
I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in the practice of my calling.
With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.
That’s a pretty intense set of promises. And I know that there’s a significant percentage of nurses who take it very seriously, at least with regard to the health of their patients. That means that when a nurse becomes convinced that a doctor is acting counter to the interests of his or her patient — such as prescribing a drug that the nurse believes will be harmful, the nurse has a tremendous conflict of interest. A nurse’s interest is supposed to be that of his or her patient’s welfare, but what happens if the nurse approaches the doctor with his or her concerns? Worst-case scenario, the doc loses it and fires the nurse. Most often, the doc will dismiss the nurse’s concerns with the implication that he or she knows better because he or she went to medical school. And since many docs are men, while most nurses are women, that dismissal is often tinged with at least a little of the patronizing and sexist “don’t worry your pretty little head about it” attitude. Sounds kind of familiar, doesn’t it? It’s a lot like the way the medical establishment treats those of us with safety concerns around vaccines, drugs we believe will be harmful. We couldn’t possibly know what we’re talking about because we haven’t been to four years of medical school, plus two years’ residency. What those doctors are not taking into account is the fact that nurses spend far more time with their patients than doctors do and, as a result, observe the effects of what they do far more directly. Just as parents spend far more time with their children than anyone else and, therefore, have a much more profound knowledge of what’s affecting them than a few days’ lecture in a medical school can possibly convey.
In 2009, many U.S. hospitals required all healthcare personnel to get the H1N1 vaccine. In the U.K., where it was optional, one-third of all nurses said they would refuse the vaccine. Sixty percent of those nurses cited concern about the safety of the vaccine as the reason for their refusal. Another thirty-one percent said that they did not consider the risks to their health from the swine flu great enough to justify getting the vaccine. Interesting, huh? A significant percentage of healthcare workers who have the option to say no express exactly the same concerns with regard to vaccination as the parents who are labeled crazy “antivaccinationists.”
An adult booster for the pertussis vaccine (whooping cough) was developed in 2005. In 2006, the Israeli government recommended all healthcare workers get the new vaccine. Compliance was so low among Israeli nurses that earlier this year a study was done to investigate the causes of this low rate of uptake. To quote the study’s findings:
A major theme that emerged from our qualitative data was the feeling of mistrust the nurses expressed towards the health authorities. This mistrust was mainly associated with A/H1N1 and seems to have added to the mistrust expressed towards the next vaccine they were asked to immunize themselves for, which happened to be pertussis. This mistrust is similar to the mistrust described by the antivaccinationists.
The nurses expressed the importance of having autonomy in the decision to be immunized against pertussis. Although the nurses followed protocol and accepted authority in treating patients, they did not accept authority to govern their own healthcare. This desire for autonomy was due to both a mistrust of the health authorities, as well as a perception that their personal and professional lives were separate. They also thought their clients had the same right to decide for themselves whether or not to immunize their children. They accepted the parents’ opinions about vaccinating their children and respected this. They demanded this same respect for themselves.
Nurses are the natural allies of the Thinking Moms’ Revolution, who are asking for a similar autonomy in making healthcare decisions for themselves and their children. Nurses are on the front lines fighting for the welfare of their patients day after day. I propose we do whatever we can to recruit them to our cause. And I offer a six-step challenge to nurses who wish to do as good a job as possible for their patients:
1. Listen. This is the single biggest gift people in the medical profession can give to their patients. Many think it’s important to give “learned” advice, but “learned” advice is utterly useless if it addresses the wrong issue, or is contraindicated by other conditions.
2. Think. Don’t just do things by rote; think about what happens when you do them. Think about how healthcare has changed in recent years. Which things actually make people happier and healthier, and which don’t?
3. Don’t Harass Patients Who Think. When it comes down to it, each of us is responsible for our own health. If you had a condition you knew little about, wouldn’t you Google the hell out of it? Of course. So don’t harass patients who have gone out of their way to figure out what’s going on inside their bodies. If you have a problem with what they’re coming up with, then do your own Googling.
4. Do No Harm. I put that fourth instead of “first,” because I honestly believe that many, many people are not aware of the harm they’re doing. If you listen and think first, then you are much less likely to do harm.
5. Be Truthful and Respectful. Remember that you are in a position of authority. If you abuse that authority by being untruthful or disrespecting your patient, you are dishonoring your profession. Remember, patients are people.
6. Learn Homeopathy, Therapeutic Touch, Cranial Sacral, and/or Reiki. I know there are lots of nurses who dismiss these therapies as “unscientific,” but the fact is, if you’re listening and thinking, you will find that there are many, many people who have been helped by these non-invasive techniques that truly “do not harm.”
I am deeply appreciative of the nurses who have been doing these things all along. You have made a difference in my life and the lives of others. And I challenge all nurses who aren’t there yet to find and channel their inner “Thinking Mom.” I guarantee you, the world will be a better place for it.
Dedicated to those whose lives (or deaths) could have been much better with compassionate nurses caring for them, especially my older brother and Killah’s good friend who died of cancer.