Power Play
Nurses must pitch in to help improve perceptions, clarify their role in health care

By Kitty Bricco-Jablonski
February 19, 2002

There isn't a person around who hasn't heard or read about the nursing shortage. This shortage, while becoming more politically intoxicating to discuss, has become a media endorsement for hospitals.

Daily, we read about the wonderful bonuses hospitals are offering to recruit nurses; we read about their inability to admit patients because of the shortage. Legislation is pending regarding nurse/ patient ratios. You probably know that capping the census allows the nurse to practice safely, but did you know that the money the hospital loses is being looked upon as potential nurse salaries? This is an appalling notion.

It places blame upon nurses rather than the institution and its antiquated perceptions of the non-importance of a nurse. The notion of mandatory shifts is absurd, but even more outrageous is the belief by nurses that we cannot empower ourselves to do not only what is right for the patients and the institution, but for ourselves as well. Why do we allow the perpetuation of this type of thinking, and how do we articulate what a nurse is and what we do?

The answer begins by identifying the four realms of a nurse's job that directly affect patient care. Once identified, we can move toward changing the perceptions of those outside of nursing and empower ourselves to create a new reality.

Mental realm

A strong disease-based medical education coupled with strong psychosocial education give the nurse the ability to care for the person within the context of the disease. In other words, nurses assess the human response to the patients' unique illness and intervene appropriately.

Nurses have been educated to intervene with this human response. Nurses are also the most knowledgeable professionals in skin breakdown, and because this is a multimillion-dollar loss for insurance companies and patients alike, it represents an incredible demand on a nurse's assessment skills.

Likewise, nurses know pain. No other team member is with the patient long enough to see the minute changes in a patient's pain level. Traditionally, the realm of pain control has always been with the nurse.

A large part of a nurse's job is health promotion and/or maintenance. This can be accomplished through extensive patient education or simply by explaining to the patient the rationale for a particular intervention. Research has shown that nurses improve patient outcomes.

Physical/technical realm

The nurse is the patient's advocate. A day consists of not only integrating the efforts of the medical team, but also implementing those efforts.

A nurse doesn't just feed the patient, he/she is watching the swallowing process, assessing functional capacity, monitoring nutrition and assessing the patient's needs. When ambulating a patient, gait stability and safety are assessed.

Nurses are trained to assess the minute changes in a patient's health status and, oftentimes, that assessment can make the difference between a simple remedy and one that requires more extensive monitoring.

Emotional realm

Because the nurse is trained to assess the human response, psychosocial issues are an integral part of the work. For this, the nurse draws upon his/her educational background in clinical psychology.

Again, nurses are educated to respond to the human response within the context of the disease.

It is the nurse who listens to the patient's fears regarding a diagnosis and offers emotional and educational support. It is the specially trained oncology nurse who gives that incredibly frightening and isolating first dose of chemotherapy while guiding the patient through every step of the process. It is the cardiac nurse's competent skills that navigate the high-tech equipment used to keep a heart attack patient alive all the while calming the family's fears, again, through emotional and educational support.

The quiet wisdom a nurse imparts helps to give the patient the courage to move through the stages of an illness.

Spiritual realm

Nurses are the people at the bedside who help family members cope. Many examples can be enumerated.

It is the nurse who offers a comforting hand to the frightened patient or family member as he/she instructs them about a new diagnosis and its implications. The nurse is there when a distraught mother looks to find meaning in her child's illness. The nurse is the only team member left after a family has had a miscarriage.

Nurses have the difficult task of helping family members say that important goodbye as their loved one is making the transition to death.

A nurse's job is mentally, physically, emotionally and spiritually challenging, and who wouldn't argue that the rewards are great? However, no one is arguing rewards. We are arguing shortages, salaries and power struggles. We are arguing within a cultural ideal that still sees nurses as liabilities. We are trying to quantify the most important (and human) of issues-as if being human can be given a price tag.

Unfortunately, in our society, these issues do need a price tag. Nurses need to be financially compensated for, arguably, the most important task in medicine-caring for the human behind the medical diagnosis.

Can we quantify the nursing profession? Yes.

Empower the nursing profession by showing your professionalism, getting involved in the issues facing nurses today and getting involved in the issues facing medicine today. Empower yourself by realizing that you are in a position of power. And, above all, remember that the traditions upon which nurses were educated stand as a foundation upon which to soar.

The time is now. The person is you.