Nurse Dramas---Helping or Hurting?

I’m surprised by my interest in and excitement about the new nurse-centered TV dramas, Nurse Jackie and HawthoRNe (and Mercy projected to debut in the fall lineup). I suppose that some of my reaction is in response to the efforts of Sandy Summers who, as the former voice of The Center for Nursing Advocacy and presently that of The Truth About Nursing, has kept a close eye on TV medical dramas and diligently campaigned for the accurate portrayal of nurses and nursing.

Summers communicates frequently with writers and producers, calling them to task for relegating nurses to insignificant roles while showing physicians performing the lifesaving skills that nurses do every day. She was told, time and again, that the viewing public is simply not interested in stories about nurses, only physicians.

From reading the accounts of her interactions with TV brass, it certainly appeared that Hollywood had its heels dug in and no changes were forthcoming. I am very curious to know if it was Summers’s persistent urging, or something else, that motivated producers to give nurses a chance to star on the small screen in not one, but three, shows—a remarkable about face.

Writers have given Jackie and Hawthorne powerful roles but also personal foibles, namely Jackie’s prescription drug addiction and Hawthorne’s rebellious daughter, in addition to questionable behavior on the parts of both nurses.

It’s early in the game but the shows are stirring up controversy within the nursing profession. The Center for Nursing Advocacy wants to explore this controversy and is asking nurses to respond to the Center’s discussion board to voice their opinions.

Go to the Center’s Web site, click on ‘discussion board’ and tell the Center what you think regarding these two questions:

1. Do you think Nurse Jackie and HawthoRNe are helping or hurting nursing?
2. How can nurses, including nursing faculty, use Nurse Jackie and HawthoRNe to educate their peers and students about the importance of becoming advocates for the nursing profession?

I’d also like to hear your opinions. Please share them here.

From Military Medic to Mainstream Nurse: A Few Changes Could Ease Nurse Shortage

A large aging population coupled with too few nurses being educated equals a massive shortage of nurses. There’s nothing new about that equation. Possible solutions for a fix are regularly bandied about but I recently read of one that is new to me and one that makes perfect sense.

Edward J. Halloran, PhD, MPH, RN, FAAN, associate professor in the School of Nursing at the University of North Carolina, Chapel Hill put the idea on the table in a recent viewpoint article in the American Journal of Nursing (June 2009).

Halloran pointed out that just the U.S. Army alone, among our branches of military, has 13,000 medics currently serving and prepares another 8,000 annually to serve as active duty replacements and also for service in the Army Reserve and National Guard.

Halloran has reviewed the army manual for medics and believes that what they learn is equal to or even greater than that of associate-degreed nurses and RNs who are products of accelerated programs for college graduates with undergraduate degrees in other fields.

While military medics are well trained and could move into nursing careers following their military service, all but one state have requirements for licensure that are road blocks to this transition. Only West Virginia allows discharged medics to sit for some health care practitioner exams, including the NCLEX-RN, without completing further training.

Nursing isn’t the only profession to take a hard line and resist allowing into its fold practitioners who can successfully test, yet haven’t completed certain aspects of traditional professional education, but is that a wise stance?

Given the critical state of our diminished supply of nurses, doesn’t it make sense, as Halloran suggests, that state legislators reassess current regulations to expedite the process for medics to gain RN certification during or after military service?

Halloran points out that beginning in 2011 all branches of the military will, for the first time, train medics together in one facility at Fort Sam Houston in San Antonio, Texas. It is his thought that adjustments be made to increase nursing and medical science aspects of that training program, and gear it to give medics the skills they will need for later certification as RNs.

It certainly does seem that we are closing the door on what could be thousands of potential RNs by refusing to make changes in the certification process. With nursing schools unable to graduate anywhere near the number of nurses we need, Halloran’s idea of morphing military medic training into an as yet untapped source for producing nurses seems truly inspired.

What do you think? Should concessions be made for medics to sit for RN exams?

Will Health Care Reform Exacerbate the Nursing Shortage?

The subject of health care reform is talked about in every sort of media outlet. Newspapers and TV news programs are rife with reports of what is or isn’t happening in the crusade to provide better health care in our country. It is my opinion that everyone should have access to health care but I certainly don’t have the answers as to how it should be accomplished. It is a massive and complicated problem that should’ve been dealt with before it grew to these proportions.

But, let’s just say that, by some miracle, a practical solution is found and enacted. Great news? Problem solved? Maybe new problems?

I frequently write in this blog about the nursing shortage. There are so many aspects to it that it is a fertile subject for ideas to discuss. But, here is an obvious aspect that I hadn’t thought of until I read about it in a nursing newsletter.

Health care reform is intended to help the uninsured and underinsured receive the care they need. If, indeed, that happens, vast numbers of those who have delayed seeking care will likely do so. The nursing shortage is expected to reach a critical stage in just a few years due to, among other things, the large numbers of aging baby boomers who will need medical care. Add to that large numbers of people newly covered in some way that opens the door to healthcare access and the nursing shortage balloons into an even bigger problem.

I am for health care reform. I want everyone to have access to care. I want there to be enough nurses to care for those who need them. We need more nurses! Perhaps the first order of business by this administration and congress should be to solve the problem of how to educate greater numbers of nurses before they do anything to create an even larger shortage.

What do you think? Please let me know your opinion.

What Happens when the Economy Turns Around

The ramifications of the projected nursing shortage have been looming over us for quite awhile. Now, the recession has created an unexpected hitch that, while a boon for the present, could exacerbate a certain facet of the problem in the future. The new problematic aspect concerns the retirement of older nurses.

That retirement is expected to significantly deplete the nursing workforce in the next several years is not a new revelation. The nursing workforce as a whole is older in age than most professions, with an average age of 47, so the numbers make it obvious that nurses will be retiring in greater numbers than replacements can be educated. The exodus was expected to be somewhat gradual, however, with a certain number retiring this year, a certain number the next and so on. But, the downturn in the economy has put a different spin on the whole thing.

Large numbers of nurses who were planning to retire this year or the next, and beyond, have seen 401Ks and other retirement accounts shrink so drastically that they simply cannot afford to retire at this time. The retention of these older nurses has the obvious benefit of continued adequate staffing, putting the problem of the nursing shortage on the back burner for many health care facilities, at least for the time being. But, what happens when the economy turns around? The fear is that the sudden departure, en masse, of older nurses, their numbers having grown each year of the recession, will create a large and critical deficit in the workforce all at once.

It all comes down to the issue of the inability to produce the numbers of nurses needed to meet the demand. Just that one thing, schools having to turn down thousands of qualified applicants each year due to a lack of faculty and clinical opportunities, is so far reaching it defies imagination—at least for me.

What about the retirement issue? Are any of you delaying retirement? What adjustments have you made to your retirement plans? I would like to hear your story.

Life Lessons from the Mouths of Patients

Although nursing school graduations happen two or three times in the span of a year these days, traditionally it is May or June that one thinks of as graduation time. So, right about now a slew of brand spankin’ new nurses are crossing over from classrooms and clinicals to the workaday world where careers are forged.

You new grads have likely been bombarded from every direction with advice on how to care, perform, be a team player and advance while simultaneously maintaining your sanity. The advice comes from instructors, colleagues and even family members without medical backgrounds. It’s similar to becoming a first-time parent—advice is being thrown at you left and right. Everyone means well but it can be overwhelming.

To add to that information overload, I’m going to offer a piece of advice of my own—but just one. My advice springs from a question regarding patient care that was asked of me by a good friend who is also a nurse. “Looking back, what would you have done differently?” she asked. Well, of course, there are many things. Hindsight has a way of allowing me to see the past more clearly and experience has a jarring way of bringing home the realization that I demonstrated a bunch of rookie behaviors. Those that I recall, though, were isolated instances unrelated to one another and would require many individual changes and, therefore, several nuggets of advice—and I’m keeping my promise of just one.

It is—ta da!—to get to know your patients. I mean really get to know your patients. Not just as ‘the gallbladder,’ ‘the fusion,’ ‘the triple bypass,’ and so on, but at least a little something about the person beyond the medical setting. Following this advice, by the way, will benefit you far more than it will the patient. You might assume I’m asking you to do this so that you can better skew your care to fit the patient and, yes, treating the ‘whole patient’ can result in better outcomes. But, that’s not where I’m going with this.

I have always been good at engaging patients in conversation and I’m not shy about asking questions. I have also asked patients for advice and opinions with a simple, “What do you think about that, Mr. Jones?” It sometimes astounds me that I vividly remember parts of so many conversations from years ago. I spent many years working with the medically indigent and it is humbling to recall the wise words and the personal stories of people who had so little and the lifelong impact they’ve had on me, a person of relative privilege.

In so many cases their words have stayed with me, shaping how I relate to others or to particular situations. There is a wealth of wisdom to be had in what we glean from our patients—wisdom that serves us well in our personal growth and in how we care for the patients in our charge. I treasure the life lessons I have learned from my patients. In many cases they have opened up my heart, increased my empathy for all others and slowed my quickness to judge. I owe them all a great deal.

I’m grateful for all I’ve learned but I know I could’ve done better and I regret that I didn’t. To restate my advice: as you teach your patients, allow them to teach you.

If you can pass along an example of a difference a patient made in your way of thinking or behaving, please do.

Will New TV Nursing Dramas Portray Nurses Accurately?

When it comes to medical dramas on TV, nurses haven’t been getting a lot of respect recently. Popular series such as House and Grey’s Anatomy mainly portray physicians. More often than not, nurses serve as secondary characters in these television series, and are seen lurking about on the fringes of the action. Small wonder, then, that despite the fact that nurses are highly skilled and saving lives every day, the general viewing public simply doesn’t get it. How could they, when they are being fed the wrong information?

But, hold onto your stethoscopes, nurses—hope may be on the horizon. The Center for Nursing Advocacy and, more recently, The Truth About Nursing, have long railed against the entertainment industry’s penchant for characterizing nurses inappropriately. The highly educated, highly skilled, life saving leader who is the real face of nursing has been nowhere in sight on TV—until now.

Two nurse-centric TV programs will begin airing in June. One, Nurse Jackie, debuts on June 8 on the pay cable channel, Showtime. It stars Edie Falco, of Carmela Soprano fame, as Nurse Jackie. She is an assertive, straightforward, plain talking, stand-up-for-her-staff kind of ER nurse who also is addicted to prescription painkillers. Showtime labels the show a comedy but the trailer I watched online was more drama than comedy. If I had my druthers I’d rather Jackie weren't wrestling with a drug problem, but television seems to feel that without a moral conundrum of some sort—in this case, having Jackie walk the line between saint and sinner—viewers won’t tune in. Whatever, let’s hope Nurse Jackie presents nurses in a more realistic light and focuses on the formidable clinical expertise that is the hallmark of the nursing profession. Showtime will make available to non-subscribers an online full-length episode of Nurse Jackie in early June, prior to its season premier on the for-pay network.

Then, on June 16, along comes Jada Pinkett Smith in TNT’s nod to nursing, HawthoRNe. Christina Hawthorne is the recently widowed Chief Nursing Officer at a busy Charlotte, North Carolina hospital. She is all about the patient and doesn’t mind overstepping her bounds to get whatever is needed, leaving doctors, administration and sometimes her own apathetic staff in her wake. Her cross to bear, for the sake of the aforementioned ongoing moral conundrum, is a rebellious teenaged daughter. Hawthorne suffers no fools and takes no prisoners—she is a formidable crusader for the cause.

NBC has also jumped into the fray with Mercy, a one-hour medical drama that focuses on three nurses and their lives inside the hospital and out. I liked the clips I watched. I couldn’t find a date for a season premier for Mercy so keep your antennae up. It will likely be in the fall lineup.

Hollywood has been solid in its stand that the public isn’t interested in shows about nurses, only doctors. That these shows have been developed at all is a huge step forward in the entertainment industry. Strong viewership is required for these programs to continue, so nurses need to tune in and we need to encourage others to do so. Do you plan to watch? I would be interested to hear what you think of these shows.

Should Nurses Have a Personal Mission Statement?

Every business, profession and organization seems to have a mission statement. That’s a good thing—it’s always good to know where we’re going, how we’re going to get there and why we are going in the first place. I view that sort of mission statement as a big umbrella under which employees collectively operate. But, what about the individual employee? Should each one have a personal mission statement—a plan, a promise or a direction to strive for?

The question, ‘What is your personal [nursing] mission statement?’ was asked recently on an online nursing forum.

On the subject of mispronunciation of words a few months back, this same forum received over 500 responses. The mission statement question has, in the 15 days since it was posted, elicited a mere 11. I’m not sure how I would analyze the difference in the number of responses. Does it mean that nurses are just showing up and doing what needs to be done with no thought as to a greater purpose? I have no way of knowing. It can’t be that they are too exhausted at the end of the workday to bother with something as insignificant as expressing an opinion on a forum thread. If that were the case, there wouldn’t have been 500-plus responses regarding the mangling of our language.

There was a mixed bag of responses to the mission statement question. Some were thoughtful and sincere: ‘to make a difference in someone’s life every day,’ ‘to treat every patient the way I’d like to be treated,’ ‘to make the world a better place,’ ‘to make people feel better about their situation.’ Trite, yes, but also noble goals.

Others began with a snippy comeback: ‘welcome to the dark side,’ followed by LOL and, then, a positive statement.

Others were decidedly negative: ‘to get through the day without being physically assaulted by patients or family members,’ ‘ to cover my [behind] at all times because no one else is looking out for me.’

One seemed angry that the question was even asked. Overall, if I counted those that began with jaded statements but then mellowed out, there were eight positive responses. Only three came from the seriously disheartened (or so it seemed).

One respondent thanked the person who posted the question and opined that it is one we should all ask ourselves.

I agree. It should be easy enough to come up with one simple sentence we can silently chant like a mantra on a daily basis, especially in challenging situations—something to hang onto when we are at our wits’ end, to remind ourselves of something positive we’d like to accomplish.

What is your personal mission statement, if you have one? Please share it here.