Zurawik: Let's stop the Hitler talk in the media

Flying scalpels and the future of health care

Op-ed: Have you ever seen a physician throw a scalpel? 5 to 10 percent of nurses have.

Have you ever seen a physician throw a scalpel? I started asking that a few years ago when I speak to groups of nurses. Each time I ask, 5 to 10 percent of the attendees raise their hands. "What would you do if someone threw a sharp knife across a crowded coffee shop?" I ask. "Call the police," they say.

But nurses rarely call the police when this happens in a hospital. They know that hospital administrators would be more likely to sympathize with a stressed-out surgeon than a nurse questioning the actions of a powerful "revenue generator."

Nurses, by contrast, are often seen as "cost centers." In fact, registered nurses are autonomous, college-educated professionals. They have a unique scope of practice that emphasizes prevention, education, patient advocacy and skilled monitoring. And hospitals exist to provide nursing care; otherwise patients would go to outpatient centers.

But insurers refuse to reimburse hospitals independently for professional nursing. Instead, they bundle nursing with the pillowcases and oatmeal.

The lack of respect for nursing wastes lives. Although nurses may not face a flying scalpel every day, too many do face critical issues that threaten patients directly: severe understaffing and a lack of professional respect commensurate with their real value.

One example is health care errors, which are now the third leading cause of death in the U.S. Nurses are the professionals most likely to catch and prevent an error. They could prevent many more if their clinical perspectives carried more weight — as Johns Hopkins safety advocate Peter Pronovost has argued — and if they were not stretched so thin that many can't get a bathroom break on a 12-hour shift.

In the 1990s, health care cost-cutting began to overwhelm nursing care. Insurance companies slashed patient length of stays. Decision-makers had little idea about what nurses actually did for patients and so they began replacing nurses with less expensive techs and medical assistants. These workers dress like nurses, but they are no more capable of replacing nurses than they are physicians. So patients die.

May 12th is the birthday of Florence Nightingale, the founder of the modern nursing profession, so we celebrate Nurses Day. Nightingale was a fierce advocate who pressed government officials for enough resources to save patients. She also fought to establish and maintain nursing's professional autonomy. In Nightingale's era, nurses founded and ran hospitals, and they decided how much nursing care patients needed.

Today, business executives and other non-nurses run hospitals and decide how much nursing care to allot patients. With cost-cutting as their overriding goal, the results are disastrous. A landmark 2002 study showed that post-operative patients are 31 percent more likely to die when a nurse's workload is doubled from four patients to eight. Yet many hospitals continue to saddle nurses with dangerous workloads. This doesn't just kill patients; it drives skilled and conscientious nurses away from the profession.

The deadly lack of respect extends beyond the hospital setting. Kids suffer when there is no professional nurse at their school, a common occurrence today. Nurse-family partnerships, in which nurses guide young mothers, are funded at less than 3 percent of their current need. So we have more child mortality, abuse, crime, substance abuse and other problems that nurses could have prevented.

Meanwhile, much of the popular media reinforces a narrative in which nursing is of no real interest or consequence. Each year new television dramas celebrate the training and practice of physicians, while nurses are at best diligent assistants, at worst meek order-takers with hardly more knowledge than a layperson. On TV, physicians perform defibrillation, high-stakes triage and complicated ICU care. But in real-life, this is the work of nurses.

So for Nurses Day this year, let's skip the annual ritual of patting nurses on the head. Instead, give nurses what they need to protect patients: mandatory ratios of four patients or fewer in hospitals, at least one professional nurse for every school, full funding for nurse-family partnerships, and a majority of nurses on every hospital board. The list is longer, but those would be a great start.

And please join nurses and their supporters on the National Mall in Washington, D.C. Thursday, when we will rally for federal legislation requiring safe staffing ratios. The lives of your loved ones depend on it.

Sandy Summers is founder and executive director of The Truth About Nursing and co-author of "Saving Lives: Why the Media's Portrayal of Nursing Puts Us All at Risk." Her email is ssummers@truthaboutnursing.org.

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