In Defense of Nursing

December 11, 2009

As a family nurse practitioner student, people regularly ask me a question that I find extremely rude:

“So why didn’t you just go to medical school?”

All nurses who are labelled as achievers, as do all male nurses, get asked this question frequently. People don’t understand why anyone would choose to become a nurse rather than a doctor. They assume that this decision is evidence of the fact that you must not “measure up” or “have what it takes” in some way. These assumptions have saddled nursing with a bit of an inferiority complex (here I go with inferiority complexes again), which we cope with as best we can by fortifying our discipline with ever-improving arms of academia and clinical expertise.

Although nursing and medicine are related, they are distinct disciplines. We’ve had our own pioneers, our own theorists and researchers and clinical heroes. For me, the difference comes with how we are taught to conceptualize things like health, wellness, disease, treatment, power, and empowerment. Nurses seek to address the patient holistically, as a balanced ecosystem of body parts, chemical reactions, cultural components, social bonds, economic resources, developmental stages, and idiosyncratic quirks. A nurse practitioner aims to use not only empirical or scientific knowledge in the battle against illness, but also personal, ethical, aesthetic, and sociopolitical knowledge as well. We’re trying to improve our understanding of how broad determinants of health, such as socioeconomic status, influence the human beings that we care for. And though we seek to sharpen our clinical judgment and expand our arsenal of skills in order to keep pace with modern medicine, we keep the focus on the global picture. This is the direction that nursing leadership is and always has been pursuing.

Of course, I’m biased towards my own profession, but I didn’t start out this way. I went into nursing with a very low opinion of the field. My only plan was to use nursing as a bridge to medical school. But my time in the real world, my experiences within the healthcare system and by the bedside profoundly influenced me. Which is why I really loved this column on nursing published by the Kaiser Family Foundation. It really rings true to me by acknowledging how nurses are trying to impact the system and how nurses contribute to improved medical outcomes. The article reviews some of the progress that nurses have made in the past ten years in terms of influencing how care is delivered. The authors describe nursing as undervalued, which is a statement that’s often thrown around flippantly, but they show the sad truth behind the statement. For instance, despite the fact that nearly half of all health care workers are nurses, and despite the fact that nurses deliver the vast majority of bedside care, only 2% of hospital boards include nurses on them.

Given the current health care climate within the larger global picture, nursing’s struggle against insane policies and practices (everything from understaffing and poor utilization of human resources to global inequities and evil economic practices) is an uphill battle. But I have confidence that nurses will succeed in shaping a more humane, more sustainable health care system in the future. I hope this blog post adequately captures how honored I feel to be in such good company as we move forward with our committment to a better world. I also hope I finally put to rest all those questions why I didn’t choose medical school. And nursing, if you couldn’t already tell, I love you.


Save the Date… and save the NM nursing practice act

September 16, 2009

New Mexico is in danger of losing its nursing practice act, along with its board of nursing, because the legislation is up for reauthorization come June 30th 2010. The New Mexico Nurses Association invites nursing advocates to join Capitol Challenge 2010 in Santa Fe on Jan. 28, 2010 in order to learn about the legislative process and support nursing and policy advocacy.

I myself will be making the grueling 40 minute drive from ABQ to attend. I can fit four other people in my car. Be warned: anybody who carpools with me WILL be forced to go to Marias or Tomasitas afterwards for margaritas. Nothing is better than drinking with other nurses and talkin’ shop. For the most ideal drunken story-swapping session, I need at least one or two ER nurses, somebody from ICU at maybe a CNM or community health nurse. Anybody interested in throwing together an exhibit for the Nurses day at the Capitol should contact me as well. I’m thinking cute matching scrubs, free blood pressure screenings and funny yet informative educational pamphlets or cards with information on what exactly an advanced practice nurse is (since no one in the public seems to know) along with important resources for the underserved in our state. Nurse friends, I hope to see you there.

Do I dare disturb the universe?

July 22, 2009

14th president of the United States Mr. Franklin Pierce would have faded into the unglamorous historical background of political insignificance had it not been for his single famous quote, “Life sucks and then you die.” This quote has survived into the present day, despite solid counter arguments put forth by humble scholar Denis Leary. Although the quote’s shallow, exasperated humor may resonate with sufferers of middle-class ennui, many victims of tortuously slow terminal illness might take issue with the factual basis of the statement. For instance, sometimes life sucks and then you don’t die… you keep on living with unrelenting pain invading every crevice of your skeleton, or brain-eating dementia annihilating your memories, or a lack of control over your own body leeching you of your autonomy. Unfortunately for the aforementioned unfortunates, Washington and Oregon are the only two states in the union that have legalized physician-assisted suicide. As per the country at large, I find the whole “right to die” debate has been twisted into tiresome headwork that’s spring-loaded with hypocrisy and fear. Although The State does not really take an interest in your education, your access to health care, or your corporation’s carbon footprint, it somehow decides to take an interest in your life once you’re riddled with cancer and longing for death. Weird, huh? You can brush up on the fascinating right-to-die debate here.

There are a few different caveats worth noting. The issue of practical concern is not really whether you have the “right to die”: the issue is whether you have the right, under certain circumstances, to a medically-facilitated death. If you have a right to a medically-faciliated death, that implies that someone with a medical background has the right to facilitate your death. If health care providers have the right to prescribe a therapeutic death, what kind of patients and what kinds of deaths should be covered by your supplementary insurance plan? And how do we write laws that prevent the Kevorkians out there from getting all trigger happy?

The right-to-die debate received a brief resurgence last week, at least amongst opera-loving folks (most of whom have reached that age when right-to-die starts to take on a personal significance), when British conductor Sir Edward Downes and his wife ended their lives in a Swiss suicide clinic. Fo’ real? Switzerland has suicide clinics? That sounds nice. Oh, wait. I’d probably rather die at home. Is that not legal in your state or country? For a nominal fee, you can go on suicide holiday! Can’t afford that? You didn’t hear it here (in fact, you heard it from the NIH), but I’m pretty sure heroin makes you stop breathing the same way morphine does.

On a personal note, death is interesting, and scary, and sad and stuff. I held a guy’s hand yesterday as he took his last breath. This has happened many times during my career, since we have a lot of hospice patients on my floor . It’s always a primordially-charged experience for me. My last words to this particular patient were “at least you still have a full head of hair!” Obviously, I did not know he was going to die. I had just arrived on shift and the patient was handed off to me with the assurance that, although he was a hospice patient, he was as strong as a horse. At least the man’s family was there. And I’m not some DNR/DNI-loving angel of death or anything. It was hard to realize that the man was done breathing and I was legally prevented from doing anything about it. But it seemed to be a peaceful death, whatever that means. It’s an honor to be present during someone’s last moments of life, just as it is an honor to be present at someone’s first moments of life (with the latter being generally more joyous.) But with death being like the biggest thing that the (presumably) conscious mind has to grapple with (besides the Snuggie phenomenon), I can see why people are so weirded out by the notion. I got the heebie-jeebies when I zipped that sweet man into the body bag. I even shuddered when confronted with the thought that, someday, someone would be zipping my wonderful mother, or my beloved sisters, or my indispensable self into one of those bags. I just don’t think the weirdness my own (alleged) mortality, or the painful thoughts of losing my own loved ones, or even my own conviction in the eternal discomforts of hellfire, should prevent someone from pursuing a humane, supportive end to their suffering. And I’m pretty sure we can find a way to legislate this without giving permission to a bunch of homicidal psychos to start “euthanizing” anybody in a hospital bed. Besides, most homicidal psychos go into patent law anyways.

What do you think?