Ok,I work in a city hospital as an RN in new york. It is so busy sometimes you don't have time to breathe. I was asked by my nurse manager to write something on what nurses do so that she could give it to the doctors. The doctors told her that they have no idea what a nurse does all day. PFFFT! Anyway I am overwhelmed and have started a list of what nurses do so that I can write something using it. I want to hear from other nurses who could possibly think of things that are slipping my mind at the moment. Its a big job to try and explain all the things we do on any given day, because every day is so different. I feel that the doctors need some good education ( maybe they'd show us an ounce of respect then? or is that wishful thinking?) Any help would be greatly appreciated. I want to write a really good response. Thanks in advance!
Heres a few things I jotted down real quickly:
Monitor vitals
assess for pain
teach
listen
Advocate for patients
determine if orders are complete/appropriate
communicate with all levels of hospital employees
(doctors, nurses, dieticians, social workers, respiratory therapists, pharmacists, , even nonlicenced personnel such as housekeeping, families, kitchen and phone/TV)
Assess for changes in patients condition
Assess for actual or potential problems with the patients health status or safety
Perform care for total care patients
Tasks like suctioning, trach care, feedings, blood transfusions, ekgs, drawing blood, start iv's, start Foleys, acquire samples for the lab, check orders and make changes accordingly, interpret cardiac strips, calculate I and o's
Ok, so I wrote it...came up with 3 pages, still am not totally satisfied with it but I gave it to my NM. I will keep my ears open to hear the feedback. I think they have some sort of a meeting on wednesday. I tried to keep my negativity out of the paper (not so easy to do). I am glad its over but I almost feel like its wasted time and energy. They will never give us the respect we deserve!
Not a chance. I have enough work to do as is. I would have told the NM that if she truly believed in this, she could do it herself. Also that at work Im too busy taking care of patients to accomplish this task. Also that my free time off is far to valuable to me to even consider getting in on this endeavour. Not, that I would have done to begin with.
No MD would have ever even asked me for something like this. He would know my answer before he even asked.
I get all the respect I deserve, I have worked for it, I have earned it, and it is totally given to me.
Here is an article from Advance Practice in Nursing eJournal. It can be found at http://www.medscape.com/viewarticle/520714 but I quoted the entire article here. The section most pertinent to your question is underlined. (By me, not in the original article.) We can make task lists all day long, but that will never explain what nurses really do. This comes closer...
Several weeks ago, I was invited to speak to a group of undergraduate students who had been asked to read my new book, Nursing Against the Odds, for their history of science class at Harvard University. During the hour-and-a-half discussion, one question that kept popping up was: "What do nurses really do?" As I left the room, I pondered, as I often do, why the public has so little understanding of the consequential nature of nursing practice. Clearly, it's because of traditional stereotypes about nursing. But it's also because nurses have been socialized to be silent about their work or to talk about it in ways that fail to reverse these traditional stereotypes.
When I ask nurses to describe their work, many respond: "Oh it's too hard to talk about. It's too diffuse, too vague, too indefinable." But I have written thousands of pages about nursing and I am not a writer of fiction. I've been able to write about nursing because I've observed nurses at work and asked them a lot of questions about their practice.
What Nurses Do
Here is what I think nurses do. Using their considerable knowledge, they protect patients from the risks and consequences of illness, disability, and infirmity, as well as from the risks and consequences of the treatment of illness. They also protect patients from the risks that occur when illness and vulnerability make it difficult, impossible, or even lethal for patients to perform the activities of daily living -- ordinary acts like breathing, turning, going to the toilet, coughing, or swallowing.
Even the most emotional work nurses do is a form of rescue. When nurses construct a relationship with patients or their families, they are rescuing patients from social isolation, terror, or the stigma of illness or helping family members cope with their loved ones' illnesses.
What do nurses do? They save lives, prevent complications, prevent suffering, and save money.
Why do nurses have a hard time explaining such compelling facts and acts? As Sioban Nelson and I have argued in a recent article in the American Journal of Nursing,[1] it's because they've been educated and socialized to focus on their virtues rather than their knowledge and their concrete everyday practice. They've been taught to wear their hearts and not their brains on their sleeves as they memorize and then reheorifice the virtue script of modern nursing.
If you analyze the words and images of campaigns used to recruit nurses into the profession or listen carefully to the stories nurses tell about their work, nurses may not use the available research to fully explain why what they do is so critical to patient outcomes. Although many studies, conducted by nursing, medical, and public health researchers, have documented the links between nursing care and lower rates of nosocomial infections, falls, pressure ulcers, deep vein thrombosis, pulmonary embolism, and deaths, most promotional campaigns and many stories nurses themselves tell about their work ignore these data.
Instead, nurses focus on their honesty and trustworthiness, their holism and humanism, their compassion, and their caring. The problem is that when they focus on caring, they often sentimentalize and trivialize the complex skills they must acquire through education and experience. They often fail to explain that caring is a learned skill and not simply a result of hormones or individual inclination. After all, knowing when to talk to a patient about a difficult issue, when to provide sensitive information, when to move in close to hold a hand or move away at a respectful distance all are complex decisions a nurse makes. To make these decisions, nurses use equally complex skills and knowledge they have mastered. But all too often nurses make these skills and knowledge invisible or describe nursing practice in terms that are far too limited.
Nurses are still talking about themselves -- or allowing themselves to be talked about -- in the most highly gendered, almost religious terms and allowing themselves to be portrayed with the most highly gendered, almost religious images. Indeed, as Nelson and I argue, with the best intentions in the world, many modern nursing organizations and nurses reproduce and reinforce traditional images of nursing as self-sacrificing, devotional, altruistic, anonymous, and silent work.[1] Just think of one of the jingles in the recent Johnson & Johnson image campaign:
You're always there when someone needs you
You work your magic quietly
You're not in it for the glory
The care you give comes naturally.
Historical Images of Nursing and Nurses
Unfortunately, like those above, many of the images and words nurses mobilize reflect the religious origins of the profession. Nurses in religious orders were socialized to sacrifice every shred of their individual identity, to be obedient members of an anonymous mass. Religious nurses were taught not to claim credit for their work and accomplishments but were instead supposed to view themselves as divine instruments who willingly assigned the credit for their accomplishments to God, the Bishop, the Abbot, or the Mother Superior.
Most importantly, these images reflect a time when nurses were taught to Say Little and Do Much because to talk about a good deed was to turn it into a bad one -- to exhibit the sin of pride. What nurses could accept were compliments for their deferential behavior and angelic virtues. What they could talk about was self-sacrifice and devotion and the outside agents they served.
If you look closely at the history of the problem of nursing visibility, you see that this religious depiction of nursing was not only a relic of the origins of nursing in Christian penitential practice but was also a legacy of the 19th century movement to professionalize nursing. In the 19th century, religious and social reformers like Florence Nightingale adapted the religious template to help women who wanted and/or needed to work outside of the home find purposeful paid work. In a society where gender roles were very rigid and people prized modesty and innocence, reformers needed to make it safe for female nurses to work in public spaces with strangers -- mostly strange men.
Nurse reformers helped respectable women affect this passage by borrowing religious images, costumes, language, and metaphors. The nun's cornette was transformed into the nurse's cap. In English-speaking countries, nurses were called "sisters."
Nurse reformers tried to desexualize nurses just as nuns (women who weren't really women) had been desexualized before them. Nursing students wore ugly uniforms, were not allowed to marry, and were sheltered in cloister-like dormitories in or near the hospital. Nurses were said to be self-sacrificing and morally superior and would thus create order out of the chaos of the 19th century hospital.
Focusing on nurses' virtues also helped nurses in their long battle with medicine for what became, in the 19th century, the highly contested terrain of the hospital. Before the 19th century, very few doctors had ever set foot in a hospital. In the 19th century, scientifically oriented doctors were moving into the hospital in greater numbers and wanted to control the hospital. They were not pleased to see a group of women who wanted authority and education competing for a sphere of influence (even a separate female sphere) inside the hospital.
Doctors were happy to have trained nurses but only if they were their servants. They wanted nurses to know what to do and how to do it but not why they were doing it. They didn't want anyone to know if a nurse had acquired scientific, medical, or technical mastery. Because nursing at this time was feminized, women with no political, legal, economic, or social power had to make a deal with medicine, and the deal was that nurses could have virtues but not knowledge.
In the 19th century, nursing was thus constructed as self-sacrificing, anonymous, devotional, altruistic work. While this was a functional bargain to make over a century ago, this template reigns today in spite of the fact that things have changed dramatically for women -- which is why it's time for a change.
Now Is the Time for Change
I believe the public knows that nurses are kind, caring, and compassionate and that they provide patients with more information than doctors do. People don't know, however, that nurses have medical knowledge, participate in medical cures, and have technological know-how. I believe nurses can advance knowledge of their profession if they amplify their caring stories and include anecdotes that help us understand that doctors don't do all the curing.
The public needs to know that nurses -- regular, ordinary bedside nurses, not just nurse practitioners or advanced practice nurses -- are constantly participating in the act of medical diagnosis, prescription, and treatment and thus make a real difference in medical outcomes. Nurses can help the public understand that nursing is a package of medical, technical, caring, nursing know-how -- that nurses save lives, prevent suffering, and save money. If nurses wear not only their hearts, but also their brains on their sleeves, perhaps the public, like those students at Harvard, will finally understand what nurses know and do.
References
Gordon S, Nelson S. An end to angels. Am J Nurs. 2005;105:62-69.
Suzanne Gordon, Assistant Adjunct Professor, School of Nursing, University of California at San Francisco; journalist, Arlington, Massachusetts; author, Nursing Against the Odds: How Health Care Cost-Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care (Cornell University Press, 2005)
Disclosure: Suzanne Gordon has disclosed no relevant financial relationships.
Specializes in psych -22 yrs, med-surg and a little OB.
Well, I hate to sound jaded, but this sounds exactly like the kind of thing a student would say. For those of us who have been in the trenches for decades, we know exactly what this sort of exercise means. We've seen it before, many times, in many forms. Just wait until you've got a few years behind you; you'll see.
I find it stretches credulity that someone could grasp complex disease processes and their respective treatments, work alongside nurses who care for their patients and carry out those treatments they order, yet then they claim with wide-eyed innocence that they have no idea "what nurses do." Sorry, that just doesn't pass the smell test. Then it's the nurses' responsibility to make the doctors a list? No way--that sort of intellectual laziness is inexcusable. If they really want to know, they can jolly well seek out the nurses--it's not like we're that hard to find--and educate themselves.
Amen! But it sounds more like a teacher - someone who's never been in the trenches - or has been out so long they don't remember. Honestly, I do think this NM is trying to educate the doctors after one of them made an off-hand remark about "well, what do they do anyway?" - but was never sincerely interested in knowing. I have never - NEVER worked with a doctor who had either the least idea of what we did or of learning what we do. I was in school 22 years ago after wanting to be a nurse since age 5. My dream became a reality when I passed my NCLEX at age 36 and my dream died during my 36th year. I have continued to work as an RN and tried to just focus on helping my mentally ill clients - but I've been blackmailed by doctors (withholding needed med orders until I apologized to him for reporting him after he was not available for 3 hours during a medical emergency when he was on-call) accused of "making me discharge people" (doctor who would discharge no one who hadn't been on the acute care unit a min. of 14 days), told I was not a patient advocate and was not to act like one- by a PhD director of services, etc. etc, etc........ the list goes on.........
Now I'm counting the days - 2 years and 132 days until I can retire. Do I sound bitter? You better believe it. But I had 4 children to raise alone and very occasionally a patient actually was better for my having been there.
Now planning to become a small engine mechanic. Lord help the doctor who needs his mower or chain saw repaired. None of my children are working in healthcare and I would not encourage it. I know those not all doctors are as bad as what I've met, but I don't know the good ones.
This just makes me ill. No wonder we can't make any headway when we have to fight against this sort of dreck.
Yes, I care. But I didn't take a vow of poverty, a vow to destroy my health, forsake myself for everyone else, etc.
Nursing is not martyrdom.
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That's why I support The Center for Nursing Advocacy. I think they sometimes need to choose their battles, but over all they are doing important work to change the image of nursing. I highly recommend that you check them out and write letters as they suggest. They do the work, all we have to do to support them is sign and send letters and emails. Especially check out their info on Gov. Corzine and the DOT spot. Talk about nauseating...
Most people miss what we do because it is often subtle. Talking to a patient about the weather involves observing the patient's affect, his orientation, his speech patterns, and his overall attitude. Looking at him we note skin color, moisture, turgor, patency of all tubes, condition of observable wounds and dressings, condition of bed linen, and (during the day) nutrition, and teaching him about the reason we are there. This is in a 2 minute interaction during a med pass. We are there 12 hours and we are working all the time and THAT is what nurses do.
It's why the greatest predictor of a good outcome for a patient is a nurse at the bedside.
this is going to vary depending on the type of nursing you are involved in.I think the nursing article covers the basic things all nurses need to use to be a good nurse.But as an example what i encounter and have to handle working in long term care is different than the hospital nurse.I still have to assess my residents and when their sick send them out to hospital,take care of their pain,Listen to their concerns and their FAMILIES,encourage to eat and drink when the appetite is gone,assist in adl's and ambulation,be at bedside when they are dying and support them so they can leave this world the way they want with diginity.We are the eyes,ears,and hands for the doctors in long termcare.I would say that 90% of the doctors I have contact with know that and appreciate nurses.I did have one doctor tell me he did not like coming to a nursing home because it was like watering dead flowers.I told him that he shouldn't come-we did not need any gardners here.His associate came after that and he never returned.The rest of the doctors count on us to fill them in on their residents and their needs and show us respect.I know this did not help with your request but it will give you a different view of what is out there from a nurse of 40 years
I have, and for several years was a supporter. Regrettably, I can no longer give them my support.
That's why I support The Center for Nursing Advocacy. I think they sometimes need to choose their battles, but over all they are doing important work to change the image of nursing. I highly recommend that you check them out and write letters as they suggest. They do the work, all we have to do to support them is sign and send letters and emails. Especially check out their info on Gov. Corzine and the DOT spot. Talk about nauseating...
Specializes in DIALYSIS, ICU/CCU, ONCOLOGY, CORRECTIONS.
I find it disheartening that your NM, who i will assume was a nurse at one time, is unable to tell a physician what the nurses do. Are they so far removed that they are unable to remember and must ask the individuals that they manage, what exactly the do in the course of their day. SOME ONE SHOULD ASK THEM HOW THEY ARE QUALIFIED FOR THEIR JOB.
Specializes in oncology, surgical stepdown, ACLS & OCN.
The doctors need to know what nurses do?
That's one line. Nurses keep doctors out of court.
Who cares about the rest from the doctor's standpoint?
I feel that nurses oversee what the Doc orders and makes sure orders are followed along with alot of things we nurses think of and the pt may need, we get orders from the doc, and yes we do keep doctors out of court!
A Vow of Silence?
teeituptom, BSN, RN
4,283 Posts
Not a chance. I have enough work to do as is. I would have told the NM that if she truly believed in this, she could do it herself. Also that at work Im too busy taking care of patients to accomplish this task. Also that my free time off is far to valuable to me to even consider getting in on this endeavour. Not, that I would have done to begin with.
No MD would have ever even asked me for something like this. He would know my answer before he even asked.
I get all the respect I deserve, I have worked for it, I have earned it, and it is totally given to me.