by Jim Murphy
There is nothing like being hospitalized to provoke thinking about healthcare! I recently spent a little over a day at one of Boston’s most prestigious medical institutions to have a cyst removed from my neck. The experience stimulated poetry (“The cyst was benign, and everything’s fine”) and provoked ideas, one being that hospital ratings are probably more determined by the quality of nursing than any other factor.
Notice that I am not saying “nurses are more important than doctors”! Rather, my thought is that when patient evaluations of hospitals are made (a big trend these days), nurses’ actions are more influential than doctors’.
For example, I learned that my surgeon did an excellent job. At least I was told so by a nurse! I was not there to judge, being under general anesthesia. In any case, one might question how competently patients can rate doctors; but they surely can tell how good nurses are at their jobs.
When in the hospital, who do you see more of – nurses or doctors? And who do you spend more time with? I spent a few minutes in conversation with doctors, but considerably more time talking with nurses.
Of course “it’s only logical” that one gets more information from and gives more information to nurses rather than doctors. One of my most vivid recollections concerns questions asked to me by an intake nurse. (“Do you have any trouble walking?” “Sometimes I get tired after twelve hours.” “Is there any person you are afraid of?” “Donald Trump” “Did you bring any weapons with you?” “Just wit and sarcasm”) And due to the recency effect another lasting impression came from how my nurse would not let me go – escorted in a wheelchair – until it was verified that the person who was picking me was there.
After all, who receives more training in caring and compassion – doctors or nurses? Well, maybe in reality neither gets such learning, but surely in literature and other arts nurses are more known for being benevolent.
Do hospitals in fact recognize the importance of nurses in their reputation? I get an e-newsletter from my health care provider every month. Each issue has an article about one of their doctors. Never a nurse! I would think that from both the sales and the employee relations points of view they might occasionally feature some other types of workers – not just nurses, actually, but food service, attendants, and administrative personnel.
As an experiment in hospital appreciation of nurses, I typed “we have the best nurses” into Google and scrolled for ten pages without finding a hospital ad or web site. I did find a nice piece on “five reasons why nurses are true heroes in health care” – not on a hospital site but one selling uniforms.
Hospitals are currently struggling to recruit and contain nurses, with some offering them large bonuses So one might think that they would be attentive to the importance of nursing in all their communication. Yet when I go the web site of the most highly rated hospital in New England the index page does not contain the word nurse! Granted, if you look for it, you can find information about their nursing operation and history. But I still think hospitals are missing out by insufficiently emphasizing one of their most visible assets.
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Thank you for this post, Jim. I think your ‘research’, as informal as it is, speaks to an underlying problem. That is that nurses are not truly valued for the work we do. This shows up in staffing inadequacies and rising violence against us. There is a lack of self-respect I think too that shows up in burnout and difficulty in self care. There are individual and organizational factors keep this paradox alive: we are the most trusted profession but not the most respected.
What can be done to change this? Hint: Consider that in many ways teachers are facing the same negatives.
Hi Jim,
As you know, it is a big question and very important to start asking it and listening to others ideas!! That would be an important step in going from any toxic culture, (including bullying, blaming or any environment where some people are not respected) to a learning organization where there is a dynamic exchange of giving and receiving constructive feedback, listening and respecting limits of others, expressing limits respectfully including asking for help, delegating, compromising and at times, saying “No”. While this topic deserves a whole book and long term commitment by leaders, some additional thoughts for leaders include setting a clear vision and expectations around behavior, apologizing for poor conduct in the past, setting up mandatory training in giving and receiving constructive feedback, Medical Improv for soft skill development, an Employee Assistance Program, Coaching services, honoring staff learning curve and eventual discipline for those who can’t or won’t meet expectations. Also adequate staffing is a priority. This includes direct care staff and security staff. For individual nurses, I think we need to develop a plan for self care and self respect as well as respect for our colleagues. Even when their needs and abilities are different from our own. That’s my short answer. What would you say?
We need a revolution: A world in which nurses are directly involved in decisions that affect their practice, employ full advocacy for our patients, speak up and out when care is compromised…a world in which this is valued in behavior and not simply words on a mission statement or policy. As the ones who spend the most time with patients, the ones uniquely trained in holistic care of patients, the ones required to fill a hospital bed, the most trusted Of all professions for 20 years in a row…. We need full, “real” organizational support for professional autonomy and full practice engagement…
Nicely said, Deb.
A revolution can begin with a single action!
Indeed, Jim! Indeed.