Washington state Sen. Maureen Walsh apologized on Monday for her comments that nurses “probably play cards” during much of their shift, but it would be a shame and disservice if we glossed over the real story behind her words. Unfortunately, her opinion is representative of a vast majority of citizens who do not accurately perceive or understand the role of the nurse, nor the implications for themselves.
In a symbiotic relationship (in which neither can exist without the other), physicians and nurses save lives and heal the sick, injured and confused. The nurses’ role in this partnership is to critically assess and give real-time feedback on your care plan, execute treatments and medications, and constantly monitor for signs and symptoms of improvement or distress while educating patients and family.
In only an eight-hour shift, nurses perform more than 160 tasks with no task taking longer than three minutes. As a previous nurse manager and national educator I can vouch that the insane level of activity required to protect our patients has escalated dramatically over the past decade as hospital stays shorten, acuity increases and the electronic record compresses our time. This frenetic pace is irrational, and dangerous — for you.
The nurse’s role is underestimated for several reasons. Television shows such as “Grey’s Anatomy” have virtually no nurses, while “ER” has 10 doctors to every nurse, when in reality the ratio is reversed. The media do not depict the nurse giving the critical dose of epinephrine, paddling the heart, or racing to start an intravenous line. So the public thinks the doctor performs all these interventions while the nurse is in the supply room waiting for the next kiss.
Another reason is that so much of nursing is unspoken and invisible. The patient believes I am coming into the room to “check” on them. I do not explain as I turn them over in the bed that I am inspecting their skin turgor (dehydration) and assessing the urine output as I count respirations while listening for the page for the physician who I called for another vulnerable patient, and the call light from the next room where I have helped another to the bathroom. All this is in my head — and on your chart.
No doubt rural hospital leaders are desperately trying to figure out how they can financially survive even one more mandate, while nurses work 12-hour shifts without breaks or meals. Both realities must be validated. This is the dangerously dysfunctional business model of health care that we as citizens have endorsed. And the answer is not mandated breaks or staffing. That is the wrong fight.
The nurse who runs for the crash cart to save your life long before the doctor arrives or identifies the early warning signs of a heart attack or sepsis; the nurse who critically evaluates the safety and efficacy of every drug … this nurse is also smart enough to know how many nurses are needed to adequately staff the unit. Furthermore, the charge nurse is the only one at the point of care with the critical information required to make this decision: the real-time acuity of the patients, and the experience of the oncoming shift.
In the current system, the only cards that are being played are with your life. Being admitted to a hospital is the third-leading cause of death in America. And inadequate support for and understanding of nursing is a major contributing factor. If our elected leaders and the public accurately understood the pivotal role of the nurse, nurses would have the authority and autonomy to keep you safe. And hospital administrators would be budgeted to support these changes.