What do nurses do?
This is such a seemingly simple question, but a hard question to answer simply. Why is it so difficult to articulate what nurses do?
Orthopods fix bones. Chefs cook. Entertainers sing and dance. Accountants prepare tax returns.
Nurses….well, nurses….give meds? start IVs? hold hands?
What do nurses do? The Nurse Stereotypes
Maybe we can get some help by asking Dr. Google. Try googling “nurse images” and see what you get. Wait…on second thought, maybe not.
According to the media, nurses flirt with patients and doctors, stand nearby in provocative poses, and look pretty while handing the doctor a syringe so he can give an injection. Or follow the doctor as he wheels the patient out for discharge. And they seem to have a lot of time on their hands for romance at work. Sexy handmaidens?
Alternatively, we have Nurse Ratchet (from One Flew over the Cuckoo’s Nest).
Controlling, pain medication with-holding, cold and sadistic. She’s scary. Of course, she’s an outlier, a rogue nurse. But an image nonetheless.
On the opposite side of the spectrum there’s Florence Nightingale, our patron nurse, who is still held in the highest regard.
So we know there are several different and mixed images of nurses and nursing out there in the public’s mind.
Overwhelmingly, though, as a profession, nurses are well liked and are assigned positive attributes. In the most recent Gallup poll, nurses were viewed as the most honest and ethical profession when compared with doctors, police officers, clergy, and others.
Traditionally, nursing has been construed as self-sacrificing, anonymous, devotional, altruistic work.
Most Americans agree that whatever it is that nurses do…it’s good. It’s a good thing.
But that still doesn’t answer the question “What do nurses do?” Let’s see what patients and families, nurses themselves, and others say when asked.
What do nurses do? What patients and families say:
Patients for the most part only see the tip of the iceberg.
A nurse friend of mine was criticized by a family member for being “too intense” and “not friendly” at the end of a twelve hour ICU shift. A twelve hour shift during which an intra-aortic balloon pump was inserted, central lines placed, and multiple drips titrated, all to keep the family member’s loved one alive.
My nurse friend was challenged and stretched to her absolute limit that day. The memory of that criticism still hurts.
Ironically, this same family member had nothing but praise for the ICU intensivist, who is one of the most dour, if not downright sour, individuals I have ever met. He doesn’t make eye contact, is aloof and has only one facial expression which makes one concerned that he is having a bad case of indigestion.
This is not to say that most patients and families are not appreciative. They are.
They do not, however, in any way understand the depth and breadth of knowledge and experience required to make safe, split second critical decisions amidst a background of constant interruption and crisis, and a cacophony of up to fifteen different alarms sounding, all on an empty stomach with no break in sight.
What about nurses, then? What do nurses say when asked “What do you do?”
While nurses understand what we do, we don’t often articulate it well enough for the public to understand.
What do nurses do? What nurses say:
Even nurses have a hard time explaining what nurses do. And that’s a problem in itself. If we can’t articulate what we do, then we cannot expect the public to, either.
Mr. Einstein would concur.
If you can’t explain it to a six-year old, you don’t understand it yourself Albert Einstein
I posed the question to nurses recently in a popular social forum and got all sorts of replies.
Here is what nurses say they do:
“We save lives and when we can’t, we give the dying some dignity and peace. We make someone’s worst day a little more tolerable with compassion, humanity, and ice chips.”
“…There is only one thing we say to death. Not today.”
“Except on those days when we say “let me help you die with dignity.” Or the days when we say “this one’s futile. Get the family in here so they’ll tell us to stop compressions.”
“We nurse. We care.”
These are some thoughtful, heartfelt answers from nurses in the trenches and they all hold truth.
But even nurses fail to completely satisfy the question “What do nurses do?”
Let’s look at one of our professional organizations.
What do nurses do? What the American Nurses Association (ANA) says:
Here’s what the ANA says nurses do:
- Perform physical exams and health histories
- Provide health promotion, counseling and education
- Administer medications, wound care, and numerous other personalized interventions
- Interpret patient information and make critical decisions about needed actions
- Coordinate care, in collaboration with a wide array of healthcare professionals
- Direct and supervise care delivered by other healthcare personnel like LPNs and nurse aides
- Conduct research in support of improved practice and patient outcomes
This is very good, but to me it sounds more like a job description. It is comprehensive, and far be it from me to critique the ANA.
But I can’t say it captures the essence of what nurses do. So then, what does this author say when asked “What do nurses do?”
What do nurses do? Nurse Beth says:
What nurses do is more than the sum of the parts. By far.
If you think about it, almost all psychomotor skills, all tasks that nurses perform, could, in theory, be safely delegated to a trained individual. Foley insertion, fingersticks, dressing changes, inserting NG tubes, newborn heel sticks, IV insertions.
After all, med techs in doctor’s offices and interventional diagnostic centers can start IVs and push meds. Techs and CNAs can do fingersticks in some settings. For that matter, patients do their own fingersticks at home!
But that doesn’t make patients, CNAs, or med techs nurses.
I know some nurses who define themselves by their IV insertion abilities, or expert cervical checks. They are not giving themselves nearly enough credit.
Because even if all their tasks were delegated… the Registered Nurse is still needed!
To think. To think critically. To determine when to perform the task, and how to interpret the results.
To coordinate all patient care. To helm the ship.
Nurses ensure safe passage
I’m not sure what person to attribute this quote to, but it is coined by the American Association of Critical Care Nurses (AACN).
I love it. I agree with it. This is what I think nurses do:
Nurses ensure safe passage
I can’t add to, or elaborate on, this statement.
It is powerful and complete. Nurses ensure safe passage.
From the moment a registration clerk applies the ID wrist band to the moment of discharge.
Nurses ensure safe passage through surgery, childbirth, illness, trauma, chemotherapy, through the dark hours before dawn, and sometimes even through life itself.
Nurses ensure safe passage through their observations, astute monitoring, skillful hands, quick assessments, caring, intuition, and timely interventions.
The next time I am asked “What do nurses do?” I will answer “We ensure safe passage”.
So with that I close with the question “What do you think nurses do?”
Until next time friend,
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This post is dedicated to an influential and visionary nurse leader I’ve been honored to work with, Chris Maupin. I can’t think of AACN’s high standards without thinking of Chris!