The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital by Alexandra Robbins Page A
Authors: Alexandra Robbins
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Association loudly protested the Doctor of Nursing Practice designation, calling it “title encroachment,” and proposed a resolution to restrict the “doctor” title in medical settings to physicians, dentists, and podiatrists. Eventually, the AMA instead adopted a resolution to “advocate that professionals in a clinical healthcare setting clearly and accurately identify to patients their qualifications and degrees attain(ed)” and to “support state legislation that would make it a felony to misrepresent one’s self as a physician.”
Nurse practitioners say they are looking to develop their knowledge, not to take over the field. In general, they have more time than physicians to spend with patients and charge less for their services. A major study found that nurse practitioners’ patients have “essentially the same” health as physicians’ patients. At the time of this writing, nineteen states and the District of Columbia allow nurse practitioners to practice independently. Nurse-owned practices are a growing component of healthcare; in 2011 (the most recent year for which data is available), 100,585 advanced practice registered nurses billed $2.4 billion in services to 10.4 million Medicare patients—32 percent of the Medicare fee-for-service population. Those numbers are expected to grow. With a looming physician shortage in the United States by 2020, nurses with advanced degrees offer an additional option to patients, particularly in rural areas where access to doctors is scarce.
Effective 2009, The Joint Commission required hospitals to have a “code of conduct that defines acceptable and disruptive and inappropriate behaviors” and a process for managing those behaviors. Since then, studies have shown “moderate improvement” in doctor bullying and nurse reporting of this behavior. In 2005, only about 10 percent of critical care and OR nurses spoke up if they were bullied by a doctor or if they felt patient care was compromised; by 2010, this number had increased to about one-quarter of these nurses. TJC continues to receive reports of intimidation, and medical researchers say “there are still large, disconcerting gaps between what we have been able to achieve and where we need to go.”
Some healthcare providers have devised helpful strategies to handle intimidation. In one surgical department, when any staff member in the room feels that tensions are rising, he or she can call out, “Tempo!” as a reminder for everyone to calm down. (That safe-word strategy would not work in all hospitals.) A Southern hospital keeps red phones at each nurses station; if a physician is berating a nurse, she picks up the phone and an administrator quickly arrives to assist her. Similarly, nurses in a New Brunswick, Canada, hospital began a practice known as “Code Pink” when they got fed up with a particular doctor bully. When the doctor lambasts a nurse, other nurses spread the “Code Pink” alarm and stand beside her in support. The practice has expanded; at another hospital, a mistreated nurse can page a “Code White” to the same effect.
Still, these codes go more toward treating a symptom rather than preventing problems in the first place—perhaps fitting in an American healthcare model. Rather than collaborating with each other, too many groups of healthcare providers view their roles as practically adversarial. Some doctors equate “nurse-friendly” hospitals with “doctor-
un
friendly,” as if what’s good for the nurse can’t possibly also be good for the doctor.
Nurses have earned their place at the table. Is it possible to have a chain of command without implied levels of superiority? To view the various scopes of practice as complementary rather than hierarchical? One strategy is to rework administrators’ perspectives and doctor–nurse relationships so that all staff members view each other as part of a team. Obviously, this won’t work for every pairing. As one ER pediatrician
Nurse practitioners say they are looking to develop their knowledge, not to take over the field. In general, they have more time than physicians to spend with patients and charge less for their services. A major study found that nurse practitioners’ patients have “essentially the same” health as physicians’ patients. At the time of this writing, nineteen states and the District of Columbia allow nurse practitioners to practice independently. Nurse-owned practices are a growing component of healthcare; in 2011 (the most recent year for which data is available), 100,585 advanced practice registered nurses billed $2.4 billion in services to 10.4 million Medicare patients—32 percent of the Medicare fee-for-service population. Those numbers are expected to grow. With a looming physician shortage in the United States by 2020, nurses with advanced degrees offer an additional option to patients, particularly in rural areas where access to doctors is scarce.
Effective 2009, The Joint Commission required hospitals to have a “code of conduct that defines acceptable and disruptive and inappropriate behaviors” and a process for managing those behaviors. Since then, studies have shown “moderate improvement” in doctor bullying and nurse reporting of this behavior. In 2005, only about 10 percent of critical care and OR nurses spoke up if they were bullied by a doctor or if they felt patient care was compromised; by 2010, this number had increased to about one-quarter of these nurses. TJC continues to receive reports of intimidation, and medical researchers say “there are still large, disconcerting gaps between what we have been able to achieve and where we need to go.”
Some healthcare providers have devised helpful strategies to handle intimidation. In one surgical department, when any staff member in the room feels that tensions are rising, he or she can call out, “Tempo!” as a reminder for everyone to calm down. (That safe-word strategy would not work in all hospitals.) A Southern hospital keeps red phones at each nurses station; if a physician is berating a nurse, she picks up the phone and an administrator quickly arrives to assist her. Similarly, nurses in a New Brunswick, Canada, hospital began a practice known as “Code Pink” when they got fed up with a particular doctor bully. When the doctor lambasts a nurse, other nurses spread the “Code Pink” alarm and stand beside her in support. The practice has expanded; at another hospital, a mistreated nurse can page a “Code White” to the same effect.
Still, these codes go more toward treating a symptom rather than preventing problems in the first place—perhaps fitting in an American healthcare model. Rather than collaborating with each other, too many groups of healthcare providers view their roles as practically adversarial. Some doctors equate “nurse-friendly” hospitals with “doctor-
un
friendly,” as if what’s good for the nurse can’t possibly also be good for the doctor.
Nurses have earned their place at the table. Is it possible to have a chain of command without implied levels of superiority? To view the various scopes of practice as complementary rather than hierarchical? One strategy is to rework administrators’ perspectives and doctor–nurse relationships so that all staff members view each other as part of a team. Obviously, this won’t work for every pairing. As one ER pediatrician
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