An Inside Look at Nursing

What happens in a nurse’s day?

authors Linda Jarrett

A bad day at work caused Theresa Brown to add “writer” to her resume.

Brown thought she had her career planned out, but as is so often the case, the plan changed.

Born in Springfield, Brown had decided early on that her father had a good life as a professor of philosophy at Missouri State University. She received undergraduate and doctoral degrees in English from the University of Chicago, and a master’s degree from Columbia University.

After graduating, she taught writing and literature at Harvard University, the Massachusetts Institute of Technology, and Tufts University, believing her career path was set in academia.

“I liked talking, I liked books, but I didn’t love it,” she admitted. “I didn’t feel the passion.”

Having three children – a son, then shortly afterward twins – and what she described as “the hardest year of my life” inspired her to change careers and go into nursing.

“I found this part of me that really loved nurturing people,” she said. “A friend of mine said that I could be a nurse.”

After finishing an accelerated nursing program at the University of Pittsburgh, she began working as a clinical nurse in a Pittsburgh hospital. After being on the job awhile, she had a bad experience, and put it into words. She was so pleased with the story, she sent it to the New York Times (NYT).

The piece, entitled “Perhaps Death Is Proud: More Reason to Savor Life” impressed the NYT so much that she has become a regular contributor.

“That started my writing career,” she said, and led to her first book, Critical Care: A New Nurse Faces Death, Life, and Everything in Between, a memoir of her first year in nursing.

Her latest book, The Shift: One Nurse, Twelve Hours, Four Patients, tells a first-hand account of what nurses do day in and day out.

By sharing the ups and downs during just one shift on the floor of a cancer ward, Brown reveals how nurses advocate for their patients, explain treatment to families, make dozens of medical decisions, chart their work, interact with doctors and hospital staff, and keep their own emotions in check--all in the span of 12 hours when the lives of their patients are in their hands.

“Being a nurse is about being in the moment,” she said. “For that 12 hours, you’re the person they depend on. I wanted the public to see how important having really good nursing care and having nurses be supported is to getting good care. You can’t separate the two. That was the job and work that I knew, and I wanted to showcase that. In writing about it, I thought there are things we could do better.”

She sees nurses’ strengths as they’re willing to go “all out” for their patients, and the thinking that they don’t take time for themselves isn’t far from the truth.

“There’s so much dedication among nurses to patients – that’s what we bring to the healthcare people and the physicians,” she said.

Brown emphasized changes are needed for nursing to advance. “We need rules about staffing so nurses don’t have more patients than they can handle,” she said. “There’s been a lot of research showing that when nurses have a number of patients above a certain level, patients will do worse and actually die because they don’t have the level of nursing care they need.”

Concerning the ideal patient ratio, Brown said it depends on the environment.

“In the ICU, the ratio is 2-1 or 1-1, depending on how ill the patient is,” she said. “On my floor, it was 4-1, but I’ve had nurses tell me they’d be lucky with 4-1, that they’ve had eight to 10 patients. We need a system that puts patients first instead of how can we give our CEOs more money or how can we have a fancier lobby or how much can we pay all these administrators. Fancy lobbies are nice, but I feel that we’ve lost our way and we think that making money is the most important thing.”

Brown’s “take home” message is for patients and families engaging with nurses and other healthcare team members to identify and work toward achieving a good health outcome.

“Let the administrator know if you’re rushed,” she emphasized. “Let them know that staff doesn’t seem to have enough time or they’re being worked too hard. If people start saying that more often to administrators, it might make a difference. You’re not blaming the individual or managers; you just get a sense that the whole work environment needs to be more supportive.”

The Affordable Care Act has impacted the medical system with some good results and some not-so-good, as the healthcare industry continues working through many glitches.

“It’s doing some good things to push hospitals toward quality,” Brown said. “But, not intentionally, it’s created a fair amount of anxiety among the hospitals systems about reimbursements. Their profits are going down and that ends up making staff feel more squeezed. And that’s an unfortunate and unintentional byproduct, so I’m hoping the initial jolts and jumbles will be worked out. It’s complicated.”

After writing the book, she left the hospital setting for home care.

“After being in a hospital and writing a book about it, I felt that there were ways we fail patients as people, “she pointed out. “So I thought if I do home care, we’d have to figure out how we can make the hospital better for the human side of people.”

There’s more control in the home environment, Brown noted.

“It’s quieter, people can sleep through the night, all these things that we’re not so good at in the hospital,” she said. “It’s given me food for thought.”

Also, Brown realized that, after working in oncology, she was “very comfortable being in that space” with patients in their homes, waiting for whatever is to come.

“I’ve found that I’m able to wait with them while they’re sad or fearful,” she said. “It’s not easy but I find it rewarding, so that’s like a gift to me.”

In two blogs for the NYT, she spoke about the problem of violence towards nurses from patients. Brown referenced a release from the American Nurses Association concerning this problem.

“They took a very strong position about zero tolerance on incivility and violence towards nurses,” she said. “I thought that was very interesting and smart the way they linked them together, but I think there are way too many nurses who think that getting hurt is part of the job, especially if you’re in the ER. That behavior needs to be addressed before patients are in a position where they can hurt someone rather than afterward. Then the realization is, ’Oh, we need to put them in restraints.’ We shouldn’t have to wait until a nurse gets hit. We need be proactive rather than reactive.”

Brown also addressed incidents of physician/nurse bullying, of which she said only a minority of physicians are guilty, “but they end up setting a tone that, in general, says that nurses don’t have to be respected, and that solutions don’t have to be civil.”

“Neither one of these things is going to give us good healthcare,” she said. “Patients get the best care when the doctor and nurse work together in mutual respect.”

The percentage of these occurrences is anywhere from 10 to 30 percent “depending on how broad your definition of bullying and uncivil behavior is,” she said. “But, in general, it leads to the attitude that nurses aren’t colleagues; they’re just these people who are there to work for us and that’s not how healthcare works.”

Brown is also a commentator in both print and broadcast national media, a regular contributor to CNN.com and the American Journal of Nursing, and the author of the book Critical Care. She participates in the Robert Wood Johnson Foundation’s “The Power of Narrative” project and speaks nationally on nursing, end of life, and healthcare issues in America.


LINKS:

Theresa Brown

The American Nurse

New York Times blogs: http://well.blogs.nytimes.com/2010/03/17/violence-on-the-oncology-ward/
http://well.blogs.nytimes.com/2012/01/30/feeling-strain-when-violent-patients-need-care/

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