You are so smart!: why didn't you study medicine?

EDITORIAL

You are so smart! Why didn't you study medicine?

Michelle Tellez

RN. MS. PhD. Nursing Administration of the University of California-San Francisco. San Francisco, CA, USA. [e-mail]

You are so smart! Why didn't you study medicine? Each nurse that is asked this question cringes. It is meant as a complement, but it is really an insult. This statement implies that although you are smart, you made a bad choice. The person asking really pities you for wasting your brain. In the public eye, being a nurse requires dedication and selflessness, not intellect⁽¹⁾. This is true in the United States as well, a place where Nurses have been the most respected professional group for several decades⁽²⁾. Respect and admiration clearly do not translate into power and leadership. In order to increase nurse power and leadership in healthcare environments, nurses must increase their level of education and speak about our work with agency⁽¹⁾.

The low skill-mix among hospital staff is detrimental to the profession and to patient outcomes. Better educated nurses are more satisfied at work and stay longer at their place of employment⁽³⁾. Better educated nurses provide care that is significantly higher quality and safer, reaching lower mortality and lower iatrogenic injury rates⁽⁴⁾. Nursing is a profession that intersects all professions. In hospital settings, we are the eyes and ears of the interdisciplinary team because we spend time with patients. We are also the mouth of the healthcare team because we are constantly communicating and translating information among professions and between the health profession and patients. In order to translate what we see and hear and fluently speak so many languages, nurses need to have a solid education. Policies that encourage nurses to continue their education are urgent and high priority⁽⁵⁾. Although the number of nurses holding terminal degrees is presently small, the Nursing School at USP is pioneering an international nursing doctoral program with the Pontifica Universidad Catolica of Chile. Ten students began taking class in Sao Paulo.

Nursing is often defined as the science of caring which is symbolized by the image of a smiling nurse and elderly patient holding hand. The message is: We care, for this reason we are able to be present in times of pain and vulnerability. We have strength of character, so you can trust us. We describe the work we do in emotional and selfless terms, making nursing a personal trait not a profession. In order to be present in a health crisis, nursing students learn psychology, counseling, crisis management, and behavior modification, so they can be sympathetic and effective at the same time. The concept of moral superiority was important in our history. Women were not allowed to work outside the home unless the work had a virtuous nature. Today, this type of characterization is inaccurate and detrimental to the profession. It de-values the education and training required to become a profession nurse and ignores four decades of nursing research

Instead of presenting what we do as God's work, nurses need to develop agency in our communication. Agency is the demonstrable capacity to act or to exerting power⁽¹⁾. Nurses do work that requires knowledge, skill, and continuous education. We should articulate these traits. Physicians focus on medical diagnoses, pharmacists on medications, social workers on psycho-social matters, and nurses deal with all these issues while also being responsible for symptom management and patient education.

It is important to be kind and attentive but it not sufficient. I am able to be present with someone in crisis not because I am a good person but because I am a highly trained professional. I can listen, observe and respond to patients and their family physical and psychological needs in a stressful work environment with strategic precision. In a moment of crisis, I can make assessment, diagnose problems or potential risks. I can set specific, measurable and timely objectives and figure out what interventions and activities I will engage in to bring the patient toward the intended outcome. I am extremely analytical, so I evaluate my actions and explore new avenues. We must be able to describe what we do in ways that demonstrate our education, our competencies and our ability to exert power. As the healthcare environment changes, patient safety depends on our ability to lead.

Can you describe what you did today?

References

• 1. Gordon S, Buresh B. From silence to voice: what nurses know and must communicate to the public. Ithaca: Cornell University Press; 2006.
• 2. Jones JM. Record 64% rate honesty and ethics of members of congress low ratings while nurses, pharmacists, and medical doctors most positive Gallup [Internet]. 2010 [cited 2012 Aug 7]. Available from: http://www.gallup.com/poll/151460/Record-Rate-Honesty-Ethics-Members-Congress-Low.aspx
• 3. Tellez MS. Work satisfaction among California registered nurses: a longitudinal comparative analysis. Nurs Econ. 2012;30(2):73-81.
• 4. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290(12):1617-23.
• 5. United States. Institute of Medicine. The future of nursing: leading change, advancing health. Washington (DC); 2010.
• 6. United States. Department of Health and Human Services. Health Resources and Services Administration. National Sample Survey of Registered Nurses, 2008. Washington (DC); 2008.

Publication Dates

• Publication in this collection
  08 May 2013
• Date of issue
  Feb 2013