What Do Nurses Really Do?

What Nurses Do

Here is what I think nurses do. Using their considerable knowledge, they protect patients from the risks and consequences of illness, disability, and infirmity, as well as from the risks and consequences of the treatment of illness. They also protect patients from the risks that occur when illness and vulnerability make it difficult, impossible, or even lethal for patients to perform the activities of daily living -- ordinary acts like breathing, turning, going to the toilet, coughing, or swallowing.

Even the most emotional work nurses do is a form of rescue. When nurses construct a relationship with patients or their families, they are rescuing patients from social isolation, terror, or the stigma of illness or helping family members cope with their loved ones' illnesses.

What do nurses do? They save lives, prevent complications, prevent suffering, and save money.

Why do nurses have a hard time explaining such compelling facts and acts? As Sioban Nelson and I have argued in a recent article in the American Journal of Nursing,^[1] it's because they've been educated and socialized to focus on their virtues rather than their knowledge and their concrete everyday practice. They've been taught to wear their hearts and not their brains on their sleeves as they memorize and then rehearse the virtue script of modern nursing.

If you analyze the words and images of campaigns used to recruit nurses into the profession or listen carefully to the stories nurses tell about their work, nurses may not use the available research to fully explain why what they do is so critical to patient outcomes. Although many studies, conducted by nursing, medical, and public health researchers, have documented the links between nursing care and lower rates of nosocomial infections, falls, pressure ulcers, deep vein thrombosis, pulmonary embolism, and deaths, most promotional campaigns and many stories nurses themselves tell about their work ignore these data.

Instead, nurses focus on their honesty and trustworthiness, their holism and humanism, their compassion, and their caring. The problem is that when they focus on caring, they often sentimentalize and trivialize the complex skills they must acquire through education and experience. They often fail to explain that caring is a learned skill and not simply a result of hormones or individual inclination. After all, knowing when to talk to a patient about a difficult issue, when to provide sensitive information, when to move in close to hold a hand or move away at a respectful distance all are complex decisions a nurse makes. To make these decisions, nurses use equally complex skills and knowledge they have mastered. But all too often nurses make these skills and knowledge invisible or describe nursing practice in terms that are far too limited.

Nurses are still talking about themselves -- or allowing themselves to be talked about -- in the most highly gendered, almost religious terms and allowing themselves to be portrayed with the most highly gendered, almost religious images. Indeed, as Nelson and I argue, with the best intentions in the world, many modern nursing organizations and nurses reproduce and reinforce traditional images of nursing as self-sacrificing, devotional, altruistic, anonymous, and silent work.^[1] Just think of one of the jingles in the recent Johnson & Johnson image campaign:

You're always there when someone needs you
You work your magic quietly
You're not in it for the glory
The care you give comes naturally.

Topics in Advanced Practice Nursing eJournal. 2006;6(1) © 2006  Medscape

Cite this: What Do Nurses Really Do? - Medscape - Feb 02, 2006.