From Silence to Voice

What Nurses Know and Must Communicate to the Public

Bernice Buresh, Suzanne Gordon

• Publisher: ILR Press
• Year: 2013
• ISBN:
  9780801467363
• Edition: 3
• Topic: Medicine
• Subtopic: Nursing

For more than a decade, From Silence to Voice has been providing nurses with communication tools they can use to win the resources and respect they deserve. Now, in a timely third edition, authors Bernice Buresh and Suzanne Gordon focus on how nurses can describe and frame their work to seize unprecedented opportunities to advance their profession and lead improvements in health care systems.The authors, both journalists, argue that because nursing needs the support and cooperation of others to fulfill its potential, it is critical that nurses communicate the full scope of nursing practice. Nurses must go beyond describing nursing in terms of dedication and caring and articulate nurses' specialized knowledge and expertise. From Silence to Voice helps nurses explain their contributions to patient safety, satisfaction, and outcomes. It shows how nurses can communicate with various publics about important aspects of their work, such as how they master and employ complex medical technologies and regimens, and how they use their clinical judgment in life-and-death situations. "Nurses and nursing organizations, " the authors write, "must go out and tell the public what nurses really do so that patients can actually get the benefit of their expert care."This comprehensively revised and updated third edition helps nurses use a range of traditional and social media to accurately describe the true nature of their work. Its analyses of images that are projected by nursing campaigns and its detailed guidance in helping nurses construct positive and powerful narratives of their work make From Silence to Voice a must-read in nursing schools and organizations and by individual nurses in all areas of the profession. Because nurses are busy, many of the communication techniques in this book are designed to integrate naturally into nurses' everyday lives and to complement nurses' work with patients and families.

Part I

Silent
No More

CHAPTER 1

ENDING THE SILENCE

Envision how things would be if the voice and visibility of nursing were commensurate with the size and importance of the nursing profession.

Because nurses had educated patients, families, friends, relatives, neighbors, and community members about nursing work, patients would be fully cognizant that nurses are key to their survival and recovery.

When faced with medical treatments or procedures, patients would do more than inquire about the details of the procedures and their physician’s qualifications to perform them. They would seek information about the qualifications of the nurses who would care for them during and after their treatments. They would want to know the nurse-to-patient ratio in their hospitals and the extent and type of nursing services available at outpatient centers, community clinics, and long-term care facilities. They would want to know how long their nurses had slept the night before and if their hospitals and health care institutions had lift equipment to help make them safe.

People would understand that many nurses, like physicians, have specialized expertise, even on a general medical floor. They would readily accept and often seek the services of nurse practitioners, mental health nurses, nurse midwives, nurse anesthetists, and hospice nurses. Similarly people would appreciate and support services provided by school nurses, public health nurses, and homecare nurses in their communities.

Because the public would understand the critical role of nursing in health care, hospitals could no longer rely on paring nursing staffs as their strategy for dealing with budget problems. Attempts to cut nursing staff, substitute aides for registered nurses (RNs), and stretch staff through floating and mandatory overtime would provoke public outcry. To the public, floating a nurse from an oncology to a pediatric unit would be in the same league as asking a medical oncologist to take over for a pediatrician.

Nursing salaries would more accurately reflect the expertise and responsibilities of nurses. This greater investment in nursing would mean that full-time jobs, with predictable schedules and decent benefits, would be readily available.

The visibility of nurses in the mass media would reflect the expanded participation of nursing in public discussions about health care. Nurses, not just physicians and policy PhDs, would be key participants in all health care forums whether they occurred in communities, before state and national legislatures, at economic conferences, or at international assemblies.

Physicians’ views would no longer dominate the media. Nursing perspectives and expertise would be sought by journalists and radio and television interviewers and would be widely expressed on nursing websites, in blogs, in comments to news organizations, and in opinion pieces.

Everyone would know that nursing requires education and training, not just niceness. This understanding would translate into widespread public support for nursing education at the undergraduate, graduate, and postgraduate levels. Schools of nursing would be viewed as major contributors to the academic enterprise and would be fully integrated into higher education systems.

Just as people recognize that it takes someone with education and expertise to perform brain surgery, they would know that it takes someone with education and expertise to care for a patient who has just had brain surgery. Therefore they would oppose politicians and academic administrators who tried to eliminate or water down nursing programs or create less educated nurse substitutes.

A more complex and accurate image of a nurse would replace dated or distorted stereotypes. Respect for nursing would mean that young women and men who show an interest in nursing careers would be strongly encouraged, not grilled about why they aren’t planning to go to medical school. With the challenges and rewards of nursing more fully appreciated, many talented women with other professional options would choose nursing. Nursing would be an increasingly attractive career choice for men.

The public would understand that medical interns and residents are not the only learners, and physicians are not the only teachers in medical centers. It would be known that hospitals are educational institutions for nurses and that nurses teach physicians as well as nurses in training. Institutional budgets would provide money, time, and extra staffing for continuing nursing education because everyone would know that veteran nurses, like physicians, need to keep up with the latest research and treatments. They would also understand that nurses do a lot of the teaching of doctors in training. In this new era of interprofessional education and practice, the concept of the teaching hospital would be transformed.

Medical research no longer would be perceived as the only scientific endeavor leading to health improvements. Health experts, journalists, policy makers, and the public would see nursing research as essential to health care and would support governmental and private funding for it.

Nursing shortages would not be tolerated because it would be crystal clear that human health and well-being depend not only on medically necessary care but also on necessary nursing care.

Nurses would receive the four Rs that foster professional satisfaction:

• Recognition

• Respect

• Reward

• Resources

Does this vision seem like fantasy?

It’s fantasy only if nurses are unwilling to make it reality. To be sure, a perfect world is not possible. But we are confident that nurses can significantly increase public understanding of and support for their work through effective public communication and sustained action. Without sustained action and communication, it’s pretty much guaranteed that things will not improve.

Effective communication is essential because all areas of nursing—clinical practice, education, research, and policy—depend on public understanding of how and why nursing is indispensable to health care. Nursing is not practiced in a vacuum. It requires substantial resources, including physical space, equipment, staff, research, and higher education. If the public doesn’t understand the significance of nurses’ work and the context in which it takes place, it will be difficult to correct conditions that drive nurses out of the clinical setting and even out of the profession. Similarly, it will be hard to attract the best and the brightest young people into the profession and keep them in it.

If legislators, policy makers, and administrators are to allocate adequate financial resources to support nursing, they and the public must have a good idea of what nurses really do. If the work of contemporary nurses is unknown or misunderstood, then nurses cannot be appreciated or supported and cannot exert appropriate influence in health care. And if they can’t do that, nurses will have difficulty delivering appropriate, high-quality care.

Missing in Action

The lack of accurate public information about nurses and their work allows insidious stereotypes to persist. Nurses tell us that many members of the public still believe that nurses are physician handmaids whose work is to carry out simple tasks under the direction of physicians. Others may idealize nurses as self-sacrificing angels of mercy. Even though surveys tell us that the public thinks highly of nurses’ honesty and integrity, disturbing images of nurses as lewd sex objects or vituperative harridans also still circulate.

Being unseen and unknown in actual practice has been a perpetual problem for nursing. Studies of the visibility of nursing in the news media stemming from the 1990s found the largest segment of the health care profession to be virtually missing from coverage of health care.1 Nurses were so rarely mentioned in health care coverage that they were essentially invisible even in those articles that dealt with hospital care.

In recent years news coverage of nursing has increased. For example, it is no longer astounding to see a news report based on nursing research. In general, we see more coverage of nurses in specialty practice. But we rarely see nursing covered as an integral part of health care and as a major source of expertise on health care and health issues.2

Health-related reporting by and large is defined as medical and focuses, often exclusively, on physicians. News stories concerning hospital care might refer to “doctors and nurses,” but beyond that nurses are rarely named and quoted. Instead, nursing usually exists in the news as a separate category and stories are prompted by something going on within nursing, often something controversial. Nursing gets space in the mass media in connection with nursing shortages, staffing issues, dissention over the scope of nursing practice, and nurses’ demands for better pay and working conditions. Nurses certainly aren’t spared attention, or blame, for patient tragedies stemming from medication and surgical errors or from workplace system problems such as monitor-alarm fatigue or hospital-acquired infections.

So the public gets to see nursing in the mass media largely in connection with what we call “problem narratives.” The public should be told about errors and nursing workforce issues to be sure, but nursing should be seen in broader contexts as well, as an essential part of health care. We should be exposed to “practice narratives,” stories that integrate nursing into health care and enable us to see what nurses actually do.

Physicians also get caught up in patient tragedies and professional disputes. But that focus is only a small percentage of the media’s coverage of medical practice and research. For decades, thanks to concentrated efforts by medical associations, the news and entertainment media have been telling stories about what physicians do. As a result, there is no information vacuum about physicians’ work or a huge mystery about their contributions to health care. The work of nurses, however, has been and remains hidden. Hence, there is not a lot to balance or even challenge misinformation or stereotypes about nursing.

Although nursing, not medicine, is the largest health care profession and nurses, not physicians, are the largest group of clinical workers within hospitals, you would never know it from the coverage of health care and hospitals. For example, the New York Times carried an article about “a troubling picture of the care offered” at some for-profit long-term acute care hospitals that have proliferated in the United States in response to higher Medicare reimbursements.3

These hospitals are intended to deliver nursing care to very ill patients, not do medical diagnosis and treatment, a point the reporter, Alex Berenson, missed entirely, even though that is clear in the Medicare inspection report on which this story was based.4 The story started with a description of the death of a horrendously neglected patient at Select Specialty Hospital of Kansas City, Kansas. The reporter seemed to attribute the death to the fact that “the sitter” whom “her physicians had ordered” had apparently not shown up, to “staff members [who] tied her down with wrist restraints,” and to the fact that this hospital “has no doctors on its staff or its wards overnight.”

Although the reporter said that these hospitals were not set up to do medical procedures and that “Medicare inspectors found that the hospital did not have enough nurses” on the night that the patient died, she did not give the details. In fact, the Medicare report said that the unit in question was supposed to have a minimum of six RNs. Two RNs were missing that night. Had this story been reported accurately, we would have seen how risky it is fo...