Not “Just a Nurse”

We don’t want undue recognition. We just want credit where credit is due.

Nurse assisting a surgeon during surgery.
It’s almost always nurses medicating and comforting patients.

Photo by Thinkstock

The View’s Joy Behar made a surprisingly ignorant comment about nurses this week during a discussion of the Miss America pageant. Miss Colorado (Kelley Johnson), dressed in scrubs and wearing a stethoscope around her neck, gave a heartfelt monologue about her work as a registered nurse. Behar was incredulous, asking why the nurse was “wearing a doctor’s stethoscope.” Behar apologized the next day, but not before the #NursesUnite hashtag had caught fire on Twitter and the American Nurses Association had issued a sharp rebuke; advertisers Johnson & Johnson and Eggland’s Best have also pulled advertising from The View.

I’m a registered nurse, and I can confirm that RNs wear and use stethoscopes for the same reasons doctors do: to listen to patients’ hearts, lungs, and bowels. The stethoscopes I buy for work are not divided into “nurse” brands and “doctor” brands. The problem with Behar’s quip, though, isn’t that it’s dumb (although it is!), but that it’s revealing of a persistent misapprehension of how health care actually works. We can’t fix our broken health care system if we don’t understand it.

Strangely enough, Kelley Johnson’s own monologue tapped into this misunderstanding. In the story she told she kept describing herself as “just a nurse”—as in, she couldn’t order different medications for the patient because she isn’t a physician. In her monologue, her patient calls her out for repeatedly diminishing the value of her job, telling Johnson that she would never be “just a nurse.”

The phrase “just a nurse” has a long history in nursing and grates on most of us. But the examples Kelley Johnson gave in her monologue highlight a true difference between doctors and nurses: Doctors prescribe and diagnose, and we don’t. That means that in many people’s minds, nurses’ work is somehow always subsumed into doctors’ work, to the point that the tools we use—such stethoscopes—end up being perceived as property of doctors.

But if the women of The View are going to mock nurse Kelley Johnson, it seems worthwhile to delineate key elements of nurses’ work. First off, nurses are present. Doctors aren’t the ones calming a frightened patient at 3 a.m. or holding a basin while a patient vomits at 3 p.m. Doctors usually aren’t the ones sounding the alarm when a patient starts going downhill fast—that’s what nurses do, because we’re there on the ward and it’s part of our job. It’s almost always nurses medicating and comforting patients who are dying. It’s almost always nurses soothing distraught family members.

Second, nurses and doctors actually have shared responsibility for patients. Doctors write the orders, but nurses are the ones who actually carry those orders out, and that process carries its own ethical burdens. I have sat in a patient’s room, dressed head to toe in latex, slowly injecting a very toxic chemotherapy drug into a patient’s IV line that goes straight into a major vein. The process requires 30 minutes of careful observation of the rate of injection and the patient’s status. If the patient suffers ill effects from the drug, in a sense I am the agent of that suffering.

Finally, part of any nurse’s job is to keep doctors accountable. We learn in school that we are the “final check” on all physician orders; that’s an obligation we take very seriously. I was a new nurse the day I was double-checking a chemotherapy order and realized that the ordering physician had written it based not on the intravenous dosing of the drug, but the intrathecal dosing—the lower dosing that goes into the brain. I took the order to the doc and noted the discrepancy. Before I could explain that I was new and might have misunderstood, he snatched the order away from me and said, “I’ll fix it.”

This is all in a day’s work, and in general nurses are not looking for undue recognition—they just want credit where credit is due. There’s a kind of humility built into the nursing profession, but our essentialness is quite real, and needs to be recognized if we really want our health care system to be the best it can be, Scott Walker’s views of nurses notwithstanding. Discussions about nurses’ work environment, nurse staffing, the ubiquity of bullying (doctors against nurses, nurses against each other) in hospitals—they’re all seen as peripheral to real discussions of what plagues health care. That needs to change. Whether you call nurses the backbone of our health care system or the spokes in the hospital wheel, strength only comes from strength, and our policy makers—and our cultural commentators—need to understand that and take nurses’ professional needs seriously.

One day, I would love to see an inversion of Kelley Johnson’s story: A patient asks a physician a question, and the doctor responds, “Oh, I’m just a doctor. You’ll want to ask the person who takes care of you 24/7—your nurse.”