Quotes from Life Support: Three Nurses on the Front Lines

- ‘Of course, the story of nursing would be different if it was not ‘women’s work’. Founders of modern nursing, in both Great Britain and the United States , often reminded their colleagues that the future of women and the future of nursing were the same.’ (Preface)

- ‘…2.2 million nurses in America who make up the largest profession in health care, the largest female profession in America, and the second-largest profession.’ (11)

- ‘The American health care system suffers from lack of access, too much fragmented, expensive, high-tech treatment, not enough attention to health maintenance and disease prevention, and failure to attend to patients’ emotional and social needs as well as their pain and suffering.’ (13)

- ‘In major studies conducted in 1976, 1986, 1989, and 1995, medical and nursing researchers linked the number and educational qualifications of registered nurses on hospital units to lower mortality rates and decreased lengths of hospital stay.’ (14)

- ‘At one moment, a nurse… may be involved in a sophisticated, clinical procedure that demands expert judgment and advanced training in the latest technology. The next moment… she may do what many people consider trivial or menial work, such as emptying a bedpan, giving a bed bath, administering medication, feeding or walking a patient.’ (20)

- ‘For people who have had chemotherapy or radiation before, there is an increase in second malignancies.’ (25)

- ‘Five Rights – Right Patient, Right Drug, Right Dose, Right Method… Right Time.’ (26)

- ‘Until the mid-1800’s, the sick were almost universally cared for in the home. For those with no other alternative, the hospital offered a place of last resort. The hospitals were dreadful, filthy asylums whose patients were the poorest of the poor or sailors or wayfarers who were far away from home.’ (33)

- ‘[Nightendale] ordered workmen to construct new wards that were well ventilated, clean, and had a source of pure water. She set up a kitchen and installed her own chef to prepare the kind of special food men suffering from dysentery and fever would require. She ordered the shirts and trousers to clothe them.’ (37)

- ‘  ‘As a nurse,’ Nancy explained, ‘you’re the patient’s advocate. You’re not supposed to get angry at the patient.’ ’ (53)

- ‘The job of the clinical nurse specialist – an advanced practice nurse who has a master’s degree – is to support the practice of bedside nurses and improve the care they provide.’ (59)

- ‘There’s so much you can do to care for demented patients safely. You can take care of their skin, and make sure they maintain some range of motion, and see they’re turned often enough.’ (64)

- ‘When a patient is that agitated and you can’t reach her, it’s better to back off and try again later.’ (66)

- ‘When a physician does help in the hands-on care, it shows respect not only for the nurse but for the patient. If it’s a simple thing like boosting a patient or fixing a pillow, why should the patient have to wait while the doctor goes off to find a nurse of the nurse goes off to get another nurse for help?’ (69)

- ‘The bulk of the day-to-day responsibility for patient care is left to the residents, and particularly to the interns.’ (72)

- ‘Surgical residents work between eighty and a hundred hours a week.’ (76)

- ‘Nurses are legally required to get doctors’ orders for any change in the patients’ regimen. But when doctors don’t write orders in a way that gives nurses enough latitude to adjust medications when necessary, they are legally bund to call the doctor for new orders. Similarly, when doctors do not view nurses as full participants in the health care team, RNs will constantly interrupt doctors to discuss the patient’s plan of care. When this happens, doctors may be tempted to dismiss the nurses’ concerns as trivial and to take the easiest, least time consuming route available to deal with the problem at hand.’ (77)

- ‘Many female physicians who – understandably – want to be acknowledged for their education and skill complain that patients are constantly confusing them with nurses.’ (80)

- ‘the two professions ought to work closely together.’ (83)

- ‘As a new nurse, you learn, she says, what someone looks like when heart failure causes fluid to back up into the lungs; when a patient develops a high fever or is having a seizure.’ (88)

- ‘Nurse practitioners are products of programs that generally offer a master’s degree… state governments can give prescriptive authority to NPs. The fact that some do and some don’t has to do with the power of the physician lobby in a particular state – not with nurse practitioners’ qualifications.’ (98-99)

- ‘Within their areas of competences N.P.s and C.N.M.s provide care whose quality is equivalent to that of care provided by physicians. The OTA also reviews 14 studies whose results demonstrated a difference in the quality of care provided by N.P.s and M.D.s. of these, 12 showed that the relative quality of care given by N.P.s was better than that given by M.D.s.’ Nurse Practitioners, Physician Assistants and Certified Nurse Mid-Wives: A Policy Analysis (101)

- ‘ ‘Home care,’ Ellen says, ‘means taking the time to get to know patients and their families so you can understand their medical and social history very well.’ (107)

- ‘When hope is so firmly tied to cure, it becomes very difficult for the health care professionals, patients, and families to abandon that pursuit under any circumstances. Doctors, patients, or their families idealize the quest for cure, and the consequences for patients are usually downplayed.’ (131)

- ‘A bone marrow transplant is perhaps one of the most difficult procedures imaginable. Unlike kidney or heart transplants, most bone marrow transplants aren’t really transplants in the conventional sense. They are bone marrow rescues. There procedures are performed when other chemotherapeutic protocols have been unsuccessful… That is why the patient’s healthy marrow has to be harvested – to rescue the patient from the chemotherapeutic assault. The harvested marrow is reinfused into the patient one or two days after chemotherapy is completed.’ (135)

- ‘The written record, which reflects the formal chains of authority and command in the medical system, maintains the fiction that the doctor is solely in charge.’ (173)

- ‘ ‘The medical model is a curative model.’ Jainchill explores the distinctions. ‘The nursing model is a care and comfort model. That doesn’t mean that nurses don’t want to cure or that doctors don’t want to give care and comfort. But given where the two disciplines start from, if you have a patient who does not have curable illness, nurses are going to have a head start.’ ’(183)

- ‘As a younger man [the patient] smoked heavily and, like half of all smokers, will probably die from complications from smoking, such as emphysema and heart disease.’ (189)

- ‘The United States is not winning the war against cancer. Despite advances in the treatment of some cancers, overall cure rates for most of the major cancers – lung, breast, colon, prostate – haven’t changed much in thirty years. Patients whose cancers recur are likely to die of them. There have been, however, significant advances in keeping people comfortable, dealing with their pain and symptoms, and alleviating their suffering. Each year, five hundred thousand Americans die of cancer.’ (193)

- ‘The Cecil Textbook of Medicine, a volume used by most medical students, devotes only three of its 2,300 pages to the care of the terminally ill. Or as another classic, Harrison’s Principles of Internal Medicine, put it, ‘The discovery and cure of potentially serious disease represents a far greater service to one’s patients than ministrations in the course of an incurable condition.’ ’(199)

- ‘Of the nation’s 126 medical schools, only five have a required course on the care of the dying. One hundred and seventeen of the schools said that the care of the dying is included in other required courses or in elective courses.’ (199)

- ‘Hospice nurses, physicians, social workers, and other personnel manage the pain and symptoms of dying patients and help patients and families deal with overwhelming emotional suffering and feelings of guilt and loss… Hospice has been far too narrowly defined in the US . Here it tends to be viewed as comfort care in the very last days of life – as in just two or three days before a patients dies.’ (201)

- ‘Studies show that residents aren’t rewarded for showing concern about the physical and emotional suffering of patients with incurable illnesses and are not taught the basics of palliative care. It’s hardly surprising that those doctors who finally refer a few of their patients to hospice programs do so far too late in the dying process.’ (207)

- ‘The catch-22s in which patients and their caregivers are entrapped, says Jeannie, are nothing short of the incredible. Insurers regularly ask Jeannie to send home patients who are unstable and still need nursing care. Will the insurers pay for quality care in the home? No way.’ (257)

- ‘A study of 281 hospitals nationwide conducted by the E.P. Murphy found that hospitals that had reduced their staff by 8 percent or more were four hundred times more likely to have increases in patient illness or mortality.’ (276)

- ‘In 1986 and 1989, studies by Knaus et al. and Mitchell et al. documented that RN staffing levels, and positive nurse-physician communication were the factors that bare the most significant impact on mortality in critical care units.’ (283)

- ‘While many nurses are struggling trying to provide care for five or even ten patients, there may be almost two people per patients ‘managing’ their care or their paperwork.’ (285)

- ‘Many states mandate by law staffing rations for the number of healthy children a family day care provider can care for and for the number of healthy students a teacher can teach in a public school classroom. Legislators may even mandate how many firefighters must be on a fire truck. But when it comes to how many of the sickest, most vulnerable human beings one nurse can care for, the sky seems to be the limit.’ (295)

- ‘Ironically, many of the same people who insist that CEOs, high-level executives, biomedical researchers, and physicians should reap greater and greater rewards so they can attract the best and brightest, continue to insist that caregivers should soldier on and make do with less and less.’ (298)

- ‘Physicians-in-training should learn what it is nurses do and in which areas they are expert. The Beth Israel nurse-for-a-day in the surgical clerkship of the Harvard Medical School is an important step on this path… And nursing students should do the same – following a doctor for a day… Indeed, nursing and medical students should encourage nurses and doctors-in-training to undertake some part of their coursework together.’ (300)

- ‘Today, most hospital public relations departments promote only medicine and biomedical innovation. Few make any effort to promote nurses’ work.’ (302)

- ‘This nurse explained that nurses are also given second-class treatment in internal hospital communications. ‘When hospital publications talk about doctors’ work, they talk about their educational background, their professional affiliations and involvement. When they briefly mention a nurse’s accomplishments, they never say where she went to college, what professional organization she’s involved in, or what roles she takes on outside the hospital.’ (303)

- Nursing: 95% women/ 8% minority (page unknown)