A portrait of the arts major as a young nurse

February 19, 2006 -- Today the Washington Post's Sunday Magazine included a fairly good article by Christina Ianzito about a former "personal organizer" with an art history degree who has returned to school to become a nurse. "The Need to Be Needed" includes much of the standard information about the merits of nursing as a second career today, including its financial security, diversity, and appeal for those who wish to help others in a "more palpable way." More interesting is the piece's portrait of restless liberal arts graduates finding meaning in nursing, and the comments of Georgetown nursing professor Colleen Norton, RN, DNSc, about how much nursing has changed since she graduated in the 1960's. Norton suggests that nursing education today is "so much more sophisticated, scholarly and demanding" than it was four decades ago that it "cannot even be compared." We understand that such suggestions are intended to persuade the public that today's nurses deserve respect. But we doubt they help the profession overall, as they may suggest that serious nursing was born yesterday, and that past nurses, including influential health leaders, are of little importance.

The piece focuses on the "thoughtful and articulate" Hilary Winkler. Winkler graduated from the University of Virginia in 1994 with a degree in art history. Since then she has held various jobs around the nation, finally ending up in the second degree program at Georgetown, from which she will soon graduate. That program's students now have an average age of 28. The piece says Winkler has spent 16 months "plodding" through this program, as if a liberal arts major would already know almost everything she needed to know to be a nurse. However, the piece does note (with some apparent surprise) that to get the BSN Winkler has had to take "organic chemistry, microbiology, anatomy, physiology and statistics before her regular course work could begin." Winkler actually remarks on all the reading. The piece follows Winkler on her last clinical shift before graduation, briefly describing some of the care tasks she's doing, including assessing vitals and giving medications. The piece also briefly profiles Winkler's 28-year-old classmate Andrea Dubenezic, who graduated from Sweet Briar College with a degree in Spanish and art history. Dubenezic apparently finds hospital nursing "intense" and is considering "something in public health."

The article is mostly a "wonderful nursing opportunities" story, so it does not mention the short-staffing that has driven the shortage and in turn helped to create so many opportunities. It does mention nursing's image problem, reporting that Winkler found reactions to her decision to become a nurse "frustrating." She notes that "[p]eople would say, 'You're really smart, why don't you go to medical school?' People think that nursing is for people who couldn't go to medical school, but they're very different professions. It's two members of a team but that have different roles in the team." This is a pretty good account of what society tells bright career seekers who show an interest in nursing, however many Gallup polls may suggest that nursing is one of the "most trusted" professions.

In discussing the state of nursing today, the article relies on Colleen Norton, who teaches "Complex Nursing Problems" at Georgetown. The piece reports that Norton says nursing is "wildly different" now from when she graduated in the 1960's. She notes: "When I was a young nurse, you were still very much subservient to the physician. The responsibility and autonomy of the nurse has just blossomed." As for nursing school then, "[i]t cannot even be compared. [Today's nursing education] is so much more sophisticated, scholarly and demanding." Speaking of the academic demands of nursing, we note that the Post article gives Norton no honorific and does not mention her educational background. In fact, she has a doctorate in nursing science. We have to doubt that the piece would have failed to identify a physician either as "Dr." or as having an "M.D." But if Norton's so smart, maybe she should have gone to medical school.

In any case, it seems pretty clear that the public and its media have not kept up with nursing's evolution. Even if they had, though, we're not sure it's helpful to suggest that nursing is so "wildly different" now from what it was 40 or even 150 years ago. We often see well-meaning suggestions in the media that nursing has changed radically, the apparent idea being that nurses today deserve respect, regardless of whatever those nurses in the past may have been about. Of course, we understand that nurses in the past often had less power relative to physicians than they do today--decades ago many had to stand when physicians entered the room. But nurses still operated in their own unique sphere of practice, and no physician developed the science of nursing. Nurses did. We also note that past generations of physicians are rarely discussed in this way, even though the specifics of physician practice have also evolved a great deal. Of course, today's physicians need not disparage their predecessors to get respect, and in contrast to nursing, many physician pioneers from prior eras are well known. However, like physicians, the nurses of past generations did their best given the prevailing scientific, political and cultural climates. Disparaging the nurses of prior generations also reflects poorly on influential leaders like Florence Nightingale, Lillian Wald, Lydia Hall, and countless others who changed the face of health care. It seems to us that the basic tenets of the nursing profession remain, even though technology and increased understanding of health science may alter many of our daily activities. Nurses now, as in Nightingale's time, work within their knowledge base and social climate to provide the best care to their patients by:

1. assessing frequently to gather critical health information;
    
2. making autonomous interventions based on their assessments and health care knowledge;
    
3. educating patients (and/or family members) to take care of themselves (or the patient) as soon as they are able; and
    
4. advocating for patients, which can mean helping them resist care plans and other forces that may not be working in their long-term best interests.

Another interesting element of the Post piece is the focus on liberal arts graduates returning to school to get nursing degrees. The piece does give some sense of Winkler's restless and unsettled life to date. But it does not really try to draw larger conclusions about why such graduates in particular might choose nursing as a second career. Perhaps there are not too many good jobs in art history. And perhaps--we're just speculating--nursing's holistic focus is not a bad fit for liberal arts graduates trained to think broadly about the human condition, and what might be done to improve it.

We thank Ms. Ianzito and the Washington Post for this generally helpful look at nursing as a second career.

See "The Need to Be Needed: A personal organizer who wants to help people in a more palpable way enters a much-changed profession: nursing" by Christina Ianzito from the Sunday, February 19, 2006 edition of the Washington Post.