You will be required to deal with bruising
Jon Stewart ridicules school nursing
October 24, 2012 -- Tonight on The Daily Show with Jon Stewart, two former U.S. military medics appeared in a segment about re-integrating veterans into the civilian workforce. We honor the service of these veterans, who appear to have significant experience stabilizing wounded soldiers, following EMT Basic training. But Stewart's repeated insistence that the medics are vastly overqualified to be school nurses is a glaring example of the elite media's ignorance of nursing expertise. Stewart mocked school nurses as being all about "kickball" and "tummy aches," even though he explicitly noted that one school nurse position he found required a bachelor of science in nursing--we guess not all bachelor's degrees are created equal (Stewart's bachelor degree is in psychology). Sadly, the medics themselves seemed to agree that they were qualified to hold registered nurse jobs. But today's school nurses need years of university science training because they manage the health of many hundreds of students who attend with serious conditions including asthma, diabetes, and allergies. Students have died because no registered nurse was available. And school nurses play a key public health role, not only educating students about critical health issues like pregnancy and STDs, but also monitoring the student population for disease outbreaks. In 2009, school nurse Mary Pappas in New York City (where the Daily Show is recorded and Stewart's children attend school) set in motion the governmental response to the H1N1 flu outbreak, identifying and managing hundreds of her students' symptoms. She later gave compelling testimony at a federal government flu summit. Plus, she made a little girl's tummy feel all better! The segment's theme reminded us of a vague but troubling comment President Barack Obama made just two days earlier in the October 22 presidential debate that veteran medics who wanted to become nurses had to "start from scratch" so it would be good to "change those certifications." Of course, all students should have a chance to show they merit advanced placement in educational programs, but nursing requirements cannot be simply waved away for people with a few weeks of health training and some field experience, no matter how courageous and heroic. Please ask The Daily Show with Jon Stewart to make amends for the damage caused when it spread this disinformation to its 2.5 million viewers--maybe with a segment about the problems school nurses face caring for the kids of a nation whose elite sees their work as trivial.
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A higher echelon of care
At the start of the segment, Stewart introduces two veterans of the U.S. war in Iraq who have struggled to find work back in the States, despite gaining valuable experience during their time in the military. We should note at the outset that the segment analyzed below is what The Daily Show actually broadcast on October 24, which appears to be an edited version of a longer interview that has since been posted on the show's website. The longer version also includes references to "nurse's aide" positions, which require only a few weeks of training--training comparable in length to the EMT Basic training the two medics have.
Stewart: I told you the story of the thousands of returning veterans not having the certification civilians understand even though they have clearly gone above and beyond the work requirements that you would need to do the jobs they're trying to get here. So I figured we would do our part to help re-integrate them into the workplace. Joining me now, two Iraq War veterans, both field-trained medics. Please welcome to the program former staff sergeant Meg Mitcham and former specialist Daniel Hutchinson. . . You guys served in Iraq, and what was your job in Iraq?
Mitcham: I was a combat medic.
Stewart: And Daniel?
Hutchinson: I served in Iraq in '06 as a combat medic and our job was to stabilize casualties until we got to the point where we could get medical evacuation for them.
Mitcham: Pretty much the same thing. Guy gets shot, we fix it.
Stewart: Well, now you're back in the States. You're looking for work. Would you like to still be in the medical field by any chance?
Stewart: I happen to have 2 openings . . . school nurse. Would you be interested in that at all?
Mitcham (shrugging): A job's a job.
Stewart: Can I see, very quickly, your bachelor of science in nursing degree?
Mitcham: I don't have one of those.
Stewart: How about the results of your National Council Licensing Exam for registered nurses?
Mitcham: No, I don't have one of those either.
Stewart: We need our people to be familiar with biology, anatomy, and physiology.
Mitcham: Yeah, got that.
Awesome! In fairness, it appears that in the original interview, Stewart mistakenly suggested that a nurse's aide job required these credentials, but for the version that was actually broadcast, the show edited the footage so that he appeared to refer (more accurately) to a school nurse position. So it is unfair to have presented Mitcham as reacting with such contempt to a school nurse job when she was actually talking about a nurse's aide job.
Stewart: What were some of your experiences that you've done?
Mitcham: Well, you see, I was over with some of my friends in Iraq, and we were driving down the road, big bomb went off, bunch of people got injured, so I used the resources that I had at the time to stabilize three different patients at the same time, stop all of their bleeding, call in a medevac request, and ensure that they were kept alive and safe until they could get to a higher echelon of care at one of the hospitals in-country.
Stewart: Do you have a certification that says you did all that?
Mitcham: Not--I have my EMT Basic license, which is some of that.
Stewart: That certifies you to do what?
Mitcham: Take vital signs.
Stewart (turning to Daniel): School nurse.
Daniel: Let's do it.
This draws laughter, because the studio audience knows as little about nursing as those on stage.
Stewart: You'd like the job?
Stewart: Do you have a professional pupil services license issued by the Ohio Licensure Board?
Hutchinson: I do not.
Stewart: What experience do you have in this field?
Hutchinson: I stabilized a guy with a gunshot wound to his chest, replenished fluids, breathed for him for the next 37 minutes until we could get a Black Hawk helicopter in there to get him to a higher echelon of care.
Stewart: Let me ask you something. Are you familiar with kickball? You will be required to deal with bruising . . . Were there tummy aches where you were?
Hutchinson: Not too many tummy aches in Iraq.
Stewart: So you are not in any way licensed or qualified to work as a school nurse.
Hutchinson: That is correct. The only certification I have is an EMT Basic.
Stewart: But you clearly both have had the experience and the training far above and beyond what any of these jobs would require and also seem to have--and I've recognized this before in people and I don't necessarily recognize it in myself--"courage and integrity," which I find employers tend to value. So what is the disconnect? What is going on here that is not allowing people that are clearly qualified, intelligent, tenacious, hardworking and courageous to get the jobs that they are absolutely qualified for? What would you say is the biggest issue?
Note the plunge off the logical cliff here. Stewart--despite his own study of psychology, a health care field--does not even ask what training EMT Basic involves, nor does he explore what training school nurses get. He makes no attempt to link trauma experience and school nursing. He simply assumes that because the medics have some health care experience, they must have skills "above and beyond" what a school nurse has. Anyway, Mitcham responds.
Mitcham: I think between what we learn in the formal training, and what we learn in the field, on the job, hands-on, just doing it, because it happens and so you fix it? Between those two things, we don't get the certification that the employers are looking for.
Hutchinson: I believe there's too many breakdowns. The first one is that we need a better transition program in place for our returning veterans, with big emphasis on resume-writing, so that a veteran can take his job skills that they did in the military, and translate it in a way that civilian employers can understand. And the second, I believe our returning men and women, they should come home with certifications, they should be able to do the same job they did in the military, you can do it in the civilian world.
Stewart: You're clearly, like, even if, as you say, you have EMT Basic, you clearly would qualify for an EMT paramedic, would you not? I mean, that is the essence of what you were doing over there, you're saving lives in an emergency situation?
Mitcham: We're practicing at that level. We practice medicine at that level, without the certification.
Stewart: And then when you get back, they want to put you back though training programs that could be two years long, hundreds of hours, and those types of things. You know, I hate to be arch about it, but it is somewhat stunning to see people of your qualifications and your talents have to struggle with a system that should do nothing more than respect and honor all that you've given. So . . . former staff sergeant Meg Mitcham and former specialist Daniel Hutchinson. We'll be right back.
Stewart makes no reference to the comments President Obama made on the same general subject just two nights before in debating Mitt Romney in Florida, but it seems likely that there is some link. (See the clip in Quicktime at broadband or dialup speed.) The comments came while Obama was arguing that the nation should focus its energies on domestic issues, particularly making it easier for veterans to find work, including
making sure that the certifications that they need for good jobs of the future are in place. You know, I was having lunch with some -- a veteran in Minnesota who had been a medic dealing with the most extreme circumstances. When he came home and he wanted to become a nurse, he had to start from scratch. And what we've said is, let's change those certifications.
Why would intelligent, otherwise well-informed people seem to assume that these medics' field experience gives them all the knowledge in a college program lasting three years or more? Because if it's nursing, it can't be difficult, and so whatever the medics did, they're qualified?
It's not clear to us exactly what Obama means by "change those certifications." It could mean simply that the medics should not have to "start from scratch" but should have the chance to place out of certain requirements, as we discuss below. Even using the term "certifications" is arguably degrading, as if nurses do not need college degrees, though we guess Obama may simply have been speaking broadly or imprecisely during the stress of a televised debate. In any event, he should know better, since he used nurses extensively to promote Obamacare.
But the comments Stewart and his guests made in the October 24 Daily Show segment clearly reflect a fundamental ignorance of nursing. They conflate two different types of experience. These two medics have basic trauma experience, and certainly that would help them a lot in training to be paramedics. They should be given the opportunity to test out of some basic course or courses as part of the relevant training program. But they are not qualified based on a few weeks training and some hands-on experience stabilizing trauma victims to be school nurses, or any nurses, to simply be handed a professional job requiring a four-year bachelor of science degree. Of course, the medics can and should be able to do "the same job they did in the military" to the extent that exists here--they appear to be qualified to be EMTs. But they didn't act as nurses in the military, any more than they acted as physicians. That is the "higher echelon of care" they mentioned. Incidentally, for some reason, it did not seem to occur to Stewart to suggest that the medics could do physician work.
We honor the service of the two veterans, but their apparent belief that they are qualified for registered nurse jobs is, well, "stunning." Mitcham says that she "practice[s] medicine," as if she were a college-educated health professional. She also boasts that she "fixes" (as opposed to "stabilizing") trauma victims. And she suggests that she knows as much about biology, anatomy, and physiology as someone who has studied nursing for four years. The show could have focused on what measures and resources would help these medics build on the training and experience they do have, and that topic is discussed in a few comments near the end of the segment. But the segment consists largely of the laughter of cavemen at the funny squiggles on a sheet of text.
Of course, the most obvious attack here is on school nurses, with Stewart plainly suggesting that the job is all about tummy aches and anybody could do it, regardless of how little formal training he or she has. In fact, school nurses are highly skilled health professionals who provide holistic, preventive care to students and manage a diverse array of serious acute and chronic illnesses, including asthma and diabetes. And they have saved many lives through timely, skilled interventions. School nurses have been hit especially hard in the cost-cutting of the Great Recession, and many are now responsible for thousands of students. It's especially hard to justify funding for school nurses when decision-makers and the public remain convinced that they are flunkeys who just handle tummy aches and bruises. Consider New York City school nurse Mary Pappas, who reportedly became a "folk hero" to nurses for her quick thinking in setting in motion the governmental response to the April 2009 H1N1 flu outbreak, identifying and managing hundreds of her students' symptoms, as well as for her compelling testimony at a flu summit held by the Obama Administration in July 2009.
One of those who commented on the medic segment at the Daily Show website, who gave his name as Jason, aptly summed up the problems with the show's treatment of school nurses:
The medics are both decorated and have done wonderful service to their country. They described their work in the army in strikingly similar words: The job is to stabilize critically injured people for transport to the next echelon of medical care. Jon chose to then have them try to apply for a job as a school nurse and lamented the fact that they met none of the qualifications . . . you know, since neither of them was a nurse or holds a degree. He mocked the job requirements and basically insinuated that all a school nurse does is put band-aids on boo-boos.
Do [the medics] know how to identify the early spread of whooping cough or chicken pox? Can they spot the five warning signs of an abused kid? How does one tell the difference between a kid with a thyroid problem and a kid with juvenile diabetes? I'm not saying the medics don't have skills, I'm saying that sucking chest wounds are thankfully fairly rare on the playground. . .
I think the training these two have sets them soundly on the road to pursuing a professional nursing degree. Maybe they should take their G.I. Bills, well-earned as part of their enlistment, and, oh, I don't know, go to nursing school? But Jon's stance that they "deserve" jobs they are unqualified for was, if well meant, idiotic.
Of course, it's no mystery why Stewart and his producers singled out school nurses. Of all the varieties of nurses, school nurses may be the most disrespected in both fictional and non-fictional media, serving as a ready example of health care work that's widely seen as a joke in terms of skills. We're not sure exactly why. Perhaps it's that most people form their impressions of school nurses very early, in school environments that remain traditional in key ways. Or it may be simply the traditional association of school nurses with children and their minor health issues, though the association with children does not seem to have had the same effect on pediatricians. Whatever the reasons, most people's idea of school nursing seems to be based on little more than the stereotypes of yesteryear--and perhaps, in the current budget-strapped era in which school nurses must care for an unworkable number of students, on interactions with persons who school officials are happy to call "nurses" but who are actually nurse's aides with a few weeks of training.
School nurses also appeal to Hollywood writers looking for an example of what physicians are reduced to when their skills are being utterly wasted. For example, in the June 2009 premiere of USA Network's summer drama Royal Pains, the brilliant and heroic physician character Hank Lawson was fired and blackballed by a New York City hospital for not treating a hospital board member before a critically injured homeless person. Afterwards, Hank lamented that he could not even find a job as a school nurse! (See the clip.) In the January 2011 premiere of the ABC show Off the Map, one of the smart young physician characters complained that all she had gotten to do that day was hand out Band-Aids, "like a school nurse!" (See the clip.) Of course, the irony is that these physician characters would not be qualified to act as school nurses, since they would lack the nursing training required. Needless to say, that is true of the medics on the Daily Show.
But should Jon Stewart and the Daily Show be held to a higher standard than some Hollywood fantasy? Or is this what the show means when it describes its work as "fake news"?