Innate compassion and learned behavior

"PARADE" covers "The American Nurse"

 
May 6, 2013 -- To mark International Nurses Day, the widely-read PARADE magazine today posted on its website 10 portraits drawn from Carolyn Jones's The American Nurse, a coffee table book of portraits published in 2012. On the whole, the portraits and related interview text give a sense of the important, wide-ranging work of nursing. A few even briefly suggest how nurses use their skills to help patients, including an excellent portrait of a New Orleans family nurse practitioner who cares for mothers and babies, and good one in which an Appalachian hospice nurse describes his dream of opening a clinic and addressing the obesity epidemic. The images are diverse; they include two African-Americans, three men, and two advanced practice nurses, as well as nurses who work in a school, a prison, and an aircraft. All interview text includes the professional credentials of the nurses, including graduate degrees. And there is no suggestion that nurses exist to serve physicians. On the other hand, a lot of the text and portraits are infected with emotional "angel" imagery, vague about nursing, or not about nursing at all. Likewise, the introductory statement from Jones--that nurses are a "special breed" combining "innate compassion and learned behavior"--doesn't exactly tell the public anything new or helpful. We also do not learn here that nurses do anything on the cutting edge, or that they are engaged in research or innovation. And although some of the photos are powerful, as past photo collections featuring nurses have shown it's hard for still images to convey the most important thing most people need to learn about nurses--that they are life-saving professionals with advanced skills. We realize that the imagery and text that appears here primarily reflects decisions by Jones, not the nurses. In any case, we thank those responsible for the imagery and text that does advance public understanding of nursing.

The feature is headlined "In Honor of National Nurse's Day, a Gallery of Striking Portraits." An introductory paragraph by the magazine's Catherine DiBenedetto describes the road trip Carolyn Jones took to create the book, which includes 75 portraits. The paragraph quotes from Jones's book introduction: "I do believe that [nurses] are a special breed--some combination of innate compassion and learned behavior. I wish I could say exactly what it is, because I'd bottle it up and drink that potion." That's nice, but between reinforcing nursing's longstanding emotional image ("innate compassion") and an apparent reference to nursing skill that's about as vague and weak as it could be--walking is also "learned behavior"--it doesn't tell readers much that's useful about the profession. And the "potion" bit suggests that there is something otherworldly about nurses, which is in some tension with the fact that they are college-educated professionals.

The introductory paragraph also includes an editorial note that "the book and the entire American Nurse Project would not have been possible without the support of healthcare company Fresenius Kabi." Fresenius Kabi is a large multinational drug and medical device company and, as with Johnson & Johnson's long-running "Campaign for Nursing's Future", it's not hard to see why such a company would wish to associate itself with nursing. Nurses top the Gallup poll on ethics and honesty every year, pharmaceutical companies are especially in need of the public trust have everything to gain by fusing themselves with professionals perceived to be ethical and honest. We note that none of the portraits in PARADE seem to suggest that any "American Nurse" is working to challenge the current roles that the private sector plays in U.S. health or health care.

A few of the portraits give at least a brief sense of the importance of nurses and their skills. Perhaps the best is that of Deborah Nettles, of the Interim LSU Public Hospital in New Orleans, a family nurse-practitioner who works on the "Mom and Baby Mobile Unit." The photo shows Nettles standing proudly in front of the Unit in scrubs and white coat. She says the Unit's purpose is to "go into the community where women may have problems with access to health care." She says she can relate, because growing up, "we didn't go to the doctor very often" and "didn't discuss" women's health, so "something as simple as a menstrual cycle was a mystery." "I believe the women's services we provide, and the things we talk about in our program, have been instrumental in saving many lives." This is great:  in the limited space she has, Nettles links her own background to what she does now for patients and stresses why it's so important.

Another good portrait is that of Jason Short of Appalachian Hospice Care in Pikeville, KY. He stands on what looks like a shallow stream bed in the woods, looking proud and steadfast. Short says he used to be an auto mechanic with his own garage, but when the economy went downhill, he thought it would be good to get into health care--a strong message about diversity and opportunities in nursing. Short focuses his comments on how he wants to help the people of his area with "the obesity epidemic," which he says affects "really young" people there. His dream is to have his own clinic and not just hand out pills but also help people "with their dieting issues, with weight loss and controlling diabetes, especially in children." Short says he's found that "once you get a taste for helping people, it's kind of addictive"--a good, honest note about the benefits of being a nurse.

And Brian McMillion, of the VA San Diego Healthcare System, describes his work as a U.S. military reservist in a hospital in Germany in 2003. He says he would wake up wounded soldiers with missing limbs from coma or sedation, remove the tubes from their throats, and the first thing they'd ask would be when they could go back to the war. He says: "You love them tremendously at that moment, but you also want to smack them and say, 'No! You ain't going anywhere. You've already given enough, brother.'" The photo shows McMillion in a suit, with a military backpack, standing outside in front of palm trees and a huge U.S. flag. This portrait shows that nurses play an important role in caring for wounded soldiers and at least hints at technical knowledge, with the breathing tube.

Other portraits are really focused on nurses' patients, which is understandable but doesn't convey much about the profession beyond the diversity of care settings in which nurses practice. Matt Tederman of the Nebraska Medical Center / LifeNet stands in front of what looks like a rescue helicopter and describes his work as a flight nurse. He says he once cared for a kid who had run into a barbed wire fence with his snowmobile and was pretty badly hurt; there was a positive outcome but, Tederman notes, things like that remind you to kiss your own kids when you get home. That's pretty vague as far as what Tederman does, though obviously he is involved in dramatic rescues of the badly injured and flying them to hospitals, which many people may not know nurses do. Rosemary Livingston, of the Children's National Medical Center, DC, notes that some could never work with sick kids, but she feels the opposite, referring to kids' strong will to survive. The photo shows her in scrubs, holding a sick baby. And Tonia Faust of the Louisiana State Penitentiary in Angola describes the 26 inmate volunteers in "the program" who ensure that "for the most part the dying inmates have someone with them all the time. No one dies alone. I mean, that is a luxury that most of us outside this prison won't have." She stands in scrubs, in front of the ward with some patients in beds, looking intense and a little sad. That's a good photo, but like the portraits of Tederman and Livingston, it doesn't tell the public much about what nurses actually do for the patients in these settings.

The rest of the portraits are not too specific about nursing, not really about nursing, or least helpful of all, seem to reinforce the unskilled "angel" image. Colleen Lemoine, also of the Interim LSU Public Hospital, is identified as an APRN and an oncology nurse. She says she's "privileged" to be with people when they're at their "most authentic," during a "very sacred time." She observes that "one of the things nurses are really good at is being present and sharing their life at that moment in time." The photo shows Lemoine in a white coat, smiling, with her face upturned, eyes closed, hugging the head of a smiling apparent patient, who faces the camera. Dolores Crowder, a nurse at E.L. Haynes Public Charter School in Washington, DC, stands with a smile, surrounded by active kids. Says she is not just a nurse at school, but "I am a nurse wherever I go. It's deeper than just a job." She uses the "RN" whenever signing any legal document because "that's who I am, through and through." Judy Ramsay, a nurse for 49 years, is photographed surrounded by Chicago's Windy City Rollers, a roller derby team on which her daughter competes. Ramsay says one night the team asked her to help with some ice for a sore muscle, and she started bringing Band-Aids. Later, she asked her husband to join because "the girls needed more help than I could give" (his profession is unstated), and now they and a physical therapist who specializes in sports medicine are the team medics. The team calls her "Mama Doc." And Sister Stephen Bloesl, of the Villa Loretto Nursing Home in Mt. Calvary, WI, describes how her organization came to acquire a number of farm animals, so "now it is quite lively around here." The photo shows her smiling and holding a lamb in each arm.

Certainly all of those portraits give people reasons to feel positively about nursing in a general way--the way most people already do--they just don't show that nurses do anything specific that a lay person could not, much less that nurses are college-educated professionals who save lives. And it seems to us that, when it comes to who will get scarce educational and clinical resources, generalized affection tends to lose out to respect for knowledge and specific skills.

Still, taken as a group the portraits do convey some important things about nursing practice, illustrating some key nursing roles and diversity in the profession. We thank those responsible.

See the article "In Honor of National Nurse's Day, a Gallery of Striking Portraits" by Catherine DiBenedetto, posted May 6, 2013 in PARADE magazine.