Commentary

Nursing today is complex, challenging, caring, and changing. Today we live in a world paralyzed by despair and inequities. People want change, yet at the same time fear change.

The health-care reform debate was a prime example of the ambivalence people are feeling. Many Maine residents have experienced the integrity problems within the health care-system of today. Nurses, the frontline providers of health care, work every day in a health-care system that they know lacks integrity, with people with excellent health coverage often being overtreated, and people with poor health coverage being undertreated.

Nurses have been walking the fine line of being the patient advocate and at the same time pleasing the institution where they are employed so that they can remain employed. Nurses today, however, are drawing their line in the sand, overcoming the paralysis they have endured from fear. They are speaking out in record numbers, disclosing the problems they witness.

Nurses are speaking out because nurses realize that their caring and integrity are the heartbeat of health care. Nurses are speaking out because nurses care about you.

Complex

Claire Fagin sums the complexities of nursing as “in the last decade, nursing has been revolutionized. Nurses have more and more complex skills and provide primary care as well as expert technical care in an increasingly technological, medical universe. They also provide the emotional and physical care essential to the broader needs of a public experiencing devastating health and social problems such as AIDS and homelessness, as well as the effects of aging and chronic and fatal illnesses. Nurses are treating the poor, teen-age mothers, infants and children, minorities, and rural Americans. They are clinicians, researchers, politicians, policy analysts, administrators, and teachers.”

Challenging

Today, nursing is being challenged more than ever. They are challenged educationally to maintain skills that keep pace with the rampant changes in complex technology and the revolving door of health-care institutions.

Nurses are challenged professionally to explore new roles and provide a wider range of services more autonomously. Nurses in our communities and homes are working with sicker and more complex patients and social ills. At the same time, resources are less available for prevention: (for example), 30 percent of Maine children under age 2 lack immunizations, and 24 percent of Maine residents die before age 65.

Nurses are challenged to maintain their ethical responsibility to remain an active patient advocate. Increasingly, nurses are terminated from their place of employment if they speak out on issues of poor quality care or unsafe care. More and more American nurses are being replaced by unskilled, unlicensed personnel and nurses from other countries. They are having their patient-care hours reduced to a part-time status. Every time a nurse is removed from direct patient care and replaced with unskilled personnel, patient advocacy is silenced.

Caring

Nurses have a tradition of caring. In the words of Dr. Linda Cronkhite, MS, RN, president of the Maine State Nurses Association, “People become nurses because they care. They care passionately about people and their welfare.

“During their professional education, nurses are socialized into roles that value individual patient care and are taught to think of themselves as professional persons and as advocates for those whom they provide care. Nurses’ greatest satisfaction comes from knowing that it is their skills, their practice, and their advocacy that bring about positive outcomes for patients.

“As a nurse, I think that it is significant that the first rescue worker to die as a result of injuries in the Oklahoma City disaster was a nurse, Rebecca Anderson, a nurse who though not on duty, left her family and rushed to the scene simply because she cared — and felt driven to help. It is also significant that even after her death, as a final measure of giving, her heart and kidneys were donated to needy recipients so that they could continue to live. For me, that nurse symbolizes what I think nurses are all about.”

Changing

Nursing is changing every day to keep pace with technology and demands. The current costly health-care system shift from that of a fee-for-service system to that of a capitated system is also demanding changes of nurses. A capitated system means that the hospital will get a predetermined amount (of money) that it and the insurance company agree upon to care for the patient per month.

Big business, the insurance industry, and the hospital industry are mandating the shift. Expensive consulting firms are reaping profits while they compartmentalize patients into “blocks of consumers.” They develop language that will sound pleasing to the ear as selling points to manipulate employee/consumer support. These unproven structures pay no regard to quality of care, to safe care, or to the cost of health care to you the consumer, or to your right of choice.

Since the days of Florence Nightingale, nurses have risen to the challenges and the changes in the health-care system to meet the complex care needs of our patients. Further, nurses have always upheld their resposibility of patient advocacy. The future will prove no different; nurses will continue to be “the heart” of health care because nurses care: They always have, and they always will.

Deborah Wheaton Gillespie, MSN, BSN, RN, is the director of public relations for the Maine State Nurses Association.