NYU Langone Medical Center and Nursing Image

In 2005, with great fanfare, New York University’s Langone Medical Center announced that it had been awarded what is known as Magnet Status.  I learned about this from reading my morning New York Times, in which the hospital spent thousands of dollars on a full page ad complimenting its nurses on having achieved an award for nursing excellence.

Oh how quickly they forget.  Fast forward to 2010 and NYU’s latest ad.  Not only are nurses gone from a new ad the hospital has run in — at least as far as I have seen — the New York Times, The New Yorker, and the Wall Street Journal.  To add insult to injury, the hospital’s latest act of nurse recognition is to award nurses’ work to physicians.  A full page ad features a man in scrubs standing by the bedside of a patient in an intensive care unit.  The headline reads “Intensive” and under it, in parentheses, is the word “Support.”  I looked at the ad and thought, great, NYU is continuing to deserve Magnet recognition because it’s continuing to recognize the work and accomplishments of nurses.  I spoke  — or rather thought — too soon.

Here is the ad copy:

“Sometimes it’s what happens in the hours immediately after surgery that makes the difference.  The Critical Care Unit at NYU Langone Medical Center Tisch Hospital is staffed 24/7 by physicians board-certified in critical care medicine, ensuring the intensive support you deserve at the moment you need it most.”

As you will note, there is not a single mention of a nurse.  This institutional (a symptom of a larger societal) amnesia is truly remarkable.   The people who designed and signed off on this ad seem to have forgotten the fact that  the intensive care unit was developed to provide intensive care nursing.  As historians Julie Fairman and Joan Lynaugh write in their excellent history of the critical care unit, Critical Care Nursing, the critical care unit developed out of the following dilemma.  In the 50’s and 60’s, “all over the country, in erratically staffed but expanding hospitals, nurses found themselves responsible for desperately ill and dying patients whose medical and nursing needs exceeded the nurses’ availability, knowledge, and authority.  Left on their own to cope with these difficult and frustrating situations, some physicians and nurses were powerfully motivated to find a better way.”  Finding that better way led nurses to found intensive care units because, as one early intensive care nurse said, “The units were invented because of the problems that came from a patient being desperately ill and needing one nurse…Finding a way to respond to that situation multiplied by thousands of times forced us to change the hospital.”  (Julie Fairman and Joan Lynaugh.  Critical Care Nursing: A History.  Philadelphia.  University of Pennsylvania Press, 1998).  This response led nurses who wanted to gain more knowledge and skill to also found the American Association of Critical Care Nurses.

In their definitive account of the development of the critical care unit, Fairman and Lynaugh include the participation of physicians and certainly do not discount them.  But they make the historical and contemporary reality crystal clear.  What is unique about the critical care or intensive care unit is that it provides intensive care nursing, usually with a mandated ratio of one nurse to one or two, at a maximum, patients. So what happens to make sure that patients are safe immediately following surgery?

Well, first of all they go to the PACU, Post Anesthesia Recovery Unit, where they are monitored one-to-one by a PACU nurse who makes sure they come out of anesthesia and are otherwise safe.  Then they go up to an ICU, if needed, where they are handed over for one to one or one to two nursing care.  Of course doctors are involved, but nurses in the ICU are the ones who give the 24/7 support.

Let me make this point again, since it seems so easily to be forgotten — patients are simply not admitted to critical are units unless they need yes- the SUPPORT — of intensive care nurses.

But nurses do not even appear in this ad for NYU’s Langone Medical Center.  No where.

Oh well, you might say, it’s just an ad. No one takes ads seriously.

Again not so fast.  The implications of this kind of hospital promotion are quite serious.  Not just because the hospital that a few years ago was happy to use nursing to get a competitive edge on its competitors seems to have forgotten the plot, but because ads that focus exclusively on doctors  convey several other unfortunate messages.  First they portray medicine and health care as a physician only affair.  Thus NYU is now suggesting  that the only thing patients have to worry about in hospitals is the presence or absence of an MD.  So don’t worry about a nursing shortage, don’t worry about nursing excellence, doctors do it all –24/7.

This message would have been reprehensible a decade ago, but its even more reprehensible today.  Since the 1999 Institute of Medicine Report on medical errors and injuries To Err Is Human, http://www.nap.edu/openbook.php?record_id=9728and its follow-up report Crossing the Quality Chasm http://www.nap.edu/openbook.php?isbn=0309072808, we know that keeping patients safe depends on team work.  This team consists not  just of physicians but nurses and many other players on the health care stage.  If hospitals, in their media( even their advertising media) do not emphasize team work, the American public — which includes people who will eventually become physicians and nurses and other health care workers –will continue to think that medicine , or nursing, or physical therapy etc, is a solo activity.  Which is an idea that is as dangerous as it is inaccurate.

I think nurses and patients all over the country should write to the CEO and CNO of NYU Medical Center to politely but firmly complain about ads like this.  I for one intend to do just that.  The CEO is  Robert Grossman and the CNO is Kimberly Glassman. You might also think about emailing some of the members of the hospital’s board of trustees.  Their names can be found at http://www.med.nyu.edu/about-us/trustees#nyuh.

You might also want to ask why there is nothing on his hospital’s home page about the Hospital’s Magnet status and not a word about nursing.  You have to know to click on nursing at NYU Langone Medical Center to find out anything about nursing.  So once again, nursing lives in its own ghetto,except occassionally when its let out and called upon to help a hospital compete.   I happen to know that NYU is connected to a top notch nursing school and that there is a lot of fascinating research going on at the hospital and school that involves and includes nurses.

Here’s a suggestion for NYU Langone Medical Center.  Obviously ads that feature nurses should be part of any campaign.  But why not have ads that feature nurses and physicians as well as other members of the health care team.  For example, the ad that just appeared could have easily featured two people at the bedside — an RN and MD (at a minimum) and the copy could have read “The Critical Care Unit at NYU Langone Medical Center’s Tisch Hospital is staffed 24/7 by physicians and nurses certified in critical care medicine and nursing.”  Problem solved.