Nursing and the Perils of Success
For years, I have been encouraging nurses to talk concretely about their work. Bernice Buresh and I have given nurses a primer in how to do this in our book From Silence to Voice: What Nurses Know and Must Communicate to the Public. As I think about nurses’ work, I continue to be convinced that nurses are not articulating their work and putting their brains — as opposed to their hearts — in the fore front of their conversation. In thinking about the nursing communication dilemma, I believe it’s important to consider what I call the perils of success. When I encourage them to talk about their work, many nurses tell me that it isn’t necessary. Patients understand what they do. They understand how important nurses are and how complex their work is. Well, I’m not so sure.
One of the problems is that a great deal of the work nurses do –whereever they practice — is preventive work. Nurses prevent bad things — or worse things as the case may be — from happening. When nurses work outside the hospital they may practice primary prevention. That is they stop people from getting sick in the first place. In the hospital, or home, or clinic, or rehab facility, nurses deal with people who are sick already. Nonetheless, they prevent worse things from happening to these patients. The person may already have diabetes, or a heart condition, or hypertension, or cancer, but that doesn’t mean that they can’t suffer from preventable complications — a medication error, a UTI, a bedsore, a DVT. It’s the nurses’ job to prevent those complications.
But ask yourself. When you prevent something, what happens? Think for a moment…….
What happens is nothing. Nothing happens when you act successfully to prevent it. And therein lies the perils of success. The danger is that a lot of people think that nothing happened to make that nothing happen, when in fact something happened to make nothing happen. If nurses do not talk about the something then people can easily think they do little or nothing. The more that nothing happens, the more people think, well, gee, who needs nurses. Nothing is happening.
Of course, what they aren’t thinking about is the thought, action, knowledge and skill went into that nothing. And that may be because nurseds are so busy talking about their compassion and niceness that they don’t talk about the skill and knowledge it takes to protect patients from the myraid dangers they will confront when they are sick. Administrators and politicians and journalists may even begin to imagine that hospitals are a lot safer than they are and that they don’t really need as many nurses because nurses are so successful at prevention.
If you doubt how seductive is this illusion just think back to Y2K. Remember, just ten years ago, when 1999 was about to turn into 2000 and we learned that all the computers in the world might fail and that at the stroke of midnight Jan 1, 2000, we would all turn into scullery maids like Cinderella and our amazing technological society would turn into a giant, global pumpkin. Newspapers were filled with stories of computer programmers frantically working to make sure that didn’t happen. But just in case it did, we were advised to stock up on water, canned food and plenty of cash (since the ATM machines would no longer be spewing out dollar bills, or Euros or Yen.)
Maybe you followed that advice. I certainly did and worried anxiously at a New Year’s Eve party about what would happen at that particular stroke of midnight. And what did happen? One big nothing. And what was my response over the next couple of days? I felt tricked,bamboozled. “What was all the fuss about? “, I thought. “Here we were chugging along just like we did throughout the latter part of the 20th century. It’s the media,” I thought, “once again making a mountain out of a molehill.” And, fortunately, then I thought again. Actually, it was because of all those people who were working on that mountain that it became a molehill. It was because of all the fuss that there was no more fuss, because of all that preventive work that our glass carriage did not turn into a giant orange vegetable.
Nursing is like Y2K everyday. If nurses do not explain to patients that they prevent any number of things, patients will never ever know. How could they? Nothing happened.
As I write this blog post, I do so in the shadow of the dramatic rescue of those 22 Chilean miners in the Atacama desert in South America. Wow, what a spectable! What a miracle! What drama! We are in love with the drama of rescue. But imagine if mine owners practiced the routine, daily, boring work of prevention, as the rescued miners keep reminding us in their post-rescue comments? And remember, for every miner rescued, hundreds are killed in preventable accidents. The point is, we cannot put our faith in the drama of rescue. We must put it into the everyday reality of prevention. And nurses must tell their patients precisely how they are practicing the science of prevention while they are practicing it. If they don’t there will be no practice, and that means patients will die.