The Trouble With Smiles

Nursing has been infected with smilitis.  Go into any hospital, and check the pictures on the walls.  Hospitals often use pictures of nurses to promote the institution.  Trouble is, the nurses are always smiling.  Doctors look serious, with serious looks on their face, because they know something serious.  Nurses, on the other hand, are used to convey an impression of coziness and comfort.  Although patients actually find comfort in the fact that the people who are taking care of them actually KNOW what they are doing, hospitals and a lot of nursing organizations seem to ignore this and focus on the sentimental value of the nurse.

Check out nursing websites and what you often find are hearts and smiles.  Like for example, Johnson and Johnson’s Campaign for Nursing’s Future. Smiling nurses greet you on every page.

In fact, the Campaign is actually asking nurses to send in pictures — all with a smile — for a mosaic they plan to prepare to inspire and encourage.  As they put it, “Your Smile Will Help Nursing Students Get a Picture Perfect Start”

“In preparation for our 10th Anniversary celebration this year, the Johnson & Johnson Campaign for Nursing’s Future is creating a unique mosaic image that celebrates the nursing profession.
A photo mosaic is a compilation of many individual pictures that are used to create a single image. In recognition of the ten years that the Campaign has been making a difference in the nursing
profession, we are working to collect ten thousand images and have extended the deadline for picture submission until April 30, 2012. The Campaign plans to unveil the final mosaic this fall.”

What’s the probem with smiles?  A lot.  First of all, the focus on all smiles, all the time makes it look like the nurses’ job is simply to cheer people up and on.  Smiles hide the fact that nursing is cognitive work, not sentimental work.  We need nurses because they save our lives, because they prevent catastrophic complications, because they have knowledge, not just kindness.  Of course kindness and caring are critical.  But when it comes to sick patients, kindness and caring involve knowledge work, not virtue work.  Nurses have to know a great deal and maintain enormous self-discipline in order to be kind and caring to people who are sick and in pain, often irritable, sometimes angry, and sometimes even aggressive and at times violent.  This is not work for the faint-hearted.  Or as one wonderful documentary about nursing once put it,“Sentimental Women Need Not Apply.”

From hospital advertising, and media campaigns like J& J’s, it would seem that nursing is only interested in attracting sentimental women and men.  I can understand why J&J harps on the sentimental aspects of nursing.  The company desperately needs to mobilize the “halo effect,” that a connection to nursing provides.  Big Pharma is, after all, not exactly flavor of the month and J&J is a company that has been attracting a lot of bad PR these days.  Just two days ago, an article in The New York Times exposed the fact that J&J has been peddling an artificial hip that was banned in the US in many foreign countries.  The article, entitled, “Hip Implant FDA Rejected Was Sold Overseas,” details the fact that the company has marketed an all metal hip socket cup with a faulty design.  The DePuy orthopedic division of J&J recalled the device in 2010 and has continued to sell it overseas.

This is not the only time that the company seems to have placed profit above patient safety .  In her book Blood Feud, investigative journalist Kathleen Sharp details how a J&J subsidiary marketed an anemia drug, known sometimes as procrit, or epogen (or to cyclists into doping -epo) for dialysis and cancer patients.  J&J encouraged its pharmaceutil reps to market the drug in doses much higher than was safe and to use it for off-label uses for which it was not tested.  Reps used bribes and kickbacks to doctors, hospitals, and pharmacists in order to encourage them to prescribe and stock the drug.  It’s a sorry tale and helps to explain why companies like J&J are so eager to connect themselves with smiling, comforting looking nurses.

Nurses themselves, however, are promoting the image of a professional whose only job is to smile at patients and occasionally hold their hands.  This morning I found an article in The Kansas City Nursing News entitled “Nurses pack sile into meal deliveries.”  The article describes the work of Babette Orlich, a neonatal ICU nurse at North Kansas City Hospital who volunteers to deliver meals her hospital prepares to people in need.  Instead of focusing on the important knowledge she mobilizes to help these sick and vulnerable clients, the article and the nurse herself focus only on the niceness of the nurse and the act of kindness she performs.  Instead of telling us that a nurse with her qualifications is mobilizing knowledge and skill when she enters the home of a sick and vulnerable person, she focuses exclusively on how sweet she is and how good she feels because of her charitable activities.  She greets them with a “sack and a smile,” the article tells us. “I might be the only one they talk to that day,” she explains.  “Hand-holding and smiles are all part of the experience, she said.”

A retired nurse, Evelyn Grill, who also delivers meals, talks about the fact that she has made long-lasting friends over the years.

What’s my problem with this article and the way nurses talk in it?  Am I a grumpy, uncaring lout?  No, I value nurses’ caring.  But this article and so many others like it devalues the knowledge and skill nurses have.  Nowhere in it, do you learn why it’s a plus to have a nurse delivering your lunch or dinner rather than  some other charitably inclined individual.  An ICU nurse will not only hold your hand or smile, they’ll notice if you have a serious problem that deserves more attention.  They can tell if you’re having trouble walking, if your house is a danger zone, if you’re at risk for a fall or some other accident just waiting to happen.  Even the smile and the hand-holding is serious business — not just a nicety or icing on the cake.  Socially isolated human beings do not recover, and if they are in decline, that isolation will only make things worse.

An article like this provides an opening for nurses to explain what they know and why their work and knowledge is so important.  Rather than taking advantage of this opening, nurses have been studiously tutored to slam the door right in our face.  I don’t blame these nurses for that.  Their socialization in what Sioban Nelson and I call the virtue script has made this almost inevitable.  But it’s time for nurses to tell the world what they do and why focusing on smiles is just not enough.

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