Earlier this month, the New York Review of Books published an article by a patient who described his hospital stay following a life-threatening accident. This was no ordinary patient—the author, Arnold Relman, is a noted physician, emeritus professor of medicine at Harvard, a former editor of the New England Journal of Medicine, and along with his wife Marcia Angell, well known as a critic of the “medical–industrial complex.” His account is very detailed and gives a good example of how it can look when the system works (and when one has access to it).
His understanding of his condition and treatment, his knowledge of the system, and also his relative prominence as an individual, all undoubtedly helped him avoid some pitfalls and make a remarkable full recovery. However, as a number of others have pointed out recently, one comment in his account was surprising.
In reflecting on his hospitalization and recovery, he wrote, “I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.” After all his years in medicine, he only realized the value of nursing as a 90-year-old trauma patient.
This week, Lawrence Altman, another physician and author, wrote an excellent post for Well, the New York Times health care blog, examining why that might have happened. Altman, attributing a good part of physicians’ attitudes toward nurses (and other health care professionals) to how they have been educated, says that clinical medical education focuses on and values the interpretation of technology—the numbers as indicators of a patient’s progress, as in vital signs, monitor strips, ventilator settings, lab results, medication dosages. But personalized care is left to nurses, Altman argues, and physicians just don’t give it much attention.
Altman recognizes that nurses are sentinels, vigilant watchers who first note potential life-threatening problems, and he urges us to work toward a greater focus on interprofessional teamwork and education. I hope all who work in health care read his article, especially medical and hospital administrators.
While it’s always gratifying to hear that influential people support nursing’s value, the fact that Relman’s insight occurred so late in his life also makes me angry. How can a leading physician, an advocate for a better medical system, an educator of the next generation of physicians, go through most of his career and not realize nursing’s worth? One would hope that working alongside nurses during years of practice would have changed any misperceptions he might have had as a new physician.
We know and have the data showing that what nurses do matters. We know and we have the data showing that when hospitals have enough nurses, there are fewer adverse events. We know that when nurses don’t have time to teach patients and these patients go home unprepared, hospital readmissions increase, driving up costs. We know that patient satisfaction (and therefore reimbursement) is tied to nursing communication and responsiveness to patients’ needs. The Institute of Medicine knows it too, as evidenced by the Future of Nursing report.