A Physician Finally Gets Nursing

RelmanArticleCaptureBy Shawn Kennedy, editor-in-chief

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.

What’s it going to take for our colleagues, administrators, and hospital boards to get it, too?

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Editor-in-chief, AJN


  1. Marianna Crane February 23, 2014 at 2:12 pm

    Reblogged this on Marianna Crane and commented:
    I couldn’t write a better post about Dr. Arnold Relman’s comments about nursing, so I’m reblogging this Post. The comments he made are both “good” and “bad.” Good: Dr. Relman, physician and former editor of the New England Journal of Medicine, stated “When nursing is not optimal, patient care is never good.” Bad: Dr. Relman finally recognized this at age 90!
    This just reinforces my belief that nurses need to make ourselves more visible (see my post “I was the only one.” )

  2. Marianna Crane February 20, 2014 at 5:02 pm

    Teresa, my example was not meant to show the inevitability that nurses are discounted but to give an example that some do pay more attention to doctors. We nurses already know who makes the difference in patient care. We need to make our contributions more visible to the general public.

  3. Dr. Teresa Goodell February 20, 2014 at 3:54 pm

    Marianna, my experience as a family member of patients has been quite different. I do remember nurses, and I know others who do. I think this is partly a choice, not an inevitability. Certainly it’s easier to remember the names and faces of 3 or 4 physicians than 8 or 10 nurses, but that doesn’t mean we can’t pay attention to the value nurses bring to the patient care enterprise.

  4. Marianna Crane February 20, 2014 at 2:50 pm

    No doubt there are other reasons that contribute to nurses not getting recognition and appreciation besides not speaking up for ourselves. However, I still maintain we are our own worse enemy because we don’t call attention to ourselves. Lee Gutkind published a journal devoted to nursing, “I wasn’t strong like this when I started out: True stories of becoming a NURSE.” He makes a case when he titles his introduction “The anonymous, irreplaceable nurse” and then goes on to say when he visited a friend in the hospital he remembers the doctors but could not “tell you what any of these nurses (who came and went in the room) looked like, what their names were, where they were from.”
    Are we really that invisible?

  5. Dr. Teresa Goodell February 20, 2014 at 11:25 am

    I am tired of being admonished to “speak up for nursing,” when nurses like me (and many others) have done research, written op-eds, spoken to administrators, written to our legislators, and delivered carefully crafted speeches to policymakers about the importance of nursing. We have been skillfully articulating our importance for decades, if not centuries. Reams of research exist demonstrating the importance of sufficient numbers of specific types of well-educated nurses to patient outcomes (e.g., certified nurses, advanced practice nurses, bachelor’s-prepared nurses, and so on.) Nursing remains underappreciated for several reasons, including sexism and the fact that our work is usually not directly billable. Willful ignorance is the real problem. Let’s stop blaming ourselves.

  6. Ruth_SJRN February 18, 2014 at 9:07 am

    Hospitals won’t be humane enough without the nurses. Most of the time, nurses are the one who fills up the emotional needs, motivation and support of some ill patients. They play vital role in rehabilitation and making them well.

  7. Becky Lehr, LPN February 17, 2014 at 11:21 am

    I have long been verbal about my opinion that we ALL ~yes that includes nurses~ need to spend some time on the “other side” of the bed-rails, as it were. Being hospitalized for 5 days during my first year of nursing certainly opened my eyes to the value and true definition of Nursing Care.

  8. Peggy McDaniel February 16, 2014 at 8:04 pm

    As a bit older nurse I would venture to guess that much of his ignorance of nursing’s role in healthcare is based on the fact that he did his training ages ago. I became a nurse in 1984 and have witnessed the change in culture around nursing. That said, we still have a LONG way to go and agree with Marianna. We need to be tooting our own horns and promote nursing exactly as it is- a separate and equal part of the patient care experience. Doctors play a role, nurses play a totally different role. When either are less than “good” then the patient suffers.

  9. Kristy Todd February 16, 2014 at 2:29 pm

    I think so many times as nurses we feel that what we do is just a part of the job. I have always been very honored to be a nurse and provide care for patients. I think we do need to recognize our impact on patient outcomes and strive every day to improve the care of the patients we serve and to take credit for the great work we do!!

  10. Deb February 14, 2014 at 9:36 pm

    Studying politics at university in the 1990’s – Right Leaning professor who thought nurses were an over paid burden on the health system- until he was admitted to hospital for major surgery. He came out with a whole new appreciation for the work we do!

  11. Laura Cannon Parker February 14, 2014 at 5:04 pm

    It’s about time. This is usually when most find out about nursing care-too bad he didn’t realize this while he WAS the editor and a current professor.

  12. Kenya February 14, 2014 at 4:05 pm

    I’m glad he finally recognized our value and had the courage to admit it and not take it to his grave. I applaud him and understand that although he worked alongside of nurses for decades he was, nevertheless, a victim of his error.

  13. Marianna Crane February 14, 2014 at 10:43 am

    We nurses need to blow our own horn and stop relying on others like doctors to do it for us. We can’t wait to be “recognized!” How do we do this? By writing our own stories and submitting them for publication, responding to articles on nursing whether positive and especially if negative, educating our new nurses to stand united for excellent practice environments. I could go on and on. We know what to do–let’s just do it!

Comments are moderated before approval, but always welcome.

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