As the [nursing] world turns…

The art of caring has taken on new meaning in the new millennium

On April 1, 1963, the soap opera General Hospital made its debut on network television in a bid to be the daytime equivalent of the wildly popular medical dramas Ben Casey and Dr. Kildare. More than 40 years later, it has outlasted both.

The staff at General Hospital featured chiseled doctors with manicured hair and white lab coats, stethoscopes draped around their necks. Their most outstanding accessories, however, were the pretty nurses — ladies in waiting whose stiff winged caps anchored to their coifs, starched white dresses, hosiery, and pumps remained as pristine at dusk as they were at dawn. Their role, as precise as their appearance, was to serve their doctors, to remain at their beck and call, to honor and obey with the devotion of a traditional wife.

Times have changed.

Winged caps have taken flight, soft teal scrubs have replaced starched white dresses, and garden-party pumps have morphed into sneakers or clogs. The role of the nurse has changed too — shifting, expanding, upgrading to a valued profession whose contribution focuses less on the doctors and more on the patients.

The question is whether the television viewing audience, still exposed to traditional roles via the ongoing attraction to “entertainment medicine,” has kept pace with the evolution of nursing or if most people still assume a nurse is contracted to protect and serve the doctor.

“You can look at nursing from inside the profession or outside the profession and get two very different perspectives,” says Carol Coates, R.N., director of Community Hospital’s Intensive Care Unit. “If you look at how we’re depicted in the media, there is a real gap between reality and public understanding. The image of nursing is very superficial, that nurses are inferior junior doctors. We are not.”

For example, conflicted TV nurse Abby Lockhart, played by Maura Tierney on the modern classic ER, walked a line dangerously close to doctorship in her role until, at the urging of fellow characters, she returned to medical school to become one. It happens, but a storyline like this also gives the impression that nurses are simply doctors in waiting.

“Most of us are not looking to become doctors,” says Main Pavilion director Marie Stewart-Helms, R.N. “Ours is a separate and distinct profession. We are privileged with so much more time at the bedside than a doctor has. There is such an intimacy happening with the patient. And today, there is so much more to do in nursing, so many roles.”

Nurses have become collaborators with the doctors and technical staffs in a hospital. Poised at the center of a patient’s medical care, the nurse is expected to know what the doctor has prescribed and why, and to understand the roles and contributions of all other disciplines involved in the patient’s care. It is quite often the nurse’s job to coordinate multidisciplinary treatment for the patient.

“Most of us are not looking to become doctors. Ours is a separate and distinct profession. We are privileged with so much more time at the bedside than a doctor has. There is such an intimacy happening with the patient. And today, there is so much more to do in nursing, so many roles.” — Marie Stewart-Helms, R.N. Director, Community Hospital’s Main Pavilion

“A nurse has a very deep understanding of the human condition and what normal health is,” says Chris Hall, R.N., director of the Comprehensive Cancer Center. “He or she learns, when health is not maintained, what it takes to get that person back to the highest level of functioning, and he or she coordinates that effort.”

Regulatory agencies now expect nurses to learn more, to know more, to be more skilled, and to question everything that registers concern, at all levels.

“The attitude is much more collaborative now,” says Coates. “It used to be a doctor expected the nurse to do his bidding, to follow his orders and not ask questions. The doctor still has medical oversight, but we have our own role. As part of a collaboration, we are expected to do our own critical thinking and to question everything.”

Historically, a nurse, usually a woman, was expected to be skilled in caring for young children and/or the sick, usually under the supervision of a doctor. The focus was on caring, while the doctor’s was on curing. Today, the two perspectives are blurring. According to Coates, patients are demanding — quite rightly — that doctors be caring and that nurses have greater knowledge to work with the doctor.

Underlying any nurse’s job is a standard approach called the “ nursing process.” “It’s actually a pretty simple concept,” says vice president of nursing Terril Lowe, R.N. “All nursing care begins with assessment. That can be something as basic as taking a blood pressure or as complex as doing a pelvic exam for a mom in labor. The next step is to make and implement a plan of care, then to evaluate how the plan worked, and finally, to start the process over with more assessment. The steps look different depending on the patient population — emergency, pediatrics, ICU — but the nursing process is always the same, and caring is always at the heart of the job.”