Saturday, April 29, 2006

Sister, I'm Speechless.

I don't know what to say. While surfing, I noticed Kim from Emergiblog's support for the concept of a US National Nurse via a US Congress Bill HR903. I can only presume this is a nursing equivalent of the US Surgeon-General.

Now, I had always thought it a bit odd that the US had a Surgeon-General, but fair enough, that's what they decided on. His or her job is to go around promoting public health. That's great. In fact, the Surgeon-General's specific duties are:
  1. To administer the U.S. Public Health Service (PHS) Commissioned Corps, which is a uniquely expert, diverse, flexible, and committed career force of public health professionals who can respond to both current and long-term health needs of the Nation;
  2. To provide leadership and management oversight for PHS Commissioned Corps involvement in Departmental emergency preparedness and response activities;
  3. To protect and advance the health of the Nation through educating the public; advocating for effective disease prevention and health promotion programs and activities; and, provide a highly recognized symbol of national commitment to protecting and improving the public's health;
  4. To articulate scientifically based health policy analysis and advice to the President and the Secretary of Health and Human Services (HHS) on the full range of critical public health, medical, and health system issues facing the Nation;
  5. To provide leadership in promoting special Departmental health initiatives, e.g., tobacco and HIV prevention efforts, with other governmental and non-governmental entities, both domestically and internationally;
  6. To elevate the quality of public health practice in the professional disciplines through the advancement of appropriate standards and research priorities; and
  7. To fulfill statutory and customary Departmental representational functions on a wide variety of Federal boards and governing bodies of non-Federal health organizations, including the Board of Regents of the Uniformed Services University of the Health Sciences, the National Library of Medicine, the Armed Forces Institute of Pathology, the Association of Military Surgeons of the United States, and the American Medical Association.
So what is the new Office of the National Nurse going to do? According to the bill:
  1. carry out activities to encourage individuals to enter the nursing profession, including providing education on the distinct role of nurses in the health professions and examining nursing issues that would increase public safety, such as issues relating to staff levels, working conditions, and patient input;
  2. carry out activities to encourage nurses to become educators in schools of nursing;
  3. carry out activities to promote the public health, including encouraging nurses to be volunteers to projects that educate the public on achieving better health; and
  4. conduct media campaigns and make personal appearances for purposes of paragraphs (1) through (3).
Now, don't get me wrong, but this seems like a rather self-serving agenda. The purpose is not to promote public health, but to promote nurses. Isn't that why there are lobby groups like the Centre for Nursing Advocacy, sworn enemies of Dr Crippen from NHS Blog Doc?

The Surgeon-General does not go out promoting the role of doctors (or even surgeons). He promotes public health by overseeing the US Public Health Service Commissioned Corps. That team consists of doctors, nurses and other allied health professionals. Is it not enough that nurses are part of a team? If they want to run the team why doesn't a nurse nominate themselves for the office of Surgeon-General? It's pretty clear that you don't even have to be a surgeon.

I don't know about you, but I am not in support of this concept. If a nurse wants to come and show that she can lead a team of health professionals then feel free. This is not a bill for a public-health advocate, or even a patient advocate. This is a bill for an Office of the Nurse-Advocate.

5 comments:

Kim McAllister said...

Hi Sheepish,

I'm posting this on both our blogs, perhaps to stimulate debate on both ends.

Thanks for commenting on my post! And, I have enjoyed finding your blog, in fact I intend to read more posts.

Yes, you are correct that the Surgeon General has all these duties. (Note: Follow the link to Sheepish's blog).

And you are correct that the Office of National Nurse is a vehicle to promote nursing. That's one of the main "points". We have an chronic shortage of nurses in the US. Part of the reason is that their aren't enough nursing professors to handle the number of people who want to become nurses.

And we need nurses. I'm not sure the situation in Australia, but here it is very severe.

The US Public Health Service is a uniformed service, NOT a volunteer organization, as the volunteer National Nurse Corps would be.

I don't want to work for the US Public Health Service, I prefer the private sector. But I have time to volunteer in my community, and the idea of being part of a National Nurse Corps is something I find very appealing.

And you could easily call it the "Office of the Nurse-Advocate" because when you advocate for nurses, you advocate for the health of the public.

And I agree with Dr. Crippen, nurses need to do nursing!! People are in the hospital because they need nursing care by....shock....nurses! : ) Basic, professional nursing care. From bedpans to ventilators to vaccinations to health education.

A national nurse would be a focal point for the nursing profession. A single, national representative to focus on nursing and their specific role and to give nurses a chance to volunteer in an organized fashion in their communitites.

So, we disagree, but in the meantime I have found an interesting new blog!

Dr John Crippen said...

Hi Sheepish

I have to say I don't have a problem with this provided it is about promoting NURSING and not, as I fear it may be, about promting accelerated promotion out of nursing into roles that leave nursing "care" to others.

I can't speak authoratatively on the US system. As you know the Centre for Nursing Advocay, which must be the most superfluous organistaion in the USA, has not sense of humour. The way the acted to the mildy amusing Mattel Corp Nusrse Quacktitioner Doll makes me giggle.


John

Sheepish said...

Hi Kim - Thanks for leaving a comment on my blog. I shall do the same.

I don't disagree in the concept of a nurse advocacy group, merely the point that the state should be funding it. The Surgeon-General is not a doctor-advocate, the Attorney-General is not a lawyer-advocate, the Department of Justice is not a police-advocate, and the IRS is not an accountant-advocate. Why should taxpayer dollars go towards funding a self-interest group? If public health is the issue, that already falls under the purview of the Surgeon-General.

On the other hand, if a group of nurses want to start up a de-facto union, then they can feel free to do so with their own funding. To say that its primary goal is patient care is window-dressing. It's primary goal is to attract more nurses and improve pay and working conditions. It is a union.

The second issue is of what such a body would do. It would be wonderful if it were to attract more nurses to the profession and retain them where they are needed - bedside nursing care. Unfortunately I fear that such a group would be hijacked into becoming a nurse-practitioner advocacy group.

We are just as short of nurses in Australia as the rest of the world is. The reason is two-fold (and unfortunately a vicious cycle).

1. Ward nursing is not as attractive or rewarding as it used to be (especially in scrooge-like public hospitals) therefore the only way to attract them into the profession or retain them is to offer a promotion pathway - i.e. managers or nurse practitioners.
2. So many registered nurses are becoming managers or "specialist nurse consultants" that there are none left to do essential ward nursing.

Perhaps later I will suggest a way to solve this. You won't like it, but there is a way.

regards,

Sheepish

Kim said...

Hi again!

Each state has its own Board of Nursing separate and distinct from all others, so our nurses are not united nationally, unless you want to join a professional organization.

Some (in my area, most) of the nurses are already "unionized", with their individual state nursing associations acting as their bargaining units. For instance, the California Nurses Association is my "union" (even though their politics are atrocious - I tend to be conservative, they tend to the liberal side of things).

There is no way there could ever be a national nurses union because the individual states would never go for it.

We need nurses who want to TEACH!

Most nurses here when they get their higher degrees stay right at the bedside. Some, become "Clinical Nurse Specialists" - now, while that can be a "loaded" term in the UK or Australia, here it means that these nurses are considered to be specialists for other nurses to use as a resource or they work in educating, on the job, nurses in their specific area of expertise, but never, ever to supplant a physician.

We actually have more applicants for nursing school positions than we can handle. If we can make the position of nursing professor more attractive
(a beside nurse makes more!), perhaps those with the gift for teaching would consider it.

And our nurse practitioners have advanced capabilities, but they are limited.

What should upset physicians more are the use of "Physician's Assistants" who act like a doctor, talk like a doctor, and are able to prescribe just like a doctor - and yes, they are overseen by doctors.

Me, I'm a bedside nurse all the way.

Doctors are the cornerstones of the health care system, they always will be and they should be. I was going to say that nurses are the bricks and then perhaps maybe the insurance companies are the grafitti! : )

Either way, as we "baby-boomers" get older, we are going to need both doctors AND nurses to take care of an aging population, so we need to start educating them now. AND recruiting them now.

Oh, and trust me, nurses here in the US do NOT gravitate to management. To be a manager is the WORST thing in the world. Those who do, God bless them. If they want to get away from the bedside, they leave the profession. Management, promotion ladders....not here.

I must keep in mind we are talking about different health care delivery systems here and the roles of the nurses are somewhat different, but they shouldn't be.

Patient care is what nurses are for.

Sheepish said...

Hi Kim, you make some good points as always. I like playing the devil's advocate.

Kim writes: "There is no way there could ever be a national nurses union because the individual states would never go for it."

1. If each of your local unions do not want to band together, then surely that means that there is either no need or no interest in a national union to campaign for working rights. A "National Nurse" would therefore be a government-sponsored position campaigning for something that is not necessary or not wanted.

"We actually have more applicants for nursing school positions than we can handle. If we can make the position of nursing professor more attractive (a beside nurse makes more!), perhaps those with the gift for teaching would consider it."

2. What happened to the apprenticeship or trainee model of teaching? It has disappeared in Australia, just has it has in the US. No longer do we have student nurses, state-registered nurses, and fully-registered or Div-1 or Div-2 nurses, each of which would train each other. All nurse training has been trasplanted to universities, where the amount of bedside teaching is dramatically reduced.

Sure, I think that it is great that nurses now learn basic anatomy and physiology, but do they really need to write a masters thesis on the psychosocial aspects of radial artery cannulation?

Nursing professors are very rare here in Australia. Each hospital has Clinical Educators. Unfortunately, my experience is that most of these are people who have dropped out of bedside nursing because they were not as good as they thought they were, and want to grandstand in front of young nursing students, and spend a lot of time instilling distrust with the medical profession.

At the end of they day, I don't learn surgery from a Professor of Surgery. I learn from everyday, ordinary surgeons. Why do you need so many Professors of Nursing when there are so many fully qualified nurses about?

Has this shift to university-based training occurred during your career, Kim? Do you think it has been for the better or worse?

"What should upset physicians more are the use of "Physician's Assistants" who act like a doctor, talk like a doctor, and are able to prescribe just like a doctor - and yes, they are overseen by doctors."

3. Thankfully we do not have PAs in Australia. I would be happy if we never have PAs in Australia. Unfortunately, this is exactly what the Nurse Practitioners are becoming. Doctors have progressively delegated their work out, and this is how each of the allied health specialties (Physiotherapy, Occupational Therapy, Dietetics etc) have developed. So far the relationship has been harmonious. Not so with Nurse Practitioners. Why? I don't know.

"Oh, and trust me, nurses here in the US do NOT gravitate to management. To be a manager is the WORST thing in the world. Those who do, God bless them. If they want to get away from the bedside, they leave the profession. Management, promotion ladders....not here."

4. Unfortunately it is commonplace in Australia. The ANF sees it as a means to gain more influence in the health sector overall, and also provide a promotion pathway for senior nurses. After all, what comes after working as the Director of Nursing at a tertiary hospital?

I have no doubt that we need more nurses. Unfortunately there are many factions in nursing politics that are pushing personal agendas and want nurses to supplant doctors. It is unhealthy, and unproductive for the health system. I fear that this "National Nurse" campaign is not as public-health minded as you may think it is.

My god, I think I'm turning into AngryDoc