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Art and Science of Nursing (DS)

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Suzanne Gordon was sitting in her Arlington home, reading the newspaper, when she came across a crossword puzzle that infuriated her. She was especially bothered by bone section of the puzzle: it was a word that fit into a two-letter block, and the clue was "ICU [Intensive Care Unit] doctor’s helper." The answer was RN.

But RNs (Registered Nurses) are not doctors’ helpers in the ICU, says Gordon. "They are the ICU. Intensive Care Units were developed to provide one-to-one nursing care."

The puzzle reflects just one of the many misconceptions that the public, media, and policy makers have about nursing, says Gordon, author of The Complexities of Care: Nursing Reconsidered and other books on the challenges and future of nursing. "We sentimentalize nurses or misunderstand their role," she says. "But nurses are the engine of the healthcare system and play a critical role, just as much as therapeutic interventions, in preventing complications and deaths from illness."

Nurses, once seen as healing angels or Florence Nightingales by the bedside, today are multidisciplinary professionals who provide quality patient care.

Nurses, once seen as healing angels or Florence Nightingales by the bedside, today are multidisciplinary professionals who provide quality patient care. While still focused on compassion and caring, 21st century nurses are trained in data collection and reporting, and work with electronic medical records, drug calculators, and diagnostic equipment, the new tools of medicine. And yet nursing is still "a balance between the art and the science," says Jeanette Ives Erickson, chief nurse executive at Massachusetts General Hospital.

"Anyone who has spent any time around nurses understands how seriously, how fiercely, even, they care about people who are admitted to their facilities," adds Diane Mason, editor-in-chief of the American Journal of Nursing.

But in this time-honored profession, an ongoing nursing shortage exists. Data point to nearly 4,600 vacant job postings for nurses in Massachusetts. Even with 120,000 licensed nurses in the state, there are not enough staff to fill the growing needs of hospitals and patients. The average age of nurses is 47, and as they leave the profession, the younger generation of nurses is not being trained in sufficient numbers to fill their gap. This, and the rising cost of healthcare, have created high patient-to-nurse ratios, leading the Massachusetts Nurses Association (MNA), the statewide union, to push legislation that would mandate that hospitals adhere to specific nurse-to-patient ratios, an approach adopted in California.

Add healthcare reform, e-health programs, and cutbacks in managed care, and the nursing picture gets murky indeed. But Beth Piknick, president of the MNA and a 36-year career veteran, says simply, "It’s still an awesome profession." Others, like Sandy Eaton, an RN at Quincy Medical Center, especially appreciate going to bat for patients who can feel overwhelmed by the complexity of the healthcare system.

Pat Folcarelli, director of professional practice development at Beth Israel Deaconess Medical Center (BIDMC) in Boston, says hospitals are doing much to try to recruit and retain nurses. For example, BIDMC is using iShift, a new web-based scheduling program that allows nurses to bid on shifts. Hospitals are also offering nurses an expanded role in decision-making, which gives them a greater voice in patient care and safety. And as with most acute care settings, at Beth Israel Deaconess, nurses can specialize in their area of interest, whether it is obstetrics or critical care.

At Massachusetts General Hospital (MGH), Erickson says increased educational offerings allow nurses to attend local and national conferences, and a nursing research program encourages nurses to develop innovative and new ways of caring for patients. MGH is at the forefront of training technologies, and has the Center for Medical Simulation (CMS), where clinicians can practice inserting catheters or treating gaping wounds in human-like, computer-automated mannequins.

And although many nurses choose to practice at the bedside, there are more professional opportunities than ever before, from legal nurse consultants and case managers to pharmaceutical supply researchers and infection control nurses. Nurses who go on to become advance practice nurses or nurse practitioners can take on expanded roles similar to family practice physicians, prescribing medicine, performing physical exams, and ordering lab tests.

Perhaps the best thing about nursing, says Eaton, who is a male nurse in a profession still dominated by women, is the "spirit of collegiality." Eaton, who works in the progressive care unit at Quincy Medical Center, says, "We really work together and try to cooperate with whatever needs to be done."

"We’ve come a long way," says Piknick of the MNA, who remembers when nurses were taught to stand up out of respect when physicians entered the room. "And we will go a lot farther. But one thing will never change: It is an honor to be in a job where you are working with people during their most vulnerable time and making such a meaningful contribution to their life."