BOSTON — On a splendid sunny day, 50 nursing students and faculty members gathered on the lawn of the world-famous Massachusetts General Hospital last month. They were carrying signs and protesting the dismissal of Elizabeth Grady, director of the hospital's Institute of Health Professions' Graduate Program in Nursing for the past eight years.
Nurses from here to California have expressed their shock at the unexplained dismissal of a strong, popular nursing educator who represents a new, more feminist, autonomous and activist approach to nursing. The hospital insists that the "Grady matter" has been misrepresented, and that the hospital welcomes strong, independent-minded nurses. But nurses fear this episode is yet another example of the longstanding devaluation of a caring profession that is 97% female.
This incident highlights a much larger and more important conflict--the struggle that nursing has waged to determine its own future. Today, this means convincing medical, business and political leaders, the media, and the public that nursing is a clearly defined profession and that the health-care universe is, in fact, a marriage between care and cure.
Many members of the public now recognize that nurses are anything but physicians' handmaids. Many people see nurses as well-educated and trustworthy health-care professionals. But few really understand the scope of what contemporary nurses do.
Nurses make up the largest profession in the health-care system. The nation's 2.1 million registered and licensed nurses outnumber, by nearly four-to-one, America's 585,600 physicians. Medicine and nursing are distinct professions. Physicians focus on disease, nurses on illness, or, as one leading nursing researcher, Patricia Benner, has written, on "the human experience of loss or dysfunction."
In hospitals, nurses are at the bedside 24 hours a day. They provide highly technical care to patients in intensive-care units, neonatal nurseries, geriatric facilities and psychiatric institutions. They translate often incomprehensible medical information to frightened patients and families who are making decisions about whether to undergo invasive treatments. They also guide patients who are facing death through the difficult decisions concerning withholding or curtailing treatment.
Some of today's most serious medical problems are, in reality, also nursing problems. Physicians cannot cure many human ailments such as AIDS, stroke, chronic illnesses, disabilities associated with growing older and mental illnesses. These problems require long-term care that helps people heal, cope and function as well as is possible.
Contemporary nurses are also pioneering programs for the emotional and physical treatment of the homeless, running outreach projects for low-income, teen-age mothers and their infants, delivering primary health care and anesthesia to rural Americans, creating models of restraint-free care for hundreds of thousands of elderly patients in nursing homes and hospitals and developing community-care centers for people with AIDS.
Nursing care is based on a blend of expert caring skills, technological know-how and scientific research. Nursing research, funded in part by the National Center for Nursing Research in the National Institutes of Health, is delving into problems that afflict millions; it is also investigating ways to prevent disease and promote better health.
These developments should have revolutionized the perception of nursing. But Americans still imagine the health-care universe to be one of either medical heroics or biomedical innovations to cure disease. Except for those who have had personal contact with nurses, nursing remains invisible.
One important reason is hospital and medical-center control of much of the information about what goes on in health care. The public-relations departments within many of these institutions have largely ignored nursing. Physicians' and researchers' activities are thought to provide the familiar elements of a "good story"--heroic enterprise, success against great odds, the dramatic struggle to vanquish disease.
In contrast, the wordsmiths don't seem to have the words to describe nursing in an understandable way. Public relations staffs often regard nursing stories--except the occasional portrait of the "nice nurse"--as too vague, too soft and inherently unmarketable to the media.
The media have also reflected traditional cultural biases about who is and who is not important in the health-care universe. A recent study of three newspapers' coverage of health care, (including coverage by this newspaper), sponsored by Nurses of America, documented that nurses were quoted less than any group that reporters sought out for information on health-care issues.