September 27, 2012

Theresa Brown, RN, is an oncology nurse and one of the very few nationally prominent nurse-writers in the areas of nursing and health care.  She on the Center’s Advisory Council and this is her first post as a HealthCetera guest blogger.

Being the “nurse who writes” means I work under a misconception. Although a number of physicians regularly opine on the work they do in books, articles in The New Yorker, and my own home base The New York Times, I’ve never heard the MD-writer combination described as odd or bewildering. However, being an RN-writer is seen as unusual, and my admittedly unusual academic background—I have a PhD in English from the University of Chicago —- contributes to the view that I’m an intellectual oddity among my nursing peers.

But I am not alone in combining nursing and writing. Many nurses will be familiar with Echo Heron’s nursing memoirs and Carol Gino’s The Nurse’s Story. Tilda Shalof, a Canadian ICU nurse, and Patsy Harman, a certified nurse midwife, are both nursing and writing right now, and Harmon’s new novel, The Midwife of Hope River was just released. Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk, a polemic by Sandy Sommers, RN, MSN, MPH powerfully argues that media stereotypes of nurses dangerously undermine nursing’s professional legitimacy.

These nurses, and I, all write for the same reasons that physicians do: educating the public about how health care works, outlining ways to make health care better, exploring how hard it is to work in a job that often deals with death, or showing what nurses’ clinical work actually involves.

By writing about nursing (or medicine) we learn about the nature of our roles as caregivers and we communicate the importance of that role to readers. In a recent column entitled “Money or Your Life” I wrote for The New York Times, I argued in favor of the Affordable Care Act by telling the story of a patient who wished for a death panel because he had no health insurance and worried that the care he needed to save his life would bankrupt his family. His choice would have been for the government to kill him rather than for his family to become destitute financing his care.

He asked me, his nurse, about death panels. That was, perhaps, not something he would have asked his physician about, or at least in this case it wasn’t an issue he had raised with his doctor. Nurses spend the most time with patients of any hospital staff and we often serve as intermediaries between the patient and everyone else, and this column highlighted the importance of the nurse’s intermediary role. The patient told me about his financial worries. I told the rest of his medical team, the social worker, and his care coordinator, and then everyone put their heads together to figure out how to best help this particular patient.

It’s a horrible story with a potentially positive resolution. If I, the nurse, hadn’t been there to listen, and then emphatically communicate what I heard from this desperate patient, the story might in the end have been thoroughly horrible. Perhaps the patient would have refused care, or his family might have suffered in silence. And although his financial concerns might have been addressed at another time, in that moment I heard and acted. That’s part of what nurses do, and it’s important to have nurses’ voices out in the world explaining that this is just one reason why we are valuable to patients.

Here at Hunter College, the Center for Health Media and Policy is attempting to prepare more nurses to get our stories out into the world via their “Narrative Writing Program.” Run by Senior Fellows Joy Jacobson and Jim Stubenrauch, the CHMP Narrative Writing Program gives nurses tools for writing about work and, perhaps even more importantly, helps them feel comfortable with the idea of themselves as nurse-writers who can contribute to conversations about health care policy. The courses taught by Joy and Jim are not about journaling in a vacuum. The point of nurses learning how to write essays, blog posts, poems, columns, and policy analyses is to reveal the emotional and physical realities of nursing to readers who are unaware of those realities and whose lives will, at some time, be affected by them.

For example, referring back to my own writing, I’ve authored columns on the need for safe staffing ratios and the problem of physician bullying. In both instances my motivation was concern for patients’ safety and I had anecdotes that made clear how these issues affect quality of care. I brought in data for both columns, too, but while data is important, it’s the anecdotal evidence gleaned from my perspective as a bedside nurse that really made the columns persuasive.

I wasn’t a writer before I became a nurse. I was an academic, and I had taught composition, but only after I became a nurse and then began, almost by chance, writing about nursing, did I find the writerly voice I now have.

Whenever people tell me that combining writing and nursing is . . . unexpected, I want to tell them about all the great nurse-writers out in the world. Whether you’re posting on a blog read by three people, or writing your third book, we nurses have a lot to say. It’s time for more of us to start writing down our thoughts and experiences, and then share them with an interested public.