November 6, 2014

This post is by CHMP’s graduate fellow, Amanda Anderson, RN.  Amanda is a practicing bedside nurse in Manhattan, and a grad student at the Hunter-Bellevue School of Nursing, where she co-directs The Nurses Writing Project. Her personal site, This Nurse Wonders, hosts her writing, and she tweets @12hourRNfile0002101523869

It’s been a strange week for nurses in the media, to say the least. We were present, but our crowning achievement – an M&M-throwing parody on SNL – isn’t exactly one for the history books. While our ability to entertain rang through the web, our titling in print stayed true to its baseline. Sure, a reporter or two mentioned going the extra mile to get our quotes, but their pavement pounding (or biking), didn’t seem to reach our far-off doors.

Or did it?

This week, I was dismayed to read not one, but three articles on a topic that is familiar to every nurse’s practice: Falls. I realize that my experience is limited to the horrible occurrence of finding a patient on a hospital floor, but I believe it’s safe to say that each nurse caring for a patient has their own version of care, and knowledge of prevention, when it comes to this topic.

My first few passes through these articles, written by a woman named Katie Hafner, proved bereft of nurse voice. Again, a huge article on a topic that is largely nurse-centric, written without a single quote from a member of our profession. In reality, our interventions to prevent and treat falls are paramount, and our profession produces scores of practice-defining research on the topic – why no word from us here?

In my frustration, I decided to reach out to the author. I asked her if she was unaware of recent nursing research related to falls? Had she missed a nurse-led initiative by the Robert Wood Johnson Foundation to implement fall-reduction protocols in hospitals, or a recent article in The American Journal of Nursing, where nurses and physical therapists discuss a mobility program, aimed at halting fall-inducing deconditioning? Did she try any of the San Francisco hospitals or care facilities that she referenced, for a quote from a clinical nurse specialist or nurse educator about their current initiatives to prevent and treat falls?  Did she know that each bedside nurse, the first line of prevention for a falling patient, could offer insight and experience into how we daily screen each of our patients for falls, as per federal requirements?

Perhaps my questions were too pointed, because she replied with prompt and wholehearted affirmation – falls could certainly not be spoken of without nurse input. So why no sourcing? She had spoken with MANY nurses, she said. Two of which – both prominent researchers on the topic – were cited in one of her pieces.

Huh?!

I went back to her pieces, scouring for the sources she spoke of. Sure enough, I found them, halfway through – Dr. Pat Quigley and Dr. Dorothy Baker. But Dr. Baker, an accomplished nurse practitioner, was just, “a research scientist” recommending chats with primary care physicians, and Dr. Quigley, a celebrated and highly credentialed nurse practitioner, clinical nurse specialist and Fellow of the American Academy of Nursing was simply, “a falls prevention expert,” advocating for the replacement of sleeping pills with warm milk.

I’ll admit to my initial oversight, but I wanted further explanation of its cause from Hafner. Why had she titled these nurses this way, stripping them of their foundational specialization? Had they asked for their otherwise prominently listed nursing credentials to be nixed for the piece? I received a fascinating and equally frustrating response: She, like any good reporter, had listed them exactly the way that they had requested.

This news is saddening to me, and surprising. Why would researchers who built their careers on a foundation of nursing experience, distance themselves from it in the media? Apparently this phenomenon isn’t rare, and brief conversations with scholarly editors and health care journalists attest to this. Joy Jacobson, former managing editor of The American Journal of Nursing, and frequent contributor, says many of her nurse sources aren’t just hard to find, they’re reluctant to speak openly for lack of support, and fear of saying something that might make them lose their funding or jobs. Others hypothesize that academic nurses want to distance themselves from a profession scarred with stereotypes and oft-poorly spoken advocates.

While we’re likely not the easiest sources to locate – a quick Google of “doctor + Manhattan + Ebola” provided far more than a search substituting nurse as provider – I think much of our media absence must be caused by our lack of knowledge on how to speak effectively for ourselves, and our lack of support in doing so. Because we are afraid or unsure of our words, we silence ourselves to the public, just like we silence ourselves at our own dinner tables – no one wants to hear of the gross things I do, anyway, we often say.

This all too familiar sentiment – one that seems to plague even those at the top of the professional ladder – must be fought with work and study. Programs exist – Diana Mason & Barbara Glickstein’s media training is nationally renowned, and the organization Working Narratives, offers multiple resources on storytelling and social change – both great places to start.

Our profession will continue to be ridiculed and misunderstood if we don’t speak up and claim it in a unified, trained voice. While Baker and Quigley requested to leave their “RNs” out of print, Kaci Hickox, regardless of the correctness of her quarantine choices, was stripped of her many professional distinctions this week, titled simply, “NURSE.” I haven’t spoken with any of these nurses, and don’t know the full story behind their titling choices or blunders. But I wonder if, in the end, they’re all the same, all falling into Jacobson’s cutting assessment of nurses as sources: “They have an unparalleled perspective on what really goes on in health care, and to survive, they feel, they have to keep it to themselves.”