Dr. Arnold Relman has been a highly influential medical educator and is a former editor of a prestigious medical journal. In the February 6 issue of the New York Review of Books, he wrote of an experience this past summer when, at age 90, he fell down the stairs at home. He suffered a cracked skull, broken vertebrae in his neck and broken bones in his face. He received emergency treatment to check bleeding from his brain and restore his breathing. Resuscitation saved his life, and over 10 weeks, he underwent numerous medical procedures and experienced a number of complications. Almost miraculously, he not only survived, but with rehabilitation, is mostly recovered. His survival is a testament to the emergency care and rehabilitation services he received, as well as to his strong will to live.
His essay is a firsthand account of his hospital experience, combined with some insightful observations about the health care system. In one passage, he points out that “What personal care hospitalized patients now get is mostly from nurses” and confesses that he “had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”
Just as Dr. Relman is grateful for the nurses’ role in patient recovery, we are grateful for his recognition of that role – though, of course, deeply sorry that he had to suffer this personal trauma to come to a realization that speaks to an often hidden insight about how to improve care.
In short, despite years of advocacy from powerful voices in nursing and medicine, a widely publicized Institute of Medicine report and various nationwide initiatives such as the Magnet program, the role of nursing remains underappreciated and, often, poorly understood in many clinical settings. This lack of understanding can create a culture where low expectations erode the contribution highly trained nurses are capable of making and, at worst, can diminish nurses’ willingness to do their best work.
It’s a culture that most schools of nursing across the country are fighting hard to combat, and as Dr. Relman’s insight makes clear, we are making some progress. We are proud of the training our graduates receive in the technical aspects of care, role differentiation that readies them for working in teams, and communication skills needed to work effectively with patients and families. And we are constantly seeking ways to up the ante, to demand more of our graduates so their patients can reap the benefits.
Thank you, Dr. Relman, for helping us advance understanding.