Saying precisely what a frontline nurse does should be the easiest thing in the world: care coordinator, final check on all orders, medication dispenser, advice giver, patient advocate, emptier of bedpans, and empathic listener.
Those are all correct. But they need to be distilled into a succinct statement to help the public understand nurses’ value as frontline caregivers. Doctors diagnose and prescribe. That’s easy. Except it implicitly leaves out surgeons, or any physicians who practice invasive medicine. Well then, doctors diagnose, treat and prescribe. That pretty much includes all MDs. It’s simple, even elegant, and conjures an image of a white-coated figure absorbed in caring for ill people.
The news coverage of overwhelmed COVID-19 units has recognized nurses’ clinical skills and technical knowledge, and photographs and videos have shown exhausted nurses talking about the challenge of keeping COVID patients alive. From these media portrayals, an accurate picture of nurses’ work has emerged, at least the work done in EDs and ICUs: nurses adjust ventilators, reset drip rates on IV pumps, know how to prone patients, talk with families, and watch in patient rooms to make sure no one goes downhill fast.
Each image of a nurse at work adds to an emerging portrait of nursing overall. Nurses: good at using machines for patient care. Nurses: knowledgeable about moving patients. Nurses: compassionate caregivers. Nurses: astute observers. All true, but summing them up well is what’s needed. Right now, these descriptors only add on to the list that started this column. What nurses do still needs to be condensed to two or three words.
Or maybe just one word: manage. Nurses manage. We manage the patient’s medical care and family; we manage the physician orders and hospital bureaucracy; we manage the rigors of birth and the sadness of death; we manage to keep working even when the job is overwhelming.
The word manager has a bad rap right now, especially middle-managers. These are the people being paid to organize and direct front-line workers while the front-line workers do the actual work of patient care. If that sounds like a cynical and unfair generalization, I apologize, but that is how many nurses I have spoken with feel. So, to be clear, a nurse is not a manager, any more than a doctor is a diagnoser. The nurse manages everything that has to do with the patient, and the patient’s orbit can be surprisingly wide.
Some people will want to gussy up this formulation of “The Nurse manages” by saying the nurse is a “care manager,” or that the nurse “manages care.” No. First, it is important to say what the nurse does, not what he or she is, since that makes a nice parallel with how MDs are described. Second, and more important, the nurse manages all sorts of things—physical, emotional, technical, and ephemeral—that include care, but also go beyond what is commonly thought of as medical care.
Read this list of synonyms for manage: contend, cope or grapple with, address, hack, handle, maneuver, manipulate, negotiate. If that list of words doesn’t sound like a nurse and nursing, I don’t know what would. My particular favorite is “hack.” Nurses definitely hack, as in life-hacks, as in workarounds, and manage includes those ideas, too.
A nurse manages. To limit time with her COVID patients, she manages to program an IV pump in a hallway. He manages to make one face mask last an entire shift, or maybe even longer, without getting sick himself. She manages to get the ventilator adjusted to reduce the amount of work the patient has to do to breathe. He manages to hold a patient’s hand as she dies.
Nurses manage. We manage. Especially on those difficult days when it seems impossible to care for patients as well as they deserve. Somehow, we manage.
Theresa Brown, BSN, RN, FAAN, is a nurse and a writer. Her most recent book, The Shift: One Nurse, Twelve Hours, Four Patients’ Lives, was a New York Times bestseller.
She is a frequent contributor to the New York Times and also for CNN.com. She has been interviewed on the NPR program “Fresh Air,” and has appeared on “Hardball,” and MSNBC live.
Brown writes and speaks about nursing, health care and end of life care. She has a PhD in English from the University of Chicago. Her kids inspired her to leave academia and pursue nursing. It is a career change she has never regretted.