What Nurses Really Contribute to Health Care: Part 1 of an Education Do-Over

There is so much to say about this profession that goes unexplored and unpublicized, and yet, nurses continue to be at the forefront of patient care delivery every step of the way.
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In September 2015, Joy Behar of The View received national attention for passing disparaging comments about Miss Colorado and nursing as a profession. In this post-Behar era, I sometimes wonder how the public's perception of nursing has been rehabilitated since then. What worries me most is that patients and soon-to-be patients do not yet fully understand that it is the bedside nurse's abilities to advocate for safety, lead necessary change initiatives, coach patients and communities, and coordinate delivery of services, that very often determine health outcomes and the procurement of ethical care.

In this Part I education do-over on what nurses really contribute to health care, we will explore their responsibilities as dictated by professional organizations and the roles they play in promoting health and wellbeing for the public at large. Parts 2 and 3 will clarify how the work of nursing impacts you and your family on a personal level and identify the role differences between nurses and other collaborative partners, such as physicians and physician assistants.

Nursing constitutes the largest number of American health care professionals and is the most predominant component of any hospital payroll infrastructure, with the current number of registered nurses being more than four times the number of practicing physicians in the United States. Nurses and their contributions are vital components of any reliable health care organization striving for zero patient harm and quality care. It has been suggested that hospitals promoting better nursing environments with above-average staffing ratios experience lower patient mortality, particularly for patients considered "high-risk."

The truth is very few people understand the myriad roles and responsibilities of nurses until they are in need of nursing care themselves. The former dean of New York University College of Nursing, Terry Fulmer, PhD, RN, FAAN, now the president of The John A. Hartford Foundation, says, "Whether people know it or not, they come into hospitals for nursing care." For example, if a patient comes in for surgery, that operation may last hours, but subsequent nursing care may be required for days, weeks, and even months, depending on the patient's trajectory. Surgery is one thing, but it is the nursing care post-surgery that will determine how quickly patients recover, the success or failure of the intended surgical outcomes, and the quality of life recovered during a tenuous post-operative phase.

Another "for instance" pertains to the extreme health challenges and life-threatening illnesses faced by intensive care unit (ICU) patients on a daily basis. What patients and families in the ICU quickly learn is that once the physician team rounds in the morning to collaborate with nursing and determine an appropriate plan for the day, it is the nursing care that assumes primary responsibility for delivering interventions in a safe and evidence-based manner, reporting and responding to patient changes in condition, and making the critical minute-to-minute decisions that keep patients alive.

In any health facility, from local hospitals to major urban academic medical centers, nursing care is the only hands-on care that is 24/7.

So what do nurses do exactly? According to the American Nurses Association (ANA), the representative organization of America's 3.4 million registered nurses, some of nursing's responsibilities include:

• Performing physical exams and health histories,
• Providing health promotion, counseling and education,
• Administering medications, wound care, and numerous other personalized interventions,
• Interpreting patient information and making critical decisions about needed actions,
• Conducting research in support of improved practice and patient outcomes.

While this concise list certainly provides an overview of nursing, it is not exhaustive by any means. There are other invaluable (and often unacknowledged) roles that nurses fulfill on a daily basis. These roles are the cornerstones of a dignified, caring practice, fueled by providing the best possible patient experience and contributing to an improved quality of life for all.

Advocate. In hospitals, nurses utilize advanced physical assessment skills and a diverse range of technical competencies to ensure patient safety. They advocate for appropriate treatment protocols, safe medication administration policies, timely symptom management, and needed consultations with specialty services. On a national level they advocate for safe staffing ratios, legislation that ensures equitable care delivery for all Americans, and environmental justice.

Care coordinator. Hospitals can be overwhelming, intimidating, and dangerous places without someone to guide you and keep you informed. The nurse is the point person for all collaborating departments: medicine, pharmacy, nutrition, social work, physical and occupational therapy, surgery, etc. Nurses assure a patient's safe passage through the hospital and organize care coordination in order to maximize timeliness, value, and efficiency and minimize injury, error, and inconvenience. Research has shown that nursing care coordination contributes to reduced overall charges, significant increases in survival with notable decreases in readmissions, improved quality care delivery, and an increased overall patient satisfaction. If you want to know how the countless spokes of any major medical center's wheels rotate with such a cohesive sense of safety, ask your nurse.

Coach. Nurses aid patients to attain their health goals and needs by honoring diverse cultures and beliefs, and approaching the patient as a "whole person" with a story worth knowing, respecting the patient as the sum of body-mind-emotion-spirit-environment. To nurses, you are not just a bed number or diagnosis. Coaching is fundamental to nursing practice and promotes partnership in health care, in stark contrast to more traditional and paternalistic approaches to the provider-patient exchange.

Leader. Nurses engage individuals and organizations to lead patient-centered care initiatives and create needed change. Through committee participation and in-house policy development, nurses ensure that health care facilities are sensitive to the patient experience and promote environments that respond to the challenges and vulnerability faced by patients. Nationally, nurses lead progress within their profession to anticipate the future health care needs of Americans, and, globally, they collaborate across disciplines and with concerned citizens to assure health and wellbeing for all.

In short, nurses are the checks and balances of health care. No wonder that 85 percent of the public has ranked them number one in honesty and ethics for the past 15 of 16 years. There is so much to say about this profession that goes unexplored and unpublicized, and yet, they continue to be at the forefront of patient care delivery every step of the way. If anyone you know sells nursing short or is confused about what nurses really contribute to health care, offer them the education needed to be informed about one of the nation's most trusted and celebrated professions.