Nurses are important allies in protecting patients' health

A message to all physicians from the president of the American Medical Association, J. Edward Hill, MD.

By J. Edward Hill, MDis a family physician from Tupelo, Miss., was AMA board chair during 2002-03 and served as AMA president during 2005-06. Posted Jan. 23, 2006.

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Some of the greatest teachers in medicine have never earned a medical degree, held court during surgical rounds or served as chief medical officer.

You see, many of the best teachers of physicians ... are nurses.

I know this firsthand and for a fact, and I believe it is the responsibility of every physician to support these most important of our colleagues.

It's a lesson I learned long ago.

Soon after I finished my medical education and training in the U.S. Navy, I headed to one of the poorest regions of the Mississippi Delta. At the time, I thought I knew everything I needed to know about delivering babies. My interactions with a nurse midwife soon set me straight.

I was delivering the baby of a first-time mother, and although her labor was progressing well and the baby seemed fine, I started to get impatient. The labor wasn't moving as quickly as I expected, and I said to the nurse, "I think we may have to deliver this baby by forceps." The nurse simply turned to me and said: "Why would you want to do that?"

With a single sentence, she reminded me that the baby would come in its own time, not my time. What's more, with her help and guidance, I not only didn't use forceps, I also didn't perform an episiotomy -- which was standard practice back then. The mother delivered her baby safely and without any tearing.

It wasn't the first time a nurse had taught me something important about vigilance and patience. Nor would it be the last.

Not long afterward, my partner and I hired four certified nurse midwives to help start a program to bring down the maternal and fetal mortality rate in our area of the Delta. Working together, as a team in the truest sense of the word, we met with unparalleled success. Within a few short years, mortality rates for local infants and mothers dropped well below the national average, even though we had previously had some of the highest rates in the country.

In short, nurses have played a critical role in my life as a physician. It is clear to me that advanced-practice nurses and nurse practitioners can and must be a critical part of the medical/health care work force. In fact, I couldn't imagine practicing medicine without their expertise and support.

Yet that is exactly what physicians may have to do in the not-too-distant future unless we do our part to attract more people to the nursing profession -- and keep them there.

Let me begin with some of the most disturbing projections.

According to the Journal of the American Medical Association, we will see a shortage of more than 400,000 nurses nationwide by 2010. A more recent study from the U.S. Bureau of Labor and Statistics projects a shortage of more than 1 million nurses by 2010.

Whatever the exact number, this much is clear: We soon will be facing a public health crisis. Inadequate numbers of nurses add up to lower quality patient care, increased medical errors and greater inefficiency -- in short, poorer health for all.

This is simply unacceptable. For us. For our patients.

AMA policy calls for government and private initiatives that would facilitate the recruitment of nurses through economic and professional incentives -- such as better pay and improved work environments.

We also encourage hospital medical staffs and local medical societies to develop programs and committees to ensure an appropriate level of nursing support, and to do so in cooperation with local nursing organizations.

Finally, the AMA encourages physicians to monitor the quality and safety of care in the hospitals where they serve on staff, particularly when restructuring affects nursing care.

Yet good policy is not enough. We, as physician organizations, as individual physicians and as members of hospital staffs, need to make these policies a reality.

What's more, we need to lead the way in creating better working conditions for our nation's nurses. Nurse dissatisfaction with their working environments is commonplace, and this is hurting recruitment.

Consider some poll results. More than 40% of nurses report being dissatisfied with their jobs. More than half of nurses would not recommend their profession to their children or friends. And, in one shocking case, more than 50% of New York City nurses working in hospitals leave their jobs before the end of their second year of employment.

Why such high levels of dissatisfaction? Why such an exodus from this noble profession?

As one researcher put it in the Journal of the American Medical Association, "As long as hospitals understaff their nursing units, require nurses to float from unit to unit, [and] require mandatory overtime ... the constant high turnover ... will continue."

So what can physicians do?

First, physician professional organizations (local and national, including our AMA) must work together with nursing organizations on mutual concerns and mutual interests, instead of wasting effort on public combat over policy. We are facing many medical and health system challenges, and we need interdisciplinary teams to address them through cooperative advocacy.

Next, we need to treat our nurse colleagues with respect -- in all ways, at all times. We need to listen to them, learn from them and thank them. We need to support them on the issues that matter.

Finally, we need to remember that while we may be the captain of the health care team, we are not the only players. Nurses are on our side, and they are our most important allies in protecting the health of patients.

More than 100 years ago, the renowned physician Dr. William Osler surely got it right when he said: "The trained nurse [is] one of the great blessings of humanity, taking a place beside the physician and the priest, and not inferior to either in her mission."

Our nurse colleagues are a blessing and a boon to us. We would do well to do all we can to keep them in our midst.

Next month: Physician shortages.

J. Edward Hill, MD is a family physician from Tupelo, Miss., was AMA board chair during 2002-03 and served as AMA president during 2005-06.

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