1. "Bedside nursing."
We may say "bedside nursing," but what we mean is "clinical practice." Most of us don't work in hospitals, and most of our patients, even those who are in hospitals, aren't in bed. In fact, generally except for periods of needed sleep bed is a bad place to be. Bed is where people are most likely to develop everything from pressure injuries ("bedsores") to pneumonia to sleep disorders, to arms, legs, and other body parts so stiff that they won't move any more. That's why even intensive care nurses wrestle with IV lines, breathing tubes, assorted monitors, catheters, and perhaps reluctant patients to move people from beds to chairs whenever possible, and from chairs to walking after that.
Beyond this, nurses work in clinics, schools, industry, shelters, public health departments, private homes, retail stores, their own offices, and many other places, providing skilled assessments and diagnoses, hands-on care, education, and advocacy for people who absolutely are not in bed. As a home health nurse, last week I saw exactly one patient who was in bed, and he was there because I arrived on short notice before he had the necessary time to prod his chronically pain-riddled body to a vertical position and then to wash and dress it before settling into a chair. Yet last week I administered infusions, tube feedings, wound care, and much more. While I definitely was engaged in clinical practice I was nowhere near a bed the vast majority of the time.
We perpetuate a narrow understanding of nursing practice when we slip carelessly into language born in a time when nurses graduated from their basic education and went to work either in hospitals or as "private duty" nurses in patients' homes. In those days the thinking was that people who are ill should rest in bed, so it was at bedsides that nurses worked. Today we know better. So now most practicing nurses are not at a bedside much of the time, but they absolutely are delivering healthcare.
It is important that those we serve, and those we bill for our services, understand this and recognize the depth and breadth of clinical acumen they are receiving. We're not "bedside nurses." We are nurses in clinical practice.
2. "Nursing school."
In the early days of what would become modern nursing, hospitals "trained" nurses in their own schools as a means of having free (i.e., student nurse) and cheap (i.e., graduate nurse) labor. While it is a stretch to call some of these endeavors "schools," many hospital programs produced generations of outstanding clinical nurses. By the middle of the twentieth century, though, nursing education was moving increasingly into the collegiate setting, initially alongside the remaining hospital schools (causing no end of confusion for the public, as people wondered how one truly becomes credentialed as a "real nurse"), and with the latter gradually closing their doors. I have worked with many of those hospital-based "diploma graduates" and know them to be outstanding. Indeed, a nurse newly graduated from a hospital diploma program was likely to be a stronger clinician than a new bachelor's-prepared nurse from from a university, because hospital programs were highly focused and included more hours of practice in patient care.
But as professional nursing moved beyond the bedside (see #1 above) and the importance of nurses' contributions to research, policy, business, healthcare leadership, and a complex, multi-cultural global society grew, it became increasingly clear that, for its many strengths, the narrowly focused "training" provided by hospital schools for hospitals' own purposes was less than optimal preparation for full participation in the broader world of healthcare and that nursing education belonged in the university. Bottom line: Today those who aspire to careers in nursing go to college. They study alongside those who aspire to careers in medicine, law, business, education, the arts, engineering, and other professional fields. Nurses earn undergraduate and graduate degrees, including both clinical and research doctorates. While some nurses patiently teach newly diagnosed diabetic patients how to prepare and administer insulin injections, other nurses run hospitals or are elected to public office. But precious few graduates of actual, old-time "nursing schools" are in practice today, and all practicing nurses have gone to college. (As nursing education evolved hospital schools began affiliating with universities, where the nursing students earned many of their academic credits. So even hospital-trained "diploma nurses" earned significant college credit.)
So that it's clear that our publics, both patients and others, aren't receiving services from graduates of an outdated "trade school" model we need to replace, "When I was in nursing school . . . " with "When I was in college/an undergraduate/finishing my bachelor's degree/a pre-professional student at [Name] University . . . " Those we serve deserve no less.
3. "Use"
People aren't commodities and expertise isn't a tool like a hammer or kitchen tongs.
People don't "use" a home health agency or therapy clinic; they choose one. And we'd do well to remember that, in a respectful and collaborative way. One doesn't "use" a medical or counseling practice; rather one is referred. Patients don't "use" a hospital or clinic; they do their research, seek recommendations, and make informed decisions. If decisions are made for them in emergency situations, patients may make different choices as soon as they are able, or their agents may act sooner. And when that happens business literally may go out the door.
We're going to work together much better and be more sensitive to and respectful of our patients as persons if we "lose the 'use,' and 'choose' instead." Instead of "use," we work with, collaborate with, refer to, partner with, and, definitely, choose for ourselves and also empower our patients to choose as well.
4. "Seniors."
Efforts to safeguard vulnerable adults have become ageist, overtly or covertly prejudicial. That is offensive to elders who find themselves stereotyped and it puts at risk others who are overlooked because they don't fit the image of a "senior" or are outside the targeted group.
When there is a blizzard or a blackout or a persistent and oppressive heat wave, when a hurricane or bitterly cold snap is forecast, or when other emergencies loom, the public and healthcare providers alike often are counseled to check on seniors. I suppose I qualify for that moniker myself now: The silver in my hair is complimented often, and I'm never asked for an ID when I request my "senior discount." But I also go to work every day, own and maintain a home, manage three large dogs, ride my bicycle everywhere, and this past weekend completed a 5K. My age alone probably does not put me at greater risk from natural and other disasters than anyone else. And I see patients who are considerably younger than I and who are far more vulnerable: One is paralyzed, several have significant chronic illness, and one is an abused woman living in temporary housing.
If we stereotype people by age we risk dehumanizing them, turning individuals into mere specimens of the group to which we have assigned them. And our assumptions about such groups are broad, general, and wrong. This is true with respect not only to age, but to race, gender, sexual orientation, religion, occupation, educational level, address, cars people drive (or don't), and fashion sense (or lack of same). A healthy 80 year-old is at less risk than a debilitated, chronically ill 50 year-old, and a 30 year-old bedeviled by drugs or alcohol who has given up may be worse off than both of the others.
While there are instances where grouping by chronological age is legitimate and useful (e.g., when referring to child development or to hormonal changes at points in adult life), most of the time this is but sloppy and prejudicial thinking, an erroneous convenience. This is harmful to the individuals in question and to those around them who don't receive and appreciate what they do not see. And those who need attention or services may be overlooked because the label attached doesn't fit them.
So when the ice storm hits, yes it's important to look out for frail or ill elders, and also to look out for single parents with small children and little support, disabled but functional adults whose personal assistants may not be able to reach them, the strapping young jock who lives alone and happens to be down with a bad case of the flu, the family on a tight budget that can't afford home repairs or even to turn on the heat; in short, for vulnerable individuals. Seniors may have solid support networks of family, friends, churches, community services, and neighborhood ties, while the 20-something who moved from out of state to go to graduate school or start a new job may be alone in cheap housing with little money and less knowledge of available resources and help.
We need to say "elders" or "seniors" when there's legitimate reason to refer to an age group, and "vulnerable" or "affected" adults the rest of the time.
5. "Still."
"Still" is used for emphasis and to point out a deviation from the norm or expected, as in, "Are you still awake?" or "Are you still there?" But when we attach it to normal, healthy, productive living we imply that normal, healthy, productive living somehow deviates from the norm, and that the norm is frailty, debility, and withdrawal from activities and social engagement.
So, instead of remarking, "Clarence is 80 years old and still going to the office every day," we might do better just to say, "At 80 years old Clarence goes to the office every day," and then we'd better add why this happens to be noteworthy, such as, "and he knows criminal case law better than anyone else in the firm. The junior partners and young associates pick his brain all the time."
"Dr. Becker had two heart attacks but he's still practicing medicine" becomes, "Dr. Becker recovered well from two heart attacks and is practicing at University Hospital. It takes awhile to get an appointment, but I understand she is accepting new patients."
Or "Mabel has her own consulting business but she still works as a nurse" is better said, "Mabel owns a consulting business and also practices as a nurse. Having that current 'real world' perspective makes her invaluable to her consulting clients."
What say that instead of assuming that elders should be frail, cognitively dull, and engaged only in playing Bingo and watching Jeopardy on television, we assume that it's normal to serve, give, and pursue a variety of interests throughout the lifespan? What if younger workers aspired eventually to retire not to lie on the couch but to explore and develop new paths? What if recovery after being knocked down by illness or adversity was expected instead of met with marveling and awe? What if experts, of course!, were expected to practice actively in their fields instead of sitting behind desks telling today's clients what worked twenty years ago?
Let's lose the indiscriminant "stills" and actively foster expectations that health, strength, creativity, and lifelong contributions are normal.
6. "Like"
Educators, physicians, engineers, attorneys, and many others specialize in particular areas of their fields. So do nurses. Expecting a cardiologist to replace an arthritic knee or a dermatologist to do brain surgery would be silly, as would be asking a high school science teacher to take over a kindergarten class. An attorney who specializes in international business law might not be the best person to call when one lands in jail on drug charges.
Nurses may specialize along medical or other lines. Some are cardiac nurses or cancer nurses or neuroscience nurses. Some are drawn to HIV or diabetes. Others are certified in wound care, pain management, or anticoagulation therapy. And while some nurse is better than no nurse, just as some doctor or lawyer is better than none when one has a medical or legal need, when the expertise of the provider matches the need of the patient, exceptionally great things can happen. And when there's a significant mismatch major errors can occur. Unfortunately, many employers don't recognize that, or they afford it no more than a passing nod while citing immediate institutional and budgetary needs (Read: "Send the pediatric nurse to the cardiac floor; there aren't many children here today but five new heart patients just arrived.")
While few would maintain that an ophthalmologist and a vascular surgeon are interchangeable, nurses' professional interests and areas of expertise often are reduced to "likes," as in, "Tom likes brain injury patients" or "Jennifer likes geriatrics."
It's a fair bet that Tom does not "like" seeing patients arrive after major strokes, accidents with head trauma, or brain tumors that are suspected or newly diagnosed. But if he has a strong professional interest in this area it is highly probable that his neurologic assessment sells are finely honed, to the point that he will discern a small increase in pressure inside a patient's head well before anyone else would notice, and before the patient is adversely affected. It's likely that he knows more ways to help patients adapt, communicate, and function as they recover. It's likely that he teaches brain-injured patients exceptionally well, understanding what and how they are able to learn at each point in time as their brains heal.
And Jennifer probably is not eager to take field trips to museums with the local seniors group, just so she can hang out with oldsters. Instead she understands the assortment of challenges and abilities that often come with advanced age. She knows how to assess individuals thoroughly and accurately, without lapsing into stereotypes or assumptions (see #5 above) but while realizing that there are differences between a 90 year-old body and a 20 year-old one. She knows how to compensate for deficits and build on strengths, and she understands the ways problems can present differently in this population than they do in younger folks. She's a whiz with "polypharmacy" and can explain comorbidities and interactions in her sleep, but is not surprised to meet an 85 year-old who takes no drugs and never has been in the hospital.
It's not about "likes," and unwittingly or intentionally assuming otherwise is counterproductive at best and dangerous at worst. A cardiologist doesn't "like" a failing heart, a neurosurgeon doesn't "like" a bleeding brain, and a nurse who is a wound care specialist doesn't "like" a gaping, infected wound. They "like" being able to make a difference, and they "like" understanding the fine points, subtle differences, and individual cues that each patient presents. They likely are fascinated by the underlying science and dynamics, and they have a unique wealth of experience from which to draw.
If patients dismiss the expertise of seasoned clinicians and specialists ("He likes coming to see me," or "I like for her to check on me") they're less likely to derive full benefit from their healthcare. And it's more probable that they won't notice if they're in the charge of a lesser qualified provider, such as an aide who also is "nice" and who "likes" the work, or that pediatric nurse reassigned to the cardiac unit with the mysterious monitors that he can't read. Where everyone is equally "likable" and seems to "like" what they're doing is where mistakes happen and are noticed too late.
Of course employers need to realize the multifold risks of sending that pediatric nurse to the cardiac unit. But they also would do well to step back and see the difference in outcomes when the nurse with a passion for diabetes or cancer works with those patients. Carefully seeing that such matches happen isn't about coddling employees or making them "happy" doing what they "like." Rather it's recognizing that professional interests and expertise translate into extraordinarily effective and efficient service . . . and into plummeting staff turnover rates.
It's not about "like." It's about the caliber of service offered to patients and the win-win-win (i.e., patient-nurse-employer) payoff that comes with acknowledging, respecting, and supporting professional interests and expertise.
So where "seniors" who once graduated from "nursing school" "still" work in "bedside nursing" because they "like" it, one might be best advised to "use" another hospital or provider. But where graduates of collegiate nursing programs bring to their clinical practice the finely honed skills of assessment and judgment born of many years' experience, because their expertise makes a difference in human lives and health and that matters, one would be wise to choose such providers . . . remembering that differences in the words we choose reflect differences in thought and action, and in the practices, systems, and outcomes that emerge from them, indeed the very difference between lightening and
The Lightening Bug.
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