The increased reliance on technology for assessing, treating, and monitoring patients can confuse and complicate the relationship between nurses and the public. But technology can't do everything, and perhaps now more than ever patients look for the familiar figure in a white uniform and want familiar responses to their needs.
During my own recent experience undergoing 10 months of dialysis and being hospitalized several times for transplantation surgery and postsurgical complications, I had difficulty making sense of current nursing practice. I was especially stunned by an experience that occurred on my third postoperative night. I had gained 50 lbs., was distended, and was having trouble breathing; as I listened to the beeps and watched the changes on the instruments, I had no way of knowing that anyone was paying attention. Afraid that I might die, I sat up all night on the side of my bed, keeping watch over myself. No nurse had bothered to tell me that I was in safe hands and could relax.
It's important for nurses to reassure the public that nursing practice, though evolving in concert with technology, remains constant in its commitment to caring for people. What must nurses do to reconcile public expectations with this evolution? A 2006 Gallup Poll showed that Americans consider nursing to be the most honest and ethical of all professions. The public's trust in nursing is still closely tied to an image of the nurse as someone who nurtures, promotes healing, and cares.
Competence is an essential part of why nurses are trusted, but it must be defined broadly enough to include caring. Nurses can't take the public's trust for granted, and no media campaign can offset the day-to-day experiences that people have with individual nurses. We must devise new strategies to reinforce the message that-no matter how our roles expand because of changes in health care delivery systems and technology-we care about patients, their families, and their advocates. Physicians, for example, now shake hands with patients and families, ask how they feel, and make polite conversation. They have gotten the message that high-quality health care depends on relationships.
Schools of nursing need to examine how students are being socialized into the profession and provide mentors who will demonstrate that a focus on relationships is possible even during the crush of daily work. Unfortunately, in today's hospitals most patients and families can't distinguish among the many uniformed personnel and don't know what to expect from them. As part of the usual intake procedures, nurses should clearly explain their role to patients. Here is an example:
"I'm Gloria Smith. I am your nurse today, and I'm responsible for overseeing your care and assisting you during this hospital stay. I'm taking your history because it helps me to understand how you have responded to your illness and how I might best help you plan for your care when you go home. I'll be assisted by a couple of technicians, who will also be coming in to help with your bath and assist you when needed. You are connected to several monitors that help me keep track of your responses to your treatments. I or one of my assistants can see or hear your monitors at all times and will come immediately if there is cause for alarm. If you have any questions or concerns, please let me know."
Though nurses have long argued for a restructured health care system and been in the vanguard of those improving access to primary care, the public most often experiences them in their roles as adjuncts in the delivery of diagnostic and curative services. While change is inevitable, the need for human caring remains constant. Nursing must demonstrate that it is the appropriate discipline to address this need.