Life Support: Three nurses on the front lines, by Suzanne Gordon. Boston, MA: Little, Brown and Company.

The book under review this month has a copyright date of 1997 but is not dated by any stretch of the imagination. Life Support: Three Nurses on the Front Lines by Suzanne Gordon is a book I believe all nurses should either have in their personal library or, at the least, have read. Why? Because Gordon, although not a nurse but a journalist, captures what it is to be a nurse.

Numerous front sales iterate the themes of the book. One such comment is from the author of Examining Your Doctor, Timothy McCall, MD. McCall states, "I work with nurses every day but it took Suzanne Gordon to open my eyes to see all they do and how important-and underappreciated-their work is. Life Support should be required reading for all doctors, health policy decision makers, and anyone else who care about the future of our healthcare system."

Bruce Ramsey of the Seattle Post-Intelligencer states, "Gordon's demonstration of the value of nursing is done with moving, and sometimes teeth-gritting, realism. It makes you not want to fall seriously ill-and to have a nurse on your side if you do so."

Gordon tells her story of how she came to realize the role nurses play in the provision of healthcare in the preface where she describes delivering her first child. Although her obstetrician was also her friend, Gordon credits the nurses with providing her "the confidence a thirty-year-old professional with no brothers or sisters, nieces, or nephews, no experience at all with babies, needed to begin her career as mother" (p. x).

Claire Fagan, Dean Emerita, University of Pennsylvania School of Nursing, wrote the Introduction for this book. Dr. Fagan raises the question many other nurses have also raised, why is there tension between nurses and doctors, thus inhibiting collaborative relationships in the work setting? Did the educational system fail to teach or encourage collaborative relationships with the medical students? The response she received was that the tension arose from work experiences, as described in this book. One of Gordon's themes is the need for all providers to look at their interactions and move to place the patient and family at the center of the interaction. This requires major changes in the manner in which nurses and doctors view their roles, domains power, and authority. Situations are described where physicians-in-training find it hard to accept advice from an experienced nurse. The resultant patient care issues are discussed pointing to the need for collegiality and acceptance of knowledge the nurse has and the physician has yet to obtain.

In Life Support, Gordon follows three nurses from the Beth Israel Hospital in Boston, Massachusetts. Although the three nurses are named, they serve as exemplars of all nurses and how we conduct our practice. Nancy Rumplik is a nurse in the hematology/oncology clinic, Ellen Kitchen is a geriatric nurse practitioner in the home care department, and Jeannie Chaisson is a clinical nurse specialist on a general care medical unit. Gordon uses these nurses, their nurse, and physician colleagues to paint the pictures she uses to illustrate numerous themes she develops concerning healthcare as a system and how it impacts individuals and families.

One of the themes Gordon addresses is the cost of care and the cost of nursing care in particular. Because this book was written in the mid-1990s, some of the examples are specific to the time period, but Gordon does address the cost-effective nature of nursing relative to the entire healthcare system and the costs involved. She looks at nurses versus physician salaries and the cost of administration of healthcare. Gordon brings to light the fact that (at that time) there were "major studies conducted in 1976, 1986, 1994, and 1995, medical and nursing researchers linked the number and educational qualifications of registered nurses on hospital units to lower mortality rates and decreased lengths of hospital stay" (p. 14). She goes on to say, "Reducing the number of expert nurses in the hospital, community, and home needlessly endangers patients' lives and wastes scare resources" (p. 14).

Another theme woven throughout the book is "Although nurses help us live and die, in the public depiction of health care, patients seem to emerge from hospitals without ever having benefited form their assistance[horizontal ellipsis]. In fact, we seem to believe that they (physicians) are responsible not only for all of the curing, but for much of the caring" (p. 15). Gordon accurately depicts the care given by nurses day in and day out that is based on knowledge, evidence, compassion, and caring. She details the thought process and anticipation that nurses use as they plan for patient care. She highlights how a home care nurse uses what appear to be simple interactions to plan, monitor, adjust, and advocate for her patient. Gordon shows how nurses develop their baseline knowledge of the patient enabling them to detect subtle changes, correct the direction of care, and thus prevent a problem. She shows how nurses question the medical plan on behalf of the patient because the nurse knows what to expect and wonders why the patient should go through the procedure or test if the resulting end will not ultimately matter to the patient's care.

Gordon also shows the reader nurses advocating for their patients and families. She repeatedly shows nurses making the healthcare system work for their patient and family. While following Nancy and her patients in the hematology/oncology clinic, the full scope of the nurses' role is revealed. We see the profound and absurd that routinely occurs as Gordon tells us about Jeannie, the clinical specialist on a general medical floor. We follow Ellen into patients' homes and see how she helps them maintain their independence. We watch as the nurse helps the medical student, resident, and attending physician understand what a nurse does and how nurses have a different domain of care, which complements and supports the physician. We also see how the nurse tries to get the physician to involve her in the planning of her patients' care because she holds valuable information the physician may not possess.

Another theme seen in Life Support is that of mentoring and educating other healthcare providers as well as family members of patients. Jeannie describes a few examples of the work she does with interns; the education and guidance she gives them that they do not receive from the residents or attending physicians. Gordon also demonstrates the not-uncommon lack of knowledge many physicians have about both the education and role of a nurse. This is highlighted by the physicians on the general medical floor who believe all nursing work is based on the physician order and do not credit the nurse with a knowledge base that directs her actions.

Now all of this is not news to you because you are one of the nurses exemplified in Gordon's book. So why review it and discuss what it contains? Because I think it is a wonderful and nonthreatening teaching tool. I and my fellow faculty members at our School of Nursing have incorporated this book into the prelicensure management course, taken by our students at the end of their program of study. We did so because we felt it accurately portrayed what nurses do and what nurses encounter in their daily practice. We find the nurses and how they practice to be strong examples of solid nursing care. We think that the system issues as portrayed are realistic without being pejorative allowing the soon-to-be novice nurse a view into their world that is both encouraging and cautionary.

I also find this book to be comforting to practicing nurses because it clearly shows nursing at its best but also within the limits encountered routinely by all nurses regardless of their practice sites. I found it reassuring to know I was not the only one to encounter barriers and roadblocks and to see how other nurses have taken on these same issues.

I think this is an excellent book to share with nonnurses who wonder what we do all day and why we do it all day. It helps explain the relationship between the actions we take and the data we are collecting. I would highly recommend it to someone who is considering becoming a nurse. It is very readable and the people and the work and stories that evolve in the book are very engaging.