Woman; 406; New Image for Nurses. Part 2

Why why. Also with this is Dr jean Spiro. Dr. Spiro is dean of the School of

Nursing at the State University of New York at Buffalo. She is chairwoman of the Board of Review of baccalaureate and higher degree programs of the National League for Nursing. Also with this is Dr. Joanne Ashley author of hospitals paternalism and the role of the nurse. Doctor Ashley is an associate professor of nursing at Northern Illinois University. She's on the board of trustees of caps. Welcome to all three of you once again. Thank you. Now last week she said some very strong things about physicians and the system under which nurses work. And I got the strong impression at the time that you would like to say something further on that subject and you probably better do it now. Well one thing I really like to add to that is Joanne was concentrating on physicians and I think we didn't really talk enough about the system it's a large complex system that needs

overhauling but I don't think physicians are the only culprits in the system. I think hospital administration has been a problem. I think the whole concept of the delivery of health care has been a problem and so that I think it's rather unfair to focus on one aspect of the system I think nurses themselves have contributed to the difficulties in the system. And currently we're trying to get nurses moving to do their thing if you will to get the system straightened out. You're not saying that doctors are not the problem not the whole problem. You're saying they are not the whole they're just part of that. That's right. And I think that I would follow through with that too because I think if you talk about health care. You have to really think in terms of a total system approach. And this includes the relationships between physicians nurses allied health professionals and you know the hospital administrators and the way in which they land together.

For what could conceivably be better health care delivery so is it not true that nurses really don't have at this point much of a voice in the power structure. It is very true. They have almost no voice at all. Now my colleagues June and I have done one thing that nurses have done for a century. Go all out to be fair to a group that for a century has walked. Beat them down. Give us some facts. Some of the things in your book for instance the history of the oppression of nurses. Well prior to the second decade of the century they worked 12 16 hours a day in hospitals. And they you know that was that was the way it was done. It was in California around 1913 that good hearted citizens not nurses public citizens women said look those those nursing students are just treated like animals. You know they

shouldn't be work like workhorses. So they went to the legislators and said listen let's get protective laws to protect women. Give them require hospitals which were defined as continuous industries to only work these poor women eight hours a day. You see me in dominance do not respect women enough to say look we're overworking you it's poor for your health. Besides those nurses work that long were dangerous to the health of patients. If you work for 16 hours I did it in 61 by the way. We would work a student all day and then they'd run out of somebody in the hospital. A nurse wouldn't come in because she probably home in bed resting woodcut would be in a college and we'd work 16 hours I've done it myself 20 minutes. She'd be home in bed rest she needed to rest you mean from work running around serving doctors. I do what I have both the nurses and the doctors. Well you know really I think I can help but you know when you know I said

before and I'll say it again I think you're painting one or two groups totally black and you're painting nursing totally Well now we're black to act as rather have nurses wear black uniforms than white ones. White means purity innocence. You only grow as a human if you go down the little few dark patches darkness. I see black. A lot. I mean even there has been a real Victorian attitude toward the north and the morality of a nurse hasn't there. Yes and I think book Julian's book you know I think there's June has said repeatedly that there is much in her book that is of great value because in her book she does write very succinctly about the historical evolution of nursing and points out I think very very clearly where why we are where we are today. And it does tie up with male female relationships in apprenticeship systems you know types of education where you know I think we're moving away from it but you look at how what

how were trained educated to behave pure innocent women in white in the hospital. But I mean when people are socialized they don't get over it overnight. OK. I was born and reared in regime nursing. But you look at how we're portrayed in the movies. We're witches bitches whores. We're human like nurses are talking. Well very often nurses when they appear in a movie. So you see I have had to ask myself What in the world of society. Expect of nurses they want this site over here. And they want this center over here. This immoral character that you know I'm tired of it. I'm tired of it and as I said in Europe there are other problems. I am at this point I don't care whether anyone believes me or not it's their health that's in danger. All right let's talk about what you claim is the damage that's been done to the public by the American health care system and let's be very specific about that and I think

June and Jeanne also agree that there's been damage. So someone tell me specifically what's been done to me and everybody helped by the fact that nurses have been oppressed by the fact that our health care system is not what it should be. Well maybe you know June you can help me a wee bit with this. I sing in. This was said on our last program that there is much more that nurses can do in the practice of nursing then they are. Currently legally permitted to do. I think. That this kind of restraint. Deprives the public of the full impact of total nursing care. Some of the other things would have to do with the ratio of professionally prepared nurses in hospital institutions. So you're asking for legislation. Really. Well no I'm not asking for legislation at this particular point in time. If you're talking about you know who is a professionally prepared nurse and what kind of educational perforation you know that's another

side issue. I think what I'm talking about is if you look at the men power within a hospital an acute care facility as an example in point. And you assess what the needs of the patients are in that kind of facility. We should be able to make a very clear determination of the ratio of professionally prepared nurses to non professionally prepared nurses practical nurses and aides. And at this particular point in time I think because of the economics of the situation very often this ratio is reversed from what it should be and there are probably more and less more. Non professionally prepared nurses staffing the wards and the institution. Then there should be in relation to patient care needs. Is it because they get lower salaries. Well they are seeing salaries are not good they are abominable in places and in other places they are coming along very very nicely. I think there are several things going

on. One is the issue of education and when Jean talks about a professionally prepared nurse she's talking about someone with a Baccalaureate or higher degree. Eighty one percent of all nurses have not acquired that level yet. There is a rising curve as I said in our last program more and more people are going into baccalaureate and masters education right now something like three point three percent of the million nurses who hold licenses in this country. Hold master's degrees. Something like between 14 around 14 percent hold bachelor's degrees and a sample size that's the effects of oppression that that is quite true. But. More and more people are going into these programs and as they are being produced the more advanced institutions and let me point out that nursing is practiced in a lot of places other than hospitals. Right. But where I come from for instance more and more of the hospitals are being are

moving to hiring baccalaureate prepared nurses for their staffs. They're going into new modes of nursing care primary care in which we nurse is responsible for a very small group of patients and she's responsible for those patients on a 24 hour basis regardless of whether she is there or not. And she plans for their nursing care. And it's a very different kind of nursing than the fragmentary parade of individuals. Housekeeper is a practical nurse a professional nurses internes Rosamond's X-ray technicians. Anybody else a million people go you know. Do you know I think we ought to pick up on one point you may know. Nurses. Do not only work in hospital. Nurses are in every and this is historical fact. Currently true there in almost every social institution that this country has got. They work everywhere. It's either in schools they're in foreign industry into the armed forces.

So it's logical for society to begin to think now if we get qualified nurses. Who really are giving health care nursing care we're going to improve the health care industry for example and I have to realize have sisters not sister in the feminist sense who work in industry. Their role is just as narrow. They serve the physician and others there just like they do in hospitals. Now in other settings nurses are more free. You know nurses like to work in the community for example. Public health nurses they have freedom. But we are everywhere and if some money could be invested in us. In an AG development. We'd have quality care. We won't have it until this is done. Let me ask you a question about primary health care service planners. Would this free the nurse from the myth of being supervised all the time. Would she then in that situation be free to make decisions and carry through on the notation care. That's a myth by the way the nurses are supervised. You know what nurses really do. They

supervise the physicians work. They very often do his work and he gets credit for it. He gets paid for it. The nurse is there doing it. She supervises medical care. She's there you just look and take a. Look around and see how many doctors you see in a hospital supervising care. The nurse does it. That's a myth. It's also legalized by the way. Legally. The nurse has always been under the Doctor it should be the other way around. He should be under her legally. If we're really going to protect the public. I can't imagine that ever happening. I don't I'm not sure what you mean by being under either because at least in the New York State Nurse Practice Act there is nothing that says when our nurse is supervised by the physician or nurse. Now that's that isn't something new. No that's OK. No it does too. Legally legally nurses were just into a decade. Where in the various states nurses are changing their nurse practice acts. Now that again is in my book.

We nurses got lost. You know they wanted to be like doctors like dentist. They wanted to be legally recognized legally protected. So they got these laws passed well before women got the vote which was about 19 20 I think. But at that time me and were superior. This was written into the law. It simply recognized what I already existed. Now we are just in this decade beginning to change those laws and it's a hassle. You know. Because physicians don't want change. They don't want this person to be free to get health care to give nursing care. They want and that's for economic reasons by the way. Only. Not only its enemies tatting with myths which have to do with you know really they influence people's behavior and you don't know you're being influenced mine. But basically its economic. So long as they can control this person. You know and keep her in her place they can hog all the money and not show it

to you and you wanted to say something a minute and well I want to say several things that I wanted to say something in relation to your comment about primary care. Which I think people are treating as if it's a new kind of CLINTON I don't mean that at all. Well again I think it deals very much with the definition but as a public health nurse many many many years before I went into education administration we were doing we were doing primary care and we were making decisions and we were treating the total family and we were doing health promotion and disease prevention as well as all of the other usual kinds of things that one thinks of in terms of nursing but you know in a hospital they're right it's no public health was in the community I had my little bag and I went out and I went to families in their homes the kinds of interviewing nurses again if they were paid less say an honest income by. 20000. We could say 50000 are unlike some of the New York doctors two

hundred fifty thousand a year. And we put enough on the street. A New York City. I wish you'd use a different. All Russian are in rural areas would have quality care. Really it is a good old. Fashion. For the counters. Well you see I guess it's you know we're talking about a good old fashioned nurse. Well I think we're talking about public health nursing. I think it is practiced that way now I think it is probably even improved over the time that I was practicing it because I think that the nurses that are doing public health nursing at least again in New York State they are required in order to be a public health nurse to have a baccalaureate degree. So I think the kind of public health nursing that they're doing probably much better because let's face reality for example. When I was in Kentucky doing my public health experience as a student I went with the public health nurse because we were super matched. You know the if you do. This woman was

so broken hearted of what she song in and around rural Kentucky. Where starvation. Now she had a heart. Now she took her paycheck really and bought food for those kids that they had thought they were dying of starvation because she couldn't stand it her husband made her quit. Now you see if people would just open their eyes. They could see horrible sights on the streets of our cities in rural communities. You people you know what you're going through and this is how the public has been damaged. People are getting care we have we have health problems that are real. Now I'm no longer going to ignore them. We've got to look at them. Now I'm saying for example. I work I teach in Illinois I work in a small rural community there and there's been so much attention focus given to medicine. It's been analyzed. It's been worshiped. What that community needs they they've got about oh I don't have any doctors let's say four. It communities get scary when an actor is late.

What a community needs is for doctors for professional or. For professional nurses. But professionally you mean with a degree. Yes. I might even get to a show somewhat different than that I don't know when I don't really know what the ratio is yet to be easier because I think this is one of the things that we have to bear in terms of health care in a literally OK. Even if you have to I think that we do have to look at it in terms of what the needs are in a given community what the skills are of the people that are delivering the health care and then the ratio of professionals that are needed in order to do you know to do the kind of health care delivery that you're talking about it may be that you need three physicians general practitioners in a community and maybe you need 10 12 or 14. Public health nurses well and you know industrial nurses or whatever you were you know your community leaders have got to start. Recruiting nurses just like they go all out to recruit a doctor

and recruit the best possible nurse the best possible nurse and make sure of it. Put demands on educational institutions and say when you need public officials it seems to me you're not likely to begin doing this tomorrow or the next Internet. What would have to happen in order for that to begin. They need to be exposed to what nurses can do have done on a very much broader scale and join you talk about a public health nurse in Kentucky spending her own salary which was very altruistic and very giving and warm and loving. But I also think it was absolutely self-defeating. She would have accomplished a great many more things along with that if she had done something about pressuring the social system to provide that into that and she needs to know about the possible resources in the in the community to do this. Turgeon you see and knew her husband was smarter than she was but he didn't have a heart. So that's the problem with nurses because they care. And she was really a little bit stupid.

You know to start her. Have to feed someone else. But then again there's a principle I would have I would have trouble trouble. But I wouldn't mind giving away. Well that's what cap is for now right. Is that the goal. To make him a political organizer to become aware of the fact that there is a huge potential among nurses. I mentioned before there are something over a million nurses who hold licenses to practice in this country. That's a million votes since a million and a lot of our nurses have friends and family and patients and clients and regardless of which side of the political spectrum they come now known. They. Have the potential to influence the outcome of voting and a group of us back in 1970 begin to look at how.

Health legislation was coming about and who was influencing health legislation and what were the perspectives of those people primarily in Washington because we were talking principally about federal legislation. But the same thing obtains in the States. We were looking at the kinds of decisions that were being made regarding health care. We looked at the fact that nurses had almost zero input into the decision making. And when we approached our legislators and said look we have we are the largest group of health care workers in the nation. And we have some very real contributions to make in some very very good ideas and we are very concerned over the issue. We were not heard very well. We were not heard because we were not organized. We were also not heard because we had. Financial resources to contribute to campaigns and that happens to be reality and there

is nothing illegal or dirty or nasty about it. We had no money because we had been forced to live in poverty as a group of women struggling. But we also had no money because we never thought that we ought to contribute any money. This this was completely outside of our socialization again our fear of thinking or many other things we just did not think in those terms. It was not within the definition of the role to be run. Absolutely not I think is I think the point that John is making and very well is that it is becoming part of the definition of the role. And I think that's important and I think that this is in a you know a very strong component of the educational program for nursing and I cannot speak for all schools but I can say that it's certainly in the baccalaureate programs one you know helps nurses to deal with how one affects change. What is power. What is the role of women and what is the role of nurses. And when I say nurses I am talking I think

in terms of the new nurse the nurse who is capable of affective decision making and who is capable of affecting change and who knows what's going on out there and realizes what it's all about. What I think is exciting from my point of view of you know talking to you and doing some research on this is the broad spectrum of political thought that's going on within the profession. Yes yes. I mean the extremes are wonderful. And the fact that you're all talking to each other and sitting down with each other. Makes me think you have a very good chance of doing films that you're interested in and I think this is one of the most exciting times for nursing. It's also when you said to me on the phone when we talked in July that it's also the most dangerous time. Yes I think so because because of all the pressures and because of all the stirring. Because of the realisation which is rising among nurses that. There are so many problems that they are powerless and they resent it and they refuse to continue to be paralysed and so they are looking

at the tools that are available to them to. Correct the health care system. To terms that they would like to see if they would like it to be a health care system system rather than a secure system. They would like to have a large influence on the system because they know they have a large contribution to make. So that this surfaces in what Julian was talking about before the move to change his practice acts. The move to obtain. Financial support for innovative educational programs to produce new kinds of practitioners to deliver a different level of nursing care and nursing I underline not anything else. All of these. Movements on the part of nursing are. Interpreted in very many ways because we're upturning a very class and apple cart. And we are being perceived as a threat. And so when we try to change a Nurse Practice Act. To make it relevant to the level of nursing

practice of the day then there is a tremendous amount of opposition. Various groups are. Discontent with our efforts and are trying to stop us. And I see there is a whole move in nursing to develop nurse practitioners who are doing more than nurses used to do. That's also at this time. You know we must not let them stop us. They say oh I don't think that this is a little bit more than just focusing narrowly. You know and you know. We've got to contact our politicians and make sure they understand the damage done to the public by the systematic they're beginning to with you know obviously some word of that kind has gotten out I mean it certainly reached me it's reached you know people and. We have to convey to present facts and discuss it with the public and the public to help us you know what I worry about coming increasingly aware I think

of the. Affects of the current health care delivery system. Surely I would be doing OK. One must keep this awareness you know in front of the public and in front of all the various you know health health care professionals. But I think we also have to do what you know is talking about and that is move towards planning for how we can help to improve the health care delivery system. Yeah you know you can expend so much energy looking at water was that you never get beyond the point of looking at what was in terms of what we can do you like it better if you don't look at what was and if you don't look at history you'll move forward. I did more than that we should and I just spend all of our time looking backward. To me that's a priority because you've got to understand the passions. Before you can wisely I had and I don't think anybody is debating what it is women I think possibly women have done.

I struggle so hard to get an education. Not supported. Not well-financed. So they put all of their energies and their efforts into trying to get into universities universities didn't want women and it was worse to be a nurse too. So they struggled and had this very narrow goal. Of getting an education getting decent schools. Took all of their energy. Plus they had to big physicians and others to let him get an education. Now I'm saying we must totally redirect our energy. That's it we're out of time. I thank you very much it's been most interesting for me. I thank you for watching and good night. This program is soley responsible for

its content funding was provided by public television stations. Additional support was provided by unrestricted general program grants from the Corporation for Public Broadcasting and the Ford Foundation. A.