my two francs :) on the Joy Behar uproar

Recently Miss Colorado, who is a nurse, recognized the gifting of nurses in her presentation of talent for the Miss America pageants. Nurses all over the world were delighted to be publicly recognized. Then the ladies of The View, a TV show that discusses trending ideas and events, mentioned her speech during one of their episodes. Their comments were less than complimentary, and unfortunately much less than intelligent.

So I've been a registered nurse for nearly four years, and I feel privileged to practice as a nurse, and I am also a millenial who likes to blog.

 

 So as a practicing millenial nurse blogger I want to weigh in on Joy Behar's "doctor stethoscope" comment in The View. Here are the main things I've thought as I've followed the social media uproar.

1) Joy Behar's comment was upsetting to many healthcare professionals because it implied that doctors may be superior professionals over nurses; it hearkened back to a time in healthcare when the nurse role was as a subordinate, an accessory, to a physician. And while I realize that this perspective not only existed but still exists, I have rarely encountered it. Almost 100% of the doctors I've worked with over the past 3 years since my licensure as an RN have made it clear throughout our interactions that they respected me not as an accessory to their concept and practice of medicine, but as an essential and equal coworker. I love seeing how doctors around the world have taken a stand on social media this week in support of nurses. In my experience, it's at the worst parts of most clinical situations that I have experienced the greatest rapport with and kindness from my sibling profession of medicine. I'm glad that in this media situation the response from doctors seems no different.

2) I'm seeing some humorous responses to Joy Behar from nurses on social media. 

I'm also seeing some really ugly, vindictive ones. No need to share those. Fellow nurses, we deal constantly with ignorance and misinformation in our clinical practice. While ignorant and even rude patients can be annoying, I largely see us respond with compassion and attempt to teach them and their families. I don't think our role in social media should be any different. We've all encountered patients who seemed stupendously deficient of understanding, and we don't refuse to care for them because of that. We just know that it's one more way they need our help. And we remember that we have our really dumb moments too. Interestingly, I feel like I tend to have more of those moments when I'm in a healthcare setting; the stress is high, my awareness of my own limitations is high, I'm often hungry and tired. I can't imagine that my patients are feeling much differently when they make statements or ask questions that might be perceived as offensive. And other people are normally kind to me when I'm being stupid, which in turn helps me be less stupid, I hope. So we can joke, yes, but can we also look for ways to be kind to Joy Behar, who is clearly suffering (nursing care plan lingo) from Knowledge Deficit and Lack of Education and Risk for Poorly-Informed Decision-Making and Impaired Communication?

3) As nurses and a sympathetic public, we have taken Joy's dig at a nurse wearing "a doctor stethoscope" personally. And it is personal. But have we considered how the implications of this statement insult and isolate physicians? It implies that doctors who trust a nurse's assessment and report are either under performing (trusting the report of an unqualified professional rather than doing their own routine every-four-hour and change-of-status assessments on ICU patients, for example) or are under informed about the abilities of their coworkers (so then what else are they underinformed about?). It implies that the judgment of of a doctor who trusts the nurses she works with is impaired. It isolates doctors under a greater burden of medical responsibility and knowledge than our society has ever before attained, making them the sole keepers of assessment and judgment. There is no state more alone than one in which even a person's colleagues are supposedly their inferiors. Hierarchies often help structure the world, but for every narrowing layer of power there is a person or persons that much more internally vulnerable - and sometimes externally vulnerable too, as exemplified by coups d'etats and the folk story of "The Emperor's New Clothes". We nurses know like few other people can that even though being a physician is a brave, beautiful, incredible thing, it is also exhausting, demanding, overwhelming, demoralizing, and often emotionally marginalizing. Implying that we can't come alongside them as peers in our own right isolates them in a way that only an unhealthy arrogance can appreciate. I think that doctors deserve a little sympathy for the weight that a perspective like that implicit in Joy Behar's words places on them. MD and DO friends, thank you for your support on social media and in our clinical lives, for sharing the practice of healthcare with us, for involving us in your thought processes and decisions, for adding to our knowledge and taking from it to better inform yours. Your schedules are rough, the expectations laid on you are beyond human, the breadth and depth of knowledge you carry and reference is astounding, the decisions you make look paralyzing to me but you still make them, and although your nurse colleagues are often too busy to talk to you, we are with you. We are your colleagues, and we need your help to know how we can stand beside you and support you even better.

4) Nursing is a misunderstood profession.  It is.  And it is misunderstood for good reasons that are bad reasons. HIPAA, the weight of caring, our history of subordination, and our majority-female demographic all affect our ability to speak up about things that matter to us. The nurse is the shock absorber, the buffer, the end of the line of healthcare. This means we are often the voiceless, the demeaned, the dehumanized, the powerless. When there is unhappiness in a healthcare setting, you can bet your bottom dollar that the person on whom it finally lands will be a nurse. When the psychotic post-traumatic brain injury patient starts calling everyone f---ing a--holes and swinging, a nurse will be the one absorbing the words and spit and possibly the blows while they hold that patient down to maintain everyone's safety. When the legendary picky surgeon or volatile supervisor finds something that isn't right, the person listening and attempting to redirect will more than likely be a nurse. (I once saw this happen; when I was a student observing in the OR, the orthopedic surgeon freaked out about something. It wasn't even a breach of protocol or sterile field - and took off his protective hard hat and threw it at - you guessed it - the nurse and the physician assistant who were still scrubbed in, closing the incision together.) When the nurse who's going through a divorce or recently lost a child or just didn't get enough sleep has had more than he can handle, the person with Kleenex in hand ushering him into a corner out of the way and staying there with him until he is okay again will be a nurse. The person who gets propositioned for a blow-job or for sex or to put a suppository in for a completely independent patient (yes, these are all true examples from my practice in the past three years, and I have many more) will be a nurse. The person management blames for 63rd percentile HCAAPs scores this quarter, whose performance must be improved with inspiratory speeches and hidden warnings, is a nurse. There is nothing like living a powerless experience to grow your inner bully - your lack of a voice just wants to come out, you just want to receive empathy for all the times that no one has given you any and everyone has looked to you for more, more, more. This, I think, is what is coming out now in the posts I've seen from nurses calling Joy Behar names and demanding the termination of The View. Guys, it does hurt when someone calls us "just a nurse." It hurts when they don't know how hard it is to become a nurse, to be a nurse, to stay a nurse. It's rough that I can't tell my mother some of the hardest parts of my day; that I can't blog about a lot of challenging or interesting situations and ideas I have; that I can't tell my friends very much about some of the people and encounters that have been pivotal in my young adult life. It's rough when we nurses (and doctors, I'm not forgetting you here) can't even ask for empathy or for acknowledgment because it would violate somebody's privacy or dignity to share about what we went through with or for them today. We have been voiceless and felt subordinate throughout our nursing careers. And finally we have an outlet - that dehumanizing perspective was voiced publicly, outside the constraints of healthcare and HIPAA, by a person we are not caring for personally or legally obligated to, and by a person who happens to be female. Voila. We've been mad and silenced and tired for a long time. But let's not abuse this outlet. Let's try to be respectful. Let's try to be kind. Even outside the constraints of legal and social responsibility, we have a universal duty to ourselves and to our species: the choice to be beautiful humans.

5) Sometimes even people who try to choose beautiful humanity get carried away. Turns out nurses are not exempt from the mob mentality. It's understandable. We're human and we have encountered the many forms of Joy's demeaning opinion throughout our practice of nursing. But guys, demanding that the View be shut down is like burning a flag, or stigmatizing a politician's name. It's taking out our frustration on a symbol that we designate... in this case, a woman and a show. It doesn't help us to mob up and shut the show down. It would be better if we asked the show to dedicate a morning to a panel discussion with real nurses and doctors. I don't mean Doctor Oz and Miss Colorado RN. I mean you, me, and the professionals we work with every day. If you're going to call ABC, do us all all a favor and ask them to help us promote better awareness. Help us rally the public behind us with better understanding.

6) Thank you everybody. What a wonderful opportunity this is. Thank you, nurses and doctors, for all the things you do and think and feel that you haven't been able to talk about and maybe never will be. Thank you, non-healthcare and non-patient people who want to understand. Thank you patients for helping your caregivers become more rounded human beings and for being willing to consider their perspective next time you interact with them. Thank you, Joy Behar and compatriots on The View, for giving us a wonderful opportunity to tackle this subject openly.

7) **********Joy, I'll come be on that episode of your show if you'd like.*************
I'll even bring my stethoscope and let you borrow it to listen to my chest and abdomen so you can learn what that's like on a relatively healthy patient.  I'm basically textbook. I have pretty good clear bilateral upper and lower lobes, typically active bowel sounds, and a regular S1S2 no-murmurs heart. I'll let you check them out. Seriously. Shoot me an email. ;)