Nurses in Nontraditional Roles

Or Mary's answer to: "What did you used to do when you were a real nurse?"

There's a persistent and pervasive stereotype of a nurse as the person in white next to the hospital stretcher or bed, and a continuing misperception that "real nurses" only work in hospitals, or in agencies or settings intricately entwined with the acute care business: home health, nursing homes, and doctor's offices. Sadly, it's not only the general public who has this misconception. Nurses themselves often labor under the same misunderstanding of the wide range of nursing practice.

It's true most of us started in hospitals after graduation. That's really the training-bed for most of us, and is in fact the traditional basis for nursing education. Nurses of my mother's generation weren't asked where they went to school, they were asked where they had training. There are still some diploma schools hanging in there, to this day. You can still become a registered nurse by attending a "training" school.

But there is more to nursing and nursing education than bedside training, as important and bedrock as that is to our special skills. We can't really become nurses without learning to care for acutely ill hospitalized patients. But many of us have left the bedside.

We are still nurses.

Sometimes nurses---and nurse-educators---define nursing by what it is not: not medicine; not social work; not psychology. But some emphasis should be taken to define nursing by what it is: caring for patients across the entire wellness spectrum in a holistic manner.

Now, I'm aware of all the cliches in that one little definition! I know "holistic" is overused, and "wellness spectrum" is so 70s! And the definition of "patient" includes individuals, families, groups and communities. Nevertheless, that's what we do; we care for patients sick and well, assessing functioning across the entire range of human experience physically and psycho-socially and basing our care on an understanding of holistic human functioning. We care by promoting health, preventing illness, or ameliorating as much as possible the effects of illness or disability.

And we do that lots of places besides at the bedside.

Nurses, with their unique education in holistic care and training in assessment of individuals and communities, are in demand by many employers far removed from the hospital bedside. There are real nurses working in community health nowhere near the local public health clinic. There are nurses in forensics; nurses in advisory roles in law and ethics; and nurses (like me) working in case management and other roles on the periphery of acute care.

Case management of people with chronic illness is an area in which nurses are uniquely qualified; we have an understanding of the way bodies work and a good perspective on individuals as part of families, groups, and communities. We can assess physical and psycho-social aspects at the same time, and use the nursing process to guide care coordination.

Case management doesn't have the "coolness" factor of, say, ICU or the ER. But I haven't left nursing, because I have left the bedside. I'm still practicing nursing. I'm just dressed in street clothes and out and about in people's homes, instead of dressed in scrubs and starting IVs at the bedside in ICU.

So in answer to the nurse who asked me what I used to do when I was a "real nurse", my answer is: the same thing I do now. I cared for people. That's nursing, after all.

mary