The New York Times and Nurses

The New York Times and Nurses

By Bernice Buresh and Suzanne Gordon

Tuesday is Science and Health day at the New York Times. Each week, the Times, the "newspaper of record," publishes an eight-page section that is more or less equally divided between coverage of developments in science and those in health and health care. The section contains reports of new research findings, discussions of the implications of trends or discoveries, useful health tips, and offerings by columnists. A weekly column by Jane E. Brody explores personal health issues and dilemmas. A feature, "Vital Statistics," reports on studies from medical journals. On an episodic basis, various physicians—always MDs—present interesting case studies under the rubric "Cases." The section also carries book reviews.

We're faithful readers of the section but each week we usually end up lamenting the absence of nurses in all of the coverage. To be sure, the New York Times, partly because of protests and suggestions from nurses, has carried articles on nurses and nursing subjects. But such stories tend to focus on nurses or a nursing topic alone, compartmentalizing the discipline rather than showing it integrated into multiple areas of health care.

For example, a reader of the lengthy article "E.R. Patients Often Left Confused After Visits" that appeared on the front page of the section, September 16, 2008, would be left clueless about the central role that nurses play in emergency departments.

The article was based on a study published in the Annals of Emergency Medicine that found that the vast majority of emergency room patients were discharged without understanding one or more of the following: "their diagnosis, their E.R. treatment, instructions for their at-home care, and warning signs of when to return to the hospital." The article cited hair-raising problems patients encountered after they went home and warned that lack of communication with patients endangers them and increases costly re-admissions to hospitals.

Typically reporters writing an article of this type seek commentary from experts who were not involved in the study. Reporter Laurie Tarkan did that, but all of the expert sources she quoted were physicians, some of whom seemed particularly unaware of the presence of nurses in emergency care.

One physician lamented that his colleagues are notoriously inept at communicating to patients as though that were the only avenue for patient communication. Another physician was paraphrased as recommending that "hospitals coach patients on self-management skills before discharge," and that "hospitals should make follow-up calls and visits to patients." We don't know if he or the reporter was responsible for the image of a building making house calls, but it's a bizarre construction when in all likelihood the follow-up calls and visits would be made by nurses.

Dr. Rade B. Vukmir, a spokesman for the American College of Emergency Physicians, proposed a "dual discharge" approach to communication, which was paraphrased as "the physician talks to the patient about the results, treatment plan, and follow-up care. Then a nurse follows-up with computerized discharge instructions." In this version, the doctor, presumably the one with the brain, does the talking, and the nurse gives the patient a hand-out.

We hope that the members of the Emergency Nurses Association have written hundreds of letters to protest this kind of contorted coverage. If they haven't yet, it's never too late.

We plan to post more examples of nurse neglect by the New York Times and suggestions about what nurses can do to make their work more visible. Meanwhile here are two more recent ones:

Two articles on geriatric care written by columnist Jane E. Brody for the December 30, 2008 section. Brody is one of the few health care writers who from time-to-time does integrate nurses as expert sources into her columns, and in one of these pieces she does refer to nurse practitioners in the first paragraph. Second article.

But all the sources in these stories on the health issues that elders face and geriatric care models are physicians. Although nurses in many settings would be dealing with the critical problems the article mentions—dementia, incontinence, risk of falls, and multiple chronic conditions—no nurses are quoted as expert sources in this nursing-rich field. Amazingly, nurses in a pilot team approach to care are referred to as "helping physicians." It seems to us that the nurses in the program who "go to patients homes, develop comprehensive care plans, help the patients in self-monitoring, help them to overcome obstacles to self care and connect patients and their families to community agencies," are actually helping patients not physicians.

One more irksome example was a "Cases" column by prolific medical writer and cardiologist Sandeep Jauhar (January 6, 2009). In it, Jauhar appears baffled by the fact that many patients actually know they are going to die before the physician does. "Doctors can’t explain it, but every day in medicine there are people who know they are near death, no matter what the tests show," the subhead on the column reads.

Possibly Jauhar wouldn't be so surprised if he had talked to more nurses who witness this phenomenon time and again. Indeed, one of the most vexing problems in the physician/nurse relationship is the often futile effort of nurses to prevent physicians from overtreating patients who are about to die. Nurses aren't given any credit for their knowledge of patients in this column. And although nurses and nursing assistants who work in long-term care often are very receptive to the cues of dying patients, Jauhar cites only a New England Journal of Medicine article about a nursing home cat with an "uncanny sense" of mortality that curled up beside residents who were about to die and purred.

We respect Jauhar. He's a physician who questions the medical system more than many others and does it repeatedly. But this piece strikes us as a classic example of medical hubris, not only because it fails to mention nurses, but because the author appears mystified that a patient's intuitive knowledge about the body he inhabits might be superior to that of the physician and his phalanx of tests. Come on, Sandeep.

Bernice Buresh and Suzanne Gordon are the authors of From Silence to Voice: What Nurses Know and Must Communicate to the Public, a public communication book for nurses that provides, among other things, instruction on how to write letters to the media concerning coverage of health care.