A Conversation with Suzanne Gordon

Suzanne Gordon ["Nurse, Interrupted," TAP Vol. 11 Issue 7] is a journalist who has been writing about nursing issues since 1986. In "Life Support: Three Nurses on the Front Lines," Gordon details the three years she spent reporting on three different nurses. Laura Maggi is a Writing Fellow at the American Prospect.

Q: In your article you talk about nurses being downsized and the work becoming more taxing and less rewarding, and I was wondering when this started happening. When did the policies start changing?

A: I think that nursing work has always been very difficult and nurses have always put up with stuff they shouldn't have had to put up with, for example, disrespect and poor pay. I think that the situation started to improve in the mid-'80s with the advent of primary nursing where you had one nurse for one patient. ... They got rid of this thing called social nursing where one nurse would do bed baths and another would give pills and nobody had the total patient picture or a connection to the patient. Also, nursing salaries went up in the '80s, and there were a lot of educational opportunities that hospitals gave nurses, recognizing that doctors aren't the only learners.

But then all of that really started to disappear when we had the advent of market-driven healthcare. And with the kind of relentless cost cutting that you see today, hospitals have really targeted nursing to cut costs. So, you see patient loads increasing, mandatory overtime, nurses' pay stagnating, and the kind of working conditions that people find impossible to work in and give quality care.

Q: But you also note in your article that hospitals now face a shortage of nurses.

A: They cut costs, laid off the most senior, most experienced nurses. They then replaced them with aides and didn't hire more nurses to fill positions lost due to attrition. And, after awhile, guess what happens? You won't have enough nurses after you do that for five or six years.

Working conditions for nurses who remain on the job become so atrocious that it gets out in newspapers, gets out by word of mouth. I've found in talking to nurses, they will instantly discourage young men or women from becoming nurses. When family members or friends go to nursing school, they will say, "What, are you crazy?"

Q: How come the healthcare system does not recognize the importance of nurses?

A: Because it is women's work, because it has always been devalued, because it is attributed to women's intuition. Because we have always taken for granted that nurses will always be there. We know we have to reward doctors. It is a social truism, people will say to you always, if you don't pay them enough we won't get the best and brightest into [the] medical profession. If that is the calculus, if the incentive for doing good things is monetary, why do we assume that the incentive doesn't apply to nurses? Most nurses aren't working for pin money -- they are working to support their families like everybody else. Many are the sole support for their families. But they are also working for satisfaction and many of them feel morally compromised.

Q: The anecdotes you use in the article seem to suggest there is a lot of despair among nurses.

A: I think there is despair among everybody in healthcare. Fewer people want to be doctors, but there [are] still more rewards for doctors. The fact is that people know it takes a lot of education and skill to be a brain surgeon. People don't know that it takes a lot of education and skill to take care of somebody who has just had brain surgery. That is the missing link in the nursing crisis. The fact is people are fighting for access to their doctors. They are not fighting with equal vigor for access to their nurse. People know they have to have doctors. All these patients' bills of rights are centered around doctors and medicine, but they need to include nurses.

Q: You reference in your article an American Hospital Association report that details patients being very critical of the absence of nurses.

A: That was just of patients who have gone to the hospital. A very small percentage of people every year are hospitalized, maybe 10 or 15 percent. So those people begin to learn about nursing. People that they interviewed in that study had just been in the hospital, they were very aware of nursing and lack of care. That is a little late to be worrying about whether we have enough nurses to take care of you.

Nurses are regarded as honest and ethical but their breadth of skill is not known. When I was at the Beth Israel hospital, I was on the oncology clinic, followed these nurses for two years. Doctor comes in one day. Had a patient with breast cancer and the patient died. The husband gives him a trip around the world. What does he give the two nurses who cared for her? A scarf. The woman died, so it didn't work. The people who cared for her were the nurses. I happen to know the doctor, he was a you're dying, I'm disappearing kind of guy. The people who take care of her were her nurses. He gets the trip around the world, they get scarves. I think that says it all.

Christopher Reeves is the perfect example of this. His book, which I reviewed a while ago, he goes on and on about these doctors and what they did for him. I'm not knocking doctors, don't get me wrong, but the people who kept this guy alive on minute-to-minute basis were the nurses in that intensive care unit. And then his whole life is dependent, literally every function in his body, is dependent on nurses. In his book, the best the ICU nurses got was that they had sweet, gentle, Southern voices. With the doctors, it was how competent they were.

Q: Every once in awhile you will read in the paper that nurses are trying to unionize or that nurses in a particular hospital are trying to get better pay. Has there been more effective agitation?

A: There is increasing agitation. Same thing that is happening with doctors, although nurses have been unionized for a lot longer. [About] 10 to 12 percent of nurses are unionized. There is increasing unionization and nurses that are unionized are getting more and more assertive because conditions are more awful.

Q: You mention a California law that requires hospitals to implement safe-staffing practices (i.e.: mandating nurse-to-patient ratios), do you expect to see more provisions like that?

A: Yes, there are staffing bills in Rhode Island and New Jersey. There are also probably about 20 states where there are whistle blower measures and safe-needle measures. There are all kinds of attempts to mandate reporting of hospitals of what they call nurse-sensitive indicators. It means to correlate certain things that happen to patients with nursing, like falls, pneumonia, [and] urinary-tract infections, with numbers and experiences of nurses.

Personally, I think there needs to be more class-action suits for putting patients at undue risks, for not having enough nurses. If a patient is lying in terror and loneliness and pain and fear, the healthcare system is supposed to be about mitigating that, not just giving them antibiotics every four hours or operating on their leg. The other thing is, we are seeing much more evidence about the medical errors that are killing and hurting patients. People ought to understand that ... nurses can't protect you if they aren't there with you. There are also [a] lot of medical injuries [that] have to do with fact that system won't listen to nurses. [There have been] cases where nurses will try to blow the whistle on physicians' failings, but they are reprimanded for insubordination.

Q: So there has to be more internal hospital respect for nurses as professionals?

A: There is a fascinating case in Canada right now going on about this. An American surgeon hired by hospital in Winnipeg to be the head of pediatric cardiac surgery. Turned out his references were not checked enough, didn't have the experience they thought they had. Twelve babies died on the table or on the ICU. A nurse who had 20 years experience as an operating nurse was watching the failings of his surgical technique and alerted hospital and medical authorities. And they basically wouldn't listen to her. In fact, one doctor told her, when she asked him to come to operating room and observe this guy's technique, he basically told her that he didn't take orders from nurses. And [large] numbers of babies died because they wouldn't listen to a nurse. [It was] only when doctors objected that they closed this guy down. What are we doing here? Why educate people as professionals if you won't listen to their judgment?

Q: You mentioned class action lawsuits, is there anything else you think we can do to change the situation?

A: I think we need a social transformation of our attitudes toward the biggest profession in healthcare. Why are they there? Not there to fluff our pillows and empty our bedpans. If they do, there is a lot going on that is very important in that work. Nursing work looks very domestic, so we tend to trivialize it like we trivialize parenting. I call nurses knowledgeable caregivers; they are who patients want at their bedsides. They may not know that before they get sick, but they will know it when they are.

Q: How did you get interested in this?

A: I got interested by being one of these people who didn't understand. Having a baby, going to the hospital and thinking it was the doctors who were going to do everything and discovering it was the nurses who do everything. I started thinking, geez this is pretty interesting. All these people out there holding up healthcare system with brains, not just grit.