A recent blog posted here urged readers to “SUPPORT NICHOLE BRUFF AGAINST THE BRAVE NEW NURSING WORLD.” Along with this request was a list of opinions with which most nurses working today would probably agree. The lines that particularly resonated with me were at the beginning, and they are a masterful hook:
“Nursing has entered an authoritarian nightmarescape. It bows to the hegemony of corporate enterprise. Nurses’ every decision is controlled and pre-conditioned. Conformity to the nursing hierarchy’s dictates brings harmony and agreement. No one who lives in the Brave New Nursing World questions authority by raising alternative ideas. Nurses are produced on an assembly line of uniformity. All the basic rules of the nursing hierarchy are expected to be carried out by every nurse.”
As an iconoclast who has never been particularly fond of cliquishness, I immediately felt sympathetic to the protagonist of this story. I too was ostracized in school, including nursing school, and I too have never “fit” within the corporate hegemony that nursing has become. The more education I attained the harder it was to fit in with demands that I behave as an automaton, doing things “because they have always been done this way.” In my master’s program, I became particularly fond of the concepts of “positive deviance” and complexity science, ideas that ended up forming the basis for my thesis (Clancy, 2010, Gary, 2013). Having established my defense, I have to admit that many of my problems are my own. I am bookish, easily intimidated, and extraordinarily inept in social situations. I am also quite opinionated and never shy away from argument. This is not conducive to success in nursing, much less gainful employment. This however is not my story.
Something about this story was a little too familiar. The problem with supporting one person against the brave new world of nursing is that we risk throwing all of our support behind someone with an agenda that does nothing to further the profession or the nurses having to endure what it has become. Remember Amanda Trujillo? No? Such is the nature of the internet. I will leave readers to look her up and formulate their own opinions (Clavreul, n.d. Kennedy,2012).
Who is Nichole Bruff (Rolfe)? An internet search leads to many less than reliable sources touting her as the poster child of patient advocacy who was unfairly expelled from nursing school in 2013 for opposing vaccinations. As of 2015, she is suing the college (Ridley, 2015, Apr 9). She bemoaned a traffic ticket in 2014 (Devereaux, 2014, Apr 9). She also ran for county commissioner in 2010. Her LinkedIn profile lists her obtaining an Associate Degree in Nursing in 2011, but that she works for a car dealership.
So, what, besides vociferously opposing vaccines, has she done for the profession of nursing? Has she urged nurses to advocate for safe staffing ratios? Was she unfairly targeted for noting that nurses are increasingly burdened by meaningless metrics or policies and procedures that are not evidence-based? Was she fired for mentioning unionization?
We have a bigger problem in nursing, a problem that is hindering our ability to do our job and resulting in increased morbidity and mortality. Stories like this are a symptom of that problem. The conformist, hierarchical, servile tenets of nursing are not the “brave new world,” they are as old as Nightingale. This is the brave old world of nursing, reinforced by the use of patient satisfaction scores to determine reimbursement (Robbins, 2015).
Nurses are working twelve-hour shifts with one 30-minute break, caring for higher acuity patients than ever before. We are routinely yelled at, spat on, punched, kicked, bitten and cursed, and forbidden from defending ourselves. We deal simultaneously with antiquated technology that does not capture nursing workflow and innovative technology that does not improve outcomes. We have to lead doctors to the right decisions without them knowing it was someone else’s idea and sometimes risk our careers to achieve the best outcomes. We have to placate families who at best have no clue what is happening and at worst are getting their medical advice from Dr. Google. All of this has been going on since the beginning of nursing, except for the internet. Now we also have patient satisfaction, IE HCAHPS, which, according to Brookes & Fenton (2014, 11 Jun), has resulted in the following:
“analysis of data from more than 50,000 adult patients indicating that the most satisfied patients (highest patient satisfaction quartile relative to the lowest quartile) were 12% more likely to be admitted to the hospital and had both total healthcare expenditures and prescription drug expenditures that were 9% higher. Most perplexing to many readers at the time, these patients were also 26% more likely to die.”
The original study can be found here. We have a powerful new tool at our fingertips, the ability to communicate the value of nursing to the widest possible audience. We have the ability to advocate for our patients in an unprecedented way. We can fight for safe staffing (National Nurses United, 2015). We can advocate for a more efficient EHR. We can put an end to bullying.
Until nurses reject anti-intellectualism, and embrace science based medicine, we will be at the periphery of healthcare, relegated to increasing HCAHPS scores instead of what we have entered this profession to do. When we, as a collective, align ourselves with those of dubious claims, who are using the ephemeral internet hate machine to gain their fifteen minutes of fame, we denigrate nursing. Nursing is not about you. It is not about me. If you want to change the brave old world, instead of spending our energy on individual trials and tribulations, advocate for “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (ANA, 2015).
American Nurses Association. (2015). What is Nursing? Retrieved from http://www.nursingworld.org/especiallyforyou/what-is-nursing
ArgusPress.com (2010, May 13). Nichole Bruff releases candidacy information. Retrieved from http://www.argus-press.com/news/community/owosso/article_e7cc4b76-5e9a-11df-b568-001cc4c002e0.html
Brookes, L. & Fenton, J.J. (2014, 11 Jun). Patient Satisfaction and Quality of Care: Are They Linked? Medscape. Retrieved from http://www.medscape.com/viewarticle/826280
Clancy, T. R. (2010). Diamonds in the rough: positive deviance and complexity. Journal of Nursing Administration, 40(2), 53-56.
Clavreul, G.M. (n.d). The Curious Case of Amanda Trujillo and the Arizona Board of Nursing. Retrieved from http://www.workingnurse.com/articles/The-Curious-Case-of-Amanda-Trujillo-and-the-Arizona-Board-of-Nursing
Devereaux, B (2014, Apr 9). New insurance, new leadership: Village of Oakley looks to move away from controversy. Retrieved from http://www.mlive.com/news/saginaw/index.ssf/2014/07/oakley_works_to_define_new_lea.html
Fenton, J.J.; Jerant, A.F.; Bertakis, K.D.; & Franks, P. (2012). The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Archives of Internal Medicine 172(5):405-411. doi:10.1001/archinternmed.2011.1662. Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=1108766
Gary, J. (2013). Exploring the concept and use of positive deviance in nursing. American Journal of Nursing, 113(8), 26-35.
Kennedy,S. (2012, Feb2). The Case of Amanda Trujillo. Retrieved from http://ajnoffthecharts.com/2012/02/02/the-case-of-amanda-trujillo/
National Nurses United. (2015). Ratios: Implementation. Retrieved from http://www.nationalnursesunited.org/pages/ratios-implementation
Ridley, G. (2015, Apr 9). Baker College instructor told students to threaten patients into vaccinations, lawsuit claims. Retrieved from http://www.mlive.com/news/flint/index.ssf/2015/04/baker_college_taught_nursing_s.html#incart_river
Robbins, A. (2015, April 17). The Problem With Satisfied Patients. The Atlantic. Retrieved from http://www.theatlantic.com/health/archive/2015/04/the-problem-with-satisfied-patients/390684/