Caring, Not Curing

In a new book, SON's Brush says nurses are being shortchanged in health care debate

By Mark Sullivan
Staff Writer

As a registered nurse who earned a doctorate in the history of nursing, Asst. Prof. Barbara Brush (SON) hears the question all the time: If she were going to spend all those years in school, why didn't she just become a medical doctor?

Although usually well-meaning, the query reflects a common misconception of the differing motivations behind the nursing and medical professions, said Brush, as well as of the relationship between the two. Many tend to think of doctors and nurses in hierarchical terms, with nurses as the subordinate helpers; a more accurate view of the two, Brush said, would be as "separate but equal" professions, with doctors motivated to "cure," and nurses to "care."

"I enjoy the contact with the patient," said Brush. "I enjoy helping people live with their illnesses, to deal with them the best they can. I don't have the desire to cure. I have the desire to help you take care of yourself."

In American Nursing: From Hospitals to Health Systems , a concise history she has co-authored of the post-war American nursing profession, Brush argues the nature and importance of nurses' care-giving role in the American medical system often remains unappreciated.

"I enjoy the contact with the patient," said Brush. "I enjoy helping people live with their illnesses, to deal with them the best they can. I don't have the desire to cure. I have the desire to help you take care of yourself."

Brush said the training and professional scope of nurses have broadened considerably in the past 50 years, with nurses today regularly assuming many clinical responsibilities once the province of physicians and performing technological tasks undreamed of a generation ago. Yet nursing remains "fairly invisible" in public discussion on managed health care, she said, and nurses have borne the brunt of job cuts as economic competition has led many hospitals to merge or downsize.

"We're mostly concerned that because nursing care has been so devalued, hospitals are concerned with having the most possible nursing at the lowest cost," said Brush, who collaborated on the book with her mentor, Joan E. Lynaugh, of the University of Pennsylvania.

Brush said American hospitals continue to employ 70 percent of the nation's nurses, but the advent of managed health care has seen many patient services shift from hospitals to community day clinics and home-health organizations. As skyrocketing medical costs have led insurance companies to push for shorter hospital stays, hospitals have sent new mothers and other patients home earlier. With fewer patients filling their beds, hospitals have streamlined operations and searched for new cost-effective ways of doing business.

Patient care - and the nurses who provide it - have suffered as a result of hospitals' increasing focus on the bottom line, said Brush, who continues to follow her calling as a nurse. She and Lynaugh recommend new approaches for doctor-nurse partnerships as health care is increasingly concentrated in the community, while cautioning against hospital economy measures that diminish quality nursing care.

Over the next 10 years, Brush said, hospitals will have to figure out how to effectively employ clinical nurse specialists with primary nurses and attending physicians to care for an acutely ill hospital population, while leaving some share of the health-care dollar for the majority of sick care which goes on outside the home.

"Hospitals are selling 'cure,' not 'care,'" Brush said. "They say, 'We'll take care of that nasty gall bladder,' but they haven't been really good on allotting care. When cuts are made, they're made in the nursing staff. You can ill afford to do that. It's such a big business, you wonder if there's a 'care' ethic anymore."

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