I think nurses should help do it.
The author, who considers Florence Nightingale the first environmental engineer, calls for The Future of Nursing 2020-2030 project to help redefine healthcare professional.
I’m not a nurse, but I am a lifetime honorary member of Sigma Theta Tau International Honor Society of Nursing (Sigma) and a fellow of the American Academy of Nursing. I work with nurses and advocate for nursing—locally and globally. Because I’m not a nurse, I often ask stupid questions about nursing, simply because I don’t know better. So, accept my apologies if this is one of them, but shouldn’t nurses help redefine the term “healthcare professional”?
I read a lot—from tweets to formal reports—and I see a number of trends in healthcare, including the following:
Nursing shortage
There’s a serious nursing shortage—too many sick people and not enough nurses to care for them. A variety of factors contribute to the shortfall. In some places, it’s because of demographic shifts toward cities and away from rural areas. In others, the shortage is exacerbated by nurses leaving bedside practice to retrain and earn more as nurse practitioners. In other situations, it’s because of pipeline and articulation issues: Potential nurses are unaware of the profession’s career benefits, and trained nurses can’t move easily across borders. Whatever the reason—and there are others—there are simply not enough nurses.
Increased costs
Costs are constantly on the rise. Litigation is a contributing factor. Malpractice insurance and lawsuits divert funds otherwise available to healthcare. Overemphasis on acute, highly specialized care—personalized medicine—leaves less funding for needy populations, communities, and the public at large. Other factors, such as the cost of pharmaceuticals and associated intellectual property issues, affect the cost of healthcare. Whatever the reason, it seems clear to me that we are spending our limited funding in suboptimal ways.
Wellness versus health
It seems that wellness has lost the fight with health. We save the one and lose the many. It may be because of a lack of universal health coverage. Or it may be because the healthcare system has been divorced from the community. Patients are seen in clinics and hospitals, not in their homes. Or because misinformation—the anti-vaccination movement, for example—has taken hold and caused unwarranted panic and fear.
Time for redefinition
Maybe nurses need to help redefine the term healthcare professional. One definition includes the following statement: “A health professional may operate within all branches of health care, including medicine, surgery, dentistry, midwifery, pharmacy, psychology, nursing, or allied health professions. A health professional may also be a public/community health expert working for the common good of the society.”
According to the same source, allied health professionals include “[individuals who] work in health care teams to make the health care system function by providing a range of diagnostic, technical, therapeutic and direct patient care and support services that are critical to the other health professionals they work with and the patients they serve.” But I ask, don’t these definitions focus almost exclusively upon serving patients in clinics and hospitals? Don’t they concentrate on downstream healthcare issues? It seems to me that these definitions are based on concepts of billable hours and procedures that lead to spiraling costs, increased nursing shortages, and a general societal lack of wellness.
Contrast that with a statement in an article about Florence Nightingale’s environmental theory: “She stated in her nursing notes that nursing ‘is an act of utilizing the environment of the patient to assist him in his recovery.’” Nightingale contended that humans are essentially healthy and that the purpose of nursing is to use the environment to return unhealthy humans to their normal state. Factors cited by Nightingale to achieve this return to health include fresh air, clean water, sanitation, cleanliness, and light, all of which have been demonstrated as critical to health. More than 150 years ago, she was at the forefront of the Great Sanitary Awakening and the realization that providing people with upstream solutions is an essential component of healthcare.
To me, it’s a straightforward extrapolation to proceed from Nightingale’s environmental theory to concluding that, in the United States, a zip code—our term for postal code—is a better predictor of health than a genetic code. Or to observing that, based on the Whitehall Study in the United Kingdom, elevated status at work correlates to better health. Clearly, social and economic determinants of health are important, perhaps more important than clinical care or hospital service.
Would you?
Would nurses, working as community organizers, consider partnering with lawyers to develop policies that combat food deserts—areas where low-income residents have limited access to affordable and nutritious food? Think of it as interprofessional healthcare.
Would nurses regard postal carriers who report hoarding in homes they serve and garbage collectors who report unusual items in trash bins as healthcare sentinels?
Would nurses collaborate with computer scientists to diagnose, based on patterns of internet use, individuals with mental disorders or antisocial behaviors?
Would nurses regard working with computer engineers to eliminate accidents caused by texting while driving an activity for healthcare professionals on the basis that it is a public health issue?
Simply put, there are two ways to solve many healthcare problems: one, by increasing the number of nurses as well as their salaries—both admirable and worthwhile goals—and two, by reducing the number of sick people through effective upstream practices. The latter would be facilitated by expanding the definition of healthcare professional to include the likes of me—an engineer—and others who value nursing theory, education, and practice.
Bottom line, nurses should help redefine the term healthcare professional by developing partnerships with others who can shoulder some of the burden of improving the environment to return humanity to the normal healthy state that Florence Nightingale envisioned. I hope this call will be considered, both locally and globally—and that, here in the United States, The Future of Nursing 2020-2030, a project of the National Academy of Medicine, will help change the definition of healthcare professional. RNL
Daniel B. Oerther, PhD, PE, FAAN, ANEF, a lifetime honorary member of Sigma, describes himself as an American science diplomat, social entrepreneur, and professor of environmental health engineering (Missouri University of Science and Technology, Missouri S&T for short). Oerther regularly collaborates with nurses and promotes nursing theory, practice, and education as sources of inspiration for improvements in science, technology, engineering, and math (STEM).