Nurse can play role of medical expert, supportive friend and assertive coach

On the frontlines at medical centers, doctors’ offices, hospitals and emergency rooms across the country, a nurse is usually the first person to see you and the one who sends you home.

“Itrust my nurses before anyone else.”

That’s Donald Czerna’s take on health care after dealing with complications from diabetes for the past several years.

“I like my doctor but he is busy,” says the 68-year-old retired electrician, who recently moved to Las Vegas from Joliet. “My nurses are the ones who talk to me. They give me ideas and help me with new ways to take care of myself.”

“They’re the ones who tell you that you keep screwing up,” yells Czerna’s wife Barbara in the background. “They’re the ones who know when you’re lying.”

Czerna agrees. “Look, I never had good habits. Bad eating, smoking, lots of time standing or kneeling in one place with my hands on wires,” he says. “It’s not going to change overnight but I try. They help me. They tell me what’s good, what’s bad.”

Czerna’s take on nurses is common. On the frontlines at medical centers, doctors’ offices, hospitals and emergency rooms across the country, a nurse is usually the first person to see you and the one who sends you home.

In and out

“We used to joke that we were ‘gown to town,’” says Harriet Fischer, a 72-yearold retired nurse who lives in Naperville, Ill.. “They come in with some problem, we put them in the gown, take their vitals, brief the doc on what’s happening and then when they’re released, we take some information and send them back out for a night on the town.”

Fischer worked at several hospitals in the Chicagoland area, including Good Samaritan in Downers Grove, St. Joseph in Joliet and Rush-Presbyterian in Chicago. “I know the names are all different now but that’s what I called them,” she says. “Everywhere I worked, I was important. I didn’t think so much maybe back then—OK, maybe I did—but in the ER, where I usually worked, you do a little of everything. You never get a break.”

Valued opinion

Fischer says she knows that the doctors she worked with respected her and her knowledge of her patients, but that didn’t mean she had the authority to make a case for a patient if she disagreed with the treatment. “Nurses are so important but not everyone wants to hear what they have to say,” Fischer says. “I never had a lot of problems but I always wished I had a little more pull, a little more weight. When I worked at a private practice, I felt like an outside sometimes. The doctor would lay down the law and that would be it. If I said anything, I’d get shot a look or I’d hear it from the patient.”

Some nurses who feel similarly to Fischer finally may be seeing that “pull” increasing, as nurses are being utilized for more input into their patients’ care before they get sick.

“There is an increasing focus on paying attention to the factors that keep people healthy in the first place, including people’s education level, employment status, how much stress they are living with, whether they have access to healthy food and whether they have the transportation to get to health care appointments, rather than simply seeing people when they show up at the emergency department and are readmitted again and again to the hospital,” according to Susan Hassmiller, PhD, RN, FAAN and senior adviser for nursing at the Robert Wood Johnson Foundation in a story on the future of nursing earlier this year in Medscape, a medical news journal.

Active role

Fischer says any step in increasing the perceived value of nurses is a step in the right direction. “Nurses aren’t doctors but they see things that doctors don’t always see,” she says. “I’m not talking about specific surgical knowledge—nothing like that—I’m talking about a patient’s mood, their attitude, their family. If you tell a patient to follow a rigorous program at home with no outside support, a nurse can tell you if it’s going to work or not. A nurse will stop you and say ‘This guy isn’t going to work on it at home. He needs to check in once a week.’ Simple things like that. They make a big difference.”

They certainly did for Czerna, who was diagnosed with Type 2 diabetes in 2011. “I admit I don’t listen to my wife when she tells me to take a walk or to not eat so much bread,” he says. “We’ve been married 44 years. She says I lot of things I don’t hear and I say a lot of things she doesn’t hear.”

But his nurses? “Oh, I listen,” he says. “They tell me I remind them of their father, that I’m stubborn. But they have power. They make me a little afraid sometimes.”

“Not afraid enough to lose weight,” yells his wife from the background again.

“See? She say something?” says Czerna. “My wife says things but I don’t hear.”