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So What Do Nurses Do, Anyway?
Sean Clarke, N., PhD, FAAN
Professor, Susan E. French Chair in
Nursing Research and Director, McGill
Nursing Collaborative
Ingram School of Nursing, Faculty of
Medicine
McGill University
My Purposes Tonight
What I will try to avoid
… or a slick sales presentation …
… or an extended discussion of media images of nurses …
A few caveats
 A presentation for you, not a presentation for
nurses (I don’t necessarily speak for all 300K
members of our profession)
 I’m not going to mention every single kind of nurse
out in the world and might make some broad
statements
 I’m going to mention nurses’ work with other
disciplines/professions, but this is not about other
disciplines
I’m not implying that nurses are the only health care
workers to:
 Interact with patients
 Provide hands-on care
 Teach patients and families
 Coordinate care
 Advocate on behalf of their
patients’ wishes and the “big
picture”
Nurses
 Largest group of health care workers in most
industrialized countries
 First point of contact for most consumers of health
care services
 Pretty much anywhere health care is delivered,
you will find nurses
We could spend the whole hour just listing nursing’s different
specialties and practice areas
Bevel Up, National Film Board--2008
What do nurses do? A first answer …
 Providing support and information for patients and
their families
• That they probably would do for themselves if they had
the knowledge, skill and opportunity/circumstances
• Often around physical and mental health crises, life
transitions, and attempts to stay healthy
 Making sure the environment around clients is
physically, psychologically and clinically safe
 Carrying out treatment plans
 Monitoring/observing unfolding situations
Protection and Rescue
 Nurses protect patients from the risks and
consequences of illness, disability, and infirmity, as
well as from the risks of the treatment of illness.
They also protect patients from the risks that occur
when illness and vulnerability make it difficult,
impossible, or even lethal for patients to perform
the activities of daily living -- ordinary acts like
breathing, turning, going to the toilet, coughing, or
swallowing.
Suzanne Gordon, 2006
Suzanne Gordon, 2006
 “Even the most emotional work nurses do is a form
of rescue. When nurses construct a relationship
with patients or their families, they are rescuing
patients from social isolation, terror, or the stigma
of illness or helping family members cope with their
loved ones' illnesses.”
 “What do nurses do? They save lives, prevent
complications, prevent suffering, and save money.”
Nurses work everywhere in health care
 Clients from birth to old age and all ages in
between
 In settings where treatment is for a short-term
illness and in places where care is provided over
the longer term
 Working with individuals, families, groups, and
even communities
The profession is 150 years old. The
work has been done since the
beginning of time and will always be
needed.
What is regulation?
 Regulation (of a profession) is a set of limitations
on who is allowed to do certain kinds of work and
under what circumstances
 Self-regulation: occupational group entering into an
agreement with government to formally regulate
the activities of its members
 When is regulation needed?
• When public would be endangered by unqualified people
performing services
Some Distinctions
NOT ALWAYS/USUALLY REGULATED
 Nursing work
 Paid personal care
 Practical/vocational nursing
 Professional nursing
 Advanced practice nursing (specialized/high
stakes—nurse practitioners/clinical specialists)
REGULATED
332 794 Regulated Nursing Workers in Canada in 2011
Psych Nurses
2%
RPNs/LPNs
21%
RNs
77%
Fast Facts: Canadian RNs in 2011 (N=291,008)
93% were practicing nursing
And of these …
Mean age 45.3 yrs (12% under 30, 40% 50 and over)
6.6% male (10% in Québec)
8.6% internationally educated
59% full-time
61% hospital employed
86% in direct care
43% held baccalaureate or higher degrees
Source : CNA, 2013
High school
CEGEP
Nursing
DEC
Post-diploma
bachelor’s
completion
program
CEGEP
Health
sciences
DEC
CEGEP
Any DEC
Bachelor
of
Science
(Nursing)
Non-nursing
bachelor’s
degree
Master’s in nursing
PhD education
Master’s entry
nursing
programs
My personal career path
 Undergraduate education
 Clinical training and experience
 Research training
 Becoming an educator
 Advanced clinical training
 Advanced research training—health outcomes and
policy research
 Leading programs and research groups
 Today …
There is less and less such
a thing as a “typical
nurse.”
What is nursing? A loose description …
 Nursing is the health care discipline concerned
with the practicalities of delivering services.
 Nurses often work with clients over extended
periods of time or on a more continuous basis
relative to the involvement of other
workers/professionals.
And nursing science/research?
 Nursing science is the study of responses of
individuals, families and communities to health
related situations as well as their responses to
interventions made on their behalf, especially in
relation to assessments and interventions made by
nurses (independently or in collaboration with other
health professionals) and the organization of
nursing care
The “Nursing Process”
AKA the problem solving cycle, the scientific method
etc. etc.
 Gathering data
 Identifying problems and issues (potential ones,
actual ones)
 Planning and sequencing treatments
 Executing treatments
 Evaluating responses of patients and families to
care
 Revising plans of care
“Traditional” illness-oriented nursing tasks
 Administering medications
 Interviewing and examining patients
 Taking vital signs
 Looking after tubes, “lines” and drains
 Feeding and things connected with feeding
 Toileting
The “thinking work” of nursing—as important …
 Knowing the health status of each patient assigned
 Identifying complications as early as possible
 Teaching patients and families how to care for
themselves
 Referring patients to various services
 Overseeing nursing care provided by others
(volunteers, family members etc.)
Medicine used to be simple, ineffective,
and relatively safe. Now it is complex,
effective, and potentially dangerous.
Sir Cyril Chantler
Dean, London Guy’s Hospital
Lancet 355(1999), 1178-81.
In Wachter & Shojania, 2004
A 68-year-old woman is diagnosed with
thrombocytopenia due to acute lymphocytic
leukemia. She is admitted to the hospital.
Where should the patient be placed? In a …
 A) private room so she won’t infect other patients and
health care workers
 B) private room so she will not be infected by other
patients/health care workers
 C) semiprivate room so she will have stimulation during her
hospitalization
 D) semiprivate room so she will have the opportunity to
express her feelings about her illness
Nursing and Biological/Clinical/Social Science
 Nurses’ work is based on a scientific foundation,
but are educated in a different combination of
sciences and in different depths than other health
professions
• Understanding normal physical, psychological, and family
functioning, how the body responds to disease
• Understanding therapies in terms of expected responses
and risks
Science and nursing …
 The science foundation tends to focus on common
conditions, risk factors and presentations (not
necessarily the simple)
 Details that help implement safe care
 A basis for understanding what treatments may
become common in the future
 Once specialized, nurses often gain very
sophisticated understandings of conditions and
treatments
In disease-oriented settings … in collaboration with
physicians, pharmacists, rehab professionals etc.
 Implementing and adapting treatment plans
 Managing symptoms (pain, shortness of breath,
anxiety etc.)
 Managing emergencies (medical, behavioral)
 Helping patients recover function safely
 Helping patients and families live as well as
possible in the long term …
“Classic” Approach to Types of Work
Professions
Semiprofessions
Occupations/skilled
labour
Unskilled labour
Why might nursing not be a “classic” profession?
 Practical orientation of the work
 Varied educational backgrounds of members
 Mixed group involvement in activities, some of
which are highly skilled, other activities not
necessarily as skilled in an obvious way
Another approach to thinking about work
 Social needs and technologies create markets for
different kind of workers
 These needs and technologies change over time
 Different groups “claim” areas of work—
”entrepreneurs” (branching out) and defense of
territory by the traditional holders …
Originally part of medical practice
 Taking blood pressures
 Use of the stethoscope
 Drawing blood
Originally part of nursing
 Respiratory therapy
 Dietetics/nutritional therapy
 Physical therapy
 Occupational therapy
 Hospital-based social work
Back to what nurses do …
 Using a scientific background …
 In collaboration with other professionals/workers …
 Building a relationship of some variety with the
patient/family and/or working from one …
 Helping patients make the most of their potential
for being healthy—including finding health within
illness …
… In the critical care unit …
The medical-surgical floor …
… The Emergency Department …
On the street …
Bevel Up (NFB, 2008)
In the home …
A concrete example of nursing practice
around a specific practice area
 Pressure ulcers (also known as bedsores)
 Protecting patients from the hazards of health care
 Assessment
 Implementing treatment
 Support of patients through long and unpredictable
courses
A bit of question and answer …
 Not quite FAQs but …
Is there a nursing shortage?
 AKA “If someone becomes a nurse, are they




guaranteed a job?”
The answer: It depends where and when we’re
talking about and also in what specialty …
The prospects are bright …
Lots of retirements coming …
Nurses will play a big role in the future of health
care
 Roles, specialties, settings, locations will likely
change in the next years …
 Opportunities will be there but they might be
different than where nurses have worked in the
past.
 What the opportunities will have in common:
science base, ability to relate to people and work
on teams, and a commitment to help people and
communities become/stay healthy
Do doctors and nurses get along?
 Yes. Extremely well in the majority of cases. Both
nurses and physicians normally learn extremely
quickly how complementary their roles are.
 Drama is mostly the territory of soap operas …
 But there are circumstances when things don’t go
as well (and life can get bad on both sides) … but
problems also arise between nurses, between
physicians …. and patients/families and health
workers/professionals
Why become a nurse?
 If interested in people and in serving society—
common to all the health professions
 Employment and advancement opportunities—
especially for the entrepreneurial and those who
work hard and think “differently”
 Opportunities to flex and grow the kinds of
intellectual and interpersonal skills nurses use
What to expect if you become a nurse…
 Interesting and varied reactions from friends and
family …
 A transition from being a “layperson” to being a
“health professions student” and then to being a
new graduate—sometimes bumpy—common to all
health professions
 The early part of most university nursing education
is sometimes more disorienting because it’s very
theoretical and angles away from technical
practice that may be what drew you into nursing
… but it gets better …
To conclude
 Nursing is a health profession focused on the
practicalities of bringing care to the public
 It and the other health professions are evolving
and so is the health care system
 Like the other health professions, it demands a
combination of self-knowledge, scientific
knowledge and practical know-how
 Consumers of health care and other health care
workers need to understand how the professions
come together to provide care
And finally …
 Nurses help individuals, families and communities
become as well as possible, and work with other
health care worker groups to make sure clients get
the best possible outcomes from the health care
system and avoid the risks of treatment
 For those with the right interests and talents, who
can be optimistic and realistic at the same time,
and who can tolerate fuzziness (in roles, in
outcomes), the nursing profession can draw forth
their best—it’s worth some thought