Top nurses

Some U.S. city magazines start to notice nurses

In recent years some monthly city magazines, long known for their annual “top docs” features, have included features on “top nurses.” Some simply add advanced practice nurses to the physician listings, while others have recognized nurses more generally.

August 2015 – Recently some U.S. city magazines have run annual “top nurses” features, either on their own or as part of “top doctors” pieces, in which the nursing element tends to be limited to advanced practice nurses. In December 2014, Madison Magazine (Wisconsin), along with local television station WISC-TV3, published a very extensive feature called “Madison’s Top Nurses 2014.” Most of that one was seven very long Q&A profiles of nurses selected from nominations by the local health care community. The profiled nurses ranged from a nurse scientist to clinical leaders to community health nurses. The piece also included Jenny Seifert’s very long and generally strong report on the state of U.S. nursing. That report focused on recent developments and, of course, on Wisconsin. Overall, the feature did a lot to debunk the idea that nurses are just nice hand-holders. The magazine had had “top nurses” features in past years, but it sounds like they were not as focused on that goal. In May 2015, Baltimore Magazine ran its first annual “Top Nurses” feature. The Baltimore item included a long piece by Christina Breda Antoniades about the state of nursing, with a focus on Baltimore. There were also seven shorter Q&A profiles of selected nurses and a full list of the 50 winners grouped by specialty. And this month, Seattle Met magazine published its annual list of “Top Doctors and Nurses,” which seems to have had advanced practice nurses since at least 2013. This feature focuses mainly on providing a searchable database of practitioners for health care consumers. Although that database consists overwhelmingly of physicians, it also has small numbers of APRNs and physician’s assistants. Portland Monthly, an Oregon magazine published by the same company as Seattle Met, ran a similar “Top Doctors and Nurses” feature, with matching database, in January 2015. On the whole, the advent of these magazine features is helpful. Some of the “state of nursing” ones could be read to suggest that nurses today are impressive, but past nurses were just low-skilled order-takers. Still, all the pieces manage to convey that nurses are skilled and critical to modern health care.

Nice people who know a few tricks (Madison)

Nurses can do anything (Baltimore)

Top nurses and doctors (Seattle)

Nice people who know a few tricks

The “Madison’s Top Nurses 2014” feature from December 2014 is massive, with very long Q&A profiles of the selected nurses and Jenny Seifert’s detailed report on nursing today. The introduction to the profiles says that past features by Madison Magazine and WISC-TV3 have highlighted “nurses who have touched the lives of patients in meaningful ways.” But this year the media entities chose to “focus on nurses as the key players they’ve become as health care evolves and becomes more complex to meet changing and growing demands.” Of course, nurses did not just become key players last year. To find area nurses “making a difference in three key areas—practice, leadership and innovation,” the magazine says it consulted “nurses, doctors, administrators and others.” The resulting portrait of “modern nursing” ranges “from behind-the-scenes organization and research to in-the-field practice reaching sensitive or underserved populations, from being a voice for patients to connecting them to valuable resources.”

The Q&As have some common themes. Many include questions about the specifics of the nurses’ practice, what the nurses like most about it, what the biggest challenges are, and how nursing has changed. Unfortunately, another common theme of the online Q&As is failing to include the profiled nurses’ names, except for the first nurse. They do, at least, include credentials, job titles, and employers. That first nurse is identified as “Cynthia Phelan, Ph.D., RN, Nurse Scientist, William S. Middleton Memorial VA Hospital.” Those identifiers highlight nurses’ health expertise. Phelan mentions her “four-year grant to conduct a study related to sleep and memory,” “testing whether brain activity during sleep can help identify brain changes in individuals with early Alzheimer’s disease.” And she notes that one project she is especially proud of is creating an advance care planning clinic for veterans. Unfortunately, she also suggests that before nursing developed “its own science” and the complexity of modern care called for more teamwork, nurses were very dependent on physicians “to direct their care.” At best, that’s a risky comment without additional explanation; at worst, it’s inaccurate and damaging. In fact, nursing has long been an autonomous profession with its own leaders and scope of practice, not a subset of medicine. Does Phelan think the nurses who preceded her were just following physician commands? They were not. In any case, she rightly emphasizes that her job requires “a love of learning, persistence and the ability to see connections that others may not.”

The other profiled nurses are diverse. An outreach nurse is identified as a “Helping Educate and Link the Homeless, or HEALTH, nurse” for Meriter-UnityPoint Health. This nurse’s work involves educating homeless patients and linking them to primary care and community resources. The nurse describes one patient with terminal lung cancer who the nurse helped to get into a hospice, so he was able to die off the street, with friends and dignity. Two sexual assault forensic nurses do at least get surnames, Baisa and Curran, since the piece must identify their separate comments. Baisa says they are nurses with “advanced education and instruction in medical-forensic examination and in psychological and emotional trauma” who provide forensic exams and educate others, including law enforcement. A cardiopulmonary transplant coordinator at the University of Wisconsin Hospital explains that he works with patients “from referral to evaluation and transplantation [and] follows them for life.” (The interviewer discloses this nurse’s gender in describing his nominations to be included.) A pediatric nurse practitioner at American Family Children’s Hospital notes that the nurse “manage[s] the George Fait Pediatric Specialty Clinics, as well as hav[ing] managerial responsibilities at the Waisman Center Clinics across the street from the Children’s Hospital,” which altogether involves managing 82 staff members. And an advanced practice parish nurse for St. Mary’s Hospital describes some of that nurse’s holistic work in the faith community, which includes low-income residents with a range of serious health issues. The nurse’s roles include “integrator of health and healing, health advocate, health educator, personal health counselor, facilitator and developer of support groups, referral agent and liaison, developer and trainer of volunteers.” The nurse describes being “gratified to see the [recent] emphasis on preventive health care, which community and public health nurses like myself have been advocating for years.”

The Madison Magazine feature also includes a long piece by Jenny Seifert about the state of U.S. nursing. Seifert begins with the standard factoid that nurses have long topped the Gallup poll as “most trusted profession”—actually the poll measures “ethics and honesty”—but she rightly notes that despite this “likeability,” nursing is often misunderstood. She quotes nurse Joan Ellis Beglinger, who had a long career in “administrative leadership” at St. Mary’s Hospital, as saying that the public doesn’t generally see nurses as “knowledge workers.” University of Wisconsin–Madison nursing dean Katharyn May confirms that people tend to see nurses as “nice people who know a few tricks,” although nurses are actually healers using science to “improve[] the human condition.” Seifert says there is “a call to make more space at the table for nurses” in the era of the Affordable Care Act (Obamacare), which has a preventive and educational focus that nurses share. The piece suggests that we are moving toward “shared governance structures in health care, where nurses work as both autonomous professionals and as equal partners in team-based environments,” a stark contrast to the old days when a nurse “was expected to give up her seat for a physician in a meeting.” That means nurses resemble navigators, giving patients the tools they need to “manage their own health care outcomes.” The piece notes that those shifts are also increasing demand for advanced practices nurses (APRNs), nurses with masters or PhD degrees who include nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists. The piece discusses the landmark 2010 Institute of Medicine (IOM) report about the importance of increasing the role and authority of nurses. Wisconsin is one of 31 states, however, that restrict APRNs from practicing independently of physicians “as they have been trained” to do. Judith Hansen, executive director of the Wisconsin Center for Nursing, says another priority is to advance nursing education, in line with the IOM report’s call for 80% of nurses to have BSN degrees by 2020 because “research shows the more educated the nurse, the better the health outcomes.” Other key issues include addressing shortages of nurses, as health reform and aging Baby Boomers increase demand, and promoting diversity in the profession, since research shows that improves access to care, adherence to treatment, and patient satisfaction.

The piece’s Q&A profiles highlight the autonomous work and health perspectives of well-educated nurses in a range of settings, except, curiously, traditional bedside nursing. That gap could lead some readers to think that the profiled nurses are some elite new supergroup, but bedside nurses are still just nice people who know a few tricks. The nurses’ responses are not generally technical—unless you count the use of jargon like “stakeholders”—but they do convey authority and knowledge. Unfortunately, when interviewees are asked what qualities nurses need, there is virtually no mention of intellect or skill. There is lots about compassion and patience, the standard “angel” qualities, even from nurses with graduate degrees who hold positions of authority. The “state of nursing” piece by Seifert shows that nurses are skilled clinical leaders. And that is especially true of the parts about the role nurses should play in health reform and about the importance of nursing education. We especially liked the focus on the gap between the reality of nursing and public understanding of it. Not everything in this feature is helpful, and despite its great length there are omissions, like an explanation of how bedside nurses save lives every day. But the piece still has plenty to admire.

Nurses can do anything

The May 2015 Baltimore Magazine feature is also huge, with many profiles of accomplished nurses and a strong piece on the state of nursing. Unfortunately, it too could leave some with the impression that nurses are amazing today, unlike in the past when they were just hospital-bound drudges. An introductory section edited by Ken Iglehart describes the process by which the magazine selected the region’s “top 50” nurses. Nurses were nominated in 18 specialties by “peers, supervisors, and patients.” Then a panel of advisors recruited by the Maryland Nurses Association (MNA) and major local hospitals made final selections. Six of the eight panel members were MNA executives or chief nursing officers at those hospitals. So it seems like they recruited an expert panel in the same way that Dick Cheney recruited a vice presidential candidate. In any case, the magazine thanks the highly experienced panel by including profiles of them as well. These convey a few helpful things about nursing. For example, we learn that Lisa Rowen is “chief nursing officer at the University of Maryland Medical Center, overseeing 5,000 nurses and other health professionals,” as well as an associate professor at the university’s School of Nursing. In addition, MNA president-elect Kathleen T. Ogle is the interim chair for the department of nursing at Towson University and “maintains a practice as a family nurse practitioner.”

Like the Madison piece, this one includes seven Q&A profiles. But these are so short that it’s hard for them to convey much of value to nursing beyond the diversity of the profession. Rebecca Dickinson, a nurse team leader at Mt. Washington Pediatric Hospital’s Center for Pediatric and Adolescent Rehabilitation, says the most important thing in working with children is “patience[,] since you have to address the child’s fears, their family’s concerns, and procedures could take longer to make sure they are as pain-free as possible.” That at least suggests nurses play a key role in patient relations. Cervical-cancer screening coordinator Lynn Richards-McDonald of the Johns Hopkins Hospital notes that the most important quality for a nurse is advocacy, explaining that she sees underserved women and her greatest challenge is getting resources for her program. Kimberly Bowen of Sinai Hospital mentions “saving lives” and “relieving pain” as two of the best things about the job. But we don’t hear many specifics about how that happens in the profiles. And overall, the comments about nursing focus more on things like patience, sincerity, and heart—qualities many lay people have—than on nursing skill.

The actual list of the 50 nurses also shows the diversity of nursing practice. And some of the nurses’ titles suggest authority and expertise. Nurses recognized include NP Cathy Chapman, who seems to have her own practice; Carol Hay, a Gilchrist Hospice Care case manager; Carol Esche, a “clinical nurse specialist / evidence-based practice and research educator” at MedStar Franklin Square Medical Center; Erin Pollitt, forensic nurse examiner at Mercy Medical Center; Megan Jendrossek, “acute neurocare” nurse at the University of Maryland Medical Center; Jeanne Charleston, director of clinical research operations at Johns Hopkins; Rebecca Dunlop, associate director of the Parkinson’s Disease and Movement Disorders Center at Hopkins; Lisa Ashton, mental-health NP at Mosaic Community Services; Nicole Henninger, ICU nurse manager at Medstar Franklin Square; Vicky Kent, clinical associate professor at Towson University; Calvert Moore, “school health resource coordinator, education specialist” at Medstar Harbor Hospital; and Marla Newmark, lactation coordinator at Greater Baltimore Medical Center. It might have been helpful to include the nurses’ educational credentials.

The accompanying article by Christina Breda Antoniades is “Florence Nightingale Would Be Proud: For today’s nurses, it’s about new roles and increased responsibilities.” That nicely conveys the piece’s main theme, although it can also be read to denigrate nurses of the past, who were not just fluffing pillows. Again, today’s nurses are not some suddenly impressive thing, but part of a long tradition of nursing science. The piece does provide some helpful information about recent changes. Hospital nurses, it notes, are now “performing more complex tasks with higher-tech tools than ever before and collaborating in new ways across countless disciplines.” And “you’ll also find nurses outside the hospital walls, heading to patients’ homes to offer care or wellness education, assisting in procedures at outpatient centers, or even providing primary care in doctor’s offices and urgent-care clinics.” MNA president Janice Hoffman says the “biggest change is where nurses work.” The piece attributes that change to factors including “reduced hospital stays for patients driven by changes in insurance coverage and cost-cutting motives, as well as enhanced technologies and practices that have allowed surgeries and procedures to move from the hospital to outpatient centers,” increased insurance coverage under the Affordable Care Act, and longer life spans accompanied by “chronic health conditions likes diabetes, heart disease, and obesity.” The article notes that Johns Hopkins Hospital helps patients manage chronic conditions and stay well. It quotes “vice president for nursing and patient care services” Karen Haller as saying home care nurses “assess how patients are progressing, to make sure the patients are able to follow up on their discharge plans, that they can get their prescriptions filled, and that their side-effects are well managed.” APRNs are playing an increasing role and the piece briefly explains their focus on community and preventive care. Unfortunately, the article also refers to NPs’ work as addressing “basic problems” of patients with “minor, acute, and stable chronic illnesses,” an unfortunately common misconception. APRNs are adept at diagnosing and managing complex conditions as well. Maggie Richard, “director of professional practice, research, and education” at LifeBridge Health’s Sinai Hospital, suggests that the last few decades have seen a big increase in the depth and complexity of the nursing knowledge base. All of this points to continued nursing shortages. The piece quotes Kathleen Ogle as saying that the profession wants to grow, but not at the expense of quality, because “nursing is consistently named as the most admired profession, and we want to remain that way.” Once again, nursing is rated highest for “ethics and honesty,” which is not the same as being “most admired.” Anyway, Ogle rightly notes that the field is diverse, with many opportunities: “Nurses can do anything.”

Top Doctors and Nurses

This month Seattle Met published a paper copy feature and a searchable online database of “Top Doctors and Nurses.” Seattle Met has run this type of feature with APRNs included since at least 2013. In past years, the magazine seems to have included prose pieces at least somewhat like the Madison and Baltimore articles. But this year it appears to have been just the database of practitioners, who number 1,065. A short note by Ariana Dawes and Darren Davis says that the magazine compiled the list through a survey of more than 1,500 “doctors, physician assistants, and nurses.” It received more than 11,000 nominations “based on years of experience, competency within his or her specialty, rapport with patients, patient satisfaction and compliance with care recommendations, and ability to work effectively with colleagues across specialties.” Those listed appear alphabetically by specialty. A look through suggests that they are overwhelmingly physicians. But there are a few physician’s assistants and APRNs, including those specializing in pediatrics, family care, geriatric care, and midwifery. Listings basically look like this:

Top Nurse
Amy Nicole Adkins-Dwivedi
Stepping Stone Pediatrics

15650 NE 24th St Ste C1
Bellevue, WA 98008
425-941-9540

Specialties:
Pediatric Nurse Practitioners
Accepting new patients:Yes
View website

Top Doctor
Rosemary Agostini
Group Health

11511 NE 10th St
Bellevue, WA 98004
425-502-3600

Specialties:
Sports Medicine (Nonsurgical)
Accepting new patients:Yes
View website

In January 2015, a very similar feature appeared in Portland Monthly, an Oregon magazine published by SagaCity Media, the same company that puts out Seattle Met. That “Top Doctors and Nurses 2015” feature was reportedly based on a survey that tallied almost 14,000 votes and resulted in a listing of about 790 practitioners. There was also an accompanying feature article credited to Ramona DeNies and Marty Patail; that does not seem to be available online now. But the searchable database is, and as with the Seattle feature, the vast majority of those listed are physicians, although there are also a substantial number APRNs and “naturopaths.” 

Features like these convey that APRNs are qualified practitioners in a number of specialties, and that is a step forward, even if specifics about what nurses do are limited. Like traditional “top doctors” features, these lists and databases function as advertising. Of course, the novelty that is evident in the accompanying reportage about nurses may not be something that the magazines will be interested in returning to every year. And that applies even more strongly to features like those in Baltimore and Madison, which don’t really seem much like advertising at all. Other publications, including the New York Times, have published annual “tribute to nurses” supplements that seem to have been sustained by advertising from those targeting nurses themselves, especially employers. Those supplements have tended to emphasize angel imagery. In any case, whether these more recent “top nurses” features are sustainable year-to-year or not, the attention they draw to nursing skill and authority is welcome. We thank those responsible.

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