Written by Fiona MacDonald
Illustrated by David Antram
Series created by David Salariya
The Salariya Book Company
Nursing rating: 3 stars
Overall rating: 2 1/2 stars
Just as important as physicians
2017 U.K. picture book gives kids a strong introduction to nursing
You Wouldn’t Want to Live Without Nurses features lots of useful, substantive information about the history, diversity, and modern practice of nursing, without much stereotyping. The book doesn’t fully convey nursing autonomy or the value of nurse practitioners, and kids may find it more informative than compelling. But it’s probably the best children’s book about nursing that we’ve seen so far.
Did you know that nurses “speak up” for those who can’t? That modern health technologies are “only as good as the expert nurses who work with them”? And that “nurses are just as important as doctors”? Well, maybe you did, but it’s not clear how many kids will unless they read the 2017 U.K. book You Wouldn’t Want to Live Without Nurses. It is probably the best children’s book for nursing that we have seen. And it stands in contrast to most of the media created for kids, which sends the message that only physicians really matter in health care. Part of a series of picture books aimed mainly at those aged 8-12, this book provides a wealth of mostly on-target information to show young readers that nurses are skilled, life-saving professionals. Topics include how nursing has changed over time, the role of technology, the diversity of nursing practice, and the work of nursing pioneers. The book also highlights nursing’s focus on “observation and communication,” including how nurses explain treatments “in ways we can understand.” Not every element of the book is ideal. The historical focus does come with old-timey uniforms, which won’t do much to persuade youngsters that nursing is a real modern profession. There are a few touches of “comfort”-oriented angel imagery. The book never quite says nursing is a distinct, autonomous profession; readers could still come away thinking physicians direct it. The treatment of nurse practitioners (NPs) is inadequate. On the one hand, the book calls them “super-nurses”—implying that other nurses are not super. Yet it also suggests NPs treat only minor, common illnesses, when in fact they also treat serious, chronic conditions. And the book’s structure, offering a series of nursing topics rather than a linear narrative packed with fun, poses little risk of undue excitement for its main audience. Still, on balance the book gives young readers an excellent introduction to nursing.
This book is one of a series of “You Wouldn’t Want to Live Without…” titles that seem to be aimed at teaching kids the value of unlikely things (including “Bacteria,” “Bees,” “Dirt,” “Money,” “Glass,” “Soap,” and “Vegetables”). Not many of the topics are human beings; the only group we saw besides nurses was “Dentists.” The book consists of a series of distinct sections about sub-topics, from a “Nurses Timeline” section before the title page straight to the end of the book, where even the back cover has a few key historical facts, on subjects ranging from Florence Nightingale to nurse practitioners. These all come with multiple illustrations and busy groups of sub-features.
There are many helpful elements. Before the title page, we get a “Nurses Timeline” starting in the three millennia BCE, when mostly male priests in Egypt, India, and Greece “treat patients in temples,” through 19th Century reformers like Florence Nightingale and Clara Barton, to the much- admired work of nurses in the world wars of the 20th Century, and to 2015, when there are more than 20 million “trained” nurses worldwide, most of them still female. And the back cover advises, “Although they don’t get the glory, nurses are just as important as doctors.”
Specific sections offer a variety of generally good bits. One section explains that school nurses are trained to assess and treat you—mentioning cuts, broken bones, and lice—as well as to advise on nutrition and medications. But it does not mention the serious chronic conditions school nurses manage today.
A career section notes that there are more than 200 nursing specialties and that nursing requires more than just “caring.” In fact, it reportedly takes the “six C’s” that nurses supposedly “often” say they need: care, compassion, competence, communication, courage, commitment. At least a checklist also includes “hardworking,” “intelligent,” and “a good team player.”
A section on “observation and communication” says that nurses listen to patients, explain treatments so they can understand them, and “speak up” for patients who can’t, indicating a focus on advocacy and psychosocial care. The book says nurses’ “healing hands” are not just comforting, but checking for illness. Yet it also says physicians “rely” on nurses to observe and record vital signs signaling nurses’ vital role in monitoring patients.
Another section explains that nurses confront stressful mass casualty situations, from wars to epidemics: “Hundreds of lives may depend on their actions. They are highly trained professionals, and many are amazing heroes.” A section on technology highlights nurses’ use of “the latest electronics to diagnose illnesses and injuries and perform lifesaving tasks, from keeping patients’ hearts beating to feeding tiny babies and delivering precise doses of powerful medicines and painkillers.” These machines are “only as good as the expert nurses who work with them.”
Another section describes nurses’ work in community settings, including in educating at-risk groups. Nurses also “run drop-in centers to treat minor illnesses and injuries.” And a “Did You Know?” section offers facts and statistics, including that polls show nurses to be the “most trusted professionals.” (Actually, polls show that people believe nurses to be ethical and honest, which differs from trusting nurses with their lives.) The section also notes that nurses are unevenly distributed; developed nations have many times more nurses than developing ones do. And a glossary near the end includes terms such as “anatomy,” “bacteria,” “intensive care” (defined by “special equipment and nursing staff”), “physiology,” “professional,” and “stethoscope.” It also includes the “six C’s.”
There is a lot of history. That lets readers know that nursing is a substantial profession that has evolved over time. On the other hand, the historical focus does include a lot of those antiquated, highly gendered uniforms. And it takes up space that could have been devoted to more detailed discussions of nurses’ roles in public health, advanced practice, and other areas. The book repeatedly explains how little was known long ago about curing illness or even caring safely for patients, and that early hospitals were dirty, dangerous places. In the 19th Century, “brave, determined reformers” like Florence Nightingale began to train professional nurses and try to keep hospitals clean. The book shows how much of early nursing was rooted in war, suggesting that American Red Cross founder Clara Barton and prison reformer Dorothea Dix were “battlefield angels.” It says that nurses impressed the public by facing death, not only in the Crimean War and the U.S. Civil War, but also in the two World Wars of the 20th Century. The main wartime section is titled “Daring to Care,” perhaps a sly reference to the Johnson & Johnson public relations campaign for nursing. In addition to toughness, the section emphasizes the “expert” skills modern military nurses must have, including in emergency and critical care.
A section called “Nursing Past, Present, and Future” traces how nursing has changed, from the distant past when nurses could “comfort” but not cure, to the present when they supposedly have “new” duties like tech-aided monitoring, to the future when nurses “won’t just care or cure, they will also work to prevent illness from happening.” But nursing has always featured careful surveillance and preventive care; maybe the book is confusing new technologies and programs with core professional functions. The last bit of the section, “super-nurses,” says that in recent decades “highly trained nurse practitioners have taken over some of the tasks that doctors used to do,” noting that NPs are “trained to diagnose (identify) many common diseases.”
And a section near the end gives brief profiles of six “nursing heroes.” They include Elizabeth Fry, who set up a small nursing school in London in 1840, before Nightingale; Lillian Wald, who pioneered public health nursing in late 19thCentury New York, including wellness checkups and other holistic efforts; Mary Breckinridge, the Kentucky nurse-midwife who established the Frontier Nursing Service in 1925; and Hazel Johnson-Brown, the chief of the U.S. Army Nursing Corps who in 1979 became first African-American to reach the rank of brigadier-general.
There are some problems. Although the book is admirably substantive overall, there are some angel overtones. Those include the “battlefield angels” bit, and a description of hospital nurses as “so kind, so patient, so caring.” In addition, although the “six C’s” are all important qualities for nurses to have, at least half of them are vague helping qualities that do not require advanced skills. And presenting the group of them together with the cute “C’s” label, as if they were a formal cornerstone of the nursing profession, may not impress the book’s more sophisticated readers.
The book never directly suggests that physicians train or supervise nurses, which should imply to attentive readers that nurses are autonomous and that they created and continue to manage their own profession. But couldn’t the book just say that, or at least mention the nursing academics and clinical managers who have long led the profession? Without anything about them, readers could go away with their media-fueled preconceptions that nurses report to physicians intact. The passing note that physicians “rely” on nurses does not help; we could as easily say that nurses “rely” on physicians.
Finally, there are the “highly trained” “super-nurses,” a way to describe nurse practitioners that is obviously complimentary but does a disservice to other nurses. Other descriptions do a disservice to NPs, who don’t just diagnose “common” diseases and do things physicians used to do. They diagnose diseases just as other general practitioners do. Research has shown NP care to be at least as effective as physician care in a wide variety of settings. And NPs are not just doing things physicians have left behind. Their role overlaps significantly with that of today’s primary care physicians. At the same time, NPs also follow well-established nursing approaches, with a focus on preventive and psychosocial care.
Many kids may find this book more informative than compelling. It doesn’t follow any discernable narrative trajectory, but instead offers a series of features about different, sometimes overlapping aspects of nursing. The lack of major characters with whom readers might identify, along with the heavy emphasis on history and not much emphasis on fun, may add to this effect.
Still, on the whole the book is a step forward not just for children’s books, but for all media about nursing that is aimed at the young, which has a long tradition of stereotyping nurses as kind but low-skilled physician helpers. This book strongly counters that damaging misconception.