New York Times ably describes PTSD in nursing but fails to identify expert as nurse
A Times article did a fine job of explaining that nurses have high rates of PTSD and burnout. That’s because nursing is so stressful, given the frequent life-and-death events and the high incidence of abuse. But the piece was marred by its failure to say that the main scholar on which it relied was a nurse! Instead, it referred to her four times as “Dr.” and noted that she was a professor at a university’s “medical campus.”
May 7, 2019 – Today the New York Times had a generally good article by Emilie Le Beau Lucchesi about the high rate of post-traumatic stress disorder (PTSD) among nurses. The frame for the piece was the experience of Dorothy Still, a U.S. Navy nurse who was a prisoner of the Japanese military in the Philippines for more than three years during World War II. Still later displayed symptoms of PTSD, but she got abuse, not support, from a Navy psychiatrist. The piece describes the progress made since then, as well as the prevalence of PTSD among today’s nurses—as many as 28% experience it. The item relies heavily on expert comment by Meredith Mealer, “an associate professor at the Anschutz Medical Campus at the University of Colorado, Denver.” “Dr. Mealer” emphasizes that practicing nurses experience many potential triggers for PTSD, from life and death events to abuse from patients and families. Mealer discusses her own research into resilience strategies to help nurses cope with these stressors. The report also relies on Cheryl Peterson, “vice president of nursing programs for the American Nurses Association” (ANA), who notes that nurses still do not get very good treatment for PTSD and that it can drive them from the bedside. The article describes other research showing the high rates of burnout and PTSD in nursing. So what’s the problem? The piece never says that Mealer is a nurse. And since what it does say is that “Dr. Mealer” is a professor at a “medical campus,” many readers will assume she is a physician; it is not widely understood that nurses get doctorates or become university scholars. In fact, Mealer is an RN, PhD. We recognize that not all nurse PhDs actively seek to be identified as nurses, presumably believing the doctorate by itself will command more respect. However, that approach not only robs the nursing profession of credit for the expertise of its members, it can also reinforce the stereotype that physicians direct the profession—damaging misinformation that is still regularly conveyed on almost every Hollywood hospital show. We urge media creators and nurses to make sure that all nurse leaders and scholars, especially those referred to as “Dr.”, are clearly identified as a “nurse” or an “RN, PhD.” And please see our new FAQ on this topic!
Nurses see people die
The piece is “For Nurses, Trauma Can Come with the Job.” It starts by describing Dorothy Still’s wartime experience. As one of 12 Navy nurses held as Japanese prisoners of war in the Philippines, she spent more than three years giving “care to diseased, starving and destitute civilian inmates in a makeshift infirmary at the P.O.W. camp.” After the war ended, Still experienced episodes of crying that were hard to control. But at a 1945 meeting, a Navy psychiatrist reportedly “offered no support or solutions. Instead, he called her a ‘fake’ and a ‘liar.’ Nurses, he claimed, could not suffer the kind of shell shock from war that sailors or soldiers could.” At the end of the piece, after a general discussion of PTSD among current nurses, the piece comes back to Still. She received an honorable discharge, married a naval officer, had kids, and eventually returned to practicing nursing. Although she said little about her wartime experiences for decades, eventually she opened up to historians. And she was ultimately buried with honors at Arlington National Cemetery.
The main part of the piece addresses the current role of PTSD in nursing. The report explains that mental health experts now recognize that nurses can suffer from it, and Meredith Mealer says as many as 28% of them experience it at some stage of their nursing careers. Mealer notes, however, that while treatment is better than it was for Still, “we still have a ways to go.” The piece explains that PTSD is basically defined as intrusive symptoms like nightmares or overwhelming feelings of stress that can arise after exposure to a traumatic event, often involving death, injury, or sexual violence. Mealer explains the triggers that apply to nursing:
Nurses see people die. They work on resuscitating patients. They try to control bleeding. They have end-of-life discussions. And sometimes they are verbally or physically abused by patients or visiting family members.
Cheryl Peterson of ANA agrees that nursing involves many potentially distressing elements.
A nurse who is in the military, or a nurse caring for trafficked individuals. Nurses who are in trauma. Nurses who are in psychiatric care. Nurses caring for opioid addictions. Any one of these individuals has the potential to suffer from burnout or PTSD. … We know PTSD is present, and it drives nurses away from the bedside. We don’t treat nurses very well, and the work environment is very challenging.
Mealer explains that PTSD is distinct from “burnout,” which generally means (in the piece’s words) “the emotional exhaustion, depersonalization and feelings of low sense of accomplishment that can arise from overwork and lack of regard.” The article cites a study in the Journal of Heart and Lung Transplantation finding that up to 48% of nurses in a critical care transplant unit “met the criteria for PTSD symptoms, includ[ing] upsetting dreams about a traumatic event, difficulty falling asleep, irritability or outbursts of anger, and upsetting memories about the event that arose against the person’s will.” High rates of burnout and PTSD in U.S. nursing do likely contribute to high turnover rates, which vary by region but range from 13 to 21 percent, the report notes. And it says that physicians and other health professionals also suffer from relatively high rates of PTSD and burnout. Finally, while treatment for these problems could be better, Mealer “is studying resilience in nurses and said preliminary research is finding that psychological characteristics associated with resilience, such as humor, optimism and social support, can be taught to help nurses cope with the stresses of the job.”
This piece has many good elements. It conveys powerful information about how difficult the practice of nursing is. Yet there is no suggestion that nurses should or do just put up with it because they are virtuous angels, which is another damaging stereotype. Instead, there are specific descriptions of stressful elements of the work and how this actually affects nurses, including in leading to high levels of burnout and turnover. And the piece commendably consults nurse experts about these issues, including their comments and even a short description of Mealer’s research. The piece might have noted that an additional cause of stress for nurses is aggression from colleagues. And it might have explained how having distressed nurses can harm patients, both through substandard care from the afflicted nurses as well as through shortages of nurses at the bedside. On balance, though, this is very helpful information.
But these benefits are undermined by the failure to identify Mealer as a nurse and the inclusion of elements that will suggest to many that she is instead a physician, namely calling her “Dr. Mealer” four times and noting that she is a professor at the “Medical Campus” of a university. Yes, the piece is about nursing, but we are not confident that many members of the general public know that nurses get doctorates, are addressed as “Doctor,” and become professors at “medical” campuses. And the misconception that physicians supervise nurses and nursing remains common. It is reinforced many times each week by popular media depictions like those on Grey’s Anatomy, The Good Doctor, New Amsterdam, and countless portrayals in non-hospital shows and other media. The result of all this is that many readers will assume Mealer is a physician, and physicians will get credit for her expertise, while nursing will suffer the continuing misconception that the profession is a mere subset of medicine. We realize that some nursing leaders and scholars do not insist on being nurse-identified and may even discourage that identification, presumably well aware that most of society will respect them less if they are associated with a profession that is not known for authority, intellect, or knowledge. But it is vital that all media creators and all nurses make clear when a cited expert is a nurse, either by simply saying so or by listing credentials, like “Meredith Mealer, RN, PhD.” By contrast, in the case of Peterson, there is no “Dr.” reference, and her association with an organization whose name explicitly says that it represents nurses (ANA) is likely enough to make the link clear.
With that enormous caveat, we thank those responsible for this Times report on PTSD in nursing.
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