When nurses are confronted with complaints about our pay, our usual reaction is, “You don’t know what I do. We work very hard, we have huge patient loads, we’re often and literally up to elbows in shit and snot. We deserve our pay.”
My reaction: So what? Take a number, the queue starts here. A lot of people have terrible, awful, thankless jobs — ask the workers in fast-food restaurants, or in meat processing plants. This answer, the I-have-a-really-crappy-job defence, frankly, is a bit whiny. More to the point, it works to our detriment by reducing nurses and nursing to a series of mindless tasks and skills — and that is exactly how we’re perceived by the public, in popular culture, and yes, by hospital administrators. And guess what? You can train a monkey to take a blood pressure, start an intravenous, or put someone on a bedpan.
So what makes nurses different? I want to suggest a slightly amended paradigm: we’re paid well not because of what we do, but because of what we know. Our value is in our knowledge. Yes, we’re well paid. Are we paid for what we’re worth?
Here’s a very small fraction of what I know; every nurse can (and should) come up with their own list.
I know the signs and symptoms of hypoglycemia.
I know why alcoholics are at risk for esphogeal varices.
I know why congestive heart failure can cause right upper abdominal pain.
I know how to triage.
I know how to pronounce death.
I know how to listen to heart sounds.
I know how to relieve pain without medication.
I know how to communicate effectively, and to teach you about your condition/medication/problems in a way you can understand.
I know how to do a head-to-toe assessment.
I know how to arrange home care services for you.
I know why mechanism of injury is important.
I know how to make you comfortable.
I know how to tell you your mother has died.
I know when you’re getting sicker, even before you do.
I know where to place the IV to cause you the least discomfort.
I know how to place an nasogastric tube safely.
I know how to recognize the early signs of skin breakdown.
I know that pancreatic pain is sometimes felt in the left shoulder.
I know what crackles mean, and the difference between fine ones and coarse ones.
I know how to protect your confidentiality.
I know the optimal lead placement to do an ECG.
I know which heart rhythms are life-threatening.
I know why Treatment X is prescribed, not Treatment Y.
I know when your blood pressure is too low, and what to do about it.
I know what an elevated heart rate can mean.
I know when you’re starting to feel better without you telling me.
I know how to document your progress clearly and accurately.
I know how to organize my care so you get the best possible care.
I know what to do in a trauma.
I know the difference between ventricular tachycardia and supraventricular tachycardia.
I know the side-effects of beta blockers. I know why it’s important I know.
I know how much morphine I can safely give you.
I know the name of the bone being x-rayed.
I know what to do when you’re about to give birth.
I know when you’re about to die.
I know what ST elevation means.
I know what fluid balances mean, and why it’s important to you.
I know how to interpret blood results, and I know when they are of concern.
I know how to interpret blood gases.
I know what to do when your heart stops.
Is this knowledge valuable for patients? You tell me if I’m paid too much.