A few months ago, an op-ed in The New York Times described how the abundance of errors in hospice patients’ medication lists puts them at risk. What may make this piece stand out for nurses is the first line: “I am a hospice nurse.”
By bringing her nursing expertise to a larger discussion about medication errors among hospice patients, Theresa Brown, PhD, RN, offers the rarely heard perspective of a front-line health professional caring for patients at the end of life.
“I’ve always felt I had a mission: to show the public what nurses really do, how textured and important our work is,” Brown said.
Brown’s writing is especially important because nurses are seldom represented in print media healthcare coverage, according to the Woodhull Study Revisited, which was partially funded by the Robert Wood Johnson Foundation. The original study, published in 1998, found similar results.
Brown’s meteoric rise to become the sole recurring nurse op-ed contributor in one of the nation’s leading newspapers and a healthcare expert who has appeared on NPR, ABC’s 20/20 and MSNBC is a story of a born writer who eloquently describes her experiences as a nurse — a perspective largely missing in the media.
Originally an English professor at Tufts, Brown earned a second degree in nursing in 2007. She processed the first sudden death of one of her patients by writing about it. She sent the piece to The New York Times, where it was published in 2008 in the newspaper’s Science section.
Brown pens books, meets president
After her essay was published, Brown said, there was a “positive surprise” that nurses could “contribute to discussions about healthcare.”
“The combination of nursing and English and being a good observer and writer all worked together to make me appealing to The New York Times,” she said.
Agents immediately contacted her, and her writing career took off. Since then, she has published Critical Care: A New Nurse Faces Death, Life, and Everything in Between, as well as the New York Times bestseller, The Shift: One Nurse, Twelve Hours, Four Patients Lives. One of her columns about a patient who had leukemia but inadequate insurance caught the eye of former President Barack Obama; his staff invited her to the White House.
Brown’s New York Times editor once told her he was interested in “Theresa Brown’s point of view,” rather than wanting her to serve as a “spokesperson for a specific viewpoint in the nursing community,” she said.
Brown remembered the advice when some nurses criticized her for writing about physicians who were bullies. Some faulted her for airing “nurses’ dirty laundry,” while others insisted that the problem had already been solved, she said.
“I was surprised by both reactions, since I believe you can’t solve a problem until you fully own up to it, but I never regretted taking a stand the way I did with the column,” she said, noting the column and others “helped hospital systems see the quality risks posed by staff who engage in what the Joint Commission calls ‘disruptive behavior.’”
Brown encourages nurses to tell their stories
When she first started writing her columns, Brown said, she was criticized for what others perceived as violating privacy regulations and disregarding an unspoken code about nurses not revealing details about their clinical work. “Doctors have been writing about their patients for years, and no one ever raises these complaints” and adds that there is “value to having nurses tell our stories and weigh in on healthcare policy questions and legislative issues related to healthcare.”
Others have referred to her as an investigative journalist rather than a working nurse, Brown said — a charge she has yet to hear leveled at well-known physician writers Atul Gawande, Danielle Ofri or Siddhartha Mukherjee.
“That kind of complaint is a way to say that nurses on our own don’t have much to contribute to the discourse about healthcare — a journalist pretending to be a nurse or posing as a nurse could contribute, but not a real nurse,” Brown said. “I am always quick to say that I am a nurse and writer, and I am, in fact, a nurse. I have the degree and do the job.”
For nurses wanting to follow in her footsteps, Brown urges them to learn how to stay compliant with privacy regulations and ensure patients cannot be identified. She encourages nurses to approach leaders in their institutions about their feelings about having employees write and publish — some may be concerned about potentially negative publicity.
“Find ways to tell the truth about nursing and healthcare without [violating privacy] if you can,” she said. “Consider a pseudonym if that makes you feel safer as a nurse writer.”
Brown also emphasizes that even reaching a small audience, including family and friends, can make a difference in how nurses are viewed by the broader world.
“Never doubt that putting your voice out in the world is a valuable contribution to the effort to make healthcare better and have nurses seen for the important, lifesaving work we do every day,” she said.
Courses related to ‘hospice care’
CE312-60: Hospice and Palliative Care
(1 contact hr)
The use of hospice and palliative care services continues to grow in the U.S. However, confusion about what the programs offer remains. This educational activity compares services and reimbursement for hospice and palliative care programs. The goal is to educate nurses so they can discuss options with patients and make appropriate referrals based on patient and family goals of care.
CE235-60: Identifying Pain in the Hospice Patient
(1 contact hr)
Hospice patients experience pain across multiple domains. Clinicians who care for hospice patients and their families need to be knowledgeable about the appropriate assessment and management of suffering in those experiencing serious life-limiting illness. This module will provide an overview of the different types of pain experienced by hospice patients and how to manage that pain.
60132: Getting Started in Hospice Care
(6.5 contact hrs)
Dying in America continues to generate debate. This course describes the history of hospice as a social construct in the world at large and as a discreet discipline within the U.S. Key concepts in this course include the role of the nurse in hospice practice, the function of the interdisciplinary hospice team, use and access of clinical consultants on behalf of the hospice patient, the structure of the Medicare hospice benefit, hospice eligibility requirements, pain and symptom management, and care of the hospice patient before death. Information about reimbursement, documentation, and anticipated changes and additions to the hospice benefit are also presented.