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(RW) Nursing II: Sarah DiGregorio
13 Plays3 days ago
(REWIND) Season 2, Episode 18: Sarah DiGregorio is a freelance healthcare journalist from Brooklyn, New York. She is also the author of Taking Care: The Story of Nursing and Its Power to Change Our World. Listen to Sarah talk about the nurse-patient relationship, healthcare billing and the political nature of nursing.
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Transcript
Introduction to The Wound Dresser Podcast
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, John Neary.
Sarah Di Gregorio and 'Taking Care'
00:00:22
Speaker
My guest today is Sarah Di Gregorio. Sarah is a freelance journalist based in Brooklyn, New York, who has written on healthcare topics for the New York Times and the Washington Post, among other outlets.
00:00:34
Speaker
In 2023, she authored Taking Care, the story of nursing and its power to change the world. Sarah, welcome to the show. Thank you so much for having me.
Nursing vs. Medicine: Complementary Disciplines
00:00:45
Speaker
So I've heard you make the distinction that nursing is, um you know, unique from medicine. Can you articulate the the role of nurses and how they bring a unique skill set to the health care setting?
00:00:59
Speaker
Yeah. So I think it's important to think about nursing and medicine a two complementary and overlapping disciplines, but they are distinct disciplines. So physicians have a particular role and nurses have a particular role and a particular discipline and expertise. um And of course, we need both and we need all of that for to to attain the best patient care. um So I think of nursing, and and this comes from many, many interviews with nurses. um Nursing is distinct from medicine in that nursing education and training and practice, of course, is concerned with um the physiology of patients and biomedical knowledge. um But in general, it goes a bit less deep on the physiology as opposed to physician practice, which goes very deep on the physiology. Nursing practice tends to go broader. So thinking about nursing a understanding the patient in their entire context. So rather than focusing their expertise on one organ system, say, or on one kind of disease, nurses are trained and their practice focuses on understanding um a patient's health and well-being in their entire
The Importance of Nurse-Patient Relationships
00:02:21
Speaker
context. So thinking about, for instance, um you know, what is their mental state like? Is that attributable to a disease or pathology? Or is there something going on in their family? And, you know, being able to have conversations that can tease out what's really going on with a patient. um Another example of that might be when a patient is being discharged.
00:02:46
Speaker
um Of course, a physician may have done all of their great work figuring out, you know, what is um going on with a patient physiologically, um perhaps prescribing medicine for that patient. But when they're discharged, you know, thinking about how that is going to interact with their environment. So, um you know, if they're being discharged home with oxygen, what is that like? Is there anyone who smokes in the home? If they um are having mobility issues, you know, are there stairs that they need to climb? You know, what are sort of the, I think of nursing as this very broad picture
00:03:21
Speaker
um kind of expertise, really thinking about the health and wellness of a patient in in um in this 360 kind of way. um and And, you know, I also think that given the pressures on everyone in our current healthcare care system, it can be very difficult for all the providers to have a deep relationship with patients. You know, everyone is pressed for time. There are often shortages in staffing, both for nurses and physicians. um But nurses really um do have a um a priority in terms of establishing a relationship with the patient and really um understanding them as human beings and understanding their family context.
00:04:13
Speaker
And out of that nurse-patient relationship comes a lot of insight and knowledge that nurses then um can use in service of the patient care. Also, of course, sharing that information with other providers. So I really think of nursing as both biomedical science and a relational science um and thinking of a patient beyond um beyond sort of a sense of pathology or cures, procedures, but really thinking about them in their in their entire context.
00:04:47
Speaker
Yeah, I think I've heard you um kind of talk about that and say like the nurses are are really the ones who are in the position to heal the patients. So yeah in your eyes, like could you talk more about like that healing that occurs um through a nurse patient relationship?
The Healing Role of Nursing Beyond Cures
00:05:04
Speaker
Yeah. You know, i think we all, everyone who spends time in healthcare, care certainly healthcare care providers, but also as a healthcare care journalist and someone who has been in healthcare settings personally,
00:05:16
Speaker
as a family member um quite often in my life, you know we know that it's important to identify you know any disease that is happening with a patient and then to provide medication or a procedure that might cure or am ameliorate that condition. But that's really um only part of what happens to patients in healthcare settings.
00:05:41
Speaker
um Sometimes there is no cure, right? Sometimes there is no fix, but people still need health care. They still need to be cared for. um and There is a world of healing that happens you know after a surgery or after a diagnosis, and nurses are really key to that healing. um So I'll give you an example um from my own life first. um My daughter was born prematurely, and as a result, she struggled with severe asthma when she was younger. um It was very, very hard for us to get it under control.
00:06:18
Speaker
Um, and so as a result, we were, um, our pulmonologist recommended a bronchoscopy. So she was, um, admitted for a bronchoscopy. It was meant to be an outpatient procedure. Um, and she had been having flare ups, you know, quite often. And so her, um, you know, she was going into the bronchoscopy. She wasn't completely well. And, um,
00:06:41
Speaker
Her airway reacted um very dramatically to the bronchoscopy. She knows shes swelled up. She had a lot of mucus and swelling. And so when she came out of it, um she was in respiratory distress. And when they finally called us back, um her saturations back into the recovery room, her saturations were in the mid eighty s There was a respiratory therapist in the room putting her on a CPAP machine.
00:07:06
Speaker
and I heard someone say, you know, we have to get her saturations up. And having been in the NICU with her and having experienced a lot of um traumatic moments with her around breathing and her ability to breathe, um i was I was immediately in an absolute panic.
00:07:25
Speaker
um I knew that her saturation shouldn't be that low. I i feared that they might have to intubate her. And um I said out loud, I said, are you going to have to intubate her? And someone said, that's one possibility. And then this nurse, the recovery room nurse, who was standing right right by my daughter's bed, she caught my eye from across the room and she said to me, we are going to get her saturations up.
00:07:52
Speaker
This looks worse than it is. And she was really the only person who connected with me in that moment and who helped me understand what was really happening. um And as a result, I was able to modulate my own trauma response, which was important also for my daughter, right? Because there's research that shows that when children are hospitalized, when parents have less fear and anxiety, the children tend to do better. um And so this nurse intervened for me in this moment for me, but also she was intervening for my daughter. So she was of course, monitoring her vital signs. She was talking to the respiratory therapist and to the pulmonologist. um And they did get her saturations up on the CPAP machine.
00:08:40
Speaker
And this nurse interacted with my husband and me and my daughter in the recovery room um in a way that was incredibly healing. So for instance, you know she she was doing chest PT on my daughter. She showed us how to do it. She told us exactly what she was doing. um She was able to establish a trusting relationship with me and my husband really in a matter of minutes. And all of this, right, she was working on so many levels. So she was communicating with the rest of the healthcare care team, She was monitoring my daughter's vitals and you know making sure her respiratory status um stayed stable.
00:09:18
Speaker
And she was including us in the care, educating us, making sure that we had our questions answered and that we felt that we knew what was happening. um And when I think about you know all of the things that happened that day to my daughter, of course, she needed the bronchoscopy. She needed the information we got out of that.
00:09:38
Speaker
But we as a family unit and and for my daughter's well-being, we really needed that nursing that day. My daughter needed it physically and we needed it for our education and for our ability to take care of
Hospice Nursing: Comfort and Dignity at End-of-Life
00:09:52
Speaker
my daughter. um And so, you know, that's the kind of healing that I'm thinking about. I'm thinking about sort of in these layers of nursing practice, which is which is, you know, of course, um taking care of the patient's physiology, but then also thinking about, you know, what do these parents need right now? These parents were in the NICU. They're having, they're they're really scared. They need their questions answered. They need a little reassurance.
00:10:20
Speaker
um And all of that is really towards the wellbeing of the patient. um So i I like to give that in this example. I can give you another example. You know, there are times when healing means something other than a cure. Right. um And so i think about um the hospice nurses that I, um that I accompanied on their home visits um as part of my reporting for the book there. i accompanied this wonderful hospice nurse named Mariana Sander, Sander of Skoia.
00:11:00
Speaker
And um she let me sit in on a visit that she made um to the home of an elderly man who was um very slowly dying of um a heart condition. He had been in hospice for about six months um and he was pretty stable, but you know he needed a lot of um management in terms of his symptoms. His heart condition gave him uncomfortable symptoms. He wasn't really able to get up very much.
00:11:32
Speaker
And so this is a context where, of course, a cure is not possible, um but healing is possible. And so you know she had established this very ah deep relationship with him and his wife. And so she would go in sat down. She would talk to him about what his symptoms had been. She would make sure that the medications that he might need were were filled, were available to him to take any time that he needed them. um And all of this towards the goal of, you know, feeling comfort, you know, being able to enjoy um your last months um or you know, days. um
00:12:12
Speaker
And the healing that she was providing to this gentleman and his wife, you know, it had to do with managing his Foley catheter. it had to do with making sure he had his medications available. He knew how much to take all of, all of those, you know,
00:12:30
Speaker
tending to his bodily needs. But it also had to do with you know a sense of reassurance that she had she had gone through this death process with many other patients before, that it was nothing to be afraid of, that you could be prepared, that sort of her expertise was in, there's never um there doesn't need to be a moment of panic.
00:12:49
Speaker
you know You don't need to call 911, that there is a sense that you're being taken care of. um that your wellbeing is being, is being understood and expertly taken care of. um And both he and his wife said that there is this tremendous sense of um relief in that, um in being able to just try to, you know, try to be comfortable and enjoy um the time that they had with each other. So when I talk about the the, kinds of healing that nurses provide, you know, that's, that's what I mean. It's, it's in so, it's so ah multifactorial. It's in so many different ah settings and it looks different in, in lot, in, in every setting.
00:13:33
Speaker
um But we all know that our health and wellbeing is not just about our organ systems. um And it's incredibly complex. And so I think that that attention to each person in their context, um when done expertly and with all of that knowledge and insight um can be incredibly healing and that that's a lot of the power of nursing.
00:14:02
Speaker
Yeah, I think what you're you're getting at is basically nurses are in the position, right, to be the the superstars of the biopsychosocial spiritual, you know, level of of patients.
00:14:14
Speaker
um I think that's like it's obviously super overlooked, so super important. um And. Hope hoping that we can kind of appreciate that and build that in the health care more as we move forward, um,
00:14:30
Speaker
yeah I know you originally started out thinking of writing the book as like ah like a chronological history yeah of nursing um and that kind of that kind of ah evolved. um I know you kind of in the book, you kind of like split it up into you know different different disciplines that nurses work in and kind of exploring those.
00:14:48
Speaker
um But just kind of like bigger picture, um you know how did nursing start and how how has it evolved to where it is today?
Historical Evolution of Nursing
00:14:57
Speaker
Yeah. Um, that, that's a really big question and you're right. i I decided not to attempt to write, um, a straight ahead history of nursing in part because I realized that, um, that's, that was, it's actually so big. It's so much bigger than I appreciated at first, which was, you know, my mistake. And I think many people's mistake. Um, and, uh, so I ended up, deciding to structure it around what i see a history of what I see as the power of nursing and pulling those threads. um
00:15:32
Speaker
But nursing has existed so you know since the dawn of human civilization. So if you think about nursing, well, first I should back up and say, in other cultures and in other times, particularly in the past, there wasn't so much of an emphasis on delineating different disciplines the way that we do. So we have a very strict system of, you know, you're a physician, you're a physical therapist, you're a nurse, you're a nurse practitioner, you're a pharmacist. So we really delineate those different disciplines. In the past, those different disciplines were not delineated in the same way. And in many cases, it was not considered important um to delineate them that way. However,
00:16:19
Speaker
the way that I looked back and tried to trace a history of nursing was to identify some, um what I think of as um a definition of nursing, which is care, hands-on care for for people with respect to, as I said, their full context, you know thinking about them in their environment, with their families, in their communities, what are the different inputs that are um bringing them towards health or illness? um And um also thinking about nurses as really engaged in building those relationships.
00:17:01
Speaker
In addition, you know i think about um some of nursing practice is about you know first aid and um nutrition.
00:17:13
Speaker
and some really fundamental sort of building blocks of providing healthcare care that have been done for millennia. You know, before we had CAT scans and before we had antibiotics and before we had all of the sort of marvels of modern medicine, people have been, you know, trying to prevent infection and, um you know, sitting up with someone who's dying, sitting up with someone who's giving birth, you know, all of these things are um practices that we think of often as nursing practice, but they are basic you know they are the basic fundamentals of healthcare.
00:17:50
Speaker
um And those things have always been happening. And so if you look back even to Neolithic times, there's evidence in the fossil record of nursing practice, you know and whether or not that happened in the home or there was a community expert, you know a lot of times the evolution of this is that nursing perhaps started in the home with family members and then Often there would be ah ah someone who who developed expertise in the community and so was known as the person who was good at delivering the babies or who knew, you know, who had knowledge of, um you know, herbs or infection control, things like that. And people have always been doing that kind of thing. They used honey, they used turmeric, um back to the Egyptians, the ancient Indian empire.
00:18:34
Speaker
um So we can we can trace those threads of nursing throughout really all of human history. um In particular, I was really fascinated by um the story of a um a skeleton that was found in a Neolithic um village in Vietnam. So archaeologists were um studying this you know this Neolithic village that they were digging up in Vietnam, and what is now Vietnam. And they came across a skeleton of a young man. um And from the skeleton, they could tell that when he died, he was in his mid-20s. And he had been born with a congenital condition that had caused him to become progressively paralyzed so that he would have been paraplegic.
00:19:23
Speaker
um starting in his teens. And nevertheless, you know he had lived for another 10 years. That meant you know he would have had trouble chewing and swallowing. He would have had trouble with his you know positioning his body, so he would have needed help um moving to prevent pressure sores and infection.
00:19:41
Speaker
Certainly nutrition would have been something he needed help with. And You know, we sometimes think of ourselves as a species for whom it's natural to just, well, survival of the fittest. Well, we'll just leave the vulnerable behind. You know, he was someone who um became disabled um in a community that was, you know, so long ago that they didn't even really have metal tools, right? Nevertheless, somebody or many someones provided what they could for him and allowed him to live for another 10 years, right?
00:20:17
Speaker
as you know as someone who couldn't move around on his own. um And so when we think about that, we think, you know that is nursing, that you know we have we have organized care for people who needed it throughout human history. And and so I think about it that way. And then um thinking about the ways that nursing has evolved, it's a really complicated story because um nursing and midwifery has been has has certainly you can find it in every culture, in every time.
00:20:52
Speaker
When you think about it, it's actually quite logical because because human societies can't function without that, right? Without nursing care, without some kind of organized healthcare,
00:21:08
Speaker
it's very difficult to have a functioning society. So for instance, you can often see evidence of nursing in military traditions. So militaries have always needed healthcare.
00:21:20
Speaker
And when you think about, you know, the importance of of military action in human history, unfortunately, um you know, the, for instance, the, you know, the Roman empire, because the Roman empire was so far flung, um they really, they needed to have military bases throughout their empire. And in order to maintain the fitness of those troops, they needed also to have hospitals there to care for the soldiers, not only from battle wounds, but also for what, you know, all of the illnesses and ailments that come from living in a barracks, living in close quarters. Um, and without the nurses taking care of the troops, you know, that was what the Roman empire's, um,
00:22:08
Speaker
That was what the Roman Empire was supported by. So you think the Roman Empire, oh, they had such an advanced military. Well, actually, how did they have such an advanced military? They had very sophisticated health care for their military.
00:22:20
Speaker
um And so, you know, you can think about this in all kinds of different ways. um But nursing has always been key to the functioning of human society.
00:22:32
Speaker
with With kind of all that in mind, um kind of just bringing it back to present day, can you sort of elaborate on the the current dynamic of like a healthcare team, like where nurses fit into that, like how it all works and perhaps things in that dynamic that you would like to see changed?
Modern Healthcare Teams: Multidisciplinary Insights
00:22:51
Speaker
Yeah. Well, of course it's difficult to say because it it um the healthcare care team dynamic I think is different in many settings. and um highly dependent on, highly dependent on the setting and also the culture of the particular institution, all of that. But to generalize, um you know of course, in a healthcare team can be made up of physicians, nurses, like registered nurses, nurse practitioners.
00:23:25
Speaker
um There are nurse um anesthesiologists who provide anesthesia. um Of course, other parts of the healthcare care team can include um certified nursing assistants, um physical therapists, occupational therapists, respiratory therapists, and all of those providers have a particular discipline and a scope.
00:23:46
Speaker
um And everyone is there, at least in theory, to use those skills to help the patient. um i In our current healthcare system, um there is an emphasis, I think, on multidisciplinary care, which you know is a model that is geared more towards um less of a hierarchy and more of a team-based approach in which everyone's discipline is valued as part of patient care.
00:24:20
Speaker
so You know, the bedside nurse has has a certain expertise about this patient. Their pulmonologist has a certain expertise about this patient. The respiratory therapist as well. You know, all of those people working together and adding their their particular discipline towards the care of the patient.
00:24:38
Speaker
um I think that that is a really good system in theory. I think that unfortunately it really often ends up being much more hierarchical than that. And some of that is based on the financial system that we have in our healthcare care ah in our healthcare care system.
00:25:00
Speaker
um So often it is, the physician is seen as the most important. um And part of that is because physicians bill um and physician care is bills out at a more expensive rate. um So makes more money for the facility.
00:25:17
Speaker
um i think that that's unfortunate because um
00:25:25
Speaker
the truth is, is that everyone's discipline is necessary. um And i do not think that one is more valuable than the others. um I have had, for instance, you know,
00:25:39
Speaker
when I've been interviewing midwives about their practice in hospitals, I recently had a midwife tell me that um midwives were barred from attending births because it was not a midwife birth bills out at a lower price than a physician birth.
00:25:57
Speaker
So even though midwives had that within their scope and within their training, um they were not allowed to attend uncomplicated births. However, when the physicians are not available, the midwives do attend the uncomplicated births. If it's then they they call it an emergent situation because the physician is not available. This midwife was describing how a physician might be doing a C-section in the OR And another patient is about to give birth. So of course, the midwife you know is going to be there for the uncomplicated birth. But at the last minute, sometimes the physician has to run in the room and basically knock the midwife aside and catch the baby, not because the physician is a terrible person, but because that's what the hospital has asked them to do, because the physician attended birth bills out at a higher rate.
00:26:49
Speaker
um obviously that's not about patient care, right? It's it's not. um And I think a lot of the hierarchical aspects of our current system um our are really because of flaws in the financial model that we have.
00:27:06
Speaker
um I actually think that the vast majority of people who go into medicine and nursing do it to help people and um and are trying their hardest within a really broken system to provide the very best patient care that they can. So it's not that I don't think that most physicians are particularly into, you know, the idea that their their discipline is more important than everyone else's. I think that there are pressures placed on everyone within this system that are really not about patient care at all and are about um the financial system and the and and who bills out to payers.
00:27:46
Speaker
um I'm sure you know this, but for instance, when you're in the hospital, um your bedside nurse, the RN who takes care of you and who really is incredibly important, and we know this from research over decades, that um the more time your nurse has to has to care for you in in the hospital, the more likely you are to be discharged alive or to have a good
Financial Challenges in Nursing
00:28:11
Speaker
outcome. And the reason for that is because nurses are um an early warning system. I mean, they they are the ones who catch signs of a stroke. They are the ones who catch signs of liver failure. um They are at the bedside and they have the expertise to know what's happening with their patients.
00:28:28
Speaker
However, when, um when you get when when the when your insurance company gets a bill for your hospital stay, the physician services are billed for, but the nursing services are wrapped up into room and board. So nursing services in the hospital are billed for kind of like meals or supplies or the bed itself. um And that does not reflect the importance of nursing care to patient outcomes. And what that forces what that means is that when hospitals are looking at their balance sheets, they're saying, hmm, these physicians make us a lot of money, but these nurses are an expense. The more nurses that we have, the more we're paying for nursing care, but but we're not getting money back from insurance companies based on that.
00:29:18
Speaker
um So they're free to see nursing care as an expense. And what do we do to expenses? We cut them. So, you know, cutting nursing staffing, squeezing nurses to provide care to more and more patients. um And that is not, that's not good for patient care.
00:29:36
Speaker
So those, that is the big picture problem that I really see with our our current healthcare. care Well, one of the big picture problems with our current healthcare system is that, you know, it forces people into this hierarchy based on the financial model. And that is not rough a reality in terms of what's important for patients.
00:29:57
Speaker
Yeah, like the the commercialization of medicine is definitely something we've i've I've tried to talk a lot about on the show. And it's it's just, it's it's sort of squeezing everybody, the the patients, the physicians, the nurses.
00:30:10
Speaker
um You mentioned a lot of the and ah members of the healthcare team, but like just zoning in on the nurses and the physicians for for a second. Like, what do you think...
00:30:21
Speaker
Like, how how do they kind of, what is their interplay? Like, what what can they do for the patient? And what, you know, how do they work as that like a team? I think that there is a really important exchange of information that happens between physicians and nurses. um
00:30:40
Speaker
Physicians are attending usually to someone's, a particular say, a particular organ system or a particular pathology that the patient presents with.
00:30:52
Speaker
And, um, figuring out what's, you know, what's going on with the patient, what's going on with them physiologically, um, running the tests, um, doing the exams that the physicians do.
00:31:05
Speaker
Um, and, you know, really trying to solve the mystery of what's, what's happening with this patient and what, what do they need? What is the treatment that they need? Um, So that of course has to be communicated to the nurse and, um and the nurse then has a lot of insight also that can be communicated back to the physician. So for instance, um you know, if a patient um is,
00:31:35
Speaker
um patient is having a lot of anxiety about going home, why is that? Or, If a patient's mental state suddenly deteriorates, um why is that?
00:31:48
Speaker
um all of you know That could be a side effect of the medicine that was unexpected. It could be a sign that something else is going wrong um that needs to be checked into. um Or say, you know, is there is there um a conversation that the nurse has had with somebody's spouse? And there's um some really important piece of information in there about, um you know, that relates to um they their illness or relates to their ability to be discharged home. So I i think that you can think of the physician as
00:32:30
Speaker
um And again, these things are overlapping, right? It's not that physicians never have these relationships or don't have these conversations. They do. And also nurses do have tremendous biomedical knowledge and they often have a lot of insight into the physiology of the patient. um But I think if you think about the the physician being most expert in the physiology and the nurse being most expert in the gathering information from the patient, both related to the physiology and related to their entire context and how much back and forth there can be there um can be really powerful actually, and can, can really provide excellent care when, when those relationships sort of are, um are functioning as, as they should.
Is Nursing a Stepping Stone to Medicine?
00:33:21
Speaker
um There's just, there's a, no one person could, provide everything a patient needs. And I think it's it's really important to sort of honor both kinds of expertise.
00:33:34
Speaker
So I think what I'm hearing is like you feel that nurses can kind of really like lean into that art of medicine while still having, you know, a broader knowledge of of biomedical concepts, physiology, etc. And the the science and the the doctors can kind of be like more like the the science of medicine, but still have those you know relationships with patients.
00:33:57
Speaker
You know, I always thought of, um as as somebody who's a medical student, I look at like the the amazing knowledge that all these nurses have and and kind of thought like, um wouldn't it make sense for a lot of these nurses to move on to like, or move on to be a physician or so or or something? is in In your eyes, is it more that you want to see nurses kind of stay on the nursing track?
00:34:19
Speaker
Or like, should should more nurses be going to medical school? should So here's the thing that I think the problem with that line of thought is thinking that going to medical school is a step up or is sort of a a natural progression when in fact it's just different discipline. Right. And actually so interesting. Many nurses will tell you that.
00:34:41
Speaker
I mean, nurses get very prickly about that idea, the idea of like, oh, you could have been a doctor. And ah many of them find that a little bit offensive where they would say like, I wanted to be a nurse. It wasn't a second class or a second choice to me. Like it wasn't because I couldn't be a doctor, I became a nurse.
00:34:57
Speaker
Maybe in the past for women, that might've been um an aspect of it, you know, when it was much, much more difficult for women to be accepted and to go into um medical school. But today, you know, bringing that that, that did come up actually in my reporting and this idea that um nurses find it,
00:35:19
Speaker
um nurses um chose to be nurses and they didn't, they often really do not see it as like, oh, I should progress to become a doctor. Sometimes they will progress or, um you know, move on to be a nurse practitioner, something like that. You know, if they want additional training and and and a sort of a bigger scope, if that's something that they're interested in But um no, I do not think that nurses should become physicians. Um, because I think that nursing is actually just as complex and difficult and crucial as medicine. I think they are equally complex, crucial.
00:35:59
Speaker
um And um people who go into nursing often have an affinity for nursing as a discipline. I mean, I guess that's obvious, but um I think that instead of thinking about you know these excellent, excellent nurses who do have so much expertise. And you're right, you know, they especially, and I've heard this from residents a lot. um And I've heard, you know, I've heard about training residents from nurses. I've heard ah about it on both sides. I know that that's a really important relationship. um
00:36:33
Speaker
And um nurses, nurses do often have similar expertise or I should say, you know, people have been working with patients in hospitals for years and years and years, they have tremendous expertise. I mean, they have tremendous knowledge from their experience, from their training, but also from their experience.
00:36:58
Speaker
um And that expertise can stay in nursing. That's really important because um that's not like extra knowledge for nurses. That's actually nursing knowledge. Do you know what I mean? It's um it's it's it's actually quite of a piece with their discipline.
00:37:15
Speaker
um So yeah no, I don't think that more nurses need to become physicians. I wish that some of this, um I think that perhaps um more you know more collaboration between physicians and nurses would be great.
00:37:39
Speaker
um And i I do think that part of like the tension between nursing and medicine sometimes is about nursing wanting to be understood as an expertise and, um you know, a discipline that is just as complex as as medicine, um which it is. And so i you know, i wish that I wish that we could kind of like do away with that altogether and and really – focus on what each discipline really brings to the table, as opposed to trying to always set them off in relation to each other.
00:38:16
Speaker
Yeah, sure. I think yeah what you're getting at what you're saying is basically, you know, there's this hierarchy that exists in medicine and we kind of have this notion of like almost like military ranks and, you know, nursing, nursing you know, you can have a five-star general nurse and a five-star general doctor who work together to kind of provide um adequate patient care to somebody who's in need. So I think, um and how do you how do you kind of um destabilize that hierarchy, I guess?
00:38:47
Speaker
or kind of, or kind of change that hierarchy that, that I think though, it's like kind of like a power struggle within medicine for who sort of, um, you know, doing things. So how do you kind of like make, make, put those people on equal footing, I guess.
00:39:02
Speaker
So I have two sort of thoughts about this. One is that, you know, it makes a difference when individuals in a system start to interact differently. So I think, um,
00:39:15
Speaker
you know, the more that nurses and physicians can individually collaborate with each other and really see it as a team that is there for the good of the patient, um that that's that's really good. But i I do think that a lot of this hierarchy and the sort of the push-pull, um,
00:39:37
Speaker
sort of a little bit of turf wars is related to, again, the financial system that we have for um paying for healthcare in this country.
The Political Nature of Nursing
00:39:48
Speaker
And I think that if we change that, it might go a long way towards um towards ending these really false and harmful hierarchies. um I will mention, for instance, um that the American Medical Association you know, is really, really aggressive about um lobbying state legislatures um not to allow for the practice of nurse practitioners. So whenever we have these conversations, I just want to say, you know, no one is saying that any provider should be providing care that they are not trained and licensed to provide.
00:40:30
Speaker
you know So the sort of hyperbole around like, oh, do you want a nurse taking out your gallbladder? Well, of course, I don't want anyone taking out my gallbladder who is not trained and licensed to take out my gallbladder, right? But um nurse practitioners in many states must work under the supervision of a physician. um And in large part, that is because of the lobbying of the American Medical Association, which really seeks to keep billing flowing through physicians. So this is a, um, this is really an issue of, um, it's not about patient care. Um, there's ah so much evidence that nurse, for instance, getting your primary care from a nurse practitioner is just as safe and appropriate as getting your primary care from a physician.
00:41:22
Speaker
Um, there's There's plenty of data to that. um So what is this you know what is this about? it it becomes ah It's really about maintaining um maintaining the financial status quo of you know billing flowing through physicians. um And as
00:41:46
Speaker
as healthcare is...
00:41:49
Speaker
healthcare care is is you know, engaged in making money, as long as, you know, um the financial um incentive in healthcare care is at odds with providing the best evidence-based care for patients, we're going to continue to see this kind of turf battle. You know, i i um i actually don't think that it is any individual's
00:42:22
Speaker
fault. I think that it's a product of the system that we have. i I know you've said that nursing is inherently political.
00:42:36
Speaker
um Can you kind of touch on sort of the relationship between politics and nursing? Yeah. Actually, I think all healthcare is political, but because nurses are are so, provide often like the most hands-on care and the most community-based care, um I think nursing is particularly political. So for example, um say, um
00:43:07
Speaker
I'll give you an example of actually a nurse, um a nurse scientist out of Emory. Her name is Roxanna Chikas. And Roxana Chikas, Dr. Chikas, is a ah a nurse PhD, and she also has a postdoc in nephrology.
00:43:24
Speaker
And um she is she does research with the Farm Workers Association of Florida. She researches farm workers in Florida to assess their kidney status and how working outside in the heat um and the humidity impacts um their kidney health because there is a um there is um a lot of evidence that um in particular, agricultural workers are at increasing risk of um kidney disease and kidney failure as a result of rising temperatures and rising humidity. So you could say that Roxanna is
00:44:08
Speaker
you know, she's engaged with the community there. She is um following these workers for longitudinal studies for the last one I think was for two years. So she has them come in, she collects data on their kidney health and she tracks it with the weather and with their working conditions.
00:44:26
Speaker
On the face of it, is that political? i i suppose not. But when you start to think about the context in which she's doing this research, it becomes quite obvious how it's political. So, um,
00:44:38
Speaker
in the United States, farm workers in particular don't have any um workplace protections against the heat. There are a handful of states that have implemented requirements for employers to provide water, shade and rest,
Healthcare and Politics: Advocacy for Change
00:44:55
Speaker
um when which protects is protective um from heat-related illness. But in most cases, including Florida, um Employers are not at all required to provide access to water, provide access to shade. So you have farm workers working, um you know, in 100 degree heat in 80 percent humidity.
00:45:17
Speaker
And um because they don't have access to water or shade breaks, they are 33% of them, according to Chikas's research, 33% of them are incurring a kidney injury every day.
00:45:31
Speaker
On any given day that they are tested, 33% of those workers have incurred a kidney injury. And when you add up enough kidney injuries, you end up with um with a chronic um kidney disease and with potentially kidney failure.
00:45:46
Speaker
So, um, The layers of this are, you know, why don't farm workers have these protections that actually many other, um many other ah workers have more protections than farm workers do. Farmworkers tend to be undocumented immigrants, especially in Florida. um they They are um often afraid to ask for what they need at work for fear of losing their job or fear of you know retribution in terms of immigration status. um So when Roxanna is doing this work with the Farm Workers Association, she's not just really focusing on
00:46:32
Speaker
these workers' kidney health. She's also saying, well, what does OSHA need? you know what What kinds of standards do we need to protect people? And that's a political issue. um Why aren't these people in particular um getting protection? That's a political issue. um And you know all of those you know all of that context is is completely inseparable from these rates of of kidney disease in agricultural workers, right?
00:47:00
Speaker
So it's, it's that kind of thing. It's sort of engaging in the why and and then the how and what needs to change. I think that's really the key. Like what needs to change so that everyone has, um everyone has access to health and safety.
Advocacy Beyond Clinical Settings
00:47:21
Speaker
um Cause everyone doesn't have access to health and safety at all. um So, I think that that's that's what makes nursing political is, you know, when, for instance, um when someone needs an abortion and can't get one, when someone is at risk of an infection because their water broke at 16 weeks, but their fetus still has cardiac activity and they can't get the health care they need, that's a political issue.
00:47:51
Speaker
um All of these things are, are, inextricably linked to how we care for each other and how we decide we're going to organize our communities.
00:48:03
Speaker
And that's what politics is, right? People think of politics as like this thing over here. Politics is just how we decide to organize our communities, how we decide to take care of each other. I definitely, as someone who's getting into healthcare, I'm trying to like lean into this idea of both nurses and physicians, kind of being being advocates for people, right? Going, not just kind of not not just kind of you know staying isolated within a hospital or healthcare setting, but saying, hey, we can also go outside these doors and um you know throw our weight around to to get things you know we want to to to to make society work better, and that'll make healthcare care better.
00:48:41
Speaker
Yeah, because you have that expertise. like You have expertise and knowledge that other people don't have. like When I see legislators passing laws about healthcare topics that they clearly don't have any expertise or insight into, you know your expertise is so necessary, both physicians and nurses, because the people making laws often do not have this context at all. And so you know even when you think about gun violence,
00:49:08
Speaker
You know, there have been a lot of physicians who have been very vocal about ending them because physicians are the ones who are trying to mend these bodies. Right. It's so um it is so tied up in, you know, it is so tied up in all of these issues. Nothing is nothing is in a vacuum.
00:49:29
Speaker
I want to go just a little deeper on like the politics so thing though. It's something I kind of struggle with just like politics and healthcare. care Cause on one hand, you know, recently I heard a speaker talk about she had been in Gaza and and she was talking about the healthcare care system there and how it's like,
00:49:47
Speaker
inevitably you can't not think about healthcare, care you know, work on healthcare care in Gaza without discussing politics. But at the same time, it's like, you know, I just did an episode that I'm goingnna post soon about civil war medicine and to hear about Confederate and union physicians and healthcare providers working together and like sharing ideas to like help each other. That's also like freaking beautiful, you know? So it's like,
00:50:14
Speaker
It's like where, you know, that that spirit of just like unconditional love that like transcends politics, that that can go beyond that division that often politics creates.
Balancing Politics and Evidence-Based Practices
00:50:23
Speaker
So where do you think like, what's the place for politics and what's not the place for politics in healthcare? That's a great question. Here's what I think. I think that healthcare care is about seeing the humanity in every single person and seeing yourself in them, seeing your family members in them, everybody. Everybody has everybody has innate human worth. And that's what I think is so beautiful about healthcare care is that that's what draws me back to it again and again, is sort of this ah this endeavor that people go into to to help people, you know to like mend their bodies as best they can. you know you i i had a my daughter was born at weeks.
00:51:08
Speaker
And i don't think you can go through that experience without seeing tremendous beauty in healthcare. I mean, the fact that, you know, a ah baby can be born like my daughter weighing one pound, 13 ounces and the level of care and and um technology and just attention to every detail what's what was possible for her through her medical care. She is a healthy, happy fourth grader. i mean, in the past, she would have died within minutes of birth, right?
00:51:47
Speaker
So I see tremendous beauty in that because I think that within caring for each other, there is no place for division. you know Everyone has the right to be cared for with equal dignity and worth. um And so um that I think is a power that healthcare care has that actually then can enable healthcare providers to act on political issues where they see that promise not being um lived up to. So,
00:52:26
Speaker
um I don't think healthcare, I think that when, when people are engaged in caring for each other and when we are engaged in, um, you know, voting for, um, you know, different healthcare laws or advocating for different healthcare laws, I think the guiding star always needs to be that everyone deserves, everyone deserves to, um, have the healthcare care that they need.
00:52:56
Speaker
and um and that truly we all deserve that. um
00:53:05
Speaker
But where it does get political is where that promise breaks down and where you see it break down and where nurses see it break down. um And I think that's where it's appropriate to to to be political. And you can call it politics or you can call it advocacy for patient safety or care. you know um
00:53:27
Speaker
people think of politics as a dirty word because, you know, that, you know, this sort of idea that it's somehow corrupt um or divisive.
00:53:38
Speaker
um I think maybe we can better think about it in terms of advocacy for um human rights or advocacy for evidence-based care um because it's okay to disagree, right? It's okay if it's okay for people to have different opinions about things. Um, what I would say is it's not okay to legislate based on, um legislate medical care based on your opinion, right? It has to be based on the evidence. So just using the example of abortion, you know, if women need care to be healthy that they can't get,
00:54:21
Speaker
um That's not good for patient outcomes. So you can say, oh, that's bringing abortion politics into health care. Or I could say that's advocating for appropriate health care to be available to everyone. You may not want to get an abortion and that is fine.
00:54:36
Speaker
Right. But but appropriate health care should be available to everybody. And so you could think about it as advocacy um for evidence based health care.
Rapid-Fire Q&A with Sarah Di Gregorio
00:54:50
Speaker
With that, it's time for a lightning round, a series of fast-paced questions that tell us more about you. So um what are your early morning and late night beverages?
00:55:03
Speaker
oh Early morning coffee. Coffee, coffee, coffee. um And late night, I really like tension tamer tea, old school, and also red wine.
00:55:19
Speaker
um Who's your favorite writer? Oh, God. um
00:55:27
Speaker
Oh, boy. um Oh, God. I don't know if I can pick just one. um
00:55:35
Speaker
Oh, that's a hard one for me. um You can give us two or three if you really want to. Okay. This is going to sound pretentious, but I studied theater in in college. So i I have a real soft spot for Shakespeare. Like I love, love, love Shakespeare. And, um, I, I just, I just do. Um, so for, for, uh, on that front, I'll say Shakespeare. And then,
00:56:00
Speaker
um
00:56:04
Speaker
let's see, i love Kate Atkinson. There's a book that she wrote called, um
00:56:14
Speaker
Sorry, I know i have to... This is not the point of a lightning round, is it? that
00:56:24
Speaker
Okay, Life After Life by Kate Atkinson. I love that book. um And I also will say Angela Garbus, who wrote Essential Labor um as a nonfiction writer that I just love.
00:56:39
Speaker
Growing up, who was your celebrity crush? Oh my gosh. Oh, this is, this is a little weird. I actually thought as a, like a six-year-old, I thought that me and Michael Jackson were going to get married.
00:56:55
Speaker
What's your favorite outdoor activity? Oh, um, I love going for a run. I love, um, I, I, I try to run every day and I live near, um, the Verrazano Narrows, which is like the straight that goes into, um New York Harbor. And so I love to run down to the pier and, um, every day i get to look out on the Manhattan skyline and it's always different, but it's always the same and it's just lovely. All right. And lastly, what's one change you'd like to see in
Vision for Patient-Centered Healthcare
00:57:27
Speaker
healthcare? care
00:57:29
Speaker
I would like to see, i would like to see the money taken out of healthcare care and the focus be put on evidence-based patient centered care, that that should be the that that should be the, the reason for everything. Um, and that we need to find some kind of different financial model, whether it's, um, whether it's Medicaid, I'm sorry, whether it's Medicare for all or some other way of figuring out, um, how we can refocus healthcare care onto, um onto patients, which I think will also make
00:58:08
Speaker
a really big difference in the lives of physicians and nurses um so that they can um feel fulfilled and um and less squeezed in their occupations.
00:58:22
Speaker
All right. Sarah DiGregorio, thanks so much for joining the show. Thank you so much for having me. I really appreciate it.
00:58:40
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neary. Be well.