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Old 09-17-2015, 01:03 PM
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Default Language matters

Hi, all,

I recently got the quarterly newsletter from my state nursing association, noting information about continuing education and advanced degrees for nurses, and news items of legislative initiatives and awards. However, I felt I had to make a request to the editor about the language we use to describe nursing and aspects of its practitioners. I?ve learned to look out for these in the work that I edit and produce; I?ve seen the effects of changing language on attitudes towards nurses and by nurses. So this is what I sent:

First, I?d like to call attention to the use of the word ?fortunate,? as in, ?I was fortunate to (get a position).? I?m sure that this nurse worked hard to earn that position. She ?and we? should own that. Injecting an intimation that luck had something to do with achievement subtly diminishes it. I note that males rarely, if ever, use this language in self-description.

This word is also used in reports of awards for achievement or grants. Award-givers bestow their awards precisely because recipient individuals and groups earn them. See the difference between, ?We are proud to have received this grant? and ?I was fortunate to receive this award??

Second is the good old ?training," as in, ??provided training in ... .? This subtly harkens back to the old training schools of yore, where aspiring nurses were trained (as handmaidens?) by physicians to serve them. Nowadays, we teach new skills and ideas, we share evidence-based best practices, we educate nurses for enhanced roles. We don?t ?train."

Last, and to my mind the biggest challenge, is the imperative to lose the term ?orders? in all care contexts, as in, ?signing home care orders." This is a vestigial organ, another leftover from the nineteenth-century military hospital model, useless in the modern corpus of healthcare writing. It should go without saying that a nurse is no longer an inferior in a hierarchy with the physician on top. So let?s do without saying anything that implies otherwise.

One of the ways I work on this is in my volunteer work on the State Nurse Practice Advisory Panel. While many of the advisories on which we are asked to opine are related to areas not in my clinical background, I make my contribution by editing for clarity and usage. Making ?(doctor?s) order? go away in favor of ?medical plan of care? and ?provider?s prescription? both recognizes that many parts of the medical plan of care are prescribed by advanced nurse practitioners and subtly removes the assumption that nurses implementing parts of it are somehow subservient, less than collaborators. Every advisory I review leaves my desk with those alterations. They have been well-received.

These archaic usages are so deeply ingrained in nursing culture that it?s a challenge even to notice them. And like other subtle, culturally-embedded forms of discrimination, the more you see them for what they are, the easier they are to recognize and remediate. Fortunately, as nurse writers and editors, we can make a difference just as subtly and (I hope) as effectively.

So what do you think? If all nurses always wrote, "Call to Dr Smith to report low u/o. Lasix 40mg IV prescribed" instead of "ordered," or, "Call to Dr Smith with lab results, no additions to plan of care," what would change? How does that feel?
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Old 09-17-2015, 05:24 PM
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I tend to agree with you, but I also think that there's a degree of laziness involved that stands in the way of most changes. People seem to be inclined to stick to the status quo if it requires less effort than it does to change things, even for the better - or am I just old?

The thing which seriously annoys me is this overwhelming tendency to try to make nursing (and health care in general) into some giant, feel-good customer service industry dripping with perfunctory directions to have a nice day (I actually told someone to stuff it recently in response to that particular platitude after my questions were answered with shrugs and smirks). Health care is a serious business and I resent being treated as if I had come to some store seeking a product that they no longer carried.


That's just me, not to mention age.
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Old 09-22-2015, 06:58 PM
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Yup, I have been fighting the use of "Nurses' Training" (just hate that terminology) with references to dogs and soldiers.

Though it's shorter to type "Dr. notified of B/P, no further orders" I will state "Dr. notified of B/P, no changes to plan of care."

Hadn't thought about the awards thing but I will now.
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Old 09-24-2015, 09:33 AM
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Whoops, just posted this in the Good Morning! thread, and should have put it here!
"Happy National Punctuation Day! That's right, on this day in
2004 Jeff Rubin founded this holiday promoting the correct usage
of periods, commas, semicolons, and any other punctuation mark
you can think of! According to CBS News, Rubin founded the
holiday after his frustration with punctuation errors he noticed
in the newspaper. His background as a reporter and newsletter
editor made him hypersensitive to the errors he saw daily,
prompting him to create a holiday dedicated to punctuation
awareness. Rubin himself said this holiday is to be celebrated
by: sleeping in late, identifying punctuation mistakes on
business signs or in the newspaper, and writing your own
error-free letter to a friend."
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Old 09-24-2015, 02:25 PM
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Dang! I forgot to sleep in late. Errors in grammar drive me berserk. What seriously bothers me is the hideous possibility that, given the frequency of some of these errors, they might some day be incorporated into the language as correct.

NOOOOOOOOOO!!!!!!!!!!!
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Old 10-18-2015, 07:52 AM
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Quote:
Originally Posted by Poliopioneer View Post
Dang! I forgot to sleep in late. Errors in grammar drive me berserk. What seriously bothers me is the hideous possibility that, given the frequency of some of these errors, they might some day be incorporated into the language as correct.

NOOOOOOOOOO!!!!!!!!!!!
My personal teeth-gritter is the plural "they" used as a pronoun for one person, as in, "If a nurse wants a break, they should ask their charge nurse." Makes me absolutely nuts.
Also, I despair ever the use of "literally" to mean something like "really" or to add emphasis. "I literally could not get out of bed" doesn't mean you were so tired it was hard to do. It means you were physically restrained so you could not have gotten up even if you wanted to. That's the meaning of "literal." I loved the commercial that says, "We literally put our money where our mouth is," and somebody says, "No, we don't literally do that," meaning that real currency is not going in anybody's mouth. (And of course, "we" don't have "a mouth.")
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Old 10-18-2015, 08:13 AM
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I want to bump this discussion because it really is that important.

Every year, as I grow my skill set, I am sought out to take the sickest of the sick, yet I feel less valued by patients, administrators and some physicians.

We are excluded from the day to day operations, told that "the standard in the industry" is some unsafe ratio and are expected to tolerate abuse. Not long ago, I was in a meeting reviewing incident reports, which was nothing but a huge nurse bashing session by "leadership" and physicians. When I stated " that's not true" and stated what actually happened, they looked at me in shock as if I had committed a huge faux pas or pooped on the table. I am quietly resentful about how adversarial, rather than collaborative, the workplace has become over the past five years. It starts at the top.

Words have power. Saying "orders" is gives the doctor power over us that he does not really have. Let's say prescription and plan of care rather than order from now on.

The public doesn't trust us because we lack confidence. They want to feel that the nurse is their protector. We need to use words that define our role and responsibilities. If you hear someone refer to him or herself as "just a nurse" or hear that phrase from anyone else, inform him or her that she/he is the nurse in charge of the patient." Because when things go south, you aren't just a nurse anymore; you are held responsible for anything and everything.

Last edited by icurnmaggie; 10-21-2015 at 08:30 AM.
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Old 10-18-2015, 10:23 AM
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While I have written "no further orders at this time" and the like many times without thinking, this post has certainly given me a different view on how much language matters. I find myself correcting patients and family members when they make certain statements, yet, I suppose I was doing just the same.

Without saying too much, I had a patient once that wanted a change in their plan of care (r/t medications) I stated that I could not do that, but, I would be happy to advocate for them and let their physician know. They responded by saying "oh that's right you're just the nurse, you have to check with the chief for your orders." Needless to say, I promptly schooled them on what I actually do and that my only "chief" is the manger that I directly report to. If we as nurses change our language and the way we refer to ourselves, I wonder if statements such as that one would start to subside and the public's view on us might change.

Professional articles using "prescription and plan of care" would be a great start to changing our language. I always felt that the media plays a huge role in how we are viewed as nurses also (as with other professions), however, that is a-whole-nother topic. I won't digress.
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Old 10-18-2015, 01:15 PM
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Not to mention this whole "customer service" crap that threatens to relegate nurses to the category of shopgirls and salesmen, none of whom are particularly venerated by society. I keep getting these stupid Press-Ganey surveys (both by e-mail and snail mail which I refuse to acknowledge, let alone fill out - other than the one where I practically wrote a book on my views of the whole mess. Too bad they probably weren't read, but at least I have something to refer to if I ever get questioned about why I won't participate.
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Old 10-19-2015, 12:42 PM
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Quote:
Originally Posted by icurnmaggie View Post
I want to bump this discussion because it really is that important.

Every year, as I grow my skill set, I am sought out to take the sickest of the sick, yet I feel less valued by patients, administrators and some physicians.

We are excluded from the day to day operations, told that "the standard in the industry" is some unsafe ratio and are expected to tolerate abuse. Not long ago, I was in a meeting reviewing incident reports, which was nothing but a huge nurse bashing session by "leadership" and physicians. When I stated " that's not true" and stated what actually happened, they looked at me in shock as if I had committed a huge faux pas or pooped on the table. I am quietly resentful about how adversarial, rather than collaborative, the workplace has become over the past five years. It starts at the top.

Words have power. Let's say prescription and plan of care rather than order from now on.

The public doesn't trust us because we lack confidence. They want to feel that the nurse is their protector. We need to use words that define our role and responsibilities. If you hear someone refer to him or herself as "just a nurse" or hear that phrase from anyone else, you say "the nurse in charge of the patient."
I agree with you. In fact, I have had an issue with the 3 2s "To" for going somewhere or doing something, "Too" meaning also, and the "number 2" spelled two. So many get it wrong.
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