The Value of Nurses

This article in the Toronto Star about the salary inequality of non-unionized and unionized nurses caught my attention, not so much because of the story itself, but because of the comments which followed. For some reason, when nurses’ wages are discussed, people go a little nuts. Apparently, we’re all lazy, stupid and overpaid. Some representative comments:

Nurses often say they work hard, handle more than a person should but I wonder, who makes those standards? and who are they making this comparsions [sic] to? I have been to a the public hospital here and oversea in asia (Hong Kong – not a third world country). When I compared to that, our nurses gossip too much, slack off often, slow paced and unefficient. Most nurses also carries this arrogant attitude when I talk to them while the ones I been to oversea is polite, helpful, direct and informed. I am not slamming unions, it’s just that they have to be realistic. Many skilled workers work much longer hours, handling more work and bring home much less. Nurses should be thankful they have a relatively secure well paid job compare to most of the workers in Ontario.

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You have to feel sorry for all those poor nurses. Here I work in a totally private company as a professional and can only dream of making $40 per hour. When will this madness ever stop? When will the public service employees realize they are not worth that much money? When will they stop holding their friends, family, and neighbors’ hostage, and stop sucking us dry? I think the real question here is why are the other nurses worth $49 an hour? Maybe they should take the pay cut down to the other nurse’s wage???

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Except the MDs who already get the astronomical pay I met showing some good attitudes, many health professionals like nurses, lab technicians taking medical tests, X-ray pictures are sometimes overly domineering, arrogant and unprofessional. Once, I did a body checkup in a clinic and a medical test in a medical laboratory, I was told to follow the steps like taking off the clothes by these ‘medical professionals’ in arrogant and almost rude manners. I didn’t feel surprised because these people are well protected by job security and don’t need to provide any good customer service to patients. Staying in hospital would be worse by deduction.

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. 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 paradigm slightly amended: 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.

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  1. #1 by Kev on Monday 06 September 2010 - 1046

    I wouldn’t take what is posted in the comments sections re pay levels to much to heart. You see most of the nastiest comments are from people who bought into the propaganda machine exhorting them to get an education, and you will earn your place on the gravy train.

    They now sit in their tiny little cubicles, staring at their meager paycheques, wondering how in hell they are going to ever pay off their student loans, and they are justifiably angry. The problem is that they take their anger out on the wrong people. Instead of attacking the corptocracy that has so corrupted our political system, they go after anyone else that they perceive to be doing better than them.

  2. #2 by evilscientist on Monday 06 September 2010 - 1117

    We get pretty much the same thing in education. My response to people who complain about teachers being overpaid and under worked is if it’s so good to be a teacher, why aren’t you one? Usually shuts ’em up.

  3. #3 by shrtstormtrooper on Monday 06 September 2010 - 1123


  4. #4 by Not Nurse Ratched on Monday 06 September 2010 - 1658

    Good point. I think even nurses forget how valuable we are for what we know and not necessarily what we do, because it IS immediately obvious how tired and overworked we feel and not so immediately retrievable how we seriously affected a patient’s survival by reporting this or that small sign to a physician that otherwise would have been overlooked. We totally do need to stop focusing on the negatives and being on the defensive and instead focus on the positive things about our profession and the things that differentiate us from other professions, because the public really doesn’t know, and we’re not helping them learn.

  5. #5 by Jenn Jilks on Monday 06 September 2010 - 1849

    You’re flogging a dead horse, Jay. We know what you do and why you went to school to learn it. My hat is off to you and yours in the profession. We cannot do without you. You cannot judge those in the ER, ED, or in crisis, as in hindsight, they realize that you are the queens of the kingdom.

    • #6 by torontoemerg on Friday 10 September 2010 - 1157

      /sticks out tongue :) Love you, Jenn.

  6. #7 by hereticrn on Monday 06 September 2010 - 2332

    I would also suggest that we are paid well not because we wade in shit, piss and vomit, but because we take the What we know and use it in the What we do to within the Where we work to do everything we can to make sure you either survive or die not alone.

  7. #8 by @rdjfraser on Tuesday 07 September 2010 - 0217

    Amazing post, Suzanne Gordon would be proud! Nurse cannot do nearly enough to explain what we know to the public. This is exactly what I talking about during Nursing Week, when there was a lot of talk of getting rid of it. This is the message that we need to be sending and acknowledging, not that we deserve chocolates and extra coffee. Nurses need professional recognition and to be valued for what we do.

  8. #9 by Sean on Tuesday 07 September 2010 - 0818

    Well said, well said. I think the take home message is two-fold. We as nurses deal with life-and-death decisions on a daily basis. We get paid to understand and recognized what and when a true emergency is unfolding.
    Second – we get paid, not for what we ‘do’, but more for what we ‘need to do’. Split second decisions and reflexive actions cannot be ‘taught to a monkey’ when emergencies arise.
    We are there for the ‘what to do’ and the ‘what if.. ‘
    And yes we continue to be underestimate, under appreciated, undermined and misunderstood – so the battle wages on.
    GREAT post. You have a new reader!

  9. #11 by The Nerdy Nurse on Tuesday 28 December 2010 - 0904

    remember reading this and loving it.
    For someone reason no one seems to complain about what physisicians make, because they are compensated for what the “know”. If the public were aware of how much our involvement with their care and what we know impacted their outcomes, I beleive this gruff opinion that we are undeserving of our compensation with diminish.
    In addition to the fact that we talk the talk, we also walk the walk.
    When is the last time a physician put down an NG tube? yet he gets all the credit for alleviating you from your immense pain and discomfort.
    What do I get? The guilt of putting you through the trama of the procedure, and the distrust from you for violating you… never mind that your bowel obstruction was resolved because I not only suggested, but also placed your NG tube. Be sure you give all that glory to the Doc who signed off on the order that I wrote on behalf of him.
    your welcome.

  10. #12 by Sarah on Wednesday 25 September 2013 - 0001

    Nursing is critical to patient health and recovery. Nurses are responsible for the day to day care of the patient. Nurses are also useful for disease prevention and chronic disease management (trust me, MD wants to go to school 12+ training in the medical model of care to tell fat Type 2 diabetics they need to stop eating pie).

    That said, yes nurses know how to
    do all the technical things listed. Respiratory threrapists can also expertly read EKGs, blood gases, and recognize heart sounds. As can paramedics. These things alone are not rocket science.

    Nurses are never trained in pathology using the medical model of care to form a differential diagnosis of disease. Otherwise they’d be unhappy underpaid junior doctors. Try calling a nurse a para doctor and see what they say. Nurses seem to forget that the nursing model of care and training is a different role from MDs.

    Sure nurses save lives and do some great things providing care for patients, but many other jobs do as well. Personally, if I have a disease, I’d be putting all my money into the MD/PhD in the lab trying to cure me vs a “good” nurse. I find most nurses can provide basic care but anything advanced is rightfully over their training. Good nurses recognize their limitations, not toot their own horn. So I gave up expecting competent nurses while in the hospital.

    Yay so you can recognize a cardiac cycle or a hypoglycemic attack in your patient (how did you let the patient get that way in the first place?!). That still doesn’t mean you have knowledge worth $40 hr+.

    • #13 by Sarah on Wednesday 25 September 2013 - 0004

      Sorry, should read “NO MD” wants to spend time blabbing about common sense lifestyle choices and behaviours, and people’s lack of ability to make intelligent health choices. Thanks to nurses, who seem to love patient education.

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