The nursing science behind nurses as coronavirus hospital heroes

The coronavirus pandemic has given nurses a rare moment in the media spotlight. They are being heralded as lifesaving heroes on the front lines of the pandemic. The Covid-19 fight is a team effort, but nurses have a unique role. In intensive care units, 86% of patient care time comes from nurses, while only 13% comes from physicians.

Nurses have always enjoyed public respect and are routinely rated the No. 1 most honest and ethical profession in the United States. But this moment in the media spotlight highlights how little most people truly understand about nursing.

Despite being the largest health care profession in the U.S., with almost 4 million nurses, we are hard-pressed to find almost anyone who can articulate exactly what “nursing” is and what nurses are doing in the fight against Covid-19. How would you define nursing? (“Doctor’s assistant” is the wrong answer.)

Unclear definitions of the profession heighten the lack of public understanding of nursing. One nursing organization says it is “the glue that holds a patient’s health care journey together … an art and a science; a heart and a mind.” We have no idea what that means, and we’re nurses ourselves.

Like medicine, nursing is a scientific discipline, and it’s time people see nurses as more than just angels or heroes. Nurses are not kind and heroic simply because they are good people, but because nursing science tells us that building relationships with patients and treating the whole-person response to disease is therapeutic for their health.

We define nursing like this: Nursing is the diagnosis and treatment of the human response to health and disease. This is distinct from medicine, which is about the diagnosis and treatment of disease itself.

Nursing involves assessing how people react physically, psychologically, emotionally, and spiritually to disease and the state of their health. It also helps them respond to disease and health. It is a scientific discipline, like biology, or oncology, or radiology. It has a history, philosophy, and theory-driven body of scientific research. That includes nursing scientists, who hold PhDs and are responsible for expanding scientific knowledge.

Nursing does not lend itself well to the -ology verbiage typical of medical science, but perhaps that’s fitting because nursing science is different than many other types. It is a practical, action-oriented science rather than a purely theoretical science. It is concerned with how to use research to improve health and health care for real patients, families, and communities.

Nurse scientists are rare, which may be another reason why many people haven’t heard of nursing science. Less than 1% of U.S. nurses hold a Ph.D. That is a problem for both research and patient care. Our country is facing a severe nursing shortage, with a projected gap of 200,000 nurses per year through 2026. One key reason we can’t increase the number of nurses in the U.S. is the shortage of nursing scientists and educators: There just aren’t enough of them to educate the nurses we need or expand our science so it reaches public awareness.

U.S. nursing schools were estimated to have turned away more than 75,000 qualified applicants in 2018, due in large part to an insufficient number of nursing faculty. High-quality nursing education matters for science, but also for health care. Patients are less likely to die in hospitals staffed with more highly educated nurses. We desperately need more nurse scientists for both educating new nurses and leading nursing scientific innovation.

There may be a more insidious reason most people haven’t heard of nursing science and scientists: Those working in this field are mostly women. The National Institute of Health estimates that 92% of students in research-focused nursing doctoral programs are women. That reflects the gender makeup of the nursing profession, 91% of U.S. nurses are women, but not the percentage of women scientists in the U.S., at 35%.

Gender bias in science is well-documented. Women scientists receive fewer research grants, fewer scientific publications, lower pay, hold fewer academic leadership roles, and are less likely to have their science covered in the media. Because nurse scientists are predominantly women, gender bias may affect the uptake of nursing research findings in a more negative way than it affects other fields. Other reasons why few people know about nursing science include the discipline’s youth (the first Ph.D.s in nursing were granted in the 1970s) and the small size of its scientific workforce size. The public’s feminized perception of nursing as a kind-hearted rather than smart-minded profession also undoubtedly plays a role.

Nurse scientists are responding in full force to the coronavirus pandemic along with epidemiologists, virologists, experts in infectious diseases and critical care, and others. They are studying the impact of Covid-19 on caregivers and family members; the stress and emotional well-being related to social distancing; and how Covid-19 affects pregnant women, children, people who are homeless, and those with cancer; to name just a few projects. They are also studying how to support, protect, and sustain our limited health care resources in the pandemic, especially nursing resources. An ICU bed for a Covid-19 patient is nothing but a bed unless it comes with a highly skilled critical care nurse to provide intensive care.

Nursing science is a bit like an iceberg: much of it unseen. As Covid-19 highlights the irreplaceable work that nurses do in direct patient care, it is an opportunity to consider the science underlying nurses’ work and what this unseen science offers our healthcare systems and communities. Nursing science can offer patient-centered interventions and whole-person care that go beyond disease treatment alone. This type of holistic care matters for achieving positive patient experiences, but also favorable health outcomes. People are finding themselves more isolated, afraid, and grieving in the Covid-19 era. As the pandemic intensifies, treating the human side of this disease with the foundation of nursing science may be the thing we need most.

Kristen Choi is a psychiatric nurse and assistant professor at the UCLA School of Nursing. Anna Dermenchyan is a director in the Department of Medicine Quality at UCLA Health and a doctoral student at the UCLA School of Nursing.