Best-selling journalist Alexandra Robbins has gone undercover again, exploring the world of The Nurses: A Year with the Heroes Behind the Hospital Curtain. While investigating a profession she calls a vital and grossly undervalued "secret club," she has unearthed a multitude of no-holds-barred truths and anecdotes revealed in interviews with nurses across the country. Now that Robbins' research and writing are complete, she reflected on the experience, explaining how this latest project surprised and changed her.
You’ve written previous books about geeks, overachievers and sorority sisters. What prompted you to write about nurses?
Nurses had been asking me to write about them for years. They wanted to get their views and stories across in a way that both nurses and the general public would find entertaining. I had initially resisted because I was on the education beat. But once nurses began telling me their stories, I was hooked. I think every nurse in the world has some incredible stories.
You write that “contemporary literature largely neglects” nurses. What’s the reason for that neglect?
My guess is that people make assumptions based on medical TV shows, which get the picture wrong. I don’t think the general public realizes just how much nurses actually do and how vital they are. They’re not just the folks who administer medicine, flitting in the background as the doctor pines by the patient’s bedside (“ER,” “Grey’s Anatomy,” etc.). The nurses know patients far more intimately than doctors do. They’re skilled and educated; they’re scientists, detectives, liaisons, advocates, teachers, diplomats, and so forth. But TV would have us believe they’re “Yes, Doctor”ing background minions rather than a critical part of the healthcare team.
"Nurses’ voices mostly go unheard, and this was an opportunity for them to get their messages across—their hopes, fears, concerns, frustrations, joys."
What was your most surprising or shocking discovery as you researched this book?
I was shocked repeatedly throughout my reporting. There are so many things that people can do to get themselves and loved ones better care—and in some cases lifesaving moves—in the hospital. But if I were to pick one shocking item, I’d say I was most surprised by some of the doctor misbehavior that goes on behind the curtain. Many doctors are wonderful, of course. Some, however, have done some pretty staggering things to patients (twisting nipples while patients are under anesthesia, pushing them to get surgery they don’t need, ignoring Do Not Resuscitate orders) and to nurses (throwing scalpels and other instruments at them, ignoring their pleas that a patient needs help, groping them, berating them). That was pretty eye-opening.
What do you think is the most common misconception about the profession?
I think the biggest misconception is that they aren’t a major part of the healthcare team. As one nurse told me, “We are not just bed-making, drink-serving, poop-wiping, medication-passing assistants. We are much more.”
Your book features profiles of four nurses and gives readers a “you-are-there” look at their experiences over the course of the year. What research process did you use to capture their stories? Did you shadow them on the job?
The process included interviewing, shadowing, and even some undercover reporting. I wrote the book this way so that it would have a fun, beach-read kind of feel for both nurses and for the general public. That’s the kind of nonfiction I like to read, anyway.
You use pseudonyms for these four nurses, and don't identify where they live or what hospitals they work for. Was this a difficult decision to make? Did you know from the start that you wouldn't be able to use identifying details?
Oh sure, I knew from the start. I was asking nurses to peel back the curtain to show us things that hospitals don’t want people to know. For the nurses to be able to share freely, they had to trust that their identities—and those of the doctors, other nurses, etc. in the hospital—would be protected. I have offered sources this kind of privacy in all of my books, from Pledged on forward. It’s important that my “main characters” are completely open, without fear of reprisal, so that they can share honestly and thoroughly with readers.
How did you go about winning the trust of those you profiled? Were nurses eager to share their stories? Were some reluctant to talk to you for fear of reprisals?
All of the nurses I spoke to were eager to share their stories; I had more nurses who wanted me to follow them as “main characters” than I had room for in the book. Nurses’ voices mostly go unheard, and this was an opportunity for them to get their messages across—their hopes, fears, concerns, frustrations, joys. I guess by now I have a reputation for protecting my sources, so trust never came up as an issue.
I think The Nurses would be fascinating and helpful to nursing school students, but I also worry that some of the harsh realities you describe might be discouraging. What advice do you have for those about to enter the field?
You make a good point; someone described the book as a One L for nurses. The Nurses makes clear, I hope, that even though nursing is not an easy job, it’s a rewarding, fulfilling, life-changing job that nurses feel passionately about. They told me repeatedly, “Nursing isn’t a job. It’s who I am.” I think students who want to go into nursing already feel that pull. There are challenges to every job, but nursing school students are well-prepared to anticipate them and to manage them. And the incredible moments of connection or healing that warm their hearts really carry them through their days.
I love all of the testimonials at the end of the book from nurses who adore the profession, but one that they told me frequently was along the lines of “I make a difference in someone’s life every working day.” How many people can say that? That’s just awesome.
One reason I didn’t romanticize the profession is because nurses need people to help them fight for better working conditions. We all do, actually, because better nurse environments (especially better nurse:patient ratios) translates to fewer patient deaths, infections, complications, falls, etc. But many hospitals haven’t been willing to hire more nurses and treat them right. How can we improve hospital care if we don’t talk about the issues? Glossing over them doesn’t serve anyone.
My advice to nursing students is to remember that there are many, many different types of nursing jobs. Nurses are everywhere—not just in hospitals. They can talk to seasoned nurses to try to figure out which nursing path is right for them.
How is your experience writing this book likely to change your thoughts when you enter a hospital, either as a patient or a visitor?
I’ve always brought treats for and expressed gratitude to nurses anyway, but now I want to give them all hugs, too. They are truly amazing. And the tips they gave me for my own or my loved ones’ hospital stay are invaluable. I have a list now that I pulled from the book that I will take with me whenever I visit a hospital, because you never know which tip will come in handy.
RELATED CONTENT: Read our review of The Nurses.
Author photo by David Robbins.