1. Diers, Donna PhD, RN, FAAN

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My RN licensure form surfaces in a pile of bills. For a moment, I wonder whether to keep my license active. It's an easy decision. Although I haven't touched a patient in a long time, it's still important to me to be licensed.


Since leaving clinical practice, I've been a faculty member in nursing and in public health, a dean of a school of nursing, and an editor of a national nursing journal-at times, all of these at once. But no matter my title, I've always been a nurse.


So what is my definition of nursing? Nursing is two things: the care of the sick (or the potentially sick) and the tending of the entire environment within which care happens. Throughout the years of changing job titles, the latter became my mission. The tending of the entire environment became more than an excuse for me to feel useful; it became the way I thought about the part of nursing that is central but invisible.


We nurses know how to get a patient discharged, how to get the right physician to show up, how to get the blood lab to pay attention, how to get a meal to a newly admitted patient in the middle of the night, where to find the secret cache of pillows, whom to call to get the defibrillator fixed, where the extra supplies are really hidden.


We know which surgeons to avoid scrubbing with, why the hospital is losing money on supplies, how patients are triaged from the ED to other units and counted in the census for billing, how mentally ill children wash through the health care system, why the work gets harder in the cardiac surgery intensive care unit when technology changes and stents replace coronary artery bypass grafts and the ICU fills up with "bellies" and trauma.


I currently work with a hospital finance department and decision-support team, mining the system's administrative data to contribute to decisions about practice, operations, and finance. The accountants and managers I work with are sweetly responsive when I can help them to see how their work might actually make a difference to the organization's patient care mission. I help them understand that the numbers they work with-the number of patients seen in the ED, enrolled in a special clinical program, or immunized for the flu-are not just numbers, but people. I've found that they want to better understand how things really work, even if occasionally my graphic description of the Whipple procedure stops the conversation cold and turns faces green.

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Isn't this nursing?


It's clear to most of my colleagues that it is. I know that they see me as a nurse when they ask how they can make the health care system work for someone they care about. When a colleague is having trouble reconciling conflicting clinical feedback, I might be asked for advice.


I know that I'm a nurse when I mine the administrative data to help nurse managers or clinical nurse specialists make sense of and take credit for their work. I know it when I supply information that will help fend off a potentially stupid decision threatening to waste money and compromise the ability of nurses to deliver care. Through my work with data and data translation, I've become an advocate for patients and patient care.


So I'm moderately offended when one of my colleagues in finance refers to me as "a former nurse." I clarify: I'm old but never former. Still, I'm not on the nursing listservs for meetings and events or notices of deaths, wakes, marriages, and changes in positions. I'm not among those who are notified when something important happens. And (sob!!), during Nurses Week, I don't get invited to the parties.


There's a whole underground of nurses out there, in business offices; in corporate compliance offices; and in decision support, legal, and informatics departments. For the most part, we don't know one another. Yet one of the joys of my present job is the opportunity to stumble onto these professionals. We recognize one another-nurse to nurse-by our understanding of how health care delivery really works. Most of us haven't left nursing, we've just broadened the definition.


There's no category on the licensure form for what I do, so I check "other." I'm an Other Nurse.