Nurses vs. Robots: No Contest

An article about robotic technology caused a minor controversy last week when it appeared to imply that "nurse" robots could replace scrub nurses. The flurry of emails and discussion it generated illustrates the nursing profession's perception problems.

The seemingly innocuous piece discussed fascinating hand gesture recognition technology developed by Juan Pablo Wachs, assistant professor of industrial engineering, and others at Purdue University.

Visual recognition technology has previously been the purview of science fiction. With Wachs’ prototype, it's potentially a few short years away from implementation in operating rooms around the country.

The creators say the robot can recognize surgeons’ visual cues to pass instruments or recognize commands to display data during surgeries. The hope is that robots may reduce length of surgeries and potential for infection.

Robots may eventually perform some tasks now performed by scrub nurses, such as handing surgeons instruments. That’s where the debate begins. The article describes the high-tech machines as “robotic scrub nurses” and Wachs discusses the advantages the machines have over human scrub nurses when working with unfamiliar surgeons, for example.

It didn’t take long for nurses to complain to me about the use of the term “nurse” and the implications that robots could replace humans.

“There’s a lot of power in a name,” says Kathleen Bartholomew, speaker, author, consultant, and nurse. “The real problem is that the casual use of the word in this way validates what we already know—which is that the general public doesn’t know what we do.”

Bartholomew believes misrepresentation undervalues and damages the profession. That leads to the second point that nurses may be replaced by a machine. At first glance, this is laughable. Outside of science fiction, no one believes machines can replace humans.

“Robots cannot detect subtle changes in patients before they crash and intervene to save their lives,” says Sandy Summers, RN, MSN, MPH, founder and executive director of The Truth About Nursing, an advocacy group that works to counter misrepresentations of nursing in the media. “Robots cannot advocate for patients and correct the surgeon who is removing a gallbladder instead of removing a pancreatic tumor, because he forgot which patient this was. Robots cannot eject drunk surgeons from the operating room.”

The nurses I spoke with cite the discussion of the robot scrub “nurse” as evidence of the commonly-held belief that nursing is merely a collection of tasks that can be completed by anybody. According to TV programs like ER and Grey’s Anatomy, nurses are invisible minions who carry out low-skilled tasks such as emptying bed pans and bringing food trays. While everyone who works in healthcare knows these portrayals are inaccurate, even within healthcare the role of nursing is frequently misunderstood and undervalued.

Furthermore, the public doesn’t understand the value that nurses provide to patients and healthcare teams. They do not see the role of nurses as critical to safety because there are no true-to-life examples in the media.

If the public doesn’t understand what nurses do, then nursing priorities do not get resources allocated. Bartholomew cited the proposed reductions of the nursing workforce development programs and health professions funding by 29% over fiscal year 2010, which are before Congress. These resources are desperately needed to ease the chronic faculty shortage in nursing schools and to open more spaces to educate students so that we have enough nurses to meet the looming nurse shortfall created by the inevitable aging baby boomers.

“Clearly the general public doesn’t know what nurses do,” says Bartholomew. “It’s easy to understand why for two reasons. One, we don’t tell them. Nurses don’t sit around bragging about how they saved someone’s life or intercepted a potential physician error or broke the news to a mother that her baby was not going to live. We don’t talk about these things amongst ourselves, let alone the general public. And the second reason is because of the obvious mis-portrayal of nurses in the media.”

When a profession is misunderstood and undervalued, it does not reach its potential. In the era of healthcare reform, we need nurses—fully-engaged, well-educated, skilled professionals with vigilant observational and critical thinking skills—to meet the needs of our patients.