EP 124: Designing Nursing Care | Sarah DiGregorio
This week we talk about the story of nursing and how it has shaped our world.
Sarah DiGregorio is the critically acclaimed author of Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human and Taking Care: The Story of Nursing and Its Power to Change Our World. She is a journalist who has written on health care and other topics for the New York Times, the Washington Post, the Wall Street Journal, Slate and Insider, among others. She lives in Brooklyn, New York, with her daughter and husband. For more information please visit her website: http://sarahdigregorio.com/
Episode mentions and links:
Book: Taking Care: The Story of Nursing and Its Power to Change Our World
Book: Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human
Book Review: Healing the Unsung Healers via NYT
Sarah Digregorio at HarperCollins Publishers
Sarah’s restaurant rec: Ayat NYC
Follow Sarah: Twitter | Insta | LinkedIn
Episode Reflection:
Hi from Dublin, Ireland! This week, the Health Design Lab is geeking out about health design in Dublin for the HSE Spark Summit Innovation Conference. And in the context of innovating in healthcare with better design, we have such a great episode for you this week!
I learned so much from our guest, Sarah DiGregorio, on this week’s episode. The stories she share about the unsung heroes of nursing throughout the ages really blew my mind. And her take on the idea that caring for the vulnerable is one of the great strengths of human kind and posits that nursing is as old as humanity itself. Yet despite this, due to many complex factors discussed with Bon this week, nursing tends to be put into a very rigid box by many. You HAVE to listen to this week’s episode (and of course read Sarah’s latest book) to hear these incredible stories that are sure to change your perspective not just on nurses and nursing, but on healthcare itself.
At the end of this week’s episode, in a very designerly way, Sarah posed an excellent question, “What if we thought about this differently and we had an actual healthcare system that was designed to maximize everyone's health and wellbeing, what would that look like?” She goes on to say that it would likely look like nurses deployed in radically different ways. “Nurses' strengths are not optimized in the system that we have. They're not fully used. And nurses I think are always gonna be unhappy as long as that's true.” If current systems aren’t working for anyone, then what can we do?
For this week, I’ll leave you with the following question. How might we deploy nurses in radically different ways to promote upstream preventative healthcare and how might we rebuild our financial incentives to pay for this? Leave your answers in the comments and send to us on social.
Written by Rob Pugliese
We want to know what your favorite “Design Fails” in healthcare are! Share them with us on social or via this FORM.
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Bon Ku: Hi, I'm Bon Ku the host of Design Lab. It's a podcast that explores the intersection of design and health. You can find me on Twitter at B O N K U and on Instagram at D R B O N K U.
Our guest today is Sarah DiGregorio. She is the critically acclaimed author of Early, An intimate history of premature birth and what it teaches us about being human.
And she also wrote Taking Care, the story of nursing and its power to change our world. Sarah is a journalist who has written on healthcare and other topics for the New York Times, Washington Post, Wall Street Journal, Slate, and Insider. She lives in Brooklyn, New York with her daughter and husband.
Please, please, please visit our website designlabpod.com. You can sign up for our newsletter, learn more about the guests. And there's a new thing that we're doing. You could submit your favorite design fail in healthcare.
What's a design fail? One of my favorite ones is having to fax over information to a doctor's office in 2023 to get medical records. This should not be. We will select one of our favorite design fails and share it with our entire listening audience.
If you liked the show and enjoy what you're hearing, please support us. You can do that by going to Apple Podcast and leaving us a review and giving us five stars. You can also give us five stars on Spotify as well. And subscribe to our podcast and tell someone about the show. Now my conversation with Sarah DiGregorio.
Interview
Bon Ku: Sarah DiGregorio. Welcome to Design Lab.
Sara DiGregorio: Thank
Bon Ku: you,
Sara DiGregorio: much for having me.
Bon Ku: Your book just came out.
It's called Taking Care, the Story of Nursing and Its Power to Change Our World. what was your inspiration for writing this book?
Sara DiGregorio: Well, I'm a journalist. I have a background in journalism, and it's really all I've ever done, but the inspiration for this book in particular was actually nursing care that I have received throughout my life. Both as a family member, actually primarily as a family member and myself. So I grew up as the only child of two chronically ill parents who both died relatively young.
And I am the mother of a daughter who was born at 28 weeks and of course needed months of intensive care and then years of follow up care to become the spunky third grader that she is today. So really, it was those experiences with nursing and these very profound and pivotal moments in my life.
That was the spark for this book.
Bon Ku: Hmm. And are you a nurse?
Sara DiGregorio: No, no. I'm a journalist.
Bon Ku: And was that hard doing all the research to write this book? Tell us about what that process was like.
Sara DiGregorio: Yeah, it was very difficult as it should have been. it was quite appropriately difficult. it was, you know, one of the things I love about being a journalist is that, you're an expert in finding things out. You're an expert in finding the people who know the things. Journalists. Have beats that we specialize in, but we are not necessarily subject experts.
and our skills are really about finding the people who are knowing how to ask them the questions that need to be asked, and then translate that for the general public. To really draw the general public into these topics. and so really that where I started and where I usually start, even if it's not foregrounded, is in these questions that I have as a person.
And I think. When you're in healthcare systems, as a family member, as a patient yourself, you end up with a lot of questions and it is very, very difficult a lot of the time to get those questions answered and to really understand what happened, what is happening. So I always start. With those questions that have come up for me, and then I can use my skills as a journalist, which really involves not being afraid to ask like a bunch of dumb questions over and over and over again to find out, you know, what is the lay of the land, you know, what is going on here.
And then to put that together and to sort of build narrative out of it and translate it for a general audience. Because my feeling is that if I have these questions, other people have these questions too.
Bon Ku: Yeah.
Sara DiGregorio: So I actually, I started working on the book right before the pandemic. I had a meeting with my editor.
A restaurant on like March 10th in New York City. Huh. And I had my hand sanitizer out and she was like, why are you, what are you doing with that? Why do you need the hand sanitizer? And I was like, I don't know. I'm just, you know, I'm feeling kind of nervous about this. And we talked about this idea that I had, which was that.
You know, nurses comprise the majority of the healthcare workforce. Nurses provide the most direct patient care, and yet I really hadn't seen their role explored in a deep way for a general audience. And she was like, really? That hasn't been done? And I was like, no, it really hasn't been done. Not for a general audience.
And she was like, well, this is a great idea. Why don't you start working on this? Write up the proposal for me. and so I did, and then of course, like two weeks later, my daughter was home from school and everything shut down and I just kept working, you know, and it became, the need for the book, of course, became increasingly clear, but even absent the pandemic, it was something that I felt really, really drawn to and really moved to wright.
Bon Ku: Yeah,
Sara DiGregorio: Yeah.
Bon Ku: it's such an important book, especially at this time with the severe nursing shortage, the crisis, the crisis of, Overcrowding in hospital and lack of hospital beds. And, I've said this before, I don't, I don't like that description of, you know, hospitals don't have enough beds. We do have enough physical beds, we don't have enough nurses.
Like that is the real essence of it. And so, , a rich book. , let's start off with like challenging a misconception. Most people think a nurse is it's just this profession to help people like me, a physician in the hospital.
Sara DiGregorio: Right. Right? Yes. People think of nurses as assisting physicians instead of nursing being its own discipline that is complimentary with medicine. And that is a huge misconception as you know, something that I spent a lot of time, on in the book, you know, correcting that misconception. and, going along with that misconception, there's a lot that's like built into that.
One of those is that the idea that nursing as a profession arose in relationship to hospitals and physicians, so that while we had hospitals and we have physicians working in them, and then of course we needed nurses within those hospitals, but that is not at all the case. In fact, nursing is the oldest kind of healthcare and it.
You know, it has always been the most fundamental kind of healthcare. And of course nurses play a big role in hospitals. But nurses are actually everywhere and they always have been.
Bon Ku: Yeah. You have this great line in the book. You say, human societies simply cannot have developed and function the way they have without nursing. Give us some examples of that in, in history where nurses have played a role in shaping, societies.
Sara DiGregorio: Well, I'll go way, way back first because I think it's, it's a really powerful example. We think of our, earliest ancestors perhaps as kind of survival of the fittest, kind of leave the, leave the week behind kind of societies. We don't think of, say our neolithic ancestors as people who organize care, but in fact, neolithic ancestors did organize care and there's, there's evidence in the thoughtful record that, for instance, people who had, disabilities, people who had illnesses that required care to survive, they often got that care.
And so I think to start out really thinking of ourselves as a species as, It is one of our strengths to care for each other and to organize care for those who need it. Organize skilled care for those who need it. That is a strength of human beings to start out with. And then when you move
Bon Ku: Holy crap. I've never even thought of that. Like, that's like wow.
Sara DiGregorio: Yeah. It really moves me, I have to say, because when you, instead of thinking of ourselves as like, Are we working against our animal instincts? Oh, our animal instincts are just to leave the week behind. No. In fact, some of our most essential and fundamental instincts as human beings is actually to organize care for people who are vulnerable in our communities.
And that has been happening since, you know, pre-history.
Bon Ku: Wow.
Sara DiGregorio: And when you think of, obviously human beings also do terrible things, but it's important, I think. To acknowledge that this is also who we are. And so our choices that we make in terms of how we organize our societies today, we can think of ourselves that way, but it's actually absolutely natural for us to organize our communities to write policy in which the vulnerable are always cared for.
Bon Ku: Hmm.
Sara DiGregorio: You know, that's part of what makes us human. So. Other examples of ways that nurses have influenced the development of human societies, do happen in war, for instance. Obviously war is not, you know, not, that doesn't have that same, takeaway that, you know, organized care and community does.
But, you know, for instance, in the Roman Empire, Most healthcare was private. And there wasn't a lot of organized healthcare sort of within different communities. But an exception to that was that there were military hospitals. And the military hospitals were throughout the empire. They were staffed by nurses.
And that is because the Roman Empire realized that they could not win wars and maintain their empire without nurses to care for their soldiers. And so, and that an example that you can find all over the world and in, you know, that really within a context of maintaining empire, nurses are quite key.
Bon Ku: Hmm. So is that why every country has a form of nursing? One of the reasons why?
Sara DiGregorio: Yeah, exactly. That's one of the reasons why exactly. Other ways that, you know, nurses have shaped human society. There was a nurse who was key to the development of Islam, was, one of Mohammed's advisors, as he was developing, uh Islam as a religion, and he was spreading it in that part of the world.
She became, like a right hand woman to him and helped him organize care for wars that happened as he, , as he spread the religion in that part of the world and what is now Saudi Arabia. ,
Bon Ku: Well, I've never heard that story.
Sara DiGregorio: Yeah, her name was Rufaida. She was really very instrumental in the birth of Islam. So, you know, that's just one example.
I mean, there are just so many examples. There was a, a nurse, in New York City, in the late 18 hundreds named Lillian Wald, who established the first visiting nurse service, but she also came up with the idea of municipal playgrounds. She came up with the idea of school lunches. She came up with the idea of school nurses.
I mean, just, you can, you can pull from different places, different countries, and really see how nurses are not always foregrounded in the histories that are written, but they're always there.
Bon Ku: I mean, nurses are bad asses. They're, they're rebels. They're throughout the history of mankind.
Sara DiGregorio: Yeah, there are these sort of like sea of power that you can find running through different histories where you see, you see, you know, sometimes in a heroic tale of survival, you only hear about the hero who survived, but you don't hear. How did the hero survive while the hero survived?
Because he had a nurse.
Bon Ku: Why aren't these heroes of nursing, talked about or, or written about when you think of nursing? All, most of us just think of Florence Nightingale and we probably can't name one other nurse, but your book has so many nurse heroes, throughout it.
Sara DiGregorio: Yeah, it's really, I think it's a problem. I think it, there's a lot going on there. First of all, the fact that Florence Nightingale is the only nurse that anybody knows about is a problem because she really constructed a version of nursing that replicated the restrictive social organization of Victorian England.
So very, very stratified around class completely. absolutely did not include people of color. You know, there was this idea that the British Empire was quote unquote civilizing. The uncivilized. That was part of her, her vision of nursing and it's a problem that she is the person who has, become this sort of archetypal nurse.
Why are other nurses not written about? Well, I should say first of all, that they are written about by, for instance, nurse historians. And, you know, there certainly within nursing there is within academic nursing in particular, there's a little bit more, attention paid to these historical figures.
But I think that, Our conception of nursing in general is quite impoverished in the general public, and so we don't have rich stories and a rich understanding of the history of nursing because we think of nurses as like a nice woman who takes our vital signs and helps the doctor. And so what is there to say about that really, other than like, oh yeah, we love them.
And everyone kind of leaves it there. But that's, you know, that is truly an impoverished understanding of nursing. So there's a lot of sexism in that. There's racism in that. And in terms of, you know, who's writing the histories, who gets written about?
Bon Ku: Who are some nurses that should be talked about more?
Sara DiGregorio: It's a great question. Oh, there's so many. So, Mabel Staupers Was a nurse, in the early to mid 20th century. She was born in Barbados and she became the executive director of the nursing, the professional nursing organization that was specifically for black graduate nurses. Cuz at that time the American Nursing Association did not admit black nurses.
And so they had their own separate nursing organization, professional nursing organization. Mabel Staupers was committed to the idea that black nurses should be able to serve their country in the Army Nurse Corps. And during World War ii there was this story of the nursing shortage is like the most perennial story.
There's always a nursing shortage, and the nursing shortage is never what you think it is. So, There was this terrible nursing shortage where, you know, there would be a thousand bed hospital in the European context of war, and there would be like two nurses who were taking care of,
Bon Ku: Come on.
Sara DiGregorio: it's,
absolutely
Bon Ku: What?
Sara DiGregorio: Absurd. Yeah. In fact, I can read you, there's this really incredible. you know, the nursing shortage was on the front page of the New York Times during World War ii,
Bon Ku: Oh yeah. Read. Read it. Read it. Yes.
Sara DiGregorio: In 1945, major general Paul Holly told the New York Times that 11 hospital units were arriving in the European War zone without a single nurse.
Army field hospitals that already had nurses were woefully understaffed. How much nursing care do you think that 74 nurses can give to 3000 patients? Poly asked? It was a national emergency. So there were some field hospitals that didn't have a single nurse. There were other times that 74 nurses were taking care of 3000 patients.
Bon Ku: Wow.
Sara DiGregorio: Now, amid all that, the Army Nurse Corps was not admitting black nurses. So there were graduate nurses who had passed. it wasn't called the NCLEX then, but it, they had passed the licensing test to become an RN. And they weren't allowed to join up. Um, there was a very small quota. It was like 34 black nurses were allowed to join up. And Mabel Staupers
took it upon herself to change that. So she, she leveraged every connection she was in, every meeting. she went to see the Secretary of the Army, the Secretary of the Navy. She had a meeting with Ellenor Roosevelt. and she absolutely pounded on this idea that. You know, you're saying that American soldiers are gonna die because they don't have a nurse.
But I have thousands of nurses here, black nurses who wanna join up and you're not letting them. So Mabel Staupers was responsible for desegregating the Army Nurse Corps in the end.
Bon Ku: What a, what a hero. Wow. I've never heard that story.
Sara DiGregorio: Right. And you know, and, she was just so formidable. You know, she'd stand up in these meetings and she'd say, you say there's a nursing shortage, but I have these nurses over here and they wanna serve. Why won't you let them serve? And she just kept at it. And she got her message out to, you know, parents essentially who were worried about their, sons fighting without a nurse to, you know, to save their lives if they needed that.
She's one of them. Lillian Wald, I think is slightly better known, but, I feel like Lillian Wald should be on Mt. Rushmore, you know, like put Lillian Wald on the $5 dollar bill.
Bon Ku: Tell us about Lillian.
Sara DiGregorio: Lillian Wald was, she was a nurse, in the 18 hundreds the latter part of the 18 hundreds in New York City.
She was, working in a hospital and was actually about to go to med school when a friend of hers asked would she go to the Lower East Side and teach like a home nursing, a home nursing class to people on the Lower East Side. And this was a very, very particular time. In the lower East side.
It was actually twice as dense as it is today. there are accounts that say that the lower East side was the most crowded place in the world at the time
Bon Ku: What it wasn't full of hipsters like it is
Sara DiGregorio: now.
No, it Maybe they had their own kind of hipsters, but Emilys who were immigrating at that time. And they were living in conditions of just tremendous poverty. And so she went to go teach this class to this group of, women on the lower East side. And as she was there, this little girl burst into the room and she was like, my mother's bleeding.
My mother's been bleeding for two days. Can you help me? So Lilian Wald follows this girl to this tenement apartment where this little girl's mother and they, it's like seven people in the family. They have two rooms. This girl's mother is lying in a pool of her own blood. She's given birth two days earlier.
They tried to call a physician, but at that time it was all pay for service. There was no health insurance. There was no way to get care unless you could afford it. So the physician had come and gone, and this woman was about to bleed to death. And so Lillian Wald stayed with them. She cared for them, she stabilized the woman.
And after that, She said it was her baptism of fire and that she just hadn't known how people were living. And now that she knew she couldn't go on as before. And so she moved to the neighborhood with a nursing school friend and they just started providing care. They started providing care on a pay what you can basis.
And this turned into, eventually, A hugely successful visiting nurse service, by sort of the, the , they had, a house called Henry Street where nurses lived and they worked and they provided care, you know, on a sliding scale And as Lillian Wald was doing these things. She also was thinking about the broader social causes of disease.
Right? So she's thinking like kids are playing in the street where there are these dead animals. Animals die and they fall on the street and the children are just playing, on the side of the road. So she was like, we, you know, children need playgrounds.
So she came up with that. You know, she pressured the Department of
Bon Ku: You know, really
What, she's like an urban designer as as
Sara DiGregorio: She was an urban designer. I mean, she really saw how things could be different if they were designed differently. That's exactly right. Yeah.
Bon Ku: Now there's been so much research that shows, if you have more nurses, you're probably gonna not die. Right.
Sara DiGregorio: yeah. Yeah.
Bon Ku: Tell us about some of that research cuz we, physicians think we're like really important, but I think overall, if you look at a population health standpoint, look at a lot of these stats.
If nurses are equally, if not more important in terms of morbidity, mortality for patients.
Sara DiGregorio: Well, right. Both are so important.
So Linda Aiken, who is a nurse scholar at, at Penn. she has been studying the impact of nurse staffing on patient mortality and morbidity for decades. And what she has found is that the more nurses on a floor, the higher the level of nurse staffing, the more likely you are to be discharged alive.
and her research has been replicated. There was actually just recently, a paper, about this in the context of NICUs where, mortality was connected to nurse staffing and census.
Bon Ku: Hmm.
Sara DiGregorio: and. Yes. I think that people don't know that, obviously what physicians do is really important, but physicians, and I don't mean this in a derogatory sense.
You know, physicians are specialists. Many of them, they have a scope that is deep but narrow, whereas, You know, if you are in the hospital after a surgery and your surgeon could have performed the most flawless surgery in the world, but if you don't have a nurse taking care of you after that surgery, you could be in trouble.
and so it actually makes perfect sense. I mean, it's a very logical.
Bon Ku: Yeah.
Sara DiGregorio: There's a term in nursing called failure to Rescue, which is the term for a complication that could lead to death that wasn't caught in time because, not because there wasn't anything that could be done, but because the nurse wasn't able to catch it.
For whatever reason. Nurses can't be in eight different places.
Bon Ku: And that, that reflects my current reality. I mean, a nurse saves my butt, every day that I work a shift in the hospital that. Nurses spend more time with patients and they they alert me when things are going wrong or they catch my mistakes and it's, nurses are so critical.
Sara DiGregorio: Yes. And I think maybe it's important to reframe that as nurses aren't saving your butt. Cause it's not that you are not doing your job well, it's that nurses have a different role and, and it is their job to monitor the patient and to call, you know, and to know when to communicate with other providers.
You know, I think of them as a kind of air traffic control. And without that, you know, you really are lost.
Bon Ku: Yeah.
Sara DiGregorio: there is no way for patients to be truly safe in a hospital without, without good nurse staffing.
Bon Ku: Do hospitals publish that like nursing patient ratios? And if not, should they, like, cuz is that one thing that as a patient, if I'm trying to decide where to go to get care, I could look at the patient nursing staff ratios.
Sara DiGregorio: Yeah. Yes. And so this is, that's a great point because people don't know to look for that people, first of all, the problem is, is that people don't know that their outcome is tied to nurse staffing. So first they need to know that second of all hospitals know this research. They sort of count on the public not knowing this research
Bon Ku: Wait, wait, wait. What?
Sara DiGregorio: well,
Bon Ku: Hi.
Sara DiGregorio: the reason, like I would just ask, why don't we know this and who does it serve that we don't know
Bon Ku: Mm.
Sara DiGregorio: It's expensive for hospitals. Hospitals see nursing as an expense because it is wrapped up into room and board. Right? And it's not really billable to insurance the way that physician services are. And so if my nurse has three other patients besides me, My insurance gets billed the same rate as if my nurse has seven other patients besides me.
So for a hospital it is quite a bit more profitable to ask nurses to care for more patients, but it is quite contrary to the interests of patients, right? So first of all, I think the public needs to know that this is really important. They should ask. you know, if you have a choice of hospital, yeah.
You should ask what is your staffing like? there, you can in some states find out what the nurse staffing on each unit is. For instance, in New York, they ha we do have a new law that says that hospitals have to publicize this. So I went digging for this. They're supposed to put it on hospital websites.
If it is on hospital website, I can't find it.
Bon Ku: haven't seen it.
Sara DiGregorio: No. I mean, they're supposed to have it on there. I cannot find it. You can find it on the Department of Health website, however, you have to dig, dig, dig, dig, dig. And then what you find is there's no standard, way that this is communicated. So basically you're getting like a spreadsheet from a hospital that.
And every spreadsheet is different for each hospital and to read it. I mean, honestly, it is my job to read these things. It is extraordinarily difficult to actually figure out what. They are saying. So it's like oftentimes they'll be like, well, the union acts for this ratio, but the hospital wants this ratio.
They list them both, but you have to know that when there is a disagreement in New York state between the union and the hospital, the hospital can override the union. So all of this to say, like if the goal is to let people know if I have a choice between Mount Sinai and NYU and if the goal is to let me know, like which one generally has higher nurse staffing on, say, the labor and delivery unit, it is next to impossible for me to actually know that even though it is supposed to be publicly available information.
Bon Ku: Hmm.
Sara DiGregorio: So that's a great design problem. I mean, you know, some, parking garages, they have like, signs that they like, Floor two has three open spots
Bon Ku: Uh, yeah. Yeah, yeah, yeah.
Sara DiGregorio: Always think like, what if every hospital
has a sign? It's like right now, because I know it changes, it changes, you know, even minutes. It's like, well, maybe it needs to be someone's job to be like right now the average nurse to patient ratio on the labor and delivery floor is this, and you just put it in lights outside your hospital because there needs to be a way to communicate to the public that this is so important.
Bon Ku: yeah. And we have to call that out. I've been practicing for like 16, 17 years, and I have never seen this exodus of nurses in my life, it is serious. So many great nurses who I work with, they're quitting. The conditions are not tolerable.
And it is going to impact care. It ands, should be a siren alarm on, on how, on how serious this is.
Sara DiGregorio: Yeah, I agree with you. I have heard that in so many interviews, nurses are walking away from bedside nursing, from clinical nursing in hospitals in particular because of the working conditions. And I think it is important that we also understand that even though right now it is very, very bad, you know, this is a problem that has existed basically from the dawn of the modern hospital, when nursing schools were, located inside of hospitals and nursing students provided the nursing for free.
Bon Ku: Hmm.
Sara DiGregorio: And then what happened was that once you graduated, you basically couldn't get a job because then you wanted to be paid.
Bon Ku: Yeah.
Sara DiGregorio: So, There has been this sort of expectation on the part of hospitals from the 18 hundreds that nursing is not something that they want to pay for. They know that they need it, but they do not want to pay for it.
Bon Ku: Wow.
Sara DiGregorio: and it's been an adversarial relationship on staffing ever since.
Bon Ku: I did not know that historical context cuz often when health systems feel that budget crunch, they look at the human capital and they're like, cut nurses. it's reflexive. And that's, I've seen that my entire career. Talk about male nurses. I've seen an influx of male nurses, which I think are so cool, but.
Has historically in all countries, nurses been female, and why is that?
Sara DiGregorio: Right. So no, not at all.
Bon Ku: So, it's Wow.
Sara DiGregorio: Yeah. Yeah. Historically, nurses have been both men and women, and in fact, It is thought that the first nursing school was in India about, a little over 2000 years ago, and that was only for men.
Bon Ku: Hmm.
Sara DiGregorio: So in a lot of contexts, like going way back, nurses actually were typically men, or they were men and women.
I think that we do all lose out when we think about nursing as this one kind of thing that's done by one kind of person. And again, going back to Florence Nightingale it's interesting to think like we think of her as the founder of modern Nursing, but like, could you say, who's the founder of medicine or like who's the founder of the idea of government or who's the founder of the idea of like reading or writing.
I don't think any of us could reach for that name. Right. So why is it that we're like, oh yeah, nursing that was founded somehow by Flo because that ma, it makes it quite small, right? In our, it's like, oh, right. Florence Nightingale so nurses are women. Nurses are white women because that's her conception of it.
And registered nursing continues to be quite disproportionately white.
Bon Ku: Yeah.
Sara DiGregorio: And I do think that, that, way of, it's almost, I think of putting nursing in like a Victorian corset. It's like that way of thinking about nursing has become so prevalent. But no, it you know, it has not always been the case at all.
Bon Ku: Men are excellent nurses and they always have been. But like 90% of nurses in the US are female.
Sara DiGregorio: Yeah.
yeah. You know, it's become gendered. It's become gendered, as a female profession quite strongly.
Bon Ku: Which is crazy. It's always like, I've never understood them. Like
why?
Sara DiGregorio: why? Well, there are some complicated reasons, and I'm sure you can make an argument in, for lots of different inputs on this, but, when the first medical schools were founded in the Middle Ages in Europe, in the European context, women by definition were not allowed in. If you were a woman who was a healthcare provider and there were lots of them, and the distinctions among healthcare providers like pharmacy and nursing and medicine, those things were, were quite fluid back then. And then all of a sudden it was like, okay, actually no, we're gonna have medical schools there for, they're for men.
And that cut out, it really changed the healthcare, the medieval, European healthcare landscape. And so I think that that was sort of the start of, and there are scholars who say that that was the start of this kind of like the gendering of medicine versus nursing because, you know, physicians couldn't do everything.
They, you know, there needed to be other, healthcare worker roles. and there was a pool of women who had been working in healthcare forever. And so then you sort of see this kind of like pushing into these gendered roles, which didn't exist as much before.
Bon Ku: Hmm. from your perspective, cuz you have this like historical understanding of, of nursing, if we were to fix our nursing crisis shortage in the US to redesign nursing, we've talked about the, this policy prescription maybe of publicizing nursing staff ratios for hospitals. What are, what are some other thoughts or suggestions that, that you have on this?
Sara DiGregorio: So my feeling, thinking about, you know, pie in the sky, kind of designing a new way of thinking about health and wellness and how we provide that to people. Right now we have a medical industry that is really not working well for anybody. Very few people find themselves well served by what we have because it's so far downstream.
It's like we're really good at reacting to crises. most healthcare happens in the hospital, but by the time you are in the hospital, you are often already sick. So what if we, you know, if we thought about this differently and we had an actual healthcare system that was designed to maximize everyone's health and wellbeing, what would that look like?
And I think that would look like Nurses would be deployed in so radically different ways. So for instance, nurses, as you know, are specialists in advocating for patients. They're specialists in education and prevention. So, you know, right now the system that we have is not built to recognize nursing expertise.
At all, right? It's like, it's considered like a supply that the hospital has to pay for. But in fact, if you think about nursing strengths, you know, and the fact that nurses are getting, you know, moral injury and are quitting from working in hospitals. What if we were deploying nurses in communities where they can reach people, like, At community centers, in libraries, at the supermarket, at church, at synagogue, where people are.
So what if we were deploying nurses' strengths that way? So what if it was like vaccines were happening in all those places? What if we were having blood pressure checked happening in all those places? What if you know, you could get a flu test, at your corner bodega? if we deployed nurses as public health workers in communities,
Bon Ku: Hmm.
Sara DiGregorio: They would know when to pull in other providers.
For instance, like there's this nurse who's so wonderful. her name is Toby Ash and she works with the ultra-orthodox community here in Brooklyn. And back when we had a measles outbreak in the ultra-orthodox community here in Brooklyn, she and her, her group of nurses who work with that community, they were the first to notice, Because they're in that community.
So they were like, wait a minute, these rates of measles, this shouldn't be happening. If they were vaccinated, this rate would be impossible. So they were like, oh my gosh, they've stopped vaccinating. Right? So they knew that. They knew it first. They knew it ahead of time. If we had nurses in every community like that, we would, it's like an early warning system so they can pull another resources when that's needed.
Bon Ku: Like the nurses in the Lower East side, that, that example that you mentioned. Yeah. Go, go back in history and go, whoa, this actually worked.
Sara DiGregorio: yes, it, and it does work. And it is nothing new. The problem is, is that it is, the financial system that we have is not set up to value that kind of thing where it's like prevention, education. Moving way upstream, and investing in nursing care in the community. And then of course, people need physicians.
People desperately need physicians when they have a problem that is, Only in a physician's scope when they're sick, people are still, would still get sick. But it's just like, it's thinking about nurses, nurses' strengths are not optimized in the system that we have. They're not fully used.
And nurses I think are always gonna be unhappy as long as that's true.
Bon Ku: Yeah. I, I could talk to you for hours about this. I have so many more questions, but we gotta stop. You gotta go on with your day and you have so many talents. One, I just realized you were like a food editor at Food and Wine Magazine. I looked up some cool recipes in the New York Times. I'm gonna make one this weekend.
The slow cooker, w bean palmers on soup. So, so I have a hard question for you. If a listener were to come visit you, where would you take them out to eat?
Sara DiGregorio: Oh, what a good question. I love this. So I live in Bay Ridge, Brooklyn, which is a wonderful neighborhood. I think of it as like, I live in like the country part of Brooklyn. It's like way down at the southern tip and it's a predominantly Middle Eastern neighborhood now. And so we have a lot of like, really wonderful Middle Eastern food, but my favorite is a place called Ayat which is a Palestinian restaurant.
And they make breads fresh all the time. So they have all, these are the flat breads and. Stuffed breads and spinach pie. And they have these wonderful sort of layered casserole with lamb and cauliflower and almonds and yogurt. And they have the most silky and delicious hummus. And so I would be, so that's where I always like to bring people.
Bon Ku: Love it. We'll put a link to that in our show notes as well as a link to your book taking care. Thank you so much for. For your book, for being on the show.
Sara DiGregorio: Oh, thank you so much for having me. It was just such a pleasure to talk to you. I could talk to you for a long time.
Bon Ku: You can follow Sarah on Twitter @SarahDiGregorio And she is also on Instagram @sarahedigregorio
Design Lab is produced by Rob Pugliese editing by Fernando Quieroz. Our theme music was created by Emmanuel Houston and the cover design by Eden Lew. See you next week.
