Who’s Flying the Plane?

We've Gotten Off Track photo: JParadisi 2009

       Perhaps a change of nomenclature is needed in health care.  Physicians should be called Pilots, and nurses renamed First Officers, like in the airline industry, which the health care industry often compares itself to. The term doctor’s orders would change to instructions. Instead of a nurse requesting orders from a doctor, the First Officer would ask for further instructions from The Pilot. The name changes promote the team approach that more accurately describes patient care. 

     Gallup Poll: Power Elite Believes Nurses Should Have More Say in Policy, Management  posted by Shawn Kennedy on the American Journal of Nursing blog, Off The Charts  quotes that “69% of ‘people who run things in this country’ see nurses as having little influence on health reform.”  The poll ranks nurses at the very bottom of the list of groups influencing health reform, under patients, who lag behind physicians. Listed as the most influential  are  government, insurance and pharmaceutical executives. In other words, the people flying the plane do not control the plane. Decisions about health care policy are made by people who are not on the plane. Sometimes the decision makers aren’t even at the airport. 

         That’s not to say that physicians and nurses should dictate health care policy without thought or consideration of cost for treatment or alternative options. In the short story Voyagers, I write about recognizing the need for administrators, whose jobs keep hospitals solvent and regulated. However, demoting nurses, doctors, and the patients themselves to the bottom of the list of influential voices in health care policy, while allowing corporate administrators to have the most influence, seems a crippling case of the tail wagging the dog.


  1. The post makes excellent points about the importance of nurses participating in health care debate. It is essential that health care providers find points of common ground that cross disciplines. That’s a task more easily said than done. The political debate contains so many elements that simply fail to consider the quality of patient care, and really, isn’t that the bottom line here?
    It’s important that nurses don’t wait to be asked.


  2. You are right. It’s easy to feel that even if nurses and other health care professionals speak up, will anyone listen? We don’t have lobbyists to work out deals, like corporations do. However, as long as nurses agree to take a seat in the back of the room without participating in the debate, we lose the power of our collective voices. Martin Luther King said It’s not the harassment of our enemies that hurt us, it is the silence of our friends. What we agree on is safe,and quality health care.


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