DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

May 26, 1982

Russell S. Boles, Jr., M.D.
76 Parker Hill Avenue
Boston, MassachuePett8 02120

Dear Russ:

If I were going to address a graduating elars of nurseo thle, year,
I think I would addresar the problems of nurse retention common
throughout the country and approach the delicate but never the less
very important problem of authority.

Whcu it come8 to nurse retention I would talk about all of the fine
traditions of nursing and the fact that expectation of nursing
sometlmes 18 different (does not necesearily fall short of). For
example, in her mind's eye the nurec pictures a baby euch as depicted
on the Gerber baby food jar8 but In reality has to deal with a child
being treated for Leukemia who ha8 lost all its hair and hae Economo'8
all over his body.  Traditional bedside nursing has given away to
problem8 in intensive care and apeclalleed nursing such a@ those who
work on an I.V. team or carry out nutritional 8upport etc.  I am Burt
you know these things better than I.

Second subject is a little more delicate in that if your experience
i8 that of mine you have witneeared over thu last decade an increasing
effort on the part of nursee to educate themselves eclentifically which
I think makes for Borne job di88ati8faction if they are not able to
utilize the scientific training that they have apent 80 much trouble
accumulating.  This then lead8 to who should do what in the clinical
setting.  ThC prirmrry care nurse ia an example of places where a nur8e
feel8 that having learned 80 much ehe is in a declaionmaklng process
but doesn't realize that without the depth of knowledge of the physician
her decleion about a patient may not only be at variance with the
physician but also may be wrong.  I would then talk about the captain
of the ship philosophy and that medicine is indeed delivery of care by
a team and that the nurse hae an extraordinarily Zqiortiant rBEe iti it? but she
cannobasurp the physician's position a8 captain of the ship.

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DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

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Still on the other bend, there are now eo meny new opportunities for
nurses such as phyaicfan's aesfstanta etc. that there is no need to
compete with the doctor for an authority role but rather to do the job
that the nurse $8 prepared to do end to do it to the best of her ability.

If you get into that subject you might even want to use BS an example
an initiative that I aat working on now and that is the training of
elderly people to control ~nccmtfneuce through biofeedback methods.
I dn not foolirrh euouglh to think that physician8 arc going to take
very rcedily to the training of elderly paticnte with incontinence
but I think that nur8e8, arc very well equipped to do this sort of
thing and using the teaching nurring homes currently being 8pOn8OrCd
a8 an expcriPant by the Robert Wood Johuson Foundation would make a
merveluus vehicle to learn the technique8 and pass thtvra on to nurses who will
have to deal with the probleaa of iacontinencc in elderly people.

If you wdntto go in thie direction e8 en cxamplc, let me give you a
few figures.  The co8t of incontfncnce in nursing hoapcs is now In
exce88 of 8 billion dollar8 per year.  Technique8 underway at the
National Institute of Aging provide a 70% 0~~~088 rate in ambulatory
patients bctwccn 65 and 90.  Those who do sot respond fail becauee of
the lack of cognitive functions.

My initiative Is to teach incontinence training in nursing homco
immediately after admiesioa end before such irrevocably thing8 as
bed sore8 develop.  I do believe that nurecg properly motivated,
trained, and guided could carry out one of the most dfgnity restoring
end cost effective nurs3.ng in&tietivea we have ever had.

k I hope this is of some help to you. This week should ace the final
decision on ths selling of sny home here end if that goes through
then I can proceed with the Cape Cod venture.  I look fonuard to 8eclng
you, perhaps this summer.

Sincerely yours,

C. Everett Koop, M.D.
Surgeon General

CEKoop:saj:5/26/82

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