Scope of Practice: A Firsthand Account from the RN Criticized by Dr. Pimple Popper

Social media can be a fantastic way of keeping in touch or sharing information, but it can also be a hotbed of controversy. Elizabeth Hanes, an RN who now works as a journalist, unexpectedly experienced this herself, when Dr. Sandra Lee, also known as “Dr. Pimple Popper,” recently commented on a story Hanes had written.

Hanes took the time to talk with us about her experience.

Exactly what happened? Please explain.

On Saturday, June 20 (I believe), Dr. Lee tweeted a link to my WebMD article (from the WebMD Twitter account). The social media people at WebMD had written social sharing text that said, “What’s the difference between sunburn and sun poisoning? A registered nurse explains.” Above this, Dr. Lee wrote, “Why would a registered nurse explain this? Why not a dermatologist?” and included an eyeroll emoji.

The nurses of Twitter did not respond well to that. The thread had, I believe, thousands of comments. I never saw the original post; I only saw the “apology” post, which also has been deleted.

Were you surprised at what Dr. Lee, aka Dr. Pimple Popper, posted? Why or why not?

I was taken a bit aback. My first thought was, “Why wouldn’t a registered nurse explain this?” This is well within the scope of what nurses do on a daily basis. My second reaction was pure amusement. I guess I will have to say I thought it sounded petty.

Many nurses responded—some were angry and even called for the cancellation of her show. Do you think that a lot of health care professionals don’t understand the nurse’s scope of practice? What about people who don’t work in health care?

I think there were two issues here. First, that many people don’t understand nurses’ scope of practice. Second, that people don’t understand how journalism works. It feels strange to have to write out that a nurse’s scope of practice includes patient education. Our entire profession is built, in fact, on the foundation of teaching patients about their bodies, about wellness, about disease, etc. To me, patient education is the essence of nursing practice. So for someone to sort of call that into question felt baffling.

But people also seemed very unclear on how journalism works. They seemed to believe that only subject matter experts should be reporters. But journalists aren’t required to be subject matter experts, themselves, because journalists know how to conduct research to find the facts they need to write a story. Sometimes that research involves interviewing subject matter experts—like a dermatologist. In this case, the process did not include interviews. That’s just how it goes in journalism.

Do all nurses educate their patients as a part of their routine care?

Yes, absolutely. All nurses engage in patient education on a daily basis. Or family education. In fact, nurses are the health educators of the world. That’s not to say physicians don’t also educate. Of course they do. But physicians often provide patient education at a high, over-arching level. For instance, an oncologist may explain to a patient what chemotherapy does, but the oncology nurse will be the one educating the patient and his or her family members about the effects of chemotherapy, how to cope with those effects, how to set up the home environment to best care for a person receiving chemotherapy—and on and on. Doctors don’t do that. Nurses do.

Why do you think it’s important for the masses to understand that nurses are fully qualified to provide health education?

I think most people turn to nurses first for health education on an interpersonal level. They do this without even thinking about it because nursing is the most trusted profession. My experience has been that people, in general, highly value nurses and their knowledge.

I think there’s a bit of a disconnect when it comes to media and reporting. For instance, during the kerfuffle with Dr. Lee, some people on social media directly questioned my background and credentials—was I really qualified to write this article. When members of the public do this, it does not offend me. In fact, I wish more people would engage in this sort of critical questioning of stories in the media. When they see a celebrity offering an opinion on some topic—let’s say it’s how COVID-19 spreads—I wish more people would ask themselves, “But what do actual epidemiologists say?”

It’s a different story when a doctor or fellow nurse or another health care professional questions my credentials—and in public, no less. These people should know that patient education of all kinds—including articles on WebMD—falls well within the scope of nursing practice. It’s disrespectful to question that or to imply that it does not.

What can nurses do to get the word out about this? Or does it need to come from higher up, like health care and/or nursing organizations? Or both?

I would like to see two things happen:

I would like to see more journalists requesting nurses as sources for their health reporting.
I would like to see more nurses become health reporters.

To the first point, I wish that more health journalists would understand that nurses play a different role in patient care than doctors do, and that their stories would be much enriched if they included the nursing perspective along with the physician’s.

Imagine a news story about a new cancer treatment that not only includes quotes from the researcher about the chemistry involved and quotes from a physician about how this treatment will provide more options for patients—but also includes quotes from an oncology nurse about how this treatment might affect a patient on an everyday level, when they’re at home after receiving it. Currently, we typically get the first story: the one that only includes quotes from the researcher and physician. But the second story gives a much deeper perspective that would benefit readers. For this type of reporting to happen, health system media relations people need to cultivate and support nurses as sources for the press and then suggest and offer those nurses as sources when appropriate.