October’s wise word of the month is the palindrome, “level.” As used by Melanie F. Ham, MA, MSN, RN, CSAC:

“Nurses bring a multi-focal perspective to the work we do. We can understand how a complex issue affects individuals, families, communities, and systems, and we are trained to solve problems in a way that takes all of those different levels of people into account.” 

The Oxford English Dictionary has 11 “level” definitions, each with different subgroups of different but closely related definitions. The definition most closely associated with “level” in the context Ham uses is “A plane or status in respect of rank or authority; position in a hierarchy. Frequently with a qualifying adjective.” In other words, Ham uses “level” to illustrate the places people lie within a social hierarchy. 

“Level” in this context is relatively new to the English language. The earliest documentation in the Oxford English Dictionary comes from American linguist Leonard Bloomfield, “Provincial colorings of standard English are tied up with differences of social level” (Bloomfield, 1933). A similar usage appeared again in 1974 in the biography, C.S. Lewis, by Roger Lancelyn Green and Walter Hooper: “The stories can be read and enjoyed on at least two levels: by the child who perhaps knows nothing..of any of the authors whose works Lewis knew; and by the reader who knows many” (R. L. Green & W. Hooper, C. S. Lewis).

In the hospital context, however, nurses play a special role in facilitating the interactions of the patients, their families, and their community with the medical facility. As Ham explained, nurses must deal with all levels of people within the medical system: patients, their families, and the larger community that the hospital serves. 

A nurse’s job requires much more than caring for patients medically. Comprehensive nursing requires nurses who can acknowledge the broad spectrum of lives they touch and how the healthcare system and policies affect these individuals. 

By interacting with a wide range of patients, all hailing from different upbringings and each with varying life experiences, nurses can more fully understand what care is most beneficial to patients - both inside and outside of the hospital.

To create continuous improvement in the healthcare system, it is up to nurses to use their experiences with patients, families, and communities to advocate for the needs of patients and ensure equitable and effective care for everyone. Every level of person concerning a patient is somehow affected by the care that hospitals and nurses provide.

Nursing inherently affects the population at large - not just the direct patient. For this reason, the nursing perspective is so valuable around the decision-making table in the boardroom: no other leader has quite the same 360-degree view as a nurse. As Ham so clearly states: “... [nurses] are trained to solve problems in a way that takes all [...] different levels of people into account”.