Valuing nurses leads to better patient care: what has happened to the notion of patient-centred care? One nurse's stay in hospital earlier this year showed few instances of real caring and empathy.
Article Type: Viewpoint essay
Subject: Nurse and patient (Analysis)
Nursing services (Management)
Nursing services (Social aspects)
Patients (Care and treatment)
Patients (Management)
Patients (Social aspects)
Author: Murdoch, Pip
Pub Date: 08/01/2011
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2011 Source Volume: 17 Source Issue: 7
Topic: Event Code: 200 Management dynamics; 290 Public affairs Computer Subject: Company business management
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 266344845
Full Text: The Royal wedding (Prince William's and Kate's) was playing on the television when I began to be aware of where I was. Like an upturned bug, I saw myself lying on a crumpled bed, cot sides up. Legs, restlessly kicking at the sheets and me tugging at the catheter I found had been inserted. I felt I needed to pee and the machine at my head was beeping loudly.

The nurse came and efficiently untangled the line in my arm and checked the catheter was draining properly. She wasn't unkind; just did her job.

By the morning I wanted my husband there. I was confused as to what had happened and felt isolated and lonely.

When the shift change occurred, a new nurse, dressed in blue, came and stood sentinel at the entrance to the "pod" I was in.

"I waa, I waa"--oh dear--"I waa!" I knew what I wanted to say but couldn't articulate it.

The nurse looked at me and said, "Your nurse is over the other side, she'll be here later."

"I waa," I started again.

Not moving from her post, leaning against the doorjamb, she shrugged her shoulders and smiled an offhand smile at another nurse dressed in blue, standing motionless in the corridor. I felt so lonely and hurt, an object of no interest to my carers.

That was my introduction to patient care in the acute medical admitting ward on a Saturday morning. The care over the following four days was varied, but what I felt most was a joylessness. The staff exhibited no sense of pleasure at being there and nursing care was minimalist. Even the way many of them walked, unsmiling, scuffing their feet along the ground, as though it were an effort even to get from A to B. They seemed disconnected from the patients and I never gained any sense they wanted to make it better for the person lying in the bed. It was as if their "empathy chip" was missing.

Once I had been seen by the registrar later that Saturday morning, I could comprehend what had happened to me and what would probably happen. I had been unconscious for more than 24 hours and had most likely suffered a stroke.

The doctor said all lines could come out, the catheter could be removed and, if I continued to improve, I could go out on leave for a few hours the next day.

One of my support team went and asked my nurse if she could remove my catheter and lines so I could shower. The nurse asked if I could wait half an hour while she showered another patient. That was not a problem. An hour later she still hadn't come and, when asked again, said she was just off for her break and would come back in half an hour. Eventually she returned and took the catheter out.

My husband said it was similar the night of my admission when the catheter was to be put in. I had gone all day without peeing despite having intravenous fluids. The registrar for people with stroke came about 5.30pm and asked that I have a catheter put in. Three quarters of an hour tater, another nurse asked my nurse if she had done so. No, she hadn't, and didn't seem in a particular hurry to do so. She was finally persuaded to and I immediately produced one and a half bags of urine, over two litres! How could I have been left so long? They must have recorded somewhere that I hadn't passed urine. Why couldn't they see the bulge in my abdomen?--my family could.

Apparently, as soon as I was catheterised, I calmed down and the change in how I behaved was dramatic. Who could be surprised at that?

Fortunately, I had plenty of family support who were great advocates for me. I was also extremely fortunate, in that my power of speech returned very quickly.

Once I was independent, I didn't see a nurse at all, until it was time to write a report when I would be asked:

"Have you passed urine?"

"Have your bowels moved?"

These were followed by questions pertaining to my level of awareness.

What is this hands-off approach to nursing?

Are nurses worried that, if they look in to see how you are, you might ask them to do something? Or are they genuinely too busy to care?

Ward staff showed an interest

It wasn't all bad. Among the sea of blue uniformed agency staff, there were a couple of ward staff who were interested in what they were doing and cared about the patients. One was the nurse who insisted I have the catheter put in; the other was a carer who was outstanding. She was cheerful, energetic and sympathetic, did much of the heavy work for other staff and was the only one who, sitting with the alcoholic going through withdrawal, was honest with him and could keep him calm. She has applied to get into nursing and couldn't get in this year. I hope someone is there to mentor her and help her get every opportunity to be included in the next year's nursing degree intake.

The second ward I went to felt much better. There were no agency staff! I was to be nil by mouth for breakfast. I knew that, as did the afternoon nurse, but strangely the night nurse didn't know and neither did the aid who handed me my breakfast. Fortunately, I was lucid and didn't eat the breakfast, but it was a ward where other patients might not be so aware. Do nurses still write reports? Do nurses read reports?

I didn't see my morning nurse until 9.30am and, when I did, she was flustered and nearly tearful. A new grad! I wondered who was supporting her. She just wanted to leave.

All in all my stay in hospital earlier this year was not a positive experience. I am fortunate to have made a complete recovery from my stroke, but am still left with negative feelings about the care I received. Why is it like this?

Staffing shortages

The reasons have to be financial. Nursing staff numbers are capped welt below the number of staff required, so the gap is made up with agency staff. These staff appear to have no commitment to the hospital; they can work when they want to and are seemingly only in it for the money. The way they walk, dragging their feet, suggests they're counting down the hours until it's time to go home. "8 o'clock, I've only got seven hours to go!"

My big question is: How can it be cheaper to hire outside agency staff than to employ sufficient numbers of staff nurses? It is something I just don't understand. The main beneficiaries are the agencies who, I would imagine, rub their hands in glee each time the hospital cuts back its staffing. Agencies get the money which should rightly be spent on in-house staffing. Do they really care about the standard of their employees' nursing practice? There is no evidence they do. Who are the agency staff answerable to?

I understand that nurses in my area hospital are being encouraged to be generalist nurses and not to become specialist nurses, and that some clinical nurse specialist roles are being disestablished. I cannot see how this works, apart from cutting back costs. Nurses need a career pathway; they need to feel there is a course they can take which will make them more knowledgeable and more valuable. Most importantly, patients need to know that, no matter what is wrong with them, there are expert nurses in the ward who thoroughly understand their condition, the optimum treatment and the side effects of any medications they might take. No one nurse can know that about every condition.

I realise nurses are the hospital's most expensive commodity, but they are also the hospital's most valuable commodity and it is time they were treated as such.

I wonder what other hospitals need to reinforce the message that "patient care is what we need to focus on!" Isn't that what hospitals do?

From the top--the chief executive and director of nursing--down through all management levels to the nurse manager of each ward, the message of patient-centred care needs to be aligned with the message "nurses matter!" If you take care of your carets, they will pay you back 100 fold in productivity. More importantly, in terms of quality, they will, in turn, take care of the patient and that is patient-centred care.

In the meantime, I hope and pray that neither I nor any of my family require hospitalisation.

Pip Murdoch, RN, works as a nurse counsellor for the Wellington Division of the Cancer Society on an informal relieving basis. She trained at Christchurch Hospital in the 1970s.
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