A nurse responds to our last two articles about nursing in New Zealand

Guest Post:

I was interested to read the two articles posted on Whaleoil about nursing, how it has changed and the experience of care both women received while patients in hospital. I felt quite incensed when reading the first one of their experiences, while being treated with breast cancer. Although I believe there is some truth in what she is saying, I think she is giving quite a distorted view of nursing in general. Frances Denz’ post was more like looking back at the “good old days” if you can call it that, when nursing was very task orientated and you weren’t allowed to think for yourself.

I am a bit of a dinosaur in the nursing profession, having started back in the 1960s as a Community Nurse, so I can relate to what the author was saying about starting work then going off for breakfast etc but also in those days nurses lived in hostels and had no life outside of their job. Doctors were treated like gods and nurses at the lower end of the pecking order had very little input in what was happening to their patient as long as the beds were made, the trolleys were in the correct position and the wheels on the beds were turned inwards.

Apart from taking four years off to have children, I have worked continually as a nurse, going on to train as a Registered Comprehensive Nurse then completed my Advanced Diploma in Nursing. Apart from a few stints overseas, I have worked in a 27-bed, fast paced Respiratory Ward in a large city hospital since 1996 and am now entitled to use my Gold Card on the bus to get to work!

Nursing has changed. The turnover of patients is much higher now than in years gone by, they come in sicker [aka ‘high acuity’] but leave the hospital sooner. The new nurses are educated over a broad range of topics dealing with the whole person and are expected to be able to reason as to why this or that is happening to the person in their care. As the years have gone on, however, students are offered less and less clinical time in their training; in fact, a new nurse may start a job on a ward in an acute hospital with their only practical experience having been gained in a community setting. This then means they must learn all the practical components of caring for a sick patient such as washing, bed making and taking time to talk to the patient while at the same time dealing with shift work, the health system, completing ongoing learning requirements, and all the other demands in their personal lives.

In my experience, a new nurse on the ward is ‘buddied’, so works with another, more experienced, nurse and this may account for one nurse talking to another ‘over the patient’ as certain things are explained to them. I still maintain my old values of washing, teeth cleaning etc and explain the importance of this to the new nurses but have to admit that due to the other expectations imposed on RNs, it is becoming more difficult to perform these tasks; they are often delegated to the Hospital Aide [ward assistant] while the RN attends to a more unwell patient. With the high acuity of patients, work is necessarily prioritised to cater to the immediate needs of the sickest patients and bed making does not rank highly amongst them. All patients where possible are encouraged to wash/ shower themselves, and if this is not part of their daily routine outside the hospital, it is not a nurse’s role to force this on a patient who has the right to choose.

Nowadays the nurse works alongside the doctor, performing tasks that were once a doctor’s role; starting intravenous antibiotics, inserting cannulas (needles through which infusions and intravenous drugs are given), taking blood, administering chemotherapy, assisting with procedures [i.e. chest drains, testing blood gas levels, and non-invasive ventilation in my area at least.] an RN must be accountable for every action they perform during a shift, including giving medications charted by the doctor. ‘Accountability’ comprises checking that each drug has been charted correctly, documenting and following up when there is a doubt. Bearing in mind that this is the 21st Century, public hospital system’s records are almost exclusively electronic with observations, medications, and even patients’ progress notes in some hospitals, computerised. A paper record is also maintained as the first point of reference for the patients’ day to day care in many hospitals. If a doctor has told a patient they are for intravenous fluids, then forgets to enter it on the electronic prescription but writes it in the clinical notes, a nurse may not see the documentation for hours, meaning time lost through needing to contact someone totally different to chart it electronically before it can be started.

As an RN who has spent all her working life in the public system I can’t comment on the private system, apart from a personal example; a friend who underwent hip replacement surgery in a private hospital was not offered post-op physiotherapy, which would be considered an essential part of post-op care in a public hospital.

I believe we would all love to nurse in a system that we learned while training and how the nursing theorists led us to believe was the best way to care for patients. Unfortunately, the real world of the health system and the pressure nurses are under to comply with changes this system makes to their daily workload, this is impossible in most instances. Patients who are unhappy with their care are now provided with redress with the opportunity to complain to the hospital concerned, the Health and Disability Commission and if it concerns a nurse’s practice, the Nursing Council.

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If you agree with me that’s nice, but what I really want to achieve is to make you question the status quo, look between the lines and do your own research. Do not be a passive observer in this game we call life.

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