I have returned to work after 10 days off. 10 days of couriering my children to their social events and trying to live vicariously through their fun without making it obvious. I am only kidding, I don’t want to run around trying to get to every party happening, whilst constantly readjusting my clothes/make up and hair. I want to have fun and try things that make me giggle or make me nervous – but not all the time!!
Last blog we started talking about nurse training and nursing care – is it ‘better’ now than 25 years ago when I was nursing? I wish I hadn’t used the word ‘better’ in my last blog, because it is a difficult word to quantify. However, I have started this and so am keen to continue to just give my opinions, and see if I can generate some interest and feedback from anyone reading this blog.
As I have said before, I nursed in the late 80’s through to around 2004 in New Zealand and overseas. When I first graduated I was so idealistic, optimistic and had an absolute gut burning drive to help others when they were ill and to improve other people’s lives. My early days at Auckland hospital were fantastic – I had strong, intelligent Charge Nurse’s who supported us to act as patient advocates, to provide planned and considered patient focused care. We were encouraged to have confidence to practice autonomously and to learn and grow. We cared about our patients and the priviliged position we were in (e.g. part of another’s life, especially when they are likely to be vulnerable). We were responsible for our own actions, and we were not afraid (most of us anyway) to make mistakes or ask others for help. We generally had a really good knowledge of anatomy and physiology, and then on top of that we had been taught about ethics, values, integrity, social needs, hollistic care.
My experience of the Wards at that time, were Doctors (consultants to house officers) were collaborative, supportive and valued the roles the nurses played in the care of their patients (and vice versa of course). In fact, the group of House officers, Registrars and Consultants I worked with for a few years were incredbly good people in the main – warm, smart, communicative and even funny in some cases. We worked as part of a big multidisciplinary team and in my opinion it was patient focused e.g. every meeting I went to, the patients name and needs were discussed more than anything else.
Somewhere in this new millenium I feel nursing changed (nursing as I know it). What I now see and hear about is harder to describe than my own lovely memories. I think maybe the change is around the emotional connection to being a nurse and providing care. It seems to me that deciding to be a nurse is a career choice as opposed to a vocation as it was for me and most of my contemporaries. Some of this has come about I believe because of 2 key changes:
1. An increasing focus on the status of nursing and high academic nurse training. Don’t get me wrong, raising the status and qualification in itself is great – I am all for raising the bar, increasing capability, enhancing professionalism and giving people the highest level of learning they can achieve. How I think this change might have been translated is that new nurses seem much more strategic and focused on their career pathway and future than the here and now needs of the people entrusted in their care.
2. Increased compliance and diminishing trust/support/tolerance/patience: Having standards, policy and process is essential in ensuring quality care and services are delivered to patients or consumers of any kind. However, using KPI’s, expectations, process, audit as a tool to criticise, ‘flog’ or condemn others in my view is not right. Surely those tools should be used to support people to grow, learn, develop (I may sound it, but I am not even that much of a ‘lefty’ – I don’t mind sharing that I voted for John Key and the National Party last election).
I am not even sure there is more compliance – or if there is less trust/support/tolerance and/or patience in general? This question will no doubt raise an eyebrow and view or 2!
I think I may start wandering into the realms of sounding like a cynic with a ‘back in my day’ mentality, or worse still an ageist with attitude – not my intention at all ha ha. I simply believe that care is the foundation for Nursing (not clinical excellence – that is a by product). The patient should come first. In my career including working as part of the trauma teams during TT on the Isle of Man, the best experiences patients had with our team were when we cared about the things that were important to them as individuals (not the science of what we were doing to them). We worked in a team nursing model where a team of us managed a particular group of patients and we worked as a team to plan care with the patient/their family – and to be honest, if the patient said their primary goal was to wear high heels again (clearly that was not a goal of any of the TT motorcyle riders!!), then we worked toward that! If they wanted to wear their own clothes each day – then if at all possible this is what we did. The goals didn’t include ensuring accurate administration of medication, completing wound cares as planned etc – unless that is what the patient identified as their goals.
Nurses generally know how to provide care e.g. how to manage a drip, how to give out medications safely, how to remove sutures, how to manage a central line, how to calculate drug dosages, how to keep patients safe but I believe the difference is the relatonship that Nurse has with their patient – how much they care about what they are doing.
I need to finish up by saying that I also know plenty of incredibly wonderful, caring, smart Nurses and health service providers around NZ and I would have no qualms getting care for myself or my loved ones from them.
My kids would laugh at the fact that I have written about only one of the questions I raised last time, and not both of them. They think I like the sound of my own voice, or in this case the tap of my keyboard – I think they might be right (not a very flattering admission)!
P.S. I was looking for an appropriate picture for this article on the web, and googled Nursing images. Made me laugh – only about 1/3rd of the pictures I looked at had a patient in it, otherwise all the Nurses looked like models with stethescopes or wearing inappropriate dress up!!