Hello, people. I’m your friendly guest blogger! I think I’ll go by the name of Stella, because I really don’t want my senior sister hunting me down in the middle of the night with a ray gun (or, indeed, a ‘formal incident reflection slip’, which is a far more intimidating weapon in the hands of an NHS line manager).
Firstly, I think a little background is in order, because my post today is going to be a rant of the highest degree, and I want you all to know that I’m normally fairly happy-go-lucky in my approach to things. I am a junior nurse and researcher, working in the NHS. In general, I am an enthusiastic fan of that institution; a staunch believer that children who have hopeless, drug-addled parents should have access to the same opportunities as the wealthy offspring of hedge fund managers; and, since childhood, I have been an incurable bookworm. My research interests are many and geeky, and my flat is piled high with crates of books, because I ran out of room in my shelves. Things that assist me in my quest for cheerfulness include: all of the dreadful/wonderful cover versions that have been recorded by Glee; documentaries and panel shows on Radio 4; playing Scrabble until the early hours of the morning; oh, and obviously, the internets, which allow me to maintain a friendship with Leigh and the rest of my friends who have chosen to scatter themselves to the four corners of the earth. Trumping all of these, for reasons that are available upon application, is my relationship with my God, who loves me and died that I might be called His daughter. Current favourite Scripture: Isa 33: 21-22 (‘But there the LORD in majesty will be for us a place of broad rivers and streams, where no galley with oars can go, nor majestic ship can pass. For the LORD is our judge; the LORD is our lawgiver; the LORD is our king; He will save us.’).
Today, rather sadly, I am not here to discuss the many merits of Isaiah 33 (my thoughts on this are also available upon application). I am, instead, here in defence of nurses and the NHS, both of which have been seriously, and often justifiably, attacked with great vim and vitriol in recent months. Commentators have laid the blame, variously, on the move to degree-level education , the increased number of staff coming from overseas (both mooted in http://www.bbc.co.uk/news/health-20599091), ‘lazy’ staff refusing to leave their lunch breaks to work (http://www.dailymail.co.uk/health/article-396258/Are-nurses-angels-I-dont-think-so.html), and nursing staff being cold and heartless ice queens (http://www.telegraph.co.uk/health/healthnews/9003490/Nurses-lacking-ability-and-compassion-warns-NHS-Future-Forum.html).
Some of the instances of abuse, neglect and poor care that have been reported by the press are horrific and inexcusable: stories of vulnerable people with learning disabilities being institutionally abused (http://www.bbc.co.uk/news/uk-england-bristol-20084254), or of sexual abuse being tacitly condoned at Stoke Mandeville (http://www.bbc.co.uk/news/health-20499664). However, there is a twofold problem with the way these stories are being reported by the press. Firstly, the words ‘nurses’ and ‘NHS’ are being used to describe issues that are not confined to registered nursing staff in the NHS. The BBC, which I think is generally pretty neutral, describes the 11 staff who were sentenced because of Winterbourne (a private hospital) as ‘care workers’; this probably means that they were unregulated, possibly untrained support workers, rather than registered members of staff. Although registered staff were implicated as well (http://www.nursingtimes.net/nursing-practice/clinical-zones/learning-disability/two-winterbourne-view-nurses-suspended-by-nmc/5031372.article), and I am certainly not naïve enough to believe that education will prevent nurses from perpetrating this kind of crime, I think it is unfair to claim that degree-level education is responsible for the supposed loss of compassion in nursing; clearly, uneducated ‘trained-on-the-job’ staff are just as capable of atrocities as those who have been trained.
Secondly, whilst the stories I have just quoted are clear-cut examples of inhumane and inexcusable (and criminal) behaviour, much of the time the issues are more complex. The CQC recently issued a warning that care standards are falling; I have to admit that I haven’t had a day off to read through the whole thing yet, but their comments are telling when it comes to the preposterous expectations that are placed on healthcare staff: they state, firstly, that their findings re: poor documentation and medicines management are probably an indication of strain due to understaffing, strain on existing services, and budget cuts; they then follow this up by claiming, airily, ‘pressures cannot be used as an excuse to deliver poor care’ (http://www.nursingtimes.net/cqc-issues-warning-over-pressures-on-nhs-staff/5052168.article). One of the articles I cited earlier complained about a ‘lazy’ nurse being unwilling to leave her lunch break to change a soiled patient. The article doesn’t make it clear whether the patient soiled himself before she went on her break or not; if it was once she’d already left, damn right it’s not her job, especially if (as indicated) she had handed care over to another member of staff before leaving. Nursing staff aren’t paid for being on lunch breaks. They aren’t (shouldn’t be) expected to work during those hours. If you are working a 13-hour shift (now the norm at most hospitals), a lunch break (and even a copy of Grazia, if you are that way inclined) may be the only thing that enables you to go back outside and face the ward again with a smile. It may be the only opportunity that you have to lock yourself in a toilet and cry, quietly, until you feel like a human being again. It doesn’t make you heartless (see http://www.guardian.co.uk/commentisfree/2012/dec/05/nurses-have-not-stopped-caring for a very good summary of my feelings on this topic).
There have been several shifts recently where, by the time I got to my lunch break (normally around 4pm, when my shift starts at 7am), I had not had an opportunity to have a mouthful of water or go to the toilet. Our ward has a policy that we are not allowed bottled water at the nurses’ station because it looks ‘unprofessional’; the other day, I realised I had gone an entire 13 hours not having eaten or drunk anything, because I hadn’t had time for a break. By the time I got home, I was dizzy from dehydration. Normally, I (and the rest of the staff) don’t leave until about 9pm, when officially our shift ends at 8. Claims that nurses are lazy for wanting to take their breaks make me angry. When nursing numbers are cut whilst the acuity of patients rises, of course mistakes will happen; of course drugs will be late, and things will be missed, and sometimes the nurse won’t go in to see a healthy patient for a few hours because she is helping to resuscitate the one in the next door cubicle. They have not yet perfected technology that allows nurses to be omnipresent (perhaps, if I haven’t changed your feed, even though you asked me to twenty minutes ago, it is because your neighbour two beds over is grey and I am worried that they are about to die). I don’t mean to sound callous, but, despite the stereotype, nurses are not angels, not superhuman. They are not either perfect or awful. People are analogue, not digital; they don’t come with either an ‘exclusively good’ or an ‘irredeemably bad’ setting. They have faults, and grey areas, and they get tired and hungry. On one ward that I worked on years ago, a patient was resident who routinely attempted to sexually assault staff; on at least one occasion, that person came close to succeeding. You know what? You do a shift like that-and more of our shifts are like that than otherwise-you need a lunch break. Wanting one isn’t ‘lazy’.
I appear to have meandered somewhat from my original point (I do this a lot), which was about compassion and intelligence not being mutually exclusive. I am quite intelligent. I read political biographies for fun, and I am doing a PhD, and I got first class honours on my undergrad degree. My favourite pastime is shouting answers at the TV during Question Time. You get the point. And yet, throughout my bumpy and often difficult training period, the one thing I was never faulted on was my compassion. Documentation? Occasionally. Time management? Yup. Clinical skills? Well, you can’t know everything straight away; that’s why you have a mentor. (I would here like to reassure the reading public that these issues were resolved in first and second year, and that I was signed off and deemed competent to enter the register). But compassion? You know, as a student I had one really awful placement. I sat in my final interview, trying not to cry, whilst my mentor basically told me that the whole ward had been gossiping about how awful I was behind my back. The one positive thing she wrote in my evaluation –the thing that allowed me to pass the placement – was ‘Stella is a very compassionate student’. Compassion and intelligence are not mutually exclusive, and to pretend that they are is patronising and simplistic.
Apologies for the rant. It is pretty difficult to be an upbeat, cheerful nurse at the moment, and I’ve used up my quota of smiles for the week.
I think I will conclude with this thought: the grace of God is an amazing truth. There were a few weeks recently where, knowing what the situation on the ward is like at the moment, the only thing that got me out of bed, let alone into work, was that knowledge that there is no condemnation for those that are in Christ Jesus. Although I do my level best to provide safe, compassionate and effective care for my patients, to lay down my life for them as Christ laid down His for me, my ultimate authority, the one in whom I put my trust, is Jesus. I am accountable to the NMC for my actions, but if I disappoint them, or my patients, or my manager—it doesn’t affect my eternal salvation. It doesn’t destroy the truth of what God has done for me, or the depth and width of His love. I provide the best care that I can, with the resources I have; at the end of the day, it is to glorify God, not to gratify man.