OPINION: What do people think of when they hear the word nursing? Is it giving medications, is it checking someone’s blood pressure or perhaps a hand-hold as the doctor explains a new, difficult diagnosis?
These are apart of our everyday as a nurse, but do they encapsulate what we really do and what our job really entails?
The word “Angel” has been thrown around far too often when talking about nurses. It invalidates the difficult job we do. It also says we’re happy continuing to put up with the poor conditions the DHBs put our patients in, and quite frankly it’s insulting.
I was not an angel when I assessed, Sifa, a patient with life-threatening asthma (widespread wheeze and shortness of breath) as needing asthma protocol (salbutamol, atrovent and prednisone).
As an emergency nurse I can give these medications under my own scope using my own clinical knowledge - as many speciality nurses do.
It was my hands that helped guide the patient through each breath through the spacer to efficiently deliver these life-saving medications into his lungs to stop his bronchoconstriction.
And it was my voice that helped slow his breathing to both allow the medication to work and settle his nerves during, what was likely, a very scary situation for him.
I was not an angel when escalating Sandra, a patient with sepsis, to the senior consultant based on my initial assessment, having already inserted a cannula and taken blood tests (letting her know that Sandra had bilateral flank pain with guarding on both flanks and into the right groin, that her vitals were showing clear signs of infection with a clear source).
The doctor then charted the appropriate antibiotics and ordered further tests. Doctors often rely on our eyes and ears to support their decisions and without escalation Sandra could have waited hours for their first dose of antibiotics and appropriate analgesia.
I was not an angel when calling the family of Yi, a dying elderly man, to come into hospital to say goodbye to their father and husband after trying to contact the doctors several times to do just this. We often have to make these judgement calls given the vast number of patients that doctors see and the, sometimes, drastic changes in a patient’s condition. There is nothing like having to delicately describe to a family member that their loved one is dying - it is absolutely heartbreaking.
I was not an angel during the countless conversations I’ve had with women who have been physically and emotionally abused by their partners, enough for them to end up in hospital, walking them through the process to get help.
To make them feel safe and unjudged in an otherwise hostile world is a skill that is deeply unappreciated.
The duplicity of being physically and verbally abused, myself, at work (often due to influxes of patients and long wait times) while trying to prevent this is incredibly, ironically distressing.
I was not an angel during the constant prioritising of care that we do during a shift. If you had the choice who would you treat first?
1) a patient who is six weeks pregnant with right groin pain, 2) an elderly patient with dementia and a stable neck of femur fracture, 3) a 40 year old patient with lower back pain, 4) a 50 year old with epigastric pain radiating to the back and 5) a 20 year old who is dizzy and hasn’t kept any food down in a week.
These are the questions flowing through our minds every minute and the decisions we have to make countless times a shift.
No angel is making these decisions.
We use our critical thinking skills, knowledge of pathophysiology and disease progression and clinical experience to deliver our care, escalate where appropriate, have difficult conversations with patients and prioritise the most sick.
Wouldn’t you appreciate if nurses had fewer patients to look after so that you felt safer? And wouldn’t you appreciate if nurses were paid more to recognise the important work they do?
Currently we are in a healthcare crisis. Our patients are more comorbid than ever with a surge in numbers in recent years across the country, while nurses are being asked to take on more and more responsibility without any formal recognition of the weight of that responsibility.
Our population has boomed in the Counties Manukau catchment and across the country. The ratio of patients to nurses is desperately unsafe. And unfortunately time and time again, it is our communities most poorly represented in health statistics who are going to fall through the cracks due to the racism that exists in our healthcare system.
The capped ratio in most hospitals is one nurse to four during day shifts in New Zealand, while Middlemore has its nurses looking after anywhere between 5 to 8 patients - and with the compounding of understaffing this can end up looking like a 1-10 ratio.
Would you like to be a patient in a hospital where the nurses had nine other patients to look after?
These situations are ticking time bombs for major patient incidents and I have already seen and heard of deaths occurring in our hospital as a direct result of understaffing. I am very worried about the grossly unsafe conditions nurses have to work in every day.
We cannot retain nurses at the current levels of pay.
Just last week I heard my friends talking of leaving to Australia, even during a global pandemic, due to the much safer working conditions and better pay that values the work they do.
We have already had multiple mass exoduses of staff, including very senior nurses, meaning a largely junior nursing force and new nurses who have to relearn our hospital system. We need to pay our nurses what they deserve to create a culture of retention and appreciation. We don’t want to lose our valuable senior nurses with vast clinical knowledge.
I am still flabbergasted at the lack of political will to offer nurses a decent pay rise. The DHBs have just put out a revised offer that struggles to get close to the 17 per cent we’ve asked for and is clouded by this “magical money” from the pay equity process. Members don’t trust the pay equity money won’t be used against them.
Why not leave pay equity out of the equation and offer an increase with no promise to reduce it later? Whatever is offered to us now will ultimately influence the pay equity increase regardless.
I keep hearing about how our economy is doing so much better than planned. If this is the case why aren’t we seeing the much needed investment into the core part of New Zealand’s healthcare? Why did the government put in a pay freeze two days before it was announced nurses were striking in June?
Andrew Little said recently that there were “plenty of nurses that had practicing certificates but were no longer working” when asked about the shortage of working nurses.
There is a clear disconnect in his understanding of the problem. If nurses felt safe and valued at work, there wouldn’t be a shortage. You can’t expect nurses to suddenly return to the workplace that had them burning out in the first place.
Andrew Little, wake up and realise that it’s going to take a significant investment in nursing to fix this issue - no small band-aid will do.
We’re not asking for the world, we’re asking for what nurses, and our patients, deserve - a profession that is able to safely look after its community. There is no other profession who does the work we do.
Jacinda Ardern and Andrew Little, if you’re going to continue making decisions that affect us then take the time to understand the situation. Come to our workplaces, talk to our nurses, charge nurses, healthcare assistants and midwives.
These are the people who have first-hand experience of what our patients are going through and what it feels like to be working under conditions that, countless nurses have expressed, have never been this dire.
Graphs can only tell you so much. What a sigh of relief it would be to have MPs finally care about the work we do past an add slogan. We are sick, tired and terrified of the conditions and lack of investment into nurses who without, the healthcare system would crumble.
The time for action was yesterday.
The author is a nurse at Middlemore Hospital
