Tom Hutchins: More work from the labour units, even if the patients are neglected

COMMENT

Dr Margaret Horsburgh, the deputy chairwoman of the Auckland District Health Board, and Dr Ian Scott, a board member, have taken the New Zealand Nurses' Organisation to task.

They criticise the nurses' unwillingness to embrace the board's "professionally led approach which has quality patient care at its core".

Clearly, they are unhappy also about the organisation's promotion of what it calls a safe staffing model for public-hospital nurses. But they concede that nursing workload management is "an issue".

Drs Horsburgh and Scott might like to take back to their board a patient's observations. I have just ended six weeks in three wards of Auckland City Hospital where I most gratefully received successful treatment.

But on five occasions nurses brought the wrong drug, the wrong dosage or omitted the prescribed drug. Only because I questioned the offerings were corrections made; a more fatigued or more ill patient might not have noticed. Four of those occasions were towards the end of shifts, and I believe fatigue may have been involved.

There were numerous times when caring nurses quite conscientiously said they would do something but did not return to fulfil the task.

For example, three times nurses went to get urgently requested urinal bottles, and returned 10 or more minutes later to find this patient had wet the bed - and then needed a bed change and shower and new pyjamas, all extra work because a 20-second walk to a nearby room was apparently aborted by other demands.

A more serious occasion was a midnight visit by a senior nurse to start an intravenous feed of antibiotic to suppress the potentially fatal staphylococcus aureus bacterium which had infected an earlier IV feed site.

The new site was a difficult one, on the inside of my wrist (we had run out of suitable veins at this stage), and it required support by a much longer bandage than was in the phlebotomist's kit.

Expecting to be away from me for about a minute to get a suitable binding, the nurse told me to keep my wrist still in a suitable position so as to not damage the needle's entry.

Half an hour later, the nurse returned, harassed but still professionally cool and super-efficient, deeply embarrassed and genuinely apologetic.

Why had we, patient and nurse, in a basic human experience of hospital life, been brought into tension, dissatisfaction, even farce if one thinks of the glib phrase "quality care"?

The "flexible management" style promoted by the Auckland District Health Board seems to mean that as soon as a nurse steps into the corridor of a ward, or is halfway through a lower-priority patient's needs, she or he is seen as a unit of labour to be immediately assigned to another patient or task, no doubt of greater priority - but in a blunt and essentially disturbing breach of the caring relationship from which she/he has just been interrupted and left unfinished.

From the bed of this unfinished patient, it appears to be a result of a management style that aims to extract the most work possible from as few staff as possible, all justified in terms of economic efficiency - but at the expense of becoming insensitive to what is already happening at the human level of nursing in the hospital.

Without exception, nurses' responses confirmed their workload had increased. And it would increase more if the move to abolish transit nurses and put their tasks onto ward nurses became policy.

I wonder how "flexible" management style can become when I had to wait 12 hours, nine hours and six hours, respectively, on three occasions for my badly soiled toilet to be professionally cleaned by a cleaner when I was in a single en-suite room with severe colitis.

That these distressing events could happen at night - as well as day - seems to escape the minds of managers.

I made attempts to clean up as best I could with the shower spray and towels, but medical asepsis of my toilet was a very low priority, despite my several pleas for a cleaner on each occasion.

And other staff were occasionally walking on the toilet floor, sometimes while I slept, sometimes ignoring my warning. It seemed to me to be an occupational health issue.

Shortage of cleaners to the extent I experienced must surely be due to budgeting. This is quite unprofessional, potentially dangerous, and redolent of the Third World.

My sympathy is fully with the nurses and medical staff. We may be just at the beginning of a harmful trend; their humane and spontaneously caring function is being opposed by a management style obliged by the maintenance of the Government's huge surplus and its inhibited sense of humanity.

That it's a Labour Government claiming to inherit the visions of Michael Savage, Peter Fraser, Norman Kirk and Bill Rowling adds to the sense of farce.

* Tom Hutchins, of Remuera, is a retired university teacher.