Deeper issues beyond nurses' wages need to be addressed

Elspeth McLean. Photo: ODT files

Raising nurses' pay and boosting staff are long overdue, but if the management system is not addressed, will we just end up with more disgruntled staff who may be better paid, Elspeth McLean asks.

Nobody is likely to pay me for my nursing skills. That's because they are non-existent.

I am firmly in the camp of a friend whose stock approach to sickness in others (possibly in the face of the dreaded man flu) is "you've told me you're sick, now just tell me when you're better''.

My realisation I was not Florence or even Nurse Gladys material began in my teens.

Once, when Dad was away for the day, I had responsibility for giving a penicillin injection to a sick cow. It took me ages to pluck up the courage and I had to have more than one stab.

I hated every second of it, possibly more than the cow did.

The cow died anyway. Did I make its final hours more unpleasant with my bumbling needle administration? It didn't bear thinking about.

At boarding school, I had to complete a certificate in home nursing. While I could do a mean hospital corner when bed making, the bandaging requirements brought me out in a cold sweat.

My efforts were more likely to give the patient a fresh injury. Inept doesn't get close to describing my incompetence.

I am not sure how I passed that part of the assessment. Maybe my "patient'' whispered a few pointers as I went wildly astray.

The only other thing I remember about the certificate was the recipe for eggnog.

This booze-free invalid's food involved whisking raw egg into milk with a little sugar and vanilla essence, and then bringing it on a prettily decorated tray to the unsuspecting patient.

We never actually did this, but the thought of it sounded disgusting.

I have always admired the breadth of skills of real nurses and it is not hard to take the nurses' side in their current employment agreement negotiations.

What worries me though, is that there may be too much emphasis on wages when the issues with nursing, and particularly public hospital ward nursing, go much deeper than that.

The kerfuffle around the negotiations has driven me to revisit Massey University nursing lecturer Bert Teekman's confronting thesis from 2012 "In Search of Nursing: The Long Term Impact of Health Reforms on Ward Nursing''.

I don't know any "lay person'' who has read this and not been shocked by the information Teekman gleaned from spending 41 days observing the practice of 12 staff nurses in unidentified medical and surgical wards (and interviewing them).

In his thesis, Teekman illustrates how the management model introduced in the 1990s has changed the way nurses work, reducing them to micro-managed task- oriented workers with reduced opportunity for individualised patient care.

Nurses, despite being the single largest group of health professionals in the country, and highly unionised, have lost their autonomy, becoming the "interruptible'' profession where they frequently pick up others' work just to keep the show on the road.

When you read Teekman's observations, you wonder how there are not more serious safety incidents in our hospitals.

While district health boards constantly mouth the patient-focused care mantra, the way wards are managed, with the constant churn of high acuity patients, and ongoing demands for more "efficiency'', do not fit that lofty ideal .

Teekman's description of a typical day in the life of a ward nurse includes concerns about time wasted sorting out things which should have been done by doctors or colleagues, problems with medication management such as interruptions and a "market place'' environment in the medications room, excess documentation, more time-wasting finding equipment,

not having time to participate in doctors' rounds and spending extra time at the end of the shift to complete all tasks.

One way nurses have tried to cope with this stressful environment is by cutting back their working hours. This has not addressed the underlying issues.

What I find saddest about this situation is that some young women I know, who were keen for careers in nursing because they saw it as a noble caring profession, soon became ground down by the reality of nursing in the public hospital setting.

For some, the only way they saw to continue in the job they desperately wanted to love, was to get out of the public system.

Raising nurses' pay is no doubt long overdue and so is increasing staff, but if the management system is not addressed, will we just end up with more disgruntled staff who may be better paid but still have little job satisfaction and still not be able to do the job they were trained for?

Instead of addressing the real issues affecting our homegrown nurses, will we just ship in a whole lot of nurses from poorer countries?

That sounds about as sensible as me trying to aid anyone's recuperation by whipping up an eggnog.

Elspeth McLean is a Dunedin writer.