Do Not Disturb:  Undervaluation in Progress
 

Originally published in the Nursing TImes September 14, 2011. Written by Sandy Summers and Harry Jacobs Summers

Recently a row has erupted over a new National Health Service program under which nurses wear tabards reading "Do Not Disturb: Drug Round in Progress." The idea is to avoid life-threatening medication errors by reducing distractions.

But the initiative has led to an outcry about nurses being directed to ignore patients. Some link the program to recent reports of neglect and abuse, which are supposedly caused by modern nurses' desire for university degrees and administrative jobs that are incompatible with their real mission. That mission, apparently, is to be unskilled angels, holding hands and fetching meals, and nothing more.

According to Jo MacFarlane's basically fair August 27 report in The Daily Mail, nurses wear the tabards only when giving drugs, and they are accompanied by "care assistants" who address concerns unrelated to the medication. Preliminary research suggests that the tabards do lead to a "slight" reduction in medication errors. But Joyce Robins of Patient Concern calls the new program "grotesque and ridiculous," arguing that if you "can't do more than one thing at a time, you're a pretty hopeless nurse." Ward manager Penny Searle says that "[w]e cannot change the workload, but we can change the way we address it" through measures like the tabards.

However, "the workload" is a central factor in nursing errors. Nurses have always faced countless interruptions from colleagues and patients, and it has been easy to become distracted. Today, understaffing has exacerbated the problem—not to mention playing a key role in at least some of the other problems nursing critics have identified. And in fact, individual nurses' workload, like their pay and the amount spent on their education, is not a law of nature that we "cannot change." It's the result of decisions by humans who control financial resources.

However, rather than address those decisions, perhaps it's easier to blame the nurses. On August 28, the Telegraph published "Nursing is no longer the caring profession," in which Christina Odone argued that the tabard program was emblematic of a system in which nurses see patients as a "nuisance" to be "ignored" as the nurses work their way up to the "desk job" they covet.

Odone says that during a recent hospital visit, nurses ignored her mother's calls for water and a commode. They also had the nerve to giggle in Tagalog while giving her a sponge bath. According to Odone, the "do not disturb" initiative aims to stop "those pesky patients from interrupting nurse during her important tasks"; she "should not have to stop her form-filling and box-ticking to quench some old biddy's thirst, for goodness' sake."

The real culprit? Odone says it's nurses' own aspirations to higher education. In particular, a "senior executive of a care charity" told her that he "rued the day that degrees became compulsory for nurses." That move "professionalised" what had been a "vocation," so that the former "angel[s] of the ward" became too uppity for "soothing fevered brows and administering TLC." Thus, nurses today "are not Florence Nightingales, but wannabe administrators."

Compassion and diligence are essential qualities in any nurse, and allegations of abuse and neglect must be addressed. Nurses should not be so burdened with paperwork that they cannot speak with patients and families. And although the tabards address a serious problem, the slight benefit they reportedly confer does not seem to justify the damaging message they send to patients, who might even hesitate to report a serious symptom, like severe chest pain.

But contemptuous rants like Odone's piece trade in stereotypes. Nurses are not angels giving simple custodial care. Nursing is a science profession that requires education because nurses use their skills to save lives and improve outcomes. Nurses' drug rounds are matters of life and death because a drug error can kill. Nurses use cutting-edge technology to monitor patients for changes in condition and intervene with advanced treatments. Nurses advocate for patients and teach them how to adapt. Nursing requires some paperwork, just as other serious professions do.

And yes, nurses also administrate. One notable example? The fiercely unangelic Florence Nightingale.

Of course, nurses can't do any of this very well if they lack adequate resources. But to pretend that the problem is that nurses are too professionally-oriented is absurd.

We're still waiting to hear that the failures of the NHS are due to physicians getting too much education.

See the article on the Nursing Times site here.