The Tea Room
|Posted by firstname.lastname@example.org on May 14, 2015 at 4:00 PM|
By Judy Hitchcock
International Nurses Day is here again, 12th May already! This year is flying by: it hardly seems any time at all since I wrote about the motivational promotional material provided by the International Nursing Council last year, inspiring us with the slogan:
NURSES: A force for change – A vital resource for health.
I was rather pleased to see that the slogan has not been changed but expanded upon to focus on the most challenging aspects of delivering health care, that being the cost.
It’s a topic that is close to my heart and many of my peer group. Only yesterday, I shared on Face Book this poignant quote from a Canadian ER nurse who posted on Kevin MD .com ‘The issue boils down to whether the healthcare industry can tolerate highly educated, vocal , critically thinking, engaged nurse collaborators who, in the interest of their patients will constructively work with- and challenge , if necessary-physicians and established treatment plans. Or does the industry just want robots with limited analytical skill, who blindly and unthinkingly collect vital signs and carry out physicians orders? More importantly, which model presents the best opportunity for excellent patient care?”
Within a few moments the replies started pinging back; a sadly overwhelming opinion that the cheapest model of care already prevails, with jarring undercurrents of cynicism, stating that Western medicine is just big business; a perception that the nurse and the patient have just become part of the process to throughput the client as cost effectively as possible; with no care for nurses who are being asked to undertake more with less. It could be argued that morale is indeed in need of a massive shot of motivation and passion.
The fact that the cost of caring has been highlighted as a responsibility that we all share, to balance effective caring against the cost of providing that care; is a challenge not just for the coming year but the foreseeable future. It is right up there on the electioneering political agenda, with the twitter feed buzzing with how to not just fund the NHS but to improve service delivery. It is of great interest to us all because the latest trends and models of care in the UK follow suit here, irrespective of cultural and demographic influences. The important fact to remember is that health delivery is not a one size fits all. What works in the metropolitan areas does not necessarily work in the rural, so applying state wide standards is going to be contentious. Is it any wonder “The way we do things around here” still prevails; because it certainly does; primarily held in check by an aging work force who are the custodians of that very mantra; but by the same token they are holding many health services together.
It’s not just radical changes that need to be addressed; inefficiencies, poor communication and mismanagement could save the health service mega bucks by simple measures, such as basic stock control: not so tight that one extra admission requiring antibiotics puts pressure not only on ward stock but also the “after hours” supply, and not so loose that veritable condiment mountains can be found in some ward kitchens, with enough jam, vegemite and honey stored to feed an army! There are some places that I have worked in Australia that are ‘the place to go to’ should you find your own supplies short changed; sock rooms and store rooms positively bursting with supplies, whereas in NZ it’s very different. We have been watching our budgets so tightly for years; nothing ever has a chance to reach its use by date!
Last year, at the neonatal nursing conference in Christchurch, NZ, keynote speaker, Philip Darbyshire, Professor of Nursing and Global Health Care consultant, encouraged all nurses not to rest on our laurels but to be more proactive in redefining the role of the nurse, to practise articulating the difference we make is providing care, not just undertaking tasks. We should all be able to easily describe what we do all day, why we do it, how we could do it better and be crystal clear in knowing why what we do makes a difference, as opposed to anyone untrained undertaking the role, let alone robot care givers being currently researched.
In order for this to be fully appreciated by those holding the purse strings, caring must be described in cost effective terms, not woolly, emotive descriptors. This is probably the most challenging aspect of engagement in the process, to be objective and business minded whilst paradoxically extolling the virtues and financial benefits of caring. It must be seen as fundamentally essential to the patient recovery providing “Optimal care at an affordable price”. It is a complete U turn to the current perceptions that the care factor for patients and nursing staff is too expensive. It is a skill to be able to articulate the benefits in terms that are of interest to the accountant, who will be delighted that the cost of the patients stay was reduced but not necessarily because the patient’s recovery was improved by being nursed at home.
That old maxim ‘Time is money’ prevails and how we best use our nursing hours is being recorded on trend care to predict effective patient acuity with nursing skill match. It is therefore essential that we not only fully engage in understanding the cost of caring but can articulate the savings to those looking at the f shaped curves on important graphs and wanting to improve the budget by cutting costs. We also need to take courage and look at ways we could do things more cost effectively, ergonomically and efficiently. We need to think outside the square and bravely challenge the way we do things, asking is there a better way to do this? And that is not easy, especially when entrenched practises and personalities dictate work culture. We need to stop blaming the culture of the establishment for stifling motivation because each and every one of us is the culture and responsible for the culture we accept. It is well known that ‘culture eats strategy for breakfast’ and yet paradoxically, we all want to be part of a culture that is dynamic, motivated, supportive, receptive to innovative ideas, caring about nurses as well as those whom we care for.
Service redesign needs to be done skilfully to retain the very best attributes whilst improving cost effectiveness and meeting targets, be they waiting list surgery, emergency department wait times and length of stay. In theory it sounds achievable but budgets are blown by ever increasing variables; that is the unexpected nature of un-wellness. I think there should be more money invested into wellness in the first place but that’s a whole new topic and debateable on many levels.
Neonatal care is notoriously expensive and there’s plenty to debate on how cost saving initiatives can be implemented when research is slow to have impact in the work place. One really exciting area currently being trialled in Canada, Australia, and NZ is Family Integrated (FI) care where parents care for their own infant under direct supervision and guidance from nurses. The pioneering research was originally shared at the Belfast conference in 2013 by Canadian researcher, Professor Shoo K Lee, neonatologist and Paediatrician-in-Chief and Director of the Maternal-Infant Care (MICare) Research Centre at Mt Sinai Hospital and showed encouraging results. Outcomes were much better, family unity and bonding improved, cross infection dropped, iatrogenic infections reduced, drug errors were minimal, breast feeding success increased and length of stay reduced. Literally a win, win, win outcome! Win for the baby, win for the parents and win for the hospital with overall cost of care in the short and long term reduced. We need more outside the square ideas like this, often originating out of necessity which, after all, is the mother of all invention.
The International nurse’s day kit provides extensive, positive promotional material, motivating us to actively engage in policy making whilst preserving the x factor, that care factor that makes a registered nurse essential in the goal for improved outcomes in health delivery. It is well worth reading and being inspired to think outside the square. As Florence Nightingale said…..
'Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back' – Florence Nightingale.