‘Welcome to a nurse’s world: 14-hour days. €14 an hour. Panic’

A new ‘Irish Times’ column offers a coalface critique of our ‘broken’ health service

Sick health service: welcome to my ward, where there can be one thermometer for 30 patients, where the hoist is broken, where the clinical nurse manager is too busy to help. Illustration: John Cassidy/A-Digit/Getty

Sick health service: welcome to my ward, where there can be one thermometer for 30 patients, where the hoist is broken, where the clinical nurse manager is too busy to help. Illustration: John Cassidy/A-Digit/Getty

 

Vocation. From the old French vocacion, a spiritual calling. Sounds wonderful. Except right now I feel like calling it quits.

Here’s why. A sixtysomething male patient shows up. He has dementia. In an ideal world he would be specialled, which is to say looked after, one on one, by a healthcare assistant, ideally in a room of his own.

But we do not live in an ideal world, especially in terms of healthcare provision. In any event the healthcare assistant is missing in action. So the sixtysomething man is assigned to my care, despite the fact that I have nine other patients, one of whom is seriously ill with emphysema.

The patient with emphysema begins to have breathing difficulties, and to panic. I go to her. The sixtysomething gent goes wandering.

Security is notified, but it is me who is charged with locating and bringing him back. I go to the main door, following protocol. I spot him, hovering. A security guard arrives, talking calmly into his walkie-talkie. I am reassured.

Within seconds, however, the security man makes it clear that he is the last resort: he’s not putting himself in harm’s way. It doesn’t matter if a patient is in his 60s; he could still pack a punch.

The patient with emphysema begins to have breathing difficulties, and to panic. I go to her. The sixtysomething gent goes wandering

The security guard asks if I am clear about this. I nod, even though I’m not clear about anything other than that I’ve been on my feet for 10 hours and am worried about the woman with breathing problems and the fact that colleagues might be too swamped to care for her.

I approach the sixtysomething gent. I place my hands on his shoulders, and he turns toward me. He is unwashed, unshaven, but was once a handsome man. A schoolteacher, according to his chart. The last traces of authority, or maybe certainty, are dying in his eyes.

He looks at me. Tilts his head, as if wondering whether he knows me. Then he punches me, hard, knocking the wind out of me.

I sink to the ground. But there is another sinking feeling, deeper inside.

I stand up. The security guard arches an eyebrow, in an I-told-you-so kind of way. The patient stares at his balled fist and seems to encounter a moment of real sadness. He slumps against me. A sudden child.

I walk him back to the ward. I feel very alone. I feel I am no longer part of the solution. I feel trapped.

And I feel no one gives a fiddler’s. “Midlands nurse punched by sixtysomething man with dementia” is not exactly headline news, is it? It lacks the significance of, say, Charlie Bird being kicked and punched at a protest rally.

For the remainder of my shift I am in a surreal state familiar to night workers and those whose working days can stretch to 14 hours. Almost mechanical. I do my best. To avoid mistakes. The woman with emphysema is restful. She manages a smile. Do I?

The sixtysomething gent is sedated. Placed in a bed farthest from the door. The window is locked. The patient next to him, a man with bowel cancer, is appointed sentry.

'Midlands nurse punched by sixtysomething man with dementia' is not exactly headline news, is it?

Handover to day staff brings a familiar degree of panic. I am hyperaware of the clock, of notes to be written, the incident form to be filled in. I get it done. Just.

“I did the right thing, but I feel wrong”

Turning the key in the ignition of my car, I feel the pain. I put my hand where he hit me; I close my eyes, tell myself it’ll be okay. But I don’t believe it. Anger floods through me.

I want to go back and yell at the security guard. But I know he is not the problem. Nor is the sixtysomething gent. Nor am I. But, like I said, I feel I’m not part of the solution any more.

Home. (Such a lovely word.) I’m hungry but too tired to eat. Did I forget something? Could I have done more? No. I gave every ounce I had. Do I believe this? I think so. My mind is muddled. My body sore. I feel much older than my years.

Up to 2,000 nurses and midwives have staged a protest over plans by their regulatory body to increase their annual registration fee.

I was warned as a student that my very thinking, my prioritising, would be under constant scrutiny. What I wasn’t told was that I would fill up with anxiety and doubt, nightly.

Theory tells me that the woman with the shortness of breath was my priority. I did the right thing. So why do I feel so wrong? Maybe I’m in shock. Maybe I should get over myself. Maybe it’s part of the deal.

Firefighters get rocks thrown at them. Paramedics get kicked and spat at. Guards get rammed in patrol cars. Nurses get punched by sixtysomething men who don’t know who they are while security stands idly by.

There’s a systems failure, yes. But there’s something more. Something broken. The way the security guard just looked on. Maybe I need to sleep. Did I forget something? Did I make a mistake?

“The money goes to the wrong places”

I am a citizen. A nurse. A woman. A human being imbued, I hope, with a sense of decency and fair play.

Working in both public and private hospitals, I have seen not just the misguided management of our health system but also its everyday injustices. (For example, why in God’s name should diagnostics be closed after 5pm in a big urban hospital?)

I have seen blatant, institutionalised disregard for the welfare of patients and casual disdain for the safety of nurses and healthcare workers.

In training I was taught about patient welfare and my personal safety. When I began my internship I learned that theory and practice exist in different worlds.

I was placed in jeopardy, daily, and so were my patients. I was asked to make decisions about the welfare of extremely sick people, on the hoof, without a supervisor, sometimes after 11 or 12 hours on my feet. It was like watching someone concoct a recipe for disaster, day in, day out.

Feelings of frustration grew when, after graduating, I realised I couldn’t afford to live.

But this is not just about money. Or conditions. It is about the slow dawning of a reality, about 80-year-olds dying on trolleys with makeshift curtains around them. It is about the lack of dignity being afforded to our elderly, our most vulnerable, day after day.

I am angry about the gaps in salaries in our HSE-run system. At how much upper and middle management consume. They are, in my view, disproportionately rewarded for their efforts, particularly as their efforts are often mere repetitions of previous short- sighted initiatives with different names.

Feelings of frustration grew when, after graduating, I realised I couldn’t afford to live

Of the €459 million increase earmarked in 2017 for the health services just €61 million is available after salaries are paid, and of that only €9 million will go directly to the hospital system. The money gets sent to the wrong places.

Investment needs to be from the bottom up: in equipment such as hoists, wheelchairs, sliding sheets; in extra nurses, in healthcare assistants, in fair wages for porters, cleaners, security guards, catering staff – the people who keep the hospital alive and functioning.

“I couldn’t afford to keep up therapy”

And nurses? Overburdened and under-resourced, they risk losing their registration if they make a mistake. (And who wouldn’t when their working days are at least 13½ hours long?) It is morally wrong that I am “fully legally responsible” for my actions when I am so stretched by sheer volume of patients.

I am healthy and emotionally resilient. But I got so sad and so burnt out so quickly after graduating that I went into therapy. It was wonderful to be heard, but even at a reduced hourly rate I couldn’t afford to keep going.

The therapist suggested that I write a diary each evening after work, vent the frustrations, the anger and the joys. This was a coping mechanism designed to protect both me and my partner, who was increasingly worried about my physical and mental health and fed up with the amount of time we spent talking about “institutionalised failings”.

He’s a good man, but he is also human – and I know he was becoming fed up with my chronic exhaustion and our diminished love life. It’s very hard to be intimate when your body is bruised and battered and your stomach is full of fear.

The risk of making a mistake

The Irish health and hospital system is utterly broken. It does not work because it no longer prizes safety, dignity or basic humanity. In too many instances it seeks to get back “investment”. It seeks to make a profit. It seeks to save money, cut corners, protect the bottom line.

It ignores best practice and the whole point of what a hospital is supposed to be. It should be a place where people come to get well, to recuperate and recover, not a place to die or wait until a nursing-home bed opens up. The system reduces our mothers and fathers, our sisters and brothers, to numbers on charts, to digits and dots, to a profit-and-loss equation.

This is the first of a series of columns for The Irish Times. In them I am not speaking for all nurses, although I will try to voice some of our communal fears and frustrations. I am not a trade unionist. I am not an activist. I am not a member of any political party. But I am interested in politics, in people power. I am not interested in passivity.

I see myself as loving, kind and honest. I am utterly dedicated to my vocation. But I’m not a gobshite. I’m not here to be taken advantage of. In future columns I will write about patriarchal attitudes, about blinkered, sexist societal attitudes to nurses. I want to shatter the Florence Nightingale myth.

Other articles will look, without flinching, at my own profession – at how directors of nursing, for example, collude to load up the nurses so surgeons can enjoy a Christmas bonanza or golfing holiday.

Welcome to the Republic of Nursing, to 13½-hour shifts, to €13.80 an hour, to panic in the gut when you see yet another seriously ill patient being wheeled in. Welcome to my world, and to my ward, where there can be one thermometer for 30 patients, where the hoist is broken, where the clinical nurse manager is too busy to help and the sixtysomething with dementia has gone wandering.

The environment that successive governments have created for our nursing graduates, both male and female, is dangerous. It is unsustainable. No human can work in the conditions of our public and, indeed, private hospitals for any protracted period without running the risk of serious mental or physical impairment.

No nurse should be asked to spend 14 hours on her feet, with just a pee break and a bite of an apple, and then make decisions that might affect a patient’s ability to walk, breathe or remain on the planet.

The author’s identity is known to The Irish Times