This is part of a series we will look at some of unique characteristics of our public health system, at an aspect called turbulence. We will even look at perfect storms in nursing.
Other characteristics include in our health care settings include holidaying while we wait , number of beds and cots ‘figures as well as lay caretakers.
Turbulence in this context is used to mean inefficient processes leading hectic conditions of work in the hospital, usually due to constantly unpredictably changing health policies, lack of resources or even sheer ignorance of the plight of patients and care providers by the management.
This can range from a state of chaos and instability to mildly altered organizational structures and dynamics, all these places new demands on health care workers. Although turbulence creates challenges for all healthcare workers, it had the most immediate effect on the nurses’ work environment.
A case in point was whereby a lot of time and effort was spent looking for supplies by non-procurement staff like nurses creating a turbulence that distracts them from their primary role of patient cares. Turbulence could also be described as some sort of compounding. Extra work on ‘voluntold’ projects kept on piling on the bedside nurse but never taking anything away. Urban Dictionary describes it as forcibly volunteered. Voluntold was coined from compelled to do the job yet it added nothing to the paycheck.
My attention was drawn by the debate whether or not to canulate ‘branulas’, do blood samples. It indeed it was part of nursing work. Well, this is neither here nor there and I will show you why. I will try and frame the debate for you.
The reactions and counter accusations on nurses’ social media about this issue squarely fit the phenomena of ‘turbulence in nursing’. As I already explained it starts with something called ‘voluntold’: these are things nurses do on voluntary basis for whatever reason including altruism, which eventually become their work.
The enforcement comes by default or through a polite memo ‘requesting’ them, off course its requesting them to ‘continue’ doing that which they were already doing anyway. Or else compelling them in a soft or not so soft language. The recent one indicated the request was driven by shortages of those whose job it was.
A task that was once voluntary has now been ordered to you. There were several examples of such assignments in nursing including ridiculous ones like doing bills, doing stores, statistics, hospital covering, transport/fleet management, ISO accreditation activities, performance targets, reports etc etc. Mostly these were other peoples jobs. How do you do other peoples work yet you have not done yours, or more precisely when they won’t do yours?
The need to document nursing care has overtaken the need to do the care itself. Technology has variously been described as disruptive especially where it is inadequate ( How does a team of nurses use one computer ‘tablet’ to cover all the 120 patients in the ward?). Again its ridiculous that all that care that involved hours of toiling is equals to just one tick in the computer and hardly accrues much in terms of billing. Some miscellaneous activities costs more than nursing care. This is a big turbulence.
In one regional referral hospital nurses who happen to be on duty during the transition period or visiting hours have to be very keen so that patients do not abscond. If they do and they often did (mainly these were Discharge-ins with unpaid medical bills) the nurse would be given hospital transport to go to the nearest police station to record a statement as soon as possible.
In yet another hospital if the patient escapes the nurse would have to pay the patient’s bill by check off from her salary. ‘It is worse that only the nurse is surcharged while other health disciplines are not’. One veteran nurse from another facility said it was now better since the security officer would also be paying. She disclosed that when a patient absconded she would ‘lock up the rest, get transport to go to the police and report, even if it was at night’.
Staff shortages, including that of support staff such as cleaners and porters had resulted in highly skilled staff such as nurses having to perform unskilled but essential functions such as mopping the floors this had happened elsewhere in Africa like Cameroon, Zimbabwe some extent here in Kenya too. I am using the skilled tab with caution in view of the SRC’s ‘de-professionalization’ of nursing during the job evaluation.
This means less time was spent getting to know the patient outside of the diagnosis (both medical and nursing). Many times there was only one nurse on duty with so many patients, so nursing care would be left undone. It was difficult for the nurse to keep track of patient care that remained to be done.
A picture of a lone nurse in a crowded ward.
(Picture courtesy of WHO)
We will be looking at another interesting aspect of turbulence and what this means especially nurses’ work. Please the perfect storms in nursing. Welcome.