Wednesday, 24 February 2010

Nursing Advocacy and Minnette Marrin

If you any of you are new to this blog you may not realise who Minnette Marrin is or what she has done to get on my bad side. 

Minette calls herself a journalist and has written extremely poor and badly researched articles about UK nurses for The Dail Fail and The Times.  I blogged about it here.

 The only thing that Minette's articles proved is that this woman has absolutely no understanding about what the word Nurse really means..  People like Minette think that any person who gets a job caring for patients in a hospital is  a Nurse.   There are many members of staff employed by the NHS to care for patients.  Most of them are not nurses and do not have the level of education that a Nurse has completed. If I have learned anything about the British press it is this:  To them, the term nurse is an umbrella term that is used to describe a worker who cares for patients.  Those of us with actual brain activity understand that the term Nurse is a professional title that one can legally use when they have completed enough high level education to register with the NMC.  Then you have jump through many hoops in the form of continuing education and payments to keep that registration.

The minimum level of education required to legally call yourself a Nurse makes the 3 years at university that a social worker, teacher, or an english major complete look like a walk in the park.  It is only the UK where those people are paid more than RN's.

Most people employed by hospitals to care for patients on general wards are not actually Nurses.  They can do tasks here and there but they cannot pull together the entire picture, give medicines or understand the rationale behind their actions.  They cannot assses or see the big picture. This leaves the few nurses around running between such a large group of patients that they are extremely ineffective, only barely managing to get most of the important drugs given during the course of their shift.  In order to do even that they must only focus on the drugs, to the exclusion of everything else.  It's horrible.  This situation makes it impossible for the Nurse's to do basic care and when basic care gets left to the care assistants important aspects of the patient's condition get missed.

I am not the only Nurse advocate who was upset by Minette Marrin's lack of insight and her promotion of lies and myths that undermine nurses and cause our hospitals to be even more dangerous.  The Center for Nursing Advocacy (now known as 'The Truth About Nursing') has also let her have it.  Despite  what Dr. Crippen has said about the Centre in his previous rants they are not an organisation promoting nurses as the new doctors.  They are not trying to turn nurses away from the bedside and into noctorhood.  Quite the opposite actually. .

Their brilliant piece about Minnette Marrin is  here.

Marrin's column did cause us to have concerns about declining standards, though nursing was not the focus of those concerns. (Marrin herself suggests, with admirable modesty, that even journalists may not deserve to be considered "professionals.") Marrin does not seem to understand the broader educational requirements of modern industrialized societies, which actually need more and more people with advanced training to create and manage all those wacky new gizmos (like the one on which she wrote her column), and fewer and fewer people to haul bricks and plow fields by hand. Increasingly, decent jobs require significant university education. But fortunately our current task is limited to addressing what nursing is and what nurses do.

Nursing is more about thinking than "washing." No one can be an "excellent" nurse unless he is also "bright," because nursing requires advanced health care knowledge and critical thinking. It is a distinct health care science led by thousands of scholars with doctorates in nursing. Nurses must initiate and administer complex treatments, monitor patients for subtle changes in conditions, teach patients how to regain health or live with their conditions, and advocate for patients with a range of other professionals, including physicians. In these ways, nurses save lives and improve patient outcomes every day.

But nurses who lack advanced training or intellect cannot effectively do that work. How does Marrin think nurses make "important clinical observations"--with feminine intuition? People in general may "vary hugely," and we appreciate Marrin's admission that at least some nurses might be "bright" and "academic," but good nurses, like good physicians, cannot vary hugely in every respect. You cannot be a good nurse if you're not bright, or not good at what nurse Rose on Grey's Anatomy memorably termed that "boring science stuff." Of course nursing also requires intimate physical work and good interpersonal skills, but so does medicine, and no one equates that profession with the "non-academic" aspects of the work. Nor does anyone argue that, because new physicians are often clueless about patient care, their extensive formal training is useless or even detrimental. Instead, new physicians gain practical experience through clinical training. So do nurses. In fact, physicians rely on nurses to spend significant time providing them informal training when they are new. Educating physicians too is quite a challenge if you're "not particularly bright."

There is compelling evidence that more nursing education leads to better patient outcomes. A Linda Aiken study found that hospitals at which only 10% of the nurses had bachelor of science degrees (BSNs) had twice the mortality rate of hospitals with 70% BSNs. A Needleman / Buerhaus study found that increasing the ratio of registered nurses (with 3-4 years of college-level training) to licensed practical nurses (with one year of *vocational* training) to the 75th percentile in all US hospitals would save 5,000 lives and $1.05 billion in total costs, decrease hospitalization by 1.5 million days, and decrease hospital expenses by 0.5% per year.

In fact, this is not Marrin's first foray into the supposed simplicities of nursing education. In August 2009 the U.K. press carried many items about a recent report detailing distressing cruelty and neglect by some nurses. One of these items was an August 30 Times column by Marrin headlined "Fallen angels: the nightmare nurses protected by silence." In it she argued that the problems stemmed not from a lack of resources but from a "cultural collapse" within nursing. Marrin attributed that decline partly to efforts to increase nurses' "professional status with a university degree," which had led them away from "old-fashioned bedside" care. But of course, good bedside nursing requires advanced university-level training, just as it requires compassion and physical skills.

It seems more likely to us that the weakness of nursing in many current settings, and the apparent lack of compassion some nurses display, is due less to a misplaced desire to attain higher status than it is to the weakness and lack of resources that are the natural results of low status and the contempt Marrin herself displays. Marrin recognizes that U.K. nurses receive "poor pay" and suffer from the handmaiden "stigma." She just seems to think nurses should be happy with all that. Maybe such forbearance would keep the "angels" from "falling." But when a profession is not respected by society, when it is subject to abuse and neglect, it is more difficult for practitioners themselves to respect it.

That last line bothers me a bit.  Bedside Nurses understand what they do.  It is the people who manage us who do not.  When nurses have 20 patients each it should be easy to see why they appear to be uncaring.  If you cannot spend more than 30 seconds at a time with any patient then you will appear callous.  The Nurses are not uncaring.  The problem behind the uncaring image is actually short staffing.  But other than that  The Truth About Nursing is spot on.  The poor image of Nurses perpetuated by the media in this country is the number one reason that care in our hospitals is so bad. 

When people cannot distinguish between a Nurse and a poorly or untrained assistant it gives penny pinching managers a license to not staff their wards in a safe manner.  If people do not think that nursing care is complex and important, the wards do not get staffed and resourced or invested in.  If I am one nurse to 20 patients they will suffer and die whether I have 2 care assistants helping me or 10 care assistants helping. They will not get their medicines, the doctors will not be given proper information or detailed snapshot of the patient condition. They will crash and it will not be noticed in time.  Crucial aspects of care that care assistants do not understand will get missed completely.  

Nursing at the bedside in acute care is too challenging mentally, physically, and emotionally to keep on doing with no respect and little pay.  The RN's run for the hills and your NHS overlords love it because they would rather have poorly paid unprofessional assistants around than actual Nurses.  They know that the public is so dumb that they will refer to the teenage care assistant as "that young nurse" and think that the ward is staffed with such nice "young nurses" who "brought mama a cup of tea". This line of thinking  is killing thousands of patients every year.  It would be barely tolerable if we were working with the internationally recognised safe ratio of one RN to 4 patients.  But what goes on in the UK with RN to patient ratios is absolutely obscene.  And that is exactly what led to this here.  Make no mistake about it.

The Truth About Nursing website is promoting a book called Saving Lives: Why the Media's Portrayal of Nursing Puts Us All at Risk.  Some excellent reviews here.

The Truth About Nursing announces the publication of its leaders' new book Saving Lives: Why the Media's Portrayal of Nurses Puts Us All at Risk. With striking examples and an irreverent style, the book explores nursing stereotypes from TV shows to the news media, and it explains how these images affect real-life decisions about nursing. The book also offers a comprehensive plan to help everyone improve nurses' image--and public health.

Poor understanding of what nurses do undermines claims for adequate staffing, and leads to a lack of resources for nursing practice, education, and research. All of that means worse patient outcomes, including death.
One study I read showed that RN staffing levels at the bedside had a more significant impact on patient care and survival than board certification of Doctors.  And that makes sense because it is the RN who implements all of your doctor's orders and treatments.  You may have a brilliant doctor with brilliant diagnostic ability but he will not be at your bedside.  Even with that brilliant doctor on your case you are still very likely to die when your overwhelmed nurse is unable to implement the doctors treatment plan and monitor your condition.  Even with a brilliant doctor  on your case you can still perish as a result of medication errors made by a rushed off her feet staff nurse, you can succumb to infection or malnutrition.  The doctors cannot fix some of the errors we Nurses make. 

If your RN has 20 other patients you could easily become a failure to rescue statistic.  Remember that the nurse is at your bedside, it is her legal responsibility to monitor you and understand the ins and outs of your disease process and your treatment ordered by the Doctor.  Remember  that the Doctor is usually the second person to know about your change in condition, and that untrained care assistants are not educated enough to know what the doctor needs to be made aware of regarding a patient's condition, nor can they implement any kind of treatment plan.

If you get time and have the inclination be sure to check out The Truth About Nursing website.  And don't forget to drop Minette Marrin a line.  Journalists benefit from higher level education as well, and you can help her out with that.


Anonymous said...

i am pig sick of trying to provide good care with ridiculous short staffing, no equipment, patient numbers overwhelming the nursing numbers. i'm sick of it. i'm getting out. marrin doesnt know what she's bloody talking about. i shall be emailing her.

Anonymous said...

I've experienced appalling nursing - neglectful, rude and uncaring - during a relative's terminal illness when - for example - there would often be several hours between a request for prn analgesia and someone actually giving it.

The problems seem to be massively compounded by there being not enough nurses to do the job. Your blog highlights this. Our observations on the ward (2 nurses need to give controlled drugs, and often there are only 2 in total who are rushed off their feet). This also seems to be one of the messages coming out of the Staffordshire debacle.

However, when we raised these concerns with management, we were met with wide eyed innocence and: "But our nurses never told us they were short staffed - had they done so, then naturally we would have sorted it".

I am quite sure they were lying. However, WHY don't nurses (and doctors) speak out when they are dangerously short-staffed? WHY do they instead let their patience and manners slip while they do a job they know is only half-done? Unless clinicians have the cojones to report up when they are being asked to do the impossible, patients will continue to suffer, and Minette Marrin will continue to fuel her fires.

Dr Delilah

Nurse Anne said...

We've tried Dr. They won't have it and it has gotten to the point where they won't meet with us. Our staff member who was the union rep is gone.

What we have learned from california and australia is that it takes legislation from government to force these managers to capitulate.

When the california nurses association started campaigning for safe staffing in hospitals the hospital chiefs in that State spent millions of dollars on ads depicting the nurses as lazy and stating that hospitals would have to "shut down" if safe staffing legislation was passed and forced.

It was passed and it is enforced and what they have learned is that safe staffing legislation retains nurses are the bedside, brings nurses into the State from all over the world and leads to better patient outcomes that save the hospitals a ton of money.

Nurse Anne said...

Countless nurses at staffordshire shouted out about the staffing levels and the poor care at that hospital. They completed and sent hundreds of incident forms about unsafe staffing and wrote many letters. It was ignored.

I save every incident form I fill in and every letter I write. I photocopy every single one of them.

Anonymous said...

"They completed and sent hundreds of incident forms about unsafe staffing and wrote many letters".

Why are the RCN not more vociferous about this? And why is it unreported?

I'm not being facetious btw - I firmly believe that we need many more fully trained nurses, and also less fragmentation and super-specialisation of doctors.

But it takes the clinicians to point this out - is there not significant incident monitering and reporting in hospitals for this?


Anonymous said...

dr deliliah,
Have you never heard of dr rita pal?

Anonymous said...

Yup - I follow Rita Pal's blog. And I accept that it's tough speaking out in cultures where management will then start witchhunts.

But it should nonetheless be part of a clinician's role to always act as patient advocate - if there are sufficient restrictions (such as totally inadequate staff numbers) for the patient's needs to be met, then clinicians need to speak up. Preferably in united large groups.


Anonymous said...

Interesting that the Chief Nursing Officer of Stafford Trust says she was not responsible for standards of care on the wards - what was she responsible for then?? Staying as far away as possible??

Anonymous said...

Thats nonsense that the managers say they didnt know the wards were short staffed - they are responsible for staffing and safety and standards - how can they not know what the acceptable staffing requirements are?

the a&e charge nurse said...

"Interesting that the Chief Nursing Officer of Stafford Trust says she was not responsible for standards of care on the wards"

Can you recall the source for this claim, anonymous? - if true (and you may well be right) it encapsulates all that was wrong with Stafford.

I'm generalising here - but the sort of nurse who moves away from the bedside to management is usually more interested in their own career progression rather than what happens to patients.

In the present climate management is often driven by DoH diktats, so that their main function is to become enablers of this process, irrespective of the damaging evidence in front of their eyes.

Anonymous said...

Reflect on this salutory story:
Fred, a male nurse, enters the room of Mary carrying two towels. Mary is a mentally competent, very genteel, shy, elderly lady but she has severely impaired speech. Fred is big, grim and unsmiling. He fills a bowl with warm water and in a loud, confident voice, without further preamble, announces he is going to bedbath her. (He is in the habit of doing this.) Mary is alarmed and horrified because she hates the idea of being bedbathed by a male nurse. She doesn't want this to happen. She feels afraid because she doesn't know a) how to stop him (she can't push him off, she isn't strong enough and she is afraid of him) or b) whether she even has the right to stop him. Of course if Fred had said "may I give you a bedbath" Mary could have either nodded or shook her head but he didn't give her the opportunity, he simply told her what would happen. Fred is an insensitive clod. He doesn't notice the expression of fear and distress on Mary's face. He briskly whips back the bedclothes and gives Mary a very thorough wash, after which he mentally pats himself on the back for a job well-done. A short while later Liz, a female nurse, enters Mary's room and finds her sobbing uncontrollably with big tears rolling down her face. Because of her speech difficulties Mary is unable to articulate that she now feels abused, violated, humiliated and powerless. She feels depressed. She begins to wish she was dead. She reaches out, grabs Liz and hugs her for comfort. This situation was real but names have been changed. It should not be necessary to remind qualified nurses but the moral of this story is do not assume you have an automatic right to do whatever you want to a patient's body - ASK patients for their consent, do NOT tell them. Mary could not give her implied consent by nodding because SHE WAS NOT ASKED! Would your like your mum to be treated like Mary?

Sildenafil Citrate said...

Ignorance is a great threat for health cares. Because People can easily misinterpret what a career in focus on. But you can bet that they like to critic something.

Kamagra said...

Minette definitely needs to put her feet on the earth, because is not possible she consider herself as a journalist when she doesn't have enough knowledge about what a nurse really means. I don't like to judge nobody, but she obviously need professional help, or at least that's what I guess.

Miami Information said...

People like Minette think that any person who gets a job caring for patients in a hospital is a Nurse.

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Steve Mezher said...

People like Minette think that any person who gets a job caring for patients in a hospital is a Nurse.

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