A Nurse’s World: Doctors think they know more than we do

This is the last in my series of "Nurse's World" columns for The Irish Times. Over the past eight weeks, I have tried to portray the realities of a system I deem broken, blind and arrogant. I have done so exclusively from the perspective of a working nurse.

Some readers – clinicians and registrars among them – did not always agree with my perspective and said as much in letters to the editor. That is their prerogative. However, they do not by virtue of their medical titles have the right to diminish my experience or to invalidate my reality.

I welcome debate, particularly when it improves patient care. However, there is, in my view, an elitist thinking which promotes the notion that doctors, surgeons and registrars know more than nurses. About what? Life? Reality? Hospitals? The HSE? How to write a column?

Reality

In my view, nurses know more than most about reality on the ward, about the reality of patients' experiences, about the reality of what is needed on the ground than many (not all) of the medical elites so appalled by, in particular, the column that began : " A patient falls out of bed . . . '' (He did. It happened in 2015 in a public hospital.)

It is a pity medical elites cannot become so exercised about say, establishing committees to ensure patients get visitors, or by the fact that relatives of patients are subjected to outrageous parking fees.

I wish that certain very well paid people would let go of the need to be right. I wish they would do the decent thing, step forward and say to the Department of Health, to the HSE, to the Minister, and the owners of and investors in private hospitals: “We, as surgeons, registrars etc, believe it is insulting for our co-workers to be paid €13.80 an hour.”

There were no letters to the editor about pay rates for nurses written by this class of medical worker. I think this is a pity. I wonder what this says about Irish medicine, a sector where factions fight for their own interests, often without even discussing common objectives.

It is amid this kind of hierarchal in-fighting that patients’ needs, already grossly minimised by the system, become overlooked and forgotten. Fight for the patient and perhaps everything else will begin to fall into place.

Safe practice

I have tried to illustrate throughout this series how HSE apparatchiks are killing the very concept of safe practice and of care. How the ideals of the Hippocratic Oath are undermined by the myopic profit-seeking of private institutions and, equally, by the inability of the HSE to listen to critical voices and to adapt. Or, to even try to learn to adapt. Titanic. Deck Chairs. Re-arranging.

There is a retention and recruitment problem; it exists because the pay is derisory and the conditions are unsafe. Nursing graduates don’t want to be slaves. They want a life. They are finally saying that their four-year degree programme is worth more than is currently on offer in Ireland. I agree.

We need 4,000 beds, and we need nursing and other staff to cover those beds safely. And that is after we fix the imbalance created by decades of under-investment – money is still being relentlessly swallowed up by HSE middle and upper management. I regard that as immoral.

I have also highlighted a mindset in wider society which, though it supports nurses, seems not to want to look at the poor wages and unsafe conditions except fleetingly, most especially after an encounter with the system.

Death

I wonder about support, Irish-style. It seems so fragmented. Unless there is death involved – we rise to that occasion well. But I had hoped to show that death – which occurs daily in the health system – often takes place without dignity. Death in a corner, with a makeshift curtain around you.

I have seen people die in this manner and I don't need to have read the Tibetan Book of Living and Dying to know we, as a society, have got something wrong.

To watch the relatives of a dying person being stranded in a corridor as their hearts break is an affront to human decency, to my training, and to my concept of a Republic.

I prefer working in the public health system. I can contribute more. But I also believe there are talented individuals in the private system willing to help cut public waiting lists if the system will adapt to meet their needs – and their fees.

I have no problem with surgeons operating on children with scoliosis being paid the market rate. Unnecessary suffering must end. As must unjust waiting lists. As must unjust hourly rates for nurses, healthcare assistants, porters, catering staff and the people who keep hospitals open, clean and functioning.

I have no axe to grind with Minister for Health Simon Harris. He may well have the energy to do what is needed, ie to dismantle the dysfunctional HSE. I hope he also has the ability to listen to patients, and to those who care for them.

I would not be able to do my job without the support of healthcare assistants. But what they are expected to do is simply unjust. Similarly, how can hospital porters get patients to wards when the institution will not provide adequate numbers of wheelchairs?

I have a final question, and it is for you: How will you the reader support the nurse? Because when you are sick, the nurse will support you. If my profession goes on strike, I want more than a honk on a car horn. Don’t send boxes of chocolates. Send letters to the Minister.

I am glad I have had the experience of both public and private health systems in Ireland. I hope you the reader were somewhat enlightened by my experience.

And look after your health. It really is your wealth.

The Nurse’s World series – comprising columns by a working nurse in Ireland – is now concluded. The author’s identity is known to The Irish Times