One of my patients, a father of three, has had an endoscopy. ‘Mr Black’ is in bed, resting, and all is well. I check with the clinical nurse manager (soon to head to London, exiting with several years of wisdom), and am told to take the break I was supposed to take three hours earlier. I am starving.
But you see, even writing that, I feel guilty. I don’t know if it is symptomatic of every nurse’s thinking, but I feel guilty for saying I am hungry, guilty for saying I didn’t get a break. Maybe I have low self-esteem, but in my mind I can hear you sigh, collectively, “Stop moaning. You knew what you were signing up for. And you’re not the only one not getting breaks and working for peanuts.”
The canteen is closed. I drink machine coffee, eat an apple, and return. Mr Black's bed is empty. I check the toilet, he has collapsed on the floor. Blood is everywhere. It is like a scene from a Tarantino movie. My training – which, by the way, is ranked among the very best in Europe – kicks in. I stay calm, check that he is responsive (he is), I pull the emergency cord, hold the door open and roar for help.
We drag him to an oxygen point and start the process of suctioning. Blood is streaming from his mouth. It can fill his lungs in seconds, we need to move fast. For a moment it seems the suction machine will clog. It splutters, then clears.
The blood flow stems, but not entirely. By now a whole team has gathered – doctors, a registrar, the clinical nurse manager. Mr Black is taken away swiftly.
Saving lives
I have helped to save a man’s life. It feels good. Exhaustion is replaced by exhilaration. There are smiles, hugs, then tears: we don’t know if he is out of danger. But we do know, and we allow ourselves take pride in the fact, that we responded with an absence of panic. We were good. We were professional.
The other patients are looking at us with a new-found respect. But for the gravely ill on the ward, the sudden appearance of death, particularly in such a visceral way, is overwhelming. Patients retreat behind newspapers and magazines and screens. Fear is palpable. There is a new reality dawning for the patients. They understand that while people come here to get well, people also come here and die.
Yes. I work in an environment where people die every single day, sometimes in the most brutal and most undignified manner. Sometimes quick-thinking, calm hands, solid training and efficient teamwork keeps them alive. Sometimes the system – or rather, the workers who keep it propped up – succeeds, despite overwhelming odds. Today, we, the nurses, two students among them, helped to save a father’s life. Tonight, at the end of my shift I will document the incident in detail. I will end up working the guts of another hour. I will not be paid one cent for this extra time. It will be “off the clock’’. Does that matter when I helped save a life?
The mentality of passivity inculcated by the hospital system (and possibly by the training), and endorsed by the wider society, dictates I should feel petty even bringing it up. But I don’t.
I believe we are getting right to the heart of the matter, deep into attitudes ingrained in society, and perhaps deep into the mentality of many in and around nursing. Nurses save lives yes, but they have a vocation, and shouldn’t complain about the privilege of being able to follow their calling, to do the extraordinary, and all it entails. This seems to me to be some kind of unwritten code.
One that enables Government and others to keep nurses relegated. A code that means it is sometimes hard for nurses to speak out about deplorable conditions. About institutionalised neglect (of nurses and of patients). A code that whispers “Shut up and put up, and don’t you dare even think of going on strike.”
I refuse to be bound by any such nonsensical code because I believe it plays into the hands of those who see nursing as a predominantly female, non-essential, vocational, “caring” job. And sure, if the Irish nurses get uppity about wages and conditions, there are plenty of women from poorer parts of the world only too willing to take up the slack.
The mentality demands sacrifice, service and near martyrdom. The code whispers it is immoral and demeaning to speak of wages or, God forbid, overtime (banned since 2009) in the context of a man almost drowning in his own blood. I disagree.
Counting the cost
This is
why. The Minister and the mandarins at the department can put a price on (mis)managing the entire health system. Bed managers can put a price on care. Big pharma can put a price on a pill that can add years to the span of a CF sufferer.
Therefore, I feel it appropriate for me to be able to put a price on my degree. On my nine-month internship, in a series of wards, from oncology to surgery, a training so demanding physically, and so draining mentally, that some give up before they even get their pin. I feel I should be able to put a price on my resilience, my stamina. I feel I should be able to place a premium on my intelligence and problem-solving abilities, just like a solicitor, for example. On my ability to listen and comprehend, just like, say, a reporter; on my ability to empathise, just like a therapist. I believe I should be able to put a price on my ability to remain cool under pressure, like say a PR person or a politician.
I don’t have a precise figure in mind. But I think Mr Black would agree that it should probably be more than €9.49 (student nurse rate) or €13.42 (graduated nurse rate) an hour. I think Mr Black and family would also agree that when I stay behind to write up an incident form, and miss out on putting my children to bed, as will happen tonight, then I should be paid for my time.
I am “off the clock” when I am holding my children. Playing with them. Making love with my partner, cooking or eating with my family. Being held. Cycling into town to meet a friend. I am not “off the clock” when I am sitting in the hospital where I have already put in a 13-hour stint, trying to get my frazzled brain to co-operate in writing out a description of how my colleagues and I helped keep someone alive.
The code is patriarchal nonsense. The mentality that demands (predominantly female) acquiescence must end.
Romantic nursing is dead and gone. It’s with Florence Nightingale in the grave.
The author's identity is known to The Irish Times.
