Why expect nurses to be superhuman?

Although one cannot imagine a hospital without nurses, their importance in the delivery of care often goes unrecognized.

It is not uncommon to hear of instances when a very critical patient with little hope of survival, has been successfully operated upon by a team of highly specialized doctors, brought back to life as it were by a group of intensivists in the ICU, and then, after several weeks in hospital when hope has mounted, suddenly dies due a wrong injection or infection from a catheter due to nursing lapse. What relatives experience at such times is a deep sense of betrayal and anger, that soon replaces the gratitude and appreciation that the previous few weeks of heroic achievement had earned.

And what compounds matters in busy hospitals is that nurses neither have the time nor the training to provide emotional support to grieving relatives at this stage, ensuring that they go back with permanent bitter memories and impressions of this hospital.

To be fair to nurses, just too much is expected of them and just too little effort goes into looking after them. Most hospitals run woefully short of nursing staff, resulting in overburdening the few.

Consider their case. A regular eveing or night nursing shift comprises 2 nurses who are expected to look afte 30 (in some 60)  sick patients over 6 to 8 hours. At first sight it may look simple, but here is the list of what they are expected to do in this period: take over the stock of medicines and details of patients from their colleagues of the previous shift (30 min), check each patient’s vitals (pulse rate, BP, respiration and temperature 4 to 6 hourly (@ 10 mins x 30 patients = 300 minutes), distribute medicines ( highly individualized) to 30 patients 2-6 hourly (90 mi), give injections (to 20 odd patients), draw blood samples for tests (from around 10 patients), start IV fluids or change IV bottles ( around 15 patients), shift patients for procedures such as surgery, endoscopy or radiology (10 patients), assist doctors in minor procedures such as ascitic or pleural taps (10 patients), supervise diet, complete discharge formalities and expalin instructions to those who are leaving, and the list goes on. On top of all this, every time a patient’s condition deteriorates, they have to assist with resiscitation (30 mins) and respond to SOS calls (quite frequent as 50% of the ward consistes of very sick patients).

If you calculate what they actually achieve during their shift, you will be surprised how they indeed manage. Where then is the time to administer TLC (acronym for tender loving care), talk and establish rapport with patients and relatives, sponge and clean them, and do all that good nursing is all about?

It is unfair to expect nurses to perform as super-humans all through their careers. While the complexity of medical care has increased several fold over the last 5 decades, the ratio of nurses to patients have hardly changed. Strengthening this pillar is essential if hospital care has to improve to the next level. 

As published in HT City (Hindustan Times) dated 22 April, 2012.