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IMAGE OF NURSING

Do not disturb: undervaluation in progress

How has the drug tabard debate affected the image of nursing?

Recently a row has erupted over a new National Health Service program under which nurses wear tabards reading “Do Not Disturb: Drug Round in Progress.” The idea is to avoid life-threatening medication errors by reducing distractions.

But the initiative has led to an outcry about nurses being directed to ignore patients. Some link the program to recent reports of neglect and abuse, which are supposedly caused by modern nurses’ desire for university degrees and administrative jobs that are incompatible with their real mission. That mission, apparently, is to be unskilled angels, holding hands and fetching meals, and nothing more.

According to Jo MacFarlane’s basically fair August 27 report in The Daily Mail, nurses wear the tabards only when giving drugs, and they are accompanied by “care assistants” who address concerns unrelated to the medication. Preliminary research suggests that the tabards do lead to a “slight” reduction in medication errors. But Joyce Robins of Patient Concern calls the new program “grotesque and ridiculous,” arguing that if you “can’t do more than one thing at a time, you’re a pretty hopeless nurse.” Ward manager Penny Searle says that “[w]e cannot change the workload, but we can change the way we address it” through measures like the tabards.

However, “the workload” is a central factor in nursing errors. Nurses have always faced countless interruptions from colleagues and patients, and it has been easy to become distracted. Today, understaffing has exacerbated the problem—not to mention playing a key role in at least some of the other problems nursing critics have identified. And in fact, individual nurses’ workload, like their pay and the amount spent on their education, is not a law of nature that we “cannot change.” It’s the result of decisions by humans who control financial resources.

However, rather than address those decisions, perhaps it’s easier to blame the nurses. On August 28, the Telegraph published “Nursing is no longer the caring profession,” in which Christina Odone argued that the tabard program was emblematic of a system in which nurses see patients as a “nuisance” to be “ignored” as the nurses work their way up to the “desk job” they covet.

Odone says that during a recent hospital visit, nurses ignored her mother’s calls for water and a commode. They also had the nerve to giggle in Tagalog while giving her a sponge bath. According to Odone, the “do not disturb” initiative aims to stop “those pesky patients from interrupting nurse during her important tasks”; she “should not have to stop her form-filling and box-ticking to quench some old biddy’s thirst, for goodness’ sake.”

The real culprit? Odone says it’s nurses’ own aspirations to higher education. In particular, a “senior executive of a care charity” told her that he “rued the day that degrees became compulsory for nurses.” That move “professionalised” what had been a “vocation,” so that the former “angel[s] of the ward” became too uppity for “soothing fevered brows and administering TLC.” Thus, nurses today “are not Florence Nightingales, but wannabe administrators.”

Compassion and diligence are essential qualities in any nurse, and allegations of abuse and neglect must be addressed. Nurses should not be so burdened with paperwork that they cannot speak with patients and families. And although the tabards address a serious problem, the slight benefit they reportedly confer does not seem to justify the damaging message they send to patients, who might even hesitate to report a serious symptom, like severe chest pain.

But contemptuous rants like Odone’s piece trade in stereotypes. Nurses are not angels giving simple custodial care. Nursing is a science profession that requires education because nurses use their skills to save lives and improve outcomes. Nurses’ drug rounds are matters of life and death because a drug error can kill. Nurses use cutting-edge technology to monitor patients for changes in condition and intervene with advanced treatments. Nurses advocate for patients and teach them how to adapt. Nursing requires some paperwork, just as other serious professions do.

And yes, nurses also administrate. One notable example? The fiercely unangelic Florence Nightingale.

Of course, nurses can’t do any of this very well if they lack adequate resources. But to pretend that the problem is that nurses are too professionally-oriented is absurd.

We’re still waiting to hear that the failures of the NHS are due to physicians getting too much education.

Sandy and Harry Summers are co-authors of Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk, and leaders of the NGO The Truth About Nursing, at www.TruthAboutNursing.org.

Readers' comments (12)

  • I would very much like to see both Joyce Robbins and Christine Odone walk in a nurses shoes for a day - perhaps they would then see that more than a passing interest in holding a patients hand is needed to become a nurse. Nurses need to have a high quality of education in order to nurse and this education is certainly not turning us all in to pen pushers. Nursing is and always will be a profession that requires you to roll up your sleeves and get involved.... As a nurse you never stop. I would still advocate the red tabard system as I have often worked in environments where you constantly get interrupted during drug rounds ... And it is not safe !!! However I cannot think of one nurse who given a mo pressing problem during a drug round (tabard or no tabard ) that wouldn't stop what they re doing and assist a patient !!

    TOO MUCH EDUCATION ... Really ???

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  • I don't think in and of itself the tabard issue has affected the image of Nursing, but it has certainly put a mirror up to how bad our public image is, and how important a role public image plays in our profession.

    I agree with Teresa, I would love to watch Odone and her ilk try and last a single shift as a staff Nurse. It is about time our profession stopped being silent and taking these attacks on the chin in a misguided hope that our actions will somehow earn us the respect we deserve. It is about time people like her are told in no uncertain terms to shut up until they know what they are talking about. The ignorance they display is truly astonishing.

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  • I am a District Nurse so this whole tabard drug round thing does not affect me directly. However when I have a patient who needs a syringe driver I try to tactfully point out to relatives that the nurse will need time, space and quiet in order to calculate and draw up drugs carefully. That doesn't mean that we would fail to respond to a need [I know it is one patient at a time for us] but does at least convey that this is not a good time for discussions. I think the tabards sound like a good idea but maybe they should simply say that the nurse is doing a drug round and needs to concentrate. I agree with the previous person who says that some nurses would ignore calls anyway. Nurses are individuals - some will zone in on a task to the exclusion of all else, others will multi task and be fine but for some distractions could lead to mistakes. We all have to be self aware and know how we need to work in order to be safe. Nothing should discourage someone from using an aid that could help them. I was taught this by a student nurse with dyslexia - she showed me that it was up to her to manage her dyslexia so that she could be a safe practitioner.

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  • We would not have the privelege of an accompanying hca to attend to rels and pt requests during drug administration. Often we are the only RN dealing with up to 10 pts at a time on a two sided ward. We would often close the drug trolley in order to deal with a priority request appropriately before continuing. This may mean finding a hca to assist or providing assistance ourselves. Some rels are anxious and expect immediate attention whilst others accept they may have to wait whilst the RN is more freely available. A decison to ask pt or rel to wait may have repurcussions in causing a greater disruption to the drug administration than stopping to give them attention there and then. As an RN it is expected that we will prioritise but often we cannot until we know what it is that the pt or rel is asking of us. So the drug administration may on occasion have to be delayed whilst a decsion re priotity can be made. Such tunics are not in use in our area as of yet. Perhaps the wording needs careful revision though how a confused/anxious /needy pt or upset rel can be expected to understand the tunics message is beyond comprehension.

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  • I think the tabards are a great idea. I have been involved in a drug error and it feels awful to have potentially harmed somebody you are trying to care for. Anything to reduce that risk is worthwhile. Another positive benefit is it means you are free to complete the drug round that more quickly to then be available to do all of those things people need you for. Long may this practise continue!

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  • It is not so long ago, or doesn't seem so, that our Trust insisted on 2 trained staff to conduct the drug round together, as a check to reduce drug errors. I can't remember patients and the public objecting to that. So probably Mike's comment that it is more of a reflection of our public image is right. Being undisturbed, not also reduces the risk of drug errors, however small, but promotes medication being given at the right time. It stands to reason though that if one member of staff is dedicated to the drug round, then the rest of the team need to support them and remain a presence to address other patient needs. Would Joyce Robbins and Christine Odone like to be interrupted whilst doing a calculation, and it have no effect on their accuracy. I dare say, they would have to start again, lengthening the task, and leaving less time to do other things.

    I do wonder which patients were asked. Would it be the patient in the next bed awaiting their medication whilst one stopped to wash and change the bed of an incontinent patient? By that I am not saying the incontinent patient should wait either. As I said above the rest of the team would be there to deal with that. A drug round has taken me 2 hours sometimes with stopping to do other things. Maybe there is no answer as to what is right, but if that is the case, then the patients and the public have to be aware of that.

    Dare I be so bold to say, but as a patient, and I have been one, we want our care to be right. At the same time how many really consider the needs of others, which has probably diminished since you only see 3 other patients in your bay, or none at all in a single room.

    This is totally a non-clinical comment, but our newspsper trolley has to alternate the route to minimise complaints, but no-one expects their newspaper and post to be delivered or rubbish to be collected in that manner....YET!!!!

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  • As a nurse in a nursing home, who also has many years experience working in the acute hospital setting, I have experienced the 'two nurse' drug round, the single nurse drug round and the drug round with the tabard. Any drug round is fraught with the possiblity of a drug error occurring. The tabard helps to limit the interruptions that usually occur. However, I don't believe that the majority of nurses would use the tabard is such a negative manner as to ignore calls for assistance in the absence of other team members. In fact the tabard helps to enusre that the person receiving those dispensed drugs get some increasingly rare, quality time with their dedicated nurse!

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  • Those who criticise the Odone article or seek to sideline it by wanting Odone to work as a nurse for a day miss the point entirely-Odones mothers needs were not being addressed-that is the issue-for those who cannot see that and think of ways in which the needs can be met and instead harp on about irrelevances proves Odones point-they should not be (classed) as nurses.

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  • Odone generalised her comments about the poor care she witnessed to the whole of nursing profession which was totally unreasonable and unwarranted.

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  • I have no choice, but to stop my drug round and help patients on and off the toilet, as there is no one else to help.
    My drug round takes up a major part of the morning as I have to do jobs in between.
    No one seem to care that I need to be uninteruppted so I don't make mistakes.

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  • I have done drug rounds with and without a tabbard and I have been interrupted!

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  • Hopefully Ms Odone reads this piece. Some of us wrote to her newspaper, DT, and complained about her odious report as well as commenting on NT sites. I also had a lengthy discussion with Dr Carter of the RCN about it. He sent a letter to the DT which they declined to publish and I never got a response from the DT Editors for my complaint.

    Ms Odone's report was written in reaction to the tabards, the idea of which she was totally against, and was also concerned with the poor care her mother had received but it was no reason to generalise her damning and unwarranted remarks to the whole profession as she did, many of which arose out of sheer ignorance about the role of nurses and nursing.

    http://blogs.telegraph.co.uk/news/cristinaodone/100102846/finally-nhs-managers-see-sense-and-ditch-their-offensive-do-not-disturb-tabards/

    http://www.telegraph.co.uk/health/8728849/Nursing-is-no-longer-the-caring-profession.html

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