Listening to recent news reports on discharge from hospital at night I wondered where were the nurses representing the needs of a 94-year-old man sent home at 1am in the morning.
The Times news story and the data it was based on was flawed, but it did make me think again about what it really means to be an advocate. Is it possible to represent your patients if you have no power to influence or change their circumstances?
I was reminded of a time - when I was working as a bank nurse at a large teaching hospital - I was asked to transfer Mr Jones, who had dementia and visual impairment, from an acute medical ward to a surgical ward at around 12.30am.
He was one of the great number of “unwanted patients” in a busy hospital pushed for beds. His medical treatment was complete and but his long-standing health problems meant he needed a bit more time to get his social situation sorted before he was discharged home. As I pushed him through the empty corridors he asked time and time again where we were going and as we got to the surgical ward his distress was tangible to the staff who greeted him.
As I told the surgical nurse about his problems I could feel her anger growing. She shared my distress about moving this frail and vulnerable person from a ward where he had become familiar with his environment and routine. Yet we were both powerless to prevent it happening.
When we were told to move Mr Jones I asked the bed manager what would happen if we refused to. She replied: “We will just get someone else to do it”. Down in A&E someone needed an acute medical bed and Mr Jones lost out.
Bed manoeuvres happen every day in hospitals and I suspect many nurses have had to push patients to other wards knowing that it will ultimately be detrimental to their wellbeing.
So where does this leave nurses as advocates? Should they think about the needs of the person waiting for the bed or focus exclusively on their patient? The NMC advises “Advocacy is concerned with promoting and protecting the interest of people in the care of nurses and midwives, many of whom may be vulnerable and incapable of protecting their own interests”.
But how do you do this in a system that is so pushed and underfunded that it demands nurses compromise the needs of patients in their care for the greater good of those elsewhere?