As I walked back onto a ward after 25 years away, I experienced a mixture of familiarity and cold fear.
I had been out of nursing to raise a family and had just started a Return to Practice course. This was my 14-week ward placement. I felt like a first year student, and yet, at several decades their senior, I also felt much more ‘life savvy’ and worldly.
I started at square one once again: blood pressures, temperatures, pulses, and helping people in and out of bed. Thank goodness people hadn’t changed, because everything else had. Even taking a temperature was different.
What struck me early on was how much paperwork there was. When I qualified in the 80s, there was a single ‘kardex’ where all nursing care was reported and communication happened through an ongoing recording process. Now, at the end of each bed was an A4 file, with dividers sectioning-off different aspects of the patient’s care. Inside each section were 3 or 4 different pieces of paper, each recording an element of care - e.g. care of the venflon (drip attachment); care of the catheter; a fluid chart; an observations chart; an ‘integrated care pathway’; a skin and pressure area assessment chart; a drug chart; a property indemnity form; a hygiene needs chart and often, many more still. Each chart needed to be assessed at the beginning of a shift and the requirements met. Then, every nursing action had to be recorded on the chart and any untoward changes reported to senior staff. I was shocked by how long it took to record properly all that was now legally required.
Part of the night staffs’ duties were to fill each file full of the relevant paperwork for patients being admitted the next day. This could take several hours.
On one occasion, was told off by a healthcare assistant for ‘talking to the patients too much’. ‘We don’t have time to talk’, she said - ‘we just have to do what we have to do’.
I wondered what had happened to the personal touch I had been taught about all those years ago. But I’m afraid, with the brazenness of increasing age, I just carried on doing what seemed right to me: talking to patients even if I didn’t have time to cross every T in the records, staying a bit longer than I should have done in the anaesthetic room when I sensed the patient wanted a familiar face and getting a relative a cup of tea, even when it was they who should have paid for it, technically.
Being a nurse is about being a human being in a very specific and privileged role. It is about being allowed to be close to someone at their most vulnerable, afraid, and when their defences are down. It is about having the highest possible standards of professional care and personal conduct. Furthermore, it is about delivering care with compassion, sensitivity and tolerance. Mostly, from my recent experience, I would say that is often the case. But we have to watch very carefully that the drive for order, accountability and the meeting of targets does not erode the foundation and fabric of nursing altogether; that in our quest for improvements and ‘quality of care’ we leave no room for being human.
Sally Moodey recently completed a Return to Practice course, having been out of nursing practice for 25 years.