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Tuesday, May 26, 2020  

Totally SkewedPublished 7/30/2008

I just read an article on which has me snorting steam from my nostrils. Both of them. At the same time. And I will tell you why. Did you doubt that I would? Was there ever even a question about it?

The article, by Cathryn Domrose titled "Not Enough Time," gave us the results of a study conducted by Ann Hendrich, RN, MSN, FAAN of Ascension Health in St. Louis, MO and Marilyn Chow, RN, DNSc, FAAN of Kaiser Permanente in Oakland, CA. Through the marvels of modern electronics such as personal digital assistants and radio frequency identification tags, the work habits of 767 nurses in 36 hospitals were tracked and studied as though they were a band of ivory billed woodpeckers. You may have read about the study and looked forward to the results, as I did.

After the study was complete, the results tabulated and analyzed, it was found that a whopping 20% – one hour and twenty minutes of every 10 hour shift – was spent in direct patient care and only 7% – or thirty minutes per 10 hour shift – was spent in assessment and vital signs. In stark contrast, documentation accounted for 35.3% of a shift and medication administration for 17.2% of a shift.

Are you surprised? No. Neither am I. This was just the kind of information that I believe hospital administrators and politicians and the general public needs to know. The world needs to know that despite the desires and aspirations of all the good little woodpeckers in our country, we are only able to spend 20% of our time taking care of your granny. I expected these results and looked forward to a great hue and cry against them. "Let nurses nurse," is what I expected to hear. Especially since the study was conducted by nurses.

But no. No, no, and a big fat double no. Guess what the response to the results of the study were. From a nurse, "The study made us more aware of how much time we spend away from the patient, which is a sad thought. It made us much more aware of the time wasted." Mea culpa, mea culpa, mea maxima culpa. Time wasted in this context means time spent documenting and coordinating care. Which is not time wasted, particularly in the litigious society in which we live. If it is not documented, it was not done, and you had better be prepared to defend any lapse in your documentation no matter what.

What did the "experts" glean from the study? Here’s where my eyes started to roll. Uncontrollably. According to the article, administrators have vowed to support efforts to increase nursing time at the bedside through more patient friendly design of nursing units and patient rooms. To quote, "One of the most important things administrators can take away from the study . . . is that nurses and other frontline clinical staff need to be involved in the design and implementation of new architecture and technology." End quote.

Architecture. Once upon a time there was a nurse, one that I know awfully well, who worked in a really untenable situation. Too many patients, too sick, too few nurses, a terrible work environment. This nurse said, "I cannot continue to work here unless things change, radically and immediately." Her supervisor said, "We will not solve this problem by throwing people at it." And then the supervisor ordered new curtains. Huzzah! Lovely, lovely curtains!

I know that curtains are not architecture. But I also know that you cannot improve the quality of care a nurse is able to provide when she is stretched to the very limit of her capabilities by buying new curtains. And yet this is the prevailing attitude among those who are not responsible for providing care. Curtains are easy to find and nurses, increasingly, are not.

I worry about the future of health care. I have come to believe that in order to burgeon the nursing population we must go back to the fundamentals. I believe that the primary fundamental of nursing is the idea of service. Service. With a capitol "S". Any smart young person can educate himself or herself for a career which will provide them with a salary similar to that which a nurse earns.

And with less heartache and backache. But few jobs offer the opportunity to touch lives, to change lives, to help, in the way that nurse are able to touch, to change and to help. I believe that there is a certain segment of the population who want to have the opportunity to help, heal, comfort and console.

I believe with all my heart that nurses can nurse, will nurse, anywhere if they are encouraged and validated and valued. No matter what the curtains may look like. And that is where the emphasis belongs. On the act, the sacrament, of nursing.

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