World Class Nursing
I'm back home after ten days at the Mater Hospital in North Sydney. One of the breast care nurses asked me if I would come back some time in the future to talk to staff about my experience as a patient. "Good and bad," she said, "We benefit from hearing it all." I told her I could only meet half of her needs.
I'm always looking for ways to improve things. It's part of what I loved about managing around eighty staff when I was the Commander of the NSW Police Fraud Squad. You could change a system and have a huge impact on efficiency and service delivery. You could mentor a staff member and improve their performance and their life.
So when, after ten days somewhere, I'm really at a loss to criticise anything other than some minor maintenance issues you can be sure I've been somewhere really special.
There is love in the walls at the Mater. The hospital was started by The Sisters of Mercy and there's a documentary on one of their channels that includes interviews with some of the elderly Sisters, some of the 'lay' nursing staff, and two doctors that become visibly moved when they talk about the wonderful legacy of this exceptional place.
The legacy continues. The Sisters would be humbled by the extent to which their original intention has been translated into a hospital providing one of the highest standards of care anywhere on the planet. They win awards. That's not why they do it.
I thought it might be useful to describe, from a patient's perspective, what makes the standard of care here so special and what we, as patients, can do to contribute. Here's what I experienced at the Mater:
1. Connection
World class nurses look you in the eye. They take the time to find out what you would like to be called. Some people prefer 'Sir' of 'Ma'am' and some people don't. Although they are very busy, they take time to find out a little bit about you. You don't feel like the next patient on the assembly line.
At the Mater they use a whiteboard opposite your bed to record the name of the nurse that will be looking after you on each shift. Hand over happens in front of you with the nurse from the previous shift introducing the nurse from the next shift. Unless you are sleeping.
We can help by responding with our own name when we are introduced and remembering that, while the nurses are hoping to recognise us as people they are also caring for others, some of whom may need them more. If you're fortunate enough to stay in a hospital with pastoral care, these people are available to listen to what's troubling you and to provide support.
I've put connection first for a reason. It's the single greatest difference between this hospital and others I've stayed in. I can remember the names of everyone that looked after me on the morning and afternoon shift, and many of those that worked night shift even though I met them only briefly. How did they do that?
2. Communication
World class nurses respect your right to know what medications you are taking and what procedures you are experiencing. They are knowledgeable and happy to answer questions. They have the ability to put themselves in our position and to appreciate that while the hospital, its facilities and its procedures are very familiar to them, they may be a source of anxiety to us. They also know the limits of their authority and will refer to your treating doctor.
The nurses at the Mater are very good at explaining things so that they are easy to understand without ever making you feel ignorant. That's good communication.
We can help by asking about anything that's bothering us. They are good, but they can't read minds.
3. Compassion
World class nurses care about their patients. They appreciate that what we're experiencing might be traumatic or routine and that everyone's reaction to hospital is different. They don't tell us how to feel. They don't diminish what we're feeling with phrases that start with "At least……" For example, "Well you've had a mastectomy but at least you're cancer free!"
First prize to Brittany, a trainee, whose job it was to book me in. "I have no idea what you're going through but I'll do what I can to help." World class nurses also know not to be visibly distressed around us. Those of us who share your propensity for compassion have a tendency to take care of others, even when we're unwell. If we think we're upsetting you we're likely to mask our symptoms and our emotions.
We can help by being honest, by remembering that we are not there to care for the nurses and by accepting that it might be time for us to be on the receiving end. If we need time alone we need to say so. If we're experiencing strong emotions we need to find healthy ways to express that, without taking it out on nurses. It's okay to be angry. It's not okay to yell at caring people.
4. Commitment to Education
World class nurses never stop learning. They have a high level of expertise and recognise that medicine is dynamic. They will happily abandon old procedure in the face of evidence. They are open to the next best way of doing things.
They are also generous with their knowledge and happy to share it with others. There were two trainee nurses on the ward while I was there and both of them are going to be as exceptional as the people that are training them. There's an attitude of intellectual generosity towards these trainees. The experienced nurses are enthusiastic about training others.
World class nurses also know that patients can be a source of information and advice. They will ask about our condition and will actively seek feedback about their performance.
We can help by sharing what we know. I made a point of letting both trainee nurses know that if there was anything they wanted to know about my condition or my treatment then I was happy to talk to them. One of them was very interested in my wounds, understanding seromas and learning about triple negative breast cancer. I think that sharing this information with her will help her to provide better nursing to someone else in the future.
5. Community
World class nurses recognise that they are part of a community of care that includes doctors, physiotherapists, dieticians, psychologists, pastoral care staff and other professionals. They know when to refer and when to ask for help.
They also recognise cleaners, ward clerks, catering staff, support staff and volunteers as part of that community. The Sisters of Mercy used to do everything from washing floors to providing meals to lifting patients. The nurses at the Mater clearly appreciate that support staff are providing services that free them up for nursing duties. They speak respectfully to everyone. They are never condescending. It feels like a team of people with equal status.
Wold class nurses never speak badly of other members of their team in front of patients. If you raise a complaint they will deal with it professionally. If you make an inappropriate personal observation they will deflect it tactfully.
We can help by treating all staff with the same level of respect. Everyone is part of this team and nobody should be treated otherwise. The cleaner is not your personal slave (although a patient in an adjoining room seemed to think so).
We can also help by differentiating between legitimate complaint and gossip. These people are professionals. Personal observations about their colleagues are not appropriate.
6. Patient Focus
I'm nervous about this one because modern management is full of 'focus' type statements and many of them are hollow. Telstra may profess to a 'customer focus' but ask anyone whose been on hold for three quarters of an hour how they're feeling.
It's also important to be pragmatic about what 'patient focus' means in a hospital setting. Some things here are non-negotiable. You might, for example, argue that you would be much happier if your dog could be with you during your stay but there are sound reasons why this isn't going to happen.
Perhaps a better way to describe this is flexibility. World class nurses not only understand the 'what' of their rules and procedures but also the 'why'. Within that context they are flexible enough to make allowances in the best interest of patients.
Here's an example. The evening following the surgery I had about a month ago, at around nine o'clock at night, one of the nurses asked me the question I was to hear again and again at the Mater:
"Is there anything else I can do for you?"
I had been asked to fast from the previous evening even though I didn't go into surgery until well into the afternoon. When I woke there was the typically meagre post surgical dinner. I was starving. And so I said, "Not unless you can get me something to eat!"
To my surprise and gratitude the nurse replied that she'd be happy to get me a snack and offered me a couple of choices. It was the best vegemite on toast I've ever eaten. It's these little things that make a big difference.
It's like the advice I had about brining my own blanket and pillow. It's the support I had for using eucalyptus spray to make my room smell nice and playing my own weird Indian music (which the beautiful Indian cleaner danced to as she mopped my bathroom).
We can help by recognising that some things are not negotiable.
So that's my summary of why I think the Mater provides world class nursing. I'd be happy for other people to add their own observations. I'm looking forward to getting back there when I'm well and helping in any way I can with training. Perhaps they would like a presentation on triple negative breast cancer. Perhaps they would like to hear my reflections on the quality of their care.
It will be very short on suggestions for improvement.
Is there anything else they could have done for me?
No.
No there is not.
So thank you to everyone at the Mater. From the welcoming admission staff to, Mateus, the lovely man that refilled my water jug and told me about Brazil. Thanks to Elinita for helping me choose what to eat and to Alice and Michiko, the exceptional breast care nurses. Thanks to Brittany and Yvette and good luck with your studies. Thanks to all of you. Thanks to Jennifer, Ban, Pon, Krys, Emma, Shona, Caroline, Charmayne, Kate and all of the nurses that looked after me during the three day post surgical haze and the night shift. Whether or not I remembered your name, please understand you are a credit to your profession and more wonderful than you could possibly know.
Thanks to my beautiful dancing cleaner. I am so sorry I don't remember your name. Your contribution to the health of patients is a critical part of the work of this hospital. But you already knew that.
If you've been fortunate enough to stay somewhere as wonderful as the Mater, please let them know. If you've had a less than happy experience then please check the circumstances before you complain. Is the problem an individual? Or is it the natural consequence of people being asked to work in conditions where they don't have enough training, equipment, people or effective management? In my experience it is usually not the fault of the individual when it comes to nursing (although there are exceptions). At the moment there is a campaign to establish common patient to nurse ratios across the country. What a great idea.
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reblogged from positive3neg.wordpress.com
My year-old blog about staying positive in the face of a diagnosis of triple negative breast cancer.
Comments
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I just read that and had a cry what a beautiful true piece of writing, I felt love and compassion in every word. Regards adean0
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Hi Robyn,
Don't worry. I could do my physio the first day thanks to all my yoga. The breast care nurses say they have two categories when it comes to regaining movement; those that do yoga and those that don't. I had my first modified yoga session back on my mat today and it really did lift my heart. Not too much 'downward dog' for while but I'm getting there.
I agree with you about missing the safety of the hospital. I also miss the breakfast tray!Meg
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