'A nurse will always give us hope.’ ‘An angel with a
stethoscope.’ ‘God found some of the strongest women and made them
nurses.’ ‘Save one life and you’re a hero. Save 100 lives and you’re a
nurse.’ ‘If love can’t cure it, a nurse can.’ I didn’t invent these
words, I found them on Google. Type the word ‘Nurse’ in Google search
and you’ll find hundreds of such gems. Going by these rosy
proclamations, you’d imagine the world adores nurses. But being
insiders, we know better. In fact reading these quotes, I get the
feeling that we treat nurses very much the same way we do our moms. In
the public psyche, we place them on a pedestal and shower them with
endless platitudes, but in reality we give them a raw deal.
To us doctors, nurses are an indispensable part of
our profession. While on the rounds, we need them by our side every
minute. While we are away, we expect them to stand in for us and do our
job by proxy. And this with just a fraction of the hard training and
knowledge that we possess. In the line of duty nurses also expose
themselves to great risk. The tragic tale of Lini, the 31 year old nurse
of Kerala who died last month to after possibly getting exposed to the
deadly Nipah virus while attending to an infected patient, is all too
fresh in our minds. Lini did not even get a chance to say goodbye to her
two kids and husband.
So are we treating nurses as we ought to? What is the
ideal way for us to interact with them? I hope my following words will
throw some light and bring greater clarity to your role vis-a-vis
our nursing colleagues.
Not Angels, But Professionals Like Us
A casual look back on the nursing profession is
illuminating for the way in which it unfolds the evolving saga of the
doctor-nurse relationship. The lop-sided equation we share, while partly
to be blamed on history, is also a fallout of some of own fallacies.
Traditionally, it was the members of religious orders, such as nuns and
monks, who provided nursing-like care. There is clear evidence of such
practices in Christian, Islamic and Buddhist traditions, and the title
‘sister’ by which we refer to them is a pointer to this historical
legacy. Many religious orders have continued to dedicate themselves to
the cause even up to this day.
In the 19
century, the pioneering efforts of Florence Nightingale, a legendary
personality in her own right, ushered in the era of professionalism in
nursing. Her observations and the initiatives that she took while being
employed as a nurse during the Crimean War laid the foundations of
professional nursing. Her Notes on Nursing (1859) laid the
conceptual framework for the future of nursing and her methods came to
be looked upon as the Nightingale model of professional education in the
field. Being closely connected to a continuously operating hospital and
medical school, it caught on and spread widely in Europe and North
America after 1870.
Meanwhile, and on a parallel plane, the modern doctor
was also born. Armed with more scientific knowledge and training, the
doctor became an authority figure, revered and feared in equal measure
but for different reasons - revered for his real healing powers, and
feared for his nasty temper, which was also real.
Somewhere along the line, their two separate worlds -
that of doctors and nurses – met and an equation set in by default. The
doctor naturally had an upperhand and the nurse became the underdog,
forced into playing a subservient role. Over the last century, their
respective roles have undergone a sea change, yet at a fundamental
level, the default equation that had been already set remains unchanged.
"The relationship between nurses and physicians is known for being
strained, with much of the strife being attributed to the nurse’s
struggle to gain professional respect from doctors who view them as
subordinates. This is reflected by an informal 2013 survey conducted by
consulting firm Advisory Board, which found that 31% of the 1,289
respondents believed there are ‘too many unprofessional clashes’ between
nurses and doctors [1]."
It is true that the doctor by virtue of his knowledge
and training is the master of the ship and his / her role cannot be
undermined. But what about the nurse? Where does she fit in?
Today we live in the age of professionalism. The
doctor is no longer the demi-god he once was. He/She is a professional –
if a highly qualified one at that – like any other, say a lawyer or a
chartered accountant. There is a growing realization that nurses too
should enjoy the same privilege. Nurses in the present day undergo years
of rigorous professional training before they join the stream. Practice
of medicine has evolved into team effort, with the doctor heading the
show, while being assisted by an entire retinue of support staff which
includes nurses, paramedics and medical technicians. Leadership is the
key to success in this format. There is no scope for the intellectual
arrogance that defined the doctors of the past and the nurse is not a
sidekick. The authoritarian leadership model is defunct. We need new
skills to harvest the benefits of synergy arising out of team work.
Make The Team Win
So where do we go from here? To answer this question,
first we need to recognize our role in the team play. McKay and
Narasimhan observe: "Despite the social and professional view that
nurses are second rate to doctors, there is a vast difference between
the two professions. The essence of each are different, yet are required
to achieve the same goal [2]."
In the modern healthcare team, doctors deal with both
technicians and nurses. While our engagement with the technical cadres
is largely technical in nature, our relationship with the nurses is
loaded with the human factor. This is where intangibles like respect and
trust come in. Team work is heavily dependent on both these essentials
of life. So it follows that building a mutually respectful and trusting
work environment should enjoy top priority. Three factors play a vital
role in fostering team spirit: Competence, Communication and Empathy.
Competence: "Professional identity is
related to demonstration of professional competence, in turn related to
development of mutual interprofessional respect and enduring
interprofessional trust [3]." Hence the first prerequisite is to assert
one’s competence as the team leader. As the doctor you are the
acknowledged expert and the outcome of patient care rides on you. Use
this to advantage by maintaining very high personal standards of
excellence. When the team respects you as a person and a professional,
the overall impact is magical to say the least. For the army general who
leads from the front, the rank and file will do anything for the asking.
The next step is to translate your personal expertise into team
expertise through transfer of knowledge. Regularly interact with the
team members so that they see the big picture and understand their own
role in it. To put it in psychological terms, this type of active
engagement with the team delivers identification, while an inert /
impersonal approach could guarantees alienation.
Communication: This is the key essential
of human leadership. There is no substitute for one-on-one talk. Gone
are the days when the doctor-nurse relationship was a one-way street.
Use your day-to-day interface with the nurses to discuss your
therapeutic strategies. Today’s nurses are trained professionals and
their clinical exposure could easily complement yours. Remember they
spend more time with the patient than you do. Respect their competence
by involving them in the decision making, inviting their suggestions,
clarifying their doubts, correcting them when they are wrong and
appreciating them when they are right. This does not mean letting the
bus conductor drive the bus – you’re still the boss, but a more
inclusive one at that.
Empathy: Have a silent understanding of
what it means to be a nurse, who has to attend to multiple patients and
report to doctors of different temperaments, while diligently obeying
hospital policies, yet showing no outwardly signs of hurry, worry, anger
or irritation. Be an observant judge of their respective levels of
competence and foster an environment which maximizes their potential. It
does not mean a permissive tolerance of inadequacy, but rather it is
about envisioning a positive and proactive leadership model for
yourself. Address a nurse by name, don’t be rude to her in front of the
patient, respect the nurse’s interactions with the patient and the fact
that the patient may be more comfortable with the nurse. Such little
gestures will go a long way in creating a culture of inclusion and also
convey the message that you recognize the nurse as a person rather than
a prop. Focusing on being a leader rather than a commander will make
nurses more comfortable asking questions and sharing patient concerns
without feeling inferior or troublesome [1].
In the contemporary scenario, the nurse’s recognized
role is that of a trained caregiver, patient-educator and on-site
advocate / health promoter all rolled into one. In pediatric settings,
the nurses need many more allied skills and abilities. Nurses outnumber
doctors by a wide ratio and they are a huge workforce who complement and
supplement you in unseen ways. They are the foot soldiers who strive
round the clock to actualize the goals that you have set for the well
being of the patient. Build the much needed respectful and trusting
equation which can propel their potential from mediocrity to excellence
through great team work. In conclusion I wish to go back to Google and
quote the one tribute to nurses that I really loved: ‘Behind every
successful doctor is a great nurse.’
References
