‘Nurses so often give a voice to the voiceless’
Society may seem divided, but we have much to learn from those who care for us, says former nurse Christie Watson
There is no job that is more terrifying as a resuscitation nurse than pressing the shock button on the defibrillator machine. Of course, there is hope as well as terror. The hope is that the patient, who has no pulse or signs of life, will respond, and their heart will start beating rather than “fibrillating”, twitching, without any real function – a bit like the movement of a jellyfish when poked with a stick.
The terror is that if nobody is listening very carefully, or you are not being clear enough, you risk seriously injuring colleagues. Today, the gel pads have replaced the more dangerous metal paddles we used to use, and the technology itself has advanced hugely. But it is still a risky business.
We are taught to say, loudly: “Stand clear, shocking,” so that the team moves away from the bed completely. If they don’t hear the command, and a nurse or doctor is leaning on the bed, or holding a bag of fluid, or trying to put in an intravenous line, then there is always a risk that person will conduct the electricity too, and they themselves would collapse into cardiac arrest.
If the person in charge of the machine doesn’t shout “Oxygen away”, and there are 10 litres of O2 blasting out of an oxygen mask, then there could be an explosion. Many years ago, a nurse was thrown across the room following such an explosion, sustaining serious injuries.
Critical incidents, mistakes and Never Events (serious, adverse events that are largely preventable – for example, accidentally killing people) are almost entirely down to poor communication, which leads to poor decision-making.
This is often influenced by external stresses, but it is usually a result of people shouting and nobody listening. Thankfully, nurses and doctors understand too well that if everyone is shouting and nobody is listening, then people can die.
Of course, there are exceptions, and occasionally communication fails, particularly during unexpected medical emergencies. The most terrifying crash calls I have ever attended as a resuscitation nurse were the shoutiest, often with no clarity from the nurse or doctor leader standing at the bottom of the bed in order to get a wider view.
One time I attended a crash call, and when I asked who was leading four people put their hands up. The patient was an elderly, tiny woman, and the chest compressions made a crunching noise like walking on snow. Two of the team members began to argue loudly about who should lead. While they argued, I looked at the door. I watched a man, her husband it turned out, face almost pressed against the glass, watching helplessly, totally powerless. I pointed him out, and the shouting stopped for a while.
One of them stepped back and took over chest compressions, the other went to the door to speak to the husband and bring him in, so he could hold his wife’s hands during her final moments: four out of five people do not survive a hospital cardiac arrest. I acted as a leader that day, but, sadly, even though the chaos diminished, the woman died, her husband holding her hand.
After we’d performed one more round of chest compressions and then stopped, I put my hand on his back, and said: “I’m sorry.” He thanked the team, despite the initial shouting and unprofessionalism. “I could see you all did your very best,” he said. And then: “What am I going to do without her?”
Sometimes life is brutal and tragic. We all feel pain, suffer loss, are capable of cruelty and of love. Human beings have always been this way, and, yet, during the past decade, our values seem to have shifted.
The world remains full of good people doing their best, but we seem to be losing a sense of decency and respect for the value of community. During the past 10 years, I’ve been saddened when I visited the care of the elderly wards to see the lack of visitors at visiting times – the loneliness on the faces of the patients who lived through the war, who fought for us, and who are now alone. Of course, families often live miles apart from each other, and these people may not have family members able to visit them at all. But I often wondered if perhaps they did: children caught up in the stress of working long hours to buy things they don’t need, neighbours who don’t even know who they are, let alone know they are in hospital, grandchildren or great-grandchildren at home on social media posting a virtue-signalling kindness message, great-nieces or nephews using up energy shouting at anyone who thinks differently to them on Twitter – energy that I wonder might be channelled into actual kindness.
Nurses treat patients as if they are family members, whoever the patients are and whatever they believe. They also bear witness to the state of our nation. The demand for beds, the stresses on the healthcare system of a growing and ageing population, austerity measures and funding cuts across the public sector and its knock-on effect to health, social care, and the NHS. Nurses can join the dots.
Mrs Fisher was recently admitted to an adult critical care unit, with an exacerbation of serious lung disease (COPD) and pneumonia. When she deteriorated, the critical care staff – in the absence of any family members – had to make difficult ethical decisions about whether or not to intubate her (put a tube into her windpipe and put her on a life support machine to help her breathe).
Staff were worried that as Mrs Fisher had numerous comorbidities (complex and multiple health problems) she would not ever be “extubatable” or well enough to come off the machines, and so they might have to withdraw treatment.
Luckily, Mrs Fisher improved on strong medication and a BIPAP machine, a mask that is less invasive than a breathing tube. She got better thanks to the skill and expertise and care of the entire team, as well as a bit of luck. It turned out that the journey to critical care started a few weeks earlier when Mrs Fisher – who lives alone – had her meals on wheels scrapped due to local council funding cuts.
This meant she stopped eating and – crucially – had no contact with any person for a few weeks. Her mobility, mood, and immunity deteriorated. She developed a cough and a serious fever.
Despite her disabilities, she somehow made it to her local shops but became progressively more breathless and then collapsed. I have no idea if the meals on wheels would have kept Mrs Fisher out of the hospital, but it might.
Meals on Wheels is around £1.60 per meal. Critical Care costs around £1,932 per night. Of course, people’s lives can’t be measured in numbers, but money speaks to power. Listen carefully to what people like Mrs Fisher are clearly saying. Listen to her nurses.
This will be a very special year for nurses: 2020 is the International Year of the Nurse and Midwife, and the bicentenary of Florence Nightingale’s birth, and also marks 100 years of the Nursing and Midwifery Council professional registration of nurses and midwives. It is a time to celebrate the most trusted of professions. it is a time to listen to nurses, who so often give a voice to the voiceless.
The past 18 months I’ve had the privilege of listening to hundreds of nurses. I’ve visited community mental health teams, learning disability nurses, military or defence nurses, spent time with nurses working in prisons, hospices, schools, primary care clinics, sexual health units, care homes, and in people’s own homes.
Nurses everywhere are entrepreneurs, innovative leaders of healthcare, researchers, academics, advanced practitioners, clinical specialists and leaders. I hope that 2020 changes people’s understanding and perception of the varied roles of a nurse. And I can’t imagine a more hopeful message that can unite people than the celebration of nurses.
I’m a lifelong Labour supporter. My dad, a working-class man from Stokeon-trent who died seven years ago, would have disagreed with my politics entirely. I know he would have voted differently to me, had completely different views about politics and the NHS. We’d have argued about Brexit and the general election; I’d have become exasperated and shouty and most likely tearful. But the political disagreements between my dad and me didn’t once make us love each other less. Not a bit. I’d give anything to have a political argument with Dad again. I’d try to listen more and shout less. We are so much more than our politics.
I’m hopeful that even when we disagree we can do so with respect, manners, kindness and careful listening. There are so many things we can individually do to make a difference within our communities: visit a loved one in a care home, pop in on a neighbour who is struggling, spend a few hours playing – really playing – with younger children, or listening – really listening – to teenagers, make time for partners and loved ones, write a letter to an elderly relative, or offer to help a person in need. I hope we can learn from nurses, our most trusted profession, who are a shining light of tolerance, forgiveness and respect for all people, regardless. I am hopeful that love always wins, in the end.
It is time to celebrate the most trusted of professions and listen to nurses