A "major paradigm shift"

June 12, 2006 -- Today The Daily Star (Bangladesh) ran an extensive, helpful analysis of why nursing matters by Dulce Corazon Z Lamagna. "Evaluating the role of nurses" aims to "improve the image of nurses" through a general discussion of what nurses do and the difficult global situation they now face. It includes an unusually strong section on the effects of short-staffing. The piece is not rigorously organized, and it has its share of low-content jargon and unexplained statements about things like "enabling environment and self-actualisation." But it also presents a good deal of accurate, important information about the nature and value of nursing, including its effect on patient outcomes. We thank Dulce Corazon Z Lamagna, an MBA student at American International University, and The Daily Star.

The piece notes that health care is an enormous global industry that will touch everyone in some way. It describes nurses as "the wheel and hub of health service":

They offer skilled care as we recuperate, advocate for our rights when we need care, educate us to assist in decision-making, stand by us at critical moments, help us understand the system when it baffles us, and reassure us when we feel doubt or fear. Nurses are front liners in providing long-term care, home care, primary and preventive care, health promotion and public health.

The piece also says that nursing has become more complex and diverse because of advances in technology, though this discussion is more notable for large words than for clarity--it does not explain just how nursing has been "intensified by redefinition, refinement and modification of [its] practice." However, the piece commendably notes that modern nursing has "developed an extensive body of knowledge and associated skills that require intensive study to master." And it seems to stress that because of the difficulty and importance of nursing, nurses themselves should be treated with respect and care, in ways that foster their own growth and health.

The largest section is entitled "Safe staffing saves lives." We assume it's no coincidence that that phrase was also the International Council of Nurses' 2006 slogan for International Nurses Day in May. This section explains that safe staffing means staffing that is adequate to meet patient needs and provide a safe work environment. The piece notes that nurses need time to exercise their professional judgment in patient care. In particular, it reports that "[s]afe staffing has been shown to contribute to better patient outcomes which ultimately result in reduced health cost for individuals, families and communities and increased tax revenues as patients return to active workforce." And unlike many pieces, this one has the courage to state this idea in the negative. It's not just that safe nurse staffing is helpful, but it is also the case that "inadequate or marginal staffing levels can lead to higher mortality rates, greater morbidity, increased risk of injury to both patient and staff, and increased utilisation of both inpatient and outpatient facilities." On the patient care point, the piece does not stop with general statements, but gives examples of the effects of short-staffing: "[l]ate or missed doses of medication, delayed meals, responses to medication or vital signs monitored in a rushed fashion, hurried lab tests, too few staff to properly clean rooms."

The piece goes on to describe in admirable detail the effects unsafe staffing can have on the staff themselves. It says that current "staffing practices" are causing an "exodus" of nurses and other health workers from the bedside, leading to critical shortages. Moreover, nurses and other direct care workers "suffer from occupational injuries such as back problems, needle sticks and joint problems when staffing levels are too low. Healthcare workers also experience high levels of work-related stress, low morale and family problems."

There is a short section about the "[c]urrent situation in Bangladesh." The author says the nation suffers from insufficient nurse staffing and a shortage that many think is rooted in "long standing problems related to the value and image of nursing and the limited role nursing has had in identifying priorities within healthcare delivery systems." In other words, nurses have traditionally enjoyed little respect or power. The piece reports that there is a "scarcity of skilled nurses," linking this to "[i]nadequate training," and it notes mildly that this results in "poor service delivery." Of course, what it results in for patients is the same thing short-staffing does--negative effects on outcomes. Perhaps the saddest comment about nursing in Bangladesh is one that comes near the beginning of the piece, right after a statement about everyone needing to navigate the health care system at some point: "On that journey, in other countries, nurses are often the professionals we turn to for assistance." (Emphasis added.) The piece might have explored the situation in Bangladesh in more detail, and included suggestions for improvement.

The piece concludes by arguing that nursing is a rewarding profession that stands at a crossroads, in the midst of what the author calls a "major paradigm shift." Nurses are trying to be accepted as authoritative "client advocate[s], health promoter[s] and teacher[s]," yet struggling "to shed the image of dependency on the medical profession." Of course, nurses have long been active in these roles, but we see the point. The final paragraph offers general testimonials about the benefits of nursing as a career. Most of these are fine--nursing does offer diverse career paths for men and women, and nurses do help communities achieve and maintain health. But we're always uncomfortable when someone describes the profession with words like "altruistic," which play into the notion that nurses are unskilled spiritual beings who don't need adequate pay or resources.

We thank those responsible for this generally helpful report, and particularly for its discussion of safe staffing.

See the article "Evaluating the role of nurses" by Dulce Corazon Z Lamagna in the June 12, 2006 edition of The Daily Star. She also published a another article "Nursing as a profession: Challenges and opportunities" on June 25, 2006 in The Daily Star.